Newport Beach Breast Augmentation

Before and After

Breast augmentation is the process by which the breast is enlarged by placing a saline or silicone breast implant under either the breast tissue or the breast muscle (pectoralis muscle). There is a recent trend where some of the patient's fat from another area can also be used to enlarge the breast but at present this technique has many limitations and will not be dealt with herein.

How Big Is Big Enough?

The first question that most prospective patients ask themselves is: How big should I go? First, let's consider a few things about why you want a breast enlargement.

  • Is it because you have very small breasts?
  • Have your breasts deflated since nursing?
  • Have your breasts dropped and are sagging now?
  • All of the above?

In addition to these reasons, there may be many more valid ones, such as feeling self-conscious about your body image and wanting to feel more feminine, sexy and confident.

However, there are also those who don't want to be too large for fear of what others might think and/or say. Some women are afraid that they won't fit in their clothes right. The bottom line is most women will UNDERSIZE themselves for fear that the whole world will know and only look at their breasts when they enter a room! Not true - but you won't believe me until you do a little rice test, which we will discuss below.

Although most women are aware that bra sizes are as varied as colors of the rainbow, they still come and see me describing how large they want to be by bra sizes. Unfortunately, the majority of women I see are wearing the wrong size bra and usually the size they are in is not their real size but the size they appear to be with the padding.

The size you want can not be found by looking at photos on the internet but this may at least give you and your surgeon an idea of what you think looks good. Your height, weight, chest size, chest shape, nipple-areola complex position and size, drooping or not, and breast size and symmetry all play factors in what ultimately will give you the size you will be happy and comfortable with.

Keep in mind that as your body adjusts postoperatively to the placement of the implants that your mind will also adjust to your new body image. Initially, the breasts will ride high because they are swollen. If put subpectorally (under the muscle), they will ride high for three to four months. During this time you will become more comfortable as the pain wears off, the swelling decreases, and they begin to feel like they have always been there. Once this happens and the implants settle, you will begin to notice that they appear to be getting smaller and smaller while mentally you were adjusting to the larger size when they were higher and swollen. As they drop down and move away from your face, you're convinced that they are shrinking.

So How Big Should I Be?

You should be as big as you want and not what everyone else thinks! This is assuming that there are no anatomical limitations, need for other procedures (like breast lifts), or that the manufacturers don't make implants in the size your contemplating. We recommend the rice test to determine your desired size. This will be a close approximation to what you think looks good for you - on your body, with your clothes. The test is described below.

You do this by making a rice stocking implant that you can vary the size on and trying at least four to five different outfits (dresses, tops, etc.) to give you an appreciation of what you look like in that size. Since most people know what too big is but not what is big enough, we recommend you start out with maybe two cups of rice in each stocking. If this looks too large then reduce it by one fourth to one half cup and retry the clothes. If they're not big enough, add to it. When you are comfortable with the outfits and how you look, measure them again for the final count. If you are undecided and like what you see in the mirror but feel it may be too big, then take a photo of yourself in this size and a smaller size. In the course of the day, compare the photos until you decide which one you think you look best in. Another method is to wear the rice sacks out and about town, this way you get the opportunity to examine yourself in mirrors or store front windows, as well as see how people respond to your changed body image. This can help you better decide if this is the right size for you.

So how does cc relate to cups and ounces and breast size? There is a misconception that a certain amount of CCs equals a certain increase in cup size. This is not true. If a patient is a 32A and you add 200ccs to there chest, she may increase her size to a B size. However, if she is a 38A this same 200ccs may only increase them about a half a size. The base diameter is so much larger on the 38 woman that the same amount of fluid is not going to increase her size the same amount as the 32 woman. What most people don't understand is that the letters A, B, C, D are proportional to the band size 30, 32, 34, 36, 38. This means that 34C breasts are not the same size as 36C breasts. The cup is proportional to the band but not all Cs are the same size. A breast on a 36C woman would be similar to the size of a D on a 34 chest woman and a DD on a 32 sized woman. What size you end up is really not important as much as how happy you are with what you look like. How happy do you think you would be if you saw what you liked while sporting the D size during your rice test and when you woke up from the surgery the first thing you think is: Are they going to get bigger? NO THEY ARE NOT! So ask your friends how many of them feel they could have gone larger. I will bet the majority will tell you they wish they went larger!

What Do You Do When Your Surgeon Says: He Can Only Put In A Small Breast Implant or It Can Only Be Put Over The Muscle?

LEAVE! There may be some exceptions under certain circumstances. There are many physicians out there that feel 350ccs is a large implant and they can't fit something much larger. They may also try to convince you that anything much larger won't look good or if you go bigger they have to put it over the muscle. This is usually because their skill set is not very good and it is difficult for them to get a much larger size using the techniques they employ. Arm pit and belly button incisions both limit the use of silicone implants, as well as adequate pocket dissection to even accommodate a large saline implant. Although a patient may be of certain chest and breast size that would limit how large she can go, I find that I can usually achieve whatever size the patient desires. This is typically done by placing the breast implants under the pectoralis muscle.

What Incision Is Best?

Do you know the expression: Don't lose the forest for the tree? Now a days, too many people focus on where the scar is going to be. They are scared into believing that if their scar is anywhere else other than the breast, then no one will know they had a breast enlargement - Wrong! If you are so concerned that the scar will be on the breast that you are willing to under go this procedure through a belly button incision (TUBA for Trans Umbilical Breast Augmentation) then you may have lost the forest (a nice looking chest with cleavage, size, and softness that you desire) because you focused on no scar on the breast (the lone tree). There are plenty of women who have achieved beautiful breasts using this technique, but there are few physicians that can do this well. This technique should be reserved for women who already have good symmetry, close cleavage, and are not requesting silicone implants. This is similar for armpit (axillary) incisions (unless they use an endoscope to do the surgery). Even with these, silicone insertion will be relegated to smaller sizes at best. Inframammary incisions (in the breast crease) are another way to insert the implants and have been popular for decades for their ease of access. Unfortunately, they may have a tendency to leave more noticeable scars and can have varied locations depending on where the implants migrate down to as they settle. Periareolar incisions (around the lower half of the nipple-areola complex) are in my opinion the most optimal approach. No it is not true that you lose more sensation through this approach. The loss of nipple sensation, which can occur occasionally (less than 10 percent) in all augmentations is due to injury of the nerves at the outermost edge of the chest where the nerves leave the rib cage and run into the muscle, and then into the breast. All of the techniques have the same liability for injuring these nerves since they all have to lift the muscle to make a space for the implant. The darker pigmented areola and lighter skin leave a good demarcation point for placing a very unnoticeable scar. Nipple skin has less chance of causing thick scars on simple breast augmentations (this may not be the case with some breast lifts) than inframammary or axillary incisions. Also dissection of a large pocket for your breast implant is easier since the incision is made in the middle of the breast, rather than many inches away like in the TUBA and axillary approaches, as well as at the bottom of the breast with the inframammary approach. In some cases, depending on the patient's anatomy or preferences, I will do the surgery through any of the approaches described – except TUBA. Always keep in mind that you can find bad scars on the internet for any of the incisions. You need to see the good ones. It is important to choose a surgeon who gets consistently great results.

Should I Go Over The Muscle or Under The Muscle?

When breast augmentation originally came about in the 1960s, all of these procedures were done over the muscle (sub glandular augmentation mammoplasty). Over time, we realized that there were a certain percentage of patients (five to 20 percent) that got capsular contracture. This is where the scar tissue forming around the breast implants begins to thicken and tighten until it becomes very snug and makes the breast feel hard, distorted, and painful. Plastic surgeons realized that by placing the implants subpectorally (sub muscular augmentation mammoplasty) they could lessen this risk to about one to six percent. Over time, more and more procedures are being done this way. On a rare occasion, there may be an individual who prefers the sub glandular enlargement or she may have certain anatomical conditions that warrant it. Previous operations may preclude a patient from being a candidate for under the muscle as well. A secondary benefit to going below the muscle is that the implant has more coverage over it, thereby somewhat camouflaging the implant's edges. It is also easier to visualize the breast tissue on mammography since the muscle separates the breast implant from the breast tissue above it. Finally, there is a certain degree of support by the muscle that keeps the implant up, which is not found with the sub glandular augmentation. This technique can be used with any incision, be it periareolar, inframammary, umbilical, or axillary. There is generally more postoperative pain with the sub muscular approach and the breast implants take longer to settle completely (approximately three to four months). The procedure also takes a little longer than with the sub pectoral approach. Some surgeons will charge less for the sub glandular augmentation mammoplasty as it is a shorter procedure. The long term benefits of sub pectoral or sub muscular approach are: 1) lower capsular contracture rates; 2) more implant coverage and less implant visibility and feel especially in very thin patients; 3) more discernable imaging with mammography; 4) internal support for the implant by the pectoralis muscle. The benefits of the sub glandular augmentation are: 1) less time in the OR (neither technique is very long; less than an hour sub glandular and just over an hour sub muscular) 2) less pain; 3) end results come about in one to two months; 4) may cost less.

Silicone or Saline: Which is Better? Which One Looks Better?

This is a difficult topic and for full disclosure you need to read the implant manufacturers brochure or the FDA patient information on breast implant safety. For my patients, I try and simplify the issues, while providing them with the information from Mentor for the more in-depth explanation.

Safety: This is everyone's concern. The FDA ban on silicone implants was lifted in 2006, because as most plastic surgeons already knew, there is no conclusive evidence of them causing all the things they were blamed for. That being said, this does not mean that in the future some things may come to light. However, silicone implants have been used for 50 years and I feel that if there was anything of significance, it would have been found by now. If a patient is comfortable with the safety of silicone implants then her options are silicone or saline. If not, saline is the only choice.

Money/Cost: The silicone gel implants cost more than double those of saline and this may make them unaffordable for some. If so, the only option is saline.

Look Better: This discussion has been going on for decades. Overall, the implants themselves look the same and in the body they will also look the same. The real difference lies with the individual and her size, shape, weight, and anatomy. If you are very thin, small breasted, and your ribs are apparent on the sides, then anything you put under the soft tissues of your chest will be somewhat apparent. This is because your ribs are covered by those same tissues and you can see them. Both implants have some ripples or irregularities along their edges that may be noticeable; these are more evident with saline implants than with silicone. As such, you may feel these palpable at the out edges of your breasts. Likewise, if you have little coverage of your own body tissues, the saline implant may be more noticeable than the silicone breast implant. It may seem that the silicone implant has a bit more of a natural feel. If you are not too thin and have enough breast tissue, the saline breast implants will be fine. Yet if you feel the safety issues are ok, you can afford the extra cost, and feel you would prefer the silicone breast implant, then these will also be fine.

Which Breast Implants Last Longer - Silicone or Saline?

No one really knows. There is no finite time frame for when you have to replace your implants. As long as you are happy with their appearance, your breasts are soft, and there are no problems with leaks, there is no need to change out your implants. The newer version of the silicone implants have only recently been released for general use, and about five years before that they were used on an investigational basis. The new cohesive gel implants do not have the longevity of use in people as the saline ones. Obviously, if your saline implant breaks or leaks you will notice your breast becoming smaller, but if the silicone one leaks you probably will not notice anything. The FDA wants you to get yearly MRIs to detect a leak.

What are the Implant Profiles and Which do I Need?

The implant profiles are moderate, moderate plus, and high profiles for Mentor. This is the width-height dimension for the implant. For the same volume of 400ccs let's say you have an implant that has a moderate profile, similar in shape to that of an M&M. The moderate plus is a bit smaller in diameter and the height is a bit higher but it is still 400ccs. The high profile has an even smaller diameter and higher projection (height) giving it more of a ball like appearance. Some surgeons prefer the high profile implant for petite women, but I think this does them an injustice. It makes the breast look too small and round like oranges, and not soft and wider like a breast. I usually reserve these for correcting asymmetry and projection. They can also be used for large, wide women who need a large size and projection to make their wide, flat chest have enough volume and projection to make a difference. For most patients, I still prefer the moderate implant, which looks very natural; occasionally, depending on the patient's anatomy, the moderate plus type works well.

What are Textured Breast Implants, Gummy Bear Implants, and Tear Drop or Anatomical Implants?

Textured Implants: Some implants are covered with a rough surface once believed to reduce the incidence of capsular contractures (see above). This is achieved by providing more surface area on the outside of the implant and modifying the body's response to forming a scar (capsule) around it. This is not true in all cases, and for the most part, many surgeons who once used these implants have switched back to the smooth surface implants for both saline and silicone.

Gummy Bear implants: These are cohesive gel breast implants in a formulation that is firmer than the present used cohesive gel. The implant can be cut in half without the silicone pouring out. The present use was restricted to investigational uses and the Gummy Bear implant may become available in the future, but it is a much firmer and less natural feeling implant than what we are currently using. It may have more specific indications for corrective and reconstructive cases. The present cohesive gel implants will retain their contents when cut, are softer and more pliable, and not as hard as the candy name type implies.

Tear Drop or Anatomical Shaped Implants: These refer to a textured implant with a tear drop shape. It is textured because of its shape, which keeps it into position as the body tends to stick itself to the implant. These implants are not used as often because the are textured and they lack upper pole fullness, which is a desirable effect in breast augmentation. Also, they have been known to rotate, with the narrow side down and the heavy, wider side up, giving the breast a less than desirable look.

Capsular Contracture, Firm Breasts, Mastopexy, Breast Lifts, Saggy Breasts & Ptosis, Breast Asymmetry

We have dealt with capsular contracture, but for completeness, I will say that no one knows for sure what causes it. It is possible that a sub clinical infection (an infection in the pocket of the implant that has no overt signs of infection such as pain, swelling, redness, or fever) may be responsible in some cases. In others, a hematoma (collection of blood in the pocket), placement of the implant above or below muscle (see above discussion), and unknown causes or poor surgical techniques may be to blame. Suffice to say we make every effort at OPSC to minimize this risk, which in our hands is less than 1 %.

Mastopexy is a breast lift and it is done for saggy breasts, also known as ptosis. Please read the section on these conditions under the list of procedures on the home page for a detailed explanation. Likewise, breast asymmetry is a condition referring to both sides of the chest that are not identical and this is also dealt with in the aforementioned section.

How long will I need to take off from work?

Every person's tolerance of pain, discomfort or fatigue varies. Most patients take about one week from work. This varies depending on the type of employment and demands at the job.

When can I drive?

Most patients can drive on or about the fourth day from surgery. However, if you are still taking narcotics or medication for pain, you should not be operating a vehicle.

Can I continue taking my birth control pills?

Absolutely. However, you may not have anything the morning of your surgery. You may take your contraception when you return to your home after surgery.

What medications should I avoid?

You should avoid aspirin and ibuprofen type products. Tylenol is fine. You will also need to avoid vitamin E and herbal remedies such as St Johns Wort, ginko biloba, kava kava, etc. Because there is no regulation over these "natural" or "herbal" remedies, any problems with them are not recognized until some misfortune. It is always better to be safe!

What medications or vitamins should I take to speed up my healing?

There is lots of discussion on what can be taken to expedite the healing process; however, we do not recommend anything specific during your recovery period. There is minimal bruising postoperatively and the pain is defused with the medications that are provided for you by Ocean Plastic Surgery Center. If you have a vitamin regiment that works for you, mention it to the doctor prior to surgery and chances are you will be free to continue taking the products you are already comfortable with.

Can I still breast feed if I have future children?

Absolutely! Again, the breast implants are behind the muscle, so the milk ducts can still function. If you have already had children and breast fed successfully prior to having implants, you should have no difficulties in breast-feeding with future pregnancies.

Can I go without a bra?

Going without a bra is a personal choice for the patient. Immediately following the surgery you will wear a support bra that we provide. After the first postoperative month we recommend that our patients find a variety of comfortable fitting bras and wear them for daily activities.

Why do some women have a big gap between their breasts? I want more cleavage.

This is a result of one or two things. The sternum may be thick or raised at the junction of the ribs and sternum, creating a small obstacle beneath the implant that doesn't allow the implant to come toward the center. Another reason, the rib cage or chest wall is round so the implants don't sit closely together.

We create a precise pocket along the midline and center of the chest (the sternum) to allow for beautiful cleavage.

How long do the implants last? When should I get them replaced?

The implants may last your lifetime. However, nothing on this planet is indestructible. A number of the implant manufacturers provide a lifetime replacement policy in the event of deflation. This is great news but rarely necessary.

What is capsular contracture?

When the breast becomes very firm and the implant cannot move.

Do you use the "adjustable" implants?

Presently, we use a breast implant manufactured by Mentor Corporation that is filled with saline or silicone.

How can I get silicone gel instead of saline?

Silicone implants are also an option if you are 22 years of age or older. After having examined you, Dr. Aiello will discuss your options as far as the saline or silicone gel implants. Some patients do benefit from the use of silicone gel implants rather that the traditional saline filled implants.

What are the risks with saline (salt-water) implants?

In the unlikely event that a saline implant becomes ruptured or leaks, the salt- water is harmlessly absorbed by the body.

Where is the surgery performed?

We have a fully accredited operating room on site at our Los Alamitos office. We perform about 30 surgeries a month in our operating room.

Will I be asleep during the surgery?

Yes, you will be asleep during your surgery. Most breast surgeries are performed using general anesthesia. We use a medical anesthesiologist in our operating room.

Are you board certified?

Dr. Aiello is Board Certified by American Board of Plastic Surgery and is an active member of the American Society of Plastic Surgeons.

Your Consultation

During this visit you, will first meet with our consultant, view several breast augmentation "before" and "after" photographs, and have all of your questions answered. You will be introduced to your surgeon, permitting you the opportunity to learn and discuss the technical aspects of the surgery you are interested in. At the time of your visit, our staff will provide you with a price quote and scheduling information. We believe the quality of our service is foremost; however, we also recognize that cost is a valid concern to everyone. Upon request, we can refer several finance companies to choose from. All you have to do is ask!

For a complimentary preliminary evaluation without having to leave the comforts of your home, simply submit any photos of the areas of concern and attach them in an email for our surgeons to review. The photos would be most helpful if you can emulate the samples enclosed in our before and after sections. Please make them comparable in composition of the photos you see throughout our site. Email photos to info@oceansplasticsurgery.com and include a phone number and the best time of day for our consultant to contact you.

We look forward to helping make your plastic surgery experience a happy and gratifying one!

Contact Dr. '90210' William P. Aiello, an experienced Orange County breast augmentation surgeon with plastic surgery centers in Los Alamitos and Newport Beach, CA specializing in various plastic & cosmetic surgery procedures.

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