But a good guess is that the implant picks up a stray germ or three from the skin of the patient as the implant is worked through the incision and down into a previously prepared pocket, usually under the chest muscles.

Now, a plastic surgeon has come up with a way to place an implant through the skin, down and under the breast without the implant touching the patient’s skin.

It works like this: the tip of a nylon funnel is placed through the incision into the breast pocket. The surgeon puts the implant into the funnel and squeezes the implant into place.

The device (pictured) looks like a pastry bag used by bakers and chiefs.

Known as the Keller Funnel, somewhere around 400 U.S. plastic surgeons are said to be using it in breast enlargements. The funnel can be used when incisions are made in the:

• Armpit, an area known to surgeons as the axilla
• Areola, the brown area surrounding the nipple
• Inframammary fold, the area under the breast where the chest wall meets the breast

Normally, a surgeon uses his fingers to squeeze, poke and prod the implant into place. It’s harder to put a silicone implant into place because it is already filled. Saline implants, however, can be inserted empty and then filled after placement.

More women and their partners often report they prefer the soft, natural feel of silicone.

The funnel’s makers say placement is easier — and more sterile — because the nylon funnel has a slippery coating which allows the implant to slide easily along the length of the funnel.

Without the device, some plastic surgeons say their fingers have become fatigued while pushing and prodding the implants into place.

One expert even did a study and found a 95 percent reduction in force surgeons must apply to get the implant into the breast pocket!

Other benefits claimed include:

• Smaller scars
• Faster and more gentle surgery
• Quicker healing
• Easier on the patients’ breasts

According to the manufacturer, about 1000 breast enhancement procedures have a used the funnel.

Until now, women who wanted breast augmentation or breast reconstruction after cancer had the choices of:

• Saline and silicone implants
• Flaps of fat and skin from the tummy or the sides

Some surgeons, reconstructing breasts for cancer patients have also taken large flaps of skin and fat from the patient’s buttocks to use as breasts.

But that causes a scooped out, flat appearance on the haunches and, usually, the need for yet another plastic surgery to create more rounded buttocks.

During one surgery, Ariel Rad, M.D., an assistant professor of plastic surgery at Johns Hopkins University School of Medicine noticed during one operation a blood vessel that would make the surgery to transplant love handles to breasts and recovery easier.

Any time plastic surgeons transplant fat, they must place it close to an existing blood supply — or else create a new blood supply. Without blood, the transplanted fat will die. Because dead fat tends to calcify, mammograms readings are blocked and may hide evidence of returning cancer in the future.

Professor Rad and his colleagues then decided to find out if everybody had that particular blood vessel. So they studied corpses and performed CT scans on living patients and found it present in 60 percent of patients.

The next step was using the method on 12 slim, athletic women who had lost their breasts to cancer. The surgeons were also thrilled to find the critical blood vessel needed to connect the blood supply in the mammary area was twice as long as the one used in buttocks grafts.

The new surgery was performed on the dozen patients from February, 2008 to one year later. All had good cosmetic results, according to Dr. Rad

The operation is performed with a microscope to connect blood vessels and provides a bonus in addition to reconstructed breasts, including:

• An improved contour of the waist
•  An improved contour of the hips

(Read more about the love handle breast augmentation procedure in ScienceBlog.com)

Now a self-described “cognitive scientist” comes forward with a method of breast enlargement you probably have not heard from a plastic surgeon — by listening to ring tones on your cell phone! (We are not making this up!)

But first, take a gander at the ways various entrepreneurs have put forth to create breast enhancement:

• Enough “special” creams to float a battleship
• More pills than Carter ever produced
• Exotic herbs by the ship load
• Ultra exotic massage techniques

One of the more unusual schemes in existence involves wearing plastic domes (pictured) over each breast.

Each dome is connected to a suction device that provides constant negative pressure on the breasts. (We are not making this up, either!) Of course, the user must put up with constant suction on the breasts for ten hours daily.

One such device went way over the top, claiming his breast suction devices would even re-grow breasts removed via mastectomy!

Stephen Barrett, M.D., at Quackwatch, a website tracking (cough-cough) dubious health claims, spotted the ad.

Dr. Barrett later took the manufacturer to court in Iowa. In 2004, he came away with a $40,000 civil penalty and restitution order for people who bought the breast enlargement device.

But that doesn’t stop the other equally, ah, dubious claims.

The claim behind the cell phone ring tones allegedly creating larger breasts is based on tones that mimic a crying baby. Irritating? Sure. But a boob job? Not so sure.

When the female of the species hears those tones, and we quote the “scientist”, Japan’s Hideto Tomabechi: “The brain tells the fat in the behind and the legs to please move toward the breasts.”

The video is a little long and wordy but, hey, judge for yourself if crying baby ring tones is likely to enhance breasts!

Oh, did we not say? You have to listen to the ring tones 20 times a day!

Fat taken from where you don’t want it and then applied to the places where it is highly desired – and desirable!

The patient's fat was used for breast augmentation. The after picture, right, was taken seven years later. PHOTO: Sydney Coleman, M.D.

In the United States, fat transfer to enlarge the breasts is getting more serious attention, according  to Denver’s Dr. David Broadway who blogs that the American Society of Plastic Surgeons’ task force on fat grafting has made a positive recommendation to surgeons about “proceeding with caution.”

However, for many decades, France, Brazil, Italy, Japan and a few other nations have been going full force ahead with breast enlargement, using the patient’s own fat instead of a breast implant.

Recently, two plastic surgeons, one French (Yves Gerard Illouz) and the other Brazilian ( Aris Sterodimas), studied 820 fat transfer breast augmentation patients from 1983 to 2007.

From the get-go, the surgeons admitted the procedures shortcomings:

• Transferred fat is often reabsorbed
• Fat sometimes dies and forms cysts of calcium
• The calcium can block mammograms and hide cancer

The 820 plastic surgery patients, ages 19 to 78, were divided into three groups of:

• Breast reconstruction patients with unbalanced breasts
• Patients born with uneven breasts
• Patients who just wanted breast augmentation

The subjects all signed consent forms outlining potential complications of injecting fat into the breasts.

Following the patients after their breast surgeries for 25 years and giving them mammograms at the six-month and one year points after the surgery, the doctors found:

• 12 hematomas, pooled blood under the skin
• 5 infections
• 76 cases of black, blue and purple bruising (ecchymosis)
• 34 cases of long term unbalanced (asymmetry) breasts
• 36 cases of striae, or off-colored stretch marks

Most complications showed up at the six-month point.

The doctors caution that the treatment has to be performed in stages with small quantities of prepared fat injected into the breasts at each session.

“The way to prevent complications is make sure the patient’s final result is not the aim of a single procedure,” wrote the doctors. Three sessions usually do the trick

According to the doctors, the procedure is predictable and satisfying as long as surgeons use at least three sessions.

(Read more about breast augmentation via fat transfer.)

In cosmetic plastic surgery, the equivalent of the sample is a set of before and after breast augmentation pictures.

When we told you in a previous post about breast enlargement with Macrolane , we did not have any samples to show.

Now, a British lass has solved that. A plastic surgeon, entertaining a very select audience, brought out an extremely, shall we say, bosom challenged young miss and then took her away for Macrolane injections.

Five days later, the surgeon then fetched his lovely subject back before the same group, to complete the before and after viewing experience.

And we’ve got the pictures!

Look for yourself how quickly – and naturally — a Macrolane breast enhancement takes effect.

Such a shame the Macrolane goes away in one to two years!

One such area is microsurgery, operating on very tiny structures of the body through a microscope.

When women lose one or both breasts to cancer, a plastic surgeon often works with the cancer surgeon afterwards to rebuild the breasts.

Many physicians like the idea of a woman waking up from surgery and not seeing her breasts gone, with scars on her chests where her bosom used to be.

So the plastic surgeon often steps up to the table right after the mastectomy surgery.

The DIEP method takes extra flesh, fatty tissue – along with their blood supply vessels — from the woman’s stomach for use in building soft, warm, living breasts. The method is usually best for patients that need a small amount of tissue to reconstruct the breast mound or those who need both breasts reconstructed.

To get donor tissue, the surgeon uses the same incision across the binki line from hip to hip as he would in the tummy tuck procedure. Then, another curved incision is made in an arc from one side to another above the first incision.

The resulting flap — shaped like a large eye – is then moved to where the new breast will be. The long scars in the tummy area fade over time.

However, the vertical stomach muscles that create a “six-pack tummy” the rectus abdominis, are not touched.

Working at the location of the breast, the surgeon then painstakingly uses microsurgery to reconnect the blood supply to the new breast.

Then, the nipples are reconstructed from flesh on the new breast. Areolas are often created with tattoo ink. The procedure can take three to four hours.

Many patients say the DIEP (”Deep Inferior Epigastric Perforator” flap) breast is often
firmer and has a more youthful look than the natural breasts.

One 43-year-old DIEP patient wrote to her surgeon: “Not only am I cancer free, but I look much better than when I first came to you.”

Another patient wrote her surgeon after having DIEP reconstruction that, after 14 years after a divorce, she had her femininity back, had met a wonderful man and was getting married again.

It happens in breast augmentation, too.

When breast augmentation became really popular around 2000, more types and sizes of breast implants were designed and added to plastic surgeons’ offices.

One, the tear-drop shaped implant, came into use because, hey, what could be greater than an implant in the natural shape of a human breast? The tear drop insert has more fullness at the bottom and looks like, well, a tear drop.

But, as always, the devil is in the details. Also known as a contoured or anatomic breast implant, the tear drop shaped inserts had to stay in a single position to provide the desired appearance of naturalness.

But a tear drop implant can rotate or turn upside down. That would give the breast a very strange look indeed and probably require another surgery.

So the envelope of the tear drop implant was textured – instead of smooth — to give internal scarring something to hang onto.

Internal scarring?

Any time nature senses a foreign object inside the body, the invader is walled off with scar tissue. The textured surface allows the scar tissue to get a better grip and hold a tear drop implant in place. At the same time, the textured surface is supposed to prevent the scar tissues from getting too firm a grip, squeezing the implant too much and making it feel hard to the touch.

It’s an undesirable condition known as capsular contracture, a hardening of the augmented breast.

Solution? Many plastic surgeons recommend a round, untextured breast implant instead.

It sounds like a contradiction, but a round breast implant does not necessarily make a round breast. When the patient with round implants stands, the inserts take on a tear drop shape anyhow.

What really makes the difference?

According to New York City plastic surgeon Joel Studin, M.D., the final shape of the breast largely depends on the size and position of the pocket the surgeon creates under the patient’s chest muscle. Other factors include the shape, elasticity and thickness of the patients’ muscles and the implant size.

Dr. Studin blogs that what really creates an artificially round breast is putting the implant atop the chest muscle where there isn’t much good skin or fat coverage.

Lesson learned? Listen to your plastic surgeon! He or she has done that a lot…. provided you chose the right plastic surgeon.

• In the areola, the dark ring surrounding the nipple
• In the bottom of the breast where it meets the chest wall
• Through the belly button
• Through the patient’s arm pit

A new article in the International Journal of Surgical Reconstruction, a professional magazine for physicians, studied 98 breast augmentations which had been done via the arm pit.

The method is technically known as the transaxillary approach.

Chinese plastic surgeons did the study because most breast enhancements start with an incision in the areola or in the inframammary crease, the place where the breast meets the chest wall.

But Chinese women -like African-Americans, Latinas, American Indians and other people of color – are prone to problem scars like hyperplastic scars.

Because the doctors must reach the breast from the patient’s armpit, they use a special instrument, an endoscope, to tunnel under the skin. The endoscope lights and shows the way with a tiny camera and a set of small surgical tools.

Those surgeons, working at a plastic surgery hospital affiliated with the Chinese Academy of Medical Sciences in Beijing, prefer to place the breast implant under the patient’s chest muscle.

Why?

Studies show implants under the chest muscle look more natural and are prone to fewer complications like capsular contracture, the most common type of scarring in breast augmentations.

The surgeons use silicone jel implants. Unlike saline — which can be filled after implanting — silicone implants require a slightly larger incision about one and one-half inches long. The transaxillary method also avoids injuries to the nerves in breast skin and nipples.

The patients were evaluated at six and 12 months after the operation. Results? No complications like infection, bleeding, scarring or capsular contractor were found. (Read more about the transaxillary breast augmentation study.)

What type breast augmentation would you favor?

• Breast augmentation
• Breast reduction
• Breast lift

say about two percent of the female population have inverted nipples which are turned inward into the breast rather than standing upright.

The condition is usually due to genetics, while some infections and conditions can cause it.

Nonetheless, affected women seek help from plastic surgeons because:

• The look is unattractive
• They are inhibited in intimacy
• Breast feeding can be a problem

Usually, the inverted nipple is held inside the breast due to scar tissue or muscles just below the skin’s surface.

In most cases, the plastic surgeon uses small incisions into those internal breast muscles to allow the nipple to release and pop up. In some cases, the woman loses the breast feeding ability because the milk ducts are severed.

One study revealed another way to repair inverted nipples is using a needle, smaller incisions and  putting the nipples in traction for a week.

Known as the Stevens Stent, the technique works like this:

The surgeon releases the muscles with a tiny incision next to the milk duct, uses a small hook to pull the nipple upright and then places stitches internally around the nipple at the 12, 3, 6 and 9 o’clock positions.

After that, the surgeon puts surgical gauze and a small medical cup a little larger than a thimble over the nipple to protect it and the surgical site. The stent is removed after five days. The stitches dissolve automatically.

Appearing in a magazine for plastic surgeons, the Aesthetic Surgery Journal, the article told how 21 nipple/stent patients were followed for one year. All reported their nipples had stayed upright during the year after breast surgery.

Would you have plastic surgery if you had inverted nipples?

Two plastic surgeons in Virginia and Maryland noticed a slightly different way to administer pain killers. It made that is making a large impact in a first study on 200 patients.

Dean Jabs, M.D. and Franklin Richards, M.D., like most other board-certified plastic surgeons, are very observant and noticed that most liposuction patients have very little pain afterwards.

So why not have the same technique for breast enlargement patients?

In liposuction, the treatment areas receive large injections of a medication to lessen bleeding – but that medication, lidocaine, is also a potent pain killer.

When performing a breast augmentation, the standard procedure for many is to make a pocket – for the breast implant — under the large chest muscle, the Pectoralis major.

Part of creating that pocket involves making incisions in the chest muscles. And that’s what creates a lot of recovery pain for patients, even though “pain pumps” are often put into patients’ chests before they wake.

Narcotics are available, but the side effects can be unpleasant.

The surgeons thought a better way might be injecting long-lasting pain relief into the chest muscles before creating the implant pocket. Additionally, they used another long acting anesthetic, Marcaine, in any muscle that had to be cut.

Soon, recovery room nurses were asking the doctors what they were doing differently. Breast implant patients treated with the pain medications at the start of the procedure were found to be more comfortable in recovery and leaving sooner. (Read more about the breast augmentation pain relief study.)

The physicians then compared 100 patients who received the new treatment with another 100 similar breast augmentation patients who did not have the extra medications.

Women treated with the extra measures went home sooner, used less pain medication while recuperating, had less nausea and were more comfortable during recovery.

What’s your experience with pain killers?