From implants to filler FAT, a little well-placed volume can help to create your perfect body contours.

WORDS BY Nancy A. Melville

Body contouring isn’t always a matter of nipping, tucking and trimming. Often it’s enhancement, not reduction, that we’re looking for, and, whether it’s adding some volume to that visage, a boost to those breasts or a curve to your bottom line, cosmetic surgery has full body options.

BREAST CHOICES

Cleavage woes? If you long for a more shapely bosom than was granted by Mother Nature, or for restoring the lift and shape diminished by Father Time, look no further than your local board-certified surgeon.

Options for augmentation generally include saline and silicone implants, both approved by the FDA and widely considered to be highly safe. Saline implants are made of an outer silicone elastomer shell filled with sterile salt water and, because they can be filled after being inserted, only a small incision is usually needed. Silicone is actually a gel, and though it requires a larger incision to place, proponents say that silicone implants feel more like natural breasts.

In choosing between the two alternatives, then, various pros and cons must be considered. Again, the first consequence is where the incision will be made. Saline implants are first inserted then filled, which makes it possible to place them through incisions under the breast (inframammary), along the edge of the nipple (areola), in the armpit (transaxillary), or even through the navel (TUBA). On the other hand, silicone implants are pre-filled and may require a larger incision area, completely eliminating the bellybutton incision area from your list of choices.

Robert Jackson, MD, an AACS cosmetic surgeon with offices in Marion and Carmel, Ind., says he often prefers an incision around the nipple, but patients may not always agree. “My preference is for a periareolar incision because it’s right along the border of where the pink meets the…skin, and, within a year’s time, you can’t even find the scar,” he says. “Some of my patients come in, however, and really want an inframammary [under the breast] incision. I advise them that if they’re lying on the beach, wearing a skimpy bikini, people might be able to see a scar there, even though we keep the

scars small.”

Silicone implants are pre-filled and may require a larger incision area, completely eliminating the bellybutton incision area from your list of choices.

The downside for saline implants is that they can rupture, usually as a result of trauma to the chest area. The good news is that, while the change in breast size is noticeable immediately, the contents are harmlessly absorbed into the body within hours. You’ll have to have surgery to replace the implant, of course, but if you’d been thinking about changing your size, this is a good time to do it!

While silicone does not burst as easily, the downside is the potential for a “silent rupture,” meaning you don’t know that it’s happened. As a result, the FDA recommends that women who receive silicone breast implants receive MRI scans every two years, beginning three years after the initial surgery. What’s more, the minimum age for silicone implants is 22.

According to Dr. Efrain Gonzales, MD, a cosmetic surgeon based in Sacramento, Calif., the MRI recommendation is one big reason why most of his younger patients choose saline implants. “If you’re just 22 years old, you probably won’t even need a mammography until you’re at least 35, so to need an MRI every two years from that early an age adds up to quite a few MRIs—which typically are not covered by insurance.” In addition, saline implants are less expensive than silicone in most practices—Dr. Gonzales charges about $4,000 for saline breast implants, versus $5,000 for silicone.

As for the ‘natural’ feel of saline, Dr. Gonzales says that can be mitigated by placement. “Some say the saline implants can have more of a rippling effect, and don’t feel as natural, but if the implants are placed behind the muscle, I don’t think there’s much difference,” he says.

Other potential complications from breast implants can range from asymmetry to capsular contracture (hardening of the breast) and nipple or breast sensation changes. The FDA advises patients to expect additional surgeries for the implants because they typically will not last a lifetime.

BEHIND THE CURVE

Beyond the breasts, the desire for curves drops to a focus on the backside. Though not as common as breast augmentation, patients also often seek some enhancement to the buttocks, either because they have been unable to develop proportionate gluteal muscles, or lack buttock fat, or simply wish to have it more pronounced.

Common buttock augmentation options include fat injections and silicone implants. Robert M. Dryden, MD, a cosmetic surgeon based in Tucson, Ariz., says he only uses fat injections in the buttocks and Dr. Jackson agrees, saying he, and his patients, tend to prefer fat injections, which may provide a more natural feel.

“You can use implants in the buttocks, but in my hands, fat works better,” he says. “I think a lot of patients simply don’t like the idea of sitting on silicone implants.”

The upside to silicone is that it’s a one-time procedure. With fat, you could require two or three injection sessions. “Patients need to be aware of the fact that they could lose a large percentage of the fat that’s put in,” notes Dr. Jackson. “But after you gradually get to the level you want, it will be permanent.”

One important issue to consider with fat injections for buttock augmentation is whether the patient has enough fat
elsewhere in their body to transfer to the buttocks.

“You usually need to be able to provide at least 600 ccs of fat per cheek, so you need to get no less than 1,800 ccs from elsewhere in the body, and some patients may not have that much,” Dr. Gonzales explains.

For those very reasons, Dr. Gonzales says he prefers the silicone implant for the buttocks.

“I would say the silicone implant is superior in the buttocks because it lasts longer and you can actually see the result you’re going to get. With fat, it’s hard to know how much will remain.”

Use of the body’s own fat (aka, autologous fat) is also considered a permanent option for face, body, and even breast volumizing, providing a uniquely natural definition. For the fat transfer procedure, fat is first liposuctioned from another part of the body, such as the thighs.

While some fat remains for the long-term, a large percentage can be absorbed by the body, resulting in the need for the additional injections. (Note: Additional injections don’t mean additional liposuctions. Doctors often freeze leftover fat for future use.)

“The fat isn’t as permanent [as implants] because some is always resorbed,” says Dr. Gonzales. “You can usually expect about 60 percent of injected fat to remain and about 40 percent to be resorbed. You may need more than one procedure to get the result you want with fat.”

The implants are inserted through incisions hidden between the buttocks, and are placed in the upper part of the buttock, above the sitting area. Recovery from a butt augmentation procedure usually takes one to two weeks.

Another body area garnering augmentation attention is the leg. Though more common among males, female patients also occasionally seek enhancement of the calves, which can be augmented with implants to add definition.

Expectations

While patients are typically pleased with the results from augmentation and the procedures are generally safe, no procedures are without the risk of some type of complication, such as infection or a rupturing implant, and the popular cable TV programs that otherwise are fairly detailed in their depictions of cosmetic surgeries often don’t show that.

“The programs often only show the happy patients and the good results, but that can lead to a misconception that everything always works out well and there is no risk of complication,” Dr. Gonzales says. “Of course, real life is not like that that. No surgeon can tell you they have 100 percent satisfaction.”

Patients can stay ahead of the game by making sure their physicians are board certified, and educating themselves on procedures through sites such as the American Academy of Cosmetic Surgery (www.cosmeticsurgery.org)

It’s also critical to take advantage of the consultation to communicate as much information as possible to the physician. “The consultation is extremely important,” Dr. Jackson says. “For breast augmentation, for example, I have patients bring in pictures to give me an idea of what they want to look like. I never guarantee that I can match the picture, but it gives me a good idea of the shape of breast in their final result.”