Breast Procedures:

Breast Augmentation

Breast enlargement procedures are some of the most common procedures performed by Dr. Chang. According to the American Society of Aesthetic Surgery, Breast Augmentation was the most popular surgical procedure in the United States in 2008. Although there are many patients who decide to have a breast augmentation when they are younger, the majority of patients decide to undergo a breast augmentation procedure to simply restore and rejuvenate their breasts after having children. After having children, their breasts lose volume and roundness, and the stretch on their skin leads to drooping.  The nipple-areola complex in some women also get larger.  These women simply want to return to some semblance of what they might have looked like before having children.

Some Reasons Why Women Choose Breast Augmentation
  • Loss of volume and fullness after having children
  • Difficulty in finding clothes
  • Small breasted woman who is self-conscious
  • One breast larger than the other
  • Marginal self-esteem
  • Desire for additional surgery such as a breast lift

breast implants before and after

Is Breast Augmentation right for me? Am I a good candidate?

There are many reasons why women might choose to have a breast augmentation procedure. The reasons, however, are unique to each individual. Some of the reasons are more intellectually based while some are more emotionally based. Whatever the reason, you can be sure that Dr. Chang will freely discuss them with you. Common reasons include:

  • Loss of volume and fullness after having children
  • Difficulty in finding clothes
  • Small breasted woman who are self-conscious
  • Breast Asymmetry - One breast larger than the other
  • Marginal self-esteem
  • Desire or need for additional surgery such as a breast lift

The majority of patients are young and healthy and in generally good health. Patients must be older than 18 years of age. Women with too much breast droop are not good candidates for a breast augmentation, but are often better candidates for a breast lift. All women over 40 require a preoperative mammogram, and all women over 45 require an EKG and standard blood work.

Do I need a breast lift (mastopexy)?

Children are the ultimate gift that keep on giving, but they often change your breasts and body dramatically. With pregnancy and breast feeding, the breasts engorge and then afterwards lose their volume and sag. The nipple-areola complex then enlarges and often, the mother is left with stretch marks. The result is breast sag, loss of breast volume and cleavage, and large areolas.

If these changes are minimal with minimal droop then an implant will provide needed volume and roundness with some breast lift. If the changes are moderate to severe, then a breast lift with an implant will be required to provide the necessary lift while an implant will provide the needed volume and roundness.

Choosing your implant type, incision and size
How to choose between a saline implant and a silicone implant

Silicone Implants
The main benefit of a silicone breast implant is how it feels. The cohesive gel feel more natural than its saline counterpart. The implant feels so real in fact that it is often difficult to feel the difference between a natural breast without an implant from one with a saline implant. Silicone breast implants, however, require longer incisions. In addition, there is less choice as to the location of the incision. The FDA has recommended that all patients choosing a silicone implant be monitored for leaks every 2 to 3 years. Silicone implants have less risk of rippling.

Saline Implants
Saline breast implants can feel very natural and was the only implant available for many years. Saline breast implants can be placed through very small incisions with a choice of placement in the axilla, around the nipple-areola, or the inframammary crease. Saline implants do not require further monitoring aside from a yearly mammogram

(A complete discussion of silicone implants and the history of silicone implants can be found below)

How to choose between the different incisions

Inframammary Crease
This is the most traditional type of incision, and is made beneath the breast in the natural breast crease. Two major benefits of the inframammary crease incision is that it has the lowest complication rate and is a very good healing incision because is hidden by the breast. This is the only choice of incision for patients who want a silicone implant.

Transaxillary Incision
A transaxillary Incision is hidden in the armpit. The highest complication rates include malposition and nerve injuries. However, the benefits include very good healing incision with no incision located on the breast.

Periareolar Incision
A periareolar incision is hidden in the natural junction between the areola complex and skin. While it is one of the best healing incisions, it may be obvious if the scar heals poorly.

What size implant is appropriate for you?

Size is a highly personal choice. Some patients want only a slightly larger implant. However, some patients want to be significantly larger. The rule of thumb is that the breast implant diameter should be equal or smaller than your natural breast diameter otherwise the implant will potentially distort the breast. But studies show that most patients having to do it over again would have chosen a larger implant. All of these options will be discussed during your consultation.

Why Choose Dr. Chang for Breast Augmentation?

Dr. Chang is Board Certified by the American Board of Plastic Surgery and has trained at some of the premier centers of plastic surgery in the United States, including a Plastic and Reconstructive Surgery Fellowship in Rochester, New York and a Cosmetic Surgery Fellowship in Beverly Hills and Newport Beach.

Dr. Chang is the owner and medical director of the Aesthetica Cosmetic Surgery and Laser Center as well as Radiance Salon and Medispas with offices in Loudoun (Leesburg and Ashburn) as well as Fairfax (Reston), Virginia.

Dr. Chang is trained in the latest techniques of breast augmentation and reconstruction and was an instructor for teaching the technique of Transaxillary Breast Augmentation to other plastic surgeons and residents.

Patient references are available upon request.

What is the Consultation Procedure Like?

Your consultation will begin with a personal consultation with Dr. Chang, and will include a discussion of:

  • Why you feel that Breast Augmentation would be good for you
  • If you are a good candidate
  • Choosing between a saline implant and a silicone implant
  • Choosing the type of incision
  • Determining what size implant is appropriate for you
  • Determining if a breast lift (mastopexy) would be a better option
  • Where is the surgery performed
  • What the recovery is like
  • When you can return to work
Where is the surgery performed?

All procedures are performed at either Countryside Ambulatory Surgery Center, INOVA Loudoun Hospital, or INOVA Fair Oaks Hospital. All of these facilities are Accredited facilities and are overseen by Anesthesiologists (not just a nurse anesthetist). No procedures are performed in the office setting.

What is the recovery like?
  • Patients will recover at home or at the Lansdowne Resort for out of town patients
  • Some patients can elect to purchase an On-Q pain pump which will eliminate pain for the first 3-4 days. Other patients will be given Vicodin or Percocet for pain. Most patients will need strong pain medicine for 2-3 days
  • Most patients return to work in 7-10 days
  • Light exercise may resume in 2 weeks
  • More strenuous exercise may resume in 3-4 weeks
  • Breast swelling can be dramatic for up to 4 weeks and requires 6 to 12 months to completely resolve
  • Final breast shape, settling, and size takes up to 6-12 months
  • Bruising and swelling take 2-4 weeks to improve.
  • The first postoperative visit is a day or two after your procedure. During this visit, your initial dressings are removed and you may start wearing a sports bra. Under wire bras are discouraged for the first 4 weeks.
  • Incisions are generally closed with absorbable sutures under the skin... there are no sutures to be removed. The scars normally take about a year to mature.
What Other Types of Breast Surgery Does Dr. Chang Perform?
  • Breast Augmentation
  • Breast Lift ( Mastopexy )
  • Breast Lift with Breast Implant
  • Breast Reduction
  • Nipple Reduction
  • Breast Areola Reduction
  • Mommy Makeover
What Is a Mommy Makeover?

The “Mommy Makeover” procedure has become a very important part of my practice. The majority of my patients are either new moms or women who have had children. Anyone who has experienced the joy of pregnancy could tell you that although their children are a blessing, what the process has done to their body is not. Most would tell you:

  • Breasts have lost their volume and roundness
  • Breasts are more droopy
  • Areola is larger and nipples are more elongated
  • Tummy is stretched and sticks out more
  • You have fat in places you have never been fat before
  • The face is more haggard (see topics on nonsurgical rejuvenation)

These women benefit from a combination of procedures I call a Mommy Makeover. As you can see, most women have predictable changes after becoming a mommy. These women usually, therefore, benefit from a combination of procedures that include:

  • Breast Augmentation with or without a breast lift (Mastopexy)
  • Full tummy tuck or mini tummy tuck
  • Liposuction of the flanks and thighs
  • Nonsurgical facial fillers and Botox

For more information, visit our Mommy Makeover page.

Dr. Phillip Chang is a Board Certified Plastic Surgeon with offices in Loudoun ( Ashburn and Leesburg ) and Fairfax ( Reston ) Virginia. Dr. Chang specializes in surgical and nonsurgical cosmetic enhancements including breast augmentation, facial lift surgeries, rhinoplasty, tummy tucks, and other Face and Body Procedures.

SILICONE BREAST IMPLANTS – THE HISTORY of THREE GENERATIONS

In my practice, I offer my patients the choice between saline and silicone filled breast implants. Within the context that both types of implants are medical-type devices, I feel that both implant types are generally safe. While there was some apprehension about the placement of silicone implants 3 years ago, the percentage of patients asking for silicone has increased in that time whereby I am placing more silicone implants now than saline.

  • Silicone filled breast implants were first developed and implanted in 1962 by the Dow Corning Corporations.
  • It’s most significant benefit, at least for my patients, is how they feel; silicone filled implants feel softer and more natural than their saline-filled counterpart.
  • Since 1962, there has been significant research and development to make the implants safer and more durable. In order to insure the safety of silicone implants, a moratorium was placed on the placement of silicone breast implants 1992.
  • By 1999, the IOM study of the FDA stated that there was insufficient evidence to establish that neither saline implants nor silicone implants caused systemic health effects and that there was no new health or safety issues associated with the use of either types of implants.
  • The IOM concluded that local complications are "the primary safety issue with silicone breast implants", making a clear distinction between local complications and systemic health concerns.
    On November 17, 2006, the moratorium has been lifted, making Silicone Implants available to patients.
First Generation of Silicone Breast Implants

The Cronin-Gerow Implant, which is generally recognized as the first silicone breast implant, was introduced in 1963. The implant was manufactured by the Dow Corning Corporation. Characteristics included a Dacron patch on the back to prevent rotation, and a tear drop shape, and filling with thick, viscous silicone gel.

The Second Generation of Silicone Breast Implants

In response to surgeons' requests for softer and more lifelike implants, breast implants were redesigned in the 1970s with thinner, less cohesive gels and thinner shells. These implants, unfortunately, had a greater tendency to rupture or "gel bleed" silicone through an intact implant shell, and complications such as capsular contracture were quite common. It was predominantly implants of this generation that were involved in the American class action-lawsuits against Dow-Corning and other manufacturers in the early 1990s.

In an effort to prevent the development of capsular contracture, implants were created with polyurethane foam coating. These implants were effective in diminishing capsular contracture by causing an inflammatory reaction that discouraged formation of fibrous tissue around the capsule. These implants were later briefly discontinued due to concern of potential carcinogenic breakdown products from the polyurethane. A review of the risk for cancer by the FDA later concluded that the risk was so small so as not to justify recommending explantation of the devices from individual patients. Polyurethane implants are still used in Europe and South America, but no manufacturer has sought FDA approval for sale in the United States.

Second-generation implants also saw the introduction of various "double lumen" designs. These implants were essentially a silicone implant inside a saline implant. The double lumen was an attempt to provide the cosmetic benefits of gel in the inside lumen, while the outside lumen contained saline and its volume could be adjusted after placement. The failure rate of these implants is higher than for single lumen implants due to their more complex design. The contemporary versions of these devices ("Becker Implants") are used primarily for breast reconstruction.

Third and Fourth Generation of Silicone Breast Implants

Third & fourth generation implants, from the mid 1980s, saw the development of elastomer-coated shells to decrease gel bleed which were filled with thicker, more cohesive gels. The increased cohesion of the gel filler reduced potential leakage of the gel compared to earlier devices and the more substantial shell improved durability as compared to 2nd generation implants. A variety of both round and tapered anatomic shapes became available from different implants in this group. The anatomic or shaped implants were uniformly impregnated with a textured surface to reduce rotation, while round devices are available in both smooth or textured surfaces.

How Did Silicone Breast Implants Gain Approval from the FDA

Silicone gel-filled breast implants were first introduced in the United States 1962 by Cronin and Gerow. As a response to reports of implant failure and allegations of resultant complications and illness, in 1988 the U.S. Food and Drug Administration (FDA) announced that all breast implants would be subsequently relabeled as class III medical devices, and called for data from manufacturers showing the safety and effectiveness of these devices.

In 1992, the FDA placed a moratorium on silicone gel breast implants for cosmetic purposes. The FDA concluded there was "inadequate information to demonstrate that breast implants were safe and effective." Access to silicone gel-filled breast implants continued to be allowed under controlled clinical studies for reconstruction after mastectomy, correction of congenital deformities, or replacement of ruptured silicone gel-filled implants due to medical or surgical reasons. Implant manufacturers were required to collect clinical trial data and were allowed distribution of the implants to a limited number of augmentation patients for these studies.

In mid-1992, the FDA approved an adjunct study protocol for silicone gel-filled breast implants for reconstruction and revision patients. That same year, silicone and breast implant manufacturer, Dow Corning, announced that it would no longer make five implant grades of silicone, but that it would continue to manufacture 45 other medical grades of silicone materials. Just three years later, in 1995, Dow Corning Corp., once the major manufacturer of silicone breast and other implants, faced 19,000 lawsuits, pushing it into bankruptcy.

In 1997, the Department of Health and Human Services (HHS) began one of the most extensive research studies in medical history by appointing the Institute of Medicine of the National Academy of Science (IOM) to examine potential complications during or after silicone-based breast implant surgeries. After reviewing years of evidence and research concerning silicone gel-filled breast implants, the IOM found that "Evidence suggests diseases or conditions such as connective tissue diseases, cancer, neurological diseases or other systemic complaints or conditions are no more common in women with breast implants than in women without implants." Most individual studies and all systemic review studies have also subsequently failed to find a link between silicone breast implants and disease.

In 1998, the FDA approved adjunct study protocols for silicone gel-filled breast implants for reconstruction and revision patients only and also approved, later that same year, the corporation's IDE study for silicone gel-filled breast implants for a limited number of augmentation, reconstruction, and revision patients.

In 1999, the IOM released a comprehensive report on both saline-filled and silicone gel-filled breast implants entitled Safety of Silicone Breast Implants. The determination was that there was insufficient evidence to establish that either or both types of breast implants cause systemic health effects and that there was no new health or safety issues associated with the use of both types of implants. The IOM concluded that local complications are "the primary safety issue with silicone breast implants", making a clear distinction between local complications and systemic health concerns. Bothersome results such as rupture, pain, capsular contracture, disfigurement, and infection, were stated to be possible local complications that could require medical intervention or repeat surgeries.

In 2000, the FDA granted approval of saline-filled breast implant PMAs, showing data on the types and rates of local complications experienced by patients. “Despite complications experienced by some women, the majority of those women still in the Inamed Corporation and Mentor Corporation studies after three years reported being satisfied with their implants.” Both PMAs were approved for breast augmentation to females of at least 18 years of age and for breast reconstruction.

The manufacturers continued to improve their gel-filled products, developing more cohesive gel implant, and continued with their studies. On November 17, 2006, the FDA lifted its restrictions on the use of silicone gel-filled breast implants produced by the two manufacturers for breast reconstruction and for cosmetic breast augmentation. The approval was given with a number of conditions including a requirement to complete 10-year studies on women who have already received the implants and a 10 year study on the safety of the devices in 40,000 women.

The post-approval studies will be closely monitored by the FDA. The FDA warned that the implants are not without risk and that women receiving implants should be suggested to have periodic MRI exams to watch for any signs of rupture or leakage. It was also mandated that patients be given brochures explaining the risks.

Currently the FDA has approved silicone gel-filled breast implants and over a million women around the world have already received these implants.

Click here to learn about Natrelle™ breast implants.

Dr. Phillip Chang is a board certified plastic surgeon with offices in Loudoun ( Leesburg ) and Fairfax ( Reston ) Virginia. Complimentary consultations are offered at Aesthetica Cosmetic Surgery and Laser Center as well as Radiance Salon and Medispa. Dr. Chang sees patients from Virginia, Maryland, and DC. Areas including Winchester, Frederick, Leesburg, Ashburn, Chantilly, Sterling, Middleburg, Fairfax, Reston, and Vienna.

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