Home/Breast Surgery Procedures/Breast Augmentation
Breast augmentation (also referred to as breast enlargement, breast enhancement or augmentation mammoplasty) is the surgical procedure that is used to enlarge a woman’s breast size and improve its shape. It is the most popular cosmetic surgical procedure being done today by women and is associated with an extremely high satisfaction rate. Surgery involves the insertion of silicone or saline implants into a pocket created either directly behind the breast tissue or the pectoralis muscle of the chest wall. Breast implants consist of an outer envelope of silicone rubber that is filled with either silicone or saline.
The concept and procedure sound rather simple and straightforward but this is definitely not the case. In order to obtain the most ideal results, many variables need to be considered and decisions made prior to surgery. The goal of any breast augmentation procedure is to add volume and improve the shape of a woman’s breasts while keeping the tell-tale signs of surgery to an absolute minimum. To achieve this goal, the plastic surgeon must have an exceptional eye for aesthetics, an understanding of each individual’s tissue characteristics, an appreciation for the three dimensional effects of the implants on the tissues, consideration for the changes over time and superior surgical skills to implement these strategies. In addition, he/she must have the ability to understand and interpret the patient’s goals and needs and then translate that into outstanding results.
With these abilities and meticulous attention to all details and variables, Scottsdale plastic surgeon Dr. Steven H. Turkeltaub has consistently endeavored to ensure that the results he creates for his patients are exactly what they had desired. (See blog: Breast Augmentation Fail or When Not to Disclose One’s Assets to see an example of what does happen when surgical planning, precision and skill are not what they should be.)
I went to Dr. T. for a breast augmentation on recommendations of two of my friends who were very happy with their results. He listened to what I wanted, spent alot of time with me and gave me all the information that I needed to make my decision. I really liked him and his recommendations and decided to have him do my surgery. My breasts are perfect – exactly what I wanted! I am so happy now. I can definitely recommend him to other friends for their surgery.
Nikki Johnson
September 16, 2017
While breast implants are most commonly associated with achieving a larger breast size, this is by no means the sole enhancement and/or purpose they can provide. In many cases, implants can be an excellent option for improving the shape or symmetry of the breasts, restoring youthful volume following pregnancy or dramatic weight loss, addressing congenital issues (like Poland’s syndrome) or even reconstructing one (or both) breasts following mastectomy—with or without necessarily increasing one’s natural breast size appreciably.
Based on your unique needs and goals, Dr. Turkeltaub can help you select the most appropriate implant type, size and shape for the breast aesthetic you desire.
Traditional round silicone breast implants are FDA approved for breast augmentation patients who are at least 22 years old and for breast reconstruction patients of any age. Though they can be used in younger women, such usage is considered to be “off label” which means that it isn’t officially approved by the FDA. This “restriction” is more of political one rather than one based on any untoward clinical findings in that age group. Saline breast implants are approved by the FDA for patients who are 18 years of age and older.While both implant types have helped millions of women achieve excellent results over the years, silicone implants are widely considered the “gold standard” in terms of aesthetic outcome – they tend to look and feel far more natural and on average last much longer than the saline ones.
In Dr. Turkeltaub’s practice, essentially all his patients choose silicone breast implants. It is exceedingly rare that anyone selects the saline implants anymore. Furthermore, every one of his patients who have had both types of implants at one time or another say that they preferred the superior look and feel of silicone as opposed to saline.For more information about silicone implants please visit Dr. Turkeltaub’s Blog.
With much hype, the FDA approved the Natrelle® 410 breast implants, also called “gummy bear” implants, produced by Allergan, plc in 2013. These are form-stable and anatomically designed in a teardrop shape to help simulate more “natural” curves. Being constructed with a highly-cohesive silicone gel, even more so than the traditional round silicone implants, they maintain their wedge shape under virtually all conditions. They have been shown to have reduced rates of rippling, wrinkling, and rupture but do feel more firm and less natural than round implants, can rotate over time creating appearance issues and are more expensive.Their usage, however, has been far less than expected nationally for a variety of reasons. This is somewhat fortunate as extensive studies have revealed that the texturing used on the envelope of these implants (as well as all other textured implants and tissue expanders manufactured by Allergan) is associated with a risk, though extremely rare, of developing what has been called “breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)”. Consequently, in July 2019, these gummy bear implants and all textured surfaced implants and tissue expanders produced by Allergan have been voluntarily removed from the market meaning that they are no longer available for usage.
What does this mean for you if you have these particular implants, either for cosmetic or reconstructive reasons?Because of the extreme rarity of BIA-ALCL, there is absolutely no recommendation to electively remove or exchange the implants. For more information on this, you can visit both the FDA as well as the Allergan websites addressing this issue. Of course, you can also contact your plastic surgeon for assistance, information and possible evaluation.
*Dr. Turkeltaub does not offer or use the textured surfaced implants, either saline or silicone, for a few reasons including an extremely rare risk that has been associated with them.
Here are three similar sized silicone implants. The one on the left is a moderate profile implant, that on the right is
high profile implant and the one behind them is an ultra-high profile implant. Note the greater the projection and
narrower the width going from moderate to high and then ultra-high profile.
Patients with textured surfaced implants manufactured by the companies Mentor and Sientra have also been diagnosed with BIA-ALCL but at approximately one sixth the rate as that of Allergan’s. As of October 2019, these two companies have elected to continue selling their textured surfaced implants.
Dr. Turkeltaub only uses smooth surfaced implants and has been doing this for many years now.
Breast enhancement is an outpatient procedure that is most often performed under general anesthesia. This approach is very safe and much more comfortable than a “twilight” or semi-awake type of anesthetic. It can be combined with many other cosmetic procedures, such as tummy tucks (as part of a “Mommy Makeover”) and liposuction, for a more extensive and cost effective improvement.
During surgery, the most appropriate implant for the patient will be selected based on the preoperative discussion of all the options and the patient’s goals. Dr. Turkeltaub uses a very precise, meticulous and gentle technique which helps to both minimize postoperative discomfort as well as the risk for less than ideal outcomes.
Breast augmentation patients can select to have their implants placed through incisions in one of three different locations. For a variety of reasons, the transumbilical, also known as the belly button technique, is not considered.
Breast implants can be placed either behind (subpectoral or submuscular) or directly in front of (submammary or pre-prectoral) the pectoralis major muscle, the large chest wall muscle. The appearance and dynamics are different in these two locations as are the consequences of the effects of time.
The most significant advantages of placing the implants behind the muscle include:
For most patients, Dr. Turkeltaub recommends that the implants be situated behind the muscle.
In general, if you have a moderate to significant amount of excess skin of your breasts along with drooping you will likely need a breast lift (mastopexy) in combination with your breast augmentation in order to achieve desirable results. Having a breast enlargement alone without removing extra skin or lifting breast tissue in these cases would result in abnormal, bizarre appearing breasts. Some surgeons, trying to avoid performing a lift in these situations, place extremely large, inappropriately sized implants above the muscle in a misguided effort to take up the skin slack and avoid the additional incisions associated with the lift. The long term consequences of this, including very thin skin and deformed, elongated breasts, can be extremely bad and virtually impossible to completely address at a later time.
During your consultation, Dr. Turkeltaub can help you determine if a breast augmentation alone or in combination with a mastopexy would be best for your needs and goals. If you would like to learn more about this option before scheduling a consultation, please feel free to explore our page on breast augmentation with a lift.
A dressing that provides some compression and maximizes comfort is placed for around 2 – 3 days. This is then replaced with a sports type bra that is worn day and night for at least 1 week. After that, a supportive bra should be worn on a regular basis, especially if you have relatively large implants, so as to help maintain the breast shape and minimize drooping over time.
Discomfort for the first few days can be mild to moderate though most patients can return to a non-strenuous job or school within 5 – 7 days. It is recommended that you avoid vigorous activities such as sports and aerobics for three weeks. You may experience muscle tightness and even spasms early on but these resolve fairly quickly.
Initially your breasts will be moderately swollen, firm and may appear larger than you were anticipating. After several weeks, much of the inflammation will subside resulting in a more defined shape and a size closer to what you can expect long term. With time, the skin and muscle (if placed in a submuscular location) will relax resulting in a softer, more natural feel and appearance.
There are many long-term benefits associated with breast enlargement. Included among these are looking better, feeling more attractive and feminine, having greater self-esteem and being able to find clothes that fit and that are more complementary. The overwhelming majority of breast enhancement patients are extremely pleased with their results.
For more information on the postoperative period after breast augmentation surgery, read Dr. Turkeltaub’s Blog: “Recovering From Breast Augmentation Surgery.”
The visibility and overall appearance of breast augmentation scarring will depend on a variety of elements including incision location, one’s genetic makeup, the incision closure method employed, level of surgeon’s skill, adherence to post-surgical advice, healing response, usage of scar mitigation products and whether one is on a restrictive diet (vegan, etc.) or not. Most commonly, the incision used to place implants will be made in or near the inframammary fold, resulting in a scar that is concealed beneath the breasts. Other scar locations include along the outer border of the lower half of the areola or in the armpit, both of which can result in relatively inconspicuous scarring (though they are utilized less frequently for a number of reasons that can be explained during your consultation).
In Dr. Turkeltaub’s experience, breast augmentation patients rarely have any issues with the final appearance of their scars particularly when post-operative instructions are closely followed and recommended scar care products/treatments are utilized.
Breast implants are not guaranteed to be lifetime devices. On average, they can last anywhere from 5 to 30 years though it can be less or even more. Silicone implants generally last significantly longer than saline ones.
Being able to determine when one’s implants will need to be replaced (or just removed) because they have worn down or lost their integrity is a relevant concern. How you can realize when it is that time is quite different between silicone and saline breast implants.
Ultimately, if there is any concern about the integrity/condition of your breast implants especially if they are getting up there in the years, you should seek the advice of your plastic surgeon.
If your body is capable of producing breast milk prior to the placement of your implants, you should still be able to breastfeed after your augmentation procedure, particularly if the periareolar incision technique is not utilized. It is important to understand, however, that some women are not capable of producing a sufficient amount of milk for breastfeeding regardless of whether or not they have breast implants. Therefore, if you have never tried to breastfeed prior to breast augmentation, your ability to do so after receiving breast implants may be uncertain. This fact greatly contributes to the misconception that breast implants impact one’s ability to breastfeed.
Another common false belief regarding breastfeeding after breast augmentation is that material from the implants will contaminate the breast milk. In actuality, the cohesive silicone gel or saline solution inside implants should not get into the breast milk or harm milk production glands and/or breast tissues. However, the periareolar approach for implant insertion can lead to some risk of disrupting milk glands. This is another reason why Dr. Turkeltaub recommends inserting breast implants through an inframammary incision for virtually all of his breast augmentation patients.
Ultimately, if you wish to start—or grow—a family after breast augmentation and are hoping to breastfeed, Dr. Turkeltaub suggests that you disclose this information during your consultation. By doing so, your plastic surgeon can more appropriately plan your procedure.
The vast majority of women undergoing regular screening of their breasts for breast cancer will have the standard two image mammogram (with the rest primarily having an ultrasound). For those women who either have had a breast augmentation or are considering one, it is therefore important to know that the breast implants used in a breast augmentation will impact the quality of routine mammograms to a varying degree. Fortunately, this can usually be easily addressed with very common standard modifications of the study.
Mammograms use very low energy x-rays to penetrate through your tissues in order to radiographically visualize your breasts. Both silicone and saline breast implants partially block penetration by these x-rays making tissue visualization and evaluation on mammograms less clear and more difficult. The effective solution for this typically is having two additional views taken along with some repositioning of the implants and/or breasts. Therefore, it is always important that when you are scheduling your mammogram as well as when you are having it done, you inform the appropriate people that you do have breast implants so appropriate measures can be taken.
For more information on this, read Dr. Turkeltaub’s blog: “Do Breast Implants Interfere with Mammograms Evaluations?”
The American Society of Plastic Surgeons (ASPS) reports the average cost of breast augmentation to be approximately $3,700*. This price is a bit misleading, however, because it refers solely to the plastic surgeon’s fee and does not take into account other related and inherent costs including the specific implants chosen, the surgical venue (hospital or private operating facility) and anesthesia expenses. Additional components that are also not accounted for in this number include such items as medications during recovery and preoperative mammograms. Of course, these numbers will also be affected if a breast lift is performed as well.
To receive a personalized quote for the cost of your breast augmentation, a consultation with Dr. Turkeltaub is necessary. During this meeting, he will listen as you describe the look you wish to attain, help you select the most appropriate implants based on your goals and desires and then formulate a customized surgical approach for you. Once a treatment plan is agreed upon, he can then provide you with a breakdown of all expenses that contribute to the total cost.
If you are considering financial assistance for breast augmentation, a member of our team will be available to introduce you to several healthcare lenders that offer affordable payment plans for almost any budget. The online application process is simple and the decision regarding approval is generally obtained quickly.
*This price is taken from data collected by the American Society of Plastic Surgeons; it does not represent the exact cost of breast augmentation at Dr. Turkeltaub’s practice.
Choosing the right breast augmentation surgeon is very important in helping to maximize the likelihood that you will receive excellent care, safe and ethical treatment and results that meet—or even exceed—your breast enhancement goals. Some of the most important factors to consider when making your decision include:
In the end, you should have no reservations about the breast augmentation surgeon you ultimately select, so take your time, do your research and only move forward with treatment when you are entirely comfortable with your choice.
Breast implants will not last forever. They may last 5-30 years, possibly less or more but expect that at some point in time they will need to be replaced or removed. It is usually easy to determine when saline implants deflate as there will be a noticeable and rapid decrease in the size of one breast. Loss of integrity in silicone implants can be more difficult to detect since there is no real change in volume and with today’s implants, little or no change in breast shape (though with earlier generation implants there often were shape changes). An MRI or digital ultrasound may be needed to make the diagnosis.
On average, silicone implants will last significantly longer than saline implants. Read more about breast implant durability.
There are three acceptable incision locations for the insertion of breast implants including:
In some situations, one site may offer an advantage over the others. Virtually all of Dr. Turkeltaub’s patients elect to have their incisions placed near the crease at the bottom of the breast (inframammary).
No matter which approach is used, the incisions usually heal fairly inconspicuously.
Breast augmentation surgery should have little or no impact on the ability to breastfeed.
We can discuss breast implants in greater detail during your consultation at our Scottsdale office.
Swimming should be avoided after breast augmentation for at least six weeks but this does vary based on individual factors. Dr. Turkeltaub can provide you with a more accurate timeline, based on your individual recovery. You can, however, submerge in a pool at or around four weeks postoperatively.
It is important to protect your scars from the sun for at least six to nine months following surgery. A sunscreen with a SPF of 45 or greater can be applied to the scars when out in the sun even when wearing a bathing suit.
Dr. Turkeltaub is a very experienced plastic surgeon who has performed a large number of breast augmentations in over 30 years of practice. The following are examples of his expertise in this procedure.
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“One year ago, I made one of the best decisions of my life to have you perform my breast augmentation surgery! I am quite pleased with my result. The boost in confidence I experienced due to the surgery led me to compete in two fitness shows this year. I plan to compete on a national level in November. I want to thank you and your great staff for the professional but very caring experience I had last year.”
For additional helpful information on a variety of issues related to breast augmentation, you can visit Dr. Turkeltaub’s Blog.
Dr. Turkeltaub is also experienced in a variety of other breast surgery procedures, including breast lift, breast reduction, and breast reconstruction.
If you are interested in breast augmentation, please contact Dr. Turkeltaub to schedule a convenient consultation. With two locations, Dr. Turkeltaub’s practice is easily accessible.
We look forward to helping you.
