What is a breast enhancement or breast augmentation?

Breast Augmentation involves the placement of a silicone or saline filled implant on the chest wall to improve the size and appearance of the breasts.  This cosmetic breast surgery often benefits those with naturally small breasts, and those who have lost breast volume after having children. It is a surgery that helps women fit better in their clothes and helps them feel more confident in their skin.  Click here to see some of Dr. Graham’s breast augmentation before and after pictures.

What happens in the operating room during breast augmentation surgery?

An approximately 2 inch incision is made at the desired fold of the breast. The surgeon then finds the pectoralis muscle and carefully elevates it off of the ribs. The muscle is usually released from its lower connections to the chest and also from some of the overlying breast tissue. This allows the muscle to “window shade” and give the breast a more pleasing shape. At this point in time, using very sterile technique, the breast implant is inserted. Any changes to the pocket or overlying skin are made at this time. This is the time the surgeon fine tunes the shape and addresses any abnormalities that may lead to a double bubble or other deformity. Once happy with the size and shape the surgeon then closes the incision in layers. Dr. Graham uses a very strong deep layer that maintains the fold of the breast to insure both that scar is always hidden in the crease and that the implant doesn’t “bottom out”.

What does breast augmentation planning involve?  How do I choose a breast implant?

Breast augmentation involves multiple choices.  Most of these factors are dependent on individual anatomy and preferences.  The three main factors to consider are size, implant type, and plane/incision choice.

Size Breast augmentation is not a one size fits all scenario, nor is it a situation in which the implant your friend or colleague had would be right size for you.  The first thing taken into consideration is your chest wall width.  We cannot put an implant in that is more narrow or wide than your current breast width.  This would result in deformity that would not only appear abnormal, but could often be uncorrectable.  Once the breast width is determined, we can then determine your desired breast size.   It is important not to choose an implant that is too large as this can irreversibly damage your breast tissue over time and result in problems such as rippling, double bubble deformity, and bottoming out.   Therefore, we are conservative with our approach.  We determine the size together based on your individual anatomy, your desires, and how you look with an implant sizer.

Implant Type – Implant type is based on your age, anatomy, and personal preference.  We typically recommend silicone implants rather than saline.  Silicone implants look and feel more natural, have less chance of rippling, and have a lower rupture rate.  From this point, we then have to decide whether to use textured vs smooth and round vs shaped (gummy bear).  There are specific indications for each which we can discuss during your consultation.  Lastly, we predominantly use Mentor brand breast implants. These implants, unlike Allergan implants, have a much lower(20-30 times less) risk of implant associated breast cancer(ALCL), and they are proudly made in the USA.

Plane- Plane is whether the implant is placed above or below the muscle.  Below the muscle has lower risks, but above the muscle sometimes gives a better shape. Dr. Graham uses the most popular and safest technique, called a dual-plane technique. The implant is partially covered by muscle and partially covered by gland. As a result, you get the lower risks of a submuscular implant combined with the better shape of subglandular one.

Incision-Incision choice, in our practice, is either periareolar  (around the nipple) or inframammary  (at the breast fold underneath).  Both choices can be very aesthetic.  We prefer inframammary as you have more surgical control over placement of the implant, less future interference with breast feeding, and an overall lower complication rate.   However, this is a choice we make together so patient desire is the ultimate consideration.

Why should I choose Dr. Graham to perform my breast augmentation?

Dr. Graham is a Board Certified Plastic Surgeon with experience in all aspects of breast surgery.  When performing breast augmentation he utilizes a combination of 2 specialized breast implant sizing systems that he has tailored to his technique.  He uses both the “High Five” Tissue Based Planning System, developed in Dallas, TX and the “ICE” system developed in Great Britain to plan for his surgerys. These proven systems uses scientific evidence to tailor each implant to the patient’s own anatomy and tissue characteristics.  As a result, a patient obtains an aesthetic result without risks of tissue stretching and breast deformity. This also insures that the scar ends up below the breast and not in a visible location.

What are the main risks of breast augmentation surgery?

Please refer to the following form published by the American Society of Plastic Surgeons


Will I have to stay in the hospital after surgery?

No.  Breast Augmentation is an outpatient procedure.

What is the breast augmentation recovery time? When can I drive? What are the other restrictions?

Dr. Graham performs a rapid recovery breast augmentation.  Dr. Graham advocates a rapid recovery protocol in which you are back to normal activities within 48 hours.  In fact, you are encouraged to shower and be out to dinner the night of surgery.  For most patients, you can have surgery on Thursday or Friday and be back to work on Monday.  Jobs that require heavy lifting may take a little longer.  You may drive when you are off narcotics and feel confident to control the car.   Most patients are able to drive within the first few days to a week.  The only real restrictions are avoidance of sexual and strenuous activity for the first week and avoiding heavy lifting for 2 months.

How much does breast augmentation cost?

The national average cost of breast augmentation with silicone implants is $6,000-7,000.  This pricing includes implants, anesthesia, surgeon, and hospital fees.  You can see Dr. Graham’s pricing here.

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