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Breast Augmentation

Breast augmentation, also known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman’s breasts. Every year, it continues to be one of the most popular cosmetic procedures performed in the United States. Using saline or silicone breast implants, our board-certified plastic surgeon, Dr. Neil J. Zemmel, can tailor the breast augmentation procedure to create a fuller breast appearance with highly natural-looking results.

This page will give you a basic understanding of the procedure, including who the proper candidates are, how it’s performed, what results you can expect, and more. Each person has individual circumstances, which may affect their final outcome, and Dr. Zemmel can answer all of your specific questions at your complimentary consultation.

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What Are the Benefits of Breast Augmentation?

Breast augmentation is among the plastic surgery procedures with the highest patient satisfaction ratings. Many women experience an immediate improvement in their self-esteem and discover a greater self-confidence. The breast augmentation procedure is often sought after for a number of reasons; some of the most common benefits include:

Am I a Good Candidate for Breast Augmentation?

Breast augmentation can enhance your appearance and self-confidence, but it won’t necessarily change the appearance of other parts of your body. Before you decide to have surgery, think carefully about the reasons you are considering breast augmentation and what your overall expectations are. Dr. Zemmel wants you to thoroughly consider and discuss your reasons for surgery.

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you’re physically healthy and realistic in your goals, you may be a good candidate.

Because of Dr. Zemmel’s extensive training and experience with breast surgeries like breast augmentation, he has developed a systematic approach to optimize your satisfaction and results. This reduces the need for “touch-up” procedures following breast augmentation. Dr. Zemmel’s approach includes a thorough pre-operative evaluation, accurate pre-operative breast implant sizing, and an emphasis on achieving a natural feel and appearance following augmentation.

How Do I Choose the Best Breast Augmentation Surgeon?

Choosing the right breast augmentation surgeon is crucial for achieving the best results. Above all, it is important to ensure your surgeon is board certified by the American Board of Plastic Surgery, as this indicates they have undergone rigorous training and meet high standards of care and safety in plastic surgery. In addition, you should find a plastic surgeon who specializes in breast augmentation and has extensive experience performing the procedure. By doing so, you can make sure they are familiar with different techniques, effectively tailoring the surgery to meet your specific needs.

Breast augmentation before-and-after photos can also be highly beneficial in your search for the best surgeon, as they can help you gauge the physician’s work and aesthetic style. To learn about other patients’ experiences with a plastic surgeon, read online reviews and testimonials to learn what you might be able to expect should you choose them for your care. Once you have narrowed down your search, you can schedule a consultation to discuss your goals and assess the surgeon’s communication and approach.

Confirm that the surgery will be performed in an accredited facility, and choose a surgeon who provides a customized plan tailored to your anatomy and preferences. Ensure you feel comfortable and confident in the surgeon’s abilities and transparency, and check that they offer comprehensive post-operative care. Selecting a qualified and experienced surgeon will help ensure you achieve your desired results safely and effectively.

What Can I Expect in My Breast Augmentation Consultation?

Breast augmentation requires careful pre-op consideration and decision-making. Dr. Zemmel begins this process with a careful initial consultation, assessing the history of any prior breast disease, prior pregnancies, breastfeeding, and breast surgeries. It is also important to assess any family history of breast disease or breast cancer. In addition, future mammography is an important consideration during the evaluation process.

During this consultation, Dr. Zemmel will evaluate your health and explain which surgical techniques are most appropriate for you. A careful physical examination is essential since the characteristics of each woman’s breast—such as size, shape, symmetry, skin quality and thickness—have a significant impact on the final result. The position of the breast on the chest wall and the position of the nipple on the breast also greatly influence the final result. Other factors include chest wall size, shape of the breast bone, patient height and weight, and any spinal scoliosis. If your breasts are sagging, Dr. Zemmel may also recommend a breast lift.

The cornerstone of Dr. Zemmel’s approach is to tailor treatment to your individual goals and circumstances. He will also ensure that you have a complete understanding of the issues involved so that you are able to make a fully informed decision. This will help you achieve the appearance you desire with the least invasive procedure available. Dr. Zemmel strives to have open, honest communication with you at all times. He believes this is the foundation of a solid doctor-patient relationship.

Be sure to discuss your expectations frankly with Dr. Zemmel, and he will be equally honest with you, describing the alternatives as well as the risks and limitations of each approach. Let Dr. Zemmel know if you smoke or take any medications, vitamins, or other drugs, as these may all affect your outcome. He will go over the details of your surgical plan, explaining the type of anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved.

Traveling from out of town? Our practice is happy to coordinate consultations for individuals that may require additional planning and travel to our Richmond location. Dr. Zemmel’s patients come from all over the United States and abroad to receive first-class cosmetic enhancements in fully licensed and accredited facilities with board-certified surgeons and anesthesiologists.

At the completion of your consultation, you will be given a written estimate of the cost of your procedure. At this time, you will also have the option to schedule your procedure if you so choose. The decision to undergo surgery is a very important one and should be given very careful consideration. Dr. Zemmel realizes the importance of this decision, and at no time will you be pressured to commit to the procedure. You are also encouraged to bring your spouse, significant other, family member, or a friend to your consultation.

What Are the Different Types of Breast Implants?

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Q & A with Dr. Neil Zemmel ‘Silicone vs Saline Breast Implants’

How Do I Choose the Right Size of Breast Implants?

This is one of the most important decisions you will make. Dr. Zemmel will use his 20 years of experience with thousands of cases to guide you through the process of choosing a size that can meet your goals. Dr. Zemmel uses several approaches to help you make the best decision based on your anatomy, personal preferences, and the appearance you desire. Most patients undergoing breast augmentation have the goal of achieving a “C”; a “D” cup tends to be the second most popular request.

Looking at Before-and-After Pictures

Dr. Zemmel will begin talking with you at length about your goals and desires. He will also show you examples of his patients’ breast augmentation before-and-after pictures. By finding someone who has a similar pre-operative appearance and evaluating their results, you will get an idea of whether or not you like the size they chose. You may wish to bring photographs from magazines or websites to better communicate to Dr. Zemmel the exact size, shape, and “look” you are trying to achieve.

Taking Measurements to Create a Natural Look

Several key measurements of your natural breast and chest shape will be taken. This gives Dr. Zemmel an idea of what size implant will help you meet your goals. As implant size increases, so does the diameter of the implant. There is an implant that will perfectly match the diameter of your natural breast, and that is a good starting point for discussion. Choosing an implant smaller than your natural breast shape will not provide the proper cleavage and shape following the procedure. Similarly, choosing an implant too large for your natural chest shape is more likely to give you an unnatural appearance.

CCs vs. Cup Size: How Breast Implants Are Measured

Unfortunately, implants do not come in cup sizes. Rather, they are categorized by the volume of saline (salt water) or silicone that they are designed to hold. There are several reasons for this. First, your final cup size will be partially determined by your pre-operative breast size, and everyone is different in this regard. Secondly, a “C” cup from one bra manufacturer is not necessarily the same as a “C” cup from another manufacturer. Everyone is built differently and bras are not manufactured to a set standard. 

If you are of average height and build, you can expect that one cup size is approximately 200cc. If you are tall or have broad shoulders, you can expect that number to be slightly higher. Similarly, if you are more petite or have a narrower chest wall, you can expect that number to be slightly lower. 

Although a desire for a certain cup size is helpful to Dr. Zemmel in guiding you in the selection of the proper implants, it is more helpful to focus on the shape and appearance that you wish to achieve.

“Trying On” Breast Implants

Finally, Dr. Zemmel will have you “try on” various demo implants in a surgical bra. You may wish to bring a bathing suit, tank top or other clothing to see how you will look with different implant sizes. This helps confirm that you are making the right implant choice. Dr. Zemmel will have you perform the “trying on” during the pre-operative visit. He also offers VECTRA® 3D imaging to further help you visualize what your final results may look like. This computer imaging technology allows Dr. Zemmel to digitally alter your photos to simulate the projected outcome of using different implant sizes on your frame.

The initial consultation is very thorough, lasts approximately one hour, and tends to provide you with a tremendous amount of information to digest. Dr. Zemmel will see you again at least one more time before surgery and you will have the opportunity to try on the sizers again before making a final decision. Our goal and the measure of our success is your happiness.

Breast Augmentation Patient Results
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How Will My Anatomy Affect My Breast Augmentation Results?

The shape of the breasts after augmentation is mostly determined by the breast shape before surgery. In general the post-operative results of the augmented breast will appear to be an enlarged, magnified version of the original. Apart from concerns about attainable shape, volume, and a natural versus fake appearance of augmented breasts, there are several unique anatomical considerations that may affect the potential outcome of your breast augmentation. 

Certain patient characteristics cannot be altered by surgery but will have a significant impact on the final shape of the breast. These factors include width of the rib cage and chest, the shape and concavity of the breast bone, the volume of the existing breasts, and quality and elasticity of the skin. Some of these issues are discussed below. Since many of these anatomical factors cannot be changed by surgery, all patients must be aware of the influence these may have on their final outcome.

Breast Asymmetry

The position of the inframammary fold (the fold where the bottom of the breast meets the chest) and position of the nipples have a large impact on the shape of the final implant result. Most women have some degree of asymmetry of the breasts, which is normal. Surgery may correct certain types of asymmetry such as difference in the height of the nipple and inframammary fold. However, volume and size differences of the breasts can be corrected by adjusting the size of the implant.

Determining Cleavage

The depth and width of cleavage achieved in breast augmentation is not equal for every patient, and is dependent on several factors. Chest wall contour and breastbone prominence, the amount of body fat, and the thickness of tissue over the breastbone all influence the smoothness of the contour transition from sternum to the breasts. The starting separation between the breasts and the position of the nipple on the breasts also influence the final result. These anatomical factors vary greatly from patient to patient.

Prominence of the Upper Chest Wall & the Breast Bone

The shape of the bones in the chest wall (breast bone and ribs) will have a noticeable impact on the final shape of the augmented breast. Women who have a prominent breast bone may have a larger intramammary space (the space between the breasts). This limits the amount of cleavage that can be produced and will also affect the position of the breasts on the chest wall. In order to compensate for these anatomic differences, Dr. Zemmel may choose to use a high profile implant in situations where the breastbone is excessively prominent. This will give a large breast volume and projection for a given width of implant. This will allow the breasts to face a more forward direction.

Tuberous (Tubular or Constricted) Breast Shape

The original breast shape, proportion, and form will impact the final result after breast augmentation. In certain women the starting point shape of the breasts will completely prevent the desired augmented shape unless action is taken to reshape the breast tissue and skin distribution. The tubular or tuberous breast is one such situation where the original breast shape requires modification in addition to a normal augmentation.

The “typical” candidate for breast augmentation will have a relatively pyramidal shape to the breast. The nipple level will be well above the level of the inframammary fold (the crease below the breast where it meets the chest wall), and the skin and breast tissue will be evenly distributed over the chest wall. When an implant is placed beneath the muscle, this results in a proportional enlargement of the original breast. The original proportions and slight variances of the breasts will be magnified. Small asymmetries present before surgery will also remain after surgery. 

Larger differences in size, width and position of the breast can be corrected with additional maneuvers during surgery, and Dr. Zemmel will discuss this with you in detail at your consultation.

The tubular breast has many variations, but all share certain common features:

  • Small breasts located under an enlarged nipple and areola
  • High and narrow inframammary fold
  • An abnormally narrow breast tissue base
  • An abnormally wide areola with a central protrusion (herniation) of the breast tissue through the areola
  • The nipples tend to be very plump
  • Often the breast tissue cascades forward centrally, falling over the tight fold, and producing significant sagging and shape distortion

Augmentation alone will result in the appearance of the native breast remaining well-defined atop the new implant mound. It will appear as if the small constricted breast is sitting on top of the implant. If the original narrow breast base diameter and constricted breast tissue are not treated, a natural, well-contoured breast will not result. Several maneuvers must therefore be performed in order to correct the tuberous breast.

First a breast augmentation is performed through a periareolar approach. The implant will be placed below the muscle. A Benelli-type mastopexy (breast lift) can be performed to reposition the tight breast tissue over the new breast mound. Areola diameter is also reduced with this type of breast lift. The breast tissue itself is also radially cut (scored) to allow it to flatten and redrape over the implant (similar to the opening of an umbrella). The incisions are then closed with absorbable sutures placed under the skin of the areola.

Placing Breast Implants Over vs. Under the Muscle

Breast augmentation involves surgical placement of the breast implants either over the pectoralis muscle (subglandular) or underneath (submuscular). Dr. Zemmel typically prefers to place implants beneath the pectoralis muscles to enhance breast size and shape, as this limits implant edge visibility. In addition, he finds this technique reduces the tendency to show visible wrinkling of the breast implant and gives a much more natural look and feel.

“Dr. Neil Zemmel and staff have been absolutely wonderful from my first consultation, through the insurance process, Pre Op, Surgery, and Post Op.”
- KyAnne H.

Where Are Breast Augmentation Incisions Made?

Dr. Zemmel usually accomplishes submuscular placement of breast implants via a periareolar, inframammary, or transaxillary (armpit) approach. While all three approaches can provide excellent enlargement of the breast with enhancement in contour, each technique has its unique benefits.

How Should I Prepare for My Breast Augmentation?

Dr. Zemmel will give you instructions to help you prepare for surgery, including guidelines on eating and drinking, when to stop smoking, and taking or avoiding certain vitamins and medications. While making the necessary preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

What Does the Breast Augmentation Procedure Involve?

Breast augmentation can be performed with general anesthesia, so you’ll sleep through the entire operation. Some surgeons may use a local anesthesia, combined with a sedative to make you drowsy, so you’ll be relaxed but awake, and may feel some discomfort. Please consult with Dr. Zemmel on which type of anesthesia you prefer.

The method of inserting and positioning your implant will depend on your anatomy and Dr. Zemmel’s recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible.

Working through the incision, Dr. Zemmel will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples. Dr. Zemmel will discuss the pros and cons of each surgical approach with you, and together you will decide which method is best.

The surgery usually takes one to two hours to complete. Stitches are used to close the incisions, which may also be taped for greater support. A gauze bandage may be applied over your breasts to help with healing. You will be placed in a soft surgical bra for additional support.

What Can I Expect After Breast Augmentation?

You’re likely to feel tired and sore for a few days following your surgery, but you’ll be up and around in 24 to 48 hours. Dr. Zemmel will prescribe pain medication and antibiotics after surgery. Within several days, the gauze dressings, if you have them, will be removed, and you will continue to wear the surgical bra. The mild swelling and bruising should subside in 10 to 14 days. The sutures used to close the two small incisions will be absorbable and underneath the skin, so they will not need to be removed.

You may be able to return to work within a few days, depending on the level of activity required for your job. Dr. Zemmel will instruct you on when to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery.

Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group, although the mammographic technician should use a special technique to assure that you get a reliable reading, as discussed earlier.

What Are the Risks of Breast Augmentation?

When performed by a board-certified plastic surgeon, such as Dr. Zemmel, breast augmentations are typically considered a safe procedure. The extensive training, skills, and qualifications required for this status ensure your surgery is being performed under high safety and care standards. With that said, all surgical procedures come with certain risks—including bleeding, infection, or a negative reaction to anesthesia—although these generally occur in less than one percent of patients. Other complications that may occur more specific to breast augmentation can include implant leakage, rupture, or rippling, changes in nipple sensation, implant malposition, capsular contracture (scar tissue that hardens and contracts around the implant), and breast implant illness. 

Dr. Zemmel takes extreme care to reduce any potential risks by conducting thorough health and candidacy assessments as well as performing all surgeries in fully licensed and accredited facilities. During a consultation, he will review all potential risks so there is a clear understanding of both the limitations and benefits of breast augmentation prior to the procedure.

What Will My Breast Augmentation Scars Look Like?

You can expect your scars to be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars should begin to fade, although they will never disappear completely.

A common concern for some patients, such as African American women, is the fear of heavy scarring (also known as hypertrophic scarring) or keloid scarring (pathologic scarring). These terms are used interchangeably, but they represent separate physiologic processes.

  • Hypertrophic Scars: These are a normal outcome in some patients, and reflect the physiologic response to healing. Factors that influence the production of hypertrophic scars are the tightness of the surgical incision, the location of those scars on the body, and the individual’s own genetic tendencies. Hypertrophic scars are limited to the area of injury, and are particularly prone to occur on the shoulders, knees, and breast bone areas.
  • Keloid Scars: This is a genetically inherited disorder in which scars heal with an extremely robust response. The scar grows outside of the original confines of the wound. Keloids are uncommon and may be difficult to treat. Some keloids respond to steroid injections. Keloids are common on the ears, neck, and over the breastbone—they are less common on the breasts. If you have a tendency to keloid, you are probably not a candidate for a cosmetic operation.

What Can I Expect in My Final Breast Augmentation Results?

While noticeable results of breast augmentation can be seen immediately, patience is also advised as it may take several months for the majority of swelling to fade. Typically, final results should be visible after one to two months, although minor swelling may last up to one year following surgery. During recovery, Dr. Zemmel may recommend performing certain exercises and movements to prevent implant malposition and ensure an appropriate breast pocket size that looks and feels natural.

Regular examination by Dr. Zemmel and routine mammograms for those in the appropriate age groups at prescribed intervals will help assure that any complications, if they occur, can be detected early and treated.

How Can I Prevent Capsular Contracture?

One of the most common complications of breast augmentation is the development of a foreign body reaction called capsular contracture. Any foreign material placed within the body will cause a reaction. All materials including suture, silicone, metals, and plastics cause a thin scar to form around the implant separating it from the rest of the body. The scar attempts to place the implant in the smallest volume possible by contracting. In most patients (greater than 98%) the scar remains thin and soft and undetectable. In a small minority of patients, the foreign body reaction is more robust and the capsular scar is thicker. Dr. Zemmel uses several ways to limit the amount of scar production before, during, and after surgery.

Refrain from Smoking

First, it is essential to maximize the potential for wound healing by providing optimal amounts of oxygen and nutrients to the wound. Smoking impairs wound healing and should be stopped at least 4 weeks prior to surgery to ensure the best results.

Limit Germs and Bacteria

It is also important to limit the amount of bacterial contamination around the implant. Dr. Zemmel observes the strictest sterile technique in the operating room to reduce the amount of bacteria around the implant. It is important to limit potential germ contamination at the time of surgery by adequate pre-op hygiene. Dr. Zemmel will instruct you to take a thorough shower the morning of surgery (using regular soap), and avoid shaving the armpits for a transaxillary approach for one week prior to surgery. This prevents ingrown hairs in the surgical field. A strong antibacterial prep is done at surgery with strict avoidance of germ contamination during the operation.

Special Surgical Technique

Dr. Zemmel creates an oversized submuscular pocket that is significantly larger than the implant, which allows the implant more room to form a capsule. This helps reduce the chance of a tight scar forming directly around the implant causing a visible or palpable scar.

Massage Your Breast Implants

Finally, Dr. Zemmel instructs all patients to begin early, vigorous post-operative massage of the implants, fully displacing them throughout the entire oversized submuscular pocket. This is used to keep the implant pockets wide open, soft, and freely moveable. This will eventually give a natural feel and appearance to the breast.

How Are Mammograms Performed with Breast Implants?

Prospective candidates over age 40 should receive yearly mammograms in accordance with the guidelines of the American Cancer Society. How breast augmentation may interfere with future mammography must be considered throughout treatment.

For this reason, Dr. Zemmel prefers submuscular placement of breast implants, which has no significant impact on breast self-examination or mammograms. After breast augmentation, women must obtain mammograms at centers experienced in using specialized Eklund displacement views.

How Much Does Breast Augmentation Cost?

Breast augmentation costs an average of $7,700 to $8,200 at Richmond Aesthetic Surgery. Since every patient receives a surgical plan tailored to their unique needs and aesthetic goals, this cost will vary for each individual.

Our team will provide you with a quote by the end of your consultation based on your treatment plan, helping you budget for your procedure. Insurance companies do not consider breast augmentation to be medically necessary, and carriers generally do not cover the cost of this procedure.

Additional Frequently Asked Questions About Breast Augmentation

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