Breast Augmentation Beverly Hills

Conveniently located to serve the areas of Beverly Hills and Los Angeles

Contents

Description

In 2012, over 286,000 breast augmentation (breast enlargement / breast enhancement) procedures were performed in the United States, making breast augmentation the most popular surgical procedure for the sixth year in a row. Advances in breast implant technology and surgical techniques have made breast augmentation an extremely safe and effective procedure, and have enabled patients to achieve beautiful, natural-looking results*.  At Gabbay Plastic Surgery, Dr. Joubin Gabbay M.D. knows that considering breast augmentation is very personal choice, and that each woman has unique and individual needs and goals for her breast augmentation surgery.  For this reason, he takes the time to thoroughly educate and inform his patients, so that they can make a well-informed decision when contemplating their breast enlargement surgery.

*Results May Vary

Options

There are many factors and choices to think about when considering whether or not to undergo a breast augmentation surgery, including:

Implant Size:

  • Implant sizes are measured in cubic centimeters (ccs) and range from approximately 120cc to 960cc

Implant profile:

  • Implant profiles specify the distance the implant projects from the body–higher profile implants result in more prominent silhouettes than lower profile implants.
  • Implant shapes can vary between round and tear-drop shaped

breast-implant-profiles

Incision pattern:

  • Inframammary (Under the the breast)
  • Periareolar (Around the lower half of the areola)
  • Transaxillary (In the underarm)
  • Transumbilical or TUBA (In the navel area)

Implant placement:

  • Submuscular placement: under the chest muscle
  • Submammary or Subglandular placement: between the chest muscle and breast tissue

Implant type:

  • Saline: implant is inserted into the body in its empty form, and filled with a sterile, saline solution after it is in place.
  • Silicone: implant is pre-filled with a silicone gel (viscous fluid that simulating the texture and feeling of human breast tissue
  • Standard versus cohesive (gummy bear) silicone gel

Before & After Photos

breast-bxa-02

*Results May Vary

Selecting the perfect size, profile, and type of implant for your surgery may feel like an overwhelming task; however, you do not need to make these important decisions on your own. During your initial consultation at Gabbay Plastic Surgery, Dr. Gabbay will offer his professional recommendations for your breast augmentation surgery, taking into account all of the pertinent details about your specific case (ie. current breast size, height, weight, skin quality, individual preference).

When considering breast augmentation surgery, it is important to truly trust your plastic surgeon and to feel confident in his/her abilities to select bring your aesthetic goals to fruition.

Dr. Gabbay is a highly experienced plastic surgeon, who believes that the doctor/patient relationship is crucial to achieving successful surgical outcomes, and invests the time needed to determine his patients’ expectations and goals.  From the moment you enter the doors of Gabbay Plastic Surgery’s state-of-the-art facility, you will feel a sense of calm reassurance, and know that you have chosen the best possible location for your cosmetic surgery.  If you would like additional information about breast augmentation surgery, please contact Gabbay Plastic Surgery today. We will be happy to answer any and all of your questions, and to schedule an initial, complimentary consultation with Dr. Gabbay.

What Is A Normal Breast?

The incredible variation of breast sizes and shapes, along with differences in personal aesthetic preferences make it impossible to define the “perfect” breast; however, some of the characteristics most often used to describe ‘ideal’ breasts include: symmetrical, full, balanced, “soft yet firm,” and having a gentle sloping projection. The ideal nipple/areola complex is often described as being circular, symmetrical, pointing up slightly, the same color, and proportionate to overall breast size.

Anatomy of the Breast

content-copyThe female breast contains two main tissue types: glandular tissues, and stromal (supporting) tissues. The glandular part of the breast includes the lobules and ducts.  In women who are breastfeeding, the cells of the lobules make milk, and the milk moves through the ducts to the nipple. The support tissues of the breast include fatty tissues and fibrous connective tissues that give the breast its size and shape.

Adipose tissue (fatty tissue) accounts for a large part of the female breast composition, and plays a major role in determining breast size.  The proportion of fatty and glandular tissue varies among different women, and over a woman’s life. The breast itself does not contain any muscles; however, there are muscles under each breast, over the ribs. Each breast is attached to the dermis of the overlying skin by connective tissue structures known as “Cooper’s ligaments,” which provide support to the breasts.  As time passes however, gravity has a detrimental impact on the strength of these ligaments, and as they weaken, the connecting skin stretches and the breasts begin to sag.

*Results May Vary

Indications

Breast augmentation surgery is one of the most common cosmetic procedures performed today and is undertaken for a number of reasons, including (but not limited to)*:

  • Increase breast size
  • Correct asymmetrical breasts
  • Enhance lost breast volume after pregnancy and breastfeeding
  • Augment breast size after significant weight loss
  • Correct imbalanced body proportions
  • In conjunction with breast reconstruction surgery after mastectomy or injury to the breasts
  • In conjunction with breast revision surgery after complications from a previous breast surgery
  • In conjunction with a breast lift, to add volume and fullness while correcting breast ptosis (sagging)

Evaluation

If you are considering breast augmentation, scheduling a personal consultation with Dr. Gabbay at Gabbay Plastic Surgery is a great first step.  During this initial consultation, Dr. Gabbay will go over any concerns you have about the appearance of your breasts and why you are considering breast augmentation surgery.

Following your medical history evaluation, if Dr. Gabbay determines that you are a good candidate for breast augmentation, he will then discuss your breast augmentation options, including: incision type, implant placement position, implant size and shape, potential complications, and implant profile. In order to help you get a true sense of what your new implants will look like and feel like, you will be able to test various implant sizes and weights in order to determine which specific implant would be the best fit for your body. It is important to tell Dr. Gabbay if you are planning to lose a significant amount of weight, or if you think that you may want to become pregnant in the near future, because both of these events can alter your overall breast shape/size.

Option Details

There are many choices and options to consider when undergoing breast augmentation surgery, including:

Implant Characteristics:

Natrelle-Inspira-Round-Breast-Implants

  • Texture—breast implants are encased in a solid silicone rubber outer shell (lumen) that may either be smooth or textured.
  • Shape—implants can be round or anatomical (tear-drop).  Tear-drop implants (also called shaped or contoured implants) create a natural sloped shape when placed over the chest muscle, and are considered to bear the closest resemblance to the natural breast shape.  Tear-drop implants must be positioned precisely in order to prevent implant rotation, which is why they are only offered as textured implants, as the rougher texture helps the implant adhere to the breast tissue. Round implants are spherical in shape, and create fuller breasts with a higher lift and a greater amount of cleavage. Round implants are offered in both smooth and textured choices, because if the round implant moves inside the breast pocket, it will not change shape, unlike the teardrop implants.
  • Composition—implants can be composed of either saline or silicone.  Saline implants are filled with a sterile saltwater solution that is non-toxic to the body. All silicone breast implants are pre-filled with a cohesive gel (holds together in a semi-solid mass).  Newer highly cohesive silicone implants (“gummybear” implants) are also available and have added options for patients to choose from.  Silicone implants are less likely to ripple than saline implants, and many patients believe that silicone implants more closely resemble the feel of natural breast tissue; however, the ultimate choice of saline vs silicone comes down to personal preference and determining which option is best for each patient’s unique situation.
  • Profile—The profile of a breast implant determines how far the implant will protrude from the chest wall. Implants are offered in four different profiles: low, moderate, moderate plus, and high. The higher the implant profile, the more they will project from the chest. In general, high profile implants are best suited for women with narrow chests and low profile implants are better choices for women with wider frames.
  • Size—implant size refers to volume, and is not measured in terms of bra cup size (A, B, C, D etc), but rather in cubic centimeters (cc), which are the are the metric volume measurement used to define the capacity of a breast implant, with one cubic centimeter being equal to one milliliter. Breast implant sizes for both saline and silicone implants range from 120-850cc.

Implant Placement Options:

breast-implant-placement

  • Sub-Glandular (Over the Muscle)—for this technique, the implant is placed directly behind the mammary gland and under the fatty breast tissue in front of the pectoral muscles.  The sub-glandular option typically provides more projection, and is suitable for women who have a sufficient amount of natural breast tissue to cover the edges of the implant.
  • Sub-Facial—for this placement option, which is a variant of sub-glandular placement, the implant is placed beneath the fascia of the pectoralis major muscle,.
  • Sub-Pectoral/Sub-Muscular (Under the Muscle)—with this technique, the implant is placed underneath the pectoral muscle. This option is better for women who do not have sufficient natural breast tissue to cover the edges of the implant.

Implant Incision Options:

The four most common incision locations include:

  • Peri-Areolar Incision—the periareolar incision is made on the lower border of the areola, and is most commonly utilized if other cosmetic breast procedures (such as a breast lift or areola reduction) are being performed in conjunction with the breast augmentation.
  • Inframammary Crease Incision—this incision type is made in the natural fold or crease underneath the breast.  The inframammary incision is popular because it allows surgeons easy access to create an implant pocket above or under the muscle for greater control of implant placement.
  • Trans-Axillary Incision—the trans-axillary incision is made underneath the armpit (axilla), and offers the advantage of very inconspicuous scarring.
  • Transumbilical Incision or TUBA—the transumbilical incision is made in the folds of the navel.  For this technique, implants can be placed over or under the muscle.

*Results May Vary

Procedure Details

Breast augmentation is typically performed as an outpatient procedure following these steps:

Step 1: Mark for Surgery—Dr. Gabbay will mark your breasts for incision locations and general measurement guidelines that will serve as a visual aid during surgery.

Step 2: Administer anesthesia—Anesthesia will be administered and you will be prepared for surgery.  General anesthesia is typically used for breast augmentation; however, in some cases,  “twilight” sedation with an IV may be used.  The surgery site will be thoroughly cleaned and disinfected before a topical antibiotic solution is applied.

breastaugmentation_clip_image002Step 3: Make Incision—once you are comfortably anesthetized, Dr. Gabbay will make an incision using one of the four techniques discussed above.

  • Inframammary Incision (Under the breast)
  • Periareolar Incision (Around the nipple)
  • Transaxillary Incision (In the armpit)
  • Transumbilical or TUBA (In the navel area)

Step 4: Create an Implant Pocket—after the incision is made, Dr. Gabbay will use a special surgical tool to create a pocket for the implant to be inserted into, and will place the implant using one of the following placement options:

  • Subglandular (above the pectoral muscles)
  • Partial Submuscular (partially behind the pectoral muscles)
  • Complete Submuscular (completely behind the pectoral muscles)

Step 5:  Place Implant—once the implant pocket is created, the implants will be inserted into position.

Step 6: Check for Proper Placement—after insertion, Dr. Gabbay will check for symmetry and proper placement.

Step 7: Close Incisions—after Dr. Gabbay is satisfied with the placement and symmetry of your breasts, he will perform a multiple layer suturing procedure, first closing the deeper tissue, and finally the surface incision itself.  A surgical bra and compression band will be applied over the top of the breasts, which will stay on for 1-4 weeks to help the breast implants settle properly into their new pockets.

Step 8: Rest in Recovery Room—Breast augmentation surgery generally takes 1-2 hours (depending on the complexity of your procedure or combination of procedures) and you will spend the first few hours after surgery in the recovery room.  When you are fully alert, you will be released to a family member or friend who will drive you home. Patients are advised to arrange to have someone help them for at least the first few days after surgery*.

Recovery

Because Dr. Gabbay uses state of the art techniques for breast augmentation surgery, many of his patients have a minimum of pain and are active very shortly after surgery*. Many patients have gone out to dinner the very night they had surgery*.  Discomfort following breast augmentation surgery is generally mild to moderate and easily managed*. After your surgery, you will notice more tenderness and fullness around the chest region as the tissues adjust to the presence of the breast implants*. You will be advised to sleep with your head and back elevated to reduce the swelling in your chest region.  Many patients choose to take pain medication to increase comfort levels during the first few days, although after three days most patients find that they no longer need the pain medication, and most patients need very little over the entire recovery period*.

Shortly after surgery, you will be allowed to remove your surgical bra and dressings to shower, but may need to wear the supportive bra for several weeks.  You will have a follow-up appointment with Dr. Gabbay one to three days after your surgery to ensure your breasts are healing properly.  During this visit, you will be instructed on daily breast massage techniques to soften and relax the breast implant pocket, which will help optimize your outcomes*.

Most patients are able to resume daily activities (including work) shortly after surgery (generally, within several days to one week)*. Light exercise may be resumed within one to two weeks, although lifting heavy objects and strenuous exercise should be avoided for 4-6 weeks, as this can slow the healing process*.

Although rare, there are risks associated with breast augmentation surgery.  Dr. Gabbay follows all his patients very closely to ensure that they have a very successful postoperative course.  Some of the complications associated with breast augmentation include: hypertrophic scarring, hematoma (bleeding inside wound), seroma (fluid around implant), deshiscence (wound separation), infection, inflammation of blood vessels, breast asymmetry, capsular contracture, implant rupture and deflation, contour problems, altered breast/nipple sensation, implant mal-rotation*.

*Results May Vary

Frequently Asked Questions (FAQ)

What is breast augmentation?

Breast augmentation is also known as augmentation mammaplasty, and it is designed to enhance a woman’s bust size.  Using breast implants, Dr. Gabbay will create more attractive breasts (shape and size) making you feel more confident about your femininity*.

What decisions will I have to make when I decide to have breast augmentation?

In addition to the type and size of breast implant, you will have several other options to consider including where to place the incision.  Dr. Gabby will place incisions either under the breast, around the nipple, in the navel, or in the armpit depending on your anatomy, and the type of breast implant chosen. The placement of breast implants is another factor to consider, and implants are most commonly placed underneath the chest wall muscle, although, some women choose to have the implants placed above the muscle.  For breasts that are beginning to sag, a breast augmentation can improve the shape of the breasts, however; for optimal results it may be necessary to combine a breast lift with your breast augmentation*.

How long will my breast implants last?

No cosmetic surgery can be guaranteed to last forever, and a possible complication from breast augmentation is that both saline and silicone implants may leak or rupture*. Your chest is constantly moving (repetitive breathing) so it is safe to assume that your implants may eventually wear out, although there is no set time frame for when this will happen.  Although studies show that by fifteen years 25% of women need breast implant replacement, there is no danger in not replacing older implants that are still intact*.  The FDA does recommend regular MRI testing for silicone gel implants, and if a breast implant does need replacement, a new implant is inserted through the original scar. This procedure is less involved than the first augmentation, if the same size is involved*.

Do implants affect having a mammogram?

If you have breast implants, you should tell your mammography technologist before the procedure so your exam can be evaluated by a radiologist who is experienced in the evaluation of women with breast implants.  Due to the popularity of breast implants, this is a relatively common situation.

When did silicone gel-filled implants become available for plastic surgeons to use?

Silicone gel-filled implants were introduced in 1991, however, the FDA concluded that the breast implant safety date provided was not adequate when determining the benefits and risks involved over an extended period of time.  After 10 years of continuous safety data, in 2006, the FDA approved silicone gel-filled implants for use in breast augmentation surgery, although for 25 years they were used in over sixty countries around the world, with safety profiles evaluated for over one million women.

Who is a good candidate for breast augmentation?

Breast augmentation is one of the most popular cosmetic procedures performed on women today and each patient has their own personal reasons for wanting their breasts enhanced.

Some of the most common reasons include:

  • Women who are embarrassed because they feel their breasts are too small
  • Women who feel that their breasts are disproportionate to the rest of their body
  • Women who want larger, fuller, and rounder breasts
  • Women who have lost breast volume after pregnancy, nursing, or significant weight loss
  • Women who have one breast larger than the other (asymmetrical)

What should I expect from my consultation with Dr. Gabbay?

Your consultation is important, because it will help determine if breast augmentation is right for you.  Dr. Gabbay will discuss all of the pertinent details involved with breast augmentation, and he will also provide a comprehensive health examination to rule out any possible complications and risks.

What causes my breasts to sag?

Ptosis is simply a medical term for sagging of the breast, and while some women inherit this condition naturally, most often it occurs after pregnancy, breastfeeding, weight loss, or the force of gravity during the aging process.  When women with extreme ptosis have breast implants, a mastopexy or breast lift is often performed in conjunction with the breast augmentation, and if a woman opts not to have a breast lift, implants are typically placed above the muscle to fill out the breast skin and tissue.  In some cases, this placement (submuscular), can result in a “double-bubble” effect, where the implant appears to be a higher breast while the natural breast tissue hangs down, making it look like a separate breast.

Is it true that saline-filled breast implants harden?

Capsular contracture can occur when scar tissue forms around the implant, becoming hard, and this condition can occur with both saline and silicone-gel filled breast implants*.

What is the difference between smooth and textured breast implants?

The outer surface of breast implants can be either smooth or textured, and there are pros and cons to each type.  Textured implants have a sandpaper-like surface and they were designed to lower the risk of capsular contracture, (although this has not been proven)*. Also, they sometimes take longer to drop into a more natural position, making the breast appear to sit higher on the chest.  Smooth implants have a balloon-like surface with a thinner shell, so they feel more natural; and since they can move freely about in their pocket, they are less likely to ripple*.

What are the differences between round and anatomical (tear-drop) implants?

Although breast implants come in a variety of shapes, the two major types are round and anatomical, also called shaped, tear-drop, or contoured.  Anatomical implants are flatter on the top than the bottom, and they were designed to create a more natural-looking breast.  Tear-drop implants are only available with a textured surface that prevents them from rotating, and by contrast, round implants are flat on the back and round on the front, and they do not change their shape with movement*.  Women who want a round, fuller “model” look choose round implants, while those who are looking for the most natural results, typically decide to use anatomical breast implants*.

Is it true that fungus can grow in a saline-filled breast implant?

The saline in saline implants is sterile, so the chance of fungus growing inside the implant is a very rare occurrence.  In the past, when an implant was filled with an open technique, the saline made contact with air.  Today, plastic surgeons use a closed technique when filling a saline implant, and this means the saline is injected directly from the bag, into the implant, without being exposed to air.  The saline breast implant is sterile when it is inserted, so it should not become contaminated within the body*.

What is the difference between saline and silicone gel-filled implants and is one safer than the other?

Both saline and silicone filled implants are basically shaped silicone envelopes that are filled with silicone gel or salt water (saline).  Silicone breast implants are filled either with cohesive gel or with “highly” cohesive gel, which is referred to as “gummy bear” implants due to their consistency.  The Food and Drug Administration (FDA) has approved both silicone and saline-filled breast implants, although, the FDA did remove silicone-filled breast implants from the market in 1992, after claims were made that they increased a woman´s risk of autoimmune and connective tissue diseases.  After a thorough investigation, the FDA declared in 2001 that silicone implants do not place women at increased risk of disease.   In 2011, the FDA issued a safety report stating that implants are safe, although they are not meant to last a lifetime, and they may need to be removed or replaced after 10 years*.

Since implant volume and size is measured in cubic centimeters (cc), how many cubic centimeters make up a cup size?

Breast implant volume or size is measured in cubic centimeters (cc) and one study says that an average of 189 cc of saline is needed to fill one bra cup size.  If a woman wants to go from an A cup to a C cup, 391 cc is required, and a B to a D requires 448 cc.  It is important to remember that bra cup sizes are not standardized, and they vary from brand to brand.

I hear that sometimes overfilling is a problem so what does this mean?

Overfilling occurs when too much saline is added to the breast implant than manufacturer recommendations, and overfilling is only involved with saline breast implants, because they are filled after implantation.  Saline implants come in a wide range of sizes and overfilling makes the implant feel firmer (it does not affect the size), while increasing the risk of deflation in the future.

What are expandable breast implants?

Expandable saline-filled implants are implants that can be adjusted by adding more saline through a special valve.  Expandable implants were originally used for women who had undergone breast reconstruction after breast cancer surgery, but they can also be used for cosmetic breast augmentation.  For expandable breast implants, a syringe is used to inject or extract saline through a valve that is located beneath the skin, where the implant was originally inserted.  Expandable breast augmentation allows a woman to try out different breast sizes without undergoing additional surgery.

What are “gummy bear” implants?

The FDA has approved two types of highly cohesive gel or “gummy bear” implants that include the Sientra’s Silimed implant and the Allergan’s Natrelle 410 breast implant.  These implants are approved for augmentation in women at least 22 years of age, and reconstruction for women of any age.  A third “gummy bear” implant is being investigated, and “gummy bear” implants are made of silicone gel with a consistency that will not leak if they are cut in half.

How is a saline breast implant inserted?

Saline breast implants are inserted through the crease beneath the breast, navel, areola, or under the arms (armpits), and once in place, they are filled with the designated amount of saline to make the breast look natural.  Filling the implants after they are inserted allows Dr. Gabbay to make both breasts more symmetrical, and because the implant is empty when inserted, the resulting scars are much smaller and less conspicuous*. Many patients say that saline does not provide the natural results that silicone implants do however*.

Will I still be able to breastfeed after breast augmentation surgery?

The type of implant surgery you have will determine if you should breastfeed or not after breast augmentation, and your concerns should be discussed with Dr. Gabbay during your consultation.

How long does it take to recover from breast augmentation?

Breast augmentation recovery depends on each patient’s capacity to heal.  The stitches will be removed within 7-10 days and typically by one month, most women are able to resume light physical activities*.  Total healing may not happen for several months after your breasts have adapted to their new shape and your scars have faded*.

Is there a lot of pain after breast augmentation surgery?

As with any surgery, discomfort may be involved depending on your threshold of pain. Typically after breast enhancement, pain subsides in a few days and can be easily controlled with medication*.

Will my scars look bad after breast augmentation?

Immediately following your breast augmentation, your scars will be visible and pink but over time, they will fade and become unnoticeable*.  To prevent visible scarring, when possible, Dr. Gabbay makes the incisions in locations that will be hidden.

What are the risks involved with breast augmentation?

Although rare, as with any surgery there are risks involved, and some possible complications from breast augmentation include*:

  • Infection
  • Nipple sensitivity
  • Blood clots
  • Interference with mammogram readings
  • Capsular contracture
  • Deflation and rupture
  • Rippling
  • Rotation

Can a mammogram cause a breast implant to rupture?

This is rare but it can occur when the pressure on a breast during a mammogram causes the implant to weaken*.  Older implants are more susceptible to trauma, but this should not keep you from have mammograms. Make sure you tell the technician that you have implants, and they will take the extra care necessary to prevent a rupture from occurring.

What is fat grafting breast augmentation?

Fat grafting breast augmentation is taking fat from other places in the body where it is plentiful (buttocks, thighs, or abdomen) before implanting it into the breast. The process involves using a liposuction procedure to harvest the fat, before injections augment and shape the breast.  This technique is complicated, and there are pros and cons, so if you are interested in fat grafting breast augmentation, you can discuss this with Dr. Gabbay during your consultation.

If I have breast augmentation, will I ever need additional surgery?

If complications from breast augmentation occur, you may need additional surgery following your initial breast augmentation*.  Some of the complications that require additional surgery are implant rupture, capsular contracture, or the development of breast asymmetry.  As you age, your implants will age along with the rest of your body, and for this reason some women choose to have additional operations to correct the results of gravity*.

What kind of anesthesia is used for breast augmentation?

Typically, general anesthesia is most often used meaning that you are asleep throughout the procedure and you will have no memory of the surgery.  In some cases, other methods are available and all options will be discussed during your consultation.

How long does breast augmentation surgery take to perform?

The time it takes to complete a breast augmentation depends on the type of implant surgery you are having and where the incision is made.  Generally, breast augmentation surgery lasts between 1-2 hours*.

Is it true that my nipple will lose sensation after breast augmentation surgery?

Most women will experience a change in nipple sensation after a breast augmentation, but this varies from patient-to-patient*.  On average, women report that any loss of feeling lasts from 6-12 months before it returns to normal, and 15% say they have permanent alterations in nipple sensation*.

When will I be able to drive after breast augmentation?

You must arrange for someone to drive you home after your breast augmentation, as you will not be allowed to do so because of the after-effects of anesthesia and pain medication.  Most women start driving one week after surgery, if they are no longer taking pain medication*.

I am physically active so will having implants limit my activities?

Depending on the size of the implant and the procedure performed, after the healing process is complete most women have no trouble resuming their physical activities*.  Weight lifting, extreme exercise, or lifting heavy objects will not affect the implant once the scar has properly healed*.

Will I be able to go home the same day as my breast augmentation surgery?

Breast enlargement is performed as an outpatient surgical procedure, meaning that you will be able to go home the same day as your surgery. Within the first week following breast augmentation, you should be able to return to most of your normal activities, adding in exercise and other activities once your healing is complete*.

Will I be pleased with my breast augmentation?

Most women at Gabbay Plastic Surgery are very pleased with the results of their breast enlargement and they are extremely proud of their sensuous figure*.  Many claim that they have a newfound confidence, and they love showing off their look with a variety of clothing that is meant to flatter: something they were never able to do before*.