Wherever you turn nowadays, it seems that big breasts are where it is at. Magazine articles, advertisements in all media including even on billboards, and marketing materials intentionally display alluring, voluptuous women. Television and movie actresses, anchorwoman and even hostesses at many finer restaurants are well endowed in clearly disproportionate numbers. Breast augmentation usually ranks as the number one plastic surgery procedure among women. Why then would a woman choose to reduce the size of her breasts? Could this apparent lack of judgment be caused by drinking too much bottled water or is it the result of a never before recognized side effect of global warming?

The real answer to this is that naturally large breasts can be very big problem. Their sizable weight can be associated with neck, back and shoulder pains, skin irritation and rashes, unpleasant odors, numbness in the extremities, fatigue, and even impairment of breathing. Some women are forced to sleep propped up in bed or in a recliner as their breasts are so massively enlarged (gigantomastia) and heavy that breathing is a chore. With time, many women develop arthritis of the neck, deforming postural changes and deep, painful grooving of the shoulders from the bra straps relentlessly digging into their skin. Exercising can be extremely difficult, painful and even embarrassing so many forego it. I have had patients tell me that they need to wear two or three sports bras just to attempt to feel more comfortable. Many give up on vigorous activities and as a consequence, gain weight. Some of that increased weight goes to their breasts and so it becomes a vicious cycle. An extremely high proportion of women with large breasts, therefore, are well above their ideal body weight which can also lead to other health issues. Finally, many find themselves being gawked at or the target of unwanted comments or ridicule.

Clearly for these women, large breasts are not a blessing but a curse. This is why many seek to have their breasts made smaller through an effective breast reduction procedure (reduction mammoplasty). By reducing the size and weight, recontouring and lifting them, most if not all their symptoms can be alleviated. They can start exercising again, engage in sports that they had to avoid previously, and can address weight issues more effectively. Self-image and confidence improve significantly.

In over 20 years of practice and performing a large number of breast reductions, I find that women who have undergone this procedure are among the happiest and most satisfied of any of my patients along with those who have had a breast augmentation.

Breast Reduction – before

Breast Reduction – after

Breast Reduction – before

Breast Reduction – after

To learn more about breast reduction, breast augmentation or other cosmetic surgery procedures, please contact Dr. Turkeltaub at 480-451-3000.

Steven H. Turkeltaub, M.D.
Scottsdale and Phoenix, Arizona

Breast implants are not permanent medical devices and should not be expected to last forever. They can be quite durable and long lasting but given enough time, all will eventually need to be replaced or removed. Many of my patients have the misconception that implants have to be replaced every 10 years whether they are silicone or saline. This is absolutely not true. The silicone implants manufactured today can last up to 20 to 30 years or more. Saline implants on average will have to be replaced sooner. Allergan’s (an implant manufacturer) ongoing prospective Core Study of silicone breast implants noted a rupture rate of 2.7% in 4 years for primary enlargements.

Many factors influence the durability of the implants. Some of these include:

• Type of implant – Saline versus Silicone.  Silicone breast implants generally last longer and are more durable compared to saline implants. There are studies that show a 5 – 10 time greater rupture rates of saline implants as compared to silicone implants at various time periods.
• Textured versus smooth implants.  In particular, textured saline implants have a noticeably shorter life span when compared to the smooth ones.
• Size of implant.  Large implants may not last quite as long as small ones.
• Manufacturer of the implant.  There are technological, manufacturing, and proprietary differences between the implant manufacturers that affect the lifespan of the implants. In over 20 years of practice, I have clearly found that significant “brand” differences.
• Surgical technique.  A less gentle, more traumatic insertion of the implant can weaken the shell of the implant and predispose it to earlier failure and therefore a shorter lifespan. This can occur in silicone implants by trying to insert a large implant through a very small incision.
• Incision location.  A trans-umbilical (belly button) incision can affect the durability of the implant due to the trauma of insertion. Insert large silicone implants through limited sized periareola or transaxillary (armpit) incisions can also be detrimental.
• Trauma.  Very high energy impacts such as car accidents can potentially affect the long term durability. I have seen many women over the years who have been involved in serious car accidents without any injury to their implants. Sharp objects that are stuck in the breast can definitely rupture the implants
• Mammograms and frequency.  Frequent mammograms, particularly aggressively compressing ones, can weaken the implant envelope.

Breast augmentation is a very rewarding procedure and is associated with an extremely high satisfaction rate. Like many other things in life, (almost) nothing lasts forever and this is true of breast implants as well.

Silicone implants - Smooth (Left) and Textured (Right)

To learn more about breast implants, breast augmentation or other cosmetic surgery, contact Dr. Turkeltaub at 480-451-3000.

Steven H. Turkeltaub, M.D.
Scottsdale and Phoenix Metropolitan Area, Arizona

Should I order that large entrée sized salad or still be hungry after eating the smaller appetizer salad? Will that 42” LCD TV look too small in the room or should I splurge and go for the 60” model. Do I want to live in a small apartment or a nice roomy house with a yard in a quiet neighborhood? Despite what you may have heard, size does matter.

With breast implants this is very true as well. When women come to see me in consultation, their first concern is about size. As is their second… They don’t request “I would like textured implants – in whatever size you have available.” or “Just give me something above the muscle.” No, it is size, size, and size. This is a variation on the mantra for a successful business where it is location, location, and location. Many studies show that the number one reason for reoperations in breast augmentation is unsatisfactory breast implant size. Nearly always it is because the size selected was not big enough.

Complicating this size issue is a misconception of what volume and proportion different cup sizes represent and what is truly proportionate or “fits my body”. One company’s “C” bra may fit exactly like another company’s “D” bra. Furthermore, many women think that a “B” is considered normal and proportionate whereas a “C” is too big. If I had proceeded to give them what they “wanted”, there would have been a lot of unhappy patients. We have had requests for a “small C”, a “regular C”, “large C”, a “small D”, etc. Have you ever gone to buy bras and asked the sales person to show you the selection of 34 large C bras? Or 36 small D bras? She would probably wonder what hole in the desert you crawled out from. There are no such bras! I’ve never seen them. Of course, then again, I have never personally bought a bra either!

Different Breast Implant Sizes

Another issue aside from cup size and proportionality is that often women don’t really know what they want. Women want to be bigger but to what degree? What is too large or not large enough? What may be too big for one woman will be too small for another even though they voiced similar desires. I have found a few constructive ways to help my patients determine what they are really looking for. Trying on implants in the office, although not entirely accurate, gives my patients a 3 dimensional perspective that they can relate to. The photographs of a wide variety of previous breast augmentation patients with specific cup sizes are reviewed. Pictures from magazines or the internet can also be helpful but are limited by several issues including their two dimensional nature, clothing (on some), air brushing, resolution and perspectives. Some people on their own have used bags of rice stuffed into bras to help in sizing. Don’t try doing this with pasta – raw or cooked. It will not usually be a pleasant experience. I find that by carefully listening to my patients, seeing where they are coming from, their overall goals, etc., plus some intuition, I virtually always can determine the general appearance/size that would make them happy.
Based on all this input from my patients and their assessment, I make the final decision on the ideal implant size during surgery. If there is any doubt, it is always better to go a little bigger than a little smaller.

Yes, size does matter!

To learn more about breast implants, breast augmentation or other cosmetic surgery, contact Dr. Turkeltaub at 480-451-3000

Steven H. Turkeltaub, M.D.
Scottsdale, Arizona

Silicone gel breast implants have been around since 1962. Over the ensuing years and with many design and technological changes, it has evolved into the safe, refined, durable and aesthetically pleasing implant that we have today. In the early days, there was a very high rate of capsular contracture, a situation where the body forms firm scar tissue around the implant causing palpable hardness and a deformed appearance of the breast. Changes were made in the 1970’s which helped lower this rate. However, with thinner implant shells and a less viscous form of silicone, there was a higher rate of implant rupture as well as silicone leaching through this outer envelope.

In the 1980’s and 1990’s, the implant shells were thickened, strengthened and made largely impermeable to the silicone. This has increased their durability and life span quite substantially. In addition, the silicone gel was altered to be far more viscous, into a cohesive form much like taffy or cream cheese. If one takes a knife and cuts a silicone implant in half (you can try this at home if you have an extra implant!), the halves maintain their fullness and shape. There is no oozing of any silicone because it is very sticky and cohesive.
In the early 1990’s, the news media began relentlessly generating unwarranted hysteria regarding the safety of these implants. Their misinformation created such a “feeding frenzy” that tens of thousands of anxious women across the country were calling their plastic surgeons concerned that they had a ticking time bomb inside them. Unfortunately, many went so far as to have their implants removed just on this fear alone despite no scientific evidence to justify their decision. Even today, I still get asked by many of patients considering silicone implants for breast augmentation: “Are they safe?”
Silicone implants are probably the most investigated, scrutinized of any medical device ever. Countless basic science and clinical studies to assess risks and other issues have been done over the years by a broad array of researchers including physicians, scientists, and manufacturers. In fact, the FDA restricted the usage of silicone implants between 1992 and 2006, until additional studies were performed to substantiate the safety of these implants. This data overwhelming supports the safety of silicone breast implants. It also shows that there is no causal relationship with significant diseases such as autoimmune diseases as had been contended by non-scientists. Quite importantly, there also is no increased incidence of breast cancer in women who have silicone implants.
When you are contemplating your breast augmentation, remember:”Yes, silicone implants are safe!”

To learn more about breast implants, breast augmentation or other cosmetic surgery, contact Dr. Turkeltaub at 480-451-3000

Steven H. Turkeltaub, M.D.
Scottsdale, Arizona