Breast Augmentation with fat Grafting (no implants)
Breast augmentation will enhance your breast size and contour with stubborn fat from...
What is breast augmentation? Breast Augmentation is currently the most frequently performed plastic surgery procedure in the United States, and very popular in Bergen County too. A breast augmentation bergen procedure can restore or increase breast size in women with small or unevenly sized breasts.
Breast augmentation in Bergen County NJ occurs through either placement of silicone implants or fat grafting to give a fuller, firmer, better-proportioned look. Women may elect to undergo breast augmentation at our NJ plastic surgery Center in Bergen County for many different medical and aesthetic reasons.
Some reasons for a breast augmentation bergen procedure include:
Improving breast symmetry
Increasing breast size, for a more proportioned, more appealing figure
Following pregnancy or weight loss, which has affected the shape and projection of the breasts.
The breast augmentation plastic surgery procedure may be combined with others such as a breast lift for more satisfying results. To achieve natural-looking breast augmentation Bergen County results , your plastic surgeon must have a an appreciation of creative symmetry, the ability to understand and interpret their patient's wishes, and the experience to transform the patient’s individual anatomic nuances into an aesthetically pleasing result.
What are the most common type of breast augmentation? Silicone implants are the most commonly chosen today for breast augmentation in Bergen County, as they provide a more natural look and feel than saline implants. Silicone implants are also available for Bergen County breast augmentation and have soft elastic gel or cohesive gel also known as “gummy bear implants”.
How are breast implants put in? During breast augmentation plastic surgery the implants are placed either behind the breast tissue or partially behind the chest wall muscle, depending on the thickness and shape of your breast tissue. Breast augmentation in our office in Bergen County includes making an incision, in the fold under your breast, lifting your breast tissue and creating a pocket under the gland or chest wall muscle into which the implant is placed.
The plastic surgery process of breast augmentation implant selection is no longer subjective for breast augmentation in Bergen County. Exact measurements are made of your chest wall proportions and breasts to help your Bergen County NJ plastic surgeon choose implants that will provide optimal breast augmentation, safety, and longevity of your breast augmentation results. Final implant selection for breast augmentation can be modified within a window of safety according to individual patient desires at our offices in Bergen County.
Breast augmentation is a routine plastic surgery procedure performed by plastic surgeon Dr. Capuano near you in Bergen County, New Jersey
The best candidates for breast augmentation in Bergen County are otherwise healthy adults, who are nonsmokers, who feel their breasts are too small for their body, feel self conscious in form fitting clothing, or who have one breast that is noticeably larger than the other.
Your breast augmentation surgeon can help determine if breast augmentation is right for you. Schedule a breast augmentation consult in our Bergen County NJ offices with plastic surgeon Dr. Capuano, for careful examination of your breast anatomy and skin quality, and consideration of your individual goals.
Please tell Dr. Capuano if you have a history of lupus or other connective tissue disorder before undergoing breast augmentation at our office in Bergen County NJ.
The breast augmentation Bergen plastic surgery procedure typically lasts one to two hours depending on the patient’s anatomy and extent of correction needed. Breast augmentation bergen surgery is performed in a hospital or surgery center in NJ with either general anesthesia or local anesthetic and sedation. You will likely be discharged home the day of breast augmentation surgery in Bergen County.
Schedule a breast augmentation bergen procedure with plastic surgeon Dr. Capuano located in Bergen County, for careful examination of your breast anatomy and skin quality, and consideration of your individual plastic surgery goals.
Most Bergen County patients are able to return to work in a week to 10 days, depending on the nature of their work. After breast augmentation you may begin light exercise at 2 weeks, while 6 weeks is required, before returning to strenuous exercise. We recommend that you handle your breasts gently and lie on your back for the first 2 months following breast augmentation plastic surgery and we recommend you avoid lifting, pushing, or pulling anything that causes pain or twisting your upper body for at least 6 months. Breast massage is initiated as soon as it is comfortable to perform.
The results of breast augmentation plastic surgery are immediately discernable. Over time, post-surgical swelling will resolve and incision lines will fade. Satisfaction with your new image should continue to grow as you recover and realize the fulfillment of your goal for fuller or more proportional breasts.
Please schedule your consult for breast augmention by NCPS plastic surgeon Dr. Capuano, located in Bergen County NJ.
Typical breast augmentation plastic surgery side effects include bruising and swelling of breasts, nipple sensitivity, or temporary changes in nipple sensation.
Schedule a breast augmentation Bergen county consult with plastic surgeon Dr. Capuano, for careful examination of your breast anatomy and skin quality, and consideration of your individual goals. Bergen NJ Plastic surgeon Dr. Capuano is a a double Board Certified Plastic Surgeon, located in Bergen County NJ.
Breast augmentation risks include bleeding, infection (possibly requiring removal of the implant), hematoma, changes in skin sensation, scarring, damage to underlying structures, asymmetry, and implant malposition. More breast augmentation risks include inability to breast feed, capsular contracture, unsatisfactory results requiring additional breast augmentation nj surgery.
Plastic surgeon Dr. Capuano, located at NCPS in Bergen County, consistently achieves excellent results with breast augmentation plastic surgery. He is a Board Certified Plastic Surgeon, and is a member of the American Society of Plastic Surgeons, and he would be happy to discuss your breast augmentation options if you are thinking about breast augmentation in Bergen County, NJ.
So, schedule a breast augmentation consult in Bergen County with plastic surgeon Dr. Capuano, for careful examination of your breast anatomy and skin quality, and consideration of your individual goals.
Contact the office of the Northern Center for Plastic Surgery in Bergen County, NJ at (201)820-5280 to schedule a breast augmentation NJ consult with plastic surgeon Dr. Capuano, for careful examination of your breast anatomy and skin quality, and consideration of your individual goals.
Breast augmentation in Bergen County, exclusive of all other costs related to breast augmentation, are $1300.00 for the pair that would be for a traditional silicone implant. The newest generation Allergan implant averages $1500, the form stable implant costs are roughly $1500 for the pair as well. As for the surgical fee, it is $4500.00 exclusive of additional operating room and anesthesia fees.
Breast augmentation bergen procedures are provided by our Bergen County office at the time of breast augmentation plastic surgery, they are packaged in a sterile container as a surgical safety precaution. The companies we use for implants are Allergan and Mentor.
You can get breast implants by receiving a breast augmentation consultation from Dr. Capuano, in Bergen County your being a suitable candidate and undergoing a breast augmentation plastic surgery which includes our board certified plastic surgeon placing the breast implant into the proper pocket which is created in your breast tissue.
Choosing the right breast implant isn't something you should worry yourself over too much. Dr. Capuano is very experienced with what implant is appropriate based on your stature and by you telling him what you are looking for regarding your results.
Bringing in a photo of what you would most like your breasts to look like is a great idea.
Though results of pictures cannot be guaranteed, it is good to show Dr. Capuano your expectations. We also have a Vectra machine, which allows us to simulate breast implants using your own photos on a three dimensional image.
Breast augmentation is not contraindicated in patients with dense or cystic breasts, so having dense or cystic breasts by itself is not a reason to avoid this surgery. If your cysts are tender however, this may not improve and may get worse after a breast augmentation.
Currently, most breast augmentation procedures are performed in a dual plane, partially beneath the pectoralis muscle, and partially beneath the gland. Because of this, screening for cancer with mammograms and ultrasound can allow improved visualization of your breast tissue that lies over the implants, however imaging of the tail, which is the portion of your breast that ascends upward towards your armpit can be more difficult. A baseline mammogram should be performed prior to implant placement, if one has not been performed within the past year. An in person consultation with Dr. Capuano, who is board certified with the American Board of Plastic Surgery is an important first step when deciding whether this surgery is appropriate for you.
Your breast augmentation consultation will last roughly an hour based on how much information you are interested in finding out. The basic run down of a consultation is as follows:
1. Check-in: Meet Caitlin our front office coordinator, upon arrival
2. Intake: Courtney our medical assistant, will bring you in to photograph your area of concern and ask basic medical history
3. Our patient care coordinator, Kim will intorduce herself and let you know how she will be assisting you during surgery
4. Exam: Meet with Dr. Capuano
5. Our patient care coordinator will further guide you in the process by giving you insight into your financial responsibilities by providing you with a quote.
Yes, it is very common and almost an expectation that you will experience tightness in your lower chest area post breast augmentation. This will subside over time, more tightness is expected if the implant is placed under the muscle, Dr. Capuano usually does a dual plane approach but if the patient's skin is thick enough he will place the implants over the muscle.
Thank you for the question and sorry to hear you are having discomfort. Is seems as though you are experiencing inflammation of a vein, which is also referred to as Mondor's cord. This is something that can occur around three weeks post surgery and will resolve somewhere around six weeks post op. We use anti-inflamatory medications to help bring down the swelling along with gentle massage to the effected area. Please call the office if you seem to be experiencing this as it is important that Dr. Capuano evaluates you in person.
The general rule of exercising post breast augmentation is that you should not do any strenuous exercise or carry or lift more than 10 pounds for the first six weeks. In addition, you should not be doing any high impact activity or sports for at least six weeks. Bouncing of the breasts is not recommended during that time good support is necessary for prolonged results, we recommend wearing a sports bra at all times, no underwire bras.
No push ups, chest presses, dips or supporting your body weight with your arms or chest muscles for 6 at least months, sleep on your back for six months. After that period, Dr. Capuano will advise you of what is appropriate going forward. Dr. Capuano generally does not recommend that you do any rigorous arm or chest exercises for at least 6 months.
A breast lift is not always necessary with a breast augmentation A thorough examination by Dr. Capuano is necessary to answer this question properly. The reason is that each individual's breast tissue, the amount of sagging in their breasts if any, needs to be examined, (ptsosis & laxity), skin quality, nipple position and size and body habitus are all taken into consideration when deciding whether or not a breast lift is appropriate for you to have with an augmentation.
Yes, in most instances, you can get breast implants but the amount of work up necessary prior to your surgery may vary depending on what your family history consists of. Breast cancer is very common in women, and 1 in 8 women will develop breast cancer in their lifetime, and most instances of breast cancer are not genetically linked.
There are circumstances where patients have multiple family members or very young family members with a history of breast cancer. In those situtations, further testing for genetic risk is important to undergo prior to any cosmetic procedure. At that point, a decision for surgery can be made between you and Dr. Capuano regrding your individual risks.
Additionally, all patients regardless of family history, should have a thorough breast exam prior to surgery, if the exam by Dr. Capuano reveals any palpable mass further imaging is required prior to any surgical procedure. it is important that all patients over the age of 30 undergo breast imaging prior to surgery as well. Keep in mind that breast implants can alter the ability to identify future cancers. Implants can improve the ability to identify centrally located lesions and more difficult to identify ones located in the tail of the breast.
With a petite frame the best option would be a silicone implant that is filled to 95% capacity. Traditional silicone implants are filled to about 85% of the capacity of the shell. If you are really thin and small you can still have rippling with an 85% filled implant. If you have the implants that are filled to 95% of the capacity of the shell you are much less likely to have visible rippling following surgery according to experience and published studies. Silicone implants carry no more risks for cancer or connective tissue disease than saline implants do. The major difference occurs if there is a rupture because when you rupture a saline implant it deflates and is easily recognized but when you rupture a silicone implant it is sometimes difficult to detect. Because of this screening with MRI is recommended by the FDA three years after surgery and then every two years thereafter. Lastly, saline implants need to be filled to their capacity and tend to be more firm and are often palpable in thin patients yielding an inferior result. They also tend to fill more uniformly so that they don't assume a tear drop shape and they look more unnatural. Please make sure to visit Dr. Capuano for a full consultation so that your individual needs may be addressed.
Thank you for the question. Fibrocystic breasts are not a contraindication to having breast implants. Cysts change size and are sometimes more painful depending on where you are in your cycle. Regarding whether or not the cysts will be visible depends on the size of your breasts, how the large the cysts are or become with your cycle, and how close they are to the skin surface. The implants will displace the breast tissue forward and towards the skin, so the cysts may feel more prominent or palpable despite not having changed in size. Certainly there are scenarios where we have patients who have very large painful cysts and the decision to have an implant needs to be individualized following a good physical exam. An in-person physical examination with a Dr. Capuano is the right place to start.
The most optimal time of year to have a breast augmentation is contingent upon your individual lifestyle. An example would be, If you are very active in the winter with skiing and other sports and find that you are more of a sunbather in the summer, then the spring would be a good time to consider your breast augmentation so that your post surgical swelling can subside by summer and you aren't using your chest muscles and arms to over exert your surgical area. It is important that you are very transparent with Doctor Capuano and his staff. Doing so will improve your ability to enjoy the process of having a breast augmentation and the relative recovery aswsociated with it.
We find that most women that request a breast augmentation go for the larger size that Dr. Capuano has offered them. There is a range that is offered and shown to the patient based on our breast simulation software and the what Dr. Capuano has decided works with the patients frame. Dr. Capuano will give you options based on your stature and suggest implants that will provide you with a natural balance for your body. If you are looking for implants that are larger than what Dr. Capuano recommends that is a discussion between the patient and Dr. C., at that point he will help you make an informed decision on whether or not that is something you want to move forward with. A thorough consultation with Dr. Capuano is the best way to answer questions that are individual in nature.
The total cost for breast augmentation surgery in Bergen County by Dr. Capuano is $8105, inclusive of all fees.
The breakdown of this charge is as follows:
Dr. Capuano's fee: $4500
New generation Allergan implants: $1400
Operating room fees (2 hours): $1330
Anesthesia fees (2 hours): $800
Cosmetic Insurance: $175
Post Operative garment (Qty:1): $0
Additionally, you will need clearance from your medical doctor, this is contingent upon your medical history and age (pre admission testing requirements vary according to this), these costs are not included in the services mentioned above. You will also be prescribed prescription drugs that are not included in this price, those scripts will be covered by your insurance carrier as per your indiviudal coverage. The doctor will recommend for you to have lymphatic massages. These massages are best served as a package price, 5 for $350 or individually for $80 per massage these massages are performed in our office.
Prices are subject to change and are based on an average cost for breast augmentation surgery performed by Dr. Capuano. A consultation is necessary to be scheduled for surgery. For those of you traveling from out of state or out of the country, please contact our office and ask for the patient care coordinator for further details regarding out of town hotel pricing and additional patient care services.
The incision location varies along with what approach is used to place the implants. There are three options, they are as follows:
1. Inframmamory fold- this is the crease that is below your breasts.
3. Navel (Bellybutton)
No, breast augmentation surgery with an implant does not require drains.
Thank you for your question. Although the recovery time from a breast augmentation may be as short as 5-7 days, I typically recommend against long flights for at least two weeks post surgery. This recommendation is because of the higher risk of blood clots in post surgical patients on long flights. Additionally, I recommend against lifting more then about 8lb for 6 weeks, and if your job requires you to lift carry-on bags into overhead compartments or push a passenger in a wheelchair up a jetway, I would recommend a more extended absence. If your job allows you to avoid these activities temporarily (i.e. light duty), you should be able to return to work by two weeks. Thank you for this question and please make sure to follow up with Dr. Capuano and adhere to his post surgical instructions.
Thank you for your question. Breast development varies greatly between women. It begins at puberty, which typically starts between age 11-14, and can continue into the late teens and early twenties. Additional development of glands occurs when a woman becomes pregnant, which can result in significant changes in the breasts post pregnancy or post breast feeding. Although hormonally driven development becomes less significant later in life, changes occur in the breasts with respect to gland density, fat content and fascial and skin laxity throughout life. These changes are often further hastened during menopause. All of these factors play a role in surgical decision making. Please contact a board certified plastic surgeon if you are considering having anything done. Hope this helps.
Great question, most women are able to nurse post implant, though there is a possiblity that you may not be able to. These risks are evaluated and discussed with each patient on an individual basis prior to surgery with Dr. Capuano and his patient care coodinator. The access point by which the implants are placed or approach can increase or decrease your chances of being able to nurse. If nursing is a concern for you, the most benign approach is via the inframammory fold. It is important that you meet with Dr. Capuano for a consultation in person to discuss your individual needs and concerns. Call to schedule a consultation to meet with Aaron Capuano MD FACS, Double Board Certified Plastic Surgeon, performing Breast Augmentation surgery in Bergen County NJ 201-820-5280
Thank you for the question and the post operative photos. Without your pre-surgical pictures it is hard to tell how closely your breasts were positioned before your surgery, or the extent to which the fascia (what connects your skin to your chest wall) over your central chest was weakened by surgical dissection. There does appear to be some fascia intact over your sternum, which is a strong sign that you will not develop a synmastia, although this fascia appears to be slightly tented by the implants. This may be secondary to some post operative swelling or because the pockets where your implants are placed haven't settled yet because you are so early post-op. The appearance of the tenting may go away once the implants settle. It is important to follow up with your board certified plastic surgeon as directed and follow all of their post op instructions. Hope this helps and best wishes. If you or someone you know is planning to have a breast augmentation, please help them by making sure they go to a board certified plastic surgeon for their surgery. Dr. Capuano is a Double Board Certified Plastic Surgeon who practices and performs breast augmentation surgery in Bergen County NJ. Book your consultation with Dr. Capuano by calling our office 201-820-5280
Hello and thank you for the question. There are many reasons why you may have one breast that is higher than the other following a breast augmentation. These reasons may include asymmetry that existed prior to your surgery implant malposition, capsular contracture, late seroma or implant rupture. And in person examination by the plastic surgeon who performed your breast augmentation is a good place to start. We don't see this often but have a massage therapist that sees all of our post operative patients with lypmhatic drainage issues and it also helps loosen up the areas that become tight and can sometimes contsrict post surgery. I hope this helps you find your way.
Hello and thank you for sharing your photographs and your question. I can see the unevenness that you are concerned about. This may just represent some asymmetry of your pre-surgical anatomy but without pre-op photographs it is impossible to determine whether this is the case. Small amounts of asymmetry are very common in patients and often they do not notice them until after they’ve had surgery. Fortunately in most cases symmetry improves as the implants settle into their pocket and they usually look more natural as well. I would wait at least 3-4 months before passing judgement, and you really shouldn’t consider any revisional surgery before that point anyway. If they look considerably better at that point, I would wait another 3-4 months, because they may continue to improve. I hope this helps.
Hello and thank you for the question. From your photographs It appears that your implants are just slightly lateral in their pocket when you lie down, which is evident by looking at them in relation to your nipples. It is normal for an unaugmented breasts to drape laterally when you’re lying down to some extent, and the same goes for augmented breasts. That said, if you are concerned about the way they look you should discuss it in person with the surgeon who performed your breast augmentation. There are ways to reduce the pocket sizes and minimize the positional migration of your implants, but if you feel they look great in every circumstance other than lying down, you may not want to go through another surgery for just that. I hope this helps. If you are interested or considering breast augmentation with Dr. Capuano please call 201-820-5280 to schedule your consultation.
Hello and thank you for your question. To answer your question I will need to know if you're happt with your current size or would like to be larger or smaller. If you desire a larger cup size or want more upper pole fullness, an augmentation mastopexy using a circumvertical skin pattern or lollipop incision would be the best option in my opinion. If you are happy with your current size a vertical mastopexy alone should give you a great result.
If you would like to be smaller, a vertical reduction can accomplish your goal and your surgeon can remove as much or as little as you want. I can see your shape and size currently from your photograph, but I don't want to assume that I know how you want them to look after surgery. Feel free to come in at your covenience for a thorough consultation.
Dr. Capuano is a double board certified plastic surgeon practicing in Bergen County NJ who he specializes in breast procedures. To book your consultation with Dr. Capuano please call 201-820-5280.
Hello and thank you for your question. I understand why you are concerned, because you do have some bruising surrounding your incision, but this amount of bruising is not unusual or excessive, nine days following surgery. The suture you are referring to appears to be an absorbable stitch that is commonly run under the superficial skin. If you are anxious, you can contact your surgeon and he or she will direct you to see them sooner than Monday if they are concerned, or during the week, and he or she will also likely let you know what they want to do with that suture when you are seen. Hope this helps. Dr. Capuano and the Northern Center for Plastic Surgery are always available for their patients, even after hours. If you have an issue post surgry that concerns you then we will make sure that your concern is addressed. To schedule a consultation with Dr. Capuano for a breast augmentation in Bergen County NJ please call 201-820-5280.
Hello and thank you for the question. Because you’re only three days post op it is common to have swelling and fullness especially in the upper part of your breasts. Also at this early stage, implants are usually tight within your skin envelope, which results in even compression of the implant from all directions. This does not allow the implant to take a teardrop shape, and contributes to the upper poles looking more full. Once the swelling resolves and your skin envelope loosens to accommodate the implants they will take a more natural shape. As far as the size difference between 375 and 415, that is roughly 40 mL which is about half a shot glass. With most moderate or moderate plus profile implants, this results in an imperceptible difference in projection and implant width. Post operative lymphatic massages as well as a gentle superior pole compression with a band can both help improve this but please check with your Board Certified Plastic Surgeon first.
To consult with Dr. Capuano for a breast augmentation, pleae call his office at 201-820-5280 for your appointment.
Great question! Post breast augmentation and recovery, one should always use a supportive bra and never use a bra that has an underwire. We highly recommend the Pillow Cup Signature Wireless Bra by Spanx. This bra provides amazing supprt and keeps the breasts more medially placed then other bras that have a tendency to push in medially and cause the breasts to be forced out to the sides.
Thank you for the question. Dr. Capuano reccomends wearing your garment for six weeks twenty four hours a day, you can switch to a garment that is more comfortable at 2 weeks, this garment or non-underwire bra needs to be approved by Dr. Capuano. We reccommend that you continue to wear your garment at night for 3 months at night (or longer if desired). You may also switch to an approved bra with no underwire after the two week point (varies from patient to patient).
Great question, to answer this properly we must first know what type of implant you currently have.
If you have "form stable", "gummy bear implants" or "shaped silicone" implants the answer may be yes. If you have round smooth silicone implants the answer may be no but you should follow up with your surgeon to make sure. If your implants are saline and you think they may have ruptured during your mammogram, the answer is yes as well.
If you want to see Dr. Capuano regarding this issue as a new patient that hasn't had their initial surgery with Dr. Capuano, please bring as much information as possible to your visit including your implant information and if possible the MRI imaging that may reveal a flip or rupture is what occurred. We will also need to see the consent that you signed before having your MRI.
Thank you for the question. We typically have one done right before your breast augmentation, as a baseline. Mammograms after your breast augmentation are only necessary when you need them for typical screening for breast cancer unless you have a high genetic risk based on your family history. Mammograms without genetic propensity begin at age 40 and are usually performed annually.
Thank you for this question. Many younger women are concerned about their breat shape and fullness. It is a very common issue for younger women and we are very careful about choosing to conduct appropriate surgery on younger women. This is a very personal issue and is handled on a case by case basis and mostly conducted with the patient's family being involved.
To answer your question directly, the FDA has cleared silicone implants safe for the ages of 22 years and older. By FDA regulations, you can only get saline implants if you were to in patients younger then 22 years of age. However, there are caveats to the placement of them in women younger then 22 years of age. Which includes certain growth issues, and other diagnosis's can allow for silicone implant placement in younger women.
Depending on the generation of implantss that were placed in at the time of your surgery can help determine whether or not it is time to exchange them. It is also important to note that you should have mammograms take to make sure they are intact and no other issues have occurred while they have been in place. The other caveat that may be concerning for you is that at a certain point the implants can start to sag as gravity has their way with them or if you have developed an implant constricture in which the implant seems to be malformed. These are all great reasons to talk with Dr. Capuano about having your implants replaced sooner then later.
Neither is necessarily better, but there are better options for different circumstances. The majority of patients are going to benefit from an implant under the muscle and here is why.
Those who are looking for a breast augmentation, who do not have ptosis (sagging of the breasts) and/or have a pinch thickness that's generally below 2 cm in the chest wall (see pinch test), and are thin or lack breast tissue, will benefit from going under the muscle. Going under the muscle allows for that thin layer that lacks breast tissue to then be covered by another layer rather than just the limited “layer” of breast tissue. If it is just breast tissue and it’s really thin - you’re going to see the top of the edge of the implant.
No, because even if the breasts are lifted with an oversized implant, the consequence is that they will have ptosis (sagging breasts) faster and we don’t typically oversize the breast anymore because we know its related to a higher complication rate like waterfall deformities and back pain and an unsatisfactory cosmetic appearance and it will lead to the need for another surgery much sooner than when performed properly and at the onset of the need for a lift.
Per the FDA, you can receive a breast augmentation at age 22 with silicone implants. Under the age of 22, you can get saline implants unless Dr. Capuano finds there is a reason for you to receive silicone implants, this would be an off label use of the implants.
All surgeons have a lower risk of capsular contracture when using the approach of going through the IMF (inframammary fold), in addition to using other no touch techniques and following up with the nasal spray Singulair. Sometimes Dr. Capuano has to go through the nipple or gland- this happens quite often in breast reconstruction cases, and it is by choice in elective cases to use an approach other than by the IMF which presently stands as the least likely to have capsular contracture occur.
Patients don’t always know what surgical breast procedure suits them. They often know what they want as an end point but don’t know the steps to get there surgically or even what the right procedure is.
It is best to know these few terms to get you started in the right direction. You can then search our website to find the appropriate procedure that makes sense for your interests.
Breast implant or Breast augmentation: To enlarge the breasts and/or create more projection
Breast lift or breast mastopexy: To redistribute the breast tissue to get rid of sagging or drooping breasts (ptotic breast)
Aug mastopexy, breast lift with implants or mastopexy with implants: A procedure that combines redistributing breast tissue that is from sagging breasts and also adding volume and projection with an implant
The pinch test will help you discover whether or not you should have an implant placed above or below the muscle. 2 cm or more of breast fullness in the chest wall is a very good indicator of whether you should consider implants above the muscle. If your pinch test is 2cms or less you should likely have your implants placed below your muscle, if your pinch test is over 2 cm's you could possibly get away with having the implant placed over your muscle. The concern with having implants placed over the muscle is that you can more easily see the top of the implant. A visible implant edge happens when the implant is placed over the muscle in people who have a pinch thickness of less than or equal to 2cms. First, find your clavicle, once you have found your clavicle measure one-hands width below the clavicle. Gently pinch the skin, with a measuring tape, measure 2cm’s and compare your findings. This is a helpful guide, there are caveats to every procedure that are specific to the individual other tests will be performed by Dr. Capuano.
Dr. Capuano gives patients the ability to choose how full they want to be, but he does limit this to about 60cc above or below what their own body measurements dictate.
The key to sizing a breast implant appropriately is the patient's breast and chest wall measurements. One of the most important of which, is their base width. For example, if you measure across that patient’s breast and you have 12 cm as a measurement, you can use an implant from maybe 11.5 to 12.5 cm.
If you go much bigger than that, you’ll be outside the dimensions of that patients chest wall. You’ll be able to see the implant bulging under the axilla and even sometimes medially, beyond the medial cleavage line.
The implant will typically be too high as well, because the implants are round, so if they are oversized with regard to their width, they will likely be oversized with respect to their height as well.
There are exceptions. For example, if you have a really tall patient, you sometimes want to be a little bit on the larger side with respect to their measurements, especially if she is tall and has a narrow frame, because you know that patient can accommodate more height to be in proportion with their body. If the patient is relatively petite you may want to stay on the smaller side of the range produced by their measurements.
Again, the most important measurement that we take with respect to implant size is the base width measurement.
The second thing we look at is the pinch thickness - we pinch at the top of the breast and then we pinch out laterally on the breast. If that pinch thickness is less than about 1.5 cm they are absolutely going to need their implants placed under the muscle because they don’t have enough chest wall to cover the implant and the top of the implant will show, creating a step off.
Additional measurements include chest width, breast height, nipple to fold distance, sternal notch to nipple distance, midline to nipple distance, clavicle to nipple distance and nipple diameter.
We also note the position of the nipple relative to the inframammary fold and the mid humerus. Additionally we note chest wall asymmetries, scoliosis, height differences of the clavicles and height differences between the inframammary folds. An in person consultation with doctor Capuano is necessary to find out which size implant is best for your individual body. At the Northern Center for Plastic Surgery, you can also try on different sized implants virtually during your consultation with our Vectra 3-D simulator. This is a helpful tool you are interested in seeing how different sized implants will suit their body.
Yes of course but choosing the right size implant based on measurements taken at the time of your consultation is very important.
Measurements can become overly methodical and there is a little bit of an art to this. You are looking at the patient's chest wall dimensions - that’s a big factor and you’re looking at how tall they are, and combining that with other measurements and factors to produce something you feel will be ideal for the patient based on what they want from your discussion with them. I think we can balance all of these variables by combining the critically important measurements and the patient's goals with a little bit of the artistic eye of the experienced surgeon to get a great result that the patients are happy with and that will last them a long time.There is no perfect algorithm because each patient is different. We take the science and utilize it in a framework and individualize it to the patient for a more consistent result. A thorough consultation with Dr. Capuano is important to discuss the proper implant placement and size.
The downside of seeing the top edge of an implant is that it is considered an unsatisfactory cosmetic result for some.
When pulled, if the breast moves or distracts forward a lot, it means they have a lot of space for an implant. It is also a sign, coopers ligaments have less integrity and skin elasticity is poor.
If it doesn't move a lot, they generally have better elasticity, skin quality and Cooper's ligament integrity.
We start with the measurements, and adjust for tissue characteristics like this. If tight, we adjust slightly smaller, if loose, we adjust for a slightly larger implant, in general, but not always. Height, chest width, and the remainder of the measurements all play a role.
The patient also always comes in with an idea of what they want and I need to be able to tell them based on their expectations what we can do for them with respect to implant size and final outcome. A thorough consultation with Dr.Capuano is important to find out which breast augmentation procedure and implant is appropriate for your body.
I typically make a curved horizontal incision at the bottom of the breast at the breast fold, I then create a pocket under the muscle and place the implant within the pocket. The lower margin of the muscle is identified through the incision, is elevated off the chest wall, and is released from its attachments medially to minimize the amount the implant moves when the muscle is activated and to open the medial portion of the pocket so the implant can be positioned properly.
The implant is then placed using a funnel, which looks similar to a pastry bag. This allows the surgeon to insert the implant without it touching the surgeon’s gloves or the patient’s skin. The inframammary fold and incision are then closed with dissolvable sutures.
The implant can be placed above or below the pectoralis muscle. The muscle is oriented obliquely and is located above the lower portion of the breast, so when the implant is placed below the muscle, it only covers the top two thirds to one half of the implant. I choose this location in thinner patients, who have less tissue to cover the top of their implant to ensure the upper portion of their implant is not visible. I also choose this location in thin patients who need or may need a breast lift in the near future, because placement of the implant below the muscle interferes with the breast blood supply less than placement above the muscle, allowing more options for lifting the breast. This location is also less likely to be a problem for breastfeeding or mammograms, but may result in the implant moving when the muscle is flexed. The tone from the pectoralis muscle also causes a slight compression on the upper part of the implant which helps to create an improved teardrop shape to the breast contour following surgery.
I place the implant above the muscle and below the breast tissue much less frequently. I choose this option in heavier patients, with thicker skin, with glands that are firm and in patients who need to be lifted slightly but do not want a formal breast lift. This location can impede breastfeeding or mammogram but does not move when the muscle is flexed. There is less support for the implant when it is placed above the muscle, and often the implant moves away from the patient's chest wall as the gland droops.