Northwestern Specialists in Plastic Surgery Dr. Neil Fine, MD, FACS Dr. Clark Schierle, MD, PhD, FACS
Contents 3 Introduction 4 Implant Shell 5 Implant Fill 6 Ideal Implant 7 Implant Shape 8 Implant Placement 9 Incision Site 10 Risks 11 General Surgery Information 12 Choosing Size 14 Patient 1 Case Study 15 Patient 2 Case Study 16 About Our Practice 17 Why Choose Us?
Introduction Breast augmentation is a very popular and common procedure that can increase your breast size by one or more sizes. By surgically inserting breast implants beneath the breast tissue or the chest muscle during breast augmentation, women can achieve larger, shapelier breasts. For some women, breast augmentation is a way to enhance self-image and selfconfidence. For others, breast augmentation is part of breast reconstruction after surgery for breast cancer or other conditions affecting the breast. During your breast augmentation consultation, you ll learn more about your options for creating your ideal breast appearance. In order to be prepared, we have put together this Ebook that details all of the information you need to know about breast augmentation.
Implant Shell The first thing to consider when discussing breast augmentation is the type of implant. There are different types of shells, which are shown and described below. Smooth Round Implant This is a softer implant with more natural movement. It is typically described as the most comfortable implant, as it feels closest to your natural breast tissue. Textured Round Implant This implant feels slightly more firm. It is also less mobile, as its texturing is designed to incorporate with your tissues and stay in one place. **In our practice, smooth round implants are used most often**
Implant Fill Silicone Fill Silicone provides a softer, more natural feel There can be less visible rippling, which occurs when you can see the implant rippling under the skin These implants are less likely to rupture There is a possibility for a longer incision, depending on the incision site and size of implant Although controversial in the past, silicone implants are now considered to be very safe, even if they were to leak or rupture Saline Fill Saline has a firmer, less natural feel There is potentially more visible rippling Saline implants have a higher rupture rate There is a possibility for a shorter incision, depending on the incision site and size of implant **In our practice, silicone implants are used most often**
Ideal Implant Although our research shows us that silicone implants are safe, some women still feel more comfortable with a saline implant fill. With the invention of the Ideal Implant, women now have the choice to have a saline implant that feels more natural and soft. The Ideal Implant combines a natural feel with the safety of only saline inside. The design itself consists of an inner and outer shell, which can be filled to different amounts of saline in order to achieve a desired look. The internal structure controls the movement of saline, which is often thought to be the cause of visible rippling, implant folding and wrinkling. These things can contribute to implant rupture and deflation, so this implant offers a decreased chance of rupture and deflation. While silicone leaks may be silent ruptures, saline is harmlessly absorbed by the body so imaging is not necessarily needed to detect a rupture. This implant is FDA approved, and only offered by a limited number of surgeons as it is newer to the market. We offer this implant and feel that it is an excellent choice for some patients.
Implant Shape Shaped Implant These implants are slightly more firm They have the potential to show less rippling They have a more natural shape, which means less fullness at the top. This can also be referred to as a tear drop shape These implants are textured, which means less natural movement There is a risk for rotation, as these implants are designed to sit in a certain position on the chest Round Implant This is a softer implant with a more natural feel There is the potential to show more rippling This implant provides more upper pole fullness, creating a rounder appearance at the top If this implant is also smooth, there is more natural movement There is no risk for rotation, as this implant is round and able to move on the chest **In our practice, smooth round silicone implants are used most often**
Implant Placement Implants can be placed above or below the muscle. The techniques are described below. Subpectoral- Under the Muscle This provides for a more natural appearance There is less chance for visible rippling There is less risk for capsular contracture, which is a hardening of the breast capsule (described below in "Risks" section) This is easier for mammographic imaging of the breast tissue Subglandular- Under the Breast Tissue This provides a less natural appearance There is a greater probability for visible rippling under the skin There is a higher risk for capsular contracture, possibly leading to revision surgery **In our practice, the subpectoral approach is used most often**
Incision Site There are different options for inserting breast implants. They are described below in detail. Inframammary Incision (IMF) This is the simplest approach, where an incision is made underneath the breast This can be ideal if there is a natural fold underneath the breast, so the incision is hidden in the fold Transaxillary Incision This approach is more technically challenging, but provides equally excellent results This can be ideal because the incision is concealed under the arm, which avoids scarring on the breast Because we have expertise in this type of incision, we feel comfortable using a larger size implant with the transaxillary approach Periareolar Incision This incision can be less noticeable due to a natural contrast between the skin and areola color However, there is a higher risk of breast feeding difficulty and change in nipple sensation This incision is more often used in conjunction with a breast lift procedure **In our practice, the IMF and transaxillary approach are used most often**
Risks Surgical Risks There can be a change in nipple sensation. Most commonly, changes are temporary and will return back to normal after healing occurs Breast feeding can be affected. However, this is often not the case and there is no evidence to prove that breast feeding ability is reduced after a breast augmentation Like any surgery, there is a risk of bleeding and infection. These risks are low. There is also a risk of implant malposition, but this is very unlikely with smooth, round implants. Long Term Risks The most common long term risk is capsular contracture. This relates to tightening of scar tissue which can make the breasts feel hard and distort the shape of the implant. Sometimes, this requires revision surgery. Implant leakage or rupture is also a long term risk. This is rare, and occurs less with silicone implants (the rupture rate for silicone implants is about one percent per year).
General Surgery Information Anesthesia options can differ depending on the surgery location - Most commonly, a general anesthesia is used - Monitored Anesthesia Care (MAC) can also be an option, where local anesthesia is used along with sedation and analgesia (treatment of pain) There is an option for a local anesthetic pain pump, which is a small catheter placed at the time of surgery that delivers local anesthesia to the breast tissue for 2-3 days after surgery. This is used in addition to pain medication after surgery The surgery generally takes about 1.5 hours Downtime after surgery is subjective and can be different for each individual patient. Typically, return to work time is about one week after surgery.
Choosing Size Choosing implant size for augmentation can be a challenging decision. During the consultation, we will give you a suggested range to start exploring the size that works best for you. It is best to aim for the "perfect" range. Size is subjective, so bra cup size does not always correlate to the size of the implant. We use a 3D Vectra system to perform imaging when helping patients to choose a size. This technology creates a 3D image of the patient with different size implants as a simulation. Gel implant sizers can be used in the office. This process allows patients to try on different size implants to see what size feels right.
Choosing Size Rice test- this is a test that can be performed at home to help patients choose the correct size -- Use a measuring cup with milliliters (ml) on it to measure the appropriate amount of rice -- Place the rice in a knee high stocking, and place the stocking inside your bra. You may also want to purchase a bra that you would like to fill -- Add rice to the stocking until you reach your desired look Choosing a size is a very individualized process, and varies from one patient to the next depending on desired outcome. For this reason, we recommend you spend time exploring different sizes at home. Try on different clothes and different bras to see what works best on your body.
Patient 1 Case Study Patient demographics: 25 year old female with no children Implant: smooth, round, silicone implant Implant placement: subpectoral (under the muscle) Incision site: inframammary incision (under the breast) Size: 300cc Before After (3 months post-op)
Patient 2 Case Study Patient demographics: 34 year old female with three children Implant: smooth, round, silicone implant Implant placement: subpectoral (under the muscle) Incision site: transaxillary incision (under the arm) Size: 375cc Before After (3 months post-op)
About Our Practice With expertise in both cosmetic and reconstructive breast surgery, our practice's exceptional strength lies in our mastery of anatomy and surgical technique and also attention to aesthetic detail. We believe in providing our patients with the understanding they need to make informed and empowered decisions. By focusing on individual needs, our staff provides the highest level of personalized and compassionate care. Dr. Neil Fine is a board-certified plastic surgeon affiliated with Northwestern Memorial Hospital and an associate professor of clinical surgery at Northwestern University. He received his medical degree from the University of California, Los Angeles (UCLA), and completed residencies in general surgery and plastic surgery at the combined Brigham & Women's Hospital- Children's Hospital- Harvard Medical School program in Boston, Massachusetts. His focus is on reconstructive and cosmetic surgery of the breast and face. Dr. Fine's expertise has been recognized in "Top Doctors" in Chicago magazine and in the Castle Connolly Guide since 2001. Dr. Clark Schierle completed the prestigious integrated plastic surgery residency program at Northwestern University, where he received extensive training in cosmetic and reconstructive surgery of the face, breast and body. He also completed a sixyear PhD and four-year MD at Harvard University after graduating from UCLA at the early age of 16. Dr. Schierle s excellence in both cosmetic and reconstructive plastic surgery has been nationally recognized with awards from the American Society for Aesthetic Plastic Surgery. He specializes in reconstructive and cosmetic surgery of the breast with expertise in transaxillary breast augmentation.
Why Choose Us? For many women, breasts are an integral part of their body image and can be an important factor in feeling confident and attractive. Every woman deserves to feel good about herself, and to be self-assured in her femininity and sensuality. At NSPS, we understand that breast enhancement requires both master of technical details and an aesthetic eye. Our surgeons make extensive use of many technical innovations to improve your results. What makes us different at NSPS? We use advanced three-dimensional (3D) surgical planning. Our Vectra imaging system allows us to take 3D images of the breast and simulate changes based on desired size of your breast augmentation. We can then compare how sizes may look on your body. We continue to use this system after surgery, so we can view your journey from beginning to end. At NSPS, we specialize in endoscopic techniques to minimize scarring. With a great deal of experience in using the transaxillary approach, our surgeons feel comfortable using larger size
implants. This is an excellent way to conceal your scar, and does not limit you to a smaller size implant than you would like. We offer pain pump technology to speed your recovery. Utilizing a pain pump that delivers local anesthesia to the breast tissue after surgery can minimize pain, as well as allow patients to take less narcotic pain medication. Pain medication can have negative side effects, and using the pain pump for local anesthesia does not offer any negative systemic side effects after surgery. This helps to provide an easier recovery. Another innovative addition to our practice has been the use of the Ideal Implant. This implant offers a natural feeling saline implant option, which has previously been unavailable to patients who want saline implants, but do not want to sacrifice the natural feel. Through years of refinement and expertise, we have developed innovative techniques to assure that patients have improved comfort and outcomes after surgery. If you would like to meet with Chicago plastic surgeons Neil Fine or Clark Schierle, click here to request a consultation online at our downtown Chicago plastic surgery office. Or you can call our practice at (312) 266-6240 and one of our helpful staff members will schedule your appointment. Call us today, and let us help you to achieve the aesthetic appearance you have always dreamed of.