Breast implants are the most popular surgical cosmetic surgery that is performed in the United States with over 300,000 women undergoing breast augmentation every year. I recently had the pleasure of interviewing Dr. Tracy M. Pfeifer on my podcast The Beauty Doc. She is a board certified plastic surgeon in NYC and an authority on breast implants and breast enhancements (augmentations).
We explored why Dr. Pfeifer was attracted to plastic surgery as a specialty. She felt that she could obtain observable results and use her creativity when planning breast surgery. She appreciates each patient as an individual with unique features.
Her preoperative assessment are based on the dimensions and size of the body, shape and width of the hips and torso, one’s height, and shape of the breast all play a part in guiding the patient towards the right size and shape of a breast implant. And of course photographs can also help in the assessment. She feels that it is a collaborative process between her and the patient for them to arrive at the most suitable match.
PATIENT’S IDEAL FOR COSMETIC BREAST SURGERY:
Dr. Pfeifer’s patients are primarily young single women in their mid-twenties to mid-thirties who want breast enhancements but don’t necessarily want exaggerated size implants. The third demographic gap is the middle age women who may have had children and have lost volume or shape to her breast and wishes to improve both
What types of breast implants are available in the US. Two types of breast implants-silicone filled (“gummy-bear”) and saline filled (“salt solution”). Each of these implants have advantages and disadvantages. Silicone implants feel softer, they are lighter in weight and more compressible which prevents long-term sagging or stretching. Saline implants are firmer, less compressible and more prone to rippling of the outer shell.
They are also heavier and more prone to stretch but they can feel warmer to the touch compared with silicone. Silicone implants are FDA approved at age 22 but are often inserted “off-label”. The implants come in two basic shapes round and tear shape. Tear drop silicone implants are cohesive (like gummy bears) maintain their shape and are ideal in tuberous breast that have irregular shape. She also treats women who have asymmetric “tuberous”breasts and can achieve greater symmetry by inserting breast implants of different sizes.
Round implants does not tend to push the skin downward in the same way as tear drop implants so round implants are not ideal in tuberous breasts or patients with little breast tissue. Round implants are typically used in patients with adequate breast tissue who want more volume.Tear drops are also used as well.
Dr. Pfeifer emphasized that the implant selection has to be proportional to the hips and frame, frame, the width of the implant should reflect the natural flare of the hips, the degree of projection and height of the naturally occurring breast dimensions all come into play when selecting the ideal implant size and shape.
Problems with Breast Surgery Implants:
Capsular contraction is a firm capsule that sometimes forms weeks, months to years after surgery. The capsules can cause discomfort and is a problem that occurs more commonly with smooth outer shelled implants compared with textured outer shell implants. Sometimes the capsular contraction requires the implant to be removed, the capsule is removed and a new implant is inserted.
Do silicone implants leak?
“No, you can develop a tear in the outer shell but the silicone is cohesive and no longer migrate.”
Do implants have to be replaced?
“There previously were recommendations that implants should be replaced every ten years but the implants that are now used no longer require replacement provided the overlying skin does not stretch over time.”
Does 3-D Imaging help preoperatively to assess a patient and give them an idea what to expect?
“3D imaging currently is used to estimate the size of the implant but in the future the technology might have the potential to create custom size implants for patients to achieve an even more perfect breast.”
During surgery different sizers are sometimes used to “see” the ideal size and shape in order to achieve the best aesthetic result. This is also achieved by sitting the patient up during surgery so that Dr. Pfeifer can see what the effect of gravity on the implant is in a vertical position. This chat about cosmetic breast surgery was full of insights about cosmetic breast surgery and I could not thank Dr. Tracy Pfeifer more for her time and the expertise that she shared with all of us on the Beauty Doc Podcast.
