Because breast augmentation surgery is highly customizable, it can be a daunting task to find a surgeon who can meet your precise expectations and goals. Even after you decide how large you’d like to go or the type of breast implant you desire, you still have to find a highly qualified and experienced plastic surgeon who can provide natural and beautiful results.

As an award-winning, renowned plastic surgeon for breast enhancement, Dr. Neavin understands how to craft results that are personalized for the contours of your body. There are multiple factors to consider when deciding exactly how you would like your breast implants to look or feel, but as one of the top breast surgeons in Los Angeles, California, Dr. Neavin can help you feel confident about the aesthetics you choose and guide you toward understanding your options.

Choosing the Right Breast Implants

You may have chosen your ideal cup size, but what you may not readily consider is the type of implant that will create the perfect breast for your form. The material you choose will often dictate the shape, texture and consistency of your breasts, which will further enhance your body. The shape, or profile of the implant that you or your surgeon decide will influence breast projection and cleavage. That is, size is only one important consideration when it comes to customizing beautiful breasts.

Silicone, saline, and gummy bear implants are all capable of adding volume to the breasts, but they each have their own unique advantages and disadvantages that are important to examine. Saline implants are filled with a sterile saltwater solution that adds fullness. Silicone implants are composed of a thick gel that takes the form of the natural breast; gummy bear implants are an offshoot of silicone implants, which have even greater cohesive qualities. Form-stable implants are yet another type of implant which may feel more firm.

The implant you choose may be smooth or textured, round or contoured, high profile, moderate profile, or low profile. It’s also possible for implants to be placed above or below the pectoral muscle, in a standard or dual plane approach. Additionally, the incision that Dr. Neavin uses to insert your implants will vary and may be located underneath the breast, in the armpit or around the areola. While incisions can be placed through the belly button, termed a TUBA (transumbilical augmentation), this approach is reserved for saline breast implants only.

Many patients find themselves stuck on deciding the right shape and texture for their breast implants. The most popular breast implants used  in Los Angeles are are smooth, round implants. In some other areas of the world, such as Dubai and many places in Europe, the most common implants used for augmentation are textured. But whatever you choose, your anatomy and aesthetic desires must be considered and integrated into the plan properly.

Smooth breast implants will drop more readily and are less likely to ripple. Textured implants integrate better with the natural breast tissue and have a lower chance of developing capsular contracture – but tend to ripple more. It is easy to see that not all breast augmentations (or breast augmentation surgeons) are equal.

The most appropriate shape of your implants often depends on the size and shape of your natural breasts. Women who are flat-chested will benefit from teardrop or anatomical implants due to the additional contour the implant can create on the chest. Teardrop implants, however, risk developing deformity if they rotate, which may require surgical correction. If a round implant rotates, the alteration will not be noticeable. For this reason,  teardrop implants are textured.  However, the risk of rotation makes this particular breast implant less desirable for many.  In addition, the anatomical implants cost more money. Discussions about shaped implant and their risks must be addressed in detail before surgery.

Your breast augmentation results rely on your expectations as well as the amount of existing breast tissue. Other factors include your body type, lifestyle and activity level, as well as Dr. Neavin’s professional opinion. His goal is to see the proper implant size, style, and shape, incision, and surgical approach fit to meet your expectations.

By understanding specifically what you want and what will suit your body, Dr. Neavin can recommend the most ideal technique. Although he uses all methods for the purpose of fulfilling your individual goals, Dr. Neavin prefers to place incisions either underneath the breast fold or around the areola since these approaches provide the most direct dissection to the pocket yielding the most precise implant placement.

Am I a Candidate for Breast Augmentation?

Dr. Neavin recommends breast augmentation for women who lack additional fullness in their breasts.  However, many women who already have reasonable breast volume desire to increase their cup size or “perkiness”.  Whether due to natural aging, genetics, pregnancy or weight loss, the breasts can sag, lack symmetry or appear disproportionate to the rest of body.

If you are feeling self-conscious about your breast size or shape, it’s essential to consider the options available with breast augmentation surgery. To help you weigh the pros and cons of the procedure, Dr. Neavin will suggest an individual consultation at his Los Angeles  or Dubai office to help you learn more about the methods available.

Dr. Neavin will guide you through your implant choices, incisional techniques and placements. With a physical examination and measurements of your bust, he can suggest a cup size that will look natural while enhancing your appearance.

To gain a better understanding of your ideal outcome, Dr. Neavin may ask you to come to your consultation with photographs of breasts that you like as well as ones that you don’t. The comparison will help Dr. Neavin narrow down the aesthetics you desire and determine the best approach to your surgery.

Beauty Comes From Breast Shape and Symmetry

There are several ways to insert breast implants, and the method chosen quite often has to do with your anatomy as well as your surgeon’s preference. The transumbilical approach, or TUBA, requires that a surgeon place the implant through the navel, which means that the implant must travel from the abdomen to the chest.

The TUBA technique is therefore performed blindly, without much reference to how the implant is traveling, but because the scar is hidden along the abdomen, the approach is desirable to some patients. With a blind insertion, however, the pocket for the implant can be imprecise, which may increase the chances of implant malposition.

The same is true for the transaxillary method, which involves an incision in the underarm. Implantation is, at times, unpredictable due to blind or poorly visualized pocket dissection.

It’s possible only for saline implants to be placed with TUBA approaches.  With  transaxillary methods,  generally only small silicone implants can be placed, as well as all sizes of saline implants.  This is because saline implants come “empty” and are filled once inside the body, unlike their silicone cousins which come filled with silicone.

Although these techniques are beneficial in some circumstances — mostly for the purpose of hiding incisional scars — Dr. Neavin prioritizes creating symmetry between the breasts and forming the most attractive breast shape. That’s not to say that fold and periareolar incisions leave large, visible scars. If performed diligently, the incisions are equally inconspicuous. They also provide direct access to the implant pocket, giving Dr. Neavin more control over the procedure.

There is much to learn about breast augmentation, and the best way to fully understand the surgery is to schedule a consultation at Artisan of Beauty. Call 310‑858‑8811 or text 323‑975‑1287 to begin your journey toward full and beautiful breasts.

Capsular Contracture in Breast Enlargement Surgery

Capsular contracture is a condition in which the tissues around the breast implant become hard. When this happens, the implant can become distorted and the tissue around it, painful. In some cases the pain or deformity is so bad that surgery is required to remove the capsule and or implant. Fortunately, the rate of this occurring is low and there are ways for you and the surgeon to reduce this risk.

There are many theories as to why capsular contracture develops after breast augmentation surgery. The most common etiology is probably bacteria. One of the leading thoughts is that some bacteria either from surgery or even after breast augmentation contaminate the breast implants. The body responds with inflammation in the region that is contaminated. Inflammation can lead to a more aggressive scar response within the breast pocket. For this reason, meticulous care for sterility is the rule when operating. Antibiotics certainly reduce this risk but cannot eliminate it.

Even under the most meticulous circumstances bacteria can contaminate the implants. Other risk factors for capsular contracture after augmentation include the type of implant, the placement of the implant, and the incision used. Silicone may have a slightly higher capsular contracture rate than saline – at least the older generation silicone products, might. While the differences in rates for capsular contracture between saline and silicone implants are small, it is not zero. Of either saline or silicone, smooth implants have a higher capsular contracture rate that textured implants. The differences in the capsular contracture rates  after breast augmentation are likely related to the way that textured implants incorporate into the body.

Surrounding tissues will adhere to the textured implants but not a smooth implant. This may offer more protection from bacterial growth or bio-film development. Breast implants placed under the muscle have a lower capsular contracture rate than those placed over the muscle, in what is called a sub glandular position. This is likely a result of the mechanical massaging that occurs when an implant is placed below the muscle. Massaging either manually or from a sub pectoral position can break up scar formation around the implant as it develops. This can keep them soft and can again, reduce but not eliminate the risk.

When an implant is placed around the areola, contracture rate is probably higher. This is likely related to contamination from the gland that often harbors bacteria. An inframammary incision  (fold incision) breast augmentation has a lower capsular contracture rate. The armpit or axillary incision probably has a higher capsular contracture than inframmary with a rate similar to the areolar approach. This is probably because the armpit harbors a lot of bacteria, as well.

Another route for bacterial contamination is from dental procedures. Women who have breast implants should take antibiotics before any invasive procedure or dental cleaning. Dental cleaning could theoretically introduce bacteria into the blood. The bacteria from the blood can then attach onto a breast implant. Because a breast implant has no blood supply directly within itself, the bacteria can grow on the shell surface. Again, this bacterial growth can generate inflammation resulting in an exaggerated internal scar formation that is recognized as a capsular contracture.

Unfortunately, antibiotics often can’t reverse a capsular contracture in advanced stages. Certain cocktails of medications including anti inflammatories or leukotriene inhibitors have been shown to soften the breast and reduce the capsular contracture rate, or even reverse mild to moderate capsular contracture. But ultimately, surgery is necessary in advanced cases.

Surgical removal of the capsule, or scoring or cutting the capsule in addition to medical therapy, have also been shown to offer benefits. Like most things in medicine, the earlier it is treated, the better the outcome. For that reason women with breast implants should see their plastic surgeon every year. Plastic surgeons can often identify a capsular contracture before the patient. Breast implant revision surgery for capsular contracture can be very expensive. Sometimes new breast implants need to be purchased or an acellular dermal matrix product needs to be incorporated.

Dr. Neavin tries to use the inframammary approach whenever he can, although there are times when armpit or areolar approaches are superior choices. Textured implants are used when its benefits outweigh the risks. Textured implants can cause rippling in thin women and may not “drop” like their smooth cousins.

Dr. Neavin spends extra time during surgery to re-prep the surgical field before implantation, changes into new, fresh sterile gloves, and often uses a Keller funnel to reduce the amount of “potential” contamination when the implant is ready to be inserted. The nipples are even covered with plastic wrap to prevent any ductal contaminant from entering the surgical field.  When it comes to breast augmentation surgery, a little extra time and care during surgery translates ultimately into better results and happier patients.

For more information on breast augmentation surgery, please watch the video or check out the blogs and articles.


Ready to discuss your options? Request a complimentary consultation with Dr. Neavin.

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