Breast Augmentation

Helping You Have the Body You Always Wanted

Breast augmentation is a procedure done in order to make the breasts look bigger. This is done either by placing an implant under the breast tissue or by placing it underneath the pectoralis muscle of the chest. There are several options available, and there are some important things that you should consider before deciding to have a breast enlargement.

First of all, you have to be clear in your mind on what look you are going for. For example, you may ask the following questions: How much larger you do you want to be? Do you want a more natural look or a more obvious (“fake”) look to your breast augmentation?

Second, you need to have a discussion about this at your consultation so that you and Dr. Fisher both really understand what your goals and expectations for the procedure are. You will look at before and after pictures with Dr. Fisher, and you may also bring pictures that you like to your appointment. This allows Dr. Fisher to counsel you about what is and isn’t possible for your particular body. Every person is different and there can be no guarantee on the exact outcome.

Some personal factors that should be considered include:

  • Body type: There are many different body shapes, and there is no “one size fits all” type of breast implant. Bone structure, musculature, height, weight, and proportions all go into determining your body type. This is important for the surgeon in considering what size range and profiles of implants will work for you.
  • Breast shape: Your breast shape before surgery will not change much after your breast augmentation. This is because your breast shape has a specific template that depends mostly on factors that cannot be changed. This includes your chest wall diameter, the amount of breast tissue you have, and any existing asymmetries.
  • Breast and chest asymmetry: Asymmetries are the differences that you have from one side compared to the other. The majority of people have some degree of breast asymmetry in shape, size or both. Asymmetries of the rib cage and chest wall are also common. These differences can be very minor or can be very obvious, and they cannot be corrected only with breast implants. Since you are asymmetric before breast augmentation, you will be asymmetric after breast augmentation. This includes the size and shape of your nipple. However, sometimes the size of the nipple can actually increase. Some asymmetries become more obvious after breast augmentation.
  • Breast size: Depending on the measurement of your breasts and chest, there will be a range of what implants can be safely placed. During your consultation, the overall size of the implant will be determined. It is important to understand that the size of the implant has almost nothing to do with “cup size”. It is not possible to give you an exact cup size for your breast augmentation.
  • Breast ptosis (sagging): Breast augmentation does not correct the shape of a drooping breast. Breast implants may only improve the appearance of sagging when there is a very minimal amount of sagging. Breast augmentation alone is not the way to treat sagging, and in the presence of sagging, can give the breasts a very unattractive appearance (like a “rock in a sock” or “snoopy deformity”). The correction of true sagging breasts requires a breast lift (Mastopexy). The breast lift procedure is completely different and creates other incisions on the breast. Dr. Fisher will determine if you would require a breast lift procedure instead of an augmentation or in addition to it.

The Implants

Breast implants currently available in the United States are those filled with saline or those filled with silicone. The outer shell of both is made of silicone. Saline implants come empty and are filled by the surgeon in the operating room at the time of surgery. Saline implants have a deflation rate of approximately 1% per year. Silicone implants come prefilled with silicone gel. The silicone in different gel implants are more cohesive than others. This means that the more cohesive, the firmer they feel and better they hold their shape. The most cohesive gel implants are commonly referred to as gummy bear implants.

There are 3 companies that currently make breast implants for use in the United States. They are Sientra, Allergan, and Mentor. Allergan and Mentor manufacture both saline and silicone type implants. Sientra only manufactures silicone implants. All implants by Sientra are highly cohesive and can be referred to as “gummy bear” type implants. Sientra is the only company that sells exclusively to plastic surgeons. By going to a plastic surgeon that offers Sientra implants you can have the confidence that your breast implant surgeon has the proper formal training to be called a plastic surgeon, not simply a “cosmetic surgeon”.

Anatomic breast implants, also called shaped or tear drop, are also available. The anatomic implants are all filled with highly cohesive gel and are “gummy bear” implants. Anatomic implants are designed to give a more natural-looking result.

Most of the time breast implants are placed behind the pectoralis muscle of the chest. This gives more tissue coverage over the implant and decreases the chances of developing capsular contracture (hardening of an implant).

It is normal and desirable to develop a scar capsule around the breast implant. When the capsule is normal, it provides a smooth pocket for the implant to reside and be moveable in. However, capsular contracture occurs when the capsule thickens and tightens. The severity of this varies; it can be minor and barely noticeable, or it can squeeze the breast implant and distort the breast and/or cause discomfort. Although there are a number of theories regarding why capsular contracture occurs, the cause is unknown. We do not know why this condition occurs in some people and not others, why it may occur in 1 breast only or in both, or why it may happen right after implant placement or years later. Treatment of capsular contracture can require the release or complete removal of the capsule, and implant replacement. In recurrent cases, other strategies may be necessary.

The Implant Coatings

Textured Implants: Textured implants are often used when implants are placed above the muscle. They may have a slightly lower risk of capsular contracture compared with smooth implants when in this position. These implants may ripple more and are also generally not placed under the muscle.

Smooth Implants: Smooth implants have a more natural feel if placed behind the muscle. They also have a lower risk of deflation and hardening when placed behind the muscle.

When breast implants are placed behind the muscle they will move with muscle contraction. If you work out your chest heavily with weights or are a body builder the implants will move when using your pectoralis major muscle. This is normal. If this is a major concern, you may wish your implants placed above the muscle, but you will have to weigh this against the increased risk of capsular contracture.

Incision Placement & Scars

There are a few different incisions that can be used for placing breast implants, including under the breast (inframammary crease), around or through the areola, and axillary (the armpit).

The inframammary crease incision is well hidden underneath the breast and is the most common place for the incision. It provides the best access to achieving symmetry. The incision around the areola increases the risk of changes in nipple sensation after surgery. The scar after this incision can be unpredictable in terms of visibility. The armpit incision has no scars on the breast, however, the scar is visible when raising the arms. If an armpit incision was used and an implant has to be replaced, an inframammary incision will be required for the next surgery.

General Risks

With any type of cosmetic surgery, there are risks, although they are minimal when your surgery is done by a qualified Plastic Surgeon. When you are trying to decide whether or not to have an elective surgery, you must weight the benefits against the risks. Potential complications of breast augmentation include bleeding, hematoma (blood that needs to the be evacuated in the operating room), scarring, capsular contracture, changes in nipple sensation, migration of the implant over time, breast tissue thinning over time, breast sagging over time, implant rupture, adverse reaction to anesthesia, unsatisfactory result, need for revision surgery. When a woman undergoes a breast augmentation, it is highly likely that sometime in the future she will require additional breast surgery. However, there is a common misconception that breast implants have to be replaced every 10 years. This is not true. If you are not having any problems with your implants, then nothing needs to be done.

Your Recovery after Surgery

Your surgery will be performed at an outpatient surgery center. After surgery, you will feel sore for about a week. You will need someone to stay home with you for the first 2-3 days. You will be able to shower 24 hours after surgery.

Depending on what you do, you may return to work in 1 week with limitations on physical activity. Restrictions include no lifting your arms overhead for 3 weeks, no lifting over 10 pounds for 3 weeks, no high impact exercise for 6 weeks.

Learn more by calling us today at (702) 362-5960!

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Why Choose
Dr. Orna Fisher?

  • Boutique Practice, Private and Personalized
  • Double Board Certified Female Plastic Surgeon
  • Member of the American Society of Plastic Surgeons
  • Member of the International Society of Aesthetic Plastic Surgery
  • Voted Best Cosmetic Surgeon in the Best of Silver State Awards and Multiple Top Doctor Awards
  • Participates Consistently in Continuing Education to Provide Best Practices
  • Known for Her Surgical Precision and for Her Personalized Approach With Patients
  • Mission is to Provide Her Patients With Top Quality Plastic Surgery and The Latest Cosmetic Procedures
  • The Only Board-Certified Plastic Surgeon on Las Vegas Blvd., Near the Strip