Breast augmentation, or enlargement, is a very popular and common procedure that many women desire for a variety of reasons. Some individuals have congenital differences and breast asymmetries they wish to address, while others may simply be unhappy with their breast size and desire to have more fullness to fit their frame. In addition, many women seek breast augmentation to rejuvenate their breasts following pregnancy. The breast is stretched and expanded during pregnancy and lactation, and afterwards, the “glandular” tissue inside the breast often atrophies. This leaves most moms with varying degrees of “tissue deflation.” Breast augmentation is a wonderful way to restore this lost volume.
Houston plastic surgeon James F. Boynton, MD is highly experienced in breast augmentation, and he has the artistic eye and surgical skill to achieve exceptionally natural-looking results that align with each patient’s unique needs and goals. Overall, this procedure has an extremely high rate of satisfaction, and it can be an incredibly empowering treatment that exudes youthfulness and vivaciousness.
Did You Know?
Dr. Boynton also commonly deals with challenging breast revision surgery that can involve “downsizing” large implants; correcting implant malposition, rippling, or wrinkling; treating symmastia; and/or placing Strattice™ or GalaFLEX® for added tissue cover.
Breast Implant Options
Breast implants are available in a variety types, shapes, sizes, and textures. At our practice, Dr. Boynton offers saline, traditional silicone, and highly cohesive silicone gel “anatomic-style” implants (also known as form-stable cohesive gel or “gummy bear” implants) from well-respected manufacturers such as Mentor®, Sientra®, and Allergan. Each of these options is highlighted below.
Saline Breast Implants
Saline breast implants are FDA-approved for women aged 18 years and older. This historically-popular implant option is composed of a saltwater-based solution encased in a silicone outer shell. Saline implants have proved to provide excellent, natural-looking results for a diverse range of patients.
Silicone Breast Implants
Silicone breast implants are widely believed to achieve a more natural look and feel in comparison to saline implants. FDA-approved for breast augmentation patients 22 and over, these conventional implants are composed of thick silicone gel enclosed by a durable outer silicone shell. They are generally considered to be more resistant to issues such as rippling and leakage, and they are typically regarded as an excellent option for patients with a thinner body frame. Since the FDA reapproved the use of the silicone gel implants in 2006, the pendulum has swung greatly in favor of silicone gel due to their natural feel and long-lasting integrity.
Anatomic-Shaped, Form-Stable Cohesive Gel Implants
Anatomic-shaped, form-stable cohesive gel breast implants, also known as “gummy bear” implants or “tear drop” silicone gel implants, are the latest implant devices to receive FDA approval in the United States. Having been available in Europe for a number of years, cohesive gel implants are well-documented and widely regarded as the most natural-looking implants available. Once placed, these progressive-style implants are known to better retain their shape, and clinical studies have shown a reduced risk of rippling and capsular contracture.
Mentor® Breast Implants
Manufactured and distributed by Mentor®, MemoryShape® breast implants are highly-cohesive, silicone-gel filled implants constructed to more closely resemble the look and firmness of a natural breast. Unlike traditional round breast implants, MemoryShape® implants are designed with more of a teardrop shape, meaning they are thinner at the top and slope gradually into a fuller projection. In addition to MemoryShape® implants, Mentor® also produces MemoryGel® smooth, round implants. This implant option comes in a variety of profiles, including the “Ultra High Profile” which can often provide exceptional results for patients who want their implants to be maximally full without being too wide. Overall, highly cohesive, silicone-gel filled implants from Mentor® are considered to be some of the softest gel implants available, helping them to create an incredibly natural look and feel for a wide variety of patients.
Sientra® Breast Implants
Approved by the FDA and available only to board-certified plastic surgeons, Sientra® cohesive gel breast implants are considered to be some of the most natural-looking and feeling breast implants on the market. Composed of durable silicone gel, these form-stable implants come in a variety of shapes (round, oval or “classic”) and sizes, with the option of either a smooth or textured outer shell. Depending on their particular size and shape, Sientra® implants can add volume while also producing a proportionate, seamless blend between the chest and the breasts. Additionally, the unique design of these cohesive gel implants has been known to reduce the risk of rippling as well as the probability of gel leakage in the unlikely event of a rupture. Ultimately, Sientra® breast implants may be an excellent option for patients seeking to achieve the most natural look and feel for their breast enhancement results.
Natrelle INSPIRA® Round Gel Breast Implants
Developed by Allergan, Natrelle INSPIRA® Round Gel Breast Implants can be an exceptional option for many women seeking to achieve improved fullness and a soft feel. These round, silicone-filled implants have a smooth outer texture and are available in 100 different sizes. In addition, they come in five projection styles to produce a customized fit for every patient. These include extra-full, full, moderate, low-plus, and low profiles. Throughout clinical studies, Natrelle INSPIRA® Round Gel Breast Implants have boasted an extremely high patient satisfaction rating for primary breast augmentation, revision augmentation, and breast reconstruction patients. Ultimately, Natrelle INSPIRA® implants can be ideal for helping many individuals attain the increased upper pole fullness they desire without sacrificing natural-looking and feeling results.
Selecting the Right Breast Implants
Choosing the right implant for you will be based on a number of different factors, including your specific needs and desired outcome. During your consultation, Dr. Boynton will discuss all of your options in thorough detail, highlighting the various advantages and disadvantages of each choice. In addition, measurements of the breasts and chest wall will be taken to devise a “biodimensional plan” and identify which implants can be safely accommodated by your breast tissues. Once all possible options have been discussed, Dr. Boynton will help you select the breast implants that can most effectively help you achieve your breast augmentation goals.
Details of the Breast Augmentation Procedure
The breast augmentation procedure is best approached using a tiny “inframammary” (IMF) incision along the crease under the breast. It is about the width of a quarter and heals extremely well, and it is well-disguised. Dr. Boynton has vast experience with patients of all demographics and types of skin pigmentation, and the incision tends to fade away for the majority of individuals. There are other incisions that can be made, but none of them give the accuracy of implant placement that the IMF incision affords. There is also a decreased chance of nipple sensitivity changes and capsular contracture with this incision (as compared to the periareolar incision). Once the incision is made, implants are typically placed in the subpectoral pocket (under the chest wall or pectoralis muscle). Dr. Boynton utilizes a minimal touch or no-touch technique with silicone gel implants that minimizes any risk of contamination, implant shell integrity loss, and even capsular contraction.
In some cases, Dr. Boynton performs a dual plane subpectoral breast augmentation when indicated, especially in patients that have some “early” changes of breast ptosis or “droopiness” to the breast. This allows some degree of “internal lift” to be accomplished in conjunction with the breast augmentation. Sometimes this is not enough, and patients require both breast augmentation and mastopexy together—also known as breast augmentation with mastopexy. Dr. Boynton has advanced training in this highly complex procedure to help determine the best plan for each patient.
You're not just a patient, he asks you how are your kids how's your mom... The way he treats you during the procedure, the before and after care... I wouldn't go to anybody else.
Dr. Boynton utilizes “biodimensional planning” with each patient that involves taking specific measurements. Once gathered, the measurements are converted into the best implant size for the individual. The patient then gets to try on the implants in a special “sizer” bra that simulates the final result. This way, Dr. Boynton incorporates the science of the measurements with each patient’s goals and wishes to arrive at the best result for each particular patient. Dr. Boynton also utilizes a special sizer at the time of surgery to ensure the best size and goals for each individual.
Breast augmentation is a very safe outpatient surgical procedure that takes a little over an hour to perform, and patients are generally able to return home the same day under the care and supervision of a close friend or family member. Risks of surgery—such as hematoma—are nationally quoted as about 1% of all patients in the U.S. Currently, Dr. Boynton’s risk of hematoma is well below that. In the event of a postoperative hematoma, early recognition and treatment are essential to remedy the problem.
Recovery from Breast Augmentation
Following breast augmentation, 85–90% of patients are pain-free in three days—in fact, most individuals feel well enough to go out to dinner the evening after surgery, if they desire. The day after the procedure, patients are seen by Dr. Boynton in the office, their ACE bandage that was placed after surgery is removed, and they are fitted into a comfortable zip-in-front sports bra. All patients are given a prescription for antibiotics, pain medicine, and a muscle relaxer. Most women take a mild muscle relaxer for several days, though many elect not to take their pain medicine because they do not need it.
Showering is acceptable the day after surgery, and the majority of patients are able to resume normal activities of daily living very quickly. That said, heaving lifting (anything over 10 pounds), overhead reaching, and any kind of aerobic exercise is restricted for two weeks to ensure safety and minimize any risk of complications.
Where will the scar be placed?
Typically, I use a small inframammary incision hidden under the breast, just over an inch in length. This incision heals better and has the highest success of well-placed implants, less hardening (capsular contraction), and less nipple sensitivity problems.
How long is the pain and how soon to recovery?
85-90% of my patients are pain-free in three days. All patients go home the same day and can even go out to dinner the evening after surgery, if they desire. Patients are seen the next day in the office, the ACE bandage is removed, and the patient is fitted into a comfortable zip-in-front sports bra. They can shower the day after surgery. All patients are given a prescription for antibiotics, pain medicine, and a muscle relaxer. Most patients take a mild muscle relaxer for several days, and many elect not to take their pain medicine because they don’t need it. Patients are doing most activities of daily living very quickly, with the exception of lifting over 10 pounds or exercise in the first two weeks.
How long will the implants take to “drop” into place?
Everyone that has implants placed below the muscle will look a little different at first. The implants are usually high, firm, and tight. The implants will “drop” into place as the swelling recedes over the coming weeks. We have a comprehensive program for implant displacement/massage or exercises for each patient that help facilitate the implants falling into place.
When can I go swimming?
Patients can take a bath, resume swimming, or get in a hot tub, lake, or ocean (if going on a vacation) four weeks after the surgery. Research shows that submerging the breast in water before then can increase the risk of implant infection.
How do I decide between silicone gel implants and saline filled breast implants?
Both are FDA-approved devices and patients do well with either. I really let each patient decide what is best for them. Silicone gel implants feel the most breast-like, they probably last or “hold up” the longest, and they have less visible wrinkling or rippling (as can be seen sometimes in patients that have very thin tissues). Either implant is placed below the muscle. There is a very informative website—www.breastimplantsafety.org—that has further good scientific information about both types of implants.
Will I have any changes to nipple sensitivity?
Most patients will experience some transient increase or decrease in nipple sensitivity due to the “expansion” of the breast, which resolves over several months. Most commonly, patients notice their nipples are more sensitive.
Can I breastfeed after the procedure if I choose to get pregnant?
Yes. I have never had a patient that could not breastfeed after pregnancy.
How long do the implants last and when would they need to be replaced?
Many plastic surgeons tell their patients that saline implants need to be replaced every 10 years. I think that if there are no concerns or problems, they only need to be changed if the patient desires a change. Saline deflation rates are typically about 1% per year. If a patient has a saline implant deflation, she will wake up one day and notice changes. It is usually spontaneous and not related to trauma. Silicone gel implants have been used since the early 1960s, and we know from history that even with the older generation of implants, they often would last 20 to 30 years. The current 4th or 5th generation silicone gel implants have better implant shell designs as well as a more cohesive gel that will be less susceptible to leakage or rupture. The current silicone gel implants have been used since 2006, and we have every reason to believe they will endure at least as well as the older silicone implants.
Are there any health concerns with using silicone gel implants?
Most of the “scare” with silicone gel breast implants stems from the 1980s and 1990s when many women had their ruptured silicone implants removed. The FDA took silicone gel implants “off the market” in 1992, and it then became the most studied medical device of all time. Lawsuits claiming illness and sickness in patients from silicone gel implants were rampant during this time. Claims of arthritis and a number of health conditions being caused by the silicone gel implants were subsequently shown to have no scientific bearing. Repeated studies have shown them to be very safe. All major countries in the world use silicone gel implants. Saline implants are rare outside the US. The website www.breastimplantsafety.org has more details on this topic.
How do I pick my size?
Dr. Boynton utilizes a system of “biodimensional planning” that basically involves a number of careful measurements about the breast and chest wall. This is a way to take into account the tissue characteristics and body measurements to help figure out what implant may be best suited for that particular patient. This is analogous to having a tailor measure a patient for a custom outfit. Afterwards, the patient is able to try on sizer implants in a special bra that simulate the changes with breast enhancement. This way, each patient can get an idea of what size they like. Dr. Boynton is able to put together the science of the measurements with the patient’s desires and arrive at consistent, excellent results that patients are excited about.
Schedule a Consultation
Dr. Boynton can answer all of your questions about breast augmentation during an initial consultation. At this meeting, he will discuss all aspects of the procedure and show you examples of a variety of sizes, shapes, and types of breast implants. If desired, he will also help you determine if you are a good candidate to combine your breast augmentation with a tummy tuck and/or other cosmetic procedures for a more comprehensive enhancement. Please contact us to schedule a consultation with Dr. Boynton, or if you would like more information about breast augmentation.