Picking the Right Implant: Knowing Your Options with Dr. Paul Zwiebel

Board-certified plastic surgeon Dr. Paul Zwiebel has over 30 years of experience in cosmetic surgery. At his private practice,the Zwiebel Center for Plastic Surgery and Skin Care in Denver, Colorado, he has performed thousands of breast augmentations, along with many other types of cosmetic procedures. Dr. Zwiebel is committed to helping his patients achieve beautiful outcomes by providing quality care for each individual. We’re talking with him today about all the options out there for your breast augmentation, including the types of implants, scarring, selecting a plastic surgeon, and the new IDEAL IMPLANT® Structured Breast Implants.

Why should patients choose you over the other surgeons in your area?

“Over the years, we have refined our consultation process for breast augmentation so that it is  really driven by each individual’s priorities and needs. In my opinion, the consultation experience should be an educational experience. Patients should become educated about the procedure, the techniques, and in the case of breast implants, the technology. We have a three-dimensional imaging system which my patients really appreciate. Women can see their own image with the various types of breast implants, both in terms of shape as well as volume. It’s a tremendously beneficial tool for a lot of women, to help them understand the implications breast implants will have on their figure.

“During the consultation, we discuss all the breast implants out on the market today in terms of size, shape, and material: saline, silicone gel, smooth or textured, round or teardrop, etc. I discuss the trade-offs among the implants and the advantages and disadvantages to each one. We pride ourselves in being one of the few practices that really offers every option out there to our patients, and I try to make sure they understand all their different choices.”

How do you help women decide on the right breast implant size specifically?

“I have my patients try on implants so that we can get a sense of what look they want, and then we build on that. During the examination, I take specific measurements of each person to make sure that we’re selecting an implant that will fit anatomically. Then, from there, we’ll go on to some of the aesthetic considerations. We discuss how much volume it’s going to take to create the appearance that an individual woman is looking for and if that’s achievable or not.

“We then go on and do the three-dimensional imaging, which is, again, tremendously helpful for women to get a better sense of proportionality and balance in their figure. Proportion is really what most women are trying to achieve. We strongly encourage our patients to then sign out the implants that they’ve chosen, in the specific size that they like, and actually take them for a test drive. I want my patients to wear them home, try on different clothes with them, make sure that the implants are giving them the balance to their figure that they really like. I even suggest bra shopping with the implants on to see if they fill out the bras in the way that they want to fill them out. We don’t want any surprises post-op that the implants are a little bit too big or a little too small for the bras that they would like to wear.”

What type of incision should a woman choose for her breast implant surgery?

“Data has continued to show that incisions placed in the breast crease produce a very high level of patient satisfaction. This is because the scars are hidden in the crease, but just as importantly, these incisions have the lowest incidence of complications like capsular contracture and interference with nipple sensitivity. We’ll usually encourage the approach through the breast crease. Other options can include going in through the armpit or going in through the areola, but they do carry higher complication risks.

“The size or the length of the incision is going to depend on the type of implants you choose. With silicone gel implants, the length of the incision is proportionate to the volume, so the bigger the implant, the bigger the incision we need for placing the implant. That’s not the same with saline implants. Because we place the saline implant deflated, and we actually inflate the implant once it’s inserted in the breast, we can make a small incision, typically an inch or slightly less in size for almost any size implant. A smaller incision is one of the advantages of saline implants.”

If a patient has to have a breast implant revision due to a rupture, is there any benefit to having a saline or structured implant versus silicone gel?

“One of the classic advantages of saline implants and why women have selected them in the past is that saline implants are filled with salt water, a natural occurring substance in the body. So if the saline implant were to leak, that salt water is absorbed and doesn’t harm the woman. Many women find that very comforting from the standpoint of a margin of safety. In comparison, silicone gel is not absorbed into the body.

“If somebody were to develop a leak with a saline implant, they’ll notice some degree of deflation. With regular saline, the implant will completely deflate, typically over a period of two to three days. With the new IDEAL IMPLANT, which are structured saline implants, only the outer shell of the implant deflates. A woman will notice the change, but it’s not going to be as dramatic.

“When we’re replacing a saline implant, whether it’s the classic or the structured saline, one of the great advantages in the replacement is its simplicity. We typically use a local anesthetic and just inject the same incision that was made before. Through that incision, we’re able to remove the old implant and replace it with the new one in a procedure that typically takes about half an hour with no downtime. Most of the time, when patients have a replacement, they can just continue with their daily activities, so there aren’t any special recovery issues.

“A disadvantage of silicone gel implants is that if they do develop a leak, there is the issue of detection. Unlike the saline, it becomes a little less obvious to detect a leak with silicone gel, because the silicone gel can’t be absorbed by the body. It doesn’t go anywhere. Those leaks are usually detected with studies likes mammography, ultrasound, or even MRI. Clinical symptoms of a deflation with silicone gel implants or manifestations might be a new mark or bump or, perhaps, the development of capsular contracture. When we’re replacing a silicone gel implant, we have to remove the old gel. Sometimes that can be done through the incision or through the old scar and the use of a detergent rinse to remove the old silicone. Other times, however, particularly if there’s been capsular contracture, we have to remove the old capsule as well. With silicone gel implants there is a potential risk in delaying the diagnosis and not appreciating that a leak has occurred, and there is also a potential that the operation to replace the implant may be a little bit more involved and a little bit more lengthy.”

How can women make sure they are getting an excellent plastic surgeon for their breast augmentation?

“Fortunately, there are a lot of very highly qualified plastic surgeons out there. You should start out by finding someone who is certified by the American Board of Plastic Surgery. The next thing you should look at is years of experience. You should choose a surgeon for whom breast augmentation is a very significant part of their practice and who’s been doing it for a long time. The surgeon’s reputation is going to be very, very helpful, as well.

“But, keep in mind that it’s not just the surgeon that you’re choosing. You’re choosing a practice. You want to be in an environment where you can feel well taken care of. You should feel as though you can trust your doctor and his staff completely. As much as surgeons are very prideful about our work, we depend very heavily on our staff. Having a great staff that’s going to be available to answer your questions and help you through the surgery and healing process is key.

“During the consultation, too, you want to make sure that you feel the right kind of rapport or relationship with the surgeon. Is the surgeon really listening to what it is that you want to achieve? You need a surgeon who really understands what you want and how to help you meet your goals. You should be able to go into surgery not worrying that the doctor may do what they want to do rather than what you really want to have happen.

“You also need to have that expert who’s going to help you sort through the many, many different options that are out there. Your surgeon should talk to you about the selection of the right implant for you, what’s going to fit your body well, the right size, the right shape, the right type of implant, all the factors that will ultimately go into your decision.”

How long can women expect their breast implants to last?

“Many women ask about the the durability of the implant or whether or not they’re going to have repeat operations in the future. For years, there’s been kind of an urban myth out there that implants have to be replaced at 10 years. That’s not the case. Implants don’t really have an expiration date. However, even the latest data does show that there’s a high likelihood that anybody who chooses to have a breast augmentation will probably have another operation sometime during their lifetime. Some data shows that it could be 30% of people. Other data shows as many as 70% of women who have surgery will have another one for a breast augmentation. I think the most important thing women can do is to go into surgery emotionally and financially prepared for the likelihood of another operation at some point in the future. While we always hope that the implants will last forever, realistically, doctors and patients have to be prepared for the eventuality of some additional surgery in the years to come.”

What trends have you noticed in breast augmentation over the course of your practice?

“I’ve been in practice now for about 34 years, and I can say that there was definitely a period of time where we saw a pretty steady increase in the size of the implants that women were choosing. More recently, we’re seeing that trend change a little bit in the opposite direction. The average size breast implant is a little bit smaller than it might have been three or four years ago. Those trends do have a tendency to change, but popular trends don’t necessarily apply or make sense for certain individuals. Again, that’s why it’s so important during the consultation that a patient make it very, very clear what it is that they’re trying to achieve. For example, during a consultation in my office, we’ll make use of different diagrams that help to illustrate the overall shape of the breast that somebody’s trying to achieve. We don’t just look at the overall volume. Oftentimes, volume and shape may be related. It can take a certain amount of volume to fill out a person’s chest, but the shape that somebody wants, I think in recent years, has become as big if not a bigger concern than the overall size.”

How long have you been using IDEAL IMPLANT Structured Breast Implants?

“In my own practice, I don’t have any particular incentive with any manufacturer, and I offer all of the implants that are currently manufactured in the United States. The IDEAL IMPLANT was available to a core group of plastic surgeons as part of the seven year study that IDEAL IMPLANT submitted to the FDA. Unfortunately, I was not part of that core group, so the IDEAL IMPLANT has only been incorporated in my practice just in the last few months.”

What do your patients think about the IDEAL IMPLANT?

“For the patients who have chosen IDEAL IMPLANT Structured Breast Implants for their breast augmentation, the satisfaction has been unanimous. Women love the appearance and the feel of the IDEAL IMPLANT, as well as the peace of mind that it carries fewer risks and complications than most alternatives.”

If a woman wants to do her own research about different types of breast implants, what resources would you recommend?

“I refer my patients to the IDEAL IMPLANT website, because it contains very helpful information about the advantages and disadvantages of the IDEAL IMPLANT in comparison with other implants. There’s a very handy chart that’s available on the IDEAL IMPLANT website that I encourage all of my patients, during the consultation, to go home and take a look at to help them in their decision-making.”

When it comes to your patients, have your methods changed over the years?

“Now that I’ve been in practice for a little bit over three decades, what has become increasingly obvious to me as a doctor is that it’s important to counsel my patients much like I would counsel a family member. As I think about choices in breast augmentation, that’s a very conscious part of my decision-making. During a consultation I’ll think, ‘What would I advise if this person were my wife?’ Part of that consideration does have to do with safety issues and the latest data that is coming out from recent studies. There are certain implants that, quite honestly, I tend to steer my patients away from, because the complication rates tend to be a bit higher than the implants made by other manufacturers. Lately, I’ve been very pleased to add the IDEAL IMPLANT to the armamentarium of choices, because they carry a lower safety risk and lower complication rates. This puts me in a position to be very comfortable in recommending the IDEAL IMPLANT for most of my patients when I see them in consultation.”

Considering breast implants in Denver, Colorado? Contact Dr. Zwiebel today to discuss your options. Simply call 303-470-3400 or visit www.drzwiebel.com. Dr. Zwiebel’s office is located at 2050 E. County Line Road, Highlands Ranch, CO 80126. Call today for more information on IDEAL IMPLANT Structured Breast Implants.