Dr. Walden´s Philosophy on Breast Augmentation
*Dr. Walden is a board-certified plastic surgeon in Manhattan (New York City) who performs augmentation with both silicone- and saline-filled breast implants. She is a principal investigator in both Mentor and Allergan's Clinical Adjunct Studies, as well as in the Post-Approval Study and Breast Implant Follow-Up Study for collecting long-term data on silicone gel-filled breast implants. She has been featured on the CBS Early Show on the FDA release of silicone-filled breast implants, and on ABC's 20/20 on the safety of silicone breast implants.
Thank you for your inquiry regarding breast augmentation surgery and for visiting this site! In my opinion, breast augmentation is a procedure that can be very satisfying for the patient, and one that can help women who are qualified candidates for surgery feel better about their self-image, the way they fit into clothes, and even more confident.
As you are considering breast augmentation, you are probably excited and even a little bit confused about all of the information on the Internet and in talking to others who may or may have not undergone breast augmentation. I hope the following helps to answer some of your questions prior to your consultation.
Breast Implant Type
I perform breast augmentation with both saline-filled and silicone gel-filled implants. Silicone implants are soft and natural feeling, and were reapproved for general cosmetic use in women over age 22 on November 17, 2006, by the United States Food and Drug Administration. All gel implants today are cohesive, which means that the gel tends to stay in place and has the consistency of something like Jello in that it does not leak or bleed into the tissue if the shell is cut. Picking out the right size of implant in the preoperative phase is very important, as silicone implants are already filled prior to putting them in the body (I may use temporary sizers in the operating room to be able to tell what will look best on you). Saline implants are filled and adjusted once they are put in the breast pocket in the operating room. Since the reapproval of silicone gel-filled breast implants, about 80 percent of my patients undergoing BA have opted for this type.
Saline-filled implants are also great and I used them on most of my primary breast augmentation patients for many years prior to the FDA's reapproval of silicone gel-filled implants. They are nice for cases of breast asymmetry because, intraoperatively, the volume of one implant over the other can be adjusted. Regardless of implant type, together we can decide on a size based on your desires, and on your chest anatomy, which I examine at your consultation. Among other factors, I use a measurement called your breast base diameter to help determine this, but your desires always come into play. I also get an idea of the size you are thinking about by asking you to bring in photographs from magazines or other sources of women with a similar frame as you with a breast size that you like. We will talk about your size preference and expectations several times preoperatively in order to maximize your result and satisfaction level after the procedure!
Breast Implant Shape
I prefer using smooth round implants, whether saline- or silicone-filled. I think they sit very naturally in the breast pocket, giving fullness in the lower part of the breast due to gravity when you are in a standing or sitting position. I use moderate, moderate-plus or midrange, or high-profile implants based on our preoperative discussion about your goals regarding the size and shape of your augmented breasts. For a given width, or base diameter, a high-profile implant has a greater height, or projection, which, in turn, provides fullness superior to that from a moderate-profile implant. I can show you examples of implants and patient photos so you can see this difference.
Breast Augmentation Incision Location
I perform breast augmentation through the inframammary crease, periareolar (on the border of the shaded part of the nipple with your normal skin), and transaxillary incisions. These are all popular incision locations that heal well, and we can decide which one is best for you based upon your anatomy and your preference. The transaxillary incision is located in your underarm crease, and I use a small camera called an endoscope to perform the surgery. The implant is placed through this site, thereby avoiding an incision on the breast itself. The inframammary crease and periareolar incisions also heal extremely well and fade very nicely.
Breast Implant Placement
In almost all of my breast augmentations I place the implant in a submuscular location. This means I put it under the pectoralis major (or breastbone) muscle after partially releasing this muscle at its lower border. I believe that this is the best place for the implant because it looks more natural, gives a more natural slope to the upper part of the breast, has less likelihood of forming internal capsular contracture, and helps the radiologist to see the breast tissue during mammogram with some additional views.
Once at your consultation, you will receive more information on scheduling, as well as on pre- and postoperative care, including breast implant massage and when/what type of bras to buy after the surgery. We have an all-female office staff that is at your service!