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Stephen Miller MD PC FACS
Breast Augmentation Surgery
Model Discovery Health

Breast Augmentation in Las Vegas NV – Saline and Silicone Breast Implants

Having a breast augmentation can increase confidence, self-esteem and body image. The most common reasons to choose a breast augmentation are;

  • Breasts are too small
  • The upper part of your breast appears “empty”
  • Breasts are asymmetric (not the same size or shape).
  • One or both breasts failed to develop normally or have an elongated shape
  • Drooping or sagging breasts after pregnancy and breastfeeding
  • Changes in breast size or shape due to weight loss or with aging
  • Reconstruction after surgery to treat breast cancer
  • Cosmetic improvements after breast reconstruction

You are NOT a candidate for breast augmentation if:

  • You are under 18 years old
  • You are pregnant, breast feeding, or recently stopped breast feeding
  • You have a severe illness or infection
  • You are being treated for Cancer

What breast augmentation surgery won’t do;

Breast augmentation does not correct severely drooping breasts. If you want your breasts to look fuller and to be lifted due to sagging, a breast lift (Mastopexy) may be required in conjunction with breast augmentation.

A Breast lift can often be done at the same time as your augmentation or may require a separate operation. Your plastic surgeon will assist you in making this decision.

Your Complimentary Breast Implant Consultation

The decision to have breast augmentation surgery is a very personal decision for women. First Dr. Miller will go over your health history to make sure that you are healthy enough for surgery.  If Dr Miller determines that you are a good candidate for the surgery he will go over all the options that will work best for your body. Each womens body is very different and each persons idea of what is beautiful is different.

There are several decisions you and your surgeon need to make together regarding your breast augmentation surgery.

Breast Implant Incision Sites

The first decision you need to make is which incision to use. Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy and patient-surgeon preference.

Breast Implant Incision Sites

Your incision options are;

Periareolar Incision-this incison is made along the bottom 1/3 to ½ of your areola. Dr. Miller prefers this incision because he feels that it hides the nicest, sometimes it is almost invisible. There is a color junction change here so if the scar gets dark it will blend with the areola and if it gets light it will blend with the skin. This incision also allows the surgeon to be very precise in his placement of the implant and good access to control bleeding. This incison can be used again if you need any secondary surgeries in the future.

Inframammary Incision-This incision is made slightly above the fold where the lower part of the breast meets the chest wall. Because of it’s location this incision also allows the surgeon good acess to control bleeding and more precison to place the implant than a transaxillary incision. One drawback is that it can often be seen in small bathing suits. This incision may be able to be used if you have any secondary surgeries in the future unless your tissue has thinned out in that area.

Transaxillary Incision-This incision is made in the crease of the armpit. The surgeon then either uses an endoscopic camera or they go in by feel, this is called the blind approach. This option is often less precise and can result in some breast asymmetries. Another drawback is the scar can often be seen in sleevless clothing. This incision can usually not be used again if you have to have any secondary surgeries in the future.

Submuscular or Subglandular Breast Implant Placement
After you’ve chosen your incision, you and your surgeon need to decide whether to place the implant above (a submammary/ subglandular) or below (sub-muscular) the muscle.

submuscular breast implant incision site

Under the pectoral muscle (a submuscular placement), is preferred for someone who is young, has not had children, has little or no breast tissue or a moderate amount of breast tissue and their breasts are still up and perky. Under the muscle gives them a little more support, sort of like an internal bra, which helps fight sagging in the future due to pregnancy, weight gain/loss and aging. Under the muscle also gives the implants a little more coverage so the implant is less visible and to help hide any rippling. If you exercise and implant that is place behind the muscle is more likely to shift or move when you exercise your chest muscles. Recovery from under the muscle surgery is a little more painful the first few days because the muscle is fighting to get back against the chest wall. Under the muscle provide slightly better visual for mammograms and may have a little less risk of developing capsular contractor.

Over the muscle, behind the breast tissue (a submammary/ subglandular placement), is preferred with someone with a moderate amount of breast tissue who desires a more natural look or someone who has a bit of sagging but either not enough to warrant a lift, or in a woman who does not want a lift. In this case over the muscle is better as this will allow the implant to follow the natural shape of the breast. Putting an implant will not lift the breasts but can sometimes give the appearance of a lift by filling out your upper pole fullness. Furthermore, the weight of the implant, combined with gravity, can make your breasts sag even more. But if there is too much sagging a lift or a lift with an implant may be needed. Recovery is a little less painful from over the muscle surgery.

Implant Choice – Silicone or Saline

The next decision you and your surgeon need to make is implant choice. This involves several things such as type- saline (salt water) or silicone (also known as Cohesive Gel or Gummy Bear), size, shape, smooth or textured and profile.
The first thing you should understand about breast augmentation Las Vegas is that they are not lifetime devices. They are man made objects and they will eventually break. As they get older the chance of them breaking goes up. Unfortunately there is no timeline for how long these medical devices will last. The FDA does have some recommended guidelines for silicone. They recommend an MRI after 3 years and every other year after and they recommend you change them out at some point. They do not give a recommended amount of time for that change. These are recommendations not requirements. No such recommendations are given for saline.

Silicone gel−filled breast implantation devices have been under scrutiny for years, but after gathering detailed and meticulous research and data, the FDA has approved them for use in cosmetic breast enhancement surgery.

In 1997, the Department of Health and Human Services requested the institute of Medicine (IoM) of the national Academy of sciences to conduct a comprehensive evaluation of the safety of medical device. The IoM panel of independent scientific experts included members of the medical, scientific and educational communities with experience in radiology, women’s health, neurology, oncology, silicone chemistry, rheumatology, immunology, epidemiology internal medicine, and plastic surgery.

After reviewing years of evidence and research concerning silicone gel filled breast implantation devices, 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.”

In addition, the FDA has approved the following three companies to develop and market breast devices and continue to collect data on their long-term safety and efficacy.

Mentor MemoryGel® (silicone) Breast Devices

Silicone gel filled breast implantation devices have undergone changes over time to meet increasingly sophisticated consumer expectations. The very first silicone device used thick shells and contained firm gel. The second generation introduced in the late 1970’s had thinner shells and used less firm gel to address concerns of patients and surgeons who believed that they were were too firm, palpable and visible. In the mid-1980s, concerns related to rupture rates of the second generation thinner-shelled device led manufacturers to introduce a third generation. The shell and gel of these third generation devices were slightly thicker but still soft. Today these third generation silicone gel are typically referred to as cohesive gel. Fourth generation, including MemoryGel® were introduced in the mid-1990s with further refinements in the manufacturing process. Today newer, fifth generation devices are available, such as with Memoryshape® , which are filled a uniquely formulated cohesive gel that provides shape retention.

Mentor MemoryGel® are filled with a proprietary cohesive gel that holds together uniformly while retaining the natural give that resembles breast tissue.

 MenTor® Memoryshape® Breast implant

Seeing is believing! A MenTor® Memoryshape® Breast implant is cut in half illustrating cohesive gel fill.

They have a set fill volume for predictable results. They come in four projection options: Moderate classic, Moderate Plus, High and ultra-High Profiles and smooth or textured surfaces.

Allergan Natrelle INSPIRA™ Silicone

In June 2015, Allergan introduced the INSPIRA silicone gel breast implant to the U.S. This implant design, which has been used safely in Europe for many years, is now U.S. FDA approved. The Natrelle INSPIRA™ Silicone implant offers both surgeon and patient an ideal option to further enhance upper breast fullness.

Historically, one of the best options for patients seeking more dramatic upper breast fullness was to use overfilled saline implantation devices to achieve the patient’s desired look. The downside to overfilling the saline implants, however, is that they sometimes feel too firm. Although, patients love the look!

With regards to silicone devices, they are prefilled, and it turns out that the traditional Allergan Natrelle implantation devices are only about 86-87% filled with silicone gel, whereas the Mentor MemoryGel are 91-92% filled. Hence, the enhanced upper breast fullness that many patients liked better with Mentor implantation devices.

Now, the Natrelle INSPIRA™ devices are available from Allergan, giving patients and cosmetic surgeons an additional option. The INSPIRA silicone gel implant is an “over-filled” or “fully-filled” silicone implant – 96-97%. Hence, a moderate-plus profile INSPIRA implant can give patients who need a moderate-plus profile implant, the high-profile look they desire from Mentor. The advantages of silicone implantation devices include a decrease in the risk of capsular contracture, an enhanced warranty, a more natural feel, and less palpable rippling.

Every silicone gel-filled breast implant in the NATRELLE® Collection has a cohesive silicone gel-filler. Basically, this means that silicone inside the implant acts more like a soft solid than a liquid. All Allergan gel-filled breast implants have a patented INTRASHIEL™ Barrier Technology. This barrier in the shell reduces shell permeability and minimizes gel diffusion or gel bleed.

Natrelle INSPIRA™ breast implantation devices come in low, low plus, moderate, high and ultra-high profiles and smooth or textured surfaces.

Sientra

Breast Implants with High-Strength Cohesive Silicone Gel. Sientra implants are currently not available in the US.

Saline -Filled are filled with a saltwater solution similar to the fluid that makes up most of the human body. Saline implantation devices are inserted into the body without fluid and then filled with the saline fluid through a fill tube during the surgery to adjust and achieve optimal volume. They have a slightly firmer feel than gel implants. They are available in Moderate, Moderate Plus, and High Profiles and both smooth and textured surfaces.

Shape

Round implants fill out the existing breasts by adding volume to the upper pole of the breast resulting in a “rounded” look. The upper pole of the breast can lose fullness over time due to gravity, resulting in a flatter emptier look. If you want a look that is more “round” at the top of your breast, you should discuss MemoryGel® Round Breast Implants or Natrelle Inspira with your surgeon. Round implantation devices come in several different profiles.

Teardrop-shaped implants are made to match the silhouette of a natural breast with more fullness at the bottom than at the top. The implantation device fill out existing breast tissue by a subtle increase in upper pole volume and a greater increase in lower pole volume. If this is the look you want, MemoryShape® products may be right for you.

Size

To determine the ideal implant size for you, the width of your breast needs to be taken into consideration. Choosing the right size implant is generally the most important decision a woman and her surgeon will make. Breast implantation devices are sized by cc volume (cubic centimeters – cc’s) not cup size. CC volumes do not accurately translate to bra cup sizes. All bra manufactures size differently and therefore bras from different manufacturers will fit differently. You may be a 36 C in one bra and a 34 D in another. About every 150 to 200 ccs equates to an increase of approximately one cup size. At our office we have sizers so that each patient can try on to see what size looks best on her. Your plastic surgeon will also evaluate your existing breast tissue to determine if you have enough tissue to accommodate the desired size of breast implant. Your surgeon is the best resource for determining what size implant is best for your body.

The NATRELLE® Collection offers a wide range of volumes from 110 ccs to 800 ccs, so you and your surgeon can find the volume that you are looking for. The final volume is determined by combining the base width that fits your chest with the projection you desire. It is important to be aware that a larger volume implant may not necessarily mean that your breasts will look bigger – it depends on your body type and shape.

Profile

Profile refers to the width at the base of the implant and the level of forward projection from the chest wall.

natrelle breast implants

Examples of Natrelle Inspira Round profiles.

Low to Moderate profile are the widest at the base of the implant. They have the least projection from the chest wall. They are best suited for someone with a fairly wide chest or someone who wants to create some upper pole fullness without adding as much volume to their cup size.

Moderate Plus profile have a wide base but a little more projection than a low or moderate profile. They are best suited for someone with a slightly wide chest or someone who wants to create some upper pole fullness without adding as much volume to their cup size.

High or Ultra High profile have a narrower base with the most projection from the chest wall. They are best suited for someone with a narrow chest or someone who wants create a more prominent breast.

Smooth or Textured

Smooth breast implants are round and have a soft silicone rubber shell. Smooth implants have a shiny, smooth outer shell. Smooth implants feel like natural breast tissue. They do not attach to surrounding breast tissue and can move freely around the breast pocket.

Textured breast implants have a slightly thicker, bumpy silicone shell, with a soft textured surface almost like soft rubber sand paper. Textured implants come in both round and teardrop shapes and attach to the tissue and prevent rotation and movement.

Try on Implants

After you are comfortable with the choices you and your surgeon have made to get the look you desire we will try on implants. This gives you the opportunity to see approximately what size you will be after surgery. We will then go through our before and after photos and find a few photos of someone who is similar to your body type so you can get an idea of how you will look after surgery.

At the end of your appointment you will have an opportunity to ask any questions that you may still have. We also encourage you to come back for another consultation as many times as you need to make sure that you are comfortable with your choices.

Your Pre-Operative Appointment

Now that you and your surgeon have made a “game plan” for your surgery it is time for your pre-op appointment. At your pre-op appointment we will have you go over and sign all of your surgical consents. We will then go over all of your pre-op and post op instructions. You will be given a lab slip for some pre-surgical blood tests and prescriptions for anti-nausea, antibiotics, pain pills and muscle relaxers. You will need to get these filled at your pharmacy. We will go over your health history to determine if you need any other pre-surgical tests or medical clearances from your primary care physician or another specialist. At this time you will also have an opportunity to try on breast implants Las Vegas again if you want. We will then take some pre-operative photos for your chart. Of course you will have time to ask any additional questions that you may have.

Your Recovery and Post-Operative Instructions

YOUR FIRST 24 HOURS

You will need a friend or family member to drive you home because you have been sedated. You will also need someone to stay with you overnight. You will need to rest for the first 24 hours but we encourage you to move your legs and get up and walk around. Try to sleep on your back with your body elevated on some pillows for the first week. Take your medications as prescribed by your doctor.

DAY 1-3

We will see you in the office to change your dressings and put you in a sports bra. You will need someone to drive you to this appointment. When you get home you can shower (if you do not have drains) and wash the incision lightly with soap and water. No baths for 6 weeks.

Day 5-14

We will remove your first set of sutures in 5-7 days. We will remove your second set of sutures a week later. You can drive at this point if you feel comfortable and are off your pain medications. Please finish all of your antibiotics; you will not need a refill.

Week 2-6

If you have any concerns or issues during your aftercare please call us and we will get you in if you need to be seen. Otherwise we will see you 1-2 more times until we release you to full activity at 6 weeks. It is very important to come to all of your post-operative appointments.

INSTRUCTIONS FOR THE ENTIRE 6 WEEKS

Continue to avoid aspirin and anti-inflammatory medications. No matter how good you feel you will need to limit your activity for 6 weeks. No lifting anything over 5 lbs. No exercise. No dishes, laundry, vacuuming, etc. No lifting your arms high to reach for something. No swimming pools or spas.

You will need to wear your sports bra 24 hours a day for 6 weeks. You can take it off to shower and to wash it only. We have extras available for purchase at the office. No underwire bras.

It is normal for breasts to heal differently. One may swell more, the shapes may be different and one may hurt more. Be patient. Once the healing process is over they should look more natural and similar. It is also normal to feel tingling and shooting or zapping pains. This is the nerve regenerating. You may want to avoid caffeine and chocolate, especially around your period as this can make your breasts more sensitive. Temporary shiny and itchy skin is also normal. This is caused from the swelling and healing process. Occasionally people feel a “sloshing” in their breast. This is not in the implant. It is from air and fluid trapped around the implant and your body will naturally absorb it.

It is very important that you do breast massages for the rest of your life. We will teach you 2 to 4 weeks after surgery. Each movement should be held for one minute and be done 3-5 times a day. We are happy to show you the technique as many times as you need.

Do not tan for 6 weeks. Wear lots of sunscreen on your breasts if you are going to be in the sun. The skin is healing and is likely to burn more than normal. Putting sunscreen on your scar for the first year is advised.

We like to re-check you at 3 months, 6 months and 1 year post op. We will see you any time after that if you have a concern or yearly for a checkup.

Additional Procedures:

View Our Before and After Photo Gallery

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Average rating:  
 1 reviews
by Sheila Townsend on Stephen M. Miller, MD, PC, FACS
Breast Augmentation

I was looking for a really good plastic surgeon for breast augmentation in Las Vegas. My friends suggested me names of various plastic surgeons in the area. It was not until I came across Dr. Stephen Miller. Dr. Miller answered all of my questions and was very impressed with him and his office. The qualified professionals working with Dr. Miller actually made me feel at home and treated me with utmost care. I am really happy with the results and not too sure why I waited this long

Schedule your free consultation with Dr. Miller Today