Denver Breast Augmentation and Breast Augmentation Surgery

Breast Augmentation Surgeon in Denver

Breast Augmentation - For women who feel that the breasts are too small or have become too small after childbearing, or just the passage of time, breast enlargement ("Augmentation Mammaplasty") may be the right operation. Through the insertion of a silicone implant placed behind the natural breast tissue, either under or on top of the pectoral (chest) muscle, the breasts are filled-out, lifted and enlarged in a natural-appearing and pleasing fashion.

The best candidates for breast augmentation are women who are seeking improvement, not perfection, in the way they look by enhancing the size, shape, and projection of their breasts. At Grossman Plastic Surgery®, breast enlargement is one of the most commonly requested procedures. Generally, the reasons cited by patients for desiring this surgery are:

• Breasts that have always been too small
• Lost breast volume following pregnancy, with or without breast feeding
• Need to correct breast asymmetry (unevenness from one side to the other
• For breast reconstruction after mastectomy

As with any cosmetic procedure, the other prerequisites for being a candidate for surgery are being in good physical and emotional health. This does not mean that someone with a chronic health condition such as diabetes or high blood pressure is not a candidate. It’s just that the medical condition needs to be under control and properly managed before surgery.
As for emotional health, this is perhaps more subtle. A poorly controlled or uncontrolled mental condition would disqualify someone for this or any cosmetic procedure. Similarly, you must have reasonable expectations regarding the results of surgery. This might include understanding and accepting that:

• The human body is asymmetric (not even) and that the breasts may not appear exactly the same
• The surgery will not repair a troubled marriage or relationship
• The surgery will not win you a job for which you are unqualified

Breast augmentation can enhance your appearance and your self-confidence, but it will not necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Grossman or Dr. Capraro.

The basic underlying principles of breast augmentation are that a space is surgically created behind the breast tissue and a soft silicone implant is inserted into that space. The space may be either on top of or beneath the pectoral muscle (the chest muscle). 

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Breast implants of one sort or another, in contrast to injected materials, have been successfully used in breast enhancing surgeries since approximately the 1950's. However, since 1963, when silicone gel prostheses (implants) were introduced, there have been numerous developments, changes and advances in breast implant technology. Breast implants of one sort or another, in contrast to injected materials, have been successfully used in breast enhancing surgeries since approximately the 1950's. However, since 1963, when silicone gel prostheses (implants) were introduced, there have been numerous developments, changes and advances in breast implant technology.

All current breast implants consist of 2 parts:

1- an outer covering or  “shell” which is made of solid silicone, and
2- a substance that fills the shell. The shell can be either smooth or have a rough surface, referred to as a “textured surface”. The texturing process has been claimed to reduce the incidence of “encapsulation” or forming tight, unyielding scar tissue around the implant, which makes the breast feel hard. The data is still inconclusive and our plastic surgeons prefer smooth implants.

The substance that fills the implant is either saline (sterile salt-water) or a gel of silicone. In the United States, the saline-filled implants are initially empty and are filled by the surgeon during the operation. The silicone gel-filled implants come already filled from the factory. The silicone that fills implants these days is a bit like jello-mold in that it tends to stick together, a characteristic described as being “cohesive”. One of the manufacturers refers to its silicone gel material as MemoryGel®. The gel filler is virtually the same from both major manufacturers (Allergan Corporation and Mentor Corporation) of breast implants.

Sizing
The ultimate cup size achieved is, of course, among the most important and challenging aspects of breast augmentation. There is no way to provide each patient with an exact visualization as to what they will look like when the surgery is completed. There are a number of means of trying to arrive at a general idea of ultimate cup size and appearance. These are reviewed with our patients at consultation, follow-up consultation, and finally on the day of surgery. We encourage the use of photos from magazines and websites to portray what each patient likes, dislikes, and ultimately desires for their own final result. Needless to say, this is an area in which prospective patients need to understand the limits of cosmetic plastic surgery and the uniqueness of each person’s tissues, shapes, and genetics. Selecting which implant volume will accomplish the desired result is something that takes place in the operating room.

There is also the question of implant shape. In general, Dr. Grossman and Dr. Capraro believe that the “round” implant shape, rather than the “teardrop or anatomic” implant produces the most natural result. Both the smooth and textured implants are available in a variety of sizes or volumes. As the implant volume gets bigger, the circumference of the implant is greater as well. Which size implant is used depends on a number of things such as patient height, weight, and chest dimensions; amount of breast tissue already present; elasticity of the skin; desired final size; and so on. The same size implant in two different women will produce two different breast sizes. The sizing process is not an exact science. Drs. Grossman and Capraro can't just pick a particular implant "off the shelf" to accomplish a specific size. It’s not as if there is a specific A, B, C, and D cup sized implant. Sizing is an approximation. But Dr. Grossman has been performing breast augmentation in Denver and Beverly Hills for more than 30 years and has performed literally thousands of breast implant surgeries. Dr. Capraro has also had significant experience in this surgery. As such, they have developed a very flexible approach to this surgery in which they actually are creating a “custom-made” breast enlargement for you.
 
Each implant type – saline vs. silicone gel – has its own benefits and shortcomings. Among the benefits of saline inflatable implants is the ability to fill one side more than the other to help correct some natural breast asymmetry that everyone has. In addition, it has been suggested that encapsulation occurs somewhat less frequently with saline implants than with silicone-filled. However, recent data seems to refute this assertion, and it appears that both implant types have about the same incidence of encapsulation. On the other hand, saline implants have a greater degree of “rippliness” and do not feel quite as natural as silicone gel-filled implants.

All implants will eventually break. It’s just a matter of time. They don’t break because you abuse them. They are very durable. But over time, through wear-and-tear, a weakness develops in the shell and the implant breaks. The probable lifespan of an implant is between 10 and 20 years. All patients should understand that they are likely to have to replace their implants at some time or other.
Overall, Drs. Grossman and Capraro prefer silicone gel-filled implants because they:

• Feel more natural
• Are more durable
• Don’t go flat when they break

If you have other questions concerning implants, please refer to Breast Augmentation FAQ’s.

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In any discussion or recitation of risks, not every conceivable risk or potential consequence can be mentioned. The ones that are touched on are those that occur with some relative frequency. Besides the general risks associated with any surgical procedure, there are the risks that are unique to that surgery. In the case of breast enlargement (augmentation mammoplasty), among the specific risks are:

Hardening Encapsulation – A veil of scar tissue naturally forms around the breast implant after surgery. If that scar tissue thickens and tightens, it is called ("capsular contracture"). It can result in a breast that feels hard and may look distorted. If this does not respond to non-surgical methods of treatment such as regular breast massage and compression, surgical release may be necessary.

Interference with Mammography – The position of the breast implant may make interpretation of a standard screening mammogram more difficult. Therefore, with breast implants, it is important to go to an experienced mammography center where the needed special mammogram views can be done, and where ultrasound examinations are available as well. There is no evidence of a relationship between implants and breast cancer!

Interference with Breast-Feeding – If you have breast-fed before, breast implants should not interfere with breast-feeding in the future.

Leak or Rupture – Like any man-made device, breast implants can and do break. How often is not exactly known, but one manufacturer studied the saline-inflatable implant breakage over the past 13 years and found the incidence to be less than 1%. And, silicone-gel implants break less frequently than the saline. If a saline-inflatable implant breaks or leaks, the breast will "go flat", usually over a period of about a week. The saline (sterile salt-water) is absorbed into your system. If a silicone-gel implant breaks, and the silicone stays within the scar capsule that has been formed, you may not be aware that it has broken until it is discovered in a mammogram or ultrasound exam. If, however, the scar capsule breaks as well, the silicone can move into the adjacent tissue or even migrate to other contiguous areas, where the body surrounds it with scar tissue. Broken implants should be removed and replaced. Sometimes with silicone gel, it is not possible to remove all of it.

Rippling – This phenomenon is palpable and even visible ripples (seen as lines or grooves of the breast) appear to be most prominent in textured (rough surface) implants – especially those that are saline-inflatable – but also silicone-gel filled ones as well. It is probably a function of the thickness of the implant shell. In an attempt to avoid this visibly unpleasant phenomenon, we prefer implants with a smooth surface. They tend to ripple much less.

Autoimmune Effects – Beginning in the early 1990's, there was some concern about a possible causal relationship between silicone and a group of disorders of the immune system called "connective tissue disorders". Since that time, however, major scientific studies undertaken to examine any possible relationship have consistently not shown any. They concluded that silicone gel either in implants or that which escapes from a broken implant is unrelated to autoimmune disorders and symptoms.

For additional information concerning risks specific to breast enlargement, please consult with your own plastic surgeon, Dr. John Grossman, Dr. Philippe Capraro or the websites for ASPS (The American Society of Plastic Surgeons) or ASAPS (The American Society for Aesthetic Plastic Surgery).

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The operation is done as a day-patient/outpatient. While several types of anesthetic are possible, Dr. Grossman recommends a general anesthetic (complete sleep) which is administered by a physician anesthesiologist. The basic principle of this surgery is the placement of an implant behind the natural breast in order to lift and fill it out. Besides being behind the breast tissue itself, the implant will be placed either on top of or beneath the pectoral muscle of the chest.

Dr. Grossman usually prefers placement beneath the pectoral. Which option is selected depends on a variety of circumstances.

To place the implant, a "pocket" or space is created through an incision. Commonly used incision locations are:

• In the fold beneath the breast
• At the edge of the areola
• In the armpit

Dr. Grossman prefers either the areola or the fold beneath the breast for incisions.

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 Breast Enhancement FAQs

Can you be too young or too old to have breast enlargement surgery?
We generally do not recommend this surgery for anyone younger than 18 years of age. It is not a question of physical maturity as much as emotional maturity. Breast enlargement involves an alteration in body image, which may be disturbing to someone who is emotionally immature. Regarding too old, as long as you are in good health, there is probably no upper age limit.

Can the surgery be done under local anesthesia?
While Dr. Grossman prefers general anesthesia (complete sleep) for his patients, it is possible to perform the surgery under a local anesthetic. If this is the choice, Dr. Grossman recommends that a technique called a "thoracic epidural" anesthetic be used. In this technique, the anesthesiologist creates a local block for the entire chest area and then administers some sedation as well.

Does it make any difference if I haven't had children yet?
No. Breast implants should not interfere with either childbearing or breast feeding for that matter.

Do I have to stop smoking or should I use nicotine patches or gum instead?
The nicotine in cigarettes as well as the nicotine replacement medications have a very bad effect on the skin following surgery and can result in poor healing with areas of skin loss. This is not quite as critical in breast enlargement surgery as it is in other cosmetic procedures such as breast uplift or reduction. Nevertheless, to eliminate some of the adverse effects during healing, no smoking, nicotine replacements, or supplements following surgery for at least 1 week is desirable. Drugs that suppress the desire to smoke, such as Zyban can be used. Our staff will prescribe this for you if you wish.

Can I have the surgery if I have a family history of breast cancer?
Yes. While we say that breast implants may interfere with mammography, generally speaking, most good mammography centers believe that they can cope with the presence of breast implants and obtain complete mammograms. It’s just that you need to have a diagnostic, rather than a screening mammogram done if you have implants. Additionally, there is no suggestion whatsoever in all of the serious research that has been done that there is any relationship between breast implants and breast or any other cancers.

Can I drive myself home after surgery?
No. Between the postoperative pain, the residual effects of the anesthetic (even if it were a local anesthetic), and the fact that you need to limit any use of the pectoral muscles, driving yourself is out. You need to arrange to have someone bring you to surgery and take you back home.

Will insurance pay for my surgery?
No. This is a cosmetic operation and is not covered by health insurance. Very rarely, when there is a birth defect that results in a breast deformity or marked asymmetry that requires the use of a breast implant, there may be a possibility of partial coverage. But I wouldn’t count on it.

Can my boyfriend/husband watch the surgery?
No.

What about having the surgery in a doctor’s office instead of a hospital?
There are a number of possible locations at which this type of surgery is performed. Many types are suitable. However, Dr. Grossman uses exclusively his operating suites at the Rose Medical Center Ambulatory Surgery Center in Denver or a fully licensed, accredited outpatient facility when at his Beverly Hills location.