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At Evolve Aesthetic Surgery, Dr.Jason Hess specializes in breast augmentation surgery in San Diego. As a board-certified plastic surgeon, he has specific expertise in performing cosmetic breast surgery. Dr. Hess has a keen eye for Aesthetics and is committed to achieving the best outcomes for his patients.

Breast Augmentation Procedure

Breast Enhancement Procedure

Breast Augmentation, technically known as augmentation mammaplasty, is a procedure that enhances a woman’s breasts for reasons including improvements in size, shape, and symmetry. Advances in breast implants and the surgical techniques have made breast augmentation a common and safe procedure for women of all ages.

Women seek breast augmentation for a variety of reasons. Many are simply hoping restore breast size and shape to youthful or pre-pregnancy proportions. Others hope to improve self esteem and femininity. Regardless of the reason for augmentation, there are many factors to consider. While full, firm breasts are generally considered the aesthetic ideal, bigger is not always better. Women who have lost breast volume due to weight loss or child bearing may consider an implant to fill loose skin and to modestly lift the breasts. Others who have large saggy breasts may choose a mastopexy, or breast lift, rather than an augmentation. Women who have lost volume and skin elasticity may choose an augmentation mastopexy (implants and breast lift).

Symmetry and shape are extremely important components of breast aesthetics. The majority of women have some degree of natural breast asymmetry. This may range from very subtle to severe differences in size or shape. Occasionally, women are born without a nipple (athelia) or an entire breast (amastia). Abnormalities such as Poland’s Syndrome and tuberous breast deformity have a dramatic developmental impact on breast shape and size. Breast augmentation is an excellent means of restoring the physical shape and self confidence in women afflicted with these conditions.

Breast Augmentation Candidates

Women of all ages seek to improve breast appearance via breast augmentation. The best candidates for surgery include women who are in otherwise good physical health and are well informed regarding breast augmentation. Women should await cessation of lactation following pregnancy prior to undergoing surgery. Also, women with active breast cancer or infection are not candidates for surgery. However, breast reconstruction is commonly performed on women who have undergone lumpectomy, mastectomy or other treatment for breast cancer. Women over 40 should generally receive a baseline mammogram prior to breast surgery. Women with breast pain (mastalgia or mastodynia) should seek treatment or an underlying cause of pain prior to surgery.

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Breast Augmentation Surgery


While breast augmentation may be performed under local anesthesia and sedation, the most common approach is to perform surgery under general anesthesia. The breast and muscle are highly innervated, and surgery is most tolerable while a patient is completely asleep. Patients may choose saline or silicone implants. Each type of implant has positive and negative characteristics. Silicone implants are very soft and feel natural, but are more expensive than saline implants. Rupture is rare, but is more difficult to detect than that of saline implants.

Saline implants are slightly more firm and tend to ripple more than silicone implants. However, saline implants can be placed through a smaller incision than silicone implants.

Implants may be placed under the pectoralis muscle (subpectoral) or under the breast alone (subglandular plane); This choice is made by the patient and surgeon depending upon individual anatomy and patient preference. Most plastic surgeons agree that placing the implants behind the pectoral muscle reduces the potential for capsular contracture (hard breasts). Implants placed in the submuscular plane however, may be slightly more painful and the recovery takes a few days longer than a subglandular augmentation. The vast majority of patients and modern plastic surgeons choose a subpectoral approach.

The incision placement is determined by an individual’s anatomy, breast shape, and personal preference.

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There are essentially four approaches for implant placement.

Inframammary Incision

The inframammary incision is placed near the crease under the breasts, slightly above where the breasts meet the chest wall. A small transverse incision is used to create a subpectoral pocket where the implant will be placed. When properly placed, the surgical scar will be hidden in the fold beneath the breast.

Transaxillary Incision

The transaxillary incision is created in a natural armpit crease. This procedure is most optimally performed with an endoscope or surgical camera. This instrument facilitates accurate implant placement and minimizes bleeding. A tunnel is created in the armpit and a pocket is created behind the breast where the implant will be placed.

Periareolar Incision

The periareolar incision (nipple incision) is placed between your areola and breast skin. The incision is marked at the outer diameter of the areola. The goal is to place the incision in transition area between the darker pigmented areolar skin and the surrounding breast skin where it can be hidden. After healing, this incision should be camouflaged or nearly invisible.

Transumbilical incision

The trunsumbilical or TUBA incision facilitates placement of saline breast implants throught the navel. This is an incision is rarely used due a high risk of implant malposition. Dr. Hess does not perform this procedure, and it is rarely performed by board certified plastic surgeons because the alternative procedures (inframammary, transaxillary, and periareolar incisions) offer substantial benefits with fewer risks of complications.

What to Expect

Breasts are often relatively numb in the period immediately following surgery. However, discomfort becomes apparent when local anesthesia dissipates from the breasts. This pain is easily controlled with prescription medication. Breasts are often swollen and the implants are often slightly higher than desired in the first several days following surgery. Swelling gradually subsides and implants settle into their optimal position a few weeks after surgery. Incisions are initially apparent, but their visibility subsides in the weeks following surgery.

FAQs About Breast Augmentation

  • Are breast implants safe?

    Many women considering breast augmentation are justifiably concerned about implant safety. Multiple studies have demonstrated no link between breast augmentation and breast cancer, arthritis, or other autoimmune disorders. Even in the case of a silicone implant rupture, there is no toxic or autoimmune response.

  • Are silicone implants better than saline?

    Each silicone and saline implants have benefits and detractors. The advantages of silicone implants are that they are soft and mimmic natural breast tissue and there is less incidence of rippling. The disadvantages are the implants require a slightly larger incision than saline implants for insertion and are slightly more costly than saline implants. Though rupture is uncommon, it may be difficult to detect and may require an MRI to determine The advantages of saline implants are that they are slightly less costly than silicone implants. There are more routes of insertion including transaxillary (via the armpit), periareolar, and inframmmary approaches require a slightly smaller incision for insertion. The disadvantages of saline implants are that they are slightly more firm than silicone implants depending on implant fill volume and there is a higher incidence of rippling, which may be an issue in women who are very thin or have very small breasts.

  • Can women breast feed following breast augmentation?

    Women can and should breast feed following a breast augmentation.

  • Does breast augmentation cause loss of nipple sensation?

    Transient loss of nipple sensation is not uncommon following breast augmentation. Permanent loos of nipple sensation is uncommon. The incidence of sensation loss is roughly 5%. Loss of sensation is slightly more frequent when a periareolar incision is used.

  • What size implant is appropriate for me?

    Implant volume depends both on your natural breast size and your desired outcome. Implants each have a specific base diameter and height. Thus, the width of the breast is an important parameter. Breast measurements can be attained on examination, and implant volume can be estimated during consultation.

  • Will I need a breast lift?

    Mild breast ptosis (droopiness) can be corrected with an implant alone. Following pregnancy, breast tissue may involute, and an implant can simply replace lost volume. Larger degrees of ptosis may require a mastopexy (lift) with or without an implant. This is determined, in part, by a measure of the sternal notch to nipple distance, a measurement attained upon physical exam.

  • What will happen if an implant ruptures?

    Upon rupture, saline implants simply loose their internal volume, and the released saline is reabsorbed by the body. The affected breast will return to its original shape and volume. When silicone implants rupture, this event may be difficult to detect. Because modern implants contain a cohesive gel, the material will usually adhere to itself staying within the confines of the breast pocket. An MRI may be required to determine the definitive integrity of a silicone implant.

  • Will I be able to receive a mammogram in the future?

    Mammography is a routine contributor to breast health after age 40. The recommended age for mammography may vary depending on personal and family health history. Mammograms are possible and recommended following breast augmentation for women over 40. Additional images called Ecklund Views are often required to maximize surveillance of breast tissue in women who have undergone augmentation.

  • How long do breast implants last?

    The popular press often quotes breast implant longevity to be 10 years. In reality, breast implants may last less than five years or greater than twenty years, depending on the patient. The key components to maximizing implant lifespan is choosing a size-appropriate breast implant and performing implant displacement exercises (breast massage) following surgery. When these factors are met, breast augmentation outcomes are optimized.

  • What are the risks of breast augmentation?

    By far the greatest risk of breast augmentation is capsular contracture. This occurs when scar tissue encapsulates an implant, and breasts can become firm and distorted. This outcome is unlikely to occur when implants are placed in a submuscular plane and postoperative exercises are performed. Infection following breast augmentation occurs in less than 1% of individuals. Bleeding following surgery also occurs in few than 1%. Other very rare complications include implant malposition or extrusion.

  • Which approach is best for implant placement?

    By far the most common approach in Southern California is via a periareolar incision. This is an incision created at the juncture of the pigmented areolar skin and the breast skin. This incision heals with an inconspicous or nearly invisible scar. Some physician have attributed a slightly higher incidence of capsular contracture to this approach. An incision beneath the breast (inframammary fold) is also an option. This is an acceptable approach, but may leave a visible scar in the breast crease. An axillary (armpit) incision is also frequently chosen. The axillary approach will facilitate the use of only small volume silicone implants. Saline implants of any size can be placed through the axilla. The recovery time for this approach tends to be slightly longer than other approaches.

  • How long is the recovery time for breast augmentation?

    Generally, most women are able to return to work 2-3 days following augmentation. Return to a full exercise routine my be accomplished in about 3-4 weeks. Following surgery, patients return home and can function with some restrictions including no heavy lifting.

  • Is breast augmentation painful?

    Women often equate breast augmentation pain to muscle soreness following vigorous exercise. The discomfort is easily controlled with pain medications which are prescribed prior to surgery.

  • What follow up is required following breast augmentation?

    It is ideal to see patients at one day and one week following surgery. After these appointments, follow up is tailored to each patients needs.

  • What care is required following surgery?

    Antibiotics and pain medications may be necessary for several days. Implant displacement exercises are begun 1-2 days following surgery. Patients must avoid lifting more than 15 pounds for about 1 week.