Breast Augmentation

Breast implants are the most popular cosmetic surgery procedure performed in Cleveland, Ohio and the United States.  Most women seek breast augmentation surgery either to improve their self-esteem and confidence.  This is often something women desire after having children due to the changes associated with pregnancy.  Other patients have always wanted larger breasts and seek breast implants to improve their appearance and balance their bodily proportions.

Dr. Goldschmidt has extensive training in cosmetic surgery of the breast and performs these procedures with great frequency. He has been featured on the radio with WMMS and Rover’s Morning Glory.   He is one of the busiest surgeons in all of Ohio when it comes to cosmetic surgery and especially, breast augmentation.  In addition, a significant portion of his practice is spent fixing previous breast implants done by other doctors. He has a thorough understanding of the complexities of breast implant surgery along with the knowledge of breast anatomy. To go along with his extensive surgical training in breast surgery, he has an artistic ability that helps give his patients the best outcome possible. Not to mention a beautiful pair of breasts! But beyond this, one of the best ways to choose a surgeon is by asking previous patients. His reputation is excellent. He has a caring nature that will make you feel very comfortable right from the start.

At your personal consultation, you are encouraged to bring a friend, relative, or significant other to any and all of your appointments. Dr. Goldschmidt will listen to your particular goals, examine you, and then discuss with you a treatment plan that fits your needs.

There are many factors that will be considered with regards to breast implant surgery:

  1. Type of breast implant- saline or silicone gel
  2. Size of the implants
  3. Your lifestyle and physical activity
  4. Placement of the implant- “above or below the muscle”
  5. Incision site and size
  6. Smooth or textured breast implants
  7. Round or anatomic (tear-drop) shaped
  8. The profile of the implant (low, moderate, or high)
  9. Future surgeries

Saline vs. Gel Breast Implants:

There are 2 types of implants in the United States that are approved by the FDA for patients who wish to enlarge their breast size: saline and gel. Both implants work well and can achieve the desired results when combined with proper placement, proper size selection, and minimally traumatic surgery. The saline implant is filled with sterile intra-venous (IV) fluid and they tend to last 8-10 years before the implant slowly deflates. The IV fluid is safe and is taken up by your body without any problems. Saline implants are easily replaced if they deflate. The saline implant tends to feel a bit firmer and may result in rippling or wrinkling which can be felt but is usually not seen through the skin. The saline implant is roughly $1000 less than the silicone gel implant. These implants can be placed through an incision a little over an inch long. Another benefit is that the implant size can be adjusted to a small extent in the operating room for patients with small asymmetries.

Silicone gel breast implants can also be performed safely and with a very natural feel and shape. In Cleveland, Ohio many women prefer silicone gel implants over saline implants for several reasons. In the middle of the last decade, the FDA approved silicone gel implants for all patients including those patients undergoing their first breast implant procedure. The FDA did recommend that after the breast implants were in place for three years, patients should obtain an MRI to insure the implants were not ruptured or damaged. One of the past thoughts was that silicone gel implants cause hardening and pain in the breast (also known as “Capsular Contracture”).   In the scientific literature, several studies showed this to be true, however, recent studies may no longer validate this belief. In fact, there is some evidence that the silicone gel implant may not be a higher risk for capsular contracture when compared with the saline implant. The gel implants feel much more natural and are less likely to wrinkle or ripple. Allergan, one of the leading manufacturers of silicone gel breast implants, now comes with a lifetime warranty.  The incisions in the past, needed to be bigger for the silicone gel implant since they come fully filled from the manufacturer. The latest device created to aid in placement of these implants is called the Keller Funnel. With this device, a small incision can be used (same size as the saline implant surgery- a little over 1 inch). Dr. Goldschmidt is one of the first breast implant surgeons in Cleveland, Ohio to begin using the Keller Funnel on a regular basis to minimize the incision length, avoid damaging the implant with insertion, and also to avoid any possible contamination of the implants.

Above or Below the Muscle

Breast implants are very commonly placed under the pectoralis major muscle. This placement tends to give a more natural appearance and helps hide the edges of the implant, especially in thinner patients. The breast sits on top of this muscle, and in some situations it may be advantageous to place the implant on top of the muscle. Patients can have the implants placed either in the subglandular position (directly under the breast tissue) or in the subfascial position (under the breast tissue and the lining of the pectoralis muscle). Sub glandular placement has a slightly higher risk of capsular contracture (where the scar tissue becomes firm and causes pain and distortion of the breast). The subfascial position may often an advantage because the lining of the pectoralis is thick enough and does not have as high of a risk of capsular contracture as the subglandular position. The subfascial position is also better for patients that body-build, weight train, and do a lot of upper body exercises.

Incisions and Implants:

Dr. Goldschmidt can perform breast implant surgery using several different incisions. The standard incisions including the armpit (transaxillary), the areola (periareolar), the crease under the breast (inframammary), and through the belly button (transumbilical). The two most common incisions used tend to be the inframammary and transaxillary sites. Most women in Cleveland, Ohio prefer these sites for breast implant surgery because they are well concealed and usually heal a very inconspicuous manner. The periareolar incision can sometimes be noticeable because it is right on the front of the breast. It can sometimes thicken or become darker or lighter depending on the patient’s characteristics. This incision is used commonly in patients who want to have a breast lift at the same time as an implant. The transumblical incision (through the belly button) is used solely the placement of saline implants. With this incision there is less ability to adjusted the shape of the breast and some patients even end up with an additional scar under the breast.

There are now 3 manufacturers that have been given FDA approval for breast implants: Allergan, Mentor, and Sientra. All products have proven safety and have similar features. The implants can be smooth or textured, different sizes and profiles, and have either round or anatomic shapes. These choices will be made once you have been examined. The goal of the implant selection is to find an implant that fits your goals and your body habitus. The most commonly used implants are smooth and round for cosmetic breast augmentation.  Some patients who develop capsular contracture may benefit from a textured implant along with patients who request a revision surgery. The smooth implants tend to be more mobile inside the tissue and may help decrease capsular contracture. Round implants to be much more widely used in cosmetic patients. The anatomic or teardrop shaped implant is best for patients with breast cancer who want a more “natural” reconstruction. The round implant tends to give more fullness in the upper part of the breast- this tends to be the area most women want to augment.

The dimensions of the implant are also important to consider. Thinner patients who have a very narrow chest, or patients who are very physically active, may be better candidates for the higher profile implant since they are narrower. Women who also want a very rounded look or more fullness above the nipple may also chose a high profile implant. The intermediate profile implant, tends to be the most common implant chosen by women in Cleveland, Ohio for breast implant surgery.

Allergan has recently been given approval for their new NATRELLE INSPIRA® Cohesive line of breast implants.  These arethe newest entry into the category of breast implants and are commonly referred to  as “gummy” implants, designed for women who are interested in increased breast fullness.  These implants offer the least amount of rippling and tend to maintain their form over time leading to fewer complications including capsular contracture.  Dr. Goldschmidt is one of the first surgeons in Cleveland, Ohio to begin using these implants for cosmetic surgery.

Cup Size

Patients commonly request to be a specific size, for example “34D”. However, implants are not sold in this fashion. They are sold by volume (i.e. 300cc). To make matters more confusing, the manufacturers of bras, do not standardize their sizing. Similar to shoe manufacturers, a 34C in one brand may be similar size to a 36B. This can be very confusing as a result because patients need to consider where they buy their bras from along with finding the right volume to obtain their desired result. In the consulatation, Dr. Goldschmidt and his staff will allow you to try on varying sizes of implants with sizing bras and clothing. They will help guide you in this process so you can get an idea as to the size you would like to be after your breast implant surgery. Unfortunately, there are no guarantees as to your final bra size, but be assured that when you look in the mirror, you will achieve the look you desire!

 

Complications

As with all procedures, there is always the possibility of a problem or issue that can arise after surgery.   The decision to undergo any procedure cannot be made without an adequate understanding of the risks of the procedure.  When looking at the risks, the vast majority of problems of rare.

Surgical and anesthetic risks with breast enhancement in Ohio.

Every surgery carries risks of bleeding, infection, and anesthetic complications. Bleeding after breast augmentation can require a return to the operating room to stop bleeding and can even require transfusion. Infection around a breast implant can require removal of the implant, which has to be left out for several months to insure that the infection clears. There have even been case reports of implants becoming infected years after augmentation. Anesthetic complications can involve allergic reactions to medications, pneumonia, blood clots, heart attacks, and other issues. All of these types of complications are rare, but real with surgery.

 

Implant leak and longevity with breast augmentation in Cleveland, Ohio.

As a rule of thumb, implants leak at a rate of about 1% per year per implant. If saline implants leak, the patient sees deflation and urinates out the fluid. If silicone leaks, it will generally stay inside the capsule (scar tissue surrounding the implant) and the implant usually will maintain its size.   The leak will go unnoticed until a change in shape occurs or until a capsular contracture develops.  The new “gummy” implants are highly cohesive unlike the silicone implants from decades ago that were filled with liquid silicone.   In fact, the FDA and implant manufacturers recommend an MRI to evaluate silicone breast implants every few years.

Realistically, most patients must consider that breast implants will not last the patient’s lifetime. So almost every breast augmentation patient will likely require further breast surgery over her lifetime following augmentation. This may be due to implant leak, breast aging around the implants (requiring breast lift), capsular contracture, or other causes.

 

Nipple sensitivity after breast enhancement in Ohio.

Changes in nipple sensitivity are common after breast augmentation in Ohio. Many patients note hypersensitivity, that usually subsides after several weeks. A small percentage of patients will experience permanent nipple numbness or tingling in one or both nipples. This is more common if a breast lift is performed with the augmentation.

 

Mammography after breast implants in Cleveland, Ohio.

Mammography is more difficult to read once breast implants are placed. Special views may be required. No large study has shown a delay in breast cancer diagnosis in augmented patients, but patients are more likely to require ultrasonography or MRI if any abnormalities are seen on mammogram.   Family history and personal history of breast cancer are important factors to consider with regards to screening mammography.

 

Breast feeding and breast enhancement in Ohio.

Breast augmentation generally does not interfere with breast feeding as long as nipple sensation is normal.   However, patients who have implants are more likely to require subsequent breast lift if their breasts enlarge with pregnancy and lactation because the combination of breast enlargement from an implant and lactation causes more stretch on the skin.

 

Breast Augmentation Revision

The most common issues affecting patient satisfaction after breast augmentation usually relates to the size or aesthetics of the breast implants.   Some patient have problems with implants that end up in the wrong position (“bottoming out”, lateralization, or synmastia).  Other patients can develop capsular contractors or deflations of the implants over time.  All of these possibilities exist after surgery and require surgical intervention to improve the cosmetic appearance of the breast.  It is important to realize that breast augmentation has limitations but the overwhelming majority of patients are deeply satisfied with their outcomes.

 

You can contact Dr. Goldschmidt at The Cosmetic Surgery Center by calling the office at 216-264-8100 or emailing him at cosmeticsurgerycenter5005@yahoo.com. A free consultation can easily be arranged at your convenience so that you can discuss all of your concerns and your desired outcomes related to breast implants. Dr. Goldschmidt and his staff have many before and after images you can look at from other women who have had breast implant surgery by Dr Goldschmidt in Cleveland, Ohio.

Dr. Goldschmidt at The Cosmetic Surgery Center, specializes in breast implants in Cleveland, Ohio. He is located in Independence, Ohio in the Crown Centre Building on Rockside Road.