Breast Augmentation in San Antonio, TX | Michael E. Decherd, M.D. (2023)

San Antonio plastic surgeon, Dr. Michael Decherd, has earned a reputation as a surgeon that produces beautiful outcomes for women seeking fuller, shapelier breasts. Breast augmentation continues to be one of the top cosmetic procedures, and more than 300,000 women undergo this surgery each year in the U.S. With Dr. Decherd's skill and the latest innovations in breast implants, San Antonio women can enjoy beautiful, natural-looking results.

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To achieve the perfect appearing breast, there is more that goes into the decision making process than simply choosing volume (CCs). Just because one woman looks great with 450CCs, does not mean her best friend will have the same results. The width of the breast is also critically important; a wider breast needs more volume than a narrower breast to achieve the same look. This is why measuring the chest wall is a crucial part of the examination process. It's important to match the width of the implant to the width of the breast. Choosing an implant that is too narrow will create too much space between the breasts while choosing an implant that is too wide will extend the implant into the armpit. Native breast tissue must also be taken into consideration. A woman with more native breast tissue probably needs less implant than a woman with less tissue to achieve a similar look.

For a given width of the breast, a woman generally has 3 basic choices with respect to the implant profile. A profile simply refers to the projection. While profiles sometimes go by different names, they are generally known as low, medium, and high profile. Women may have preconceived notions about the implant profile. During the consultation, determining the desired breast size is the first step in the process. From there, this helps determine the profile. Sometimes, what would be high profile in silicone ends up being medium in saline.

Both saline and silicone implants are good products for breast augmentation. There are pros and cons to each. The biggest difference is that silicone feels softer and a bit more natural. Visually, both saline and silicone implants look similar as long as the saline implant is filled within the manufacturer's fill range. Saline implants are filled during surgery, whereas silicone implants are pre-filled from the manufacturer. Usually, if a person has implants that look disproportionately large, it is likely a saline implant that has been overfilled. It is believed by many surgeons that silicone has less "rippling" than saline. Silicone implants are also a little bit more expensive than saline implants. Saline implants are FDA approved for women 18 and older. Silicone implants are FDA approved for women 22 and older. The FDA recommends MRIs 3 years after surgery for women who have silicone implants, and then every 2 years after that to ensure a rupture has not occurred.

Questions about the safety of silicone implants have been resolved by science. Silicone implants before 1992 were runnier (an oil). Now, silicone implants are made of a cohesive gel that binds to itself and doesn't ooze or seep if a rupture were to occur. Even on a saline implant, the shell is made of silicone elastomer. Silicone elastomer is used, by the way, in multiple different types of medical devices, such as catheters, lines, tubes, etc. If a saline implant fails, the saltwater is absorbed by the body and excreted in the urine. It is not a medical emergency but it may be a cosmetic emergency. Think of a flat tire. If this happens, new implants would be needed.

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Recovery Time

1-6 Weeks

Average Procedure Time

1-2 Hours

Post-op Follow-up

2 Weeks

Procedure Recovery Location

Outpatient

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Options include beneath the breast, around the areola (nipple), or in the armpit. Most of the time, especially for silicone implants, we need to go beneath the breast in the inframammary fold (where the bottom of the breast meets the chest). This allows for a longer incision for these pre-filled implants. In most cases, especially if the breast has any degree of sag, the patient almost never sees this incision.

Implants are made with either a smooth or a textured shell. It is the belief of some surgeons that textured implants fail more often than smooth implants. Therefore, smooth implants are usually a more common choice. However, this isn’t always the case. Some women will benefit from a textured shell. This can be discussed in greater detail during the initial consultation.

Implants come round or shaped (such as a tear shape). While some women think that a shaped implant will be better, Dr. Decherd prefers a round shape. First, the implant has to be textured to prevent rotation after surgery (a problem a round implant does not have). Also, they seem not to give enough fullness to the bottom half of the breast. By contrast, a round implant under the muscle essentially assumes a teardrop shape, but can rotate without causing a problem.

The implant pocket can be created either under the muscle or on top of the muscle. Even under the muscle there are some areas inferolaterally where the implant is not covered by the pec (think about the pec's shape), but the muscle helps fill in the upper pole of the breast. An under the muscle placement also helps prevent capsular contracture. It is a common approach to almost always go under the muscle on a first-time breast augmentation.

Breast augmentation surgery generally has a 24-hour recovery period. What this means is that patients should take it easy for the first day once they are released and resting at home. Most patients feel pretty good but will be tired, sore and feel as though they just had a vigorous workout. Patients should get up and moving soon to help with circulation. Exercise will need to be avoided for several weeks or longer to prevent any possible bleeding.

It is common for many women to panic or feel anxious right after surgery. This is because there is swelling, and the implants ride high at first, so they appear larger and higher than they will once they assume their final position. It takes about 3-4 months for the implants to settle and take on a natural look. Women love their new breasts once this occurs. The results for most women are long lasting. Today’s implants are manufactured well. The average implant can last between 10-15 years or longer.

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