Q: Dr. Eppley, I am seeking silicone breast augmentation. I am currently a 32A cup and looking to be a D cup. I am interested in a silicone implant with the transaxillary approach placed in the submuscular location. Are you very experienced in this approach? How many of these have you performed compared to other techniques?
A: When it comes to breast augmentation over the past twenty years,I have placed over 500 transaxillary breast implants. The use of silicone implants being placed through the armpit incision has been more recent with newer silicone implant styles and insertion techniques.
When using silicone breast implants, however, there is a limit as to the size of the implant that can be inserted through the transaxillary approach. Generally it becomes difficult to place implants greater than 400cc to 450cc due to the greater stiffness of today’s gummy bear breast implants. Their insertion is helped greatly by using the Funnel insertion device technique and also lowers the risk of injury to the implant shell as well. Whether that will take you to a D cup remains to be determined by an actual physical examination and assessment of your desired results using a Volume sizing system. Larger implants can be placed but this often leads to a longer transaxillary incision and resultant scar.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in having breast augmentation. I have had several plastic surgery consults and they have left me confused. One doctor told me that silicone implants do in fact appear more natural (less rippling on the breast) than saline after surgery. Another doctor told me that it doesn’t matter and I should get saline implants because they are cheaper and he could do it through a periareolar incison. Is the appearance difference between silicone and saline implants real or is this a myth?
A: What constitutes a natural appearance after breast augmentation is largely a matter of one’s viewpoint. Beauty truly is in the eye of the beholder. But the definition of what a naturally-appearing breast augmentation result is aside, the more natural appearance of a silicone implant compared to a saline implant is largely a myth. But as in all myths there is usually a kernel of fact hidden in them and this is equally true of this breast implant issue. With good breast tissue and a submuscular position, both types of breast implants will have a similar appearance and one could not tell the difference. However, differences in their appearance may be seen in very thin patients with little breast tissue particularly if they are placed above the muscle. The real differences in these implants is how they may feel, with saline implants having a higher risk of rippling which can be felt in the bottom and sides of the breasts where there is no muscular cover. I always tell my patients that choose saline implants that they can expect to feel riplping in their implants which affects show they may feel but not how they look.
Dr. Barry Eppley