Breast Implant Size – How to Choose Cup Size in CC for Breast Augmentation

Dr. Brooke Seckel discusses how to chose breast implant size in Boston

Although most plastic surgeons measure breast implant size in cc or cubic centimeters of liquid volume, most patients seeking breast augmentation in Boston want to know how to achieve a specific bra cup size after breast augmentation. At the Boston Plastic Surgery Specialists has many patients asking “how many cc of breast implant do I need to achieve a B cup, C cup or D cup?”

Since bra manufacturers and retailers can label the same bra a different cup size it is important to estimate breast implant cup size in cc by using the brand and size of non-padded bra that you want to wear after breast augmentation.

Front-view of 300cc breast implant for full B to small C bra cup

Side-view of 300cc breast implant for full B to small C bra cup

Before and after of 300cc breast implants for full B to small C bra cup

The following breast implant sizing methods can be used to estimate how many cc’s needed to increase your cup size.

150cc-200cc of Breast Implant Equals a Cup Size in the Same Bra

This is not an exact figure determined by scientific research but rather an estimate based on anecdotal experience. It takes 200cc of breast implant to increase from an A cup to a B cup and may take 250cc for a full B cup. If you are a full B cup and want to enlarge your breast two cup sizes to a D cup then you will need at least 350cc-450cc of breast implant size to achieve that enlargement with a natural breast shape.

Using the Rice Test to determine breast implant size in cc

The Rice Test is a convenient method for determining breast implant size in cc in the privacy of your own home. Start by filling twist tie sandwich bags with rice and inserting them into your desired bra size. Once you have enough rice in the bag to give you the cup size that you want, empty the rice into a measuring cup and record the volume of rice in cups. Then convert the cups of rice to cc’s to get an estimate of the cc’s of breast implant that you will need according to the chart below:

  1.   1/8 cup = 30cc
  2.   1/4 cup = 59cc
  3.   1/3 cup = 78cc
  4.   1/2 cup = 118cc
  5.   2/3 cup = 156cc
  6.   3/4 cup = 177cc
  7.   1 cup = 236cc

Breast Implant Sizers

We now have specially shaped trial breast implant sizers in the office that may be placed over your breast inside a non-padded bra so you can see how various sized implants look on you. These implant sizers are calibrated in cc. You can try different sizes until you achieve the look that you desire and easily record the cc volume of the implant size you have chosen. This is similar in concept to the Rice Test but the specially shaped breast implant sizers can create a more realistic look. 

Breast Implant vs Breast Implant Sizer

A 350cc breast implant (left) next to its breast implant sizer (right) that is used to mimic the shape that the implant has inside the body.

Before and After Photographs of Patients with Different Cup Sizes

Viewing before and after photographs of patients who have had breast augmentation can be very helpful in deciding the breast implant size in cc that you want. Mentor, a breast implant manufacturer, has an online system which allows you to choose your starting cup size and desired cup size and will give you a series of before and after photos of patients who have chosen the same increase in cup size with the cc volume of breast implant used. 

Breast Implant Size Visualizer

Mentor also has a computerized imaging system which allows you to download your breast photos and enlarge them with the computer to see how they will look after enlargement with an implant.

Front-view of 400cc breast implant for full C to small D bra cup

Side-view of 400cc breast implant for full C to small D bra cup

Before and after of 400cc breast implants for full B to small C bra cup

Determining Your Breast and Chest Measurements for Implant Sizing

During your consultation for breast augmentation, several measurements will be taken of your breasts. One important measurement for deciding on breast implant size is called the base width of your breast. The breast base width is the distance from the interior edge of the breast next to the sternum to outer side of the breast near your arm.

Once the breast base width is measured, that width is compared to a chart of the diameter (nominal fill diameter) of various sizes (volume) of breast implants. (See Chart Below). A breast implant that has the same or less diameter as the base width of the breast will fit your breast properly.

Chart of Breast Implant Volume (in cc) and Diameters

Choose a breast implant with a diameter that matches the base width of your breast.

Choosing the Right Plastic Surgeon

Doing your homework on your own is very important before choosing to have breast augmentation. However, nothing is as important as choosing the right plastic surgeon. Your surgeon’s experience and knowledge will help you decide the breast implant size in cc and shape that will be best for you. Several recommendations that may help you are:

  1.   Choose a plastic surgeon who is certified by the American Board of Plastic Surgery.
  2.   Choose a plastic surgeon who is a member of the American Society of Plastic Surgeons (ASPS). ASPS members must be board-certified and adhere to strict ethical codes.
  3.   Choose a plastic surgeon who is a member of the American Society for Aesthetic Plastic Surgery (ASAPS). Members of the ASAPS have to have five years of experience after board-certification in plastic surgery and have demonstrated experience and skill in aesthetic or cosmetic surgery.
  4.   Choose an experienced plastic surgeon who has an excellent reputation in your community.

Let us help you to decide what cup size in cc you should choose for your breast augmentation. For more information on breast implants and how to choose the right one for you, please contact the Boston Plastic Surgery Specialists today.

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Breast Augmentation with Breast Asymmetry

Almost all my Boston breast augmentation patients are surprised to learn during their initial consultation that they have breast asymmetry. I reassure my patients that 88% of women have different sized or asymmetrical breasts and it is normal to have breast asymmetry.

 I believe that most patients are not aware of their breast asymmetry because women do not study their breasts visually carefully.  However once patients have breast implants especially in the first weeks after surgery they study their breasts carefully in the mirror. It is important that they know ahead of time to expect to see the normal minor asymmetries that they had before surgery.

What are the most common breast asymmetries?

  • Most common breast asymmetry is difference in the inferior level of the inframammary crease-the fold under the breast = 55%
  • Nipple position asymmetry-53%
  • Breast volume/size asymmetry 44%
  • Breast base constriction causing a triangular shaped breast 29%
  • Chest wall asymmetry 9%

When is minor modification of one breast needed during breast augmentation with breast asymmetry?

  • When there is asymmetry of the level of the fold underneath the breast careful lowering of the higher fold can be done.
  • Minor asymmetry of nipple position does not require modification. However, a major asymmetry may require lifting as described later.
  • Breast volume asymmetry if significant for example one breast is 100cc smaller in some cases a larger breast implant is placed on the smaller breast side.
  • Breast base constriction causing a triangular shaped breast can be corrected by a procedure to release constricting bands in the lower pole of the breast during breast augmentation. This allows the breast implant to expand the constricted breast and create a rounded breast shape.
  • Chest wall asymmetry occurs usually when one side of the chest or rib cage is higher than the other side. This can push the implant more forward and make the breast on that side look larger. Usually if the patient agrees the same size breast implants are used on both sides. However, if intraoperative sizing with saline filled breast implant sizers demonstrates that a smaller implant on the higher side of the chest creates better symmetry then a smaller implant can be used on that side.

When is major modification of breast augmentation needed to correct a breast asymmetry?

Some patients present with a major breast asymmetry. In my experience this involves one breast sagging much further down on one side of the chest. The sagging breast is called mammary ptosis. In these cases the lower breast is lifted with a procedure called a dermal mastopexy and implants are usually placed on both sides. See below:

Before and after Breast Augmentation with lift of lower breast to correct breast asymmetry

Bilateral breast augmentation with lift of lower breast to correct breast asymmetry

Most breast asymmetries do not require modification and same size breast implants are used during breast augmentation.

In most patients the degree of asymmetry is mild, and most patients are used to their minor asymmetry and the same sized breast implants are used.

However, I use saline filled breast implant sizers to check the position and adequacy of the breast implant pocket before inserting the final implant. With permission from the patient I can evaluate whether a larger implant in the smaller breast looks better and use the larger implant if it looks better if the patient requests that I make this judgement.

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Mentor® Memory Gel® Xtra Breast Implants

My Breast Augmentation patients often request a fuller breast profile with volume above the nipple areola when considering breast implants. This is especially true in patients who have had children and feel that their breasts look empty and sagging after breastfeeding. The new Mentor® Memory Gel® Xtra Breast Implants are precision-filled with a proprietary cohesive gel that provides increased breast projection above the nipple areola with a soft natural feel.

Mentor® Memory Gel® Xtra Breast Moderate Plus Breast Implant

Mentor® Memory Gel® Xtra Breast Moderate Plus Breast Implant

Mentor® Memory Gel® Xtra Breast Implants give more fullness above the nipple areola.

Mentor® Memory Gel® Xtra Breast Implants with Breast Projection and fullness above the nipple

Memory Gel® Xtra Breast Implants provide fullness above the nipple areola and project the breast

Many women who choose to have breast augmentation today request that extra fullness above the nipple areola be achieved after breast implants. In time some standard breast implants drop to a point where much of the implant rests below the nipple areola. While this creates a nice sloped natural look from the side view, today’s women often request more cleavage and a fuller look above the nipple areola. The Mentor® Memory Gel® Xtra Breast Implants with their special cohesive silicone gel and specially designed implant shell provide a breast shape that has more fullness above the nipple areola and more projection of the breast. These breast implants are still very soft and natural feeling.

Mentor® Memory Gel® Xtra Breast Implants improve projection of sagging breasts.

Mentor® Memory Gel® Xtra Breast Implants enhance fullness above nipple

Mentor® Memory Gel® Xtra Breast Implants enhance fullness above nipple

Many women report that, after breast feeding or weight loss, their breasts feel empty and sag. In these patients if the nipple is at or above the level of the Inframammary Fold, which is the fold underneath the breast, the Mentor® Memory Gel® Xtra Breast Implants increase the projection of the breast. This can create a lifting appearance, and also restore volume to the breast. If, however the nipple lies below the level of the fold underneath the breast then a formal breast lift is needed in addition to an implant to restore the breast after breastfeeding.

Mentor® Memory Gel® Xtra Breast Implants provide more natural breast firmness.

Mentor® Memory Gel® Xtra Breast Implants are soft and create a Natural look

Mentor® Memory Gel® Xtra Breast Implants are soft and create a Natural look

The cohesive silicone gel used in these new breast implants feels soft and natural. However, the gel also has more firmness than other implants to help hold the desired breast shape over time. This contributes to both the fullness and projection above the nipple areola which enhances cleavage.

Mentor® Memory Gel® Xtra Breast Implants cohesive gel stays in place in case of implant rupture.

MemoryGel-Xtra breast implant cut in half

MemoryGel-Xtra-cut in half-note cohesive silicone gel does not run out but stays in place in case of implant rupture

Cohesive silicone gel breast implants, sometimes called Gummy Bear Implants, are constructed of a silicone gel that feels soft, but unlike the older liquid silicone implants, stays in place if the implant ruptures. This is an important safety factor.

Mentor® Memory Gel® Xtra Breast Implants have a lower chance of capsular contracture.

These new breast implants have a lower chance of hardening or capsular contracture than many similar breast implant brands. When combined with the No Touch Breast Augmentation Technique and the use of the Keller Funnel for implant insertion this rate of capsular contracture can be reduced to less than 2%.

Mentor® Memory Gel® Xtra Breast Implants are made in the USA

I have used Mentor Breast Implants exclusively for thirty-six years and have been very happy with the quality of these implants. The fact that they are made in this country is an extra benefit.

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Textured Breast Implants Health Risks

Recently the Federal Drug Administration (FDA) released information on breast implant associated anaplastic large cell lymphoma (BIA-ALCL) a rare tumor associated with textured breast implants used in breast reconstruction and cosmetic  breast augmentation. This rare tumor has been studied and updates provided since 2011.

What is BIA-ALCL?

Breast implant associated anaplastic large cell lymphoma is a rare form of lymphoma that develops adjacent to textured breast implants. Only about 300 cases have been reported in an estimated 5,000,000 patients with breast implants. An estimated risk in patients with textured breast implants is 1 in 30,000. BIA-ALCL has never been reported in patients with smooth walled silicone or saline breast implants. BIA-ALCL is NOT BREAST CANCER.

What is a textured breast implant?

Most silicone and saline breast implants have a smooth outer silicone rubber shell that contains either silicone gel or saline. Textured breast implants have a rough, irregular pebbly surface that is not smooth. See the image below: to compare textured breast implant with smooth walled breast implant.

Textured breast implant shaped – Boston Plastic Surgery Specialists

Textured breast implants shaped

 

smooth walled silicone gel breast implant not associated with BIA-ALCL-breast implant associated anaplastic large cell lymphoma

Smooth walled cohesive silicone gel breast implant

Why were textured breast Implants used?

Textured breast implants were developed because studies showed that textured breast implants were less likely to develop hardening of scar tissue around the breast implant, a condition called capsular contracture.

In addition, the wall of the textured breast implant is thicker, more rigid and allowed for the production of specially shaped, tear drop shaped breast implants which had advantages in breast reconstruction after mastectomy and in some cosmetic cases.

What are common problems with textured breast implants?

While textured breast implants have been used successfully, mostly in breast reconstruction, there are some issues unique to textured breast implants that have made widespread use in cosmetic breast augmentation less common than smooth walled breast implants.

First, because the textured implant wall is thicker oftentimes the textured breast implant does not feel as soft as a smooth walled breast implant. In addition, because of the adherence of the textured implant wall to the surrounding tissues, the textured breast implants do not move as naturally with the body, and are not as freely movable within the breast implant pocket as are smooth walled breast implants.

Finally, if implant removal becomes necessary for any reason, the textured implant is adherent to the surrounding tissues and can be difficult to remove.

How often are textured breast implants used for cosmetic breast augmentation?

At a recent meeting of the American Society of Aesthetic Plastic Surgeons (ASAPS), a society of Board Certified Plastic Surgeons with experience and expertise in Aesthetic Plastic Surgery a survey was held in a course on breast augmentation/lift. The result of the survey was that 83% of these experienced surgeons present use smooth walled cohesive silicone gel breast implants.

 

What are the signs or symptoms of BIA-ALCL?

  1. Swelling of the breast due to fluid accumulation called a seroma.
  2. A palpable lump on the implant usually attached to the breast implant capsule, a membrane that forms around all breast implants normally but when abnormal, thickens and tightens around the implant.
  3. Average onset of symptoms is 8 years after implant placement but the range is 3-14 years.

How is BIA-ALCL diagnosed.

Physical exam by your plastic surgeon especially if you develop swelling or a lump in the breast and have textured breast implants.

If fluid accumulation is expected an ultrasound exam is done to confirm the presence of fluid, and fluid is drained to examine the fluid for presence of cells associated with breast implant associated anaplastic large cell lymphoma.

What should I do if I have textured breast implants?

BIA-ALCL is a rare occurrence even in patients with textured breast implants and fortunately produces detectable symptoms of seroma and can produce a lump or mass that can be felt on breast exam.

First be aware of whether you have textured breast implants by contacting your plastic surgeon or the facility where the implants were placed. Be conscious and aware of your breasts and if you develop swelling, especially on one side, or detect a lump, see a board certified plastic surgeon for an examination and possible ultrasound.

What if I develop BIA-ALCL?

Fortunately, BIA-ALCL is curable. The implants and implant capsule around the implants are removed completely. All known cases where diagnosis was not delayed have been 100% cured to date.

Can I have new breast implants after textured implants and BIA-ALCL is removed?

Yes, after an appropriate time for healing new smooth walled cohesive silicone gel or saline implants can be used to replace the previous textured breast implants.

What type of breast implants are used by Dr. Brooke Seckel for cosmetic breast augmentation?

We do not use textured breast implants for cosmetic breast augmentation. We use only smooth walled cohesive silicone gel or saline breast implants made by Mentor. Mentor breast implants are the only brand made in America and I have been using them successfully for 37 years.

Where can I find more information about Breast Implant Associated Anaplastic Large Cell Lymphoma occurring with textured breast implants?

Further information on breast implant associated-anaplastic large cell lymphoma can be found online at:

https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/ImplantsandProsthetics/BreastImplants/ucm241086.htm

https://www.plasticsurgery.org/patient-safety/information-on-bia-alcl

https://www.plasticsurgery.org/for-medical-professionals/quality-and-registries/bia-alcl-summary-and-quick-facts

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Breast Implant Capsular Contracture Prevention

A serious concern for many breast implant patients is the risk of the development of a breast implant capsular contracture. A breast implant capsular contracture can cause the breast implant to be hard, painful and the implant to be displaced upward. Fortunately, today we have a greater understanding of what causes breast implant capsular contracture and how to lessen the chance that this complication of Breast Augmentation with breast implants will occur.

Before and after breast implant capsular contracture with snoopy deformity front

Before and after bilateral capsular contracture around breast implants front view.Implants are hard and have moved up causing a Snoopy Deformity

What is breast implant capsular contracture?

A capsular contracture is the occurrence of excessive abnormal constricting scar tissue which forms around a breast implant. A normal breast implant capsule forms around all breast implants. However, a normal breast implant capsule is soft and flexible enough that it allows the breast implants to be soft and movable. When this normal capsule scars excessively and tightens around the implant making the implant hard and immovable a capsular contracture has occurred.

What Are the signs of breast implant capsular contracture?

The clinical signs of a capsular contracture are firmness or tightening of the implant which can be painful and can cause upward displacement of the breast implant. Breast implant capsules are categorized according to a Baker classification as follows:
Baker I-the breast is soft, movable and appears normal
Baker II-the breast is slightly firm but looks normal
Baker III-the breast is significantly firm but still appears normal
Baker IV-The breast is hard, looks abnormal, is often displaced upward and is painful(see photos below)

Before and after breast implant capsular contracture on right side with snoopy deformity

Before and after capsular contracture around breast implant, right view. Notice implant has moved up and is hard. Has also caused a Snoopy Deformity.

How often does breast implant capsular contracture occur?

Prior to the introduction of cohesive silicone gel or gummy bear breast implants in 2006 the rate of breast implant capsular contracture was often reported in as high as 30% of breast implant patients. However, the initial studies of the cohesive gel or gummy bear breast implants revealed a capsular contracture rate of 9.5% in Mentor breast implants and 14.8% of patients with Allergan breast implants.
More recently, with significant improvements in breast augmentation techniques including the no touch technique and the use of triple antibiotic irrigation the incidence of breast implant capsular contracture has been reduced to 1.8% in 1 study.

What causes breast implant capsular contracture?

The most likely cause of capsular contracture around the breast implant is the occurrence of a bacterial biofilm which forms around the breast implant during surgical insertion. Bacteria that are normally present in the nipple and areola are accidentally shed during surgery and contaminate the implant.
In addition, a hematoma or excess bleeding if not treated with surgical removal of the blood, can increase the chances of a capsular contracture.
However, in some cases there is no obvious explanation of why excessive scar tissue and capsule formation occurs.

How can the risk of breast implant capsular contracture be reduced?

Currently recommended guidelines to reduce the risk of capsular contracture following breast augmentation are the following:
1. Intravenous prophylactic antibiotic at the start of surgery
2. Avoid the incision through the areola
3. Cover the nipple areola with Tegaderm™
4. Inframammary crease incision underneath the breast
5. Dual Plane breast augmentation-placement of breast implant underneath the chest muscle
6. Careful dissection to avoid bleeding–meticulous hemostasis
7. Avoid dissection into the breast gland
8. New surgeon’s gloves, patient drapes and instruments prior to implant insertion
9. Implant pocket, surgeon’s hands, the breast implant and surgical field irrigation with triple antibiotic solution
10. Implant introduction sleeve or Keller Funnel for insertion of implant
11. No touch technique, do not touch the implant before, during and after insertion
12. Close the incision with multiple layers and avoid the use of drains
13. Prophylactic antibiotics in the future for dental work and other surgical procedures

How is breast implant capsular contracture treated?

Treatment of Baker III and Baker IV capsular contracture requires surgical removal of the capsule and implant. Insertion of a new implant wrapped in a bio membrane called Acellular Dermal Matrix such as Belladerm™ can reduce the chance of recurrence. There is some evidence that the use of an oral Asthma medication called Singulair™ can reduce the recurrence of capsular contracture after revision surgery.

A Better Outcome After Breast Augmentation

With the advances in Breast Augmentation techniques over the past ten years the chance of capsular contracture has been greatly reduced from over 30% to possibly as low as 1.8% under ideal circumstances. The use of the new cohesive silicone gel or Gummy Bear implants, the no touch technique, the use of the Keller Funnel™and triple antibiotic irrigation greatly increase your chances for a soft natural looking breast after Breast Augmentation.

Before and after breast augmentation with soft moveable breast implants without capsular contracture

Before and after breast augmentation with soft moveable breast implants without capsular contracture

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Mentor Breast Implants

Why I Use Mentor Breast Implants

Before and After 300cc Mentor Breast Implants front View

Before and After 300cc Mentor Breast Implants

At our plastic surgery practice we use Mentor Breast Implants exclusively for breast augmentation. I have used these implants for the past thirty-one years. During my Harvard plastic surgery residency at Brigham and Women’s Hospital I had the opportunity to use breast implants from 3 different breast implant manufacturers. What I noticed was that many silicone implants had a greasy film on the outside which represented silicone gel that had leaked through the implant shell, something referred to as implant “sweating.” This greasy material had to be wiped off with alcohol before the implant could be placed into the patient.

When Mentor implants became available in 1984 I noticed that the outer shell of the implant was dry with no greasy film on the outside. My interpretation of this experience was that the Mentor breast implant shell was better and prevented leaching of significant amounts of silicone gel to the outside of the implant and into the patient. I have no scientifically controlled study to prove my theory however it made sense to me that preventing leakage of silicone gel into the patient was beneficial to my breast augmentation patients. Since that learning experience in 1984 I have only used Mentor breast implants for my patients.

Mentor Breast Implants Are Made in the USA

Mentor breast implants are the only FDA approved breast implants made in the United States. The United States imposes strict quality control standards for manufacturing that often exceed those of other countries. Recently a manufacturer in Brazil that supplied implants to the United States market has been closed down due to the discovery of microscopic “particles” on the outside of the implant shell. This event left surgeons who use those implants in “limbo.” In the past there have also been implant manufacturers in Europe that have had to close down due to lack of FDA approval for use of their implants in the United States.

In my opinion, using a product made in the United States which meets FDA standards is not only the best option for my patients but also patriotic, just my personal opinion.

Mentor Breast Implant Sizing System

The Mentor Breast Implant Sizing System has greatly improved our ability to help our patients choose the properly sized breast implant for their desired breast augmentation result. We have a set of specially shaped Mentor breast implant sizers designed to mimic the shape of a breast implant once it has been placed into the body. These sizers are used during patient consultation to estimate the proper size of implant for each individual patient.

Many factors go into the breast implant sizing decision. During sizing, measurements of the patient’s breast base width are taken. Using this measurement a chart provided by Mentor is used to find the proper breast implant diameter to fit the patient’s breast.

Next breast implant sizers of the appropriate size are placed into a non-padded sports bra so the patient can see how they will look with that sized implant both in a bra and in clothing.

Using this system has significantly improved patient satisfaction with the size of implant chosen for breast augmentation. In years past before we had this system some patients would say at a year after surgery they wished they had chosen a larger implant. This rarely, if ever, occurs now with use of the Mentor Breast Implant Sizing System.

Before and After 300cc Mentor Breast Implants Side View

Before and After 300cc Mentor Breast Implants Side View

Mentor Breast Implant Extended Warranty

Mentor provides a lifetime warranty for replacement of a deflated saline implant or ruptured silicone implant which is standard for the implant industry. However coverage for capsular contracture or seroma is not provided.

Recently Mentor has offered an Enhanced warranty which can be obtained by the patient for a fee of $200 and enrollment before 45 days after surgery. This new enhanced warranty provides up to $3500 in financial assistance for surgery required to treat Baker 3 and 4 capsular contracture, double capsular contracture and late occurring seroma for up to ten years. This warranty also provides free replacement of the second or opposite side implant.

This is an extremely important warranty protection against a serious, but fortunately unusual complication of breast augmentation.

FDA Approved Breast Implants

Both implants made by Mentor and Allergan are FDA approved for use in the US. Both implants made by Mentor and Allergan are excellent safe breast implants. Your plastic surgeon will have his or her own personal choice and personal reasons for choosing one implant over the other. I have chosen to use Mentor Breast Implants exclusively for breast augmentation during my thirty-one years in my plastic surgery practice. I have been happy with this choice. I have described above the factors which have led to my personal preference for Mentor breast implants. The new extended warranty to me demonstrates Mentor’s own confidence in their product and is likely based on their own clinical studies on the safety and durability of their product.

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Better Breast Implant Results with the Keller Funnel

The Keller Funnel 2 is an important device that we use at our practice to achieve better breast implant results for all of our breast augmentation patients. In my opinion the Keller Funnel 2 is the most important advancement to improve results of breast augmentation and breast implant surgery in the past ten years.

Before and After Breast Augmentation with Breast Implant Insertion using the Keller Funnel

Before and After Breast Augmentation with Breast Implant Insertion using the Keller Funnel

What is the Keller Funnel 2?

The Keller Funnel 2 is a medical grade sterile silicone breast implant sleeve, designed like a pastry bag or cake decorating bag, that is used to insert silicone breast implants into the body during breast augmentation. Using this device eliminates the trauma to the skin and breast implant that was caused by the older technique of forcing the implant directly through the skin incision with the surgeon’s gloved finger. This newer less traumatic technique leads to better breast implant results in our plastic surgery practice.

Photo of Breast Implant In Keller Funnel Ready to Insert Into Breast Augmentation Patient

Breast Implant In Keller Funnel Ready to Insert Into Patient

The Keller Funnel Technique

The device is first soaked in triple antibiotic solution. The breast implant is then dropped into the funnel after the implant has been soaked in triple antibiotic solution. The breast implant is never touched.

Photo of Keller Funnel being soaked in triple antibiotic solution before placing the breast implant into funnel

The Keller Funnel is Soaked in Triple Antibiotic Solution Before the Breast Implant is Placed Into the Funnel

Photo of breast Implant being placed into the Keller Funnel without touching the implant, the no touch breast augmentation technique

The Breast Implant is Placed into Keller Funnel Without Touching the Implant, the No Touch Technique

The mouth of the funnel is then placed into the breast augmentation skin incision and the silicone implant sleeve or funnel is squeezed to direct or push the implant into the breast implant pocket beneath the breast gland or chest muscle. The implant never comes in contact with the patient’s skin or gloved surgeon’s hand or finger.

Photo of squeezing the keller funnel with breast implant inside to insert into breast implant pocket in the patient

The Keller Funnel with Breast Implant Inside is Squeezed with Two Hands to Insert the Breast Implant Into the Breast Implant Pocket

How Does the Keller Funnel 2 Technique Produce Better Breast Implant Results

Less Capsular Contracture or Hardening of Breast Implant using the No Touch Technique

The traditional method of inserting the breast implant involved pushing the implant through the skin incision into the breast implant pocket with the gloved surgeon’s finger. This technique allowed bacteria containing skin cells to contaminate the implant pocket. This bacterial contamination is believed to be a significant cause of capsular contracture or hardening of the breast implant.

The No Touch Technique involves soaking the implants in triple antibiotic solution, irrigating the implant pocket with triple antibiotics, and not touching the implant during insertion.

Using the Keller Funnel 2 and the No Touch Technique for breast augmentation reduces potential bacterial contamination of the breast implant. This reduces the chance of capsular contracture of breast implants in my opinion.

Easier Breast Implant Insertion

This new technique allows the implant to easily glide through the funnel into the patient. This is a much gentler and less traumatic technique than the older method. Less trauma to the tissues leads to less scarring and better recovery.

Faster Breast Implant Procedure

The ease of implant insertion reduces the time it takes to complete the breast augmentation procedure.

Smaller Breast Implant Scar

Because breast implant insertion is so much easier a smaller skin incision can be used. A smaller skin incision produces a smaller scar.

Less Chance of Breast Implant Rupture

The amount of force needed to insert the breast implant is greatly reduced with this technique when compared to the traditional manual insertion technique. Less force on the implant reduces the risk of rupture of the implant during insertion.

Before and After Photo of Breast Augmentation Using the Keller Funnel Technique for Breast Implant Insertion Side View

Before and After Photo of Breast Augmentation Using the Keller Funnel Technique for Breast Implant Insertion Side View

This new device has led to a very significant improvement in breast augmentation technique and has led to better breast implant results for our plastic surgery patients. We use the Keller Funnel 2 and the No Touch Technique on all of our breast implant patients.

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Breast Implant Shape – Round or Teardrop

Dr. Brooke Seckel discusses the difference between round and teardrop breast implant shapes

There are two major different breast implant shapes. There are round breast implant shapes and teardrop breast implant shapes. Round shaped breast implants have been in use for over 50 years. In my practice round breast implant shapes are more popular than teardrop breast implant shapes. Teardrop shaped breast implants were developed more recently in an attempt to create an implant that is closer to the natural breast shape when you are standing upright. The teardrop breast implants are also called shaped, anatomic, or contour breast implants. If you are considering breast augmentation one important decision you will have to make is which breast implant shape you want to have. There are many other important decisions that you will have to make, however in this article I am going to focus only on breast implant shape.

Round breast implant shapes

The photographs below show round breast implant shapes:

Smooth Round Breast Implant Shape Side View

Smooth Round Breast Implant Shape Side View

Round breast implant Shapes top view of different profiles

Round breast implant shapes top view of different profiles

Round breast implants are by far the most common breast implant shape used today. Round breast implants can be textured or smooth walled and can be filled with cohesive silicone gel or saline depending on patient preference. The round breast implant shape is designed to mimic the actual shape of the female breast gland. When the round breast implant is placed into the body either beneath the breast gland or underneath the chest muscle the size and fullness of the breast is increased. When you are in the standing position, the silicone or saline that is inside the round breast implant migrates downward or drops to create fullness beneath and below the nipple and areola. For most patients the round implant creates a natural looking side and front view of your breasts. Smooth walled round breast implants move with your body motion in a natural way and in my opinion feel more like natural breast tissue than teardrop shaped textured breast implants. Notice before and after photograph of patient with round breast implants below:

Before and after round breast implant shape 350cc front view

Before and after round breast implant shape 350cc front view. Note fullness above and below nipple.

In my opinion smooth walled round breast implants create the most natural appearing breasts after breast augmentation. They are my choice for most of my young patients who have not had children and want breast augmentation.

Round breast implants are also my first choice for patients who have had children and want to restore their breast back to their pre pregnancy shape and size. The most common complaint about the breast after pregnancy and breast feeding is that the breast gland is smaller and has sagged so that the breast tissue is below the nipple and areola or in the lower pole of the breast.

When this happens most patients want to increase fullness above and below the nipple areola to improve cleavage and breast fullness above and below the nipple areola in the upper and lower poles of the breast. The round breast implant is the best choice to restore upper breast pole fullness above the nipple areola and improve cleavage. Note upper and lower pole fullness above and below the nipple in the before and after round shaped breast implant photograph below:

Before and after 350cc round breast implant shape side view. Note upper pole fullness above nipple.

Before and after 350cc round breast implant shape side view. Note upper and lower pole fullness above and below nipple.

Teardrop, shaped, anatomic or contour breast implant shapes

Shaped, anatomic, teardrop or contoured breast implants are only available with a textured implant surface but are available with saline or cohesive silicone gel on the inside of the implant. Teardrop shaped breast implants have more volume in the lower pole or lower portion of the implant and are thinner at the top or upper pole of the implant as you can see in the photograph of the teardrop shaped breast implant below:

Shaped, teardrop, anatomic or contoured textured breast implant shapeimplant, front and side view

Shaped, teardrop, anatomic or contoured textured breast implant shape, front and side view

This shape mimics the natural shape of the breast when you are standing and the breast gland falls downward with more breast fullness underneath the nipple areola in the lower pole of the breast. Unlike the round implant, the shaped breast implant produces less breast fullness or volume in the upper pole of the breast above the nipple areola and in the cleavage area but more volume in the lower pole of the breast. Notice more fullness in lower pole of the breast in the before and after photo of a patient with a teardrop or shaped breast implant below:

Before and after 350cc shaped, teardrop, anatomic or contoured breast implant shape. Note more lower pole and less upper breast pole fullness

Before and after 350cc shaped, teardrop, anatomic or contoured breast implant shape. Note more lower pole and less upper breast pole fullness

Side view of before and after 350cc shaped, teardrop, anatomic or contoured breast implant shape. Note less upper breast pole fullness above the nipple.

Side view of before and after 350cc shaped, teardrop, anatomic or contoured breast implant shape. Note less upper breast pole fullness above the nipple.

In addition the textured shaped breast implant is firmer and in some cases may be more palpable when in the body. Because shaped breast implants are textured, they adhere to the tissue surrounding the implant. Thus shaped breast implants move less with your body and can feel less like natural breast tissue in some patients.

Another consideration is that teardrop shaped implants must be placed very accurately and symmetrically. If one slide is placed only slightly differently the asymmetry will be very obvious after surgery. Smooth round breast implants do not have this potential problem.

Shaped breast implants are marketed as providing a natural look. However I would say that shaped or teardrop breast implants provide a natural look that the breast has when you are standing up. In my practice I use shaped breast implants when the patient specifically wants breast fullness below the nipple areola and the bottom of the breast but does not want fullness in the upper breast and cleavage area.

Shaped breast implants are also very useful in breast reconstruction after mastectomy. In addition, in some patients with breast sagging or nipple ptosis when the nipple is low but not below the fold under the breast, shaped implants can add volume to the lower pole of the breast and push the nipple forward.

How to choose round or teardrop breast implant shapes

First, understand that a properly performed breast augmentation can achieve a beautiful result with either a round or teardrop shaped breast implant. Thus your most important decision is to consult only plastic surgeons who are certified by the American Board of Plastic Surgery and experienced in aesthetic breast surgery. The Smart Beauty Guide can be a valuable resource to find experienced board certified aesthetic plastic surgeons in your area.

Your plastic surgeon will examine you, take specific measurements of your breast width and nipple areola position as well as determining the shape and size of the breast that you hope to have after breast augmentation.

A sizing evaluation is also done in my office using the Mentor Breast Implant Sizing System to help you decide the size of breast implant you need to achieve the breast look that you desire. Following this you will be shown both round and teardrop breast implant shapes, and your surgeon will help you choose the best breast implant shape for your desired or goal look.

You can also study before and after photos of patients with different breast implant size and breast implant shapes by visiting LoveYourLook.com to help you in your choice of implant. You can even upload your photos to see how you will look with different implant sizes by visiting the breast implant visualizer.

Generally speaking I recommend:

Round Breast Implant Shape for:

• Young women with firm breast tissue
• Women who have had children, lost volume but the nipple areola is in a normal position above the inframammary crease or fold beneath the breast
• Women who specifically want full firm breasts above the nipple areola, the upper breast pole, and cleavage

Teardrop Breast Implant Shape for:

• Most post mastectomy breast reconstruction patients
• Patients who specifically want fullness below the nipple areola or lower breast pole and do not want upper breast pole fullness and full cleavage.
• Patients who want breast shape to remain constant standing or lying down
• Patients who have had sagging and stretching of the breast and exaggerated round shape after previous breast augmentation and are having a revision
• Patients with mild sagging or breast ptosis who do not want a breast lift and specifically want more breast volume in the lower pole of the breast with more nipple projection

In summary, your most important decision is to choose an experienced board certified plastic surgeon who you are comfortable with and allow your chosen surgeon to advise you on your best breast implant shape. After a thorough examination and understanding your specific goals and unique breast structure your surgeon should be able to help you pick the best breast implant shape for you. Good luck!

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Breast Implant Profile

Dr. Brooke Seckel discusses the different breast implant profiles available for breast augmentation.

If you are considering having breast augmentation with implants there are many important decisions that you will have to make with the help of your plastic surgeon. In addition to choosing the type and size of your breast implants you will also have to choose a specific breast implant profile.

What is a breast implant profile?

300cc breast implant profiles available, moderate, moderate plus, high profile and ultra high profile breast implants

Side view of the different breast implant profiles available in the same size of breast implant. Each implant is 300cc

The breast implant profile refers to the forward projection or height of the implant on your chest. As you can see from the photograph above of various profiles of 300cc Mentor smooth round silicone breast implants, the same size or volume of breast implant in cc can come in a variety of profiles. The higher the breast implant profile, the narrower the width of the breast implant. Conversely, the lower the breast implant profile the wider the breast implant.

Why are there different breast implant profiles?

During your consultation for breast augmentation your plastic surgeon will measure the width of the base of your breast. This measurement is referred to as breast base width. It is very important that the breast implant you choose match or be close to the same width as the base of your breast.

For patients who have a narrow base width but want a larger sized implant, High Profile implants with a narrower base width can be used. Patients with a wide breast base will require Lower or Moderate profile breast implants.

Base width or diameter and projection of a breast implant are measured in centimeters (cm). There are 2.54 cm in an inch thus a cm is slightly less than ½ inch.

Below, are the common smooth round silicone gel breast implant profiles made by a manufacturer called Mentor:

Moderate Profile Breast Implant Profile

Moderate Profile 300cc Mentor Smooth Round Silicone Gel Breast Implant

Moderate Profile 300cc Mentor Smooth Round Silicone Gel Breast Implant

The Moderate Profile smooth round breast implant is the lowest profile available in Mentor’s smooth silicone gel breast implant line. The 300cc moderate profile implant in the photo above has a base diameter or width of 13.5 cm. and a projection or height of 3.0 cm.

Moderate Profile Plus Breast Implant Profile

Moderate Profile Plus 300cc Mentor Smooth Round Silicone Gel Breast Implant

Moderate Plus Profile 300cc Mentor Smooth Round Silicone Gel Breast Implant

The Moderate Profile Plus smooth round Mentor breast implant projects more than the Moderate Profile but is narrower. The 300cc Moderate Profile Plus in the photo above has diameter or width of 12 cm and a projection or height of 3.6 cm which is higher than the moderate profile.

Below are before and after photos of a patient with 350cc Moderate Profile Plus Mentor breast implants:

Before and After 350cc Moderate Profile Plus Breast Implants Front View

Before and After 350cc Moderate Profile Plus Breast Implants Front View

Before and After 350cc Moderate Profile Plus Breast Implants Side View

Before and After 350cc Moderate Profile Plus Breast Implants Side View

 

High Profile Breast Implant Profile

High Profile 300cc Mentor Smooth Round Silicone Gel Breast Implant

High Profile 300cc Mentor Smooth Round Silicone Gel Breast Implant

The 300cc Mentor High Profile smooth round silicone gel breast implant pictured above has a base width of 11.1 cm and a projection or height of 4.5 cm.

Below are before and after photographs of a patient with 350cc High Profile Mentor Breast Implants. Notice the volume, 350cc, is the same as the patient pictured above, but the base of the implant is narrower and nipple projection is greater:

Before and After 350cc High Profile Breast Implants Front View

Before and After 350cc High Profile Breast Implants Front View

Before and After 350cc High Profile Breast Implants Side View

Before and After 350cc High Profile Breast Implants Side View

Ultra High Profile Breast Implant Profile

Ultra High Profile 295cc Mentor Smooth Round Silicone Gel Implant

Ultra High Profile 295cc Mentor Smooth Round Silicone Gel Implant

Mentor does not make a 300cc Ultra High Profile smooth round silicone gel breast implant. However the 295cc Mentor Ultra High Profile smooth round silicone gel breast implant pictured above has a diameter or base width of 9.7 cm and a projection or height of 5.0 cm a full 2 cm higher than the moderate profile.

How to choose your breast implant profile at your consultation

Your board certified plastic surgeon will help you choose the proper implant for your unique breast shape and size. Your surgeon will take several measurements of your breasts.

Next a breast implant sizing evaluation will be done. Specially shaped breast implant sizers will be placed into a non-padded bra so you can see how you look with various sized implants. Once you have chosen an estimate of the size of breast implant that you want, your surgeon will use your breast base width measurement to choose the best breast implant profile for your breast in that size implant.

Be sure to consult an experienced plastic surgeon who is certified by the American Board of Plastic Surgery. The Smart Beauty Guide is a valuable source of information about plastic surgeons who are members of the American Society of Aesthetic Plastic Surgeons and experienced in cosmetic breast surgery.

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BREAST IMPLANT SCARS

Dr. Brooke Seckel discusses how to get the various types of breast implant scars

A major concern of my patients seeking breast augmentation with implants is the location and visibility of the breast implant scars. It is important to understand that a great deal of attention is placed on hiding your breast augmentation incision to give you the best breast implant scar possible.

In addition the action of the chest muscle or Pectoralis Muscle under which the implant is placed, tends to push the implant up higher on the chest toward the arm pit.

Where are Breast Implant Scars Placed?

Beneath the breast-the Inframammary Crease (IMC) breast augmentation incision.
Through the Areola of the breast-the Trans areolar (TA) breast augmentation incision.
In the Axilla or armpit – the Trans axillary breast augmentation incision
Through the Umbilicus or belly button-the Trans umbilical breast augmentation (TUBA) incision.

How are breast implant scars hidden?

Inframammary crease breast implant scars are hidden in the fold underneath your breast, the Inframammary Crease. After breast augmentation the enlarged breast falls over the crease and hides the incision scar. Length of scar depends on size of silicone gel breast implant, larger implants require a longer scar.

Photo of Inframammary Crease Boston Breast Implant Scar hidden by normal breast position

Photo of Inframammary Crease Breast Implant Scar hidden by normal breast position

Photo of Inframammary Crease Boston Breast Implant Scar with Breast pulled up to show scar

Photo of Inframammary Crease Breast Implant Scar with Breast pulled up to show scar

Trans areolar breast implant scars are placed in the pink area of the areola. The color of the final scar is closer to the color of the areola and is less noticeable. In addition since the areola is usually covered, even with a bikini, the scar is rarely seen.

Photo of Trans areolar Boston breast implant scar

Photo of well healed Trans areolar breast implant scar on the right side of Areola

Trans axillary breast implant scars are hidden in the hair bearing tissue of the arm pit and can only be noticed when you raise your arms.

Photo of Transaxillary Boston Breast Implant Scar hidden in the armpit

Photo of Transaxillary Breast Implant Scar hidden in the armpit

Trans umbilical breast implant scars are hidden inside the belly button far away from the breast and are unlikely to be recognized as a breast augmentation scar

How is the location of your breast implant scars chosen?

It is very important to understand that many factors go into the decision as to where to place your breast implant scar. This important decision requires a consultation with a board certified plastic surgeon and a thorough discussion of your options. Of course your preference for the location of your incision is very important. However, your first choice may not always be recommended because of individual variations of your anatomy and the type of implant that you choose. Several important factors that determine this decision are:

The type of breast implant that you choose. Saline breast implants can be placed and later filled through very small incisions in almost any of the above locations. Silicone gel breast implants require longer incisions and big sized silicone gel implants cannot always be placed through the arm pit or areola. Textured implants can be more difficult to place than smooth walled silicone gel or saline implants.

• Your age and whether you plan on breast-feeding in the future. Generally speaking younger patients who plan to breast-feed in the future should not have breast implants placed through the areola. There is risk of injury to the ductules of the mammary gland which could interfere with breast-feeding later on.

The shape and size of your breast and areola. If the areola is very small it can be difficult to place silicone gel breast implants through a Trans areolar incision. If the breast is sagging, a condition called mammary ptosis, a breast lift may be needed. If a breast lift is needed there will be additional scarring around the areola and possibly a vertical line on the bottom half of the breast. Most often breast implants are placed through the breast lift incision that is being used. Patients with tuberous breasts often require a complex augmentation procedure which may involve an inframammary crease incision and or a breast lift incision.

Surgeon preference. Most plastic surgeons are able to perform several variations of the breast augmentation incision. However your board certified plastic surgeon will likely have a preference for the incision that works best for that particular surgeon. It is important to ask why and understand the reasons that your surgeon prefers a particular incision. Many plastic surgeons will attempt to accommodate your choice if possible.

Which location gives the best breast implant scars?

The best breast implant scar location is the one that you and your board certified plastic surgeon choose after your breast augmentation consultation and a thorough discussion of the options that are best suited for you. There is usually more than one option and you will have to choose one. Some generalizations which may help you to decide between the different options are:

The Inframammary Crease Incision-This incision is the most frequently and commonly used incision for breast augmentation. In most cases it is very well hidden beneath the fold of the breast and can usually be seen only if you lift your breast up to show the scar. The benefits are that during surgery the visibility of the important breast and chest muscle anatomy is excellent so that a very accurate symmetrical placement of your breast implant is possible. In addition this incision allows for easier placement of larger silicone gel and textured breast implants. Another benefit, which I feel is important, is that the breast gland is never cut using this incision. This is a definite advantage, in my opinion, for patients who plan to breast-feed in the future.

The Trans Areolar Incision-The advantage of the trans-areola incision is that it is well hidden by the color of the areola. However this incision must be carried through the breast gland tissue to reach the plane beneath the breast and to access the space underneath the chest muscle for placement of the implant. In my opinion the Trans areolar breast incision should not be used in women who plan to breast-feed in the future because the breast gland and ducts can be violated during this procedure. Another disadvantage is that visibility and exposure of the breast implant pocket beneath the breast or beneath the muscle is more limited with this approach than with the inframammary crease incision. In addition larger silicone gel implants are difficult if not impossible to place through this small incision.

The Transaxillary Incision-The benefit of Transaxillary breast augmentation incision is that it is well concealed in the arm pit away from the breast. In my opinion the disadvantage of this technique is that the surgeon has no visibility of the breast implant pocket unless an endoscope is used. In addition the action of the chest muscle or Pectoralis Muscle under which the implant is placed, tends to push the implant up higher on the chest toward the arm pit. In some cases this can prevent adequate dropping of the breast implant into the proper position underneath the nipple areola and lower portion of the breast. This can result in the implants appearing too high on the chest. In my experience this tendency for the implants to be too high after Transaxillary breast augmentation can result in the need for breast implant revision to drop the implant lower into a more natural position. This revision will require a new inframammary crease incision.

The Trans Umbilical Incision-The trans-umbilical breast augmentation is a relatively new technique and in some areas is highly marketed. The benefit is that the incision and thus the scar is hidden far away from the breast. The disadvantage is that an endoscope must be used to tunnel under the skin from the belly button region up to the breast to create the pocket for the breast implant. This limited visibility can interfere with the creation of an adequate accurate pocket in which to place the implant. In addition only saline breast implants can be placed using this technique. Because the saline breast implant must be passed through an endoscope and possibly be traumatized, use of the Trans umbilical breast augmentation approach invalidates the manufacturer’s warranty of the implant. For this reason I do not use this approach.

How long does it take breast implant scars to heal?

Healing of your incisions occurs in stages. It takes two weeks for the initial healing phase to finish and your scar to become less pink and able to be gently massaged. However the scar does not begin to develop significant strength until about six weeks. This is why heavy lifting and vigorous exercise and physical activity is usually not recommended for at least six weeks after breast augmentation.

The strength of your scar continues to increase significantly from six to twelve weeks. Healing continues for months, and research studies have shown that most skin incision scars are pink for on average seven months. The color can continue to lighten and improve for two years.

What Is the Best Breast Implant Scar Treatment?

The best breast implant scar treatment I have found is Mepitac tape. Mepitac is a silicone scar tape with an adhesive backing. It is the only silicone scar tape I have found that will tick to the skin surface and not fall off with sweating or activity.

I start using Mepitac about 3-4 weeks after breast augmentation once the incision has stabilized. The results in my experience are truly remarkable. It is best to leave the tape on the scar until it loosens or becomes soiled. The longer it is attached the better the result will be. Some red scars may require use of Mepitac for up to six months

How to improve bad breast augmentation scars.

Occasionally some breast augmentation scars can become red, raised, itchy and lumpy or bumpy. These are called hypertrophic scars and some individuals are prone to forming this type of scar after any surgery or injury to the skin.

In my practice I treat hypertrophic or red scars with the 1540 non-ablative fractional Erbium laser. This laser treatment is the most successful I have ever seen in my 32 years of practice and can turn a red raised scar into a flat white or skin colored scar. The treatments require no down time are very tolerable without anesthesia and take only a few minutes. At least 4 treatments scheduled a month apart are required.

Most Important

Your choice of your plastic surgeon is the most important decision you will make when considering breast augmentation surgery with implants. Delicate surgical technique, including use of the Keller Funnel for inserting the implant, can improve your result. Be sure to consult at least two Board Certified Plastic Surgeons. Choose a surgeon who is very experienced in breast augmentation and aesthetic plastic surgery. The Smart Beauty Guide is a good place to start as surgeons must be board certified, members of the American Society of Plastic Surgeons, and the American Society for Aesthetic Plastic Surgery to be included in this guide.

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