Breast Augmentation Newport Beach
Breast augmentation is one of the procedures by which plastic surgeon skills are measured. Globally, breast implants have become a beauty phenomenon since their introduction in the 1960′s. In the media, we see examples of breast enhancements gone great or plastic surgery gone bad, depending on the result. Increasingly younger women are seeking breast augmentation, and we now have an array of great implant options from which to choose, along with better consultation tools that we utilize in educating and serving our patients. Instagram pages have sprouted up just focusing on breast implants (check out Dr. Sayed’s Instagram page: @timsayedmd), and augmentation that enhances female form has had life-changing effects for millions of women around the world. Having practiced in high volume and demanding environments like Miami and Palm Beach, Dr. Sayed is proud to bring his extensive experience to Southern California, where the media’s fascination with feminine aesthetics and the year-round environment of sunshine combine to create a demanding clientele. From Palm Beach to South Beach to Newport Beach to Pacific Beach, Dr. Sayed sees patients wanting a variety of breast augmentation options:
- Silicone and Saline implants
- Anatomic and round implants
- Under- or over-the-muscle approaches (we’ll educate you on why we prefer certain techniques)
- Revision of prior breast augmentation
- Correction of capsular contracture or symmastia (the two breasts lacking adequate separation)
- Combination with breast lifts, especially after childbearing or breastfeeding
- Resizing of implants
- Replacement of failed/ruptured/leaked old implants
- Natural vs. Highly augmented (artificial) look
- Infamammary vs. periareolar vs. transaxillary approach (and we can even discuss trans-umbilical breast augmentation and why Dr. Sayed steers away from it)
Patients today have more options than ever for cosmetic breast enhancement with implants. Dr. Sayed can simulate a variety of results using Crisalix® software to help get you excited for surgery!
Breast Aug 101
The most common technique for breast augmentation is the “dual plane” technique, where the implant is partially covered by muscle and partially by the breast tissue. This allows a more natural contouring, but is also appropriate for more augmented looks, depending on implant style.
This side view gives you an idea of the seating of a breast implant that is covered by muscle in its upper half to 2/3 and covered by breast tissue below. This may create a nice lilt or bounce to the breast depending on the size of the implant and the amount of breast tissue sitting in front of the lower portion. In the subglandular technique, the entire implant sits in front of the muscle – this technique is reserved for patients with certain anatomy and/or prior implants. There is some evidence that capsular contracture rates may be lower in patients who have at least some muscle in front of a portion of the implant.
The most commonly used incisions include the inframammary (breast fold) incision, which allows rapid access to creating the implant pocket and may minimize exposure of the implant to biofilms. The periareolar incision around the lower semicircle of the nipple-areola complex is also commonly used and produces a nice scar that is well hidden along the border. The circumareolar approach is a modification of the periareolar incision which is used when performing the perilift (Benelli lift) in selected patients who need only a small amount of lifting to the nipple.
(Not shown is the transaxillary approach.)
Breast Augmentation FAQ’s
1. How do I know if I am a candidate for breast augmentation surgery?
Some of our selection criteria to include you as a breast augmentation candidate include:
- Small breasts, bust size smaller than desired, tuberous breast deformity or other conditions that can be improved with implant placement
- Minimal to no droopiness to the breast (don’t worry, if you have droopiness, breast augmentation can be combined with a breast lift for correction)
- General good health, meaning you do not have major uncorrected cardiovascular, respiratory, kidney or other major organ conditions
- Age 18 or older for saline implants, 22 or older for silicone (FDA recommendations)
- No masses on breast examination – if you have a significant family history of breast cancer or are over 30 we will request a preoperative mammogram if you have not had one within a year
- Nonsmoker or willing to commit to NO NICOTINE IN ANY FORM for at least 3 weeks preop and for the duration of your recovery
- Available support system of friends, family, caregivers or others who can help you to keep your appointments, complete your preop and postop tasks, and emotionally bolster you through this exciting journey
- Reasonable expectations of how much breast enhancement is possible with specific techniques
2. How long does breast augmentation surgery usually take?
Most breast augmentation procedures are about an hour in duration, depending on the incision approach, type of implants, and other factors. If you are having breast augmentation combined with a lift, the operation may take 2 to 3 hours. Other combinations are also possible, like breast augmentation combined with breast lifting and a tummy tuck (also known as a “mommy makeover,” or breast augmentation and liposuction).
3. What is recovery from breast augmentation surgery like?
Most breast augmentations are performed on an outpatient basis in a AAAASF-certified operating room, meaning the facility is up to very high standards of accreditation. Patients usually spend up to a couple hours in the postoperative suite before being discharged in the care of a companion, family member or friend. Dr. Sayed gives a 24 hour phone number to all patients who can reach him for urgent questions, and we also issue access to a patient engagement application that allows the patient or companion/caregiver to send SMS messages, photos, video and other content to our team in a secure, private digital format. This keeps us mutually informed on your recovery and allows us to update your instructions while requiring a respectful number of face-to-face visits in the office.
Early postop recovery findings can include bruising and swelling, mild discomfort, the implants riding in a slightly high position, numbness or diminished sensation in nipples, and some mental adjustment to the process of healing which most patients undergo. Most patients are advised to take a few days out of social circulation and we’d prefer that you not drive yourself in the first 10 days or as long as you are taking any prescription pain medication. Most sutures are dissolvable but there may be a few that need to be removed at around 14 days postop.
We ask that you abstain from exercise for 2 weeks and then return to light fitness routines after that. You will be asked to wear a surgical bra and avoid underwires for a few weeks, and it will be easiest for you if you wear tops that button down in the front in the first 10 days or so. Dr. Sayed and his team provide close postop care in the office and with our remote engagement tools. You will be asked to take some supplement medications to aid in your recovery, which may include medications for pain, bruising, swelling, and dietary optimization.
4. How long do breast augmentation results usually last?
There seems to be a lot of confusion out there about breast implants and how long they “last.” There is a common misconception that patients need to have implants changed out every 10-15 years. The reality is that breast implants are man-made devices and although they are safe, well tested and regulated by the FDA, they are subject to some wear and tear over years. There is a small risk of implant failure/leakage – if your implants are saline, the device will deflate and likely be noticeable; if the implants are silicone, you might not be aware of any changes in the device as the new generation of cohesive gel implants are made of a next-generation silicone that has better integrity. For this reason, the FDA recommends screening MRI’s every few years in patients who undergo silicone implant breast augmentation, although the choice to comply with this is the patient’s. The implant companies offer warranty programs that protect your investment in certain circumstances.
Many women have breast implants placed in their early 20′s and some go on to have children, breastfeed, gain or lose weight, or have other changes that impact breast shape and size, so redoing breast augmentation after such events may make sense. Many women also have changes to their breast that accompany menopause. It should be emphasized that many women who undergo breast augmentation never choose to have their implants removed or replaced or their breasts otherwise modified – “if it ain’t broke, don’t fix it.”
5. How can I prepare for my breast augmentation surgery?
- Have a reasonable expectation of what surgery can accomplish
- Look at before and after photos and understand what kinds of techniques you are interested in
- Bring in photos of ideal results that can help inform us of your goals
- Don’t smoke or take nicotine in any form for at least 3 weeks and ideally longer before (and after) surgery
- Stay well rested and well hydrated and eat a nutritious diet balanced with plenty of protein
- If your diet is lacking in vitamins, take vitamin C and zinc supplementation but ask Dr. Sayed about other supplements. We have a list of ingredients we ask you to avoid in the immediate preop phase to optimize healing and minimize bleeding risk.
- Designate a caretaker who can help you through the first 5 to 7 days after your breast augmentation.
- Identify whether any female relatives in your immediate family have any history of breast cancer
6. How much does a breast augmentation cost in Southern California or South Florida/Miami?
We don’t like to publish pricing as it is subject to market changes and dependent on the types of procedures you consider. We do have a fee schedule available in the office after your consultation, and we can give you an estimate through virtual consultation tools available on this site like our Zwivel® page. Feel free to contact us for a pre-consultation and we are happy to provide more information. The cost of your surgery will partly depend on where you have it, the brand and style of implants, and whether you are combining breast augmentation with a breast lift or other procedures.
7. How do I select between saline, silicone, or Ideal implants?
Saline and silicone implants, along with the newer Ideal Implant (a type of saline implant designed to feel like a silicone device), are all FDA-approved breast implants in the US. Patients have a variety of choices when deciding on implant size, style, manufacturer, profile, etc. Here is a simple list of pros and cons of various implant choices:
- Saline implants are introduced deflated and filled with sterile salt water in the operating room. For this reason, they can often be placed through slightly shorter incisions, though it really depends on the pocket size and the ability of the surgeon to safely create the pocket through the planned incision approach.
- Saline implants may feel slightly firmer to the touch when the breast is handled; this is because the water in the bag is less compressible than silicone and the shell can feel stiffer when the water is compressed, like a water balloon. Some patients want this firmer, stiffer look and feel, whereas others think this is less natural.
- Saline implants can leak and if they do, the fluid will typically come out of the device and it will deflate, requiring replacement.
- Some surgeons believe saline implants are more likely to ripple, causing unusual waviness to the breast.
- Leaking saline fluid is harmless in the absence of infection, so some patients prefer this for piece of mind.
- Any patient who is a candidate for breast augmentation can have saline implants without age restriction.
- Saline implants generally cost a little less than silicone implants.
- Sometimes patients can detect sloshing of fluid in the implants, which may be annoying.
- Silicone implants generally are preferred by most plastic surgeons because they tend to feel more like natural breasts. There is a “give” when a silicone implant is squeezed, which can make the implant harder to detect inside the breast.
- Silicone implants are now manufactured with a next generation silicone gel that is more cohesive, which means the implants are unlikely to spill out silicone if the shell loses its integrity. This is one of the main issues that originally led to problems with the older generation silicone implants. The newer generation are often referred to as “gummy bear” implants because the consistency of the gel is more uniform and less likely to liquefy.
- A leaking silicone implant may not result in symptoms, as the gel stays together better and usually remains inside the capsule of the implant. In uncommon cases, silicone can leak out and cause a local reaction of painful hardening or swelling.
- If a silicone implant is shown to be leaking on mammogram or MRI, plastic surgeons usually recommend replacing it to reduce the risk of inflammatory reactions, and also for patient piece of mind.
- The FDA recommends an MRI after silicone breast augmentation every few years after surgery as a matter of surveillance in order to continue to gather long-term data, and also because the rare implant that leaks may not show symptoms.
- The FDA recommends that only patients 22 and older have silicone implants.
- Silicone implants cost more to manufacture and test so they cost more to put in.
- Sometimes the incision needs to be larger, especially if very big implants are being put in, since the silicone is already pre-filled in the implant.
- The Ideal Implant is a brand name of a new, FDA-approved saline implant that is designed with internal chambers to “slosh” around less, giving more of a silicone feel to the device.
- These implants are very new and are not yet mass marketed and mass produced, which means they cost more.
- Long-term data is not yet available on leak rates but early data is very encouraging, and these implants share the benefit of saline implants in terms of just containing salt water in the event of a leak.
- The procedure may take a little longer because the device has to be filled a little differently from the regular saline implants.
- Not many surgeons have much experience with this type of implant yet, but more and more are starting to use them.
- Incision size can be around the same size as regular saline implants.
8. How do we select the right size implants?
As for implant style and size, often the widest implant that fits the patient’s base diameter and is within the volume range the patient seeks would be best; if a patient selects an unnecessarily narrow or excessively high profile implant, she may end up with wide cleavage or implants that can move too much in the pocket. However, it also depends on the type of projection being sought. In general, implant volume is determined by a combination of estimating the patient’s own breast volume and the target cup sizes, and determining a range of added cc’s of volume that would be expected to achieve the goal. Implants come in a variety of “profiles,” which is a term that describes how much of the volume is used to create width vs. forward projection of the breast. Moderate profile implants are wider and flatter, while high and ultra high profile implants are narrower and taller, and “moderate plus” implants are somewhere in between. A patient with a very narrow chest wall and little native breast tissue is often a good candidate for a high profile implant, whereas patients with a lot of native breast tissue and a wide chest may do better with a moderate or moderate plus implants style.
During consultation, Dr. Sayed will take breast measurements including the chest wall, and will look at whether you need a lift, areola reduction, or other approaches, as these can also impact the implant size that will give you the best result.
There is no “cookie-cutter” approach to sizing for breast implants to achieve a “natural” look, or even a “done” look. Because breasts have significant variability, depending on native breast volume, shape, nipple position, descent (or “sag”), and symmetry issues, what one patient considers natural may differ from another patient’s perception. It is therefore very important to try to explain your cosmetic goals to your plastic surgeon during your consultation.
Pictures of models illustrating your ideal breast appearance can be helpful, but be careful not to assume that there is any guarantee of getting the exact same look. Many patients who end up with an “unnatural” look do so because of poor communication regarding their goals preoperatively; but there are also intraoperative and some postoperative factors that can contribute to the appearance. The dissection of the implant pocket by the surgeon is the most “controllable” factor in determining the final appearance. Using overly large implants for the patient’s chest wall measurements can contribute to an unnatural outcome. In addition, the placement of implants over the muscle may make them more visible and detectable, particularly in patients with relatively small preoperative breast volume. The surgeon must take care to make a well-designed pocket for the implant – not too spacious, and not too tight – and this step is often aided by careful preoperative marking and review of photographs.
Because of these variables, we use surgical simulation software (Crisalix) in the office to simulate the effects of different styles, sizes, manufacturers, and even positions of the implants, which helps take a lot of guesswork out. This is typically combined with the use of a sizing kit designed by the implant manufacturer. The kit has a variety of inserts that the patient can put into her bra or into a tight fitting top to simulate the effect of augmentation with various-sized implants. When combined with simulation software, this helps us agree on implant size, style, manufacturer, and other variables. We rarely have to revise our own breast augmentation patients for size as a result of this careful planning. However, we are often called on to perform revision breast augmentation on patients who had surgery elsewhere.
9. I have asymmetric breasts: what is the best approach to improve symmetry?
Most patients have some breast asymmetry. The human body is not perfectly symmetric, although we aim to make the breasts as symmetric as possible when we perform plastic surgery. This starts with assessing whether you have had prior breast surgery, and examining for prior scars, the nipple position, location of the greatest fullness in the breast, positioning of the folds below the breasts, and any other factors that may be contributing to the asymmetry. If you have prior breast implants, it will help to provide operative notes and records to help Dr. Sayed know what size and style implants you previously had. This is important information to help guide planning.
If your breasts are naturally asymmetric, Dr. Sayed will assess whether this is due to one side being significantly larger than the other, hanging lower than the other, and other factors. Some patients need one breast to be reduced in size during the surgery. Some require lifting of one or both breasts, sometimes using identical breast lift techniques and sometimes using different lift methods. If you are undergoing breast augmentation and you are asymmetric, Dr. Sayed may reduce the larger breast in surgery in order to place the same style and size implants in both breasts. Alternatively, sometimes the right answer is to use different implants on the two sides. It is a very personalized approach in every patient.
10. I want to redo my breast implants: how do we get the best result?
First, try to get old medical records on your previous breast augmentation. What size, style, company, silicone vs. saline, scar location, etc. This is all helpful information to aid us in planning. If your implants have dropped significantly (hanging lower than they used to), a lift may be in order. The same is true if your implants are riding high vs. your natural breast tissue. Surgical simulation software is very helpful here as it allows us to estimate the proper volume of a new implant by “subtracting” the old implant volume from the 3D breast model. A certain amount of surgical judgment is necessary in the operating room to make the final decision on implant size and style in many patients with prior breast implants.
11. How long do implants last?
Saline and silicone implants are placed with the goal that they not need to be replaced, but since they are manmade devices, a certain degree of wear and tear and failure is not uncommon. On average, 10-15 years seems to be a timeframe where many women who have implants are having them replaced, either because they have developed leakage, capsular contracture, asymmetry or another issue, or have breastfed/had pregnancies which change the shape of the breasts, or just plain develop sagging with time and gravity. Basically, if something changes in the breast that is concerning or not to the patient’s satisfaction, there may be a reason to exchange the implants (either with new saline or new silicone implants, depending on patient choice and situation). Otherwise, if it “ain’t broke, we don’t fix it.” It is important to know that Mentor, Allergan and Sientra all offer breast implant warranties to cover many common scenarios in the event you need to replace breast implants.
12. I am petite but want a natural breast result. Is a teardrop anatomic breast implant or smooth round implant best for me?
The short answer is it depends on how big you want to be. Petite patients with A cup breasts often have very little upper or lower pole breast tissue to provide coverage. In that case, it is possible an anatomic implant may give a more natural result, but there are some risks with these devices owing to their textured surface and the possibility of rotation (low risk). If you want to go very big, and you have enough tissue coverage, a round implant will likely give you a little more of a “done” look. Silicone is likely to give a more natural result than saline in a petite patient in Dr. Sayed’s experience.
13. How soon after breast surgery can I start scar treatment?
This depends on the operation and surgeon preference. In our patients, Dr. Sayed insists that all incisions be fully closed and not at risk for separation with skin pressure/tension before starting scar therapy, i.e., the incision has to mature from a wound to a scar first, before we try to treat the scar. Newer technology like the Embrace system from Neodyne Biosciences may be useful to minimize tension on the healing wound early, but the cost of this system will add to the cost of surgery in most cases.
For our patients, we usually start with Steri Strips for the first 2-3 weeks, followed by Vaseline ointment for a month or so until the scar is not dry or scaly and is well healed to closure. Then we start Vitamin E and silicone gel for most patients and they are free to use these for 6-12 months if they so choose. Strict avoidance of sun exposure is mandatory for the first 2 months on the scar and sunscreen should be liberally used. Fraxel or other resurfacing laser can be used later on if the patient is interested in further blending the scar, for an added fee.
14. What exactly is a “gummy bear” implant?
Even surgeons are not fully aligned with what defines a “gummy bear” implant.
When silicone implants were brought back on the market in the US after the new generation of technology was FDA approved, the term “gummy bear” implant started to gain in popularity. Some surgeons strictly use this term to refer to the highly cohesive, form-stable shaped textured silicone implants (teardrop shape, textured shell), while others use the term to describe all of the newer generation silicone devices that use a cohesive gel which does not leak out like a jelly donut if the implant leaks. All of the currently available silicone gel implants have silicone that is reasonably cohesive, meaning it is more like a jelly candy or gummy bear in consistency. If you cut a silicone implant in half, it should not spill out but instead look like two halves of a silicone implant. Dr. Sayed prefers not to use the our patients on the pros and cons of silicone vs. saline, smooth vs. textured, round vs. anatomic shaped implants and be clear about all of the factors that can vary among implants. This is coupled with using our surgical simulation software, Crisalix, for showing patients potential results with different model implants.
15. How long does it take for implants to settle?
This is a common concern after breast augmentation. Surgeons are somewhat divided on beliefs when it comes to implants settling. Implants placed under muscle in a subpectoral or dual plane approach appear to take longer to drop fully into the pocket for shaping, probably due to some spasm and compression by the muscle, when compared to subglandular implants. Subglandular are not commonly done anymore due to risk of capsular contracture.
Implants should either look centered behind the nipple or very slightly high in the beginning to account for the dropping that occurs with tissue relaxation. If the implants are very visibly above the level of the natural breast tissue, that could mean a couple of different things:
1. The patient needed a breast lift which was not performed, so now the breast tissue sits below the point of greatest projection of the implant – this may not correct even with settling of the implant without performing the lift.
2. The implant pocket was made too high – it is possible this might come down with time and massage (probably time is the key ingredient as massage has not yet been proven to truly make a difference), but if not, corrective surgery may be required.
Dr. Sayed also finds that many patients think their implants look higher than they really do, probably because the patient’s main vantage points is looking downward at the chest cleavage area, rather than forward toward the chest the way another observer would see them. Checking with the surgeon regarding progress on a regular basis is key to managing patient expectations.
16. How do I know if a silicone implant ruptures?
The new generation of form-stable silicone gel implants (often called “gummy bear” implants) have a new technology that limits the ability of the silicone to leak out of the shell, when compared to old fashioned Dow Corning, PIP and other silicone implants no longer on the market in the US.
Because of this, it can be hard to detect leakage in the occasional case where it occurs. Unlike a saline implant, which would be expected to deflate if it leaks in the same manner a water balloon would deflate when you poke a hole in it, a silicone implant can maintain its shape well even if the shell has lost integrity.
The FDA recommends MRI be performed at 3 years and every couple of years after that for patients with silicone implants in order to monitor the implants. However, this is not enforced on either the surgeons nor the patients, so it ultimately is at patient discretion whether to do it. A leaking silicone implant may cause no symptoms or in some cases may cause hardening, capsular contracture, and/or pain. The MRI is the way to monitor against “silent” leaks.
The implant companies – Mentor, Allergan and Sientra – all have valuable information including the results of studies on leak rates available on their websites.
17. I have tuberous breast deformity. Will breast augmentation improve my shape enough?
Correction of the tuberous breast is very challenging. The tuberous breast is characterized by a few typical findings:
- A bulgy areola/nipple that sticks out prominently – some have linked it to the appearance of cartoon character Snoopy’s nose – and is usually wide in diameter
- A tight fold under the breast with little tissue under the skin between the nipple and the fold
- Sagging of the native breast tissue with upper pole deflation
Correcting these issues often requires an aggressive release of the inframammary fold which is usually very constricted. This is a maneuver we would not normally do in a straightforward breast augmentation but is common for the tuberous breast in order to allow accommodation of the implant and proper positioning of the nipple. If the old crease persists, it may benefit from fat grafting or may require further surgical release internally. In some cases, patients with severely constricted breasts in the lower portion may need surgery done in two stages:
- Stage 1: Release the breast tissue internally and place a tissue expander to stretch the muscle and skin for better shaping. The tissue expander is then filled with saline (some newer devices use carbon dioxide to avoid having to inject with needles) over time until it is fully stretched out. The nipple and areola may be lifted and reduced in this stage.
- Stage 2: Remove the expander and replace it with a permanent implant.
Treatment is individualized based on the patient’s unique findings in all cases.
18. How do I know if I need a breast lift or if implants alone will give me a good result?
Many plastic surgeons will offer breast augmentation alone to poorly selected patients who actually need lifts. This can result in either the nipples looking low/pointing down, the implants looking high, the shape being oblong instead of rounded, or the whole breast being larger but sagging below the fold. Which one(s) of these findings occur depend on:
1. The preoperative position of the nipples
2. The preoperative position of the breast tissue bulk
3. The size of implants being selected
4. The skin laxity
5. The size of the areolae
Dr. Sayed takes all of this into account and uses measurements and Crisalix software to then simulate the effects of implants alone vs. implants with lifts. If the nipple is below the fold, a lift is generally indicated, especially if the nipple points downward when the patient is standing. If the breast is very flat up top and the breast bulk hangs below the fold, a lift will usually provide a much perkier result. The key to selecting the right procedure is close communication and visual education that Dr. Sayed provides during the consultation experience. This is even more important for out of town patients as video consultations can help us avoid last minute surprises that can result in additional time in surgery, additional scars, or patient expectations that don’t match the technique. Dr. Sayed has a great system for advising patients on the need for breast lift when it is indicated.
19. Is there a link between breast implant and “breast implant illness?”
The term “breast implant illness” is not a medical term nor one devised by plastic surgeons. It probably refers to the unsubstantiated link that was made between the old generation of (Dow Corning, primarily) silicone implants in the 1980′s/early 1990′s and a variety of ill-defined diseases like fibromyalgia, lupus, and other conditions. The vocal contingent of patients who “swore” their symptoms were from their implants managed to get silicone implants off the market in the US for about 17 years. Meanwhile, in the rest of the world, there was no epidemic of lupus or fibromyalgia among breast implant patients in countries where this operation is done in high volumes. The FDA required very stringent data on silicone implants with the new cohesive gel technologies for many years before concluding the new implants are safe for use and approving them. One might say these are the most highly studied medical devices in history.
Surgeons almost universally welcomed the return of silicone implants to the US market as our results with saline, while good, were occasionally lacking in some features and there were limitations to the shape and feel in many patients. Accordingly, many surgeons now do fewer saline augmentations and there are new devices like the Ideal Implant trying to capture the best of both worlds – feel of silicone, leakage content of saline. If a saline implant leaks, the implant will typically deflate like a water balloon, whereas a silicone implant with leakage is unlikely to cause symptoms. The new gel stays together more like a gummy candy than a jelly donut so the contents are better contained even if the shell develops a breach.
Having said all this, if a patient were to express a strong concern about constitutional/musculoskeletal symptoms or “breast implant disease” during consultation with the plastic surgeon, we may be inclined to recommend saline devices which may provide more piece of mind to the concerned patient. Patients in this category may indeed be best served by the Ideal Implant device, and be willing to pay the premium for this new technology.