While I have contrasted silicone vs. saline implants in the past the purpose of this blog is just to give an update on what breast implant options are out there. At the conclusion I will share my preferences.

Summary:

Three companies are currently are FDA approved in the United States to make Breast implants:

Mentor

Allergan

Sientra

Mentor and Allergan make saline and silicone implants, Sientra makes only silicone.

Each company has its own version of low, moderate and high implants.

Each company offers round or shaped implants.

Each company offers implants that are smooth or textured. Shaped implants are textured so they do not move.

Each company’s implants are cohesive minimizing the risk of leakage.

The “gummy bear” implant is a shaped and coarsely textured implant made by Allergan. As of today, it has not been FDA approved.

Mentor and Allergan offer implants for sizing in the office.  As of this writing Sientra does not have its own sizers, but this should change soon.

Opinion:

What do I like and use?

I generally use smooth round implants. The smooth shell lets the implant move around within the implant pocket and I feel this give a more natural motion to the breast. I believe the smooth surface is less noticeable.

Textured implants stick inside the pocket and do not move as naturally.  I believe the texturing is more noticeable to the patient. While there is evidence that a textured implant can diminish the risk of capsular contracture I do not believe it is a large advantage when implants are under the muscle.  I favor submuscular implants, which means, the implants are located under the pectoral muscle.

I don’t favor teardrop implants because they are all textured and can still sometimes still rotate. If a round implant rotates it makes no difference. Teardrops are fuller at the bottom and most of my patients are looking for fullness up top.

I prefer the look and feel of silicone implants but I offer both and always go over the pro’s and con’s in consultation.  Silicone gel implants are softer and more natural looking and feeling and ripples the least, but they require more future thinking and evaluation.

So which companies breast implants do I offer?

I offer all of them; the key is to find which one fits the patients frame and goals the best. I have my patients try on actual implant sizers in a testing bra. I find this to be the most accurate method for choosing a size.

If you are interested in looking at or trying on breast implants just give us a call and we can find the right fit for you.

For this article I would like to go beyond the basic facts that are posted all over the internet and give a personal opinion based on almost two decades of experience and thousands of breast implant procedures performed.  This blog covers the most frequently asked breast implant questions:

1)      Under or over the muscle:

I generally favor implants under the muscle because they tend to look more natural.  This is because the muscle gives a gentle slope to the upper breast. When the breast implant lies under the muscle mammograms are easier to interpret.  Infection rate is lower because muscle has a better blood supply and blood supply fights infection, there is also a lower rate of capsular contracture. If you want a breast lift later in life, more of the blood supply to the breast is preserved when under the muscle.

2)      Best sizing method: Trying on implants –

I think trying on an actual implant sizers gives the most accurate information, and allows you to see your whole frame.  Breast Implants relate to the entire body, hips, shoulders and height. Things like magazine pictures, internet photos or computer imaging don’t tell the whole story. You often don’t see the patient’s full stature.  Other options such as rice or water bags have no shape, these methods are very inaccurate.

3)      Incision:

Here are the most common body locations for incision:

• Armpit- This sounds cool but implants often ride too high, because it’s hard to be precise when you have a limited view inside the breast.
• Belly button- This technique is done more by feel, therefore it is less precise.
• Areola – The is the most precise, and allows best visualization inside the breast.
• Inframammary – This is good for large gels and allows good visualization.
• TABA (transabdominal  breast augmentation)- Implant through a tummy tuck, for select patients, slightly less precise.

4)      Silicone or saline:  (this could be a blog unto itself)

Silicone implants are softer and more natural feeling, they give a softer transition in the upper breast, and have the least rippling around the edges. Because of these properties they tend to look more natural.

The downside of silicone implants are they sometimes need a longer incision, and the volume can’t be changed.  Surveillance is recommended with an MRI every 3 years.  Silicone implants are generally more expensive then saline implants.

There is no more controversial topic in plastic surgery than plastic surgery on the younger patient.  As a board certified plastic surgeon I feel that younger patients should need us the least. We are not a substitute for a healthy lifestyle, diet and exercise.  There are however certain instances where I find that surgery at a younger age is justified and even beneficial. Here are some examples:

Male breast reduction:

This procedure is indicated in enlarged male breasts or gynecomastia. In certain young men, often for no discernible medical reason, the male breast tissue is enlarged. This can happen even without weight gain. Long lasting gynecomastia leads to stretching of the breast skin over time. When the skin is loose it is often necessary to excise it, leading to more visible scarring.  Early treatment is therefore preferable and can often be done with minimal incisions and visibility.

Rhinoplasty

The majority of nasal growth ends with puberty, so rhinoplasty at this time makes medical sense for an appropriate candidate. The driving force here, though, is social. For many of my patients, the end of puberty, the end of high school and the break before college all coincide.  It is a time when many patients have the support from their families, time off to recover and the opportunity to subtly transition to a new environment.

Otoplasty

Otoplasty is the setting back of protruding ears.  For the child with prominent ears, otoplasty at a young age can save a lot of peer teasing and unnecessary ridicule. Ear cartilage is softer in the younger patient as well, which often leads to a more stable result.

Surgery after massive weight loss

The message is getting out and people are listening. Each year I see more and more people, particularly young people who, through shear perseverance, diet and exercise have lost a large amount of weight. One remnant from massive weight loss is an excessive amount of loose skin that won’t recoil without the help of plastic surgery.  While most of my tummy tuck patients are post partum mothers, it is the most common surgery in the massive weight loss patient at any age.

Breast augmentation for Amastia

Amastia means no breast tissue. Each year I see a number of very young women, often with their mothers, exploring breast augmentation for the sole purpose of feeling “normal.” These are healthy young women who don’t have small breasts; rather, they have almost no breast tissue at all.  These younger patients return to school and life in general with a sense of feeling whole or balanced.

If you are a young person or parent reading this, please know that I will never push you or your child into surgery.  The greatest joy in my practice is educating patients and families about the surgeries they are contemplating.  If these are thing you have been thinking about it would be my pleasure to educate you as well.

In a single day of patient consultations I often have two patients asking about the same surgery.  One will tell me my prices are too high, the other will ask me why my prices are low.  It’s a paradox that as a physician they just don’t teach you about in medical school. I know medicine. I don’t know marketing, which I hope you will think is an asset.

Priced too high will put surgery out of reach for people with achievable goals. In this world of plastic surgery pricing I strive to be the one in the middle and provide good value.

Over a decade ago I started publishing the prices of my most common surgeries.  It’s the age of the internet (as you know if you’re reading this) and people want to know what to expect. Most of my colleagues hated it; now most of them do it. The world has changed.

Price notwithstanding I want to be the physician who gives the best consultation even if you don’t have surgery. I want my patients to feel they have learned all the ins and outs of what they are embarking upon so that they can make the most educated decision possible.  Even if you don’t like what you hear in my consultation because it is not what you were hoping for I want you to leave feeling that you got candid and sincere advice and that what I’m saying makes sense.

As a final word of heartfelt parting advice… don’t choose your doctor based on price. A few dollars plus or minus will never make up for lack of information or unrealistic expectations. Beyond any dollars it is important that you like and respect your doctor and feel comfortable in their care. I have never charged for cosmetic surgery consultations. I hope the information speaks for itself.  You can’t put a price on that.

For many people breast implants will last a lifetime when properly cared for and not impacted by rupture or defects that will require their replacement.

Manufacturers of breast implants design them to last a lifetime.  We often hear that breast implants should be replaced every 10 years. This is simply not the case, we have many patients that have had implants for over 20 years.  Of course this varies from patient to patient and over time many patients opt for breast implant revision surgery due to many factors including pregnancy, weight gain etc.

Breast Implant rupture does happen, but not very often.  If one or both of your implants rupture due to trauma, capsular contracture, or defect no need to worry.  Both silicone and saline ruptures are not know to cause adverse health effects.  Replacing the ruptured implant quickly is recommended.

If you are in the need of breast augmentation revision call Dr. Tattelbaum today and schedule a consultation.

Many cosmetic surgeons claim to have the latest in technology and equipment however experience is the key to having great cosmetic surgery Maryland results.  Dr. Tattelbaum has by far the best before and after results in Maryland.  With over 20 years of experience he has helped thousands of people obtain natural and beautiful cosmetic results.

One of the most common procedures performed by Dr. Tattelbaum is the breast augmentation procedure.  Many women have insecurity about their natural breasts and opt for breast augmentation procedure.  Breast augmentation is one of our more common procedures, we offer both silicone and saline options.  Each has its pros and cons that Dr. Tattelbaum with educate you about during your consultation.

If you are considering cosmetic surgery Dr. Tattelbaum is one of the best he has three location in Maryland, DC and Virginia for your convenience call today for your consultation.

Often clients will ask whether they should go over or under the muscle with respect to implant placement.

• Breast Implants placed below the muscle  submuscular, or subpectoral, plane or position.
• And Breast Implants placed above the muscle are in the subglandular position under the breast gland but over the muscle.

In most cases a breast augmentation procedure is performed under the muscle.  Although the breast is not a submuscular organ it is very much like a collection of sweat glands that develop above the muscle.  So from a technical standpoint placing the breast implant under the pectoral muscle is not anatomically correct way to create a breast.

There are a number of reasons why most breast augmentation procedures have been performed with the implant below the muscle.

• The implant has a much more natural look to them under the muscle than above the muscle.  By placing the implant under the muscle it gives the implant a softer and more natural look and feel than above the muscle.
• Capsular contracture occurs much less when the implant is placed below the muscle, why this is we don’t know.
• Mammography is much easier with the implant below the muscle also.

Allergan, Mentor or Sientra? Saline or silicone gel ? Textured or smooth? Shaped or round, cohesive or gummy bear? And that’s just the beginning. In this brief blog I will try to share some thinking and philosophy about the “too many” options we now have with breast implants.

If you read my last breast blog (silicone or saline) you know that I prefer silicone gel, provided the patient is comfortable with it. If you have a B-ish or C-ish breast you will hide a saline well, but silicone will usually look and feel more natural, particularly if you are starting with minimal breast tissue.

Three manufacturers are currently FDA approved to sell breast implants in the United States.  All make silicone gel implants, Allergan (formerly Inamed) and Mentor also make saline.  If you ask each company they will assure you that their product is best.  In my opinion, they all make excellent products and because they are all FDA approved they have gone through extensive testing. While I offer them all to my patients, I always recommend that the patients go with the brand their surgeon is most comfortable with.  We are just starting to offer Sientra—they are the new kid on the block, recently approved for use.

Textured or rough surface implants were created to minimize the risk of capsular contracture. The idea is that the rough surface breaks up the scar tissue. While evidence supports this for implants placed above the pectoral muscle, submuscular placement (which I prefer) does not benefit as much from texturing. I don’t like textured implants. I think they are more noticeable under the breast and the breast does not move as naturally.

Some implants are shaped, such as teardrop or oval. In order to maintain their position in the body these implants must be textured so that they stick inside the breast pocket. Occasionally they fail to stick and will rotate into an abnormal position. I think shaped implants are a good option for breast reconstruction when trying to match another breast, but I don’t favor them for cosmetic augmentation. I prefer a smooth round implant. If a round implant rotates around in the pocket it will not affect the appearance of the breast.

All currently available silicone implants have a cohesive (sticky) gel.  This means that the gel is most likely to stay put in the event of an implant leak or rupture. The gummy bear implant has the most cohesive gel, but as of this writing is not yet FDA approved or available. Even when available it is being brought out only as a shaped and heavily textured implant and will most likely find a home in reconstruction more than cosmetic breast augmentation.

If you are reading this then you are eager to hear the details. I encourage you to come in so that I can answer any further questions you may have.

I know it may seem silly, but to me perhaps the most important part of a tummy tuck is that little crease, no more than a centimeter, that is the belly button.  Why so important?  Well a tummy tuck by definition is a scar operation.  We pull down loose abdominal skin creating a scar in the lower abdomen. While every effort is made to minimize this scar, it is real and permanent, but fortunately well hidden. Good scar or not, the bikini or underwear will usually hide it.  The belly button is another story—it is an unhidden scar and in most cases the only visible sign of a tummy tuck.  In my opinion, it can make or break the result.

I pretend that all of my tummy tuck patients will want to wear a two piece bathing suit on the beach one day.  Because of this I feel compelled to create the best belly button I can.

Plastic surgeons have described heart shapes, “U” shapes and a variety of special belly button patterns that I do not use.  I find them cumbersome and unnatural looking.  My philosophy is about size.  I prefer a small belly button and here’s why:

Nothing is as natural as a G-d given belly button.  Therefore, keeping the surgical belly button unobtrusive is my first goal.  Smaller draws less attention; larger looks like a tummy tuck belly button.

I pretend that despite my best efforts the patient will make a thick scar and I would rather have a small thick scar than a big one.

Erring on the size of small is safer.  If a belly button is too small it is very easy to make it larger, but it is very difficult to make a large belly button smaller.

There are other subtleties as well. The opening can be vertical or horizontal. Vertical looks better but horizontal can allow me to lower the lower abdominal incision, removing more tummy skin.

The inside of the belly button can be pulled up or down as need be.  It is important to leave a reasonable distance between the belly button and the bathing suit line.  I will sometimes shorten the inside or even reshape it if it has been stretched or flattened by pregnancy.  I like to tether it inwards a bit, which can help keep more of the scar on the inside.

Paying attention to these details not only makes the best belly button, but the best tummy tucks as well.

Which do I need, liposuction or a tummy tuck, patients frequently ask this question when they visit their plastic surgeon. Patients can try to answer this question for themselves before they visit the plastic surgeon by understand the difference between the two procedures, figuring out what bothers them most about their body, and what they want to accomplish.

Liposuction

Liposuction reduces the fat volume in problem areas that make patients uncomfortable about the way they look. This is a more intense procedure as it takes more fat from different areas of the body and not just one location. This can include love handles, midriff, buttocks, thighs, and so on. Small incisions are made by the cosmetic surgeon in order to remove the excess fat from the troubled areas. The pitfall for this type of cosmetic surgery is that it doesn’t remove excess skin so in order to consider this procedure one should have a good skin tone or may have to consider having a tummy tuck.  Dr. Tattelbaum is a liposuction Maryland specialist he will  review your goals and advise whether lipo or tummy tuck is ideal for your goals.

Tummy Tuck

A tummy tuck is for women who may have just a bit of fat they want removed but have extra skin that needs to be removed as well from their mid-section. Some women with weak abdominal walls, as well as, those with poor skin tones would benefit more by seeing a tummy tuck Maryland specialist.

Before consulting with a cosmetic surgeon as to whether which is best for you, liposuction or tummy tuck, Maryland women should look at themselves in a mirror. Figure out what you don’t like most about your body. Are you just wanting to give yourself a younger looking flatter stomach or do you want rolls removed from it and maybe your upper back or love handles. Knowing what your desires are can help determine whether you should have lipo or tummy tuck Maryland surgery.

Another thing that should be taken into consideration is the cost variation between a liposuction and tummy tuck Maryland procedure. Although most Maryland cosmetic surgeons will work with patients to find the right treatment plan at the right cost, one should still take their budget into account. There are many liposuction and tummy tuck Maryland professionals to choose from, so before you run out and have some work done, compare costs and services provided between a few different professionals.

Hopefully this helps answer your question!