Breast Implants have been around for 60 years, and Fat Grafting to the Breasts even longer. While Breast Augmentation with Breast Implants quickly, and almost completely, replaced all other Breast Augmentation options, Fat Grafting has returned as an option in selected cases. Today’s topic is Breast Augmentation and the available options.
Breast Augmentation Before and After Pictures – Breast Augmentation adds volume to the breasts. (Click on image for uncensored version.)
Breast Augmentation Options
There are currently two methods of Breast Enlargement: Breast Implants and Fat Grafting. Included in these broad options are several alternatives, which I will review below. It is important to note that not all options apply to everyone. The decision for Breast Augmentation should be made with the guidance of a Board Certified Plastic Surgeon after a medical history and physical examination have been performed.
Breast Implant Options
There are two categories of FDA Approved Breast Implants in the US: Saline and Silicone. Both types of Breast Implants have a tough outer shell made of solid silicone. The difference is the filling.
Saline Breast Implants
Saline Breast Implants are filled with sterile saline. Saline is basically water with 0.9% salt (NaCl) added to make them as salty as the human body. The volume is adjustable and they are firmer than silicone breast implants. If you are looking for overfilled round breasts, saline is better at creating this artificial shape; however, they can also be used to create more teardrop shaped breasts.
The main advantages of Saline Breast Implants center around leakage. If a saline implant leaks it goes flat. This means no special tests are needed to check for implant integrity. Moreover, if saline implants leak, the saline is quickly absorbed, like the water was drunk. There is no reaction to saline.
Silicone Breast Implants
Silicone Breast Implants are filled with a cohesive silicone gel. The feel is more like normal breast tissue, so they are softer than saline implants. These implants come prefilled, so the volume is not adjustable; however, they are available in a large number of different shapes and volumes. High profile implants are used to add larger volumes to a narrow chest, while low profile implants can add smaller volumes to a wider chest. This is important because when the implant diameter is matched to the breast diameter the results are more natural.
The main disadvantages of Silicone Breast Implants also center around leakage. Unlike saline, when silicone implants leak the semi-solid gel is not absorbed. Newer breast implants are more highly cohesive than their predecessors. Also known as Gummy Bear Breast Implants, are made with a strong gel that does not flow like older breast implants. As a result, the gel is more likely to stay in the capsule, the pocket around the implants, and less likely to migrate.
Unfortunately, the confined gel, whether in the implant shell or outside the shell in the capsule feels the same in the breast, making detecting a leak more difficult than with saline implants. Because of this, an MRI or high-definition ultrasound test is needed to check for implant integrity. The FDA currently recommends an MRI or high-def ultrasound five to six years after the implants are placed and every two to three years thereafter to monitor for asymptomatic silent rupture.
MRI is the most sensitive exam. When patients were sent for an MRI by a plastic surgeon suspicious of a leak, MRI was 90% accurate. When used as a screening exam in asymptomatic patients, it is unclear if the same accuracy will be seen. Recent studies has sensitivity rates of 80-90%.
Fat Grafting to the Breasts
Fat Grafting to the Breasts has been around longer than breast implants, but rapidly fell out of favor due to inconsistent results and low volumes of augmentation compared to breast augmentation with breast implants.
Breast Fat Grafting requires a donor site, the place where the fat is harvested for transplantation. Very thin patients may not have enough fat to donate, and you cannot use fat from another person.
If you have enough fat, it is collected with Liposuction. The removed fat is decanted or “washed” to reduce oil, fibrous tissue and damaged fat cells. Healthy fat cells are more likely to survive the transplantation, whether to the breast, buttock (BBL), face (Rhytidectomy) or another area that needs some additional volume.
Once processed, the fat is injected into the breasts in small aliquots to maximize survival. Threads of injected fat have more surface area from which to gain a blood supply. A good blood supply is necessary to prevent the fat from resorbing or forming cysts.
Unlike breast implants which come in known volumes that do not change, only a percentage of the fat graft survives. Sometimes most of the fat lives, sometimes most of it resorbs. The amount is not predictable, so additional fat grafts may be needed to achieve the desired goal. If you gain or lose weight after surgery, the fat will behave like the area it was taken from and increase or decrease in volume.
“Alternative” Methods of Breast Enlargement
Many other methods of Breast Augmentation have been used in the past. Sponges, free silicone and other injectables have caused a lot of harm and are not appropriate for breast enhancement. Suction enhancement vests have provided small amounts of augmentation after ten weeks of treatment, but they proved uncomfortable, difficult to use properly and obtained often disappointing increases in size. Herbal pills are advertised as a “natural” way to increase the bust, but they are poorly regulated and even less reliable.
Consultations for Breast Enhancement
Breast Enhancement covers a wide range of procedures including enlargement, reduction and lifting, so it is important to consult with an experienced Board Certified Plastic Surgeon who is familiar with the full spectrum of options. In the San Francisco Bay Area call (925) 943-6353 to schedule a private consultation appointment tailored to your individual needs. We will review your goals and recommend treatments designed to best achieve them.
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