Augmentation of the breast using breast implants has long been one of the most popular plastic surgery procedures, especially here in Santa Barbara. As one of their particular specialties, plastic surgeons Dr. Sheffield and Dr. Lowenstein have provided improvements in the breast form of hundreds of women- both locally and those who come from significant distances for their expertise.

As with all of the plastic surgery that they perform, education is the mainstay of the pre-operative process. Both Santa Barbara plastic surgeons will spend significant time to ensure that you have a thorough understanding of your options and the decisions that go into producing an exceptional postoperative outcome. These decisions are largely in the areas of implant choice, incision location, and the anatomy of the pocket where the implant is placed.

Historically, several different materials have been used for breast implants. The most significant of these have been the saline breast implant and the silicone gel breast implant. As with all of plastic surgery, there are advantages to each type of breast implant, and your plastic surgeon in Santa Barbara will help you make the right choice for you.

Saline breast implants have a silicone shell and are filled with the same type of saline fluid that is used many times in intravenous fluid- the saline is completely compatible with your body, and in fact, the water, sodium, and chloride (water and salt) that makes up the saline also makes up most of your body mass. These breast implants come deflated, and are placed in this deflated state into the appropriate pocket behind your breast by your plastic surgeon. Because these breast implants are not filled at the time of placement, they can be rolled up, and inserted through a relatively small incision. Once in the pocket, your plastic surgeon will inflate the implant, much like inflating a balloon. Although the implant has a recommended fill size, your plastic surgeon has some leeway in the amount of saline placed into the breast implant. This feature of saline breast implants can help Dr. Lowenstein and Dr. Sheffield to improve cases of breast asymmetry, which is a very, very common situation. By placing extra saline in the implant on your smaller side, if you have one, the plastic surgeon can provide you with an improvement in the similarity of your breasts from one side to another.

Silicone gel breast implants were first developed in 1961. Because of some concerns in the 1980s about a correlation of silicone gel with some medical problems, silicone implants were removed from the market in 1993. This was done, unfortunately, before significant studies were performed to prove or disprove any of the allocations against silicone. These studies were subsequently performed, however, and in these major studies, no significant correlation has been found between silicone breast implants and the connective tissue disorders that were of concern years ago. For this reason, silicone gel breast implants were returned for public use with an endorsement by the Food and Drug Administration in 2006.

Silicone gel breast implants have the advantage of a smoother, more natural feel than their saline filled counterparts. Like the saline breast implants, the outer coating of the silicone breast implants are made of a silicone shell. These implants come pre-filled, and therefore must be placed into the appropriate pocket behind the breast through a slightly larger incision. Once in place, however, silicone implants are thought to show less rippling and have a more natural overall feel to them. Silicone breast implants are often recommended for women who have very little breast tissue preoperatively, when they will be easily felt through the overlying skin and small amount of breast tissue.

Like any device in medicine or, in fact, life for that matter, breast implants can fail after a period of time. This may be in the form of a rupture of the outer shell of the implant, causing the saline or silicone to leak out. With saline breast implants, the saline is absorbed by your body without a problem, and your affected breast becomes “deflated” or smaller again. With silicone gel implants, however, your body does not absorb the leaking silicone in the same way, and therefore there may not be any outward signs of any problem. Because of this, the FDA has recommended that patients who have silicone breast implants are checked with magnetic resonance imaging (MRI) periodically to make sure that there are no problems with their implants. In the case of rupture of either a saline or silicone breast implant, replacement is indicated and can be easily performed by your plastic surgeon.

Breast implants are placed into the pocket behind the breast through a variety of incisions. Some approaches, like those in the bellybutton or axilla (under the arm) are felt to be somewhat more problematic by both Dr. Sheffield and Dr. Lowenstein. These approaches have more concerns with respect to poor positioning of the implant- these incisions are very remote from the area where the breast implant pocket needs to be meticulously created, and less visualization through these remote incisions can create a less than optimal outcome. The two incisions favored by your plastic surgeons in Santa Barbara are the periareolar (around the nipple) and the inframammary (in the crease below the breast). While the periareolar incision heals very nicely in the line of change between the pigment of the nipple and the rest of the breast, the inframammary incision lies below the fold of the breast and is hidden in the upright position. You may have reasons for choosing one type of incision over the other- Dr. Lowenstein and Dr. Sheffield will be happy to discuss either option with you to minimize your scar following your plastic surgery in Santa Barbara.

Once the type of breast implant and the incision are determined, your plastic surgeon will discuss the optimal placement of the implants to create the best breast form. Classically these options have been either completely behind the muscle, called the submuscular breast implant position, or in front of the muscle, behind only the breast tissue. This latter placement is called the subglandular breast implant position. A third option, and the one that is most often used by Dr. Sheffield and Dr. Lowenstein in their plastic surgery procedures, is the dual plane breast implant position and combines many of the best features of the submuscular and subglandular breast implant positions.

The submuscular position for breast implants requires elevation of the pectoralis muscle, as well as some of the serratus muscle in order to have total muscle coverage of the breast implant. This placement has been thought to be the decreased risk of capsular contracture, or problematic scar tissue forming around the breast implant. Additionally the extra muscle coverage adds a layer of natural tissue over the breast implant in order to mask the ability to feel the implant. Unfortunately, women who have some substantial amount of breast tissue, and especially women who have some ptosis, or drooping of the breast tissue, can have difficulties with the placement of the breast implant completely behind the muscle. This is because the natural breast tissue can droop over the muscle and implant, causing a “double bubble”. The double bubble occurs when there is fullness on the chest wall from where the breast implant is being held up high by the muscle layers, while the breast droops down and creates a second, un-natural appearing fullness in a lower position, below the breast implant. This is a tell-tale sign of breast augmentation and a situation that your plastic surgeon in Santa Barbara will do everything he can to avoid.

The subglandular position for breast implants requires the breast implant to be placed over the muscle, and only behind the breast tissue. This can have a great effect on filling out the lower breast mound by adding volume to the area of the breast behind the nipple. Unfortunately, breast implants placed in this position have a slightly higher incidence of capsular contracture, and are more easily felt and seen without the muscle covering the breast implant in the upper portion of the breast. While the subglandular breast implant position may be a good option in some women who have minimal ptosis and a deflated appearing breast, the difficulties with this breast implant placement often preclude its use.

In Santa Barbara, Dr. Lowenstein and Dr. Sheffield have found that the dual plane breast implant position, in many cases, combines the best of the submuscular breast implant position with the subglandular breast implant position. The muscle is released from its lowest origin in the inferior and lower medial portions of the breast area. The muscle is elevated in the superior aspect of the breast implant pocket, but the implant is allowed to rest behind the breast tissue in the lower aspect of the pocket where the muscle has been released. This allows the muscle to cover the upper breast implant and hide it from being easily seen and felt. At the same time, the dual plane breast implant position allows the implant to fill out the breast in the lower region, behind the nipple, to create a great teardrop shape and a natural breast appearance. Additionally, the muscle is able to massage the implant in the superior portion of the pocket, and thereby help reduce the problematic scar contractures that Dr. Sheffield and Dr. Lowenstein want to avoid.