Delivering breast augmentation with exceptional skill and a woman's sensibility
"Breast augmentation is about putting the right volume in the perfect spot. My results are natural looking." -Dr. Lisa B. Cassileth, Board Certified Plastic Surgeon
Age: 33, from Marina Del Rey, California. Patient had subpectoral breast augmentation with silicone implants - 300cc.
Your surgical expertise, concern, artistry, and true listening to my desires have left me happier and more natural-looking and beautiful then I ever hoped. Thank you for all of it, and for your compassion and time. I am so truly grateful."
Breast augmentation is about so much more than just size. Dr. Cassileth delivers extensive skill in breast surgery and an essential feminine sensibility to help you make choices that will ensure exceptional results. Her goal is to give you the most natural looking results that fit with your body shape and size.
Determining the incision location
An incision must be made in order for the breast implant to be inserted. There are four places where an incision can be made to put in an implant:
- Inframammary - Just above the crease at the bottom of the breast
- Peri-areolar - At the edge of where the areola meets normal skin
- Transaxillary - In the armpit
- Transumbilical Augmentation (TUBA) - In the belly button
The inframammary location is easy for the surgeon, and if placed correctly, will not show when you are wearing a bikini top. There will be a scar on your breast that is 3cm to 4cm long.
The periareolar scar is well-masked because it is located at a natural line, and is usually Dr. Cassileth's favorite. The scar is usually just around the lower half of the areola, right where the pigmented skin meets the normal breast skin. However, very small areolae cannot be used for silicone breast implants.
The transaxillary approach places the scar behind the fold in your armpit crease. This scar is usually very difficult to see and there is, of course, no visible scar on the breasts. Because the implant is placed from the top, the implant will tend to sit higher than if placed using another method.
TUBA places the incision in the top part of your belly button. The whole operation is done through a long tube passed from the belly button to the breast. Placement of the implant is unreliable using TUBA, and for that reason Dr. Cassileth does not offer this method.
Implant Location: Subpectoral vs. Submammary
Breast implants can be placed in two different layers: under the pectoralis (the chest muscle), called "subpectoral," or over the pectoralis muscle, called "submammary." Dr. Cassileth feels that the only advantage of the submammary approach is that it gives the breast more lift if you want to augment a saggy breast. In all other ways, however, this method is inferior.
With subpectoral implants:
- The breast implant tends to stay in its position over the long term
- Mammograms are more accurate
- Visible rippling is less likely
- The breast appears to be more natural, especially in those with thin skin
- The risk of capsular contracture is lower
Choosing your ideal breast implant size
Breast implant size is primarily a personal decision. There are several important things to remember when choosing an implant size. First, larger implants are also wider, so if you choose a size wider than your chest, your breasts will look unnatural. If you want to go large, you may want to try high-profile implants, which give you more outward projection with a smaller implant width.
It's important to know that large implants do bad things to your breasts over time. If you are considering a size larger than 500cc, think carefully about what your stretched-out breast skin will look like when you are 50, 60, or 70 years old.
During your consultation you will have the opportunity to try on breast implants by inserting them into your bra. This will give you a rough idea of how your breasts will feel and look. For best results it is a good idea to wear a close fitting T-shirt during your consult. It is helpful if you bring some photos of breast shape that you like to share with Dr. Cassileth.
At your consultation, we will take a three dimensional photograph of your breasts with our Vectra 3-D imaging system. This allows our computer software to project what you will look like with your chosen implants and allows the most accurate selection of your final implant style and size. This is just one of the important aspects of your consultation that allows Dr. Cassileth to deliver among the best breast augmentation results in Beverly Hills and Los Angeles.
You can view videos below of women talking about their experience with the Vectra 3-D system and how it helped them to make their decision about breast implant size.
Choosing implant shape and texture
Implants come in a number of different shapes. The two most common are:
- Cohesive gel implants - These are fuller on the bottom, where a breast is naturally fuller, and are intended to look more natural. These implants are slightly heavier, denser and hold their shape in any position. They have the least amount of rippling, so for thin patients with little or no breast tissue, these may be a good option. Cohesive gel implants are also sometimes called teardrop implants or gummy bear implants.
- Round implants - These are equally full on the top and bottom of the breast. They have a flat back side that goes against the chest wall (if the implant is placed in the sub-mammary position).
Low profile implant - used for women with broader chests, or that may want a small augmentation. Moderate profile implant - used for most patients, accommodate a standard augmentation size. High profile implant - these implants are best for patients that have a very narrow chest, or for patients that want a large augmentation.
Selecting a breast implant filler
There are three types of implant fillers: saline, standard silicone and highly cohesive silicone (410). All are contained within silicone sheeting. Saline implants are filled with salt water that is completely safe to the body. Because they are filled with water, many feel they are more "water balloon"-like in feel and appearance. Silicone implants feel much more like real breast tissue. The current consensus in the medical community is that silicone does not cause autoimmune disease or cancer. Silicone implants, like saline, may rupture. The standard silicone is jelly-like in consistency and soft and amorphous in shape. The highly cohesive silicone (410) is gummy bear in consistency, is firmer and holds its shape. For more information on breast implant safety please visit breastimplantanswers.com
What to expect after your breast augmentation from Beverly Hills plastic surgeon Dr. Cassileth
Dr. Cassileth will perform your breast augmentation in our on-site, out-patient surgical suite in Beverly Hills. When you arrive home, it's important to lie down and rest with pillows to support your back and arms. Make sure your medications are within reach, and have a bag of ice to place over your breasts during the first 48 hours.
Dr. Cassileth administers a local pain medication called Exparel® in surgery. This reduces post-operative pain dramatically such that you may not need pain medication. It lasts for three days. We ask that you take it easy after you surgery, even if you feel great!
Your breasts will be supported by a surgical bra and/or elastic bandage. For the first few days, leave the bra and or dressings in place and do not shower. Get plenty of rest and do not exercise or lift anything over 10 pounds. You can gently stretch and move your arms to keep your muscles loose and flexible. To promote blood circulation, you can walk around the house when you are feeling up to it.
It's important to have someone with you for at least the first night after your surgery. Also plan on having a friend drive you to your first post-operative visit. You will be able to drive again when you are off all pain medication and are cleared to do so by Dr. Cassileth or Kristen Davis, PA-C.
At your first post-operative visit, your dressing will be removed, and you'll get to see your new breasts. They may tend to sit high on your chest, which is perfectly normal and results from swelling of the pectoral muscle. In a few weeks, your implants will settle into their correct position. Some bruising and swelling is also normal and expected.
During your first post-op appointment, Dr. Cassileth will prescribe a bra for you to wear as you continue to heal. It is very important to wear it as directed, as it will help ensure proper implant placement and healing. It is okay to take the bra off for an hour or so each day so you can shower.
Most patients return to work a week to ten days after surgery. However, you should continue to avoid lifting anything over 10 lbs. for 3-4 weeks. Avoid all strenuous activities for at least a month, and when you do resume these activities, start slowly.
To promote excellent healing, at your second post-op visit with Kristen Davis, PA-C, she will review and evaluate your skin and help ensure that your scars heal quickly and as invisibly as possible. We will also, during this visit, start you on a massage program for the implants to ensure a soft, natural look and feel, helping deliver the best breast augmentation Beverly Hills has available.