Breast Augmentation La Jolla, San Diego

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What to Expect from Breast Augmentation

Breast augmentation is an outpatient procedure done under general anesthesia.

We offer most approaches of breast augmentation and incision placement, as well as several FDA-approved implants with silicone and saline. The modern procedures we use allow us to fashion incisions in inconspicuous locations, either in the crease of the armpit, peri-areolar (an incision under the nipple at the areola where the color changes naturally) or inframammary (under the crease of the breast).

We also implement three choices for placement of your implants:

Sub-Fascial

A newer technique in which we insert the implant under a thin, but solid layer of connective tissue which shelters the pectoralis major muscle. With this technique, you get a support advantage of the sub-muscular technique without implant movement which causes your implants to shift when your muscles contract.

Sub-Glandular

The implant is inserted under the gland of the breast.

Sub-Muscular

We insert the implant under the muscle

After placement and positioning, Dr. Singer will close with sutures, and bandage your breasts. Sometimes he will place a surgical garment, helping your breasts to stabilize with the implants.

After surgery, you will be taken to a recovery room and monitored for a short period. Finally, we will release you into the care of an escort, who should drive you home and help you for at least 24 hours.

There are different types of implants. When you decide to get breast implants, you have many specific choices, not only regarding the size and type of material but also regarding shape. We have an extensive selection of implants that will fit your unique body type. We will discuss the advantages and disadvantages of different implants with you so you can make the optimal choice for your needs.

Saline breast Implants

Dr. Singer will fill saline breast Implants after insertion, which allows for a smaller incision. The ability to fill the implant after insertion will allow Dr. Singer to adjust the size during surgery. These implants are FDA-approved for women 18 and older.

Silicone Breast Implants

Silicone breast implants are believed to have a softer, more natural feel than saline. We recommend these implants for women with thin or little breast tissue. Silicone implants require a larger incision because they are intact with no filling required. These implants are FDA-approved for women 22 and older, although younger women may qualify for their use.

While not a frequent occurrence, saline and silicone implants may rupture. The FDA recommends women with silicone implants have an MRI every two years to determine if a rupture has occurred. When a silicone implant ruptures, there is no immediate leakage and no reduction in size making ruptures harder to detect. Because saline implants deflate soon after rupture occurs, it is easily detected.

"Gummy Bear" Breast Implants

Cohesive Gel Implants, also known as “gummy bear” implants, may rupture, but it’s silicone filling will not leak out. The gel of these implants is similar in consistency to gummy bear candies, are less prone to leakage, and a rupture of the outer shell will not alter their shape or size. These implants also have a more natural, teardrop shape.

Implant shells can be smooth or treated with a finishing process which texturizes the outer surface. It’s important to know your breasts will feel natural if you have textured implants. The texture assists the implant’s adherence to the adjacent breast tissue to avoid rotation.

Will I be able to breastfeed after a breast augmentation?

Some women, who never had breast surgery, are naturally unable to breastfeed, and some variations of breast augmentation may make it more likely that you are unable to breastfeed, but most women with breast augmentations are able to successfully breastfeed. Breast implants pose no medical risk to your baby.

What if the implant ruptures?

Both silicone and saline breast implants can rupture or leak. If this should occur, treatment may require surgical removal of the implant and possible replacement. When a saline (salt water) breast implant leaks, it will usually deflate very quickly similar to what occurs when a balloon loses its air. Your breast will change in size or shape. It is less common for saline to leak slowly, although it can happen. When the saline leaks, the body absorbs it.

A rupture or leak of a silicone breast implants may occur very slowly, produce no symptoms or problems (called a silent rupture), and go unnoticed, because the gel is contained within the normally occurring fibrous tissue that forms around an implant. Sometimes the rupture is discovered only with on mammogram or an MRI or when an implant is replaced. It is possible, however, for the fibrous tissue to become inflamed or form additional internal scar tissue which can lead to:

• Pain, soreness or swelling in the affected breast
• Change in breast size or shape
• Lumps in the affected breast
• Softening or hardening of the affected breast

Implants have been thoroughly evaluated by the FDA and ruptured silicone breast implants aren’t thought to cause breast cancer, reproductive problems or connective tissue disease, such as rheumatoid arthritis.

What are the risks involved with breast augmentation surgery?

As with any surgery, there are risks associated with breast enlargement. Unfavorable scarring, asymmetry, changes in breast/nipple sensation, implant displacement, and rippling are all possible side effects. More serious complications which occur infrequently include: reactions to anesthesia, bleeding, and infection. Long term, potential problems include deflation or implant leakage requiring implant removal and possible replacement surgery as well as capsular contracture which occurs when the scar or capsule, which naturally forms around the breast implant begins to tighten, squeezing the implant and causing the breast to feel harder.

Is breast and nipple sensitivity affected by a breast augmentation?

Breast sensitivity may be increased, decreased or the same after surgery. Sensitivity varies greatly from person to person. After breast augmentation, you may find the nipples have decreased sensation, which generally returns. When it returns, the nipple complex may be hypersensitive before it returns to normal. In most patients, it takes 6-12 months before achieving the final level of sensitivity which may not totally return in some patients, no matter where the incision was made to insert the implant.

How long is the recovery period after breast enlargement surgery?

You should “take it easy” the day of your operation and the following days. Increase your activity as instructed. Depending on the kind of work you do, you may return to your job as soon as you are comfortable. If your work is fairly sedentary, you may go back to work in three to four days after surgery. Do not lift anything over ten pounds for three weeks. Exercise can typically be resumed three to four weeks following breast enlargement surgery.

Will a breast augmentation hurt?

You will be asleep during the procedure and feel no pain. After surgery, pain and discomfort can be easily relieved with prescribed medication and usually subsides in a matter of days. The greatest period of discomfort usually lasts about twenty four to forty eight hours. Thereafter, you should have less discomfort and less need for medication. Occasionally, it lasts a little longer. Implants placed in the submuscular position initially produce more discomfort than those placed in front of the muscle.

Who is a good candidate for a breast augmentation?

• Small breasted women, women with breasts that are unequal in size, women whose breasts are markedly smaller after pregnancy, and women whose breasts are sagging due to aging all may benefit from breast enlargement surgery.
• A healthy women over the age 18 (for Saline Implants)
• A healthy women over the age 22 (for Silicone Gel Implants)

What anesthesia will be used?

General anesthesia is commonly used in order to make the intra-operative portion of the procedure pain-free and as comfortable and pleasant experience as possible.

How long does the breast implant procedure take?

Cases may differ, but on average the surgery lasts one to two hours.

How long do breast implants last?

There is a myth that implants will last 10 years. There is no data to support that statement. We have seen patients with implants that are over 30 years old and still intact. You should realize that no one can guarantee the life cycle of an implant, that it may not last forever and it may not be a one time surgery. The implant manufacturers have limited warranties on the implants.

Are “gummy bear” implants better?

There are a number of new implants referred to as “gummy bear”, “jelly bean”, “form stable”, or “highly cohesive gel” implants that are available, but there are no long term results to show that they are significantly better or will last any longer than the current implants. They do feel firmer.

How do I choose the right size implant?

It depends on multiple factors: Individual anatomy, existing breast volume, breast dimensions of height, width and projection, ribcage width, chest shape, tissue thickness, desired outcome, and realistic expectations. There is no standardization of cup size. A 32 C and a 36 C are very different. Cup sizes vary from bra manufacturer to bra manufacturer. Even different styles from a manufacturer will vary in what they label a cup size. The best way to choose an implant size is to try on try on sizers in the office while wearing a tight t-shirt, bathing suit or leotard.

What are the options for breast implant placement?

There are two choices for breast implant placement: sub-glandular (under the breast tissue and in front of the chest muscle – the pectoralis muscle) or sub-muscular (under or partially under the chest muscle). The best location depends on many factors including: tissue thickness, weight, desired outcome, and individual anatomy. Each position has advantages and disadvantages:

Subglandular implant benefits:

• A shorter recovery time.
• Less discomfort initially.
• No distortion of the breast when the pectoralis muscle flexes.
• Mild preoperative sagging can be improved, especially if no breast lifting procedure is performed.
• Easier surgical procedure.
• Larger implants can be placed.

Subglandular implant disadvantages:

• The implant may be more visible.
• More visible rippling, especially in patients with a small amount of natural breast tissue.
• Generally, saline implants do not produce a good result in front of the muscle.
• Higher incidence of capsular contraction.
• “Bottoming out” in some patients.
• Some radiologists have more problems reading a mammogram with an implant in front of the muscle.

Submuscular implant benefits:

• Usually results in a better appearance for naturally small breasted women
• Less tendency for seeing ripples of the implant.
• A more natural feel to the breast especially in slender women who don’t have much of their own breast tissue.
• Less interference with mammograms, although most radiologists take additional views no matter where the implants are placed.
• Lower rate of capsular contraction.
• Less of a chance of “bottoming out” where the implant bulges at the lower aspect of the breast and the nipple and areolas tend to appear excessively elevated.

Submuscular implant disadvantages:

• Recovery usually takes a little longer and is more uncomfortable initially.
• There may be an “animation deformity”, which is a temporary distortion of the breasts when the pectoralis muscle is flexed. Body builders and weight lifters generally prefer implants in front of the muscle.
• It is harder to achieve cleavage in women who have widely spaced breasts.
• The implants often ride higher on the chest.

Actually, most patients who have breast augmentations today have breast implants placed in a combination or “dual plane” position. This approach has the same benefits and disadvantages of a total “submuscular implant”, but with a lesser tendency to ride high on the chest wall. The disadvantage as compared to a total “submuscular implant” is a higher tendency for bottoming out.

The ideal placement in any particular patient depends on their particular anatomy and understanding of the pros and cons of each approach. Your concerns should be discussed at the consultation.

Are saline implants as good as or better than silicone implants?

There are advantages and disadvantages of each type of implant. Both are utilized by surgeons across the country with satisfactory results. They are both approved for usage by the FDA. The best way to determine what the best implant is for you is to discuss the advantages and disadvantages of the various types of implants along with your concerns and personal preferences at a consultation.

What are the differences between smooth and textured mammary implants?

The surface of the outer shell of breast implants can be either smooth or textured. There are pros and cons of each. Smooth implants usually have thinner shells and move more freely in their pocket than their textured counterparts. Many plastic surgeons believe that the thinner shell allows smooth implants to feel more natural. Implants with smooth surfaces are also less likely to ripple. Textured implants were designed to lower the risk of capsular contracture, but whether it achieves that is open to debate. The textured implants may have a greater chance of leakage or deflation. One type of implant shape, known as the anatomical or tear-shaped implant, is only available with a textured surface, because this surface helps keep these contoured implants in position and diminishes the risk of rotation and distortion. Some of the differences of the implant surface characteristics depend on whether the fill material is saline or silicone gel.

What are the breast implants options?

The Food and Drug Administration (FDA) has approved both saline filled breast implants (for women 18 years and older) and silicone gel filled implants (for women 22 years and older). Both are basically shaped silicone envelopes that are filled with silicone gel or sterile salt water (saline). Silicone breast implants are filled either with cohesive gel or with “highly” cohesive gel, which are sometimes referred to as “gummy bear” implants due to their consistency. The outer surface may be smooth or textured.

What are the alternatives to a breast augmentation?

• Accept your breasts as they are.
• Wear a padded bra or an external prosthesis.
• There are no creams or ‘magic formulas” that are marketed to produce non-surgical breast enlargement that have ever been proven to work.

Are breast implants safe?

Breast implants are among the most tested of medical devices. No other medical device has been studied to the extent that breast implants have. Extensive studies of tens of thousands of women with breast implants have shown that both saline and silicone implants are safe. They do not produce a higher rate of cancer or autoimmune disease. After vigorous evaluation by the FDA, both are approved for cosmetic and reconstructive usage.

Dr. Singer has the respect of his peers and patients across San Diego and the surrounding Southern California area. He has helped thousands of San Diego residents with an eye for balance and beauty and the skills of an artist. Dr. Singer has been engaged in private practice in the La Jolla area of San Diego since 1976 and is now an internationally recognized plastic surgeon. You are in the best of hands with Board Certified Plastic Surgeon (American Board of Plastic Surgery) Dr. Singer.

Please learn more about Dr. Singer’s affiliations, memberships, awards, honors, and accomplishments. The full list and Dr. Singer’s curriculum vitae are available upon request.