Many  of the articles in this series have addressed new technology in the world of Plastic Surgery, and this one will continue  that trend focusing on breast augmentation. Since the inception of the operation in the 1960’s, there has been a continued stream of technological innovation yield- ing better and more predictable results. While a full discussion of that technolo- gy vastly exceeds what can be covered in the scope of this article, it is insightful to consider the options available for today’s patients including available implants, the planning process, surgical technique, and pain control postoperatively.
The overwhelming majority of patients in my practice seek to achieve a natural fullness which is proportionate  to their body size and shape.  While this may seem simple, accomplishing it requires significant  planning  before surgery as well as an accurately performed opera- tion. Implant size selection is one of the most critical factors and is one that we place significant emphasis on during the planning phase. Of course, patient choice is always respected  since some patients prefer to have a more noticeable or less natural appearing, result.
Each surgeon must develop their own process for selecting the best implant size. Our process relies on the patient to make the majority of these decisions. Measurements of the chest and breast will give a range of possible implants to choose from which will fit on the patient’s chest. Following that determination,  we allow the patient to try on implants. Implants are sized according to volume and dimensions, not bra cup size. Trying on implants provides the patient a good understanding of how those numbers translate into appearance on their own body. Tech- nology helps in the third step which involves computer simulation of the desired result. While these methods are not entirely exact, we have found this system almost always yields a satisfied patient.
Likewise, selection of implant type is a decision based both on patient preference and the technical demands of the procedure. There are two basic types of implants available to US patients today; saline filled implants and silicone gel filled implants. Technologic advancement has contin- ued within the last couple of years with the entrance of highly cohesive gel shaped implants. We use all of these implant types and work to select the best implant for the individual patient’s needs.
Both gel filled breast implants and the highly cohesive gel implants come from the factory with the gel sealed inside the implant. Until recently, this fact some- times limited our choice of incision and necessitated a larger incision. The recent development of implant funnel technol- ogy now allows us to minimize incision length and use all of the standard inci- sions located in the armpit, at the nipple, or underneath the breast.
Placing implants  under the muscle is the most common method of perform- ing a breast augmentation. While this method has numerous advantages,  it has a tendency to be more painful than placing implants on top of the muscle. Here again, new technology has helped with the recent development of a very long-acting numbing medicine. It is used in the operating room prior to starting the procedure. The early results with this technique have been excellent. With all of our surgical procedures, any- thing we can do to minimize pain and patient recovery time is a priority.
As with all plastic surgery procedures, it is important to seek out a surgeon certified by the American Board of Plastic Surgery. Only surgeons who have attained that certification may be members of the ASPS (American Society of Plastic Surgeons). Board certified surgeons who devote sig- nificant practice time to cosmetic surgery may also seek membership in the ASAPS (American Society for Aesthetic Plastic Surgery) as an added credential.  Look for the ASPS and ASAPS logos when you choose a sur- geon to ensure that the highest standards of training and experience will be met.

David S. Kirn, M.D., F.A.C.S.

Dr. David Kirn is a Board Certified Plastic Surgeon who is devoted  to advanced techniques in Cosmetic Surgery of the Face, Breast, and Body. In private practice since 1998, he is located in a state of the art facility which includes a full service skin care center. The practice is focused on personalized patient care and attention to detail. Where possible, Dr. Kirn utilizes minimally invasive procedures. The goal is to deliver quality clinical results while minimizing patient recovery time. Examples of this include a no-drain tummy tuck, armpit incision breast augmentation with gel or saline implants, fat grafting, and a short scar facelift (the MACS lift). In addition, Dr. Kirn and nurse-injector Carey Sanders, RN offer a full spectrum of non-surgical treatments such as Dysport®, Botox®, Restylane®, Juvederm®, Radiesse®, and laser.


Posted on 2014-12-18 by