Thursday, July 9, 2009

Why Discount Breast Implants Are a Bad Deal in Los Angeles

This is a cliff known as Tahquitz in the mountains near Palm Springs.

Did you know that implants of different shapes have different costs to the doctor? And did you know that the discount Los Angeles breast implant surgeons generally use only the cheapest breast implants?

Implants made by the two major manufacturers approved for USA use have almost identical shapes. There are three types: flatter (the oldest and cheapest), intermediate, and “high profile.” The high profile implant, for the same volume, has a narrower base diameter and has a bit higher “projection” or distance out from the body when placed under a breast. This is the best implant for most people, but it’s significantly more expensive. In order to visualize this better, the lower or flatter profile implant is shaped more like a Frisbee (not this flat, but you get the idea), while the higher implant looks more like a real breast. The higher profile implants ripple less, a significant consideration especially when saline implants are used.

Now, base diameters must match the patient’s chest. If you have a larger chest, maybe the flatter implant is OK for you to help your cleavage, but for implants over about 350 cc volume, we use almost exclusively the more expensive high profile implants because they look better and the base diameters are usually fine for even a bigger chest. We won’t compromise the result by spending less on the implant. And the wholesale cost of the implant from the manufacturer is a significant part of your breast implant expense.

The Los Angeles breast implant field is an art, because women’s breasts are all different and we have to match your psychological needs for size and shape with both your breast type and the implant choices. We also use different approaches—over versus under the muscle and the different surgical approaches—to try for the best result for you. For example, with relatively large breasts that do not sag, there are many options. Many times, patients like this get the best results with a through-the-armpit approach over the muscle, but under the “fascia” or skin of the muscle. This has many advantages of If you have saggy breasts, many times just an implant will be enough. You may not need a lift, which puts scars on the exterior breast. But some breasts need a lift to get the right result. And if you have very little breast tissue, through the belly button under the muscle may be best. And the “peri-areolar” approach, given careful closure of the incision, gives the best control of the breast pocket and the incision usually almost vanishes. The areolar skin is sort of like lip skin, it hides scars well if the surgeon does his or her job well.

A “one size fits all” approach just won’t give the best results for every person. For example, one surgeon we know only performs his breast implants as over the muscle through the crease at the bottom of the breast. I can’t believe his results are consistently the best. And because his prices are so cheap, I’m sure he’s using only the low profile implants, which aren’t optimal in most cases.

We like silicone implants, but it’s of course your choice if you can’t afford the silicone implants (wholesale cost roughly $2000 to the doctor), or have concerns about silicone. And while we are on the subject, I want to mention the “gummy bear” implant. It’s great marketing, but these implants are hard and unnatural. Too hard for my preference. And they are touted to have a thicker silicone that won’t migrate or run into other tissues if the implant shell ruptures or breaks. I don’t think this is true based on what I have seen when the implants are cut. The silicone in these implants runs and is just as sticky and has characteristics just like the silicone which is used in ordinary implants.

Check out three implants of the same volume, with the three profiles to show the three profiles we use for our Los Angeles / Fresno/ Visalia area patients, here. Remember the high profile implant, the more expensive one, is usually best for implant sizes above 350 cc. You get what you pay for. And you will have a really hard time making decisions about all this complex stuff by yourself, no matter how much reading you do. Try to keep an open mind when you come in for your consultation(s). Choose a surgeon who’s willing to carefully select a size, style, and surgical approach that has the best chance of working, and who is experienced with all four surgical approaches to breast augmentation. And be patient if you don’t get what you want right away. Implants often need to settle into place, and sometimes months of treatment with oral medicines can help this, rather than insisting on an immediate secondary surgery. Much more information is available at, in particular see this link.

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