There’s more to the breast augmentation discussion than just silicone or saline. Did you know breast implants come in different shapes and textures as well?
Check out our exclusive interview with a board certified cosmetic surgeon from Houston, Texas who’s been performing breast surgery for over 30 years!
Dr. James Tang of the Cy Fair Plastic Surgery Center takes the time to answer all of our breast augmentation questions. Listen to the full interview or read through the transcript.
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Nip Lift Tuck (NLT): Hi everyone! Our special guest today is Dr. James Tang. A board certified plastic surgeon from the Cy Fair Plastic Surgery Center here in Houston, TX. Hi Dr. Tang!
Dr. James Tang (DJT): Hi, how are you?
NLT: I’m fine! Thank you for joining us today to talk about breast augmentation.
DJT: My pleasure.
NLT: This is a subject that’s very popular, lots of people want to know about it, including myself. So, maybe we can start with the basic question: What exactly is breast augmentation? Is it the same as breast implants or is it just another word for it?
DJT: Well, breast augmentation is one of the most commonly performed plastic surgeries that we do. We’ve been performing this operation for over 30 years now. This is a procedure for women that are unhappy with the size of their breasts for whatever reason, either due to nature or due to having children and breast fed and having lost some of their breast size.
It’s a procedure that’s done as an outpatient, it doesn’t require hospitalization. It usually takes about an hour and a half or so and then the patient can go home. It is performed with a breast implant. There are a couple of types of implants. The most common type that we use is a saline implant, but we also use silicone implants.
Saline implants are filled with saline. They are usually put in empty, and we create a pocket underneath the breast tissue and under the muscle. Then we place a saline implant that’s usually empty at first and then we fill it with saline. It is very safe. If it should ever leak, the saline is absorbed by the body and excreted in the urine.
The manufacturer has a lifetime warranty on all their implants. If it should ever leak, they’ll replace it free of charge. And for the first 10 years, they’ll pay [your] surgeon to replace them for you. And silicone implants are also popular, and they are already prefilled with silicone and they come in a variety of sizes. We can pick and choose the right size for you.
NLT: How do you decide whether to go silicone or saline?
DJT: Both types of implants give very good and natural results. There isn’t a big difference once they’ve been put into the body. Some women feel more comfortable with saline implants, feeling that they might be safer if they ever leak. And so they may choose to go with saline implants. The other women that prefer silicone implants because they feel that they have a more natural feel. Both give very similar results, and I’ve had women who have been satisfied with saline implants as well as silicone implants.
NLT: So which one do they seem to prefer the most?
DJT: Well, presently, I’m doing more saline implants. Partially because they are cheaper than silicone implants but they give pretty much the same results. Presently, for women who have never had implants, I usually recommend saline implants. So, 90% of the women that I do, I use saline implants. If ladies have had problems before with saline implants and still want to have implants, then I usually recommend going with silicone.
NLT: Now, has silicone ever leaked?
DJT: Yes, and that’s one of the problems they used to have with silicone implants, and that’s why they were taken off the market for a few years. But now manufacturers make the silicone implants with a thicker shell that does not leak. And also they don’t tend to bleed the silicone gel like the older types of implants. In my opinion, I think the present silicone implants are much safer, much better than the older type of silicone implants.
NLT: What about the smooth versus textured and round versus shaped… There are so many options. How do you determine the best size and shape of breast implant for a patient?
DJT: Yes, you’re right. There are a number of different types. As you said, there are smooth implants and there are textured implants. I usually prefer the smooth implants. I don’t really see any advantage to using textured implants. Pretty much all of the implants I use, either saline or silicone, are smooth.
Also, I prefer round implants. I think that they give a very natural appearance and shape. So I don’t prefer any other type of implant other than round, although some women prefer special shapes. Some may prefer tear drop shape and we can special order that. In my opinion, there’s no real advantage to any other shape other than round.
NLT: I didn’t understand the whole shape difference…why it would make such a big difference if they’re inside?
DJT: That’s right. They’re inside, and with time and gravity, they’ll be a very natural tear drop shape, regardless.
NLT: Speaking of gravity… Do you ever have to redo the implants at some point down the road?
DJT: Well, sometimes as women get older and their skin and tissue relaxes, they may have drooping of the breasts and they may require a lift. Sometimes women may want to go larger, especially if they have lost some weight, and so sometimes they want to go back and get larger implants.
So we do sometimes re-operate on women for those two reasons. Also, rarely, I mentioned before, saline implants can leak, and the manufacturer has a lifetime warranty on leaking implants and they will replace them free of charge.
NLT: That’s good. How do you determine the size?
DJT: Well, the size is largely up to the patient. What I do is examine the patient. I ask them what size bra they currently wear, also what size bra they’d like to wear. I have different sizes of implants in my office, and then I try them on with the patient. I have her look at various sizes and determine what size she would like. I do my best to try and accommodate the patient’s preference.
NLT: And you take before and after pictures, I assume?
DJT: I do. I take pictures of them right before surgery and then usually three to four weeks later after they’ve had a chance to heal and the breasts become softer and more natural.
NLT: I assume that three to four weeks is the normal recovery time?
DJT: Yes. Most patients are able to go back to work in three to four days [after their breast augmentation surgery]. There’s usually minimal pain after surgery and they’re up and walking around the day of surgery. And then they usually can drive within two to three days. I ask them not to shower for two days in order to keep the incisions dry. But often patients are able to go back to work after three or four days, or a week at the most.
NLT: How do you make sure patients have realistic expectations of the surgery?
DJT: What I do is show them before and after pictures of patients I’ve done previously, I show them what they might expect, I do warn them that each patient looks different and each person’s breasts are different from others. So patients have to be aware that sometimes I cannot achieve the size and shape that they have in mind.
NLT: Do you ever have anyone that sort of regrets having the surgery and later on decide to have them removed? Has that ever happened to you?
DJT: Yes, but very few. I would say less than 5% of patients that have had breast augmentation later choose to have them removed. The most common reason for that is that one of the complications is capsular contracture, which is hardening of the breast. This is due to a layer of fibrous tissue called a capsule that grows around the implant.
In some cases, the capsule becomes thick and squeezes on the implant, making the breast feel hard and look round. In most cases, you know, sometimes, the women will elect to have the implant removed. Sometimes by changing the implant or changing the placement of the implant we can get rid of that problem.
NLT: What would you say are the pros and cons of getting the surgery? The best reasons that people get it, and all the reason that it might not be a good idea.
DJT: I think the main reason patients get the operation is to improve their self-image and to enhance their self-confidence. And I think those are valid reasons. The patients who come to me for those reasons tend to be the happiest with the outcome.
Now the patients that have unrealistic expectations of their breast surgery, that either desire to have implants that are too large for their body, or if they decide to have implants for various reasons such as to attract a mate…
Or things like that may have unrealistic expectations, and they may not be the best candidates for breast surgery.
NLT: Well, I know we promised to keep this short, so I’ll just ask you… Is there anything else you’d like to tell us about breast augmentation or anything else that would be important for our listeners to know about breast augmentation?
DJT: Well, I have performed this operation for over 30 years. I have many happy patients. The youngest patients are generally around 18 or so and I have performed surgery on people as old as 65. Most of my patients are in the 20-40 age group.
I would suggest if someone is interested, to give my office a call at 281-955-0115 to schedule a free initial consultation. Also, they can consult my website which is www.CyFairPlasticSurgery.org. There’s information on my website about the procedure, and also some before and after pictures.
NLT: Excellent! Well, I really appreciate your taking the time to talk to us today and give us information about breast augmentation. It was very useful, and I really appreciate it! And if you have any other questions about Dr. Tang, be sure to call or visit his website. Thank you, Dr. Tang!
DJT: You’re welcome, thank you!