Welcome to the Stephens Plastic Surgery Guide for Breast Enhancement
Dr. Stephens is considered one of the Puget Sound region’s experts on cosmetic breast surgery including breast augmentation and breast lift procedures, (mastopexy), as well as complex revision breast procedures. He is one of the nation’s experts in using the TEAM® procedure, as he was one of principal surgeons behind the development of it in the 1990’s.
His technical knowledge, skill and experience provide an intimate understanding of how breast implants and breast tissue work together to shape the breast. Just as important, during your consultation and preparing for your procedure, our wish is to understand your aspirations and concerns and work with you to achieve your individual aesthetic goals. To this end, we are one of the few practices in the Northwest that use the Vectra 3D Imaging System® that shows how you will look after your augmentation procedure.
Breast augmentation, (breast enhancement with implants), remains the safest, most reliable and effective way to improve the size and shape of your breasts. The FDA has established that silicone implants are safe and reliable through rigorous research and long term studies. They have been among the most thoroughly studied of all medical devices. The new, IDEAL Implant, which is a “structured” silicone/saline filled implant designed to feel like a silicone device, is a great alternative to silicone gel implants as well.
Each woman’s body and breast shape is unique as is her thoughts about her breast size and proportion to her body. Most women having breast augmentation want to better balance the upper torso to their waist, hips, buttocks and legs to improve their feminine silhouette as well to be proportionate in their clothes and swimsuits.
Women who have breast implants are happy with their bodies but find that their breasts are proportionately too small and want to improve their self-image and confidence in their femininity and feel better in clothes and swimwear as well as athletic gear.
We provide a very thorough and comprehensive consultation regarding breast procedures including breast augmentation. During your consultation, we will get background information about your breasts, your breast health and overall medical history. We perform a Vectra 3D Image®, that allows you to see an image of the size and shape of your breasts and body following breast augmentation when comparing different types and sizes of breast implants. It is an amazing and effective way to see what your potential results can look like. We love the way it provides a discussion of breast implant concepts and is very popular with our patients.
We take time to share your goals and specific personal considerations for your breasts. Our desire is to create your breast that enhances and balances your silhouette while providing a natural breast shape. We discuss the long term considerations and implant safety in detail as well as well as newer techniques in breast surgery.
Breast augmentation procedures are performed in our AAAASF certified and state licensed, “state of the art” in office, ambulatory surgical center (ASC). Our board certified anesthesiologist uses a gentle, fast acting, light general anesthetic so that you will not feel anything in your procedure, with a fast, comfortable recovery. Our experienced team is committed to ensure a safe, pleasant and comfortable experience.
Dr. Stephens uses three approaches to place implants: the inframammary, areolar and trans-axillary, (armpit) incision. Each approach has advantages and disadvantages. The traditional inframammary incision, is the most straightforward and simple approach to the breast pocket and can be nicely hidden in a deeper crease where the breast meets the chest called the inframammary fold. In poorly developed shallow folds, particularly in young women, the scar can show though. The infra-areolar incision, can blend in nicely with the areola and is popular in our Asian or darker pigmented skin s because the scar generally heals darker and blends in nicely in the areola. Areolar scars typically hear well also.
In the 1990’s as an assistant professor, Dr. Stephens and his colleagues embarked on developing new minimally invasive procedures using small hidden incisions under the legendary leadership of his chief, Dr. Luis Vasconez. As a result, they developed a new approach to breast augmantation using the (T)Trans-(A)xillary (E)ndoscopic assisted (A)ugmentation (M)ammoplasty, (TEAM) procedure. Using an incision nicely hidden within the armpit, the endoscope is placed allowing a precise dissection and creation of a breast pocket for the implant. Both round and certain shaped breast implants can then be inserted while hiding the scar completely off of the breast and chest wall. It has been a workhorse as he has done literally thousands of these procedures through the years with happy results.
Dr. Stephens generally places the implants in the partially sub-muscular position under the pectoral muscle and breast tissue which gives a nice natural shape to the breast. It preserves nipple and breast sensitivity and the ability to breast feed. “Sub-muscular”, breast implants have a much lower incidence of capsular contracture than above muscle implants and do not thin out the breast tissue nearly as fast over the years as above the muscle implants. It simply causes much less wear and tear to the supporting breast tissue due to the ability of the muscle to “protect the breast”, as it helps to support the breast implant. Sub-muscular implants allow for more accurate mammograms and safer breast biopsies if they are ever necessary. The minor downside of sub-muscular implants is a mild change in the breast shape when flexing the pectoral muscles. It can be used in athletes and active women as it doesn’t affect pectoral muscle strength.
Choosing Implant Size Simply Understood
Probably the most common question that comes up in breast augmentation is how breast implant size relates to a desired breast size. In your consultation, we discuss the idea of dimensional breast analysis which describes your breast size and shape as well as the relationship of your breast with your chest and body type. We review the concept of the “breast footprint” or the “base width” of the breast and how it determines the width of the implant to give a desired proportionate result. We review how the different projections of the breast implants affect breast size and especially the breast shape. Implants
Breast implants are either made of silicone gel or saline filled, silicone shell implants. Silicone implants come as round or shaped implants. Implants have a smooth or a textured surface but all shaped implants have a textured surface which allows them to adhere to the breast tissue and prevent them from rotating.
Silicone Implants – (What is cohesive? What are gummy bear implants?)
Most women opt for silicone gel implants because their softer feel is similar to breast tissue. Breast implants come in different projections, (the distance of the implant from its base on the chest to the front of the implant). As an example, Allergan makes breast implants with low, low-plus, moderate, high, (full) and extra high, (extra-full) projection. The most popular styles are the moderate and high profile (projection) implants. Cohesiveness just means that there are more crosslinked polymers of silicone gel that provides structure to the gel. All modern breast implants have cohesive gel but the cohesiveness varies between implant types; some cohesive implants are softer, like “Jello®”, while more highly cohesive implants the “Gummy Bear” implants, have more crosslinking and therefore are firm. They retain their shape whether they are flat or standing up on their edge. Gummy Bear, or “Form Stable”, implants are found in both shaped and round types.
In any given style or type of breast implant, as the implant volume gets bigger, they get wider; the implant projection doesn’t really change that much from small to larger volumes. Likewise, as the implants get smaller they get narrower. The key is to “fit” the implants within the breast, like a “hand in glove”, to give it the ideal desired size and shape. A narrower breast will not need as large an implant as a wider breast. So a moderate profile 360 cc implant is .75 cm wider than a moderate 310 cc implant but has only 0.2 mm more projection.
A new hybrid, “structured” saline filled implant has become quite popular in our practice that is called the The Ideal® Implant. It has two chambers, one that is adjustable containing baffles inside it to reduce the “water bag feel”, thereby giving it a softer feel, similar to a silicone gel implant, without the need to monitor the implant with MRI studies for failure and gel leakage. Learn more about the The Ideal® Implant.
Patients vary in their recovery so it is misleading and dangerous to suggest a 24 hour recovery with early unlimited activity. We have a “fast recovery”, program to get you back to your activities as soon as reasonably possible. This combination of nerve blocks to the breast at the time of your surgery as well as the mix of a potent anti-inflammatory, muscle relaxant medications and tailored pain medications has been consistently successful in providing a speedy recovery. Early range of motion exercises, icing and quiet activities are encouraged as well as application of ice to the pectoral muscles followed by gentle heat, unless a breast lift is performed. This comprehensive care plan eases your discomfort as the implants settle in place. Sub-muscular implants require more time for recovery to allow the pectoral muscle to adapt to the implant. Larger, high profile implants as well as breast implants in women who haven’t had children can take longer to settle into their natural position with potentially more discomfort.
Following your procedure, you are seen frequently in the first month to assess your progress. We provide instructions for long term care and maintenance of your implants. Following this, we will see you periodically to monitor your progress and are available for any questions that may arise. Our experienced and caring staff is here to help you through every step of your recovery. We welcome you to return or contact the office following your surgery should you have any concerns or questions.