Breast Augmentation – San Diego
Breast augmentation is an immensely popular procedure in the San Diego area and all over the world and is one of the procedures by which a plastic surgeon’s skills are measured. Since their introduction in the 1960′s, breast implants have become a global beauty phenomenon. In the decades since, the media has bombarded us with images of breast enhancement results—both good and bad. Today, younger and younger women are seeking breast augmentation, and there is a wider array of great implant options to choose from; we also have superior consultation tools that we can utilize for educating and serving our patients. Most recently, Instagram pages have sprouted up that are dedicated entirely to breast implants (check out Dr. Sayed’s Instagram page: @timsayedmd). The digital age is now documenting not just how this popular treatment has evolved, but how it enhances the female form and changed the lives of millions of women around the world. With new medical and media technology came a new kind of patient: one that was exacting, collaborative, and knowledgeable about their transformation with breast enhancement.
View real patient before & after results in our photo gallery.
Having practiced in high volume and demanding environments like Miami and Palm Beach, Dr. Sayed is proud to bring his extensive breast augmentation experience to the Southern California, San Diego area, where the media’s fascination with feminine aesthetics and the year-round environment of sunshine combine to create a discerning, demanding clientele. Dr. Sayed now sees patients from all over the San Diego county area wanting a variety of options: Having practiced in high volume and demanding environments like Miami and Palm Beach, Dr. Sayed is proud to bring his extensive experience to the Southern California, San Diego area, where the media’s fascination with feminine aesthetics and the year-round environment of sunshine combine to create a discerning, demanding clientele. Dr. Sayed now sees patients from all over the San Diego county area wanting a variety of breast augmentation options:
- Silicone and Saline implants
- Anatomic and round implants
- The revolutionary breast implant device, the Ideal Implant
- Under or over-the-muscle approaches (we’ll educate you on why we prefer certain techniques)
- Revision of prior cosmetic breast surgery
- 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)
San Diego patients today have more options than ever for cosmetic breast enhancement with implants including the ability to take the guesswork out of the process; Dr. Sayed can simulate a variety of results using Crisalix® software to help get you excited for surgery!
Contact us today!
If you’re in the San Diego or Newport Beach areas and have any questions or wish to schedule a consultation on breast augmentation with Dr. Sayed, please contact our office.
Breast Augmentation 101
The most common technique for breast enhancement surgery is the “dual plane” method, where the implant is partially covered by muscle and partially by the breast tissue. This allows for a more natural contouring of the breast, but is also appropriate for more augmented looks; of course, this depends on the implant style.
This side view gives you an idea of how the breast implant will be seated: with the upper ½-1/3 covered by muscle and the rest covered by breast tissue. This may give the breast a nice lift or bounce 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. Keep in mind that there is some evidence that rates of capsular contracture, a complication that results in the formation of hard tissue around the implant, may be lower in patients who have at least some muscle in front of a portion of the implant.
One of the most commonly used incisions in breast augmentation is the inframammary (breast fold) incision, which allows rapid access to creating the implant pocket and may minimize the implant’s exposure to biofilms. This doesn’t just allow the surgeon greater control during the surgery—it also lowers the risk of complications like capsular contracture or infection.
The periareolar incision is also commonly used; it’s made around the lower semicircle of the nipple-areola complex and produces a nice scar that is well hidden along the border of the areola. The circumareolar approach is a modification of the periareolar incision which is used when performing the perilift (Benelli lift) in select patients who need only a small amount of lifting to the nipple.
We liberally use the Keller funnel implant placement technique during surgery to reduce the risk of capsular contracture. To further reduce the risk of other complications, we employ antibiotic irrigation and a “no-touch” technique on the skin when handling implants. (Not shown is the transaxillary approach.)
How Your Breast Augmentation is Planned
Your breast augmentation journey starts with a detailed questionnaire that determines your ultimate goals for the procedure. Once the questionnaire has been completed, we use a potent combination of imaging technology (like Cristalix 3D simulations and EMA Plastic Surgery photographs) and sizers to help you narrow down your choices for different breast implants. Of course, natural, balanced results also come from Dr. Sayed’s focus on details, precision, and mastery of the human anatomy. Each procedure will be intricately planned and personalized towards your unique anatomy. By respecting your unique characteristics and tissues, Dr. Sayed’s creates results that are natural and long-lasting. To achieve breathtaking results, Dr. Sayed considers a number of factors to tailor your breast augmentation:
- Breast volume
- Breast volume
- Type of body frame
- The movement of the natural breasts and whether they significantly splay when lying on your back
- Asymmetry – this can be vastly improved by breast augmentation but might not be fully corrected
- The position of the nipple with respect to the breast fold and the breast mound
- The tightness of your chest muscles Whether you have adequate natural breast tissue to cover the implants
- Breast thickness
- The patient’s fashion preferences
- How reasonable your expectations are
- …and much more
Choosing Your Breast Implants
Breast Augmentation FAQ’s
Some of our selection criteria to include you as a candidate include: 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, 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 pre-op 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 pre-op and postop tasks, and emotionally bolster you through this exciting journey
- Reasonable expectations of how much breast enhancement is possible with specific techniques
Most implant placement procedures are about an hour to an hour and a half in duration, depending on the incision approach, type of implants, and other factors. If you are having augmentation combined with a lift, the operation may take 2 to 3 hours. Other combinations are also possible, such as implants, lifts, liposuction, and a tummy tuck (also known as a “mommy makeover“).
Most breast augmentations are performed on an outpatient basis in an AAAASF-certified operating room, meaning the facility operates on hospital or higher levels of safety. 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 provide a patient engagement “app” 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 informed on your recovery and allows us to update your instructions while requiring a respectful number of face-to-face visits in the office.
The early postop recovery might result in 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 after your breast augmentation 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. This post-operative bra will be sized and measured for your unique figure so that the bra can enhance the shape of the healing breast tissue and minimize the occurrence of muscle spasms.
San Diego based 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 diet optimization.
There seems to be a lot of confusion out there about breast augmentation and how long implants “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 procedures, although it’s up to the patient to comply with this guidance. The implant companies offer warranty programs that protect your investment in certain circumstances.
Since many women have breast implants placed in their early 20′s and some go on to have children, breastfeed, gain or lose weight, or undergo other changes that impact breast shape and size, it makes sense that some women choose to undergo a revision. Menopause can also change the shape of the breasts. It should be emphasized that there are much more women who undergo breast augmentation that never choose to have their implants removed, replaced, or have their breasts otherwise modified. As the saying goes– “if it ain’t broke, don’t fix it.”
- Have a reasonable expectation of what breast augmentation 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
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 deflated when they’re inserted into the breasts; then, they’re filled with a sterile salt water filling. Because they’re deflated, 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 much 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 implant 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 peace 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 are generally 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 of silicone implants. The newer generation is 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 give the patient peace of mind.
- The FDA recommends an MRI every few years after silicone placement in order to continue to gather long-term data and because the rare implant 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 the brand name of a new, FDA-approved saline implant that is designed with internal chambers ensure the filling doesn’t “slosh” around. This gives 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 that they contain saline in the case 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.
Round implants are, well, round, while anatomic implants are tapered at the top and rounder on the bottom. Also known as “teardrop” implants, anatomic implants are considered to give a more natural, subtle look than round implants. One negative is that if an anatomic implant rotates, it can change the shape of the breast.
A “gummy bear” implant is simply a silicone implant filled with a highly cohesive gel. That means that if the implant was cut or ruptured, the filling will stick together rather than leak. Some surgeons feel that gummy bear implants give more natural results than other implants.
In general, implant volume is determined by a combination of estimating the patient’s own breast volume, choosing target cup sizes, and determining a range of additional ccs 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.
When it comes to choosing an implant style and size for your breast augmentation, the best implant is usually one that fits in the breasts’ base diameter and is in the patient’s desired volume range. If a patient selects an unnecessarily narrow or excessively high profile implant (meaning, it sticks out prominently), she may end up with wide cleavage or implants that move too much in the pocket. However, the patient’s preferred degree of the profile should also be considered.
During your consultation for Dr. Sayed will take breast measurements of the chest wall and other features; he’ll then look at whether you need a lift, an 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 that depends 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 with your breast augmentation. Many patients who end up with an “unnatural” look do so because of poor communication regarding their goals. But there are also intraoperative and some postoperative factors that can contribute your 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 breast volume before their procedure. 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 visualize 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 results for size as a result of this careful planning. However, we are often called on to perform a revision on patients who had their procedure elsewhere.
Most breast augmentation 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 their procedure. Some require lifting 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 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. Treatment is a very personalized approach to every patient.
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 your revision surgery. If your implants have dropped significantly (hanging lower than they used to) after your breast augmentation, a lift may be in order. The same is true if your implants are riding high relative to your natural breast tissue. Surgical simulation software is very helpful for revision 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.
Saline and silicone implants are placed with the goal that they not need to be replaced, but since they are man-made 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 that change the shape of the breasts, or just plain developed 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 with breast augmentation revision.
As we’ve mentioned before, we recommend that patients wait for 2 weeks after their procedure before doing any kind of strenuous activity like exercise. After that, it’s best to stick to a light fitness routine for a little while. We ask that you also don’t lift anything heavier than a milk jug for about a month after your breast augmentation.
As for work, we recommend that patients wait at least a week before returning to their job, but if their work is more physical than an office job we ask that you wait even longer. It will really all depend on how you’re healing; if you’re unsure, you can contact Dr. Sayed or you can err on the side of taking it easy.
You should begin to see your final results as your breasts start to heal and settle; what happens is that as your breasts heal, the implant “drops” into the pocket created by your surgeon during the surgery. On average, this happens over 6-9 months.
In their most basic form, here are the steps in breast enhancement surgery:
- Anesthetic is administered
- An incision is made in the chosen area
- A pocket in the breast is created
- The implant is inserted through the incision and placed
- The incisions and the pocket are closed
Because breast augmentation is subject to market changes and dependent on the types of procedures you consider, there isn’t one set cost. Review our Pricing page to build a “wishlist” and get estimated pricing. We also have a fee schedule available in the office after your consultation. Feel free to contact our San Diego office 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.