When it comes to enhancing and enlarging the breasts, women now have more options than ever. Thanks to Seattle area plastic surgeon Dr. Marosan’s, advanced techniques. With traditional breast augmentation surgery, either saline or silicone gel implants are inserted into the natural breasts to increase size and produce a better shape. Dr. Marosan focuses on quality, so he only uses FDA approved Allergan, Sientra and Ideal Implant implants. These implants come textured or smooth, round or shaped and in a variety of sizes, so Dr. Marosan will work with patients to choose the perfect look and fit.

For women who opt for breast augmentation surgery but want a more natural look and feel, they can choose the fat grafting method, where a woman’s own fat is used. With this method, there are no scars or incisions and the breasts look natural. A woman can expect about one cup size increase with this technique. The process can be repeated to further increase volume and define shape. This technique avoids future implant issues.

Dr. Marosan uses the Vectra 3D, which takes a three dimensional photo to analyze the patient's breasts and chest wall and simulate the breast augmentation process with implants. The patient is able to see what she will look like after surgery, during the consultation process!  This is very exciting technology and removes the guessing and fear how one might look after surgery.

 Saline implants have always remained a positive choice for patients when deciding what type of implant to use for breast augmentation. Because these implants are filled with a sterile saltwater solution, any potential leakage does not pose a threat as the solution is safely absorbed by the body. Saline implants also cost less than the silicone type. One of the disadvantages of saline implants is that in some cases, rippling can appear. This is especially something to consider for women who are thin and have thin breast tissue. Those who opt for this type of implant must be at least 18 years old. The Ideal Implant was recently developed, which combines the benefits of saline and silicone gel implants. This is a saline implant which feels almost like a silicone gel implant.

Silicone breast implants are very popular today and are highly recommended by surgeons for patients who are thin and desire a natural look. Since the FDA validated their safety and efficacy, safety concerns surrounding these implants are no different than that of saline. The silicone shell is prefilled with silicone gel and comes in different sizes, shapes and textures. Unlike saline implants in which leakage is absorbed by the body and implant volume appears visibly flat, it is difficult to tell when a silicone implant ruptures. The new generation silicone gel implants have cohesive gel in them. Even if the implant shell breaks, the gel stays solid. An MRI is required to detect any rupture. Patients considering silicone implants must be at least 22 years old.

For patients who desire fuller breasts but do not want an artificial implant to achieve this look, there is also an option known as autologous fat transfer (AFT). In this procedure, the doctor will harvest fat from donor sites of the patient, such as the flanks, abdomen, back and thighs via liposuction. The fat collected will undergo a process of refinement and purification, and then re-injected into the breasts with smaller injection cannula and syringes so the shape is evenly enhanced. This is a scarless operation and the patient gets a body contouring procedure as well.

There are several manufacturers approved by the FDA.

• Natrelle and Inspira by Allergen – silicone and saline implants
• Mentor – silicone and saline implants
• Sientra – silicone and saline implants
• Ideal Implant - saline implant with internal baffles

Breast implants come in a variety of different profiles. The selection is based on how enhanced the breasts’ projection would be, as well as how wide the implant will be on the chest wall in relation to the base width. Since the silicone implants are already pre-filled, the standard profiles come in low, moderate, high and extra high. Saline implants are filled in the operating room by the surgeon. The silicone shell is inserted then filled with saline solution up to the recommended fill volume for that particular implant. Choosing the right profile can sometimes be a difficult decision and it is up to a skilled surgeon to help guide the patient accordingly. High profile breast implants will have greater projection, but less width on each side, whereas a moderate profile, for example, will not have as much projection, but will be broader. Dr. Marosan use the Vectra-3D camera system to simulate your results during the consultation process. You may also want to try on sizers to see how you would look post surgery.

The standard shape of a breast implant can either be round or tear drop-shaped. Each shape serves a different aesthetic function as it pertains to the patient’s goals. Round implants produce a shapelier curve on the top portion of the breast. The teardrop implants are shaped to copy the natural appearance of the breast, so they will not appear as high, but push out the lower poles of the breasts.

Implants are made with either a smooth or a textured surface. In general, smooth implants are more common. The textured implants were initially conceived out of the idea that it reduces the chances of capsular contracture (the constriction of scar tissue around the implant) although there is no valid claim to this in long term studies. The textured type is more common with the teardrop shape as the rough texture adheres to tissues helping the implant stay in place.

The two most common placements are on top of the chest muscle or under it. When the implant is placed under the muscle, a pocket is created within the pectoralis major muscle. A pocket is also created if it is placed in front of the muscle, but many surgeons do prefer the submuscular approach (behind the muscle). This helps cover and camouflage the implant superiorly and medially. Placing the implant behind the muscle in thin patients, provides a more natural look. With submuscular implants, a person can get implant animation or movement as the chest muscles contract. Dr. Marosan's technique minimizes this to be less noticeable.

There are several standard incision approaches for breast implants. The most common is known as an inframammary incision, which is an incision near the breast fold. Second, is an incision made under the areola, which is known as a periareolar incision. It is up to the patient’s desires and surgeon recommendation as to what approach is best to take. Scarring is also discussed at this time with each method.

Breast augmentation is an outpatient procedure that may last from 1-3 hours. It is performed using intravenous sedation in our AAAASF accredited surgical suite. Dr. Marosan use a 24 hour fast recovery technique, involving tumescent local anesthesia, gentle cautery dissection avoiding the ribs, zero bleeding, no touch implant insertion using the Keller funnel, no drains and injecting Botox into the chest muscles two weeks prior to surgery to minimize muscle tightness and spasms. There could be some swelling and minimal bruising, but he does not place patients into compression bras. It is normal to feel tightness around the chest area as the skin adjusts to the breast’s new shape. Most patients can resume normal activities within 3- 7 days; work outs should be avoided for 4-6 weeks. It takes approximately 3- 6 months for the breasts to look, feel and function normally in regards to softness, sensation and final placement.

This depends on the patient’s breast make up. Those who opt for implants may choose between saline or silicone as each has its own advantages. Generally, patients who have thin breast tissues will benefit from silicone implants; otherwise, saline implants are acceptable. For fat transfer, the advantage is that it poses less risk since there is no introduction of foreign material in the body. However,fat grafting to the breasts can give you about one cup size enhancement in the long run.

Negative notions about silicone started back in the early 90's when there were cases of leakage and complications. With today’s advancements in engineering, the silicone-based shells are made durable and safe, and have been approved by the FDA. Today, in fact, silicone is preferred more than saline since they feel more natural.

Breast augmentation is a cosmetic procedure designed to enlarge breasts while a breast lift is designed to tighten the loose skin of a droopy breast. Both resolve different breast issues. There are cases that the procedures are simultaneously done when it is agreed that a breast lift with augmentation is necessary.

Today’s silicone implants are strong, durable and safe. Technical advancements have come so far, that even if a silicone implant does rupture, the shell of the implant will keep the silicone gel encased and protected from entering the body. In a rare case that a silicone implant does rupture, an MRI will be needed to detect the rupture. This is the main reason why the FDA recommends an MRI 3 years after surgery and every 2 years succeeding the first MRI.

Implants are warranted by the manufacturers up to 10 years. As long as the implant shows no signs of damage or visible defects, such as breast rippling or a deformity, replacing them is not necessary. What’s necessary, however, is a periodic check of the implants to make sure that they are still intact. Dr. Marosan will discuss his follow protocol with you during the consultation.