FAQ-Aesthetic Breast Surgery: examples of typical questions related to cosmetic plastic surgery

What method do you use for reduction mammaplasty? If you use more than one technique, what would determine which technique would be best for the patient?

Answer from Dr. Kremer:

The approach used for breast reduction varies and is based mostly on the size of the patient's breasts, the amount desired to be removed as well as the patient's tissue quality. I use several different technique and personally favour periareolar and vertical mammaplasty approaches, designed to decrease the amount of scarring, to maximize blood supply to the nipple and minimize the risk of damaging sensation to the nipple. However, if a large reduction of breast tissue is necessary, an inverted T-scar will remain, that fortunately for most cases hides nicely below the breast fold and is generally accepted by patients for the trade-off.

For your own safety, I require each patient to undergo a mammography before surgery and the removed breast tissue is being sent to pathology to rule out any forms of so far undetected breast cancer.

Have you ever known anyone to have had silicone breast implants for more than 30 years? How long do silicon implants last?

Answer from Dr. Kremer:

The question as to how long silicone implants last is often asked and the answer is unknown. There are many women who have silicone implants that are 30-40 years old but we cannot really say how much longer they are going to last. The implants utilized at that time are not the same as those currently being utilized. I do believe that each year the implant technology improves and the implants we are using now are clearly better than they were 20 or even 10 years ago. The advice I give to my patients who have silicone implants is to get yearly mammograms, which are probably indicated for early cancer detection if the patients are over 40 anyway, in order to detect any pathological changes.

Saline filled silicone implants, which I personally from my professional experience in the US prefer over silicone filled implants, are much easier to monitor and a leak will not result in inadvertent side effects as can be the case with silicone. Also the rate of capsular contraction is significantly lower in saline filled implants.

If you seriously consider breast augmentation, I will be happy to go over further details of this rather confusing matter with you during our personal consultation and you will be able to see and feel different kinds of implants.

Dr. Kremer, I have been considering breast augmentation surgery for quite a while and have a question: do you ever do the armpit insertion, if a patient is suitable. I wish to preserve as much nipple sensation as possible and dislike scars around the nipple. I am 42. Is this too old? Thank You!

Answer from Dr. Kremer:

Breast augmentation in a 42-year-old is not an uncommon procedure. As patient's age, their breasts become more ptotic (droopy) and sometimes an additional breast lift needs to be done. I personally prefer the armpit approach due to my good personal experience with this method while working in the US as this leaves only an almost invisible scar behind.

I almost always use saline-filled prostheses that are being placed underneath the pectoralis muscle. Permanent sensation changes of the nipple hardly ever occur with this method.