Breast Augmentation

Before and After

(Breast Enlargement, Boob Job, Breast Enhancement)

Related topics: Mastopexy, Breast Lifts, Breast Asymmetry, Capsular Contracture, Firm Breasts, Saggy Breasts

Learn All About The Most Important Issues and Questions Concerning Breast Implants and the Enlargement Procedures

Breast enlargement is the process by which the breast is enlarged by placing a saline or silicone 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 everyone who is contemplating this asks 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 are very small or your breasts have deflated after nursing or they have dropped and are sagging now or is it all 3 reasons? Whatever the reasons and there may be many more valid ones you are feeling self conscious about your body image and want to feel more feminine, sexy and confident about your body image and self esteem.

Now, realizing this you are equally self conscious about being too large for fear of the similar things you were before. people notice, your all breast (rather than little breasts), your not fitting your clothes right, your mother will find out and your co-workers will talk. 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. So a 34 B is really a 34A. Then I am told they want a small full" 34 B??! What size is that? If they are in fact a B" then what is a small full B"? That would be a B"!! They are so overly concerned about being too large that they down size by saying small" and upsize by saying full". Have you ever seen a bra labeled small C" or full C"?

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, 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 your mind will also adjust to your new body image. Initially the breast will ride high because they are swollen and if put subpectorally (under the muscle) they will ride high for 3-4 months. During this time you will become more comfortable as the pain wears off and 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. Now you think they could have been a bit larger!!! Yet you were adamant with your surgeon (that should be me) not to make you 450cc only 425cc because you were sure you would look like Dolly"! For reference 25 cc is less than a shot glass!

So How Big Should I Be?

You should be as big as you want and not what everyone else thinks! This is providing there are no anatomical limitations or 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 4-5 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 2 cups of rice in each stocking. If this looks too large then reduce it by ¼ -1/2 cup and retry the clothes again. If not big enough then add to it. When you are comfortable with the outfits and how you look then measure them again for the final count. If you are undecided and like the what you saw in the mirror but feel it may be too big then photo yourself with your phone or camera in this size and a smaller size and in the course of the day compare the photos till your sure which one you think you look best in. Another method is to wear those implants out and about town and when you get the opportunity to examine yourself in mirrors or store front windows and how people respond to your changed body image you will have conclusive evidence that the size you selected is comfortable for you.

So how does cc" and ml" 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 32 a" and you add 200ccs to there chest they may increase their size to a b" size but if they are a 38 a" 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 make her the same size larger 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 a 34C" breasts are not the same size as 36C" breasts. The cup is proportional to the band but all Cs" are not 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 you are happy with what you look like. To go back to the beginning of this writing most women are wearing the wrong size bra or one that is padded and believe they are bigger than they really are and ask to be a size that isn't made by any manufacturer (like full C or small D) and then fret that they may end up being a D" instead of a one of those non existent sizes. Meantime they measured enough rice in their testing to make themselves a double D but when I tell them that the 600cc they measured isn't in the full C small D" size, they seem to panic and say they only want to be 400ccs! How happy do you think you will 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! You begged the day of surgery that we should do 400ccs because 600ccs sounded too large and none of your friends or relatives were that large and you don't want to be a D". So for a while you adjust but after about 6 months you return and ask if you could go larger..say maybe 650cc or maybe..700cc. Now this scenario isn't everybody for sure but it brings up the point that most patients are afraid of going to a size they really want despite the fact that they got to visualize it in the privacy of their home and if they wanted to wear the rice implants out in public. So ask your friends how many of them feel they could have gone larger. If you find 10 (that I didn't do) 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! Well under certain circumstances there may be some exceptions. There are many physicians out there that feel 350ccs is a large implant and they can't fit something much larger or they try and convince you that anything much larger won't look good or if you go larger 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 and possibly adequate pocket dissection as well to accommodate even a large saline implant. You may be of certain chest size and breast size that would also limit how large you can go but I find that for the most part I can usually achieve whatever size the patient desires and can do so 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 day too many people focus on where the scar is going to be and are wooed into believing that if their scar is anywhere else other than on their 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 softness that you desire) because you focused on no scar on the breast (the lone tree). There are plenty of women that have beautiful breasts using this technique to be sure but there are few physicians that can do this well and it should be selective for those 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 at best will be relegated to smaller sizes. Inframmamary incisions (in the breast crease) are another way to enter into the area 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%) in all augmentations is due to injury of the nerves at the most outside 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 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 inframmamary or axillary incisions. Also dissection of a large pocket for your breast implant is easier since the nipple is in the middle of the breast rather than many inches away by the TUBA and axillary approaches and at the bottom of the breast with the inframmamary approach. In some cases depending on the patient's anatomy or preferences I will do the surgery through any one of the other approaches except the umbilical one. 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. There are a lot of doctors who shouldn't be doing this surgery and so their results may influence you to pick a physician by what incision he does or doesn't use (lose the forest for the tree approach) rather than one on who gets consistently great results.

Should I Go Over The Muscle or Under The Muscle?

Originally when breast augmentation 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 in the 5% to 20% range that got capsular contractures". This is where the scar tissue forming around the breast implants begins to thicken and tighten till 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) lessen this risk to about 1% to 6%. So over time more and more procedures are being done this way. On a rare occasion there may be an individual who for certain reasons prefers the sub glandular enlargement or they may have certain anatomical conditions that warrant it. Previous operations may preclude a patient from being a candidate for under the muscle as well. The secondary benefits to going below the muscle are that the implant has more coverage over it thereby camouflaging the implants edges some. 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 approaches. There is generally more postoperative pain with the sub muscular approach and the breast implants take longer to settle completely (approximately 3-4 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 therefore 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 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 1-2 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 every ones concern to be sure. After all the 15 or so years of FDA banning the silicone implants there was a decision to release the use of silicone implants in early 2007, because as most plastic surgeons already knew there is no conclusive evidence of them causing all the things they were blamed for. That be said this does not mean that in the future some things may come to light. However silicone implants have been used for now 50 years and I for one feel that in all that time and with all the additional research the FDA demanded from the manufacturers in the 15 year band that if there was anything of significance it would have been found by now. So if a patient is comfortable with the safety of silicone implants then her options are silicone or saline. If not then 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 then the option is saline only.

Look Better: This discussion has been going on for decades. Overall the implants look the same and in the body they will also look the same. The real difference lies with the individual and their size, shape, weight and anatomy. If you are very thin and 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 since 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 more so with saline implants than with the silicone ones. 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 is a bit more natural" feel. So if you are not so thin and have some breast tissue the saline breast implants will be fine. Yet if you feel the safety issues are ok and 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 and your breasts are soft and there are no problems with leaks then there is no need to change out your implants. The newer version of the silicone implants have only been released early 2007 for general use and about 5 years before that they were used on an investigational basis. So the new cohesive gel implants do not have the longevity of use in people as does the saline one. Obviously if your saline implant breaks or leaks you will notice your breast becoming smaller but if the silicone one leaks you probably will notice nothing. The FDA wants you to get yearly MRIs to detect a leak but this is a bit absurd since it hasn't been proven that you can see all leaks with this test and they would recommend this expensive test to be done yearly to detect a leak which will not cause cancer but will not recommend it for detection of cancer on a yearly basis for all women regardless of age! And who will pay for this yearly test? Certainly not your insurance.if you have any. Five years of those costs and you can replace your implants all together!

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 in moderate profile the shape 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 or 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 when breasts are of unequal size and projection or 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. I still prefer for most patients the moderate implant which looks very natural and occasionally depending on the patient's anatomy the moderate plus type.

What are Textured Breast Implants, Gummy Bears 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) by providing more surface area on the outside of the implant causing the modification of the body's response to forming a scar (capsule) around it which will be softer. This is not true in all cases and uses and for the most part many surgeons who once used these implants have switched back to the smooth surface implants be they saline or 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 this implant may become available in the future but it is a much firmer and less natural feeling implant than what we are currently using and may have more specific indications for corrective and reconstructive cases. The present cohesive gels also will retain their contents when cut, they are softer and more pliable than 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. Because of its shape it is textured which keeps it into position as the body tends to stick or Velcro like itself to the implant. These implants are not as used, one because the are textured and two the lack upper pole fullness which is a desirable effect in breast augmentation and finally they have been noted on occasion to flip 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" above which causes firm breasts" 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 and in others a hematoma (collection of blood in the pocket), placement of the implant above or below muscle (see above discussion), unknown causes or poor surgical techniques. I would venture to guess many may be do to the latter and former and less for the rest. 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 in depth explanation. Likewise asymmetry" is a condition referring to both sides of the chest are not identical and this is also dealt with in the aforementioned section.

Breast augmentation is a surgical procedure to increase the size of the breasts and enhance the body contour of a woman. Over 2,000,000 women have increased the size of their breasts through breast augmentation. The saline or silicone implant is placed under the pectoral muscle to provide increased breast size with a natural contour. A variety of implant size options are available. The procedure is done on an outpatient basis, and patients are usually able to return to work within one week.

How long will I need to take off from work?

Every person's tolerance of pain, discomfort or fatigue varies. Most patients take about 1 week from work. However, some return to work sooner, others later depending on the type of employment and demands at the job.

When can I drive?

Most patients can drive on or about the 4th 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. Even if you experience cramping during your menstrual cycle (we know you may lean towards Motrin, however, only take Tylenol products). 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 the remedies 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.

Where do you make the incisions?

For most of our patients the incision is created at the lower half of the nipple along the areola border. The lighter skin of the breast meets the darker skin of the areola and allows the incision to be very well camouflaged.

We also offer the axillary (armpit) and inframammary approach to our patients who may have too small of an areola for the standard incision. When using the axillary approach, we use Endoscopic Technology when inserting an implant through the armpit area. This approach is a nice alternative for many patients and has better results than the traditional "blind" approach.

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. When dressing up for the evening or dressing down for fun in the California sun occasionally you may want to go without a bra and that's fine too.

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

This is a result of 1 or 2 things. The sternum may be thick or raised at the junction of the ribs and sternum, creating a small obstacle beneath the implant not allowing the implant to come toward the center, or 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) allowing 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 kind of implants do you use? What are the advantages and/or disadvantages?

We generally use smooth round implants which are filled with your choice of either saline or silicone. These implants move with your breasts and with your body to provide a much more natural look and feel.

The textured, contoured, anatomical or teardrop shaped implant does not have the same mobility as the smooth implants and therefore doesn't allow for the same natural quality of the breast. The aesthetics can be nice but breasts have a certain feel as well.

At Ocean Plastic Surgery our goal is for your results to look and feel natural.

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.

Do I have to move the implants?

Because we understand the importance of a natural looking and feeling breast it is important to move the implants under the muscle. We feel that this aids in reducing the occurrence of capsular contracture. Our patients are always so pleased at how natural the breasts look and feel.

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 with you 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.

How do you determine size?

When you come for your free visit, you and Dr. Aiello will have the opportunity to discuss what your needs and wants are. We also provide several photographs for your review -- this is a tremendous help in determining implant and breast size. We encourage patients to bring photos to the office of breasts they find attractive and suggest the size the patient may be considering. In conjuction with what your desires and the measurements performed, we also ask you to perform the "rice test", which will be described to you in detail during the consultation in our Newport Beach or Los Alamitos office.

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 MD 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 via e-mail 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.

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

Click here to contact Dr. '90210' William P. Aiello, experienced plastic surgeon with plastic surgery centers in Los Alamitos and Newport Beach, CA specializing in various plastic & cosmetic surgery procedures.

Plastic surgery in Los Alamitos, Newport Beach, Long Beach, Huntington Beach, Costa Mesa, Cypress, Fountain Valley, Los Angeles, Orange, California.

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