Breast Augmentation

Selecting the best implant for you is determined by many factors. First, we will discuss your ideal look whether it’s an athletic, more natural look or a round, shelf look with more cleavage. A higher-profile implant usually creates more roundness and cleavage. Inspiration photos can be helpful to understand your goals.

Dr. MaDan will take breast measurements and assess your natural breast tissue. The most important measurement is your breast width, which indicates the maximum base width of an implant that can fit on the chest wall. This ensures your implants won’t interfere with your hobbies and daily activities—no one wants an implant in their armpit. We will use our silicone insert sizers to try out different volumes to give you an idea of the look in clothing. We will also use our 3D software to simulate what that size may look like on you. We review before and after photos to visualize the differences various implant profiles and volumes could make.

Skin quality and soft tissue envelope are also important factors that affect implant selection. A thin patient with a tight skin envelope may only be able to hold a certain implant volume. During your consultation, Dr. MaDan can help you determine what is realistic and anatomically possible. With secondary breast procedures, like implant exchange, patients are often able to increase size as the soft tissue has already expanded and stretched.

We use multiple methods to help you choose your desired volume. We use a sizing insert system that shows you what your desired volume looks like in clothing. Our 3D software simulates what your desired volume will look like on you. Another method is reviewing before and after photos of patients with a similar build and starting volume as yourself. Physical characteristics, such as breast width and soft tissue envelope, may influence or limit possible volume.

It is important to understand that breast implants are not considered lifetime devices. This means you will require future surgery for implant exchange or removal depending on your goals at that time. It is easier to exchange implants for a larger size than downsizing as soft tissues expand to accommodate the larger implant. However, tissues may not bounce back or tighten up if smaller implants are placed. Sometimes, downsizing implants requires a breast lift at the same time to remove the excess skin that previously stretched with larger implants.

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Silicone implants will feel the most supple and similar to natural breast tissue. The silicone gel is form-stable while still feeling soft, which minimizes the risks of unnatural-looking rippling and wrinkling. Saline implants may feel harder and more unnatural, depending on the fill volume. Due to the property differences between silicone and saline, saline implants have less height retention in the upper pole in a standing position. The cohesive silicone gel maintains its shape in the upper pole, giving you more shape and upper pole fullness in all positions.

Maximum cleavage can be achieved with the most cohesive gel and a higher profile implant like full/high or extra full/extra high. When placing implants in the sub pec—behind the pectoral muscle—position, Dr. MaDan is limited by a patient’s anatomy to a certain degree. Some women naturally have a wider space at the midline between the breasts. Releasing too much of the pec muscle from the sternum can create a complication called symmastia. Generally, the breast footprint, where the breast is located on the chest wall, cannot be changed.

Placement of an implant does create a lifting effect due to the implant’s volume and projection (height). The entire breast position is not altered when a breast lift is performed. Rather, a breast lift functions to reposition the nipple and tighten the lower pole of the breast by removing excess skin.

The Keller Funnel is a useful tool that increases safety during the augmentation procedure. It resembles a pastry bag with the implant as the icing. With the implant in the Keller Funnel, squeezing the back, or the open end, of the funnel will propel the implant forward. With the Keller Funnel, Dr. MaDan can insert large implants through small, 4 cm incisions. The Keller Funnel also minimizes the risk of contamination because no one, not even Dr. MaDan, touches the implant with their hands. In essence, the implant goes from its sterile container, into the funnel, then into the breast pocket.

The no-touch technique is a method of handling the implant for optimal safety during the procedure. The Keller Funnel ensures the implant does not come into contact with the skin or other contaminants. Additional measures Dr. MaDan employs to maximize safety are nipple shields and antiseptic solutions. The breast is not considered a sterile organ as the nipple, which allows breastfeeding, is open and may allow bacterial contamination. Nipple shields are an occlusive dressing applied during the procedure to decrease the risk of bacterial contamination of the implant. All of these steps are performed as part of the ”no touch” technique to reduce complications.

GalaFLEX or Durasorb are brand names of an internal soft tissue scaffold made of absorbable, strong, synthetic suture material. While this mesh is usually not indicated for primary augmentation procedures, it can be placed for extra support if needed. The mesh is more often used in breast revision surgery. It can be used to correct a double bubble deformity, which is the disruption of the inframammary crease during a prior procedure. Some revisionary surgery requires a total capsulectomy after which the implant essentially has no support. In this scenario, the mesh can be placed for additional soft tissue support for the implant. The scaffold is absorbed and incorporated into the capsule around the implant over many months.

If the implant is not enough to fill out the soft tissue envelope and elevate the nipple to an acceptable position (ideally pointing forward and positioned on the most projecting point of the breast), a lift can be performed in combination with implant placement. The purpose of the lift is to reposition the nipple and remove excess skin from the lower pole of the breast. The “pencil test” is something you can try at home to assess your potential for needing a lift. Place a pencil in the natural fold below your breast. If there is breast tissue holding the pencil against your chest, you may be a candidate for a lift. If the pencil falls to the ground, you are less likely to need a lift. Learn more about Breast Augmentation with Lift

At your consultation, our 3D imaging software will simulate your potential results with and without a lift. This tool can help your decision process to achieve your ideal appearance. Ready to get started? Upload your photos here.

Yes, breast surgery is performed in an accredited surgical center under general anesthesia provided by an anesthesiologist. Typically, an IV is placed in the pre-op holding room. You are given IV medications for relaxation and induction of anesthesia. After you are asleep, an airway (LMA- laryngeal mask airway or ETT- endotracheal tube) is placed to assist your breathing during the surgery. When you are awakened from anesthesia, the breathing tube is removed. Some patients may experience a sore throat afterward. This is temporary and usually resolves quickly. It is important to inform your plastic surgeon and the anesthesiologist of any adverse effects of prior anesthesia (including nausea) or family history of anesthesia problems. Anyone taking GLP-1 medications like Semaglutide or Tirzepatide should pause their injections for a minimum of 1 week before surgery to minimize the risk of aspiration. It is acceptable to resume those medications after surgery.

Yes, the minimum requirement is having someone drive you home from surgery and stay with you for the first 24 hours after anesthesia. Depending on your home situation, you may find assistance beneficial, especially if you have young children, pets, or other lifting requirements. You can drive 24 hours after stopping all narcotic pain medications.

Yes, you will be placed in a supportive bra following surgery. You should wear this bra at all times except when showering. This bra will support and protect the tissues throughout recovery. You will not be allowed to wear underwire bras for 6 weeks following the procedure. In approximately 3 months, you’ll see your final shape and implant position. At that time, it will be beneficial to be remeasured for your new bra size.

The recovery process is different for everyone. Generally, you may feel sore and tight after surgery. Swelling peaks 72 hours after your procedure. Ice packs and anti-inflammatory medications can help your recovery. The biggest risk of breast augmentation is bleeding. While the risk is extremely low, approximately 4%, we want to optimize your safety and minimize the post-operative risks.

No exercise or intense activities for 2 weeks following your procedure. After 2 weeks, light activity is acceptable. Light activities are walking, stationary bike, slow Stairmaster—nothing high impact or causing excess bouncing like running or jumping. You will have a weight restriction of 10 pounds for the first 4 weeks following surgery. Upper body exercises should be minimized for at least 6 weeks.

Dr. MaDan recommends waiting to resume strenuous CrossFit-like exercises, bodybuilding, or heavy weightlifting with a barbell (heavy, intense, repetitive upper body exercises) for at least 3 months to minimize the risk of implant malposition.

Time off from work depends on your occupation and desired speed to return to work. When you no longer need narcotic pain medication and can abide by all restrictions, it is acceptable to return to work. A note can certainly be provided for you outlining your specific restrictions. Typically, Dr. MaDan recommends a weight restriction of 10 pounds or less for the first month, then 30 pounds or less for weeks 4 through 6.

Yes. Routine mammograms begin at age 40 and should be performed annually. High-risk screenings should begin at age 35. Inform your mammogram technician of your implants as certain views are needed to displace the implant to allow complete visualization of the breast tissue.

No, drainage tubes are not indicated following a breast augmentation.

No. Dr. MaDan performs a meticulous multi-layer closure to ensure the implant is protected. All sutures are absorbable and do not require removal. After surgery, Dr. MaDan covers the incisions with steri-strips that will remain in place until your first post-operative appointment. Once the steri-strips are removed, Dr. MaDan will start you on her medical-grade scar therapy regimen to ensure your scar becomes almost invisible.

Permanent sensory changes following breast augmentation are uncommon. However, temporary changes are common. The majority of Dr. MaDan’s primary breast augmentation patients experience more sensitivity during recovery. After things have healed and settled, nipple sensation typically returns to normal. However, the incision and resulting scar will always remain numb, like any other scar.

Yes. Breast implants are not considered a lifetime device regardless of material—silicone or saline. Generally, 10 years is the recommended time for replacement. At 10 years, the rupture rate is quite low. Implants left in place for many years, or even decades, can develop a calcified capsule or shell that can become hard and painful. If calcification occurs, the entire capsule is usually removed with the implant. Total capsulectomy is more invasive and is a higher risk than an implant exchange.

The most common complication following breast augmentation is bleeding. However, the risk is extremely low, at approximately 4% risk, and typically occurs during the first 2 weeks after the procedure. Dr. MaDan will never leave the operating room if something is bleeding; however, non-compliance with restrictions, such as exercising or overexertion, can cause a blood vessel to open and start bleeding. Bleeding can be a life-threatening complication that should be managed emergently. Other less common risks are infection, fluid collection, implant malposition, capsular contracture, permanent sensory changes, BIA-ALCL, BIA-SCC, and breast implant illness.

Yes, any surgical incision will leave a scar. The inframammary fold scar is approximately 4 cm, or about 2 inches, in length. Initially, the scar may appear red but will fade and soften over time. Dr. MaDan will provide you with her medical-grade scar therapy regimen to help the scar fade and achieve the best possible appearance.

Yes, implants can break or rupture. Shell failure is the most common reason for implant rupture. This can occur if the implant folds upon itself and is subjected to repeated friction and shearing forces. This is most likely to occur with an underfilled saline implant. The repeated shearing forces of the shell folding on itself cause shell failure. Saline implant rupture is usually obvious. These implants are filled with IV fluid or saltwater that is absorbed by your body upon rupture and can create a noticeable volume difference called a deflation. 

The highly cohesive, fifth-generation “gummy bear” silicone implants may not show any outward signs or symptoms of implant rupture or shell failure. It’s called a silent rupture. Currently, MRIs are the gold standard for rupture surveillance of silicone implants. However, high-resolution ultrasound, like our Clarius L15, can be used in the office to evaluate your breast implants. Although the Clarius L15 is not the “gold standard,” it can be quite useful in obtaining information regarding your implant status before considering an MRI.

No. After surgery, your chest will feel tight. You may notice pressure from the implants with each breath you take. Swelling and muscle spasms will subside, and the pectoral muscles will relax and stretch, allowing the implants to soften and settle. Although your chest may feel tight and sore, you should be able to perform activities like brushing your teeth and washing your hair without causing surgical complications. It’s important to use your normal arm mobility as shoulder stiffness can occur.