The further you are from the nerve to the nipple, the less chance you have of involving or injuring the nerve. The incision that has the highest chance of numbness to the nipple is thought to be the periareolar incision. This makes sense, as the nerve is traversing to the nipple, and can be in the dissection of putting the implant in. The second most incision is thought to be the inframammary incision, but way less than the periareolar approach. Because the dissection is furthest from the nerve to the nipple (the nerve comes from the back about at the level of a bra and enters into the breast at the level of the tail of spence about 4-5 inches below the incision for the transaxillary incision), it appears that the transaxillary approach has the least chance of having nipple sensation loss. A paper that was in the Aesthetic Surgery Journal in September of 2011, that I authored, had extremely low incidence of loss of nipple sensation. I hope this helps.

Dan Mills, II, MD

Breast Augmentation

It depends on your plastic surgeon and also how much lipo you are going to have done.

Personally, I do not like to add a lot of fluids that will cause swelling when I am doing a neck or facelift. If it is a small amount of liposuction that is to be done, like under 300 cc's, there will not be that much fluid added. But if there is a lot of fluid added to the lipo area, then there will be more swelling of the neck, which could make the result of the tightness of the neck not that good.

Good luck.

Dan C. Mills, II, MD

Miscellaneous

In a word---Safety!

The implants cost about 3 times as much partly because of FDA regulations and restrictions. It was not that long ago when we had the PIP implant crisis overseas where implants were taken out of the patients because of safety, and these implants were not FDA approved. They were not shown to be safe for the public here in the USA, so they were not used here.

We also have regulations and restrictions on the operating rooms that we have here that make it much more costly. Things like having a defibrillator in the Operating Room we take for granted here in our country, but you can save costs by not having them where there are no restrictions. There are at least 100 things that we simply have to have that are not so everywhere.

These things can even cloud judgment of the surgeon. Most plastic surgeons in this country put the implants under the muscle, where as many times outside the country they are put in under the breast tissue, even though we know that putting them on top of the muscle has a significantly higher risk of capsular contractures (a complication of breast augmentation surgery), and it may make it harder for a mammogram to find a breast cancer as well as giving the patient not as good aesthetic results generally.

Lastly, when you have a complication in another country, it is hard to find a plastic surgeon that wants to take on the problems of another surgeon because the result is always suboptimal. So frequently you have to travel back to the initial surgeon for a revision.

It just costs more here in this country because of regulations and laws that are put in place to protect the public. I would advise you to go see an ASAPS member for a consult, that way you know that you are getting a Board Certified Plastic Surgeon who does a lot of aesthetic surgery.

Good luck on your search, and I hope even though this answer just scratched the surface, it gave you something to think about. Cost should not be the only consideration when you are dealing with your health and life. Do you really want to take the lowest bid when you are talking about your safety?

Dan C. Mills, II, MD

Breast Augmentation

The type of implant is controversial. Saline costs less but has more ripples generally. The smooth silicone implants are by far the most used in the United States today. There is the newer gummy bear implants that are textured and we hope will last longer, but we don't know that yet. It is a fact that implants put on top of the muscle have a much higher complication rate than those put under the muscle, especially with capsular contractures (nationwide 10% under the muscle vs 30% if over the muscle). You should go over your choices with your ASAPS plastic surgeon as he is Board Certified, and does more Aesthetic (Cosmetic) surgery.

Usually the shape of your breast with implants looks just like the shape you have now, just larger.

The areola will usually become a bit larger with augmentation as it stretches the skin out - less with under the muscle than over the muscle, but bigger always. Never smaller! Good luck with your search.

Dan C. Mills, II, MD

Breast Augmentation

Silicone can show up on mammograms as being very dense and light in color. If there was some residual of the silicone still there, it could leave some residue on the capsule or scar that makes it show up. This could be if there was a rupture of your implant and sometimes if there was a texture to your implant, and the silicone is still involved with your internal scar (or capsule). Most of the silicone would be removed if the capsule was removed (the scar around the implant, called a capsulectomy). Seek out an ASAPS member as your surgeon, so that you know that you have a Board Certified Plastic Surgeon who does a lot of Aesthetic Plastic Surgery.

Good luck!

Dan C. Mills, II, MD

Breast Augmentation