Many patients come to my practice seeking breast augmentation, and because breast implants in Scottsdale are seemingly ubiquitous, it’s often assumed that it is a “simple procedure.” Plastic surgeons simply create an incision in each breast, insert the implants, and voila! No major organs are involved, so not much can go wrong, right?

Wrong.

While breast augmentation may seem like the most basic plastic surgery procedure, the truth is that in the hands of the wrong doctor, a great deal can go wrong. Choosing a plastic surgeon who is board certified by the American Board of Plastic Surgery can help minimize much of the risks present when untrained, inexperienced doctors or dentists (yes you read that correctly) perform the procedure usually at cut-rate prices. If you want a bargain, check your mailbox or coupon websites, you won’t have to search that far, but buyer beware. I always tell my patients to keep in mind the adage “you get what you pay for” because when breast augmentation is not done properly, serious issues can arise, such as infection, necrosis (tissue death), nipple loss or worse.

Other complications resulting from poorly performed breast augmentation may not be initially apparent and can include: unpleasant looking results due to wrong implant size and/or wrong implant type or incorrect positioning. Even if your augmentation looks good initially, if the surgery wasn’t done correctly, your implants can shift significantly over time. There is also the risk that they can drop or even rupture. Many women come to my practice unhappy, some even despondent, just a short time after they had breast augmentation performed by a non-board-certified doctor. In most cases, they undergo revisionary surgery to fix the mistakes the prior surgeon made the first time around. Don’t let that be you, especially when the cost of going to a plastic surgeon who is board certified by the American Board of Plastic Surgery—the first go around, would have been significantly less in the long run.

Size matters & Beauty is Balance.

If you know anything about me, you know that my focus is always on natural-looking results. My goal is always to have a result that appears natural, beautiful, and balanced. While that is my preference, there are other reasons prospective patients should avoid considering breast implants that are too large for their body type. Implants that are too large can migrate to the sides of the chest over time, creating overly wide cleavage. Sometimes heavier implants will even drop downward. They can also stretch the skin and surrounding tissues so much that they become thin, veiny, or (in the case of “above the muscle” placement) create a rippling effect where the implant can actually be seen through the skin.

These days many in the Phoenix area are getting on board with my natural-looking philosophy and are beginning to become familiar with what’s known as the “bio-dimensional” approach to breast augmentation. With this approach, I take many factors into consideration to help determine what size implants are most appropriate for my patient. Clinical factors such as the width of the chest wall, thickness of breast tissue, skin quality and laxity as well as patient goals are taken into consideration and discussed during patient consultations. It is fairly common for me to elect not to perform surgery on women that want larger implants than I feel comfortable placing.

Silicone VS. Saline

Go Silicone. Over the 20 years that I have been performing breast augmentations, I have seen and tried many different types of implants from several different implant manufacturers. It has become very clear to me which type of implant I prefer– a round, silicone gel implant. This type of implant is the most like natural breast tissue as far as look and feel and is durable with low rupture rates and an exceptional safety profile. These implants don’t tend to “ripple” like saline implants, and I believe they provide a more natural movement than shaped “gummy bear” silicone implants. That said, I always listen to my patients. If you have a preference that differs from mine, I am happy to listen to your needs and desires and see if I am comfortable helping you achieve them surgically. If not, I often can recommend one of my peers who’s philosophy is more aligned with the type of procedure that would achieve your desired outcome.

Beware of T.U.B.A.

T.U.B.A. stands for transumbilical breast augmentation, meaning that implants are placed through an incision in the belly button. You don’t need an expert in anatomy and physiology or have any medical background to fully appreciate how far apart your belly button is from your breasts. And in the world of plastic surgery, the two may as well be miles apart.

The appeal of this technique to many uninformed or unsuspecting patients is this notion that TUBA is a “scarless” procedure. However, there are a number of big negatives associated with this technique, so many in fact that you will be hard-pressed to find any board certified plastic surgeons performing it. First off, it’s very difficult, if not impossible to 100% ensure proper placement of implants when you are inserting them from the belly button area and literally pushing them up to the breast, “violating” the inframammary crease, the area where the breast meets the chest wall. This technique translates to a less-than-natural-looking result. Something else to consider is that secondary or revisionary surgery (which most if not all will need) can’t be done through the “TUBA” technique, meaning when you need additional surgery, you will end up with visible scars anyway. Something else to consider is the fact that only saline implants can be used in a TUBA procedure because the implants must be inserted empty and then filled once they are surgically placed.

We’ve already established that I believe round silicone gel implants provide the most aesthetically pleasing, durable and safest option. I prefer the inframammary approach: a small, two-inch incision on the underside of the breast where minimal scaring remains easily hidden in the crease where the breast meets the chest wall. I also prefer to place the implants in the muscles of the chest wall for the most natural result as well as ease of breast care (mammograms, etc.).

Choose your surgeon carefully. Regardless of what technique, implant type or size you think you want, always, always go with someone who is board certified by the American Board of Plastic Surgery. I cannot stress this enough. Infection, nipple loss, disfigurement and even worse are all very real outcomes for countless women who have chosen the wrong, often cheapest doctor over a legitimate plastic surgeon.

Choose someone who performs breast augmentation on a regular basis. Ask the surgeon for before and after pictures of breast augmentations he or she has performed (some of mine can be seen here). Ask to see pictures of women who look like you in terms of body size and whose surgery, implant size and implant type are as similar to your choices as possible.

Besides general aesthetic appeal, here are some specific things to watch out for in before and after photos:

Rippling. This is when you can see the line of the implant from the side or oblique view. The implant should transition naturally into the rest of the breast tissue with no discernable “line.”

Bottoming out or “double bubble.” This is when the implant slides out from under the natural breast tissue.

Nipple placement. Some combination procedures require surgical repositioning of the nipple, thus one should look for nipple placement that appears natural from both the front and side views.

Asymmetry. Both breasts should be reasonably similar in size, shape, and appearance.

Keep in mind the time specific photos were taken. If they were taken immediately or just days after surgery the breasts may be higher up on the chest and fuller at the top. The most useful photos for prospective patients to view, are those taken several months following surgery.

To summarize, do not fall into the trap that many do— of thinking that breast augmentation is simply a “routine” outpatient surgery. In the right hands, it is indeed a safe and effective procedure, but it’s still surgery. Making the wrong choices during your decision-making process can be disastrous. Value yourself, and commit to doing your homework. Find the right surgeon, set your expectations and communicate openly with them. Surgeons such as myself genuinely want the same things that you ultimately do— safety, fantastic-looking results, and overall patient satisfaction. After all, that’s what aesthetic plastic surgery is all about.

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