Breast Augmentation Secrets from Dr. Jon Paul Trevisani

By Danielle Briones

Published on April 14, 2008

During a DocShop Webinar about breast augmentation, hosted by Orlando plastic surgeon Jon Paul Trevisani, MD, we got Dr. Trevisani's expert opinion on the various implant options and surgical techniques in use today.

We found out that some treatment approaches work best on certain body types, while others can be chosen based on an individual's aesthetic goals. Read on to learn about the benefits and drawbacks of each breast augmentation technique.

The Science of Breast Augmentation

"You just can't cookie cut breast augmentation surgery, it's very individual - based on your anatomy, based on what you want, and what you desire," Dr. Trevisani explains.

Implants: Silicone vs. Saline Implants

According to Dr. Trevisani, silicone implants are generally considered the superior implant because they offer a more natural feel and appearance than saline implants. They are also less likely to cause rippling.

"Silicone is a little bit softer, it feels more like breast tissue, it [feels] a little more natural, so it's certainly an upgrade from the saline implants," Dr. Trevisani opines.

He stresses that women with little breast tissue benefit most from silicone over saline implants.

"People who are very thin, whatever you put in those people - that is going to be their breast," he says.

Saline implants boast their own benefits. They generally cost less than silicone implants. And in many cases, saline implants produce a shorter scar than silicone implants because the implants are filled after they are inserted into the breasts, thus requiring a smaller incision.

Conversely, silicone implants come pre-filled, requiring a slightly longer incision through which the implants are placed.

Placement: Above or Below the Muscle

"Placement of the implant really depends on the anatomy and what is going to make [the patient] look good," Dr. Trevisani says assuredly.

Because the quality of breast implants has improved greatly in recent years, both under and over the muscle implant placement are appropriate breast augmentation techniques. Dr. Trevisani recommends placement type based on the patient's body type and expectations.

"Having been trained in both ways, there's indications for one over the other," Dr. Trevisani cautions.

For example, women with breast laxity will benefit more from implants placed above the chest muscle. Implants placed under the chest muscle will ride higher than the sagging breast tissue. This can result in a "double-bubble" effect, Dr. Trevisani warns.

However, women who lack breast tissue may be best suited for implants placed beneath the muscle. The chest muscle will provide additional implant coverage, Dr. Trevisani explains, resulting in a more natural appearance.

Unfortunately, Dr. Trevisani concludes, many plastic surgeons are only trained in one of these surgical methods. This illustrates the need for the patient to be educated about the various options available; it helps ensure the patient is not guided into undergoing the procedure the doctor offers, rather than the technique that is best for the patient.

Size: Implant Size vs. Bra Size

If there is one thing Dr. Trevisani commonly hears from potential breast augmentation patients, it is the request to be a certain bra size.

However, implant sizes do not equate to bra sizes. Each implant will produce a unique look depending on the individual. Instead of basing implant size on generic bra sizes, Dr. Trevisani has his patients try out various implants during a consultation.

"What we do to help you pick a size is we give you a bra and we have you put implants in the bra so you can tell me what looks good on you. My job is to tell you how big you can go and still safely close the incision."

Dr. Trevisani generally offers additional advice when his patients are choosing their implant size. Because many breast augmentation patients wish they had gone a bit bigger after the swelling from surgery goes down, he encourages his patients to think a little big.

In the end, however, it is up to the individual to make the final decision.

"You go into it knowing pretty much where you're going to be when you come out. It's not a big guessing game. And basically you pick the size as the patient," Dr. Trevisani emphasizes.

Incision: Incisional Approaches

Dr. Trevisani does not perform breast augmentation using the transaxillary (underarm) approach because he says it involves a higher rate of infection due to the hair follicles and sweat glands.

He prefers to insert breast implants using the areolar (nipple) or inframammary fold (breast crease) techniques.

According to Dr. Trevisani, the areolar incisional approach is a great solution for women who desire as little scarring as possible.

"It takes about a year for those scars to really fade to a little white line," Dr. Trevisani says, adding that the scar discreetly blends in with surrounding skin.

Breast implants placed through the crease of each breast will leave scars. However, the scars cannot be seen straight on and their appearance will continue to fade with time.

"The scars are the scars. They never fade permanently, but they do fade with time," Dr. Trevisani notes. "When you lift up the breast, you will see a white line in the crease of the breast. But it's not unsightly."

Making the Right Choices

Dr. Trevisani stresses the need for patients to understand the procedure they are to undergo and to be as educated as possible about their surgeon's credentials.

"Anyone can call themselves a cosmetic surgeon if they have an MD after [their] name. So looking for a board certified plastic surgeon is very important," he says.

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