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Breast augmentation is the surgical procedure to help enhance breast size and appearance. Many changes will occur to the breasts due to the affects of time, pregnancy, and basic hereditary factors. Many of these changes may be corrected and improved surgically. The breast augmentation procedure is focused on restoring or adding volume to the breast tissue with the ideal individual being one who has otherwise good support and basic positioning of breast tissue but desires more volume. This patient is likely to experience highly desirable results from the augmentation technique.*

Breast augmentation surgery alone will not fundamentally change basic defects, major asymmetry, or droopiness. There may be the need for procedures that address these concerns. If there is more than mild or modest droopiness of the tissue (ptosis) then a breast lift may be needed.

Breast augmentation is a safe procedure that generally produces pleasing and satisfying results. Refinements in technique and implant technology have minimized most of the older problems and concerns. Patients who will benefit the most will be those who have realistic expectations and are psychologically stable. Overall, breast augmentation mammoplasty is a safe and effective cosmetic enhancement option with a highly satisfactory outcome.*

Implant choices

Modern implants are of dramatically better quality and stability than in the past. We predominantly utilize silicone gel implants as these result in the most natural outcomes with a very normal “feel” to the breast tissue. It is typical to not be able to feel an implant at all-just normal breast tissue.

The gel implants we utilize are from Mentor Corp which are the only implants manufactured in the United States and the company offers a very comprehensive warranty and guarantee.

There are 3 types of gel with the key difference being the “cohesiveness” of the gel-basically the “firmness”. The most recent choice is the “XTRA” implant that has a moderately cohesive gel offering slightly better, more youthful “fullness”. The other choices are the regular (somewhat softer) gel, and lastly the firmer gel (Gummy Bears). These are reviewed with you in detail at the time of consultation.

*Individual results may vary

The saline implant has a long track record of overall safety and offers some advantages in incision size considerations. As the implant is inflated once positioned it can be inserted through a very small incision. Additional advantages include the complete absence of any risk from leakage as the worst case scenario would be deflation that is easily fixed. There is likely as much as a 1% yearly volume loss with saline implants. Unlike silicone, saline causes no tissue inflammation or other problems that have been occasionally associated with silicone implants-generally old styles. This has been dramatically reduced as a problem with new silicone gel implants.

Saline implants are best suited for those who have somewhat more breast tissue for coverage to help reduce the tendency to see rippling of the implant. In most cases, a saline implant may not have as “natural” a feel or appearance as compared to silicone gel; this would be particularly true for someone who has relatively small amounts of natural tissue.

Silicone implants have undergone immense study and review prior to their returned availability on the market. They now represent a very safe and desirable alternative. Silicone gel is ideal in terms of feel, softness, and reduced rippling tendency. It represents an ideal choice in a thin individual with little natural tissue. The risk of leakage has been dramatically reduced and the silicone is a very thick gel rather than the more liquid prior implants which limit the problems even in the unlikely case of leakage.  Modern silicon gel implants are the gold standard in terms of achieving reliable, natural and great outcomes. We utilize Mentor implants (only implants made in the United States)

We offer 3 different types of silicone implants which differ in the “cohesiveness” of the gel. These are the standard gel, the “XTRA” gel, and the cohesive gel (AKA “gummy Bear”). A good analogy is to consider these like soft, medium, or firm jello.

What is the right size? Many factors will play a role in decision making. It is very inaccurate to think of size by bra cup size as one manufacturer’s “C” may well be another’s “D”. It is better to think of the degree of volume to be added in cc’s and what will this actually look like in you. A given size implant will often appear very different from one individual to another given differences in one’s body size and shape as well as natural breast dimensions. It is of little value to assume that the same size implant in one individual will yield similar results in another.

We have addressed this issue by offering the most accurate sizing option available-the Vectra XT 3D imaging system.

Your consultation will include the use of this great tool allowing us to see in real time the appearance of various implants as well as the possible changes from a lift or reduction option.

It is rare for patients to be dissatisfied with size after the decision making process as noted above.*  It is, however, possible to adjust up or down although this would be at additional cost.

*Individual results may vary

Will breast augmentation treat droopy breasts?

We see many patients who are seeking to achieve great looking, youthful, and natural breasts but are very uncertain if they need a lift. If there is some droopiness there is a general misconception that a breast augmentation alone will achieve a great result. Worse, there are some surgeons who claim that by simply putting an implant above the muscle and/or just putting in a bigger implant will solve the problem. Unfortunately, this usually results in big droopy breasts! A larger implant may create fullness but the natural tissue then seems to “fall off” and droop-not a great outcome.

So, generally speaking, the answer is no; however, there are some exceptions.

As we all know breasts come in many shapes and sizes.  Multiple factors determine whether or not they become “droopy”

  • Changes following pregnancy. If there has been a significant expansion followed by tissue involution this essentially results in a “deflated” type of appearance and droopiness.
  • The elasticity of the skin tissue plays a role as do supporting structures within the breasts themselves- commonly known as  Cooper’s ligaments.
  • Gravity and time are factors and certainly, if the natural breasts are initially larger they may be more impacted by gravity over time.
  • Differential loss of tissue can result in an appearance of droopiness. If there is a loss of predominantly upper pole tissues this may result in what is known as “pseudoptosis” in that it looks like there is drooping but in fact, there are minimal changes.

The classic grading of ptosis is in 4 classes- 1-4.

  • Class 1 is essentially normal.
  • Class 2 -the nipple is essentially at the level of the inframammary fold
  • Class 3- the nipple is below the fold
  • Class 4- the nipple is significantly below the fold tending to point down
  • Pseudoptosis-the nipple is in a good position but there is a droopy lower pole excess

So-do I benefit from a lift?

For grade 3 or 4 ptosis, a lift is essential in order to achieve an aesthetically pleasing result. In grade 2 ptosis it depends and there are exceptions. There are individuals with minor ptosis who will have very nice outcomes without a lift even though there may technically still be a minor element of “droopiness”. These are the individuals who may find that having some minor residual droopiness is a reasonable tradeoff with not having visible incisions. This is particularly true with those who have predominantly undergone a “deflation” of the skin envelope with predominant upper pole loss. For these individuals augmentation alone may be an excellent option.

If there is “pseudoptosis” then an augmentation alone with the restoration of upper pole volume and improved projection is often a great option.

If you can easily “hold a pencil” then probably you would benefit from a lift.

I heard that high profile or “gummy bear” implants will give me a lift

High profile implants may be a great choice for a given individual resulting in better projection with less “widening” of the breasts. If there is mostly loss of upper pole volume and minimal droopiness then the results may be excellent. But they will not truly correct droopiness.

A shaped implant offers no help in correcting droopiness.

Do I need an implant if I have a lift?

A lift basically addresses the position and size of the areola and will reduce the droopy tissues in the lower pole. Unfortunately, a lift does not restore the loss of upper pole fullness and roundness. The majority of lifts I perform include a well-sized implant to restore the upper pole giving us great results.

Ultimately, there are many factors that must be carefully considered and balanced in order to achieve great outcomes. During the consultation, we review your specific anatomy and changes that have taken place in order to determine the potential need for a lift.

We utilize the Vectra XT™ imaging system which will allow us to accurately simulate a lift and/or augmentation. This system uses remarkable technology to capture a 3D image allowing us to accurately visualize multiple surgical options. You can then best understand and make the appropriate choices resulting in a great outcome.

Call 425 576 1700 and ask for “Peggy” to set up a Vectra imaging consultation to see options for great looking breasts.

No one has perfect symmetry and it virtually impossible to achieve perfect symmetry with any form of breast surgery. However, symmetry is usually very good within the parameters of what is possible given the basic anatomy.

The degree of cleavage that can be obtained is highly individual and is generally dictated by the basic position of the nipples and natural breast tissue . The chest contour also plays a significant roll. Implants need to be centered with the nipple to look normal and not result in a “walleye” or “cross-eyed” breast configuration. This is the greatest factor in how much cleavage is possible. A larger implant may allow for more cleavage within limits. If there is need to correct the nipple position there is also the opportunity to improve the positioning for better cleavage.*

*Individual results may vary

There are four choices of incisions for placement of implants.


Although commonly utilized, this incision (armpit) may be more visible in a given individual than alternatives. It is most commonly used with saline implants but is less desirable with silicone implants given the larger incision that would be needed. Other limitations include the reduced visibility of the area of implant placement with more limited ability to precisely control position and minimize bleeding/bruising.*


This incision is the most common we utilize. It is placed in the crease of the breast fold and is well hidden. It offers excellent access for placement of implants. There is also complete visibility of all areas allowing for precision control of even very minor bleeding areas. This approach also allows for a very gentle procedure with the added ability to precisely release some areas of breast tissue from muscle allowing for the best appearance after placement under muscle. We believe that ultimately, for most, this is the least visible incision option.*


This incision is made at the margins of the areola and allows good access for implants as well as other possible corrective surgery. It is often well hidden in a given individual; however, there is a visible line at the transition of the areola to the skin which may be evident. This approach does mandate some dissection through breast tissue in order to create the implant pocket and there is a very small potential for sensory changes with this. Lastly, there is a very small added risk of micro contamination of the implant from bacteria at the nipple that cannot be completely sterilized.*


This is the approach to implant placement via a belly button incision. It is limited to saline implants only but results in a minimal scar for most individuals. We do not offer this approach as we feel that the limitations tend to outweigh any benefits of consequence.

*Individual results may vary

There are four choices for implant placement divided in two categories-above and below muscle. The above muscle option is “submammary” or “subfascial”; the below muscle options are “subpectoral” or “total submuscular”.

Placement above the muscle would be most useful for an individual desiring a very “augmented” look. This approach is also useful for someone who is a body builder as placement under muscle could result in a  flexion deformity problem (creasing of the breast appearance with the flexing of the chest muscles).

Placement below the muscle is generally the preferred location as there is an added layer of tissue that helps to create a natural appearance and feel.*

*Individual results may vary


This is a rare problem and is one of the specific reasons we will plan on seeing you the following day. If there is a hematoma it will likely need to be drained and might require implant removal and replacement at that time. If there has been a hematoma there is a somewhat increased risk for capsule contracture in the future.* To date, we have not had this occur.


Postoperative infection is very rare but potentially serious and needs to be treated by removal of the implant and antibiotic therapy. Once resolved the implant can be replaced generally after 3 months. We treat all our patients with antibiotics to help minimize this possibility.* To date, we have had no infections.


There is a possibility of a temporary decrease in nipple sensation (we have had no cases of this)- this would generally improve over a period of several weeks to months. A significant permanent decrease is rare. It is possible to at least temporarily experience an increase in nipple sensation.*

*Individual results may vary


There is a normal and necessary capsule that will form around an implant. In some cases this capsule becomes thickened and contracted in an adverse fashion. The degree of the problem varies considerably from the minor which may not need much treatment to the more significant needing to be treated. Signs of significant contracture may include firmness, distortion, displacement, traction, and occasionally some pain.*

The risk of contracture is approximately 1% per year for several years.* Some surgeons have reported higher incidences.There is evidence to suggest that smooth sound silicone gel implants placed under muscle may be somewhat less prone to contracture. Form stabilized (gummy bear) implants may be associated with a slightly lower capsule rate. Repair of contracture may require release or removal of the capsule and then replacement of the implant possibly in a different pocket.*

*Individual results may vary