You should have your doctor examine you to be sure you do not have a breast lump.

It is common especially after breast augmentation with saline breast implants to feel folds or bumps in the breast implants. Sometimes they are visible. The breast implant bump or fold is usually a fold in the saline implant and is not dangerous. Causes of breast implant bumps after breast augmentation can be:

1. The valve used to fill the saline breast implant
2. A fold in the shell of the breast implant
3. A capsule or scar tissue around the implant.
4. A very loose pocket around the implant so the implant is not held firmly in the breast
5. Very thin skin with minimal breast tissue-inadequate coverage of the breast implant
6. Breast implant placed beneath the breast gland instead of beneath the chest muscle-again less tissue covering the implant.
   

The breast implant bumps or folds are not dangerous but do bother patients very much especially if they are visible.

You can minimize the chance of breast implant bumps or folds during breast augmentation by:

1. Use silicone gel implants-they are less likely to fold
2. Place the implant beneath the chest muscle-this provides more coverage for the implant
3. If the breast implant pocket is too large, an operation can be done to tighten the pocket. If this is done I recommend replacing the saline implant with a silicone gel implant
4. Massage the breast implants daily
   

Of course it is important to have your doctor examine your breasts to make certain the bump you are feeling is not a breast lump. If this is the case you will need a medical work up to make certain the breast lump is not dangerous.

Breast implant bumps or folds are almost impossible to avoid when using saline implants in thin women with minimal breast tissue.

Today I most often use the new silicone gel breast implants for breast augmentation which usually, but not always, do not form breast implant folds or breast implant bumps.

The results can be excellent.

For more information on breast implants contact me. Be sure to sign up for my free email newsletter.

Dr Seckel

978-369-4499

Boston, Massachusetts

Concord, Massachusetts

Thank you for your email. Breast augmentation or breast enlargement with breast implants is one of the most common plastic surgery procedures. Results are usually excellent and patient satisfaction is very high.

Above: Before and after breast augmentation

Breast augmentation is also frequently done in combination with a breast lift for patients who have had sagging or breast ptosis after having children:

Above: Before and after breast lift and breast augmentation

Unfortunately a very high per cent age of Saline breast Implants do develop palpable, and occasionally visible folds after a number of years. The problem is intrinsic to the saline implant and is the most common complaint I receive. The breasts usually look excellent but patients just don’t like the feel of the saline implant especially if they feel the fold. Most commonly the fold occurs, as it has in you, at the bottom of the breast and towards the side.

Most plastic surgeons over fill the saline implants to avoid this problem but folds still do occur.

The new silicone gel breast implants are much less likely to cause folds and generally feel more natural than saline breast implants. Safety data for the new silicone gel breast implants for breast augmentation and breast enlargement is excellent and complication results are very similar for saline implants and the new generation of silicone gel implants.

Breast implant folds are felt to be more common with low profile breast implants. The low profile implants have a wider base and less projection and do have a greater tendency in my experience to cause folds.

Today I more frequently choose a moderate or medium profile implant which projects the breast more forward and has fewer tendencies to fold.

In your case, since you have had folds in your saline breast implants my recommendation would be to replace your saline breast implants with a moderate profile silicone gel breast implant, possibly a bit larger to fill the space and compensate for any stretching of the skin from your previous breast implants.

My experience with the new silicone gel breast implants has been very positive. Patient satisfaction with the silicone gel breast implants has been very high and patients who have replaced their saline breast implants with the new silicone gel moderate profile breast implants have been very happy with the results.

The safety data are very similar for both the saline and new silicone gel breast implants. The one downside is that the FDA recommends follow up MRI scans to check the implant at 2 years. This is a safety feature but can be an inconvenience to you.

Typically the procedure to remove your old saline breast implants and replace them with new silicone gel breast implants is a very simple procedure with less discomfort and recovery than was experienced with the initial breast implantation or breast augmentation surgery.

Thank you for your excellent question.

If you would like to learn more about plastic surgery or breast implants please visit DrSeckel.com or contact me at 978-369-4499.

Be sure to sign up for my newsletter to learn about new developments in breast augmentation and plastic surgery.

Thank you,

Dr Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts

Thank you for your email. Silicone breast implants have recently been approved for use by the FDA and many patients are choosing to have the Silicone implants because of the more natural feeling after placement of the implant. Boston is a conservative town and many plastic surgeons are still only using the Saline implants. The Silicone gel implants are safe but there are certain precautions and follow up care that are required if you have Silicone gel breast implants.

The results of breast augmentation are usually very pleasing- see below or click on this link:

A successful result oriented breast enlargement can create a beautifully shaped feminine breast.

Experience, artistic sense, and a shared image of your goals for breast augmentation are important factors in achieving a good result.

Most women seeking breast augmentation do so because they feel:

They have always wanted bigger breasts

• Their breasts have become smaller and less full after pregnancy
• Their breasts have sagged
• They do not like the shape of their breasts
• They want to look better in a bathing suit
• They want to look better in clothes
• They just want fuller more voluptuous breasts
• They want a more feminine looking body
• They just want big breasts

Breast augmentation is one of the most frequently performed plastic surgery operations done in the US today. Overall results are excellent and patient satisfaction and happiness with their new breasts is very high.

With the recent FDA approval of Silicone Gel Breast Implants the options and choices available to you are many. There are also many options for placement of the incision and the implant.

The Breast Augmentation Procedure

What bothers my patients most is the lack of breast fullness and cleavage of their breasts. They just want to have fuller breasts and be able to fill out their bathing suit and look good in today’s fashions.

If your breast is small or is normal size but has no sagging, the breast augmentation procedure is very straightforward and requires little modification.

If you have sagging breasts after weight loss or childbirth, depending on how much the breast has sagged, you may need a dermal mastopexy or breast lift in addition to the breast augmentation.

For most women, however, the breast augmentation procedure can correct the post pregnancy or weight loss breast appearance without the need for a breast lift or mastopexy.

The key issue in making this decision is the position of your nipple. Check the crease in the skin below your breast. This is called the inframammary crease. If the nipple is above this crease then chances are a breast augmentation can be done without a breast lift.

Most often I place the breast implant through an incision in the fold beneath the breast, called the inframammary breast augmentation. This scar normally does not show unless the breast is lifted up. The implant can also be placed through an incision in the armpit called a transaxillary breast augmentation.

If you have had children and your breast has sagged only a small amount I often use a technique called the Transareolar Breast Augmentation. Using this technique I make a very small incision in the areola—the round pink part surrounding the nipple. I then modify the breast gland so that it falls nicely over the implant. If you heal well the scar is hard to notice.

The Transareolar approach does push the nipple up and places the volume of the implant under the nipple and which is where the volume of the normal breast was during pregnancy.

The breast implant can be placed either under the breast gland, called the sub glandular breast augmentation, or under the chest muscle, called the sub muscular breast augmentation. There are advantages and disadvantages to each technique which I will explain to you at the time of your consultation.

Today you have a choice between saline breast implants and silicone gel breast implants. The main difference in the result of breast augmentation with saline breast implants from that with silicone gel breast implants is the feel of the implant. If there are no complications such as hardening of the implant, and the result of the surgery is satisfactory, then a silicone gel breast implant will feel more natural than a saline implant-the silicone gel implant often feels more like breast tissue than does a saline implant.

However, this difference is subtle not dramatic, and there are many people who have saline breast implants in whom I cannot tell the difference between a saline and a silicone gel implant.

There are many factors to consider when making your decision about which type of breast implant to chose. I will give you information about both types of implants at the time of your consultation.

Your Consultation

When we meet I will talk with you and ask you to explain to me the specific goals you hope to achieve with breast augmentation. I will examine you and tell you my findings and recommend the breast augmentation procedure which I believe is best for you.

I will discuss the procedure, your recovery, and expectations and answer your questions. Photos of your breasts will be taken. You will be given an estimate or quote of the cost of the procedure. Financing is available.

Pre OP

The pre operative visit is the time when we will sit down and clearly define your goals. We will discuss what you hope to achieve and what I believe I can achieve with the breast augmentation procedure.

You will also undergo a history and physical exam to make certain that you are healthy and have no medication allergies or contraindications to surgery. An EKG (electrocardiogram) may be done if you have a history of heart problems or have reached a certain age. You will also be given prescriptions for post operative medications.

You also will be asked to read and sign surgical consent forms which outline the risks, potential complications, limitations and expectations of breast augmentation surgery.

The Operation

Breast augmentation is done with you asleep under general anesthesia. Very experienced, superb anesthesiologists will be taking care of you. Safety is our first concern. We use modern, very safe anesthesiology techniques, and take precautions to avoid nausea after surgery.

Breast augmentation scars are usually not noticeable. The scar is usually hidden beneath the breast, in the armpit, or within the pink part of the areola. You will not have visible sutures or suture marks following surgery. I use buried sutures to close your incision. Buried sutures produce less noticeable scars and help avoid the old style “railroad track” suture mark seen when interrupted external sutures are used.

Breast augmentation is done as an outpatient or day surgery. You will go home the same day after surgery. The operation takes about an hour.

After you wake up you will be taken to the recovery room where a nurse will be taking care of you. The nurse monitors you, makes certain you are comfortable and checks your vital signs. You will spend 1-2 hours in recovery. After that, as soon as you are comfortable, able to drink and eat a bland food such as crackers or cookies, and able to go to the bathroom, you will be discharged. The nurse will escort you by wheel chair to your car.

We require that someone bring you to the surgery center and take you home, and that you have someone staying with you the first night after your surgery.

Post op- What to expect

In the recovery room you will be given medications to control any discomfort you are experiencing following your surgery. You also will have medications to take for discomfort at home. You will experience discomfort in the breast area for the first 3-4 days after surgery. If the breast implant is placed under the chest muscle, the discomfort is greater than if the implant is placed under the breast gland.

The day after surgery I will have you start implant displacement exercises. I have you use your hand to massage and move the implant. This technique helps avoid hardening of the implant and actually reduces the length of time you will feel discomfort post operatively.

Most patients are quite comfortable by day 5 post op and some are able to return to work. Generally full recovery takes 2 weeks. I ask you to wait 3 weeks before heavy weight lifting or aggressive work outs.

A Consultation with Dr Seckel

I can tell you a great deal more about breast augmentation and how it would work for you if I see you in person. Call me to set up a consultation or contact me by email. If you would like to email me your questions or photos I can email you my thoughts about which procedure I would most likely recommend for you. For more information on breast augmentation read my blogs about breast augmentation.

Be sure to sign up for my new free email newsletter so you will receive information on the newest techniques in plastic surgery.

I look forward to meeting you.

Dr Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts

Thank you for your question. Interestingly, women in your age group who have had children and share your concerns are the largest group of patients seeking Breast Augmentation in my Boston Plastic Surgery Practice, and have been for many years. The use of the name “mommy makeover” has brought a great deal of attention to the combination of breast and abdominal or tummy rejuvenation following pregnancy, usually a combination of a tummy tuck or abdominoplasty and a breast lift or dermal mastopexy with or without breast augmentation or breast enlargement. Many women complain of small breasts, sagging breasts and a loose tummy or sagging tummy skin after pregnancy.

Most commonly in my practice a “mommy makeover” consists of a tummy tuck and a combination of the breast lift and breast augmentation. Recent studies have reported that the combination of these procedures is safe if performed properly on a healthy patient.

Above-Before and After Bikini Tummy Tuck

Below-Before and After Breast Lift and Breast Augmentation

My own opinion is that the mommy makeover, that is the combination of a tummy tuck, breast lift and breast augmentation or breast enlargement can be done safely under the following circumstances:

1. The patient is healthy-a Class 1 Anesthesia Risk-that is a person with no significant medical disease such as diabetes, high blood pressure, significant obesity, history of blood clots, and many other potential medical complicating conditions.
2. The board certified plastic surgeon is skilled and experienced at doing multiple procedures
3. The procedure can be accomplished in less than 4 hours ( this is my personal opinion, longer surgeries increase risk )

The mommy makeover requires a healthy patient and an experienced and skilled plastic surgeon that can expeditiously perform the combination of a tummy tuck, breast lift and breast augmentation. Your choice of a surgeon is critical and you need to ask specific questions about the doctor’s experience and the time it will take for the operation.

Not every patient who wants a mommy makeover requires all three operations, that is a breast augmentation, breast lift and tummy tuck. Many women only need a breast augmentation if they have small breasts after pregnancy but not sagging breasts. Other women who have adequate breast tissue but sagging breasts will only require a breast lift or dermal mastopexy. In my practice a mommy makeover which requires only a minor tummy tuck and a breast augmentation can be achieved in less than 2 hours.

If a combination breast augmentation, breast lift, and a major abdominoplasty are required the procedure can take as much as 3 hours.

The decision as to what type of mommy makeover is required depends on your particular anatomy. You can read more about how decisions about breast augmentation, breast lift, and tummy tuck are made by reading my previous blogs on this topic.

The mommy makeover, that is the combination of a tummy tuck and breast lift and or breast augmentation, in my experience, produces excellent results and produces some of my happiest patients. The improvement in the self esteem of my patients has been remarkable. Many patients say “I can’t believe it”, “I love my breasts and my new shape” and other happy comments.

The most important thing for you is to make certain you are healthy and you must find an experienced plastic surgeon who can safely and in a reasonable operative time accomplish a good cosmetic result.

If you would like to see results of plastic surgery visit my clinical website drseckel.com.

If you would like to learn more about how to choose a plastic surgeon read Save Your Face. If you would like more information contact me.

Dr Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts

There are many factors to think about when deciding whether to have breast enlargement or breast augmentation with silicone gel breast augmentation or saline breast augmentation.

The newer silicone gel breast implants have been approved by the FDA and have been available since January 2007. Many women share your concern about the safety of silicone gel implants for breast augmentation.

My first comment is that breast augmentation or enlargement with silicone gel breast implants or saline breast implants, if done on an appropriate candidate by an experienced board certified plastic surgeon should produce an equally pleasing and successful aesthetic or cosmetic result.

The main difference in the result of breast augmentation with saline breast implants from that with silicone gel breast implants is the feel of the implant. If there are no complications such as hardening of the implant, and the result of the surgery is satisfactory, then a silicone gel breast implant will create a more natural breast implant feel, more natural than a saline implant-the silicone gel implant often feels more like breast tissue than does a saline implant. Some refer to silicone gel breast augmentation as a natural feel breast augmentation or natural breast augmentation.

However, this difference is subtle not dramatic, and there are many people who have saline breast implants in place, and I cannot tell the difference from a silicone gel implant.

There are many factors which contribute to the different feel of the Saline implant and most of them can be predicted or managed. In very thin women with very little breast tissue to cover the implant, the saline will be more palpable. If a capsule forms around the saline implant, it will be a more palpable breast implant. If the surgeon does not over fill the saline implant, a palpable breast implant fold can develop.

Placing the saline breast implant beneath the chest muscle helps prevent palpability and over filling the implant helps prevent folds. Meticulous surgical technique and avoidance of bleeding during surgery also helps avoid the capsule which is scar tissue which makes the implant hard. Saline implants also tend to form fewer capsules or hardness, about 5% of cases as compared to 13-15% of silicone gel breast implants form breast implant capsules or breast implant hardening, called capsular contraction.

A silicone gel breast implant which has been placed under the breast or muscle, with meticulous technique and which does not form a capsular contraction of breast implant or breast implant hardening, does result in the most natural feeling breast. A “perfect result” with a silicone gel implant does feel better than a “perfect result” with a saline breast implant, but visually, the way they look, is about the same, in my opinion.

There are however disadvantages to silicone gel implant breast augmentation or breast enlargement. The new FDA guidelines require that you have frequent MRI exams to check for breast implant rupture-this is expensive. In addition the additional risk of capsular contraction of the breast implant-13-15% compared to 5% with saline breast implants is significant. In addition if the implant does rupture and need to be replaced, the surgery to replace a silicone gel breast implant is more complex than that for a ruptured saline breast implant.

Most women in my practice find the decision an easy one. Many patients are very health conscious and only concerned with safety, want the least risk, don’t want to bother with MRI’s, and are most concerned with how the breast looks and don’t care about a subtle difference in feel and want the least risk of firmness or capsular contraction of the breast implant. These patients are usually married, have children, and are in their late 20’s to early 40’s. They typically choose saline breast augmentation.

By far the largest group who select silicone gel breast augmentation are patients who have had a previous breast augmentation, usually with saline breast implants, and are unhappy with folds or the feel of the implant and want a more natural feeling breast implant and choose to have replacement with silicone gel implants. The other large group of patients selecting silicone gel breast implants are younger women, single with no children, who have read a lot about breast augmentation and want the most natural feeling breast implant and do not want a palpable breast implant fold.

It comes down to your priorities and your situation. Silicone gel breast implants are safe and if there are no complications, silicone gel breast implants produce a beautiful natural feeling result. The complication rate-firmness or capsular contraction of the breast implant is greater however with silicone gel breast implants.

If you want the peace of mind of not worrying about firmness and having to have MRI’s and worrying about the possibility of rupture and you are willing to accept the fact that the implant will be subtly palpable and MAY (many do not form folds) form a palpable breast implant fold that likely only you will notice, the saline breast implants are a better choice for you.

If you want the best feeling or most natural feeling implant then silicone gel breast implant is the best choice.

The most important thing is for you to find an experienced board certified plastic surgeon who has done many breast augmentation operations and can give you an honest opinion.

In my opinion the most important factor in achieving a good result with either type of breast implant is the skill and experience of the surgeon. This operation needs to be done meticulously and carefully, and not all surgeons take this approach.

If you would like to see results of breast augmentation check my clinical site drseckel.com.

For further information on how to find and chose a plastic surgeon read Save Your Face or contact me.

Sincerely,

Dr Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts

Your question is one of the most common situations I see in my plastic surgery practice. Most women who have had children notice lax abdominal skin or a sagging tummy and experience laxity of the breasts or sagging breasts and no amount of hard work can completely firm these areas back to the way they were before pregnancy.

The tummy tuck and breast augmentation or breast lift are frequently done together. A minor tummy tuck involves only an incision down low in the abdomen which can be designed to be hidden under today’s brief bikini’s so that the scar is not visible at the beach. A major tummy tuck, called an abdominoplasty, done when there is a great deal of abdominal skin laxity and excess abdominal skin and stretch marks, require an incision around the “belly button” or umbilicus, and thus creates a visible scar. Most women in your age group only need a minor tummy tuck.

Many women who only have a small amount of sagging of the breast, called glandular ptosis, can restore their breast shape and firmness with only a breast augmentation or breast enlargement with a breast implant. The implant can be a saline breast implant or a silicone gel breast implant which has a more natural feel.

For women who have more severe breast sagging, called breast ptosis, a breast lift or dermal mastopexy is required. This decision is made based on your breast anatomy. Generally if the nipple is below the inframammary crease (IMC) the diagnosis of mammary ptosis is made and a breast lift or dermal mastopexy is required.

Most women do not want to have the breast lift, called a dermal mastopexy, done because the dermal mastopexy or breast lift creates visible scars on the breasts. However the breast lift or dermal mastopexy can create a beautiful youthful breast shape and many women choose this procedure and accept the scars which are much less noticeable with time.

The lollipop lift or lollipop breast lift is a procedure designed to minimize the scars associated with the breast lift or dermal mastopexy. The lollipop breast lift involves a circular scar around the areola and a vertical scar running straight down the breast beneath the areola so it looks like a lollipop when viewed from the front.

My recommendation is that you consult 2 surgeons who are certified by the American Board of Plastic Surgery and get their opinions as to the best options for you.

Thank you for your question.

For more information on plastic surgery and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts

Thank you very much for your email. As a Plastic Surgeon I do many breast operations and welcome your important question,

By far the greatest number of women seeking breast augmentation and or lift are women just like you who have had their children and are unhappy with what has happened to their breasts after having children. During pregnancy the breast is full and very feminine looking. After childbirth the actual breast gland atrophies, gets smaller, and the skin that has been stretched during pregnancy sags and allows the breast to drop.

What bothers my patients most is the lack of fullness and cleavage. They just want to be able to fill out their bathing suit and look good in today’s fashions.

There are many wonderful techniques available today to restore the breast to a beautiful full youthful feminine appearance. Depending on how much the breast has sagged some people may need the dermal mastopexy or breast lift, which as you point out does leave noticeable scars.

But for most people the breast augmentation procedure can correct the post pregnancy breast appearance without the need for a lift or mastopexy.

The key issue in making this decision is the position of the nipple. Check the crease in the skin below your breast. This is called the inframammary crease. If the nipple is above this crease then chances are a breast augmentation can be done without a breast lift and restore your breast to a full youthful appearance.

Another technique I use to avoid scars and lift the breast is called the Transareolar Breast Augmentation. Using this technique I make a very small incision in the areola—the round pink part surrounding the nipple. I then modify the breast gland so that it falls nicely over the implant.

Using the Transareolar approach does push the nipple up and places the volume of the implant under the nipple and which is where the volume of the normal breast was during pregnancy.

The other benefit is that the areolar scar is almost invisible. Scars tend to be pink, the areola is pink, and so the scar is not as noticeable as it is when placed under the breast or in the armpit. Also in my experience there is no increase in risk to the sensation or feeling of the nipple it nearly always remains the same as it does with other breast augmentation techniques.

The implant can be placed either under the breast or under the chest muscle using this technique, but when a breast lift is needed the implant is usually placed beneath the chest muscle directly under the breast gland.

Obviously I would have to examine you to see exactly which procedure will give you the result that you will be happy with.

However most women I see who complain of small sagging breasts after having their children can get a beautiful result with the Transareolar Breast Augmentation and avoid the scars associated with the breast lift or Dermal Mastopexy Procedure. I have hundreds of very happy patients who came to me with exactly your problem.

Thank you for your very important question.

To read more about plastic surgery read Save Your Face or contact me.

Dr Seckel

978-369-4499

Concord, Massachusetts

Boston, Massachusetts