Breast Augmentation

Breast augmentation surgery is an area of special clinical interest to Dr. Samuels, and is one of our most commonly requested surgical procedures. Dr. Samuels trained at the prestigious University of Texas Southwestern (Parkland and Baylor Hospitals), which has been named the #1 plastic surgical residency training program for the last 15 years. It was while in Dallas that Dr. Samuels trained with the surgeons who developed the new shaped silicone breast implants that were approved by the FDA in 2014. Additionally, having been specially selected among only a handful of providers in the U.S. to conduct clinical research on today's breast implants (which spanned two decades), Dr. Samuels does not believe that there is a single breast implant which suits all patients. Therefore, Dr. Samuels uses round as well as shaped implants, smooth as well as textured saline and silicone gel breast implants, and implants from all three brand name companies, rather than just a single device or manufacturer. She uses a detailed bio-dimensional approach based upon each patient's unique breast measurements and an assessment of soft tissue needs in order to select the best implant for each woman. As women themselves, Dr. Samuels and her staff are uniquely equipped to understand the needs of the female patient seeking breast enhancement surgery.

Types of Implants

1. Saline - Saline implants are filled with sterile saline, or salt water, which is a natural body substance. These implants are placed within the implant pocket and are then inflated with saline to the desired volume. While the incidence of rupture is low, it is slightly higher than with silicone gel due to the fluid nature of the filler as well as the presence of the fill port which can fail. Since salt water is absorbed by the body, a rupture is more easily detected by the patient. Should a rupture occur, all of the brand name implant manufacturers provide a lifetime warranty for replacement of the device. Also since the implant is filled with a fluid, the risk of rippling, wrinkling and heaviness in the lower pole of the breast are greater than with a silicone device, and it is easier to feel the edges of a saline device . The more soft tissue coverage provided, the less noticeable these findings will be. For this reason, most saline devices are placed beneath the pectoralis major muscle if possible and are not as popular as their silicone gel counterparts.
2. Silicone (Gel) - Round and shaped, smooth and textured silicone implants are filled with a semi-cohesive silicone gel that gained FDA approval in 2006. These implants are unlike the old liquid gel devices used previously, in that the gel is thicker, rupture and capsular contracture are infrequent, and if there is a device failure (which is actually less likely than with a saline device), the gel sticks together and would be unlikely to leak into surrounding breast tissue. If a mammogram were suspicious for implant rupture, an ultrasound or MRI might be indicated for diagnosis. Cohesive round devices are available in three different projections, and textured shaped devices also exist. Many women believe silicone gel devices feel softer and more similar to normal breast tissue than saline implants, with less chance of detectable rippling, wrinkling, or edge palpability.
3. Cohesive shaped ("Gummi-bear") implants - All three brand name implant manufacturers have historically made anatomically shaped, more cohesive silicone gel implants, most of which gained FDA approval in 2014. Dr. Samuels is one of fewer than 30 surgeons in the U.S. selected to complete the clinical trial of some of these textured, shaped devices. These devices remain safe and extensively studied and widely used in Europe and the U.S., and textured shaped devices remain some of the best devices for breast implant revision and reconstruction patients. Since Dr. Samuels was one of the few surgeons in the U.S. who were approved to use the early shaped and round high profile devices, patients come from all over the U.S. for evaluation. Shaped devices provide a great option for patients who desire a more natural breast shape and for revision patients. Also, the more cohesive the filler, the more "form stable" its shape will be, and the lower the capsular contracture and rupture rates will be. In 2019, Allergan's textured saline and silicone gel shaped devices were removed from the market for general use due to a very low risk/association with a capsular disease process known as BIA-ALCL. ALCL (Breast Implant Associated - Anaplastic Large Cell Lymphoma) was reported to have developed in the capsule of 0.03% of all textured devices. Sientra and Mentor's risk of this rare disease is at least 6% lower than that of Allergan, so Sientra and Mentor do still make a differently textured device that is still available for those patients who would receive a better cosmetic result with a textured, shaped device (than with a smooth round device). The nuances of which breast implant is best for each patient is carefully discussed with each patient at the time of their personal consultations. For more information on ALCL, please visit plasticsurgery.org or contact our office.

Best Candidates for Breast Augmentation

This surgery is usually performed for women whose breasts are undersized in proportion to the rest of their body, or women who have lost fullness due to pregnancy, aging or weight loss. The surgery may also be performed for congenital deformities or breast asymmetry.

Surgical Planning

The surgical procedure involves the insertion of an individually selected implant chosen to provide the look and feel of natural breast tissue. The incision location is chosen individually for each patient, but usually is concealed in the breast fold, axilla or areola.

Implants may be placed either on top of or beneath the pectoralis major muscle, depending upon individual characteristics of the implant and each patient. Routine screening of implanted patients by mammography proceeds according to the recommendations of The American Cancer Society and may be supplemented by MRI at intervals for gel patients, although this is not made mandatory by the FDA. You should alert your mammographic facility to the fact that you have breast implants so that additional views will be taken to adequately visualize the breast tissue. If this is done, breast cancer detection rates are unchanged after implant surgery. Likewise, breastfeeding is also possible following implant placement, but we would like to know if this is planned when we discuss surgical timing and incision selection.

Surgical Preparation

Dr. Samuels and her staff will give you specific instructions regarding surgical preparation including medications to avoid and nicotine cessation two weeks prior to surgery. The surgery is performed under local anesthesia with intravenous sedation or a light general anesthetic as an outpatient. Dr. Samuels was an initial owner/investor at Baptist Eastpoint Surgery Center and prefers to utilize this 5-star facility (with special pricing), but can also accommodate patients at Premier Surgery Center, Baptist Hospital East, Norton Brownsboro Hospital, and Jewish Hospital Medical Center East.

Post-Operative Care

Quick Recovery Breast Augmentation - While all surgeons do not utilize this surgical technique, Dr. Samuels learned this carefully controlled technique while training in Dallas with the world's leading breast surgeons. This technique not only limits true recovery to merely days, it also drastically reduces revision rates with breast augmentation to less than 5%. View our blog postings on the Quick Recovery Technique and Revisional Surgery to learn more about them. All sutures are dissolvable and patients may resume normal daily activities immediately.

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