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Breast Augmentation
Prior to the use of fiber optic technology, breast augmentation was performed by making an incision under the breast, around nipple, or making an incision in the armpit. For technical reasons, many plastic surgeons abandoned the armpit incision, or transaxillary approach. The reason it was abandoned was because the armpit incision was a remote incision from the breast and visualizing the implant pocket and then placing the implant in the correct position was significantly more difficult to accomplish with the transaxillary approach rather than the other approaches.
225cc saline implants filled to 247cc. Ht. 5'0". Wt. 90 lb.s The implants are smooth round saline implants placed endoscopically through the axilla in the submuscular position.
Submuscular versus Subglandular
With the development of fiber optic technology the transaxillary approach has become a technically more precise procedure. The endoscope (the fiber optic camera) allows the implant pocket to be well defined and easily visualized which insures a more accurate placement of the implant. The endoscopic technique also lends itself to placing the implant in a submuscular (under the pectoral muscle) versus a subglandular (under the breast gland) position.
There are two major advantages of the submuscular placement of the implant:
(1) decreased rate of capsule contracture
(2) more tissue to cover the implant to prevent the implant from being easily seen or felt.
This patient underwent a subglandular (above the muscle) augmentation and several subsequent revisions by an outside surgeon prior to presenting to Destin Plastic Surgery. Here she underwent an endoscopic implant exchange from over the muscle to under the muscle. Note the tremendous improvement in the shape and contour of her breast in the bottom photos when the implant is under the muscle.
Capsular Contracture
Capsule contracture
is the term used to describe the formation of scar tissue around the implant which, when thickened, can make the implant feel hard and round. Although the implant itself remains soft, the scar tissue "squeezes" the implant which makes the implant itself feel hard. In the submuscular position, the rate of capsule contracture is decreased in general from 15% to 3%. That's a significant difference.
"Rippling" occurs when the implant shell is easily felt beneath the skin. With subglandular augmentation, the possibility of this occurring is greater than with the submuscular position. Large studies have shown that the chance of "rippling" is 3 times greater with subglandular augmentation than with submuscular augmentation.
The disadvantage of the submuscular placement versus subglandular placement is that the postoperative recovery is lengthened and the patient may experience more postoperative pain. In addition, there may be more motion of the implant with forceful pectoral contracture.
All things considered, the submuscular placement of an implant is the least at risk for for the complications of capsule contracture and "rippling."
Incision Site
3 incisions are in general use for placement of an implant for breast augmentation:
(1) beneath the breast, inframammary fold (IMF) incision;
(2) beneath the areola, periareolar incision
(3) under the arm, transaxillary incision
Many surgeons will have a preference. The surgeons at Destin Plastic Surgery have significant experience with performing augmentations through each of these incisions.
Typically, all 3 incisions will heal equally well in the same person. The selection of the incision should be based on the following:
(1) If you wear a 2-piece bathing suit the IMF incision will be visible when you raise your arms and the bathing suit top raises slightly. This incision is also visible when the bathing suit top does not completely cover the inframammary fold area.
(2) The periarealor incision is only visible when topless. If, however, you form a poor scar or a hypertrophic scar, the scar would be in a highly undesirable position and visible, through sheer or tight fitting clothing.
(3) The transaxillary incision places the scar remotely. That is, no scar is placed on the breast. If a bad scar should form, it is in a well-hidden place. In the underarm area, everyone has a crease and the incision is well hidden in this crease. Rarely does anyone look under your arm.
All things considered, the transaxillary incision is the best-hidden incision
 
The axillary incision is hidden in the crease of the underarm and is barely visible 3 months after surgery.
Types of implants
There are two types of implants that are commonly used, saline and the new cohesive gel silicone implant .
Saline
Currently, the most popular saline breast implant choice for breast augmentation procedures. Round breast implant shapes are available in a wide array of sizes to accommodate various body types. It also comes in a High Profile and Moderate Profile style for greater projection in the breast profile. This should be discussed with your surgeon. Typically the profile is chosen based on the width of your breast so that the implant width matches this width of your breast.
Round breast implant shells come in two textures, Smooth or SiltexÆ. Smooth surface breast implants may be less likely to be felt through the skin and tissue and tend to ripple less than textured implants.
Smooth Round Moderate Profile Saline Implants
One of the most popular saline breast implant styles for over 20 years. A full, rounded look that adds greater dimension to the breast. This is the implant preferred by the surgeons at Destin Plastic Surgery. It gives the breast a nice fullness at the top while maintaining the natural tear drop appearance. The saline implant is filled with salt water (saline) and therefore will go "flat" if it ever leaks and is very obvious to the patient. The limitation of the saline implant is that the larger the implant and the less breast tissue a woman has, the more likely it is to ripple or be felt underneath the skin. As long as a woman has adequate breast tissue to cover the implant, saline implants are an excellent choice.
Silicone
After rigorous scientific review, the U.S. Food and Drug Administration (FDA) on Friday November 17th, 2006, approved the marketing of silicone gel-filled breast implants made by two companies for breast reconstruction in women of all ages and breast augmentation in women ages 22 and older. "This is great news and will greatly improve the outcome for many women who seek to improve the appearance of their breast but have had limited options with the previous saline implants." said Dr Ennis. "There are many women who would like to enhance the appearance of their breast but may not have enough breast tissue to adequately cover a saline implant. This could lead to problems with rippling. Silicone implants will offer these women new options that where not previously available with saline implants." said Dr Burden. Silicone implants may have significantly less rippling in some patients. The doctors and staff at Destin Plastic Surgery have been investigators and involved with the FDA approved study allowing women to receive silicone breast implants since 1997. Both Dr. Burden and Dr. Ennis are among the top plastic surgeons in the nation in regards to placement of saline and silicone implants for women who want breast enhancement. They have been performing breast augmentations with silicone gel implants under the FDA guidelines since 1997.
The new gel implant is more cohesive and therefore is less likely to leak into the tissues than the old liquid filled silicone gel implants.
Silicone implants offer a much more natural feel and allow women with small breast to have larger enhancements without the problems of rippling that can occur with saline implants.
Dr. William R Burden, MD, FACS and Dr. L. Scott Ennis, MD, FACS are known for their experience and dedication to staying in the forefront of leading technology in plastic surgery. They perform over a thousand breast procedures per year including many revisions from other places. Drs Burden and Ennis not only treat many patients from the Florida panhandle including Panama City, Pensacola, Fort Walton Beach, Tallahassee, Dothan, Atlanta, and Birmingham but also from around the world. Many people travel from Europe, South America and Asia to Destin to seek out their services.
Silicone implants are available today at Destin Plastic Surgery! Contact Destin Plastic Surgery now for more information!
(850) 654-1194
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