This patient chose round saline implants, inserted through an axillary incision of armpit, to compliment her small frame.View Patient Details
Breast Augmentation (Breast Implants)
What is Breast Augmentation?
The Breast Augmentation, or Augmentation Mammoplasty procedure, enlarges your breast. This can be done with either silicone or saline implants, as well as using your own fat. The procedure can also change the shape of your breasts or make them more symmetrical. This outpatient procedure can be performed under either IV sedation or General Anesthesia. Most patients take one week off from work.
I've always felt that my breasts were not in proportion to my body
What concerns does a breast augmentation address?
Most women who undergo breast implant surgery in our Baltimore office fall into one of two groups. The largest group consists of women in their thirties with children. They have noticed a loss in skin tone and a decrease in the size of the breast (most noticeable in the upper and outer portion). The second group consists of women in their twenties who want larger breasts to balance the rest of their body. A breast augmentation addresses the following most common concerns:
- lack of upper pole fullness of the breasts
- lack of projection of the breasts
- not enough cleavage
- asymmetry of the breasts
- disproportionate balance of overall figure
- tubular (tuberous) breast shape
A breast augmentation in itself will generally NOT improve sagging or drooping breasts. To address sagging and drooping, you'll want to consider the breast augmentation procedure combined with a breast lift. The straight breast augmentation works best when the nipple is positioned above the inframammary fold line, also called IMF. This fold line is the the point where the bottom of the breast projects out from the chest wall. If your nipple sags below that point, you would likely need a breast lift with your implants. If implants are added to a breast with a nipple position below the IMF, there is a good chance that your nipples will point down. For this reason, do not discount the recommendation for a breast lift with your implants!
How is a breast augmentation performed?
I perform breast augmentations under IV anesthesia in our AAAASF accredited surgery center located right next to my office here in Baltimore, Maryland. I use IV sedation instead of General Anesthesia to make your recovery as quick as possible and to eliminate the pulmonary risks associated with General Anesthesia. For the utmost safety, your anesthesia is administered only by Board Certified Anesthesiologists. By using IV anesthesia instead of General Anesthesia, much, if not all, of the post op nausea is eliminated. The procedure takes up to two hours and you can go back to work in one week.
What are the pre-op requirements?
Patients undergoing breast augmentation have a lot of decisions to make and will need to undergo medical clearance two weeks prior to surgery. You will have a pre-operative appointment in the office to make the final decisions about size, surgical plan, and to discuss the informed consent forms.
We require patients to have an H&P (history and physical) as well as a CBC blood test. You should also stop smoking for at least four weeks prior to surgery and stop all aspirin products two weeks prior to surgery. On the evening before surgery, you'll be asked not to eat or drink anything after midnight.
What decisions will I need to make?
Most patients elect to have breast augmentation with breast implants, because it is the most affordable option. For those patients who go with implants, we discuss the following decisions during your initial breast augmentation consultation:
- saline or silicone
- implant volume (size of implants)
- round or oval (shape of implants)
- textured or smooth (surface of implants)
- under or over the muscle (placement of implants)
- location of incision site (placement of implants)
- moderate profile, high profile, extra high profile
- with or without a lift
Breast Implant Sizes and Styles
Women considering breast augmentation often focus on the size of the implant. Your breast size after surgery depends on two main factors: how big you were before surgery and the volume of the implant inserted.
The volumes of the breast implants are measured in CCs, (30cc = 1oz). You can get a rough idea of how big you might look after surgery by placing the desired volume of water in a freezer bag and then placing it in the lower part of your bra.
I have breast aug patients try on actual implants by placing them inside different bra sizes to try during your consult. You should bring two different types of tops (a blouse and a tank top) with you to your consultation. This will help you make your decision about the implant size.
The most popular type of breast implant in our practice is high profile (HP) silicone. We recently did an analysis of our last 125 cases to determine the most popular implant size is 400cc. Learn more about our findings in this case analysis blog post. While the selection of implant size and shape is always customized for each patient, average metrics are worth noting. The top 3 implants in our analysis were:
- 400 cc HP Silicone
- 350 cc HP Silicone
- 450 cc HP Silicone
The Difference Between Moderate Profile and High Profile Implants
High profile implants are usually selected if you want a lot of projection or if you are a small framed woman with a small chest wall. I wrote about this in further detail explaining the difference between moderate and high profile implants in this blog post.
If you are having breast augmentation, you should first consider the implant profile type before you select the size of the implant. See me talk about the two types of breast implant profiles and what body types each is most suitable for in the YouTube video here on the right.
The Difference Between Silicone and Saline Breast Implants
Silicone implants have a much more natural feel than saline implants. I've worked extensively with silicone implants and believe they are the best choice for many women. To understand the differences further, please see this blog post.
Are silicone implants safe? The short answer is yes, but I would like to share some of the history of the silicone implant controversy with you to comfort any concerns you may have:
Between 1992 and 2006, silicone breast implants were banned for use for cosmetic reasons while the FDA gathered information regarding their safety. The only patients who received silicone implants during the ban were reconstructive patients and patients with problems such as capsular contracture and breast asymmetry. These patients were required to enroll in a study where they were followed for 5 years post operatively.
All of the FDA studies led researchers to conclude that silicone breast implants did not cause any kind of disease. Studies showed that there was no greater incidence of any type of disease in women with silicone breast implants compared to the general female population and silicone implants were determined to be medically safe.
I am very experienced with silicone implants, I have been using them since 1988. Prior to the ban in 1992, I used silicone implants as the implant of choice for cosmetic patients because of their natural feel. Since 1992 I've had scores of patients involved in the FDA study. Read even more about the historical perspective on the silicone implant controversy.
The Difference Between Over or Under the Muscle
Each approach offers some benefits, however I generally recommend going under the muscle. Placing the implants under the muscle provides the most natural and long term result. Additionally, it is usually easier to obtain a mammogram.
Breast Incision Locations
During breast augmentation, there is an incision made to insert the actual implant. There are three main choices of incision locations: inframammary, infraareolar, and axillary. I rarely performs the TUBA as I prefer to work through the nipple, especially since most of our patients select silicone implants. For more information, please see my blog post on breast augmentation incision choices.
What is post-op recovery like after a breast augmentation?
Following your procedure, you should plan for the following:
- 1 week off from work
- no driving for 1 week
- wear bandeau or ace wrap for first week
- drains for 2 or 3 days, removal at first post op appointment
- pain pump removal at day 2-3, depending on pain tolerance
- some swelling for 4-6 weeks
- exercise: resume lower body activities at 10 days, upper body activities at 4-5 weeks
- post op appointments at: day 2, one week, one month, four month
Is there a way to reduce the pain after surgery?
Over 95% of my breast augmentation patients opt for the pain pump!
As our patient, you'll have the option of purchasing a pain pump which dramatically reduces your pain in the first 2-3 days following your surgery. You will be able to stand up straighter sooner, and it will shorten the number of days in recovery. The pain pump delivers local numbing medication to dull the pain. It does not contain narcotics, so the prescription pain pills can be taken at the same time and work to complement the pain pump in your recovery. They work in different ways and it is not too much to do a pain pump and pain pills together.
The pain pump is inserted at the end of the procedure, while you are still on the operating room table. I've written more about why pain pumps help in breast augmentation and urge our patients to strongly consider the option. Over 95% of my breast augmentation patients opt for the pain pump.
What types of complications can occur with breast augmentation?
Breast implants have been used for over 40 years. Most women have no problems. However, your Plastic Surgeon should review the list of possible complications during your consultation. Possible complications following Breast Augmentation surgery include:
- capsular contracture
- deflation of the implant
- seroma (fluid accumulation)
- implant wrinkling
- implant leakage/rupture
The most common complication that we see after surgery is capsular contracture. This is tightening of the capsule that surrounds the implant. The area often responds to massage, but may need surgery to eliminate the capsule. The average incidence of capsular contracture in breast augmentation among all plastic surgeons ranges from 10-15%.
I recently reviewed my last 200 breast augmentation cases to calculate that my capsular contracture rate is 5%, which is well below the average! While deflation of the implant is less likely than capsular contracture, should it occur the deflated implant would need to be removed and replaced. Both Mentor and Allergan, the US implant manufacturers, do offer warranty programs.
How Much Does Breast Augmentation Cost?
The TOTAL cost for breast implant surgery depends on the implants you select. Silicone implants are more expensive than saline implants. We are currently running a special discount promotion here in our AAAASF accredited surgery center through the end of August, 2015.
Total breast augmentation costs noted below include:
- Surgeon Fee
- Operating Room / Recovery Room Fee
- Anesthesia Fee (Board Certified Anesthesiogist)
- Implants (saline or silicone, all profiles)
- All follow up office visits
Total Cost for Silicone Implant Augmentation is $5900
Total Cost for Saline Implant Augmentation is $5000
A pain pump, which is highly recommended, can be added for $250.
These prices are good for surgeries performed by August 31, 2015.
We believe that these are the best implant prices in the Baltimore area! To understand how great our prices are, please see our survey of local Plastic Surgeons to find out the average cost for implants in Baltimore. Similarly, if you do any comparison shopping, be sure to get quotes for total cost which should include the surgeon's fee, operating room and recovery room fee, the silicone or saline implants, Board Certified anesthesiologist fee, and all follow-up office visit fees. You should also receive a quote for both with and without a pain pump.
Can I finance my Breast Augmentation surgery?
Yes, we work with a number of finance companies so that you can have a low, affordable, monthly payment. Please call the office at 410-494-8100 or see our financing section for more information.
Use Our Before and After Gallery to Help Pick Implant Size
Take a look at our before and after breast augmentation photo gallery to see pictures of actual patients who have undergone breast augmentation. Examining the pictures will help you consider what size and shape might be right for you. Please note that all of the patients featured there have given their written consent to have their photos displayed on our site. We are very grateful for their willingness to participate in patient education!
Having your Breast Augmentation in Baltimore
Updated August 2, 2015
Ricardo L Rodriguez
Board Certified Plastic Surgery