Breast implants vs. fat transfer for breast enlargement. Seattle Plastic Surgeon compares the two operations.
I have been doing fat transfer to the breast for about three years now. When I started practice in 1991, fat transfer to the breast was dismissed as ineffective. And indeed it was because the technique did not lend itself to long term viability of the fat. These days, thanks to fat transfer pioneers like Dr. Sydney Coleman and Dr. Richard Ellenbogen, we know how to harvest, handle and inject the fat in such a way that most of the fat survives in its new location. Fat transfer has become an important addition to my breast enhancement practice. Based on my experience, here are the main differences between breast implants and fat transfer for breast enhancement.
For most patients, there is a clear choice between these procedures but a few patients are really torn about which way to go. In consultation, I provide as much information as I can about each procedure and make sure that patients understand the limitations of fat transfer and also the long term consequences of having breast implants.
Seattle Plastic Surgeon reassures her patients that breast implants usually do not interfere with athletic endeavors.
Hey girfriend! Where’s your sportsbra?
Many of my breast implants patients are very physically active and the effect of breast implants on athletic performance is a common question.
Except for the world class athlete, breast implants won’t likely interfere with even vigorous sporting activities like waterskiing, snow boarding, rock climbing, kick boxing, barrel racing, Zumba, parkour, rowing, dog agility, lacrosse, roller derby, etc.
I do warn warn patients that their upper body strength may be a little diminished with sub-pectoral implants but that they won’t likely notice the difference once they are healed.
Also, once a patient with implants starts doing upper body exercise, their implants may feel weird for a few weeks but that they will get used to it. I also warn them that they will definitely need a good exercise bra to protect their investment and they may be getting a little more attention at the gym or the roller derby track.
Seattle Plastic Surgeon knows a lot about shoes and breast implants.
You won’t want to wear them if they don’t fit.
Can you imagine buying an expensive pair of shoes that just don’t fit? Maybe they are too small and you have to cram your little piggies into a too tight toe box or maybe they are too big and slip and slide everytime you take a step. Crazy, huh? Size really matters when it comes to shoes and who cares about the number on the inside of the shoe as long as it fits. Right?
Well, it’s the same with breast implants. Sometimes patients get really, really hung up on numbers. For example, a patient will come in saying “I want a Style 20, 650 cc implant that will get me into a 32 DDD bra”. Whoa, and that’s before I have even examined her!
If she is a slender woman with a narrow chest, that implant is going to have too large a diameter and it’s going to give her the dreaded unaboob a.k.a. synmastia, or it’s going to end up spilling into her armpit. On the other hand, if she is a larger woman with a really, really broad chest, that implant is not going to give her the medial fullness to create a nice cleavage or the lateral fullness to balance her hips. If she has a moderately broad chest and a breast diameter of around 15 cm (about 6 inches), that implant will probably fit her pretty well. But it is my job to examine her, measure her and guide her towards an implant that fits her. A little bit like Goldilocks and the Three Bears, huh?
The other number I’d like my patients to forget about is bra size. Repeat after me “bra size doesn’t matter as long as my implants enhance my figure“. As all ladies know, bra sizes are all over the place and there is precious little standardization. Take a look in any women’s lingerie drawer and she likely has 2 or 3 or even 4 different sizes. I tell patients the best way to deal with bra size is to get professionally measured, buy bras that fit well and, if they don’t like the size, cut out the tag!
SOOOOOOOOOOOOOOOO – keep an open mind about what size of implant will be right for you and trust me (I am a doctor) to use an implant that will fit your body and then, after surgery, keep and open mind about what size bra will be right for you and trust the bra lady (especially if she has a little gray hair and reading glasses) to get you into the right bra.
Seattle Plastic surgeon blogs about one of her pet peeves – Big breast implants and a Benelli (circumareolar or donut) lift done to avoid a full breast lift.
Big implants and a Benelli lift. IMO it’s just not a good look. A full lift and smaller implants would have served this patient better.
I do alot of breast revision surgery and I see at least one patient a month who had the operation shown on the left who is unhappy with their result. And it is almost always the case that the patient did not want the scar from a full breast lift to treat significant sagging. So she and her surgeon agreed on a large implant to take up some of the slack breast skin and a Benelli (a.k.a. circumareolar a.k.a. donut) lift to lift and reduce the diameter of the nipple and remove some excess breast skin.
The Benelli lift always flattens the area around the nipple as is seen in this case. Occasionally flattening is indicated if a patient has a tuberous deformity. And if the Benelli is expected to lift just a little and tighten just a little, the results can be very pleasing. Problems occur when surgeons and their patients ask too much of this technique.
With breast and body surgery, shape and contour is more important that length of scars. A long scar almost always will fade and smooth out but a weird contour will not change over time.
Seattle Plastic Surgeon explains what causes a double bubble deformity in the implanted breast.
The implant rides high and the breast falls over the lower edge of the implant creating the weird shape of the “double bubble”.
I saw two patients this week with the so-called double bubble. Both of these ladies had implants that were over 10 years old and both had experienced some sagging in their natural breasts.
The double bubble occurs when time and gravity result in the natural breast drooping and falling below the bottom border of the breast implant. Breast implants tend to stay put over time because they are held in place by the implant pocket and the resultant scar capsule that forms around them. Or, in some cases, the scar capsule starts to thicken causing a so-called capsular contracture and the implant can be displaced up which can result in an early or really bad double bubble.
Treatment depends on how much the double bubble bothers the patient, how bad the double bubble is, the age and condition of the implants and the condition of the patient’s breasts. Usually treatment will consist of doing a breast lift to get the breast back up into a better position relative to the implant. If the implant has developed a tight capsular contracture, removal of the old implant and capsule and replacement with a new implant may be necessary.
Sometimes ladies in middle age develop the double bubble and don’t really want to do anything surgical. It can be “fixed” with a good bra. And sometimes ladies in middle age decide that their implant days have come to an end and opt to have the implants out and a breast lift. These ladies are often relieved to be implant free and often just love their smaller and perky breasts.
So, with the double bubble and many other things related to plastic surgery, the main culprit of is time and gravity, which keeps me in business.
Seattle Plastic Surgeon discusses a common and annoying skin condition – Keratosis Pilaris.
Pilaris keratosis – annoying but harmless.
Earlier this week I saw a young woman in my office requesting breast augmentation. During the consultation, she also wanted me to take a good look at her upper arms and anterior thighs. She had scattered teeny, tiny little red and while bumps.
Now there are many, many dermatologic conditions that I know very little about but her condition, keratosis pilaris , is one I am very familiar with because I have it.The little bumps seen in keratosis pilaris are caused by plugged pores. This condition seems to be hereditary (thanks, Mom) and usually shows up around puberty and tends to get better with age. The most common areas affected are the upper arms, the thighs, the cheeks and the other cheeks.
Most cases of keratosis pilaris do not require medical attention because self care is often very effective. There are many over the counter ointments that contain some type of acid, be it lactic acid, glycolic acid, salicylic acid or urea. These mild acids break up the plugs of keratin that block the pores. These ointments need to be used regularly to maintain their efficacy. Sephora makes a cream specifically for this keratosis pilaris, KP Duty. I’ve heard it works very well. And as a person ages, the keratosis pilaris usually just sort of disappears. Just one of the many wonderful things that happens as we get older. Really! So if you have keratosis pilaris, start with some self treatment and be glad you don’t have something worse!
Seattle Plastic Surgeon comments on Wall Street Journal article about the realities of fertility.
If you are over 32, your clock is ticking.
This morning there was an article in the Wall Street Journal about the realities of female fertility and the conflicts that reality can create for the modern woman. I hope this article gets into circulation among the young and fabulous and indecisive.
I always ask cosmetic breast patients about their child bearing plans and often hear “I haven’t decided yet” and it often comes from women well into their thirties. I try to educate patients, in the nicest way possible, that it just may be time to decide.
Back in 2001, The American Society for Reproductive Medicine ran a public education campaign urging women not to wait too long to bear children. I remember very well how this campaign was taken as an attack on the modern woman by many and how Dr. Michael Soules, the society’s president at the time was vilified. I just shook my head at the push back that resulted from Dr. Soules and his group just presenting the cold, hard facts of life. And I knew what a gentle, skilled and kind physician Dr. Soules was. He was one of my fertility doctors way back then.
I am glad that the Wall Street Journal is shining the light again on this topic. It’s as if age related infertility is a topic that must never be discussed by the ambitious and well educated and liberated woman. But it should be.
I’ll end this blog with the words of one of the doctors sited in the article : “There’s never going to be a perfect time.”
Fat transfer to the breast by Seattle Plastic Surgeon takes time and patience.
Fat transfer to the breast doesn’t seem like it would be a time consuming procedure but it is if done properly. Here is what’s important and why fat transfer takes time and patience:
Patience – one of my few virtues.
The fat must be harvested very gently at a low vacuum. This is a much slower process than regular liposuction.
The fat is often harvested from the posterior hip and buttock and lateral thigh area with the patient prone. This means that a position change is necessary and that also takes time.
The fat must be handled with great care when it is transferred into injection syringes. It’s important to have a patient and detail oriented assistant.
The fat must be injected in small aliquots into the breast, making sure to inject into several different layers. This tedious technique pays off in the long run because it gives the fat a much better chance of survival compared to injecting big blobs of fat that probably won’t survive. It has to do with blood supply. That’s another blog topic.
The areas of injection vary with the shape of the breast. When doing an augmentation with an implant, there is very little control of the breast shape but with fat transfer, the shape of the breast can be altered. This also takes time and multiple visual assessments with the patient sitting up.
Some surgeons do not have the temperament to do procedures as tedious as fat transfer to the breast. But I do!
Seattle Plastic Surgeon reports just published information about patient satisfaction with “Gummy Bear” implants used for reconstruction.
“Finally, someone asks me what I think!”
The most recent issue of Plastic and Reconstructive Surgery has an article that asks women who have had breast reconstruction with breast implants what they think about their result. This study involved 65 ladies with round silicone gel implants and 63 ladies with form-stable silicone gel implants a.k.a. “Gummy Bear” implants. They were asked what they thought of their results and to rate their sexual, psychological and physical well-being.
The findings are quite interesting. There was no difference in patient satisfaction and well-being between round implants and the form-stable a.k.a. “Gummy Bear” implants. The only difference found by study was that patients felt the “Gummy Bear” implants were significantly firmer than round implants.
This is a small group of breast reconstruction patients and I am looking forward to studies involving larger groups and also a similar study done on ladies with implants for breast enhancement. With information like this study, I am not quite ready to jump on the “Gummy Bear” bandwagon just yet.
Seattle Plastic Surgeon riffs on Gummy Bear Breast Implants and Gertrude Stein.
Gertrude Stein painted by her close friend, Pablo Picasso
So, you ask, what does Gertrude Stein, that feisty feminist writer of the last century, have to do with the latest breast implants on the market??? I’ll start with a quote from Gertrude that rattles around in my head a lot: “A difference, to be a difference, must make a difference.” Wise words, in my opinion. And so we come to the “gummy bear” breast implants which will be heavily promoted to the public by their manufacturers now that they are available for cosmetic use. The question is, of course, do they, will they, can they make a difference in routine breast augmentation? And, if they do, is it a good difference?
About 6 or 7 years ago, I heard a presentation given by a very sharp plastic surgery resident on the topic of “anatomically” shaped breast implants. She had experienced plastic surgeons look at a bajillion before and after breast implant cases and to indicate whether anatomically shaped implants or standard round implants had been used. They, the experienced plastic surgeons, could not tell the difference. If my memory serves me, these were all saline implants because the study was conducted prior to the reintroduction of gel implants for cosmetic use. So it could be that “anatomically” shaped gel implants do make a difference but the jury is still very much out and it will take some convincing to get me to jump on this particular bandwagon. By the way, a bandwagon stops by my office about 2 or 3 times a week.
So why am I reluctant to promote the latest and supposedly greatest of breast implants? Here’s why:
The “gummy bear anatomic” implants are form stable. Form stable means firm. And these implants are firm, sort of like an adolescent breast. They stay put and do not shift with change in position like a natural breast. This means when a woman with these implants reclines onto her yoga mat, her breasts stay up there at full salute. A good look for an eighteen year old but for a 35 year old mom of three? Not so much.
The “gummy bear anatomic” implants, if they do shift, can rotate or even flip and result in a bizarre and/or painful distortion of the breast.
The “gummy bear anatomic” implants have a textured surface that is supposed to adhere and stick to the surrounding chest tissues to prevent shifting around. This textured surface can cause a problem with traction distortion and is also associated with late fluid collections (seromas).
I did many, many augmentations with anatomic saline and, through an implant study protocol, anatomic gel implants well over ten years ago. I came to dislike these implants. My re-operation rate for patients with anatomic implants was 2 or 3 times higher than for those with round implants. It was a painful learning curve for both me and my patients.
So I’m trying to keep an open mind about these implants but will need to be convinced that they really make a difference. Well over 90% of my breast augmentation patients are thrilled with their results with smooth round saline or smooth round gel implants. It’s hard to argue with those results.
@lisalynnsowder
