Breast Augmentation in Phoenix / Scottsdale

Every woman's breasts are unique, and more often than not, each woman has some level of asymmetry (differences between the right and left breasts). Because of this, I spend a significant amount of time with each of my Scottsdale and Phoenix breast augmentation patients to analyze the shape, size, positioning and asymmetry of their breasts. After this evaluation, I am able to provide customized recommendations to create a natural result.

Save $50 on your surgical consultation with Dr. Cohen to learn more about breast augmentation. The Scottsdale Center for Plastic Surgery is conveniently located for patients living in Tempe, Paradise Valley and other areas of Greater Phoenix.

Dr. Cohen's Surgical Techniques

Unlike some surgeons, I do have preferred techniques which I feel allow me to achieve the finest possible results. These preferences have to do with placement of the implants relative to the chest muscle (pectoralis major muscle), the location of the incision, and the breast implant material. When you read more about breast implant types, you can get answers to typical questions I receive from my Scottsdale and Phoenix breast augmentation patients about implant placement and incision types.

Is it best to have the implant over or under the chest muscle?

In my practice, almost all of my patients have their breast implants placed underneath the pectoralis major (chest) muscle. This is a more meticulous and advanced technique than placing the implant over the muscle, but it provides some major advantages. Placing the implant under the muscle:

• Allows extra padding and soft tissue coverage over the upper and middle parts of the implant. This creates a natural slope at the top of the implant rather than a more pronounced shelf, and also reduces the risk of visible wrinkling or rippling. I believe this is a very important factor, particularly in thin patients, with regard to obtaining the most natural and aesthetic final result.
• Creates a situation where the implant is constantly "massaged" by the muscle. This has been shown to reduce the risk of "capsular contracture," a condition in which tightening of the scar tissues around the breast implant makes the breast look or feel firmer than it should.
• Can make it easier to get an accurate mammogram as there is less distortion of the breast tissue itself.

Click here to learn more about Phoenix breast augmentation implant options.

Where is the best location for my incision?

Although breast augmentation surgeons in Phoenix, Arizona and local communities offer many options for incision locations, I have a few strong preferences. The most common routes are through the areola (the pink area surrounding the nipple), through the inframammary fold (the fold under the breast), through the axilla (armpit), and through the umbilicus (bellybutton).

I personally do not like to place implants through the armpit or through the bellybutton for a few reasons. Most important, both these approaches represent an indirect means of creating the breast pocket, the space that is surgically created to fit the implant. In my opinion, extreme accuracy in creating a breast pocket is the key to a natural and symmetric final result. When creating a breast pocket from a distance (i.e., the bellybutton or armpit), the surgeon relies on a long metal instrument or an inflating device to stretch and create the pocket. In my view this is a less accurate technique than performing the dissection directly with your hands. Additionally, armpit scars can sometimes be visible and are not hidden by a bikini, while the bellybutton approach does not allow the option of using silicone implants.

With the vast majority of my patients, I use a periareolar approach to placing implants. This involves a fine incision along the lower border of the areola. This technique has a number of advantages:

1. The incision is blended in along the natural color junction of the breast and areola, which helps to camouflage it.
2. The skin in this area tends to heal with a very fine scar.
3. No matter how small a bikini you wear, the incision will always be covered.
4. If simultaneous (or future) breast tightening procedures need to be performed, you will minimize any extra scars.

I want to clarify one common misunderstanding of this technique: the majority of the nipple/areola is left untouched during the periareolar approach, and the nipple/areola is NOT flipped up or removed during this type of surgery. I will occasionally use the inframmamary (under the breast) approach for placement of implants, usually when a woman's areolas are too small to allow access for an implant. Fortunately, this is rarely the case.

Does incision location affect sensation or breast feeding?

This is a major concern for my breast augmentation patients from Scottsdale and Phoenix. Nipple and areola sensation is primarily provided by a branch of the 4th intercostal (between the ribs) nerve. This nerve starts at the lateral part of the chest on each side (where your arm would normally rest when it is hanging down) and travels toward the breast. Studies have shown that placing implants over the muscle and the placement of excessively large implants increase the risk of nerve damage; however the location of the incision (periareolar versus inframammary) is not a significant factor. Obviously, any time a woman has breast surgery, there is always a possibility of damage to nipple sensation, however the risk is very low (less than 1% chance of permanent numbness) if performed by an experienced surgeon.

With regard to breastfeeding, women who have never had breast surgery have, on average, an approximately 70% chance of being able to breastfeed successfully. For various reasons, some women are unable to produce enough milk to support a baby's needs. With breast augmentation surgery, the chance of being able to breastfeed may go down slightly (by less than 5% or so), but most women with breast augmentation surgery (saline or silicone) are able to breast feed successfully. The location of the incision is not a significant factor as the majority of the milk ducts are left unharmed regardless of the surgical approach.

Click here to save $50 on your consultation fee, or call 602-702-5380 to schedule a consultation with board-certified plastic surgeon Dr. Cohen at the Scottsdale Center for Plastic Surgery. He will be happy to answer any questions you may have about breast enlargement.  Dr. Cohen welcomes patients from all over Arizona, as well as other states and countries.  His facility, the Scottsdale Center for Plastic Surgery, serves Scottsdale, Phoenix and Paradise Valley.