Today, women have so many choices in breast implant devices, which is good, but how in the world do you know which one is the best breast implant choice for you? There are saline breast implants, silicone breast implants, round breast implants, shaped or anatomic breast implants, smooth breast implants and textured breast implants.  And don’t even get me started on all the different profiles of breast implants, not to mention that there are now three US manufacturers that all have FDA approval. Whew! So with all these choices how do you find the best breast implant option?

Most women will simply go with their surgeon’s recommendation. Most surgeons tend to fall into a complacent routine of using the same implant from the same manufacturer that they have used forever and are familiar with their product line. However, now with the Internet playing such a large role in patient research and manufacturers recognizing that fact, we see more patients researching a particular breast implant and then finding a surgeon that has experience with the device. For example, I get questions from a lot of women who have suboptimal results from their first surgery and they all wonder if a shaped implant will fix it for them. Shaped implants were NEVER meant to be used in a secondary pocket, so they are a horrible choice for revision surgeries. But because it is new and different, they think that might be the magic solution.

There is no magic best breast implant. I tell patients all the time, it is not about the breast implant, but how that breast implant is used. A surgeon can have the prettiest shaped breast implant in the world, but if it is too big for the patient he or she is operating on, that shaped breast implant is still going to end up looking like two grapefruits stuck on the patient’s chest – a true boob job! Or let’s say a patient chooses a saline implant because she thinks it is the “safer” breast implant but the surgeon puts it above muscle when it should be partially below pectoralis muscle – then she has nothing but edge visibility and rippling problems to go along with her “safe” implant.

I think the best breast implant choice for each patient can only be chosen after careful evaluation of that patient’s breast tissue using the High Five System®. When breast augmentation surgeries are planned using objective criteria, you take the guess work out of what is best for the patient – the type of implant filler, the shape of the implant, the shell type of implant and the best pocket location for the implant. Dr. Tebbetts uses several manufacturers of breast implants, as each company has slightly different matrix parameters that make the implants slightly different so they truly can be customized to the patient’s measurements. The secret to a pretty, natural breast augmentation result doesn’t lie in the breast implant, but in finding a surgeon who will evaluate your breasts using scientifically proved processes, like the High Five System ® and then use those findings to help you find the best breast implant for you!

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Silicone breast implants have been used since the sixties and rocked along just fine until a media report in the early nineties made every woman with a silicone implant believe that she was going to die tomorrow because of it! The reports made all types of health claims from breast cancer to autoimmune diseases that really scared a lot of people. So the FDA took them off the market and put them under study. It took us over 16 years to get a better silicone product back on the market – so long story short – the National Institute of Health’s report concluded that silicone didn’t cause any of those scary things, but that they were failing too much. And that was the chink in the amour that all the lawyers found and what the basis of all the law suits ended up being – that the implants failed over time and too much. Back then surgeons and manufacturers weren’t making it clear to patients that implants don’t last forever. So let’s be clear – no implant lasts forever – it’s a thing and nothing last forever. However, during all those years under study, the implants were completely reinvented – improving their safety and longevity records. They changed many things, but 2 of the most important things that changed are:

1. The increased the viscosity of the silicone gel – when it is thicker, it makes it harder for it to bleed or leak out of the shell improving its life span and decreasing it’s capsular contracture risk.

2. They put more filler in each shell – protecting the shell making it last longer. Silicone implants also now have a warranty that comes with them – each warranty varies depending on the manufacturer but you should receive a booklet like this from your surgeon that explains your warranty and you should keep it with all your insurance paperwork.

On the lighter side of it, patients will always tell me they prefer the feel of silicone to saline and with a thicker silicone gel that stays more evenly distributed throughout the shell, they tend to age better with you. Silicone breast implants cost more than saline breast implants, but if they last longer, it is well worth it.

Saline breast implants arrive in your surgeon’s hands empty and are filled at the time of surgery – which means they have to have a valve. So now we have TWO devices in one that can fail – the valve and the implant itself. There are lots of reasons a saline implant can fail, but the two most common are the valve and the simple fact that it is filled with basically water – a very thin solution. This is why saline implants are more prone to fail or deflate over time reducing their life span. Now, it won’t hurt you if it leaks, it’s just saltwater and your body will absorb it. But it means you have to have another surgery to fix it – that means another trip to the OR, more anesthesia, more recovery, more time off work and more money. Saline implants have warranties too, but remember neither warranty will cover all of your expenses associated with another surgery. Another downside to saline is that they seem to weigh more on your tissue causing an increased risk of sagging or ptosis over time. This added weight also tends to produce more visible rippling – especially in thin patients. Saline breast implants are less expensive than silicone breast implants– at least initially – but if they increase your risk of more operations, just how good is that deal you think you are getting?

During the 16 years that silicone was being reinvented, we only had saline breast implants to use and Dr. Tebbetts used about 6-8 saline implants a week – - now we see 3-4 deflations back a month. At least, now, we have a better breast implant – silicone – to offer these deflation patients. As a primary patient, you have lots of implants to select from today – lots of shapes and fillers, shell types and profiles. Discussing all your options thoroughly with your surgeon and truly understanding the pros and cons of each option is very important. Don’t just assume something is safer or buy it because it is cheaper – - know the facts!

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Question:

So ladies I need ya’ll with experience! I am a 34 A right now, and the docotor said 400 cc would be a good look for me.  I really am afraid that I am going to small because I want a full D if not DD cup.  Is 400 cc’s a correct fit, or do I need to go larger? Any one?

Answer:

A really good idea of where your breasts can SAFELY go is where they have been stretched to before – ie pregnancy.  That is what High Five gives us – clinical measurements that tell us how much your breast needs.
I know it’s hard – when you have wanted implants for so long and it’s cosmetic….you tend to think you can just order up what you want.  And it’s true, you can put any implant in any breast, but you can’t hide from your own body, what you start with , what your tissue is like and you certainly can’t run from gravity.  There are limits  – you bring them to the surgeon and the OR table.  We cannot change those limits and if you and your surgeon chose to ignore them…well, that is what, I think, has given breast implants such a bad rap.  Boob Jobs happen when patients and surgeons ignore limits.
I think the old adage “Be careful what you wish for” says it all here……this is surgery that will change your body forever.  Please let clinical measurements plan your operation…not guess work.  You may very well need that 400 – - but I would like clinical proof that you do.
Which means – part of the delima of achieving a safe, natural result with a breast implant may mean that you have to adjust your expectations if your body won’t comply.

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast.com

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Boy, have times changed in the incision location department!  When the FDA took the old silicone gels off the market in the 1990′s, we were forced into using nothing but saline implants for over 16 years.  Saline implants come to the surgeon empty and are filled through a valve after they are placed (one of the reasons they have such a high failure rate) in the pocket.  Placing an empty implant left us with a lot of incision options – endoscopic axillary, peri areolar and inframammary – were all incision options.
Now, with the advent and use of thicker silicone gel implants, we are limited to mainly the inframammary (under breast, crease) incision.  This incision option provides maximal accessibility without compromising the implant shell or filler.  The inframammary incision has always been the leader in fewer risks – it is always hidden in the crease under the breast, the surgeon only has to pass through minimal tissue and he is in the pocket, it does not increase risk of infection or sensation loss (like PA incisions do).
All of Dr. Tebbetts incisions are closed from underneath the skins surface, avoiding track marks on the skin that might be visible later.  The stitches dissolve on their own and require only a small piece of brown, paper tape to cover them.  This piece of tape is your only “bandage” and it comes off on its own in about two weeks.

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast.com

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Determining where your breast implant will be placed in your body is a  very important decision in planning your breast augmentation.  For Dr. Tebbetts,  this determination goes back to the measurements – it goes back to YOUR body.

If you have 2 cm or less of pinch thickness in the upper portion of the breast, the breast implant needs to be placed under more of YOU to camouflage it over time – make it age better with you and make your mammograms the best they can be over time.
Dr. Tebbetts developed and published the Dual Plane method in 2005.  I hope the illustrations in this link will help you understand the difference between over, under and dual plane.  http://www.thebestbreast.com/about/breastaugmentationdallas.php

We would be happy to discuss any specific questions you have about pocket location. P.S… nobody’s implants are completely “Under” no matter what your buddies told you – it’s just a phrase that is very commonly used amongst patients and surgeons.  The breast implant is usually place partially under the pectoralis muscle covering the upper third of the implant.

With Dual Plane placement, Dr. Tebbetts’ patients still experience a 24 Hour Recovery.  Returning to full range of motion the afternoon of surgery – so with no added down time for patients, they still get the best soft tissue coverage for their implants with the Dual Plane technique.  The more of YOU that covers the implant, the better it will age with you and the better your mammograms will be in the long run.

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast.com

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When considering breast augmentation, one of the major options and choices a patient has is the type of breast implant the surgeon will use.  However, when you ask most women who have had implants, they don’t know what type of implant they have!  You and your surgeon will make that decision together and after surgery, you should recieve implant ID cards and warranty information.  This documentation should be kept with all of your insurance paperwork for future reference.

We have learned a lot about breast implant devices over the years and they just keep changing.  In fact, since we went to press with TBB2 and now, everything has changed, making Chapter 5 in TBB2 out of date.  After careful review of the data available, at this time, Dr. Tebbetts prefers the safety and longevity characteristics of round, smooth cohesive silicone gel breast implants.  These implants have been approved by the FDA since 2006 – for both American manufacturers, Mentor and Allergan.
Each company has slightly different sizes to offer, so Dr. Tebbetts prefers to use your measurements (the High Five System) to determine which manufacturer will be the best fit for your breasts.  Each company offers long term warranties as well – we provide each patient with manufacturer’s handout material, implant serial number cards and warranty information after surgery.
We are happy to discuss all the implant questions that you may have, like: “Isn’t saline safer?”, “What happened to textured implants?”, “What about shaped implants?”  Ask away and we will be happy to discuss what we know, given the data available, at the time. It is very important to remember that what makes a pretty, natural breast is NOT the type of implant that is used, but HOW the breast implant is used – the size chosen and pocket location chosen.  In other words, if the breast implant size simply fills the breast envelope (not pushing it) and the proper pocket location is used to give adequate soft tissue coverage over the implant, it could be any shape, fill, or shell type and it will look natural on you.  It is not the implant – but how the implant is used that makes you a pretty result!

Choose the best implant product to improve safety and longevity of your result.  Choose your surgeon to help you work with your body to make the implant beautiful and natural.

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast.com

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How to choose the breast implant size for each patient is probably the most heated debate for surgeons and most worried about option/choice for patients.  The most common methods are all subjective and mean nothing when it actually comes down to walking into the operating room – ie – putting sizers in your bra, talking cup size, looking at photos of other people, 3-D imaging, and we can’t forget one of my personal favorites, the rice test!  Let’s face it, patients are either worried that they will be too big or not big enough.  Although talking “full C” with your surgeon or bringing him or her a photo of what you want to look like may make you feel all warm and fuzzy at the time, I guarantee you, when you leave your consult, you will be wondering if they actually understood what you want.
Dr. Tebbetts makes all surgical decisions about how to change a breast – whether it needs augmenting, lifting or reducing – based on a scientifically proven and published measurement system called, The High Five System®.  It is so simple to use – even patients can measure themselves at home to get an idea of what their body – their breast is calling for.  It is five measurements that are applied to a formula – the answer gives you the CORRECT amount of fill for each individual breast…. every time.
By simply filling the empty breast envelope, the High Five System® produces beautiful, natural appearing breasts that are least likely to cause you more operations in the future.  So if you want to change your breasts – after time, babies, nursing, weight gain and loss – and yet you don’t want a “boob job”, the way Dr. Tebbetts approaches how to determine size – The High Five System®- is just the ticket for you!

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast.com

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I hope everyone had a wonderful Thanksgiving break – I know we did and we were very thankful for the time off with our daughter!!  During the holiday I recieved a note from a patient I had consulted with by phone a while back.  I had advised her that, given her photos, she might need a mastopexy, instead of an implant (never go by photos – seek the measurements!).  Being familiar with Dr. Tebbetts techniques (24 Hour Recovery, High Five and Dual Plane), she thought to ask me the following when a surgeon she saw was touting Dual Plane 3 as a replacement for a Mastopexy or breast lift.  The following is our exchange:

Terrye,

I spoke with you some time ago and discussed a breast lift and later augmentation if needed. Are you familiar with a technique called dual-plane? It seems is some cases it avoids a lift and I was wondering if you had any advice about it?

Carol –

Familiar with Dual plane? Yes ma’am!  Dr Tebbetts developed and published it!!

Terrye,

Great, that’s what I thought.  Actually ours was a phone consult and it has been some time ago but I think you were pretty confident I would need a lift. There is a surgeon touting dual plane III as a way to avoid a lift. Just curious what your thoughts are on this approach, is success plausible or are you possibly begging for later trouble?

Carol –

Nothing.  Nothing replaces a lift if you really need it.  Dual plane is a tool in a surgeon’s bag of tricks, if he truly understands it, that can help him manage even the most difficult augmentation patients and yield better results.  However, if a surgeon is trying to skate the hard realities of what a patient might need and just use Dual plane as a marketing tool….shame on him or her.

Did I send you the measurement sheet when we talked?  If you can measure nipple to fold under stretch in cm, please let me know what t number is and then we can go from there.

If you really need a lift – it’s a wonderful thing, not a frankensteinish thing!  Tebbetts is publishing a paper right now on his very special techniques in mastopexy, funny you should recontact us now!

You can’t cut corners (or shorten incision lengths etc) on a procedure to apease the patient and get an optimal result.  Our job as plastic surgery professionals is to evaluate, measure and educate each patient about the procedure they need or want.  In my position as a patient educator, I spend most of my time helping patients reconcile what they WANT with what their bodies will realistically allow them to have.  Plastic surgery is not magic.  Each surgeon must work with what you bring them to work with….the trick now a days is to get the surgeon to truly be honest with you about the realities you BOTH face going into surgery.

It all comes back to the measurements – to High Five.  A breast implant has to go to the BOTTOM of the pocket or breast envelope it is given to go to.  If there is too much excess skin, then the breast after implant will be a bigger, saggier version of what it started out as – not lifted or perky – bigger, and firmer with more projection but NOT higher and perky.  I think the biggest problem is with those patients who are borderline – they aren’t really a candidate for a lift, but an implant won’t do what they want it to do.   These patients are the ones who usually get screwed by the system – - simply because most professionals are not willing to reconcile wants with reality.

Our job is to help patients achieve their goals and expectations.  We all LOVE happy patients.  Telling patients what they don’t want to hear is hard, but in the end, it is the only way I can sleep at night.  I wish they were all easy, but they aren’t.  Honesty is the best policy but often it is the hardest one to live by.  However, making one surgical technique try to replace the operation that is really needed is marketing hype that, in the end, produces unhappy patients.  I am so glad she brought this issue to my attention.  If you are thinking about breast surgery – measurements are truly the key to your success long term.  Seek surgeons who make clinical decisions based on objective criteria – based on measurements of your body.  And try to have an open mind as you research to the fact that what you thought you wanted might not be the right thing for you but there is a procedure that can help you – it’s all about balance.  If patients and surgeons communicate honestly this whole process is so much easier and successful!

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast

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Well, there are 7 new pairs of beautiful breasts in the world today!!  When I called last night they were all over town by 6 pm – at swim meets, out to dinner, exploring downtown Fort Worth and taking care of their kids!  It is even one of their birthdays today!!  Happy Birthday – what a nice present to give to yourself!!  I love 24 Hour Recovery!!

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast

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I think sometimes patients are afraid to ask their surgeon about other surgical methods.  Please don’t be afraid to ask them!  They should be happy to answer your questions about other surgical techniques – even if they don’t use them.

Surgeons are supposed to keep up with their own continuing medical education hours (CME credits) that means going to meetings and learning from other surgeons or reading the current literature in scientific journals.  So they should be aware of what is new and available to patients, even if they don’t use it.

If you and your surgeon decided implant size based on a traditional SUBJECTIVE method – cup size, stuffing sizers in bras, 3D imaging, photos of others – - you probably have some doubts about what it will actually look like – some grey area of uncertainty…..by asking that very same surgeon to apply a proven clinical measurement system, you can get rid of the unknown and feel comfortable about your decisions going into surgery.  It never hurts to ask them to use High Five to verify the sizer method…..all you have to do is ask.  One lady did and here is her note to me…..

Hi Terrye!

Thank you very much for offering to send me the High Five measurement sheet information, it’s so very appreciated.  As you know I am very nervous about going too large.  I have my pre-op appointment at 2:00pm today and the PS should be doing all his measuring then, I will mention the high-five system to him as I’m not sure what he uses.

Answer ~

Here ya go – sorry I just now got this – but you can always measure after your visit too!  Dr. Tebbetts says the system is so easy to use that patients can certainly use it at home before going into consults so they have some idea of what their own body will safely allow!

I guarantee it will never be too big if your body made the choice and simply fills the empty space.

Please let me know what you and the ps come up with!

Terrye,

You are a life saver!  Thank you so much I feel much better about everything now.  I just got back from my pre-op and did the measurements for the high-five system and my doctor recommended EXACTLY what you would have which makes me feel a heck of a lot better.  Yay!!

*hugs*

About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast

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