Breast Augmentation in NYC

How do you perform breast augmentation?

The technique I use for your surgery will depend on your desired results. Personally, I like to place the incision in the fold beneath the breast, or around the areola.

I will do the axillary incision in the armpit for patients who really want it, but I also warn them that statistically, the axillary approach has a higher incidence of problems.

Do you perform the trans-umbilical or TUBA procedure?

No, I will not insert breast implants through the navel. It’s an imperfect operation. There’s a lot of misplacement of the implants; there’s a lot of capsular contracture, where the breast hardens after implant surgery; there’s a lot of streaking due to infection. If you get an infection, you can get streaks from the navel all the way up to the breasts.

Plus, some implant manufacturers will void their 10-year warranty against breakage if the implants are inserted through the navel with a TUBA procedure.

Do you prefer silicone gel or saline breast implants?

I prefer silicone, but the decision is always up to the patient. Silicone is a far better product—it feels much more natural. I don’t see how anybody can really argue about it. The rest of the planet never stopped using silicone gel implants. We have tens of thousands of women and patient years demonstrating that there’s no correlation between silicone implants and auto-immune diseases.

Do you prefer smooth or textured implants?

I prefer smooth implants. The argument for textured implants, theoretically, used to be that they have less incidence of capsular contracture. But we’ve also found that textured implants result in more wrinkling at the side of the breast—which women definitely don’t like.

Do you prefer round or teardrop-shaped implants?

I prefer the round implants—they’re the simplest, safest, and produce pretty reliable results.

Anatomical, or teardrop-shaped, implants are a great idea in theory, but unfortunately, sometimes they get out of position. If you imagine an oval-shaped implant that turns sideways, it makes the breast look ridiculous. Then it’s a nightmare—you have to go back in to operate to fix it.

Interestingly, studies have analyzed women with round implants. When they observed the patients in a standing position, the researchers found that over time, the round implants end up turning into a teardrop shape due to gravity. So why even deal with anatomical implants?

Do you ever use high-profile implants?

Yes. I will sometimes use high-profile implants to achieve more volume in women with a narrower chest. And there are some women who want high-profile implants because they want their breasts to look as large as possible and get the most cleavage.

Does breast augmentation surgery leave noticeable scars?

The scars that form from these incisions generally fade nicely and may be hidden within the natural creases of your body.

Do you prefer to place the implants over or under the chest muscle?

That depends on the patient. From an aesthetic standpoint, I like to place implants under the muscle because they’re more subtle. I think that’s probably a better operation because it’s been shown that patients have less chance of infection and fewer chances of problems with the implant itself.

You’ll also be able to get better mammograms if the implant is placed under the muscle. The patient’s health has to come first and foremost. However, the downside of placing the implant under the muscle is that it’s more painful.

However, if the patient is a woman under 30 who has a reasonable amount of breast tissue to camouflage an implant, I’ll place the implants over the chest muscle.

Can a woman still breastfeed after having implants?

Yes. Particularly if the incision is made in the crease under the breast or in the armpit, you should be able to breastfeed after having breast implant surgery.

In some cases, breast implant surgery might affect the volume of milk you produce, so it’s a good idea to monitor your baby to be sure he or she is getting enough milk from the breast—and, if necessary, supplement with formula.

What happens if an implant ruptures?

If a saline implant ruptures, it’s visually apparent right away—the implant simply deflates and the saltwater filling is reabsorbed by the body.

If a silicone gel implant ruptures, it’s much harder to detect—it may take an MRI to confirm that a rupture has occurred. With today’s cohesive or gummi-bear silicone implants, the filling stays intact; it is designed not to spread from the breast into the surrounding tissue. However, you should replace a ruptured silicone implant promptly.

Do most women want to look like they’ve had breast implants?

No. Most of my breast augmentation patients want to look natural. They want a little more volume—but not too much. They don’t really want their friends to know that it was done; they just want to look a little bit better, and they want it to be subtle.

Are there women who want to look like they’ve had implants?

Yes. Once in a while, I’ll get a woman who wants the whole shebang. She’ll say, ‘What’s the point in having breast augmentation if it’s not going to look like that? That’s why you do it! I want to look sultry and sexy.’

It’s a matter of personal taste. There are women who just want to have a little bit more, and then there are women who want to look ‘hot.’ It’s all OK. As long as the patient tells me what she wants, I can try to deliver.

That’s fine if that’s what you’re looking for. I know how to deliver that, too. It’s just not what I prefer to do.

How do you define a well-done breast enhancement?

To me, a well-done plastic surgery procedure is one where the outside world would never know I ever touched the patient. But not everybody wants that—particularly with breasts.

Sometimes, women really want a lot of cleavage. They want that rounded shape on the outside of their body—where, if you look at them from the front, the borders of the breast actually go beyond the border of their chest wall.

Will breast implants alone correct sagging breasts?

It depends on how much your breasts are sagging. I may suggest performing a breast lift procedure in conjunction with your breast augmentation surgery to be sure that your result appears natural.

Sometimes, implants alone can give a wonderful result if your breasts have mild sagging—particularly after having children. There’s a condition called pseudo-ptosis. ptosis simply means hanging. In pseudo-ptosis, the breast isn’t really sagging, because the nipple is in a good position, but the breast has lost volume.

Women with pseudo-ptosis might think they need a breast lift, but they don’t actually need all the scars associated with that procedure. If I just put implants in, it will have the effect of lifting the nipple and volumizing the breast. And the woman’s breasts will look much more like they did before she had children.

For a woman with grade 1 or even grade 2 ptosis, where the nipple is at or slightly below the breast crease, implants can sometimes help. It’s all a matter of how big you want your breasts to be. The more lift you want, the larger the implant needs to be—and I don’t like to make women’s breasts look unnaturally large.

How long do breast implants typically last?

It’s important to realize that breast implants are not lifetime devices. You can expect implants to last a good 10 years. In fact, the manufacturers warranty their implants for that long—and you can also purchase an extended warranty that will cover all of your surgical costs if you need to replace your implants. I know some patients whose implants have lasted for 18 years.

Can a woman with breast implants still have mammograms?

Yes, after breast implant surgery, it’s important that you continue to have mammograms as often as your primary care physician or OB/GYN recommends. When you go for a mammogram, be sure to let the technician know you have breast implants.

There is a special mammography method called the Eklund technique for women with breast implants. This technique, which has improved the ability to visualize more of the breast tissue in patients with implants, is available at every accredited mammography facility in the U.S.

Does breast augmentation surgery require a hospital stay?

No. Breast augmentation does not usually require a hospital stay. Your procedure may be performed in a hospital, an outpatient surgery center, or an office-based surgical suite.

How long does breast implant surgery take?

Breast implant surgery usually takes a little over an hour.

What kind of anesthesia is used for breast augmentation?

Breast augmentation is performed under general anesthesia; you will be asleep during the entire procedure.

What should you expect immediately after breast augmentation?

When the operation is complete, you will be wearing a support bra and sterile dressings. You’ll be taken to a recovery area where you’ll be closely monitored for a few hours before going home. I use absorbable sutures, so you will never have to have stitches removed. In most cases, surgical drains are not necessary after breast implant surgery.

You should be able to see the results of your breast enhancement immediately. Within a day or two after surgery, you should be up and around. And any discomfort that you feel can be controlled with medication.

How long does it take to recover after breast implant surgery?

Within the first week, your swelling may be significant but will begin to improve. You will be able to shower, and can return to work as long as it does not involve a great deal of manual labor.

For the first few weeks after surgery, you will need to wear a surgical support bra. After several weeks, swelling will improve and you will resume most of your normal exercise routine.

What results can you expect from breast enhancement?

In my medical career, the most grateful patients I’ve ever had have been kidney transplant patients—and the second-most-grateful are breast augmentation patients. They love it. They tell me how it’s changed their life, and they’re just thrilled. They say they can wear all the clothes they couldn’t wear before, and that they have so much more confidence.

One of my colleagues claims that his breast augmentation patients have a 90% engagement rate within one year of surgery. They certainly get a lot more attention!