1. How does the shape of the ribs affect augmentation decisions?

Shape of the rib cage has a significant influence on the augmentation result. Example in Pidyeon chest deformity the center of the chest protrudes while the side of the rib cage slopes down and out. In these instances the implants will look too far apart and facing outward.


2. What is minimally-invasive surgery?

Minimally invasive surgery means achieving surgical results with less surgery. It involves a smaller incision or performing more procedures through the same incision such as my Invisible Breast Lift. It’s a procedure that combines augmentation and internal lifting performed through the augmentation incision. Another general example would be endoscopic techniques which require minimal incision, versus open surgery which requires larger incision and longer recovery time.


3. Will the veins on the breast skin become more noticeable?

In thin patients who have very superficial veins due to inadequate fat layer, one can occasionally notice more visibility of the veins.


4. What is the difference between implants in-front-of versus behind the pectoral muscle?

The rib cage is covered by a thick muscle the pectoralis. Implants are placed over the pectoralis muscle just under the breast or under the pectoralis muscle which is a deeper placement. Behind the pectoral muscle is preferred because the deeper the implant is placed the less visible and softer and more natural it will look. This is important in thin patients. In well padded patients placement of the implant behind or in front of the pectoralis muscle does not make much of a difference as far as the shape and feel of the breasts.


5. Can you explain about textured vs smooth implants?

Several years ago it was thought that rough or textured implants caused less capsular contracture or hardening of the breasts. Therefore manufacturers started producing textured implants in hopes of reducing capsular contracture; however experience has shown that this is not the case. On the other hand, problems with textured implants are harder to feel because the shell is thicker, more rippling occurs because the rough texture adheres to the breast and limits its natural movement.


6. What is meant by wrinkling or rippling of implants?

An implant placed out side on a flat surface looks round and smooth. As opposed to when it’s placed inside the body it is subjected to the pressures and forces of the breast and pectoralis muscle, therefore it becomes somewhat crinkly and develops folds. These folds which are called rippling are more visible with saline implants than silicone implants. Rippling is more visible in thin individuals due to lack of fat tissue padding.


7. What does the term "Optimal Fill" mean?

Saline implants are designed so that a small amount of saline can be added or subtracted from its original intended volume during the implantation surgery. Surgeons can choose the lower volume or the upper limit which may be up to 1-1.5 ounces of a difference. An under filled Saline implant is slightly softer but has more chance to ripple while an overfilled implant is firmer and smother with chance of rippling yet feels harder. Any volume below or above the manufacturers recommendation will be considered optimally filled. The same is not true for Silicone implants as they are pre-filled and cannot be adjusted during implantation procedure.