Breast Augmentation Before and After Pictures

Breast augmentation is the most popular cosmetic surgery procedure in the United States, with over 300,000 surgeries performed.

Breast augmentation surgery has a very high satisfaction rate, if the patient has realistic expectations and understands the limitations of the surgery within her anatomy.  For example, see the breast augmentation before and after pictures I have displayed for illustration.

Either saline or silicone implant can be used.  Both implants have the same shell covering.  For saline implants, the shell is empty and is filled with saline (salt water) through a valve on top of the implant.  Silicone implants are already filled with silicone cohesive gel and the volume is not adjustable.  The choice of implant depends on the patients desire, amount of breast tissue, degree of breast asymmetry and cost (silicone implants are significantly more expensive).  One cannot determine what type of implant is used by looking at a patient (see adjacent images).

With the news about PIP implants and their high leakage rate, it is important only FDA approved breast implants be used.  Currently, only two companies in the United States qualify: Mentor and Allergan (Natrelle implants).  Both companies offer a life time warranty in case of implant leakage (ALL  breast implants eventually deflate) and provide partial compensation for surgery costs up to ten years from date of original surgery.

Please see below for additional breast augmentation before and after pictures:

Breast Augmentation Before and After Pictures

Breast Augmentation Before and After Pictures

Breast Augmentation Before and After Pictures

Breast Augmentation Before and After Pictures

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 12 years of experience.  His office is located in Orange County, California.  To schedule a complimentary consultation, please call 714-834-0101.

A previous patient of mine came to my office recently for a left breast  implant deflation.  She had saline breast implants placed in 2006, and now had an obvious asymmetry on the left side.  On examination, the left and right breasts were soft to touch, with no masses or tenderness.  The right breast was significantly larger than the left, consistent with a left breast implant deflation.

As a background, ALL breast implants will eventually leak and ALL breast implants will form a capsule around them.  The capsule is basically our body’s way of “ignoring” the implant, which is a foreign body.  Typically, the capsule is very thin (sometimes almost transparent) and very pliable.  If the capsule becomes thick, it can become tight and squeeze the implant into a tight ball.  This is called capsular contracture and depending on the severity, may require surgery to remove the tight capsule.  In cases of implant deflation, the capsule always closes a bit, and is easily opened up during surgery.  This is not capsular contracture, is as much as the capsule closes a bit due to the deflated implant.

Given the softness of the left breast, I anticipated a relatively easy implant exchange.  Was I in for a surprise!  I found the capsule to be very thick (up to 3mm in some areas) and very tight.  When I placed the new implant in, it became obvious early on that the patient had developed a significant capsular contracture.  Could the contracture have caused the implant to leak?  If the capsule was so tight, why did the patient have no complaints prior to the deflation?

I performed a near complete capsulectomy (removal of capsule) which was very difficult, as the capsule was adherent to the breast tissue, followed by placement of a new implant.  I did recommend bilateral breast lift to position the nipple over the center of the implant.  However, the patient did not wish to have the procedure done at this time.

The patient is one week after her surgery, and the implants and the breasts are soft.  As expected, the left breast is more swollen due to the surgery, and will take several months to “settle in”.

This is an unusual case and shows even an experienced surgeon can sometimes be fooled by clinical findings.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 12 years of experience.  His office is located in Orange County, California.  To schedule a complimentary consultation, please call 714-834-0101.

As an Orange County Plastic Surgeon, I am asked this question frequently.  It is time to put this myth to death! Consider me the breast implant “myth busters”!

I am not sure how the facts became twisted, but here is the truth.  If you have had a breast augmentation with or without a lift in the past 8 years and the implant was made by either Mentor or Allergan (formerly called McGhan), there is a LIFE TIME warranty on the implant if a leak occurs.  Up to ten years from the time of surgery, both companies will also pay towards the cost of the procedure.  Currently, there are two warranties for saline implants: standard and extended.  The standard warranty will cover up to $1200 towards the cost of the procedure. The coverage increases to $2400 for the extended warranty.  For silicone implants, the most recent warranty is $3500.

After ten years, both companies will NOT cover any costs related to the procedure.  If your implant is more than 7 years old, it’s best to contact the company and confirm the terms of the warranty, as it may have been different.

I hope this clarifies any confusion regarding the ten year replacement fear.  If your implants are soft and look and feel natural, and there are no medical conditions such as breast cancer, leave those implants alone!

I also want to emphasize the importance of asking for your implant warranty card after your surgery.  Most reliable surgery centers place the implant serial number and volume on the card and it should be given to the patient before discharge.  I do keep track of all this information as well.  However, some surgeons don’t.  If your implant should deflate at any time, having your implant information will make it much easier for the surgeon to find the correct replacement.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in Orange County, California.  To schedule a complimentary consultation, please call 714-834-0101.

I occasionally receive frantic phone calls from patients, usually after hours, where the patient is in stress because she feels her breast implant has deflated.

Stay calm!  An implant leak, whether saline or silicone, is not dangerous to your health.  In case of a saline implant deflation, the body will absorb the saline (which is the same fluid which is placed in your IV when one goes to the hospital).  For silicone implants, the silicone may leak (the newer silicone implants have cohesive gel and the leakage rate is much less than before) and will stay around the implant.  Silicone is ubiquitous in nature.  In fact, if we randomly biopsy a piece of our tissue, we will all test positive for silicone.

The timing of the implant change is really up to the patient. Obviously the sooner the implant is replaced, the sooner the breast symmetry will occur.

If your surgeon used Mentor or Allergan breast implants over the past 4-5 years, the company will have a life-time warranty on the implant.  The company will also pay a certain amount towards the cost of the procedure, if the implant deflation occurred within ten years from date of surgery.  If your implant is older than 4-5 years, I recommend calling the company for exact details on your warranty.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience in both cosmetic and reconstructive surgery.  His office is located in Orange County, California.  To schedule a consultation, please call 714-834-0101.

Is this cause for panic and concern, especially if you already have breast implants?  In my opinion, absolutely not!

The American Society of Plastic Surgeons (ASPS) has actively become involved to provide correct information to its members and to the public.   I have provided the link for consumers below.  The important point is that ALCL is an extremely rare type of cancer.  Of the estimated 10 million breast implants placed since 1989, only 34 cases of ALCL has been reported.  This translates to an approximate risk of 1 in 300,000.  For comparison, the risk of death from anesthesia in an out-patient surgery center is 1 in 50,000 and the risk of death from driving is 1 in 5000.

So, if you already have breast implants or are contemplating getting one, I do not feel the above data justifies concern.

Here is the ASPS site link for consumers regarding breast implants and ALCL:

http://www.plasticsurgery.org/x10998.xml

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in Orange County, California.  To schedule a complimentary consultation, please call 714-834-0101.

As simple a concept as breast augmentation is (just place an implant to enhance the size of the breast), it amazes me how many issues one must consider.

First, the patient has to decide between saline (salt water) and silicone implant. Currently, the FDA has limited the use of silicone implants to patients 22 years of age or older. Secondly, the silicone implant is significantly more expensive than saline and, therefore, the cost will be higher. If age or cost is not an issue, silicone implant, overall, does feel more natural than saline implant. This advantage is more evident if the patient has thin skin, and less evident if the patient has adequate breast tissue and skin thickness. The disadvantage of the silicone implant is the additional cost, the inability to detect an implant leak in all cases (since the silicone gel is not absorbable, a leak may not be detected on physical exam), thus requiring additional imaging studies, and the inability to adjust the volume of the implant, which may be a factor if the patient has significant asymmetry before surgery.

Breast Implant Leaks

Since the subject of breast implant leak came about, let’s talk about it. ALL breast implants will eventually leak. When a leak occurs is unknown, I have had patients with a deflated breast implant 18 months after surgery, and I have seen patients who have had silicone implants for 22 years without any issues on physical exam. The good news is both Mentor and Allergan, which are the only two FDA approved manufacturers of breast implants in the United States, have a LIFETIME warranty on the implant, if it should fail. Currently, both companies also provide financial assistance towards the cost of surgery up to 10 years from the date of original surgery. To me, this indicates the rate of implant leak up to 10 years is low enough to allow both companies to exchange the implant AND cover some or all the cost of the surgery and still make a profit! This is good news for the patient.

Breast Implant Placement

The next question is should the breast implant be placed above the pectoralis muscle (the chest muscle which body builders flex to impress the judges) or below. I prefer to place the implant under the muscle for two reasons. First, the implant is partially covered by the muscle (there is no chest muscle at the bottom of the implant or to the side) thus minimizing the feel of the implant. Second, given that one in seven women in the United States will develop breast cancer, placing the implant under the muscle allows better visualization of the breast tissue.

Styles of Breast Implants

What about the style of the implant: low profile, moderate profile, high profile, tear shaped (also called anatomical), textured versus smooth or adjustable implant?

Low profile implants are so low in projection, I do not know of any surgeon who has used them for breast augmentation. The choice between moderate and high profile depends on maximizing the volume of the implant for the patient’s chest diameter and chest height. If the patient has a narrow chest and short chest height, but desires the largest implant volume possible, the high profile implant will allow us to place a larger volume (with more projection of course) and still keep the implant within the natural boundaries of the patient’s breast anatomy.

The tear shaped breast implant is flatter on the top and fuller on the bottom. Theoretically this will result in a more natural breast shape. In practice, however, the difference is NOT detectable. There have been some studies which have showed the tear shape implant to look less natural. In my opinion, the theoretical advantage of tear shaped breast implant does not justify the extra cost of the implant and the potential for rotation of the implant. All breast implants may rotate when placed inside the body. With the anatomical breast implant, if the implant should rotate, surgery is required to reposition the implant.

To minimize this risk, the surface of the implant is textured (rough to touch), with the hope that the rough surface will adhere to the muscle or breast tissue. The potential problem with the textured implant adhering to the tissue is that when the patient moves it may pull on the tissue, causing rippling. Most plastic surgeons currently use smooth, round implants for breast augmentation.

What about adjustable breast implants? Adjustable breast implants have an outside shell filled with silicone gel, with a central “second” implant, which can be filled with saline. Seems like a great idea, right? Not so fast! The problem is most patients have swelling after surgery, which may take 3-6 months to fully resolve. Therefore, during the initial period, it is difficult to know how much to fill the implant. After 3 moths, if the patient desires additional volume, it may be difficult to do so, as the body forms a capsule around the implant to “ignore it” and “wall it off” from the rest of the body.

It may be difficult or impossible to expand the implant and still retain a natural look and feel, if the capsule does not yield. Theoretically a great idea, but in practice does not justify the additional implant cost.

Nipple Sensitivity

What about nipple sensitivity, and breast feeding? Regarding nipple sensitivity after breast augmentation, the answer is no one can predict how nipple sensation will be.

In my experience, approximately 1/3 of patients have normal sensation, 1/3 has less, and 1/3 is more sensitive than pre-surgery. One important factor to keep in mind is the size of the implant. The nerve which gives sensation to the nipple comes from the underside of the chest muscle, at the outer edge of the muscle. It then travels towards the nipple to provide sensation. A larger (and therefore wider) implant will increase the risk of nerve injury. If the implant is too large, the patient may even lose nipple sensation completely. Therefore, it is critical to choose an implant which comfortably fits within the confines of the patient’s breast.

Regarding breast feeding, if a patient has never had a child, there is no way to know if that patient can breast feed at all. If a patient was able to breast feed with previous children, ANY type of breast surgery may affect breast feeding, and there is no way of predicting who will be affected.

“My friend got the same type of implant as I did, but my breasts don’t look anything like hers.”

Occasionally I hear this comment, usually from my younger patients. Young patients, for the most part, are very impatient! The culture of “every thing happening right now” can not be applied to surgery. Any surgical procedure will result in swelling. In case of breast augmentation, it may take 3-6 months for the implants to settle in their pockets.

Initially, when the implant is pushed up by the swelling, the breast may look smaller than it will be once the implant has settled in. Also, every one’s breast shape, amount and thickness of the breast tissue and skin is different. Therefore, having the same volume or style of implant is not going to achieve the same result in patients unless their breast shape is EXACTLY the same (even identical twins do not have perfectly symmetrical bodies). Therefore, competing or comparing your breasts after surgery is a self defeating exercise.

At our office, the patient tries the implant with a bra in front of the mirror. This is as close an approximation as we can provide the patient and the patient must be honest with herself.

Are Breast Implants Dangerous?

Does breast augmentation increase risk of breast cancer? Not according to studies. The risk of breast cancer does not appear to increase with breast augmentation surgery. Of course, the patient must follow the guidelines for breast examination and mammography. As mentioned previously, I prefer to place the implant under the chest muscle to increase the chance of tumor detection by mammography.

Are breast implants, especially silicone ones, dangerous if the implant leaks? No. Multiple studies, studying tens of thousand of women have found no correlation between auto-immune disease and breast augmentation (saline or silicone).

“My friend didn’t need a breast lift, why do I need one?”

Your friend’s nipple was in a good position relative to the breast tissue and she had no loose skin. If your nipple is low relative to the rest of the breast and you have loose skin, the nipple must be repositioned and the loose skin removed, otherwise the breast will have fullness on top with the nipple and loose skin hanging over the implant. Believe me, this is not an attractive breast! That is also why the same patient above is surprised about why her total cost is more than her friend. Depending on the type ofbreast lift, considerable amount of additional time is required, thus resulting in additional cost.

“I had breast augmentation and now my breasts feel hard and the shape is strange.”

What the patient is describing is capsular contracture, which is hardening and tightening of the capsule which normally forms around all breast implants. The most common classification used for describing capsular contracture is Baker’s.

• Grade 1: the breast and implant feel and look normal.
• Grade 2: the implant feels slightly firm, but otherwise the breast looks normal.
• Grade 3: the implant feels firm to touch and the breast shape is distorted.
• Grade 4: the implant feels hard to touch and the breast is painful to touch and is distorted.

Unfortunately, we do not know what causes capsular contracture and therefore cannot prevent it or predict who is at higher risk. What is known is the risk for contracture increases with the age of the implant.

In my experience, patient’s who had bleeding right after surgery, even if the amount was small enough not to warrant surgery, are at much higher risk of capsular contracture. Patient’s who do not massage their implants after surgery are also at higher risk.

Currently, the only solution for treating Baker grade 3 and 4 capsular contracture is surgery. The options are capsulotomy (making vertical cuts in the capsule to open up the pocket) or capsulectomy (removing a portion or the entire capsule).

In general, if the capsule is not too hard and this is the initial episode of contracture, I perform a capsulotomy. If the surgery is for recurrent contracture, I perform a capsulectomy. It is important to note both procedures increase the risk of thinning of the breast tissue, thus increasing the possibility of implant visibility and palpability.

“I had surgery six months ago and I want to go larger.”

Increasing the volume of the implant or exchanging to a larger size is not as care free as it seems. First, in my experience, in order to notice a significant change in the breast size, an increase of at least 60cc (2 ounces) is required. This usually requires exchanging the implant, since adding 60cc to an already fully filled implant may make the implant feel harder than desired. Second, since the capsule has already formed, a capsulotomy is required to increase the pocket size for the new implant. The patient must seriously consider whether the cost and potential risk of complications is worth the additional volume or not. My advise is “if it isn’t broke, don’t fix it!”

“I had breast augmentation and now the skin at the bottom of my breast is slightly red and the skin is shiny.”

This can imply an infection and you must contact your surgeon immediately! Although in rare cases the implant can be “saved” by admitting the patient and giving IV antibiotics, the usual scenario is removal of the implant followed by antibiotics. The patient must then wait at least six months before contemplating insertion of a new implant (the same implant should NEVER be used). This is a horrible experience for both the patient and the surgeon. Although the risk of infection is very low, infection is always a possibility with any surgery or procedure.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over ten years of experience. His office is located in central Orange County. To schedule a complimentary consultation, please call 714-834-0101.

The “gummy bear” breast implant is a cohesive gel breast implant, which means the silicone molecules in the implant are linked together in a “cohesive” manner.  This will result in less chance of leakage if the implant should fail (as my blog readers know by now, ALL breast implant shells will eventually break down).

Many people think the “gummy bear” implant idea is new, but it is not.  Mentor Corporation and Allergan have been using cohesive gel implants for several years now.  The difference is that the “gummy bear” implant is more cohesive than the current silicone implants available in the United States.  I have seen photos of the implant where a wedge of the implant was cut and the wedge was squeezed between the fingers without any visible leakage of the silicone gel.  This is where the confusion lies:  “gummy bear” implants are cohesive implants (which is not a new concept), yet the degree of cohesion is more than the standard implants available in this country.

My concern was that the “gummy bear” implant will feel hard to touch, given the increased amount of cohesion.  However, it does not.  I have felt an actual “gummy bear” implant from Allergan (known as style 410 implant) and it feels very natural.  My best description is feeling a young, nulliparous breast which is firm, yet not hard.

My only criticism about the implant is that it is anatomical in shape (tear-shaped) and because of that, it has a textured surface.  The concern with tear-shaped implants is that they can rotate, necessitating additional surgery.  The theory with the textured surface is to minimize chance of rotation by having the breast tissue “stick” to the textured surface.  This, however, will increase the chance of rippling as the breast tissue moves.

As of yet, the “gummy bear” silicone breast implant is not approved by the FDA, but it eventually will.  I hope they will make smooth, round versions of it though!

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in Orange County, California.  To schedule a complimentary consultation, please call 714-834-0101.

My method is not scientific at all but based on experience, having performed hundreds of breast augmentation surgeries over the past ten years.

I measure the patient’s chest before surgery to come up with bra size.  It is amazing how many of my breast augmentation patients are wearing the wrong size!  Whatever the bra size is, I add 4 and 6 to that number.  For example, if a patient has a bra size of 32, I have the patient purchase a 36 and 38 sports bra (most sports bras come in C cups).

The reason I have the patient purchase two sizes is that every patient will have different degrees of swelling after surgery.  There is no way to accurately predict this pre-operatively.  The two sizes allow me to properly fit the patient with a support bra which is not too tight and not too loose.

With this simple “technique”, more than 90% of my breast augmentation patients have chosen a sports bra which fits properly.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in central Orange County.  If you like to schedule a complimentary consultation, please call 714-834-0101.

As have been stated in my previous blog, mommy makeover surgery addresses the changes which occur after pregnancy.  These changes primarily affect the breast and the abdomen.

The breast can be enhanced with an implant (breast augmentation) with or without a breast lift.  A breast lift may be required to reposition the nipple and tighten the loose skin.

Although some patients are lucky enough only to require liposuction, most patients will require a tummy tuck (abdominoplasty) to address the loose skin, stretch marks, and the weakened abdominal muscles which occur after pregnancy.

So, can both surgeries be combined together?  The answer, in most cases, is yes!

There are two limiting factors preventing both procedures to be performed at the same time: the patient’s financial situation, and the total time the patient is under anesthesia.

Mommy Makeover surgery is among the more expensive procedures performed by plastic surgeons.  The surgery may take 4-6 hours and the cost of anesthesia/operating room, implant and surgeon’s fee will add up quickly.  Having said this, if the patient can afford the cost, there are many benefits to having the procedures combined.  First, there is one recovery period, both from anesthesia and from the surgery.  For patients who work, one recovery period is financially advantageous.  Second, combining both surgeries will result in a 10-15% reduction in overall cost.  Surgery centers typically charge more the first hour and the price decreases after that.  Therefore, staging the surgeries will result in more added cost to the patient.

The second limiting factor is the anticipated anesthesia time.  The current recommendation by the American Society of Plastic Surgeons is to limit anesthesia time for elective, outpatient surgery to six hours.   Therefore, if the surgeon feels the surgery may take longer, it is best to stage the procedures.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in Orange County, California.  To schedule a complimentary consultation, please call 714-834-0101.

So, is breast augmentation worth it?  Remember, you as a patient are going to pay thousands of dollars, temporarily feel bad and look bad, for the hope that your breasts will look better after surgery!

Well, the answer is “it depends”.  If you have realistic expectations and are doing the surgery for yourself and yourself only, then the satisfaction rate is very high.  Although I haven’t done an actual survey, the satisfaction rate for breast augmentation seems to be greater than 90% in my practice.   Realself.com, a reliable web-site, lists a satisfaction rate of 78% amongst respondents who had breast augmentation.  Perhaps the difference is due to patients having unrealistic expectations and/or not achieving the result hoped for.  As I have mentioned previously, selection of your surgeon is critical.  He/she should be board certified in plastic surgery, and have before and after photo gallery either in the office or on-line (preferably both).  It is important you feel comfortable with this person operating on you and like the result of his/her work.

Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience.  His office is located in Orange County, California.  To schedule a complimentary consultation, please call 714-834-0101.