Breast Augmentation

Women from all walks of life and all parts of the country are choosing 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, Dr. Sigalove, or Dr. Olson 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 — every woman who comes to my practice near Scottsdale and Phoenix, Arizona, has unique needs and different goals for her breast augmentation. Our board-certified plastic surgeons always listen carefully to each woman’s 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 my patients achieve their ideal appearance using my 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 my surgical philosophy when you view photos of some of our doctors’ breast augmentation patients to compare their pictures before and after surgery.

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 my 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 subfascial (over the muscle but under the muscle fascia) or subglandular (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 though 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.

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

Most patients can return to work or school around 3 to 5 days after surgery. Bruising and swelling will gradually subside over the next few weeks. After about 2 months, you should be close to full recovery and can resume most physical activities.

What to Expect After Breast Augmentation

If you are interested in learning about what to expect during the recovery process following breast augmentation. We encourage you to read our cosmetic surgery 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.

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.

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.

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