Choosing the Right Surgeon

It can be a daunting task to find a surgeon who can meet your precise expectations and goals for your breast augmentation. 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 beautiful results.

As an award-winning renowned plastic surgeon, 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 augmentation results to look or feel, but as one of the top plastic surgeons in Los Angeles, California, Dr. Neavin can help you feel confident about the aesthetics you choose and guide you toward understanding your options.

Implant Choices for your Breast Augmentation


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 look for your form. The material you choose for your breast augmentation procedure will often dictate the shape, texture and consistency of your look, which will further enhance your body.

The shape, or profile of the implant that you or your surgeon decide will influence projection and cleavage for your breast enlargement. That is, size is only one important consideration when it comes to customizing your end look.

Saline, silicone, and gummy bear implants are all capable of adding volume, but they each have their own unique advantages and disadvantages that are important to examine.

Saline

Filled with a sterile saltwater solution that adds fullness. While not popular for the majority of breast enlargement procedures, they are still an option depending on the patient’s desires.

Silicone and Gummy Bear Implants

Silicone implants are composed of a thick gel that takes the form of the natural breast; gummy bear implants are an offshoot of silicone, which have even greater cohesive qualities. Form-stable implants are yet another type of implant which may feel more firm.

Best Areas of Incision to Achieve Natural Results

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 only.

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

  • Smooth implants will drop more readily and are less likely to ripple.
  • Textured implants integrate better with the natural 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 plastic surgeons) are equal. Breast procedures requires precise measurements to achieve a desired result. That’s why choosing Dr. Neavin as your surgeon will provide you the best breast augmentation Los Angeles has to offer.

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 implant less desirable for many.

In addition, the anatomical ones cost more money. Discussions about shaped implant and their risks must be addressed in detail before surgery.

Your 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 for your breast augmentation procedure. Although he uses all methods for the purpose of fulfilling your individual goals, Dr. Neavin prefers to place incisions either underneath the fold or around the areola since these approaches provide the most direct dissection to the pocket yielding the most precise implant placement.

Candidates


Dr. Neavin recommends breast augmentation for women who lack additional fullness in their chest.  However, many women who already have reasonable 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 size or shape, it’s essential to consider the options available with plastic surgery. To help you weigh the pros and cons of the procedure, Dr. Neavin will suggest an individual consultation to help you learn more about the breast enlargement methods available.

Dr. Neavin will guide you through your implant choices, incision 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 breast enlargement surgery.

Achieving Balance & Beauty Through Proper Consultation


Surgery Details

There are several ways to insert breast implants, and the method chosen quite often has to do with one’s anatomy as well as surgeon preference for breast augmentation procedures.

The transumbilical approach, or TUBA, requires that a surgeon place the implant through the belly button, which means that the implant must travel from the abdomen to the chest.

The TUBA technique is therefore performed blindly. There is little reference to how the implant travels under the skin.  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. This  may increase the chances of implant malposition.

Transaxillary Breast Augmentation

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 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 come “empty” and are filled once inside the body, unlike their silicone cousins which come filled with silicone.

Breast Fold (Inframammary Incision): Dr. Neavin prefers this incision for most breast procedures.  He places the incision just a few millimeters above the breast fold.  The incision at this location will results in the scar just above the fold, on the under-surface of the breast.  This will allow women to wear virtually any type of bikini without exposing the scar.

The incision in this area generally heals very well.  It is well hidden.  Revisions in this area are made easily.  However, it is rare that a patient desires a scar revision from the inframammary (IMF) incision.

Periareolar Incision: The periareolar incision refers to the incision that extends from 4 to 8 o’clock along the border of the areola.  The incision is placed where the dark skin meets the light skin.  In women with dark skin, this incision may yield a dark raised scar.  There are few advantages to this incision.  The main one is that it provides now additional scars if combined with other procedures.

breast augmentation incisionsTUBA , TRANS-AXILLARY, IMF (inframammary fold), PERI-AREOLAR

Breast Augmentation Scars

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 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.

Potential Complications


Capsular contracture is a condition in which the tissues around the 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 when undergoing breast augmentation 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 from surgery 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 breast implants.

Risk Factors

Other breast augmentation risk factors 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 cases between saline and silicone are small, it is not zero. Of either saline or silicone, smooth implants have a higher case rate that textured ones.

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. That is, textured implants have a lower case rate than smooth implants.

Implants placed under the muscle have a lower chance 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) has also has a lower chance. 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.

Bacterial Contamination

Women who have had plastic surgery 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 implants have 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.

Treating Capsular Contracture

Unfortunately, antibiotics alone 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 rate, or even reverse mild cases. But ultimately, surgery is necessary in advanced cases.

Surgery for Capsular Contracture

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 should see their plastic surgeon every year. Plastic surgeons can often identify a capsular contracture before the patient. Revision surgery can be very expensive. Sometimes new implants need to be purchased or an acellular dermal matrix product needs to be incorporated.

Dr. Neavin tries to use the inframammary approach for his breast augmentation surgeries 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.

capsular contracture

ABOVE: GRADE 4 CAPSULAR CONTRACTURE

capsular contracture revision

ABOVE: CAPSULECTOMY WITH IMPLANT EXCHANGE

Preventing Capsular Contracture

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.

Infection

Fortunately, infections after surgery are rare events.  If they do occur, most are treated with antibiotics and resolve.  In cases where the implant itself becomes infected, the implant may need to be removed.  After waiting at least 3 months, the implant generally can be replaced.

Bottoming Out: Bottoming out refers to a descent of the implants below their normal position. The breast implant should sit directly behind the nipple. The implant usually starts off too high after surgery.  Over time, the implant drops to a position that is ideal.  The breast fold generally supports the implant.  In some cases the implant drops below the fold and creates a new, lower fold.  Bottoming out is often seen in very large breast implants that are not supported after surgery.

Early stages of bottoming out can be corrected with certain bras. Advanced cases must be corrected with surgery. Surgery entails the creation of a new fold.

Visit Us at our Los Angeles Office for Your Consultation


If you are interested in discussing your options for a breast augmentation procedure, please don’t hesitate to contact Artisan of Beauty© at: 310-858-8811.

I am so happy to find Dr. Neavin after moving to Los Angeles, he is AMAZING!!! He is a true artist and a very skilled Plastic Surgeon! I went with gummy bear breast implants and I had my breast augmentation done with Dr. Neavin. I am very happy with my new breasts and I am extremely pleased with my breast augmentation results and continue to go to him and send ALL of my friends and family! He is extremely kind, takes his time with patients and is very honest! In my opinion, he is the best plastic surgeon!!!!

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