Breast Augmentation

Women from all walks of life and all parts of the country choose breast augmentation. In fact, the women who visit our practice from Scottsdale and Phoenix, AZ, as well as other nearby cities and beyond, have made breast augmentation one of the most popular cosmetic procedures our board-certified plastic surgeons perform. Most women we see at our office who are considering breast enhancement feel that their breast size is disproportionately small compared with the rest of their body; however, those patients aren’t the only good candidates for this procedure. Other women are concerned that their breasts have lost volume after childbirth and would like that volume restored. Some women are unhappy with the shape of their breasts, would like to increase breast fullness, or are concerned about breast asymmetries (size and shape differences between sides).

Request a cosmetic consultation with Dr. Cohen or Dr. Sigalove or call (480) 423-1973 to learn more about breast augmentation. Our facility is conveniently located for patients living in Tempe, Paradise Valley, and other areas of Greater Phoenix. We often serve patients from throughout North America and overseas.

Your Personalized Breast Augmentation Consultation

We are able to improve a woman’s breast appearance through surgery that is carefully planned and performed. Proper breast enlargement is not a “cookie-cutter” procedure where the same technique is applied to every patient. As some of the best breast augmentation surgeons in the Phoenix and Scottsdale, AZ, region, Dr. Cohen and Dr. Sigalove understand every woman who comes to their practice has her own needs and cosmetic goals. They always listen carefully to their patients’ concerns and thoroughly discuss the key points of the procedure.

Physical Considerations

Examples of the factors our doctors consider when developing a personal recommendation for a patient include:

  • Overall height and weight
  • Size and shape of the underlying chest and ribcage
  • Tightness and elasticity of the skin
  • Amount of natural breast tissue
  • Desired results

Just as important as the physical factors are the goals and expectations each patient has. Our surgeons do not have an agenda to make every woman considering breast augmentation into a C cup. Some women prefer smaller augmentations and wish to end up with a modest B cup, while others feel more confident with a D cup.

Our role as plastic surgeons is to help our patients achieve their ideal appearance using our experience, in-depth knowledge of anatomy, and understanding of the latest implant technology and surgical advances to advise them on how best to reach that goal during their consultations. You can see the results of our surgical philosophy when you view photos of some of our doctors’ breast augmentation patients to compare their pictures before and after surgery.

How Do I Know If I Need Breast Augmentation or a Breast Lift?

While breast augmentation and breast lift surgery are both breast enhancement procedures, they provide different benefits. Breast augmentation fills out the breasts, but it will not correct significant sagging. Breast lift surgery removes excess lax skin to raise the breasts and restore a rounded, youthful shape. While no breast tissue is removed, a breast lift can make the breasts look smaller. If you’d like your breast to be fuller, higher on your chest, and firmer, it is likely you need a combination breast augmentation and lift procedure.

Breast Augmentation Choices

There are many choices you need to make before your breast augmentation surgery, explained in the sections below, including the location of the incision, whether to place the implant under or over the chest muscle, and what type of implant to use. We offer multiple types of silicone gel breast implants, as well as saline implants. You can learn more about breast implants by exploring our breast implant options page and by talking with your surgeon personally.

With regards to implant selection, our plastic surgeons are not committed to any specific implant, because each patient will have an array of implants that will work for them. Our job is to understand each patient’s goals and use our knowledge to help her select the implant that will allow us to achieve the finest possible results with her breast augmentation. This includes considerations of shape, size, symmetry, and longevity. During the consultation, your surgeon will have a lengthy discussion about breast enlargement choices with every patient so that they feel confident about their decisions.

Is It Better To Place the Breast Implant Above or Below the Muscle?

In our practice, almost all of our patients have their breast implants placed underneath the pectoralis major (chest) muscle. In reality, when surgeons say “under the muscle,” they generally mean “partially under the muscle,” or “dual plane” as the pectoralis covers the upper and inner part of the breast, but not the outer and lower part. 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. Our surgeons 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.

Is Over the Muscle Implant Placement Ever Recommended?

There are certain situations based on lifestyle and anatomy, where sub-fascial placement (over the muscle but under the muscle fascia) or subglandular placement (over the muscle and fascia but under the breast tissue) makes sense, especially with mesh reinforcement. If applicable, these options will be discussed as well.

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Breast Enhancement Surgery Incision Options

Although plastic surgeons offer many options for incision locations, our plastic surgeons have a few strong preferences. The most common routes are through the:

  • Inframammary fold (the fold under the breasts)
  • Areola (the pink area surrounding the nipple)
  • Axilla (armpit)
  • Umbilicus (belly button)

Our plastic surgeons do not like to place implants through the armpit or through the belly button 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 our plastic surgeons’ 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 belly button or armpit), the surgeon relies on a long metal instrument or an inflating device to stretch and create the pocket. In our view, this is a less accurate technique than performing the dissection directly with your hands. Additionally, armpit scars can sometimes be visible and are associated with a higher capsular contracture rate, while the belly button approach does not allow the option of using silicone implants and is by far the least accurate approach.

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Advantages of the Inframammary (Breast Crease) Incision

With the vast majority of our patients, our plastic surgeons use an inframammary approach to placing implants. This involves a fine incision along the lower crease of the breast. Although Dr. Cohen used to perform mostly periareolar incisions, new data has shown that the inframammary incision has the lowest risk of capsular contracture. When textured implants and a Keller Funnel™ (implant placement device) are added, the risk of capsular contracture is even lower. This technique has a number of advantages:

  • The incision is blended in along the natural crease under the breast, which helps to camouflage it.
  • The skin in this area tends to heal with a very fine scar.
  • The breast tissue, milk ducts, and lymphatics of the breast are not significantly affected by this approach.
  • If simultaneous (or future) breast tightening procedures need to be performed, these scars will rarely get in the way of further surgery.

When Should the Incision Be Placed Around the Areola?

The periareolar approach is still a reasonable technique, particularly for patients with tuberous breasts or the need for areolar tightening, and our plastic surgeons are very comfortable using it as long as the patient understands she will have a modestly higher risk of capsular contracture. Our doctors 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. The technique involves an incision halfway around the areola that is carried straight down to the chest muscle, creating a tunnel through which an implant can be placed. Because of this, the technique is better when patients have larger areolas and relatively smaller amounts of breast tissue.

Does Incision Placement Affect Nipple Sensation?

This is a major concern for breast augmentation patients. Nipple and areola sensation is primarily provided by a branch of the fourth 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 the placement of excessively large implants increases 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.

Does Incision Placement Affect Breastfeeding?

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 implants (saline or silicone) are able to breastfeed 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.

Breast Augmentation With Fat Transfer

Women who want a modest increase in breast size (about 1 cup size) and an alternative to breast implants can consider having breast augmentation with fat grafting. This procedure, also called natural breast augmentation, involves harvesting fat with liposuction, purifying it, and injecting it into the breasts. Our surgeons can increase overall fullness and enhance specific areas of the breasts (such as the cleavage) with fat grafting.

Can I Combine Breast Augmentation Surgery With Other Procedures?

Definitely! Our surgeons often combine breast augmentation with other procedures to give patients multiple improvements with a single surgery and recovery period. Popular options include:

These combination procedures are often called mommy makeovers because they are popular with women after pregnancy, delivery, and breastfeeding.

How Long Does It Take To Recover From Breast Augmentation Surgery?

While patient experiences vary,  the recovery process following breast augmentation generally proceeds as follows:

  • Right after surgery: Patients return home the day of surgery. Prescription pain medication may be taken to control discomfort.
  • 3 to 5 days: Most patients can return to work or school.
  • 1 month: Bruising and swelling have subsided.
  • 2 months: Most patients are close to full recovery and can resume normal physical activities.
  • 3 months: Final results are achieved.

For more information, we encourage you to read our Post-Op FAQ about postoperative issues such as care for incisions, time away from work, and ability to engage in exercise and other activities.

Frequently Asked Questions

Is breast enhancement surgery safe?

Breast augmentation is one of the most frequently performed cosmetic surgeries in the world and has an excellent safety record. However, every surgery includes a certain amount of risk. The best way to guarantee safe, satisfying results is to find a board-certified plastic surgeon to perform your procedure.

Can breast augmentation really treat tuberous breasts?

In most cases, improving the appearance of tuberous breasts is more complicated than adding implants. Our surgeons are experienced in the specialized techniques needed to give tuberous breasts a beautiful, natural shape, such as expanding the breast skin, lowering the breast crease, and reshaping the areola.

Can you improve the size or shape of my areolas during a breast augmentation?

Yes. Our surgeons can make improvements to one or both areolas (as well as nipples) as part of a breast enlargement procedure.

How long after surgery do the implants settle?

Breast implants settle into their final position (“drop and fluff”) in about 3 months once swelling fades and the chest muscles and breast skin relax.

I’ve heard you should massage the chest following breast enlargement surgery; is this true?

Your surgeon will customize your post-op care instructions to account for your implant placement and other factors. Once healed, patients may be instructed to gently move the implants within the pocket to help the breasts feel soft and natural. Make sure to follow your surgeon’s instructions and ask about any tips you see on other websites.

Will I have noticeable scars after breast augmentation surgery?

No, most scars aren’t noticeable after breast augmentation. Incisions are placed in easily hidden locations (such as underneath the fold of the breast), and the marks will fade with time.

Is there anything I can do to prevent scarring after surgery?

While scarring differs between individuals, there are ways to help your scars end up as unnoticeable as possible. First, as discussed in the previous answer, your surgeon can place the incisions where the scars will be unlikely to be seen, such as along the breast crease. Next, intentional aftercare, such as wearing a proper bra, applying scar cream, and performing scar massage, can help improve your scars’ final appearance. Learn more in the last part of this blog post.

Will I have to replace my implants?

While breast implants don’t have a specific “expiration date,” they also don’t last forever. Most women replace their implants about 8 to 10 years after their initial breast augmentation. Sometimes, they choose replacement because their aesthetic preferences for size and shape have changed. Other times, replacement is needed to address implant movement or other device-related issues. Each patient is unique, and there is no set timeline for breast implant removal. Revision surgery is only necessary if you experience complications or wish to upgrade to a newer model.

Do silicone implants feel more natural than saline?

Each breast implant material type has its unique benefits. Silicone implants move with the body like real breasts and create a more natural look and feel. Most women today choose either silicone gel or highly cohesive (gummy) silicone gel for their breast implants.

When will I see my final results after surgery?

You can notice a larger breast size immediately after surgery. The swelling will subside, and your breasts will fully “settle” after around 3 months. Your healing process may take less or more time, depending on your surgery details and your overall health.

What if I decide later that I don’t want implants anymore?

If your personal preferences change or you experience complications at some point, our surgeons can perform breast implant removal (also called explant surgery) along with other breast enhancement procedures, such as a breast lift and fat grafting.

To learn more about all of your breast enhancement options, request a consultation using the online form or call Scottsdale Center for Plastic Surgery at (480) 423-1973 to schedule a detailed and customized evaluation with Dr. Sigalove or Dr. Cohen.

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