Breast augmentation is the enhancement and enlargement of the breasts with implants. The implants are either round or tear-drop shaped, and consist of a silicone envelope filled with either sterile saline (salt water) or silicone gel. The implants are placed either under the chest muscle (pectoralis), or between the muscle and the breast tissue. Implants can be either textured (rough surfaced), or smooth.

The most common surgery is using smooth, round implants in the submuscular position. I will provide a complete explanation of all options during your consultation. The size of the implants is best chosen by taking measurements of your breast diameter, and picking the implants from this measurement. I use many computer photographs of my previous patients to demonstrate the different breast sizes (cups A,B,C,D) before and after surgery. I also will show you with patient pictures, the difference between the round and tear-drop implant, and the difference between above or below the muscle implant placement.

Incision sites can be either through the bottom of the areola, the crease of the breast, or the armpit. The incisions are short (~1 inch), and fade well with time. The "belly-button" approach is not used by most plastic surgeons because of the increased likelihood of implant malposition, the "blind" nature of the procedure, and the possible trauma to the implant as it is passed through a metal tube.

I place all implants "visually", that is, I always see the entire pocket where the implant will reside. If the incision is in the armpit, I use an endoscope that projects an image of the pocket onto a computer screen. If the incision is along the areola, or in the crease of the breast, I use a specially adapted lighted retractor to completely see the pocket. Why is this important? Because this allows more exact formation of the pocket, more exact positioning of the implants, and I can make sure that there is absolutely no bleeding. Many plastic surgeons believe that bleeding, even a small amount, can contribute to the occurrence of capsular contracture, or tightening around the breast implant.

Silicone-gel implants are again available, as of November, 2006. There are some definite advantages and disadvantages of these implants when compared to saline-filled implants. In general, silicone gel implants feel softer, more "natural", and may have less wrinkling. However, silicone gel implants may require more follow-up in the future (MRI scans are recommended every 2 years to evaluate the implants), and will need a longer scar for placement. The choice between saline and silicone is influenced by your anatomy and your desires. I will explain this during your consultation.

Surgery: Breast augmentation requires general anesthesia, takes appx. 2 hours, and you go home that day. Before the surgery is over, but while you are still asleep, I like to administer a local anesthetic around the pocket where the implant sits. This will drastically reduce the pain that patients may experience. The incisions are all closed with dissolvable stitches, under your skin, so there are no stitch marks or stitches that need to be removed, and the scar usually fades nicely. A dressing is then wrapped around your chest, and no drains are used. A pain pump can also be placed, for those patients who want one, but there are some "pros and cons" which we will discuss.

Healing time: Walking is started immediately, limited exercise at 1 week, but no heavy lifting or upper body exercise for 2 weeks. Most people take 1 week off from work. Soreness of the chest, especially when trying to sleep, may last for 4-6 weeks. Breasts continue to soften for 6 months.

Pain level: Most people take pain pills for 2-4 days, then switch to Tylenol®. Rank=6-8Pain information

Photos: Photo information

Risks: You will get a scar along the incision site (either areola, crease of breast, or armpit), but this fades well, especially if it is placed where the color changes on the breast (areola). Numbness may be persistent, but lessens with time. Initially, there is a low risk of bleeding or implant malposition which could require return to the operating room. Infection is extremely rare. The most important risk is that of capsular contracture, or firmness around the implant. Other risks.Risk information

Costs: $6,000 to $7,000 for saline implants, $7,000 to $8,000 for silicone gel implants.Cost information