Body art traditionally refers to tattoos and piercings, but some would say cosmetic plastic surgery is a form of body art. It is not scalpelling, but a scalpel is used. As body art becomes more main stream, questions regarding breast augmentation before and after nipple piercing come up more often than you might think.
Preexisting Body and Nipple Piercing - Before Breast Augmentation
After Breast Augmentation - Body and Nipple Piercings Survived.
Pre-Existing Nipple Piercing
If you have pierced nipples, and are considering breast implants, breast augmentation can be safely performed in the presence of pierced nipples. A few precautions need to be taken to maximize the safety and predictability of you surgery:
The piercings need to be clean and without irritation. Irritated piercings are a set up for infection, and this could lead to an infection around the breast implants.
The jewelry should be removed from the piercing immediately before surgery. Electrocautery is used routinely during surgery to prevent bleeding. An electric shock to your piercings would cause a burn.
The jewelry should be replaced immediately after surgery. At the end of the breast augmentation I normally replace the jewelry to prevent the piercing from closing.
If the piercing should become irritated or infected after surgery, it should be addressed immediately. Sometimes this means removing the jewelry from the piercing.
Nipple Piercing After Breast Augmentation
If you already have breast implants, and are considering getting your nipples pierced, I don’t recommend it. If you are still determined to get a nipple piercing, you need to be especially vigilant. Choose a reputable establishment, which uses sterile technique. Infections can occur with any piercing, and every infection has the potential to spread.
Nipple piercings can be especially problematic as the breast gland itself can become infected. This can put the both the breast tissue and the breast implants at risk, especially if your breast implants are in front of the pectoralis muscle. If there is any redness, swelling, discharge or increasing pain at the piercing site, call you plastic surgeon, and seek immediate treatment. The jewelry may need to be removed, but it is better to lose a piercing than to lose a breast implant.
Dove took some criticism for its Curves ad campaign.
Perhaps the most difficult decision in breast augmentation surgery is the size. When Dove tried responding to criticism that the women seen in ads are not representative of real women, they found themselves being criticized again for selecting a broader, but still restricted, subset. It is really hard to represent all women in a single print ad or even a 60 second commercial. Women come in all shapes and sizes, and for this reason, so do breast implants.
Selecting the best breast implant is an important part of obtaining the optimal breast enhancement. And when it comes to breast implant volume, there is more to it than choosing a number. Size matters, and in more ways than you might think. The size of the existing breast, the size of the desired breast and the size of the woman, are all important. Here is one example.
Not Your Average Breast Augmentation
A young mother came to me with a desire to repair some of the damage caused by pregnancy. A big part of her concern was the almost complete loss of breast volume. She was not trying to “make a statement” with her breasts. She just wanted them back. Her clothing no longer fit, and she missed the more feminine curves she once possessed.
Trying to figure out your desired breast implant volume can be very confusing. For breast size, we tend to think more along the lines of cup size rather than cc’s, and cup sizes are confusing enough. The most common breast augmentation requested is a C-cup, but C-cup volumes vary by the manufacturer and even by the style of the bra.
Internet resources claim anywhere from 100 to 250 cc’s will give an increase of one cup size. The highest volume in the range is more than double the lowest volume, yet the range is about right. Cup size depends on band size — the distance around the rib cage below the breasts. To state this in the most obvious terms, bigger girls need bigger volumes, to get similar results.
Before breast augmentation.
After breast augmentation.
The average implant size used varies by region. The average volume used in the United States is in the 300-350 cc range. My patient desired a breast size proportional to her body. She wanted to be able to find clothing that would fit without being too baggy or feeling too tight. Being of average height and desiring an average size, you might think she would require the average implant volume. If only it were that simple.
The breast augmentation pictured above was accomplished with saline breast implants placed under the muscle via a periareolar incision. A moderate profile implant was selected so that the diameter of the implant matched the diameter of the breast. Matching the breast diameter is critical with saline implants. The correct breast implant diameter, especially for saline implants, is often more important than the implant’s volume.
The volume selected was above average at 420 cc’s. A larger breast implant was necessary because there was smaller amount of native breast volume present before surgery. Additionally, the larger volume was needed so that the implant’s diameter would match the chest. While 420 cc’s may seem large, in this case, the result is just what the patient wanted.
The result is a beautiful breast that is well shaped and well proportioned. Despite using a round implant, the shape is natural. Placing the implant behind the muscle, for a woman with little breast tissue to disguise it, can give a round implant a pleasing teardrop shape.
Too Small, Too Big, Just Right
Most patients want breast enhancement that is big enough, but not too big. They want enough change so that they know breast augmentation was done, but not so much that is becomes a new source of embarrassment. After breast augmentation, you want to feel comfortable, and you want clothing to fit well.
The most common reason for breast augmentation revision surgery is to increase the size of the implants. As a breast augmentation patient, the most helpful thing you can provide your surgeon is a good idea of how much breast enlargement is enough. I have tried to offer useful suggestions in: How to Choose the Correct Breast Implants: Size.
Breast Implant Profiles – Shape Matters Too
The profile of the implant can influence the final shape and location of the breast. For implants of the same volume, the wider diameter found in lower profile implants, adds more “side boob”. On the other hand, the narrower diameter of a high profile implant, will increase the space between the breasts.
For implants of the same diameter, the lower volume in a low profile implant will result in a breast with less forward projection. The opposite effect is obtained with a high profile breast implant. A high profile implant will result in a breast with more projection, and a larger cup size. Here is some additional information about Breast Diameter and Breast Implants in Breast Augmentation.
The Advantage of a Board Certified Plastic Surgeon
In determining the correct volume for my patient, the advantage I have, besides being a Board Certified Plastic Surgeon, is that I was able to do a physical examination, take measurements, determine skin elasticity and compare what I saw with the size, shape and volumes available for breast implants. There is no better way to determine what needs to be done for a cosmetic procedure than with a focused medical history and physical examination. My patient’s goals, combined with her measurements, determined that a larger than average volume implant was necessary in this case.
When it comes to breast size, there is no secret formula and there is no right answer, there is only the right size for you. It varies with each individual, and it is often the most difficult variable to pin down. This is the advantage of seeing a Board Certified Plastic Surgeon with experience in breast augmentation who cares about how you are going to look and feel afterwards.
Whether it is spring fashion or spring fever, the demand for breast augmentation is on the rise. If you are considering breast augmentation, you are looking in the right place.
Get Informed
Heidi Montag prior to her recent breast augmentation.
Many options are available for gathering the breast augmentation information you need. The Internet offers a wealth of information — some good; some not so much. While not all the information you read will apply to you, visiting reputable web sites can give you an idea of what your options are.
Friends and family members can be important allies. If you are fortunate enough to have friends or family members who have had breast augmentation, they can provide you with unique and personal insight into the procedure. It is important to note, however, that everyone’s experience (and body) is unique.
The best breast augmentation advice is found during your consultation appointment. As a diplomate of the American Board of Plastic Surgery, I put the focus on your goals, so that I can formulate a plan that addresses your unique needs.
Here are a few resources I have created to help you with some of the most common questions:
My main web site has a page dedicated to breast augmentation, including many frequently asked questions. It reviews options for incisions, implant placement, types of implants and size selection . Click here to visit the breast augmentation page on DrMele.com.
On this blog there are many posts and videos discussing breast augmentation. Clicking on “Breast Augmentation” to the left under Categories will give you pages of all the pertinent breast augmentation articles. The subheading “Breast Implant Options” list articles discussing how to pick the best implants for you.
Many of my television appearances discussing breast augmentation can also be viewed via YouTube. Clicking the YouTube button at the top of the left column will take you to my YouTube channel. For breast augmentation, I have also created two YouTube playlists:
Whether you are considering breast augmentation, or you want breast augmentation revision, when you are ready, the next step is to schedule a consultation appointment with a Board Certified Plastic Surgeon. You can check my (or any doctor’s) certification on the American Board of Plastic Surgery website.
A consultation with a Board Certified Plastic Surgeon will allow you to express your goals, explore your options and ask your questions. If you are ready to take the next step, call (925) 943-6353 for your personal consultation appointment.
Breast augmentation remains the most frequently performed cosmetic plastic surgery procedure in the United States. At the recent American Society for Aesthetic Plastic Surgery (ASAPS) meeting in Washington DC, breast implants, and breast implant revision surgery were hot topics.
I had the opportunity to compare notes with other breast augmentation revision specialists both formally and informally. National meetings are a great place to share information. Instructional courses are useful, but informal conversations with other Board Certified Plastic Surgeons who are faced with the same opportunities and challenges that I face can be just as enlightening.
What’s new in Breast Implant Revision Surgery?
Neosubpectoral Pockets
Implant malposition includes breast implants which are:
too close to the center (symmastia or bread loafing)
too low (bottoming out)
too wide apart (heading for the armpit)
or too high
are all addressed by modifying or changing the pocket in which the implant sits.
For symmastia, the problem is that the implants are too close together, so that the skin between them becomes elevated. Traditional treatment has been to close off the pocket centrally to reestablish cleavage. If the implant is above the muscle, they can be moved to new pockets below the muscle. This allows for the creation of two new pockets that are separated sufficiently in the center to preserve the definition between the two breasts.
When the implants are below the muscle, they can be moved to in front of the muscle. There are some disadvantages to moving the implants to a subglandular (in front of the muscle) position. This is where the neosubpectoral pockets can help. The name literally means “new pocket under the pectoralis muscle”. By working outside the old pocket’s capsule, a new space can be created for the implant. This can be used to correct symmastia and other problems with implant malposition.
Acellular Dermal Matrix (ADM’s)
An Acellular Dermal Matrix is dermis that has been treated to remove all the living cells, leaving a collagen matrix that can be used as an internal patch to help cover breast implants. It can be used to help disguise rippling and to help support an implant that is displaced. Both human and pig skin are used in the manufacture, and the off-the-shelf availability is a big plus when the native tissue is sparse. Brand names include:
The downside – it is very expensive. A sheet of ACD costs more than a breast implant. So when local tissues are available, it can save you thousands of dollars.
Fat Grafting and Stem Cell Grafting to the Breasts
Interesting cases where presented of utilizing fat (which contains lots of stem cells) as a volume expander for the breast. Some techniques involve suction expansion of the breasts for a month or longer before grafting to increase the size and vascularity of the recipient bed. This is bleeding edge new, and the long term results are unknown.
Breast are mostly fat, and the principle of replacing like with like is a good one. However, if some of the graft doesn’t take – it dies, and dead fat can lead to lumps, hard spots, infection and calcifications. The problems with lumps, hard spots, and infection are pretty clear, so what is the problem with calcifications? Calcifications are what we look for on mammograms to help identify breast cancer. They stand out as bright white spots in the relatively dark breast tissue, and make identifying breast cancer much easier. If a breast is already full of calcifications, it can be very hard to identify a breast cancer. Either every calcification would need to be removed (making the breast smaller) or risk the early detection of a breast cancer. The implications of increasing the number of stem cells (cells that can become anything) in the breast is also unknown.
For now, research in this area should only be performed in carefully controlled studies. The problems that still need to be overcome include insufficient volume, unpredictable take, interference with mammography, long term outcome. Remember, before breast implants, not too long ago, free silicone was injected into the breasts to increase their size. It worked and felt very natural, at first. Long term, however, the breast became firm, lumpy and painful. The outcome may not be the case with fat grafting, but long term follow up is not yet available, and an assumption that everything will be fine is naive.
Gummy Bear Implants (Gummi Bear Implants)
Still awaiting FDA approval.
The most recent delay was rumored to be that the FDA was waiting to see that the current breast implant follow-up studies where progressing. I am an investigator for both Allergan and Mentor, and each has filled both their Saline Breast Implant and SIlicone Breast Implant follow-up studies. All that remains is to collect 10 years worth of data.
Will it take 10 more years to get FDA approval for the gummy bear implants? It took 14 years to get the current silicone implants re-approved.
Emend
Originally marketed to prevent the nausea and vomiting associated with chemotherapy (CINV), Emend is meant to prevent nausea and vomiting rather than treat it after it has occured.
Emend would need to be administered prior to post operative nausea and vomiting (PONV) to be effective. Currently this is an off-label use, and it has only sparingly been tried to date. Zofran, another medication that is currently widely used, started down the same path 20 years ago.
Risk factors for PONV:
female gender
young age
non-smoker
motion sickness
Since most of my breast augmentation patients have several of these risk factors, they all get treated prophylactically, often with several medications. If one med could prevent all PONV, it would simplify the treatment. Fingers crossed…
The world is crazy. There has been a lot of chatter about terrorists implanting women with exploding breast implants in a effort to crash planes. But first, if you are reading this to find out if your normal, non-explosive, breast implants will explode the next time you board an airliner, rest assured, they won’t.
Why Your Breast Implants Won’t Explode in the Airliner
Airliners are pressurized, and must be maintained to atmospheric pressures below 8000 ft. While the air inside our ears and belly expands, the fluid inside breast implants barely does. Cabin pressure regulations are more complex than you might think. (Reasons for maintaining cabin pressure and the allowed tolerances can be found on Wikipedia’s Cabin Pressurization page.)
While Lady Gaga is red hot, and her fans may enjoy the visual, there is nothing entertaining about the sudden loss of cabin pressure. That would be a terrorizing event. TSA would not allow her to board with the outfit pictured to the left, the concern is that explosives inside a breast implant would be difficult to detect.
If you are still worried about your non-explosive breast implants, in the event of a complete loss of pressurization, your breast implants would easily survive the pressure change. Since they are mostly water, the breast implants would expand about the same amount as the rest of body. (I will not elaborate on all the real problems that would occur elsewhere in the body, but Wikipedia has a page on uncontrolled decompression with many unpleasant facts.)
Booby Traps
It sounds like a script contrived for a Hollywood movie: terrorist implanting their breast with PETN filled breast implants. The idea of surgically implanting an explosive inside the body is horrifying. Though from the terrorist’s perspective, it is only a short leap past strapping on a bomb. The worst part is, it is entirely possible. A small amount of explosive would be enough to disrupt cabin integrity, and cause explosive decompression with devastating results.
Media Coverage – KABC Los Angeles
It’s not surprising that the possibility was broadcast this February in Los Angeles.
But by March it has made world headlines on Fox News and The Sun. and the story is now being given further credibility by the need to discredit the report on True/Slant with science and with satire.
It Could Happen
Possible?
Yes. With enough determination and thought, anything is possible.
Probable?
No. I’m no terrorist, but there must be easier ways.
Reality
There is a fine fine line between a cautious and phobic. The reality is, we could spend our entire lives worrying about what could go wrong, and become paralyzed.
Bombshells not Bombs
As a plastic surgeon, the surgery I perform is elective and is held to a higher standard. While I worry about the complications of surgery, this is my motivation to achieve safer and more predictable results, day after day. This is why I spent years in training to become a Board Certified Plastic Surgeon. This is why I operate only in Accredited Surgery Centers, and use only Board Certified Anesthesiologists. This is why my patients trust me, and can keep their thoughts on the goal, rather than the process. No matter how bizarre the news from the outside world, when I am performing surgery, there is only one thing I am thinking about — my patients well being and happiness, and there is no greater gift I can give this crazy world than a happy patient. ( …and non-explosive breast implants)
The American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) have released their annual statistics on cosmetic plastic surgery for 2009. Surgical and non-surgical procedures are tallied and compared to previous years. Overall the numbers are down 2% from 2008, but still up 147% since 1997, when the statistics were first compiled. Of the almost ten million procedures performed in 2009, 85% were non-surgical and 15% were surgical. He are some quick facts, a link to the full statistics can be found at the end of this article.
Additional information can be found on the ASAPS web site, or downloaded here. It is a large file, and may take a while…
*Dr. Joseph Mele offers these procedures through his Walnut Creek Plastic Surgery Office. Search the San Francisco Plastic Surgery Blog categories to the left, or click on the links above for more detailed information available on DrMele.com.
Radiant Life – RLM Success Files features breast augmentation by Dr. Joseph A. Mele.
As seen in Radiant Life Magazine. (Click to enlarge.)
Radiant Life® Magazine is The Aesthetic Wellness Magazine, and is dedicated to innovations in cosmetic plastic surgery. The current issue of Radiant Life® features an article by Lindsay Haakenson on the latest innovations in Breast Augmentation entitled Breast Surgery 2.0.
Radiant Life Magazine approached me with a short deadline and the need for an example of modern breast augmentation. My staff contacted a few of our many satisfied patients. Jennifer was the first to respond, and she immediately agreed to both an interview with Radiant Life Magazine and the use of her pictures, and for that she gets my sincere thanks. This is a true testimonial* to how worthwhile breast augmentation surgery has been for her. Thanks goes out to my other happy patients who also graciously responded, and to Lindsay Haakenson for including me.
Jennifer first came into the office for a consultation after noticing her breast volume had decreased after pregnancy. She was interested in restoring what mother nature had both given and then taken away. She expressed a desire to maintain proportions with her body, and wanted a natural look that would be attractive, without being distracting.
The excerpt to the right is from the Breast Surgery 2.0. At the top are her breast augmentation before and after pictures. Before submuscular (subpectoral) breast augmentation, her breasts where asymmetrical, small, had a relatively low set nipple and a constricted base. The distance between the nipple and the inframammary fold was short, and the remaining breast tissue was firm. She had a mild form of what is sometimes referred to as a tubular breast.
The simplest way to correct a tubular breast is with a subglandular breast augmentation. Often a periareolar mastopexy is performed to lift and reshape a protruding nipple/areolar complex at the same time. Okay, that may not sound so simple, and in Jennifer’s case, the easiest way was not necessarily the best way.
Every patient requires careful thought and consideration. In Jennifer’s case, the tubular deformity was mild, and a periareolar breast lift was not needed. The lack of breast tissue higher on the chest meant that the upper pole of the implant was more likely to be seen. A saline implant was placed behind the muscle to help soften the upper pole of the implant, and to give a more teardrop shape. A periareolar incision was used, and this, as is usual, healed very well.
For a more pronounced tubular breast deformity, this approach may not work. Unlike the approach using a periareolar lift, it will not correct a bulging areola that is often seen in concert with the narrow constricted breast base. If you are considering breast augmentation, it is important to seek a qualified and experienced, board certified plastic surgeon, so that the safest and most predictable plan can be constructed.
I want to thank Jennifer for volunteering to share her results with you. The best part of my job is helping my patients. I am thrilled that Jennifer is happy with the results of her breast augmentation.
* As per the latest American Society of Plastic Surgeons Code of Ethics this is a true testimonial. I have not reimbursed my patient in any way for her kind words, and I have not paid Radiant Life Magazine to be included in this article. To read the entire Radiant Life Magazine article, click here. You need to be able to view pdf files in order to display the contents properly. To download the latest version of Adobe Reader for free click here.
Breast Augmentation Revision Surgery, has become an important area of specialization in my Walnut Creek plastic surgery practice. As many as 25% of women undergoing breast augmentation, will require a second surgery in the ten years after surgery.
Breast augmentation revision surgery may be elective, and may be performed to increase or decrease the size of your breast implants. Increasing breast implant size is one of the most common, and simplest forms of breast implant revision.
Breast implant revision surgery may be needed to replace a deflated implant or to revise the scar around the implant (capsular contracture). The major US breast implant manufacturers offer lifetime replacement of their breast implants if a breast implant deflation occurs. They also provide financial support if the breast implant leaks occur within ten years of the primary breast augmentation.
You will find videos on breast augmentation and breast augmentation revision surgery posted on the San Francisco Plastic Surgery Blog. They can be viewed here or on my YouTube channel. Please remember, the 800 number appearing on the video was only for the live show, to contact my office for additional information or to schedule a private consultation appointment, call (925) 943-6353.
This video comes from a segment of KRON’s Body Beautiful. You can hear:
What is Breast Augmentation Revision surgery?
Who needs Breast Implant Revision surgery?
Do your silicone breast implants or saline breast implants come with a warranty?
Is there an expiration date on my breast implants?
Before and after pictures of Breast Implant Deflation Replacement Surgery?
Can breast implant asymmetry be improved?
How does Capsular Contracture present?
Can breast surgery be performed for a diabetic (a person with diabetes)?
If you are considering Breast Implant Revision Surgery in the San Francisco Bay Area, a Board Certified Plastic Surgeon can help. This first step is a consultation appointment so that existing problems can be defined and achievable goals can be set.
Breast Augmentation Revision Surgery, has become a specialty unto itself. While most women will never require breast augmentation revision, a large minority will. The exact number is difficult to pin down; however, studies have indicated that in the ten years after breast augmentation, as many as 25%, will undergo a second breast augmentation related surgery.
Many times there is no complication, and the primary motivation for breast augmentation revision surgery is to change the size of the implants. Perhaps the most common breast implant revision surgery is to replace breast implants with a larger pair. This is the reason I place so much emphasis on defining the goal size for breast augmentation before surgery. Even so, minds and goals can change with time.
Other times breast implant revision surgery is less volitional, and may be due to gravity (requiring a breast lift), breast implant failure (breast implant deflation or breast implant rupture) or capsular contracture (tightening of the nature scar that surrounds the implant causing movement or firmness of the breast implants).
Other videos on this subject have been posted on the San Francisco Plastic Surgery Blog and they can be viewed here (see bottom of article for links) or on my YouTube channel. When you are watching this video, please note, the 800 number on the video was for the live show, to contact my office for additional information or to schedule a private consultation appointment, call (925) 943-6353.
On this episode of KRON’s Body Beautiful you can learn:
What are the main reasons for Breast Augmentation Revision surgery
Do breast implants wear out?
What is the capsule around the breast implants?
What is Capsular Contracture?
How long is the Breast Implant Warranty?
How many Breast Augmentations are performed each year?
How is Breast Implant Revision Surgery performed?
What is the recovery like after Breast Augmentation Revision?
Breast Augmentation Revision Surgery requires a careful analysis of the existing problem, a thoughtful discussion about the good (and bad) aspects of all available treatments, the ability to adapt the plan to any new findings found during surgery, and a careful recovery, to speed you return to daily life. The first step is a private consultation with a Board Certified Plastic Surgeon.
After children (or weight loss) the breasts lose volume and the abdominal wall is lax.
The Mommy Makeover remains one of the most frequently requested combinations of cosmetic plastic surgery procedures. Often performed to repair the damage after childbirth, the Mommy Makeover most commonly combines Breast Augmentation with the Tummy Tuck.
Depending on what needs to be fixed, however, other procedures can be substituted. Sometimes a Breast lift is added to, or used instead of the Breast Augmentation. If the breasts remain too large after childbirth, a Breast Reduction may be more appropriate. The Mini Tummy Tuck can sometimes replace the full Tummy Tuck, and Liposuction is often used as an adjunct.
The combination of breast enhancement and abdominoplasty is usually performed after childbirth, but is also common after significant weight loss. In both instances the problems are similar. The breasts may lose volume and support, and the abdomen is often left with excess skin and muscle laxity. The Mommy Makeover restores lost volume and support to the breasts and tightens the abdominal wall (skin and muscle).
The woman pictured to the left is lucky. Although she has lost volume in her breasts after childbirth, her nipples remain high above the inframammary fold (the bottom of the breast). This means a breast lift is not needed. Instead, the lost breast volume was restored. Breast implants were placed behind the pectoralis muscle with a natural result.
Her abdominal wall had been stretched, resulting in loose skin and weakened abdominal muscles. There is a small amount of fat behind the lower abdominal skin, but this will be removed when the skin is tightened. Overall she is in good shape, and a good candidate for a Mommy Makeover.
Starting at the Top – Breast Augmentation
Before Mommy Makeover, the breast have lost volume and are smaller than before pregnancy.
After Mommy Makeover, breast volume has been restored to a pre-baby state.
Breast augmentation was performed to restore volume. The goal was to restore the lost volume, and just a little bit more. Smooth round implants where placed behind the muscle via a periareolar (below the nipple) approach. This gives a nice teardrop shape the the breasts. By selecting the appropriate size, a very natural appearance can be obtained.
Around the Middle – The Tummy Tuck (Abdominoplasty)
Before Mommy Makeover, the abdominal muscles and skin are over stretched.
After Mommy Makeover, the abdominal muscles and skin have been tightened.
The Bottom Line – Restoring Proportions
After children (or weight loss) the breasts lose volume and the abdominal wall is lax.
After Mommy Makeover, the abdomen is flat and the breast's proportions are restored.
The art of plastic surgery has a lot to do with proportions. By giving volume to the breasts and taking volume from the abdomen, an aesthetic balance is achieved. But, there is more benefits than just looking nice. Clothing fits better and the energy wasted on feeling self conscious can be used for more productive endeavours. Having children is something to be proud of, not looking like you’ve had children … priceless.
