Breast Augmentation in New York City
with Dr. Shridharani
What Is Breast Augmentation?
Since 2006, breast augmentation surgery has remained the most commonly performed cosmetic surgical procedure in the United States, with nearly 300,000 patients annually undergoing the procedure.
Breast augmentation, also known as augmentation mammoplasty, is a procedure that increases breast size by using saline or silicone breast implants. In addition, Dr. Shridharani is also able to perform this surgery by using the patient’s own fat, known as fat transfer to the breast.
During your consultation for breast augmentation, Dr. Shridharani will thoroughly discuss your goals in relation to your ideal breast size and shape to determine which implant is best for you. During surgery, Dr. Shridharani will measure the patient’s breasts with an inflatable implant sizer to determine the exact implant size for that individual patient. Implant size may vary for each breast in order to correct a patient’s asymmetry.
Watch Dr. Shridharani Perform a “No Touch” Breast Augmentation
Types of Breast Implants: Silicone Gel vs. Saline
Silicone breast implants: Silicone breast implants are filled with silicone gel to feel more like natural breast tissue. If the implant were to break the implant will not collapse and the gel might even remain inside the implant. These implants are FDA-approved for women ages 22 and up. Silicone implants are the most commonly used implant globally – as they offer the most natural feel and last longer than saline implants.
Saline breast implants: Saline implants are filled with sterile saline (salt water). If the implant were to pop the saline would be absorbed and naturally expelled from the body. Saline implants provide uniform shape and are FDA-approved for women ages 18 and up.
How Are Breast Implant Sized?
Some people assume breast implants are sized the same as bra cup sizes. This is not the case. Implants are sized by the amount of material filling the implant, measured in cubic centimeters (cc’s). So, an implant size could be 300 cc’s, for instance.
Breast Implant Shapes
Breast implant shapes can be either round or anatomic also known as the “teardrop” shape.
Round breast implants: Round breast implants make breasts appear fuller than form-stable implants and generate more projection. Round implants vary in projection to specially be tailored to each patient’s body. There is no concern about the implant rotating, since the implant is the same shape in all dimensions.
Anatomic or “gummy bear” breast implants: Gummy bear breast implants are also called form-stable implants because they keep their shape even if the implant shell has been broken. The silicone gel inside these implants is more viscous/cohesive/”gummy bear” like than the filling of tradition silicone implants. The consistency of the silicone gel inside the implant is thicker than traditional silicone gel implants. These implants are also firmer than traditional implants, but are thought to be less likely to break.
Gummy bear breast implants are usually shaped to a natural breast shape rather than just round. They have more projection at the bottom and are tapered towards the top. If a shaped implant rotates, it may lead to an unusual appearance of the breast. Due to the shape of gummy bear implants, there is always a slight chance that the implant could rotate requiring a revision to place the implant in the correct orientation. Placement of gummy bear implants may require a longer incision in the skin.
Smooth and Textured Breast Implants
Smooth breast implants: Smooth breast implants are the softest to the touch. These implants can move within the “breast implant pocket” giving the breasts more natural movement. Due to their soft nature, these implants MAY produce visible rippling of the skin over the span of years.
Textured breast implants: Textured breast implants develop healthy scar tissue that attaches to the implant. This ensures the implant will not reposition on its own. There is an overall reduction in the natural movement. Because textured breast implants develop scar tissue to stick to the implant, they are less likely to move around inside of the breast and get repositioned. Research shows that textured implants may offer some advantage in diminishing the risk of a scar capsule.
Are Silicone Gel Implants Safe?
YES! After extensive population-based studies failed to show a correlation between autoimmune disease and silicone implants, the moratorium on silicone gel implants was lifted in 2006, and silicone breast implants came back into popularity in the United States. The most recent generation of silicone implants features a barrier layer to reduce the silicone bleeding/leaking phenomenon seen in older implants. Manufacturers of breast implants say each product should last roughly 10 years. Silicone implants have a rupture rate of 1-2% each year.
Breast Implant Incisions and Placement
Breast implants can be inserted through a variety of incision sites. The most common regions to place incisions for breast implants are periareolar (around the areola of the nipple) or inframammary (under the breast fold). Other less common options include placing the incision in transumbilical (belly button) and transaxillary (underarm). Dr. Shridharani can guide you based on what your goals are.
Breast implants can be placed under the muscle or in the fascia above the muscle. Implant placement varies from patient to patient. Patients with little breast tissue will want to have the implant placed below the muscle providing a more natural appearance. However, if a patient already has a decent amount of breast tissue to begin with, an implant may be placed above the muscle. There are advantages and disadvantages to both techniques.
- Areola — This incision is placed just outside of the areola, the darker pigmented skin surrounding the nipple. This incision will be well hidden when you’re fully healed. Through this incision, the implants can be placed either over or under the pectoral muscle. On the downside, this incision location can limit the size of silicone implants, as they are pre-filled and will have to fit through the incision. Also, there is a higher risk of loss of nipple sensation and the future ability to breastfeed with areolar incisions.
- Inframammary crease — This incision is made along the crease at the bottom of the breast. It is usually placed just about the crease to hide it under a bikini or lingerie. This incision offers the best view and control for the surgeon. Implants can be placed either above or below the chest muscle through the crease. On the downside, this incision leaves the most visible scarring. To place implants beneath the muscle, it will have to be cut to gain access, which complicates your recovery.
- Transaxillary — Here the incision is made vertically in the armpit. The surgeon may or may not use an endoscope to provide a view of the breast pocket. Obviously, this incision leaves no scarring on the breasts, and even the scar in the armpit becomes almost invisible. Placing the implants under the pectoral muscle doesn’t require any cutting of the muscle. The implants don’t come in contact with the milk ducts, where bacteria can cause inflammation and capsular contracture with areola and inframammary incisions. Larger implant sizes can be accommodated. On the downside, this incision does limit the placement of larger silicone implants. There is also a slight risk of the implant coming into contact with bacteria because it rubs against the skin during insertion. Wearing deodorant will necessarily be prohibited for around two weeks.
- Transumbilical — In this technique, the implants are inserted through the belly button. This incision is the rarest of the four options, by a long way. An endoscope is used to provide a view of the inside of the body. Scarring is virtually nil, as the incision occurs inside the belly button. Only one incision is required for both breasts. Recovery is usually easier, since this method is less invasive than the other three options. There are no scars on the breasts. There are some downsides with belly button insertion. Almost any revision work or implant replacement cannot be done through the belly button incision. Silicone implants cannot be placed with this method. Bleeding is more difficult to control. There is also a slightly higher risk of damaging the implant during this placement.
Dr. Shridharani will review all of this information with you during your consultation with him at the office in New York City.
The patient had a 270 cc smooth, round, moderate plus profile silicone gel implant placed on the right side and a 210 cc smooth, round, moderate plus profile silicone gel implant placed on the left side. Both implants were placed underneath the muscle (pectoralis major) through an inframammary incision approach (underside of the breast). She is pictured here 1 week prior to surgery and 9 months after her procedure.
How Long Does a Breast Augmentation Procedure Take?
The time for each breast augmentation procedure varies patient to patient. Generally, the surgery takes around a couple hours to perform.
Watch Dr. Shridharani Perform A Breast Augmentation with Fat Transfer
Breast Augmentation Recovery
Recovery from augmentation surgery is not as difficult as you might assume. For the first few days, you will have some discomfort, but many patients do not even use their prescribed pain medication. Those patients who do, usually only need it for the first week or less. Recovery varies by your incision location, the size of your implants, and whether the implants were placed above or beneath the pectoral muscle.
Your chest will likely feel tight, but this is perfectly normal as the tissue needs to stretch and the implants need to settle into place. When you first look at your new breasts, they may appear too high on the chest. But this is also normal, as settling will bring the implants down somewhat.
Once you return home after clearing your general anesthesia, you’ll be wearing a medical compression bra over your incision bandages. This helps to minimize swelling and keeps stress off of your stitches. You’ll wear this for your entire initial recovery.
Most patients can return to work in just four or five days, although sub-muscular implant placement may require a full week. You can begin non-impact activity in a week or so, but impact exercise needs to wait for at least one month. Specific upper body exercises can resume in six weeks. You also can’t lift anything above your head for at least six weeks.
Will I Need to Wear a Special Bra After Breast Augmentation Surgery?
You will be placed in a medical compression bra when you first return home. You will need to continue to wear this surgical bra 24 hours a day for at least the first three to four weeks. Depending on your incision location, this timeframe may be longer. These bras are not the most comfortable things in the world, but they provide the breasts necessary support while healing. In some cases, you may be able to switch to a sports bra at three to four weeks, but this varies by the patient.
Possible Side Effects After Breast Augmentation
Breast augmentation is major surgery, and it has the risks involved with any surgery: anesthesia reaction, bleeding, infection, and such. For augmentation, there are some specific risks. These include the loss of nipple or breast sensation, loss of breastfeeding ability, implant leakage or rupture (if the implant is somehow nicked during placement), or improper positioning.
The main enduring risk or problem with implants is capsular contracture. This is the body’s reaction to the implants, which is to build scar tissue around them. If the scar tissue becomes too aggressive, it may deform the implants and cause them to feel overly firm or hard. If this happens, they will need to be replaced and the excess scar tissue removed.
Otherwise, numerous studies have found no link between breast implants and autoimmune or other systemic diseases.
Will I Need to Get my Implants Replaced During my Lifetime?
Unfortunately, there are no “lifetime” implants. Like anything that is manufactured, implants have a lifespan. Implant manufacturers warranty their implants for 10 years, so they expect them to last at least that long. However, some implants may only last five years, while others last 20 years. When implants reach their lifespan, they will weaken and rupture. That will require revision surgery to remove the ruptured implant (and any silicone gel that may have leaked out with silicone implants) and to replace both implants with new implants.
So, a woman having breast implants in her 30s can reasonably expect to need to replace her implants at least two or three times, and possibly four times in her lifetime. Implants are becoming more durable, but at this point this is a good estimate.
One plus about replacing implants is that the surgeon can enter through the original incisions. Plus, unless there is extensive capsular contracture, the breast pockets created for the original implants should still be able to be used for replacement implants.
Schedule a Consultation
Ready to learn more about breast augmentation and find out if you are a good candidate? Call (212) 508-0000 to schedule a consultation with board certified NYC Plastic Surgeon, Dr. Shridharani.
Breast Augmentation FAQ’s
My patients have the ability to have their procedures performed at my office or at area hospitals and “surgicenters” in New York City. My operating room and facility have certification and accreditation by the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). Our team provides patients with the option of having their procedure performed in the safety, convenience, and comfort of our office/facility.
Breast augmentation surgery is the most commonly sought after cosmetic surgery procedure in the United States. Like any surgical procedure, there is some discomfort involved with having an incision on your body. One of the biggest factors in having breast augmentation is implant placement. Many surgeons opt for placing the implant “below the muscle,” which often entails more pain. Nonetheless, patients liken the pain the first few days to having performed “a lot” of push-ups and then progressively less pain as the week continues. A good regimen of anti-inflammatory medications with long acting local anesthetics paired with good surgical technique leads most patients to be off narcotic pain medication by 2-3 days after surgery.