Medical Tourism, like the name implies, is part medical and part tourism, and as a treatment consultant, I receive multiple inquiries daily about a wide array of treatments.
As you can probably imagine, providing the best, updated information is essential for my clients. So, when I get the chance and a few spare moments, I schedule a little time to sit down and speak with some of our specialists for a bit of continuing education.
And recently, that’s what I did with one of our distinguished MTH board-certified plastic surgeons, Dr. Istvan Szemerey. I’ve been working with Dr. Istvan since 2007, and I presented him with a few questions about breast implant surgery and breast implants. Dr. Istvan is a specialist in breast augmentation. In the 1990s, he was part of one of the first groups of research plastic surgeons exploring the then-new silicone material chemistry.
I thought I would share my questions and his responses, which I promise will help you in your understanding of breast augmentation. Our time was limited, so consider this just a brief bit of continuing education.
Dr. Randy – Many patients ask me whether they should have round-shaped or anatomical ‘teardrop’-shaped breast implants. How do you generally make this type of evaluation for patients?
Dr. Istvan – This really depends on the patient. Usually, I say that if a patient has enough natural breast tissue, then it makes less difference what type of implant is used. By enough tissue, I mean, I can measure a minimum of 3-3,5cm of natural breast tissue thickness over the chest wall. In these cases, the breast tissue that covers the implant makes up the difference that the shape of the implant would make. So, it matters much less what type of breast implant we choose.
In patients with petite breasts or less than 3cm of natural breast tissue thickness, the decision is up to the patient whether she wants more defined cleavage or a softer, more natural look.
Dr. Randy – I also get asked a lot, what happens if the implants rupture. Will they leak into my body?
Dr. Istvan – It used to be that breast implants were made from a more ‘liquid-like’ silicone material. And, it’s true that if there were ruptures, that the implant could (and in many cases would) leak to cause irritation, inflammation, or even systemic illness. The only solution was explantation(breast implant surgery removal), and that left patients with a whole new set of issues. Thankfully, nowadays, a much more cohesive(sticky) form of silicone is used inside the implant, so there is no leakage, even if the implant (capsule) breaks. As a matter of fact, a capsule break may go utterly unnoticed for long periods.
Dr. Randy – Can you talk a little about implant placement. Should breast implants be under the breast tissue or underneath the chest wall muscle?
Dr. Istvan – submuscular placement is what we actually call the ‘dual plane’ technique. In the dual plane method, only a part of the chest wall muscle(upper 1/2) covers the implant. The rest of the implant(lower 1/2) lies underneath the breast tissue. So, it’s a bit of a misnomer to say that the implant is submuscular as it’s only partially covered by the muscle. The reality is that the muscle isn’t big enough to cover the entire implant. So, the dual plane is what we call submuscular.
Most plastic surgeons around the world use this dual plane technique as their preferred technique for the insertion of implants during breast implant surgery.
There are a few instances when placing the implants strictly under the breast tissue would be the best choice. For example, if the patient has a very strong chest muscular wall or uses her chest muscles in athletics or heavy sport. In this case, I wouldn’t want to cut the chest muscles to insert an implant. This would weaken the muscles and could adversely affect her performance. But, these are extreme cases only.
Another instance that I would use subglandular implant placement is when the patient has tubular breasts. With tubular breasts, the whole movement of the breast is more in harmony than with a dual plane placement.
Of course, I can’t leave out one of the most important reasons to place the implant under the breast only – that is what the patient wants!
Dr. Randy – many women today are heavily into sports and even bodybuilding. Would you place breast implants under the breast tissue or the chest muscle in a female bodybuilder (or athlete), for example?
Dr. Istvan – Yes, as I mentioned previously, this is a perfect example of a case where I would choose a subglandular placement over the dual plane technique. Female bodybuilders have strong chest muscles under their breasts. With many professional bodybuilders, their natural breast tissue is less anyway, and therefore, breast implant surgery results in a slightly less natural look with a more defined cleavage.
Dr. Randy – What’s the best practice to lift sagging breasts? Can an implant help?
Dr. Istvan – this really depends on the degree of sagging. If there is just a mild sagging to the breasts, then I would choose an implant with a higher profile or forward projection. In the course of healing after surgery, the implant and the patient’s breast tissue adhere to one another, and this adds lift and support to the breasts.
In those patients that have more severe sagging, an implant is simply not enough. I have to make a breast lift(mastopexy) surgery, and the patient can decide whether she wants to have an implant together with the lift or not.
Dr. Randy – I’ve heard about the ‘Double Bubble’ effect, but could you say a few words about what this healing complication is?
Dr. Istvan – as I already mentioned, after an implant is inserted, the breast tissue adheres to the implant capsule. This fusion holds the implants in position relative to the breasts and, thus, keeps the breasts from slipping lower, off the implants. There are some cases where this fusion doesn’t occur well, and the breasts slip off, creating a double bubble effect. This is not a surgical error, but rather a complication of the healing process.
Dr. Randy – this question comes up quite frequently among inquiring younger patients looking for breast augmentation surgery. Does breast augmentation affect breastfeeding?
Dr. Istvan – for a breast implant surgery, we make the incisions right below the lower part of the breast in the inframammary fold. It doesn’t matter whether I’m using a round implant, anatomical one, or placing the implant subglandularly or in the dual plane. The incision is the same, and the placement is always underneath the breast tissue. So, it does not affect the ability of a mother to breastfeed.
Dr. Randy – as a follow up on the previous question, what about nipple sensitivity?
Dr. Istvan – yes, again, the incision that I mentioned for breast implant surgery is made in the lower part of the breast or in the inframammary fold. The nerves to the breast and nipples come from the lateral side of the breast, so as long as the incision doesn’t extend too far laterally, there shouldn’t be any issue regarding nipple sensitivity. The incision should stay within the midline of the inframammary fold. With that said, however, it can happen that the patient experiences either a loss or an increase in sensitivity to the nipples after surgery. This issue usually resolves on its own after about 6 months or so. So, it’s not something the patient needs to be too worried about. It does happen.
Dr. Randy – What type of implants do you prefer to use, smooth- or textured- surface implants?
Dr. Istvan – actually, nowadays, all around the world, plastic surgeons use textured surface implants. This used to be a question some years ago, but today not. I prefer implants from the highest quality manufacturers like Polytech from Germany, but there are others as well that are equally good. I’ve been using Polytech implants many years now, and I trust the quality, and my patients love the results.
Dr. Randy – Thank you again for your time. Is there any aspect of breast implant surgery that demands more from you? In other words, what the biggest challenge for you in breast augmentation?
Dr. Istvan – in my experience of being a plastic surgeon, I’ve always found the biggest challenge is secondary breast implant surgery.
Whether it’s a result of time, aging implants, or normal breast aging, the challenge is always about how to create a fresh look and refreshed breasts. I need to think out of the box and not always use the regular rules.
This is when I need to be my most creative.
Dr. Randy Simor