Breast Augmentation Los Angeles

Like most life decisions, it is weighing the risks v. the benefits. Each woman will perceive the risks and benefits for herself differently. On the positive side, breast augmentation patients studied after surgery report higher self-esteem and confidence, enjoying their appearance more both in and out of clothing. But that must be weighed with the recognition that in all likelihood this is not a "once-in-a-lifetime" procedure – at some point a breast revision may be necessary. Complications such as infection after breast augmentation surgery can occur. Scar tissue can form around breast implants; implants can break; implants can get out of the right position; there are additional costs in the future; there can be changes with mammograms, and much more that each woman considering breast augmentation should consider. Despite all of these tradeoffs, when women come in to have these problems treated, they are usually so happy with their implants they rarely are willing to give them up.

There is a misunderstanding that round breast implants always create a round breast and teardrop implants always create a natural breast; this is not true. If a round implant is of the proper size, it can look beautiful. If a teardrop implant is too big it will look bulgy on the top and fake. So the determination of what implant is best is not based upon the shape. What matters is whether someone wants to participate in the trial of the gummy bear implant; whether they want a softer or a firmer implants; whether they feel more comfortable with an FDA approved implant or a newer implant not yet approved. Dr. Teitelbaum tends to suggest gummy bear implants more in a patient with a tighter envelope and the round standard softer silicone more often in someone with a looser envelope.

There is an ideal shoe size for your foot. Too small and your foot will be crammed and too large and your foot will not fill the shoe. The same thing is true with breasts: too large and it will look round and fake; too small and it will be loose and empty on the top. If you are reading this, it is probably because you thought the photos of my patients looked beautiful. The common denominator to the most beautiful breasts is that they were sized objectively on the basis of measurements. Dr. Teitelbaum measure five things, and from that he uses a formula to determine the ideal size. This formula has been published and thoroughly vetted by top plastic surgeons. Dr. Teitelbaum even has a patent for an implant-sizing device based upon these principles, so he is thoroughly versed in making this determination.

This remains one of the biggest concerns of every augmentation patient, so it will bears repeating: there is an ideal implant size for you. You can go smaller, but you won’t be filled up. You can go bigger, but you will look round. Think of a soft-sided purse: if you put only a couple of things, it will collapse and lose its shape. If you shove a lot of stuff into your purse, it will always look round. With a breast, the shape changes as the volume changes meaning you cannot have the same shape with any volume. If you want to look relatively natural, there is a limit to how large you can go. If you want to look relatively filled, there is a limit to how small you can go.

Sometimes Dr. Teitelbaum measures a patient and they want to look smaller than what anatomically is the ideal size for their breasts. That is okay, so long as they understand their breasts may not be totally filled up, and that they may be empty on the top.

At other times he measures a patient and they want to be larger than that ideal size. If they do go larger, they face two tradeoffs. The first is that they will look rounder and less natural. The second is that the size and weight of an implant that is too large for their tissues will more rapidly stretch their skin over time and compress their own breast tissue, leading to rippling, an implant that can be felt, and perhaps the need for a lift in the future.

The best incision is under the breast, and I will explain why. I base this suggestion not on unsubstantiated anecdote, but upon objective scientific evidence.

Most patients decide on incision based upon where they want the scar. But each incision sets up an entirely different operation. Risks and complications are different, and those issues are more profound than the scar. The armpit incision tends to be more painful and less accurate than the other approaches. If a revision is necessary, another incision usually must be made.

The nipple incision yields a scar that is barely visible on most but not all Caucasians, but on patients of other races it very frequently gets pigmented and thick. It often results in a reduction of muscle coverage over implants due to technical issues, which means the implant can be more seen and felt. By cutting through the breast tissue, there is more pain, swelling, and changes in nipple sensation. Most important of all, is the fact that this incision requires pushing the implant through the breast. Though we do not really think about it, the ducts within the breast have bacteria within them. When the implant goes through the ducts, those bacteria get on the implant. And it is exactly those bacteria that cause the inflammation that causes capsular contracture. This remains the leading cause of revision surgery after breast augmentation, and it should be a priority to do everything possible to reduce this possibility. Significant experimental data demonstrate this to be true.

The best published results are with the under the breast – the inframammary – incision. The incision is hidden in the crease under the breast; there is less contamination with bacteria in the breast; more nerves are avoided; the breast tissue itself is not cut so there is less pain; the same incision is the ideal incision for any kind of future revision; and the list goes on. Most important of all is that the very best published data is with this incision. Plastic surgeons and plastic surgery patients too often make decisions based upon undocumented personal experience, and this is inaccurate. If we just look at the facts, the results are best with this incision, which is why I encourage all patients to select it.

Today almost all implants should be placed "dual plane." This means that the upper and inner areas of the implant are placed behind the muscle, where coverage is necessary in order to prevent the implant from being visible. The lower and lower outer part of the implant have no muscle in front, because in this area we need to usually expand the breast. With a modern dual plane technique, I can control the extent of muscle coverage based upon the requirements of your breast. The dual-plane technique combines the benefits of both being in front and being behind the muscle, while minimizes the downsides of each. Dr. Teitelbaum has taught this technique to many surgeons and many surgeons have written him back to tell him how thrilled they are with this method.

You must accept a risk of some loss of sensation. The most common area to lose sensation is on the skin of the lower outer quarter of the breast. Whether this happens is related to the course of the nerve to this patch of skin. Less common, but more important, is whether sensation is lost in the nipple. The nipple incision is more apt to create this problem, but with all incisions this is a risk because the major nerve to the nipple comes from the very side of the breast, and any dissection puts this nerve at risk. The larger the implant, the wider the pocket has to be, and the greater the chance of this damage. The less accurate the dissection, the greater the risk of this problem. But even when everything is done perfectly, some women can permanently lose sensation and all patients must be able to accept that risk before proceeding.

No. The risk of breast cancer does not change if you have an implant. And the cancers are not detected later, larger, or with a worse prognosis. In fact, by having the uniform implant behind the breast tissue rather than the irregular rib cage, it is easier to feel the breast tissue and more breast cancers are picked up by the patient with implants than those without.

How long implants last and how long it will be until you have your next surgery are two different issues that are often confused. A broken implant is not even in the top five reasons for having a revision. The most common reasons patients have another surgery is the build up of scar tissue, drooping, implant getting out of position, wanting a change in size, etc. Implants only break at a rate more or less of 1% per year. Sometimes those breaks can be noticed as a change in the breast. At other times the patient cannot detect a difference and the break can only be detected by an MRI.

Sometimes when a silicone gel implant ruptures the breast feels different. Sometimes harder, but more often there is less of a sensation on careful examination of the discrete borders of an implant, but rather a more amorphous feel to the breast. While we recommend that a woman with a ruptured silicone implant have the implant removed and replaced, there is no evidence that a ruptured silicone implant will make you sick.

We warn all patients that they may lose the ability to breastfeed, but in the scores of patients of my own who have had implants I cannot recall one who was unable to nurse.

After you have scheduled surgery, you will be given a detailed list of what you need to bring. But you do not need to bring a special bra or anything in particular with you.

Most of our patients go out to dinner and shower the night of surgery, needing nothing more than Ibuprofen (Advil, Motrin) for their pain. Most describe it as a pressure, or a weight on their chest, much as if they had worked out hard or their milk was coming in. Please see the video testimonials on plasticsurgeryvideoguide.com to see and hear what actual patients have to say about their pain.

When you will feel ready to do your job is highly individualized. So long as your work doesn’t involve straining and heavy lifting, you can expect to be back to work after three or four days. Some people go back even sooner, and many work from home the next day.

There is nothing about an airplane ride that is inherently problematic. The issue is whether you are going to a place where there is a doctor who can take care of you if you develop a problem.

Elevating your heart rate or blood pressure, bending hard, straining or sweating. But light walking is beneficial starting the day of surgery.

You can lift a cooperative child that is up to 35 pounds right away. But don’t try to pick up your child if he or she is fighting you or if you have to bend way over a playpen.

We would like to say never, since they are bad for you. Smoking does slow down healing, and it would be best to avoid them for three weeks.

You should shower the evening of your surgery. Your incision can get wet, but don’t rub it. Soap your breasts and let warm water hit them.

It is not supposed to look perfect right after surgery! The upper breast almost always looks too full. Some of that is swelling; some of that is that the implant will drop down to the bottom of the breast. Pronounced upper fullness usually goes down between 4-8 weeks, but it continues to improve for a full year.

Swelling increases after surgery, usually peaking about 5-6 days after surgery. After that, the swelling will subside, rapidly at first, and then gradually. After one month, you’ll think the swelling is gone, but it will still go down more at three months, and even more at six months and even a year, though at that point changes are subtle.

Everyone is different. Some swell a lot, some swell a little. Generally, though, the breasts do start off somewhat swollen, and that will go down. However, they will also get softer and more mobile, so that in a sense they can actually be made to look larger once they soften up enough to be pushed up and molded by a bra. Similarly, as swelling goes down, the borders of the breast become better delineated, so that they appear to be more distinct from the chest wall. They also lose the excessive upper fullness with time as they drop in the breast. Another way to think about it is right after surgery the tightness of your skin is compressing your breasts against your body. As the skin relaxes, even if the swelling goes down a bit, your breasts will project more and look larger.

Your stitches are dissolvable and therefore do not need to be removed.

Wearing a bra is optional unless you were specifically told for your situation that you needed one. Some people feel comforted and supported by a bra, others feel it to be restrictive and uncomfortable. It is your own decision just based upon fashion and comfort. Even underwire bras are okay, so long as they are not rubbing against your incision or bothering you. You will be given a bra after surgery. Many people find that sports bras are the most comfortable for the initial week or two after surgery. Also, they are inexpensive, and it doesn’t make sense to spend a lot of money on bras until the swelling has gone down and the breasts settled a bit, which takes a few weeks.

It is a build up of an excessive amount of scar tissue by your body around the implant. It makes the implant feel hard, move upwards, and look round. It remains the leading cause for revision surgery after breast augmentation.

There is no specific time that an implant will last. The rate of shell failure is about 1% per year. We know that about 30% of women have another operation by seven years, but most of those are not because a woman needed to have surgery, but because they wanted to improve something. There is a myth that they need to be redone at 10 years, but that is totally untrue. It is just that by around ten years, probably around half of the patients or so decide to have another operation, even though it is not required to do so.