Breast Augmentation in Manhattan and New Jersey

Breast Augmentation with Implants

Many women feel their breasts are too small, too large, are unsightly and asymmetric, or droop. Procedures such as breast augmentation with implants, breast reduction, and breast lifting are helpful in improving the appearance of the breasts. I perform breast augmentation in a hospital or surgicenter in New York or New Jersey.

Breast Augmentations increase the size of the breasts. Incisions are made in the creases under the breasts and pockets are created either under or over the pectoralis muscle and either silicone rubber implants inflated with sterile saline (salt water) or silicone gel are inserted. The incisions are then repaired, using sutures that do not leave cross marks.

In most cases, the results are natural. The patient satisfaction rate is very high.

The Dual Plane Technique

I usually place breast implants with the “DUAL PLANE TECHNIQUE”. In this procedure the implant is placed partially under the muscle and partially over the muscle. Conceptually, it may be difficult to understand. However, the important thing is that the operation preserves the ability to have a breast lift in the future and it also decreases the likelihood of seeing implant wrinkles. Upper breast bulging is also less likely. If you are not planning on having more children and if your breasts do not droop significantly, you may be a candidate to have your implants placed in front of the muscle. This procedure has the added advantage of significantly less pain after surgery.

Silicone Gel and Saline Implants

After a 14 year ban, silicone gel breast implants were approved by the FDA for cosmetic and reconstructive reasons. The new versions of silicone implants are better than the old ones.  They feel more natural than saline and have less wrinkling. On the other hand, the incisions are longer and rupturing is still an issue. During your consultation, I will discuss the various options open to you.

“Gummy Bear” implants are the new silicone breast implants that are "game changers" in cosmetic breast surgery. I’ve been using them for a few years and they are a huge improvement over prior generations of implants.  These implants are placed through incisions in the crease and are usually, but not always, placed under the muscle.  There is a lower chance of rupture and scarring around these implants.

Motiva Implants are the newest development in breast augmentation. These implants are technically "smooth" and have never been linked to the problems of the textured implants. But because of a marvel of engineering, the implants also have technical characteristics that allow them to hold their position in the chest better, giving a more natural result.

Are Implants Safe? A good question. Silicone gel implants were taken off the market in 1992 because they were thought to be unsafe. The implants ruptured and leaked gel. Many women and attorneys claimed that the implants caused diseases such as rheumatoid arthritis or scleroderma. In fact, over the last decade, there have been a number of studies looking at thousands of women with implants. Women with and without implants were compared for the presence of any disease. No diseases were found to be increased in women with implants. The gel implants certainly are problematic in that they can leak. Gooey gel spreads throughout the chest wall requiring a complicated surgical removal. There have been a very small number of lymphomas that appear to be caused by textured implants. While the FDA has not taken these off the market, I no longer recommend textured implants. I also recommend MRIs of the breasts to be sure there are no abnormalities. (More on this a few paragraphs down.)

The two types of implants currently available are silicone/saline implants and silicone gel implants. Saline implants have the advantage of not having silicone gel that can leak. The main disadvantage of saline implants is that they feel abnormal in many women. Saline has the consistency (or viscosity) of water and gel implants have the viscosity of breast tissue. Because of the low viscosity, the implants might show wrinkles. Not everyone has this problem - it is most common in very small breasted women with stretched out breasts who have had textured saline implants placed.

The advantage of saline implants is the fact that if they leak, no gel spreads. In addition, the incision required to place these implants is half the size required for gel implants. You can have saline implants at age 18, but have to wait until you’re 22 to receive gel implants (interesting FDA logic!).

All implants block mammograms. This is a major problem and will require the patient to undergo costly MRI studies in order to be see the breast tissue. My recommendation is to have MRIs of the breasts every other year, alternating years with digital mammograms. Your health insurance will not pay for the MRIs. If you can not afford the fees for these tests, you simply should not have a breast augmentation.

A note about fat grafting into the breasts...

Fifteen years ago, this procedure was considered malpractice. Now, the practice is commonly performed. However, I DO NOT BELIEVE THIS IS UNIFORMLY SAFE and will not do this procedure. Here's my reasoning:

During a fat grafting procedure, fat is suctioned from your belly or hips.  It is purified and reinjected into the breasts to make them larger or to hide imperfections. In order for this fat to survive, blood vessels must grow into it within 3 days. And for about a month, any touch to the grafted area will disrupt those new blood vessels and kill the fat. Tiny amounts of fat have a chance of surviving, but when large amounts (more than an ounce or so) are injected, most of it will not survive long term. You won't know that for many months, if not years, because the dead fat sits in your breast much the same way wrinkle filler like hyaluronic acid would. But eventually that fat breaks down into oily cysts. Some of it will scar and calcify. If this were your buttocks, we would only be concerned with cosmetic appearance.  But in the breasts, a tissue with a 13% lifetime chance of developing cancer, you rely on examinations and mammograms to stay safe and detect early disease. In fat grafted breasts, oil cysts feel lumpy and calcified tissue may look like cancer. Both of these situations demand a biopsy to be safe. In addition, there is some evidence that fat grafted into breasts may actually stimulate the formation of cancer.  All of these issues may or may not be proven over time, but there's enough questions to cause me to never inject fat into breasts.

On the other hand, I commonly inject small amounts of fat into lips and faces and cellulite and have been doing so since the 1980s. There issues are not the same in these areas.