Breast Augmentation in Beverly Hills
Dr. Minniti is an expert in performing breast augmentation in Beverly Hills and the surrounding California area.
BREAST AUGMENTATIONS IN LOS ANGELES
Breast augmentation, or breast enhancement, is the most common cosmetic plastic surgical procedure performed today. Although fat transfer has been in the news lately as an alternative to breast implants, the science of fat transfer, along with the use of stem cells, is still in its infancy, and reliable and quantifiable breast augmentation is not yet obtainable by this method. Breast implants are therefore the safest and most effective way to perform breast augmentation.
Also known as augmentation mammoplasty, breast augmentation will make a woman's breasts larger, firmer, and more symmetrical. Attributes that good candidates for breast implant augmentation have include:
- Subjective feeling that your breasts are too small.
- Poorly fitting clothing tops.
- Unwillingness to wear form fitting tops or bathing suits due to feeling self-conscious.
- Loss of breast size, shape or feel due to weight loss or childbirth
- Asymmetry of breast size, where one breast is larger than the other.
To the benefit of the systematic and methodical analysis by John Tebbits, M.D. over the last fifteen years, the breast augmentation experience has been improved by advances in all the processes that make up breast augmentation, including patient education and informed consent, clinical evaluation of the patient, preoperative planning, implant selection, surgical techniques, and post operative care. Gone is the need for tight wraps, straps, or special bras, drains, pain pumps, narcotic pain medication, muscle relaxants, ‘implant massage’, or restricted normal activities. The ultimate result of these changes has led to a vastly improved patient experience and a dramatic reduction in the risk of reoperation from a national average of 25% in three years to 3% for those surgeons that employ these streamlined process oriented improvements.
During your consultation, a priority will be placed on patient education and informed consent. Crucial to providing the lowest risk and highest satisfaction outcome is your understanding of the risks, alternatives, and benefits to proposed breast enhancement the surgery and how choices made can in implant size, shape, or projection. A full medical history will be obtained which includes any medical conditions, medications, allergies and previous surgeries. Breast cancer history will be discussed, as well as potential benefits of a mammogram discussed. Lifestyle history will also be obtained including work place activity, general activities and exercise, drug and alcohol use, and smoking.
A physical examination will be performed that will assess your body type, chestwall shape and size, breast width, tissue thickness of breasts, tissue elasticity, breast shape, and nipple position relative to the inframammary fold. This examination is crucial in determining breast implant size, shape and projection.
BREAST IMPLANTS IN BEVERLY HILLS
Since November of 2006, silicone gel implants have been approved by the FDA and released for use in primary cosmetic breast augmentation. This now gives American women the choice not available to them since 1992.
The primary advantages to silicone gel implants are their more natural feel, with less risk of rippling or wrinkling that is common in saline filled implants, especially in thinner women with minimal breast tissue. Silicone gel implants are also more durable than saline implants, decreasing the likelihood of a secondary surgery for implant leakage (rupture), especially in the first ten to fifteen years.
There are some disadvantages to silicone gel implants, however. When a silicone gel implant ruptures, it is ‘silent’, and there is no change to the appearance of the breast (unlike the deflation seen with a saline implant). Therefore, silicone gel implants should be monitored using either ultrasound or magnetic resonance imaging (MRI), at some time after surgery. When to perform this exam is an individual choice made by the patient and her surgeon. Because silicone gel implants are filled and sealed at the factory, they require incisions on or near the breast for placement, in contrast to incisions that can be placed in the belly button for saline implants. Finally, silicone gel implants are three times more expensive than saline filled implants.
Implants come in a variety of ‘shapes’, from traditional round to the teardrop, contoured, or anatomic types. In general, the non-round implants are oval, being taller than they are wide, with their most projecting point located toward the lower portion of the implant. Because these implants can rotate, affecting it’s positioning, and because they offer no advantage to a ‘natural’ look, most surgeons use round implants almost exclusively.
Implants come in a variety of projections, thereby affecting their overall width and height for any given volume. This allows the surgeon the ability to match a particular implant to the size of the patient’s chest wall and breast dimensions. The surface of an implant can be smooth or textured the latter most common in non-round or teardrop implants. In general, most surgeons utilize smooth implants because their walls are thinner, making it less likely to feel rippling or wrinkling once surgically placed.
There are four potential incisions that are available for placement of breast implants in Los Angeles. The periareolar or nipple incision is most commonly thought to decrease nipple sensibility, which is not true. (In fact, nipple sensibility is most affected by the size of the implant). It tends to heal well with an inconspicuous scar. The quality of scarring cannot be determined beforehand, however, and therefore there is uncertainty of its ultimate appearance.
The inframammary incision is also very commonly performed, yielding a scar in the crease below the breast (if there is a crease). This and the periareolar incisions are utilized most for silicone gel filled implants because of their proximity to the breast for ease of placement.
The armpit or transaxillary incision is a remotely placed incision primarily used for saline filled implants. Some surgeons use this site for placement of silicone gel filled implants, but requires an incision that is slightly larger than the usual inch and one half. Surgery can be performed with or without an endoscope or television camera. The bellybutton or transumbilical or TUBA incision is only for saline filled implants. It is the only technique yielding a singular incision, utilizing the one incision for both breasts. Few doctors are adequately trained or have enough experience for this surgery. There are many misconceptions regarding this surgery, propagated by both patients and doctors too. In the right individual, this is an excellent way of placing implants.
Although there are many different names for the locations implants are placed, there are really only three potential places that exist: below the breast (subglandular), below the pectoralis muscle and gland (subpectoral or dual plane), and below all the chest wall muscles (submuscular), the last being the least common.
There was a tendency for surgeons to place silicone gel implants in the subglandular position prior to and during the early days of saline filled implants. The imposed restrictions on silicone gel implants in 1992 gave surgeons more experience with saline implants and their more pronounced tendency to wrinkle or ripple. This prompted surgeons to place implants into a submuscular or subpectoral position, giving the saline implant more tissue coverage with a better look and feel.
Today, there is a general consensus that implants placed under the pectoralis muscle look and feel better, and have a lower risk of abnormal scarring called capsular contracture compared to implants placed in the subglandular position. Regardless of this, there are some doctors who prefer the subglandular position for implant placement.
The issue potential breast augmentation patients worry over the most is ‘how big are my breasts going to be?’ Most patients are worried that their breast augmentation will be too big, and they will look out of proportion. The reality is that after surgery many women wished they had bigger implants!
Unfortunately, there is a significant increase in risk of complications, both short and long term, with placement of implants that are too large for the patient’s breast and chestwall dimensions. Worse, some of these complications can be difficult or impossible to correct. The most important parameter for the surgeon and patient to consider is the matching of the base width of the breast with the width of the implant to be used. By keeping the diameter of the implant equal to or less than that of the breast, the risk of many complications can be minimized. Other very important parameters include skin pinch thickness in upper and lower poles of the breast, and skin stretch at the nipple, and nipple to inframammary fold distance under stretch.
PREPARATION FOR SURGERY
The risks, alternatives and benefits of breast augmentation surgery in Beverly Hills will be discussed by Dr. Minniti and again separately by his consultant. Ample time will be given for your questions, so that you will feel perfectly comfortable about your decision to proceed. Remember, this is the beginning of building a long and trusting relationship with your surgeon.
Please view before and after photos of Dr. Minniti's past Beverly Hills and Los Angeles breast augmentation patients.
In rare instances a mammogram may be indicated, but is unlikely based on the data from the United States Preventative Task Force recommendations in 2009. If you are a smoker, you will be asked to stop well in advance to decrease the risk of poor healing and infection, increased bleeding and bruising, and abnormal scar formation (capsular contracture). A list of medications to be avoided will be provided, including aspirin (Excedrin, Buffrin), ibuprofen (Motrin, Advil), and naprosyn (Aleve). Other instructions will be provided as well.
The surgery is performed in a fully accredited outpatient surgery center located in the same building as Dr. Minniti’s office. A board certified anesthesiologist will provide general anesthesia, which is the safest type of anesthesia. After your surgery, you will be taken to the recovery area and closely monitored. You will be permitted to go home after about an hour.
There is usually minor pressure and stiffness experienced by most patients immediately after surgery that is managed well with ibuprofen or Motrin. The patient is placed only in a bra, and told to move her arms above her head that evening. Most patients are driving in 2 to 3 days, and feeling back to normal in two weeks. Most people begin light exercise then, and resume their regular athletic routine by 2 weeks.
Your breasts will be minimally swollen but have no bruising. They may appear very high or full on top, but over the course of weeks to months your breasts will drop, soften, and take a very pleasing shape.
Follow up visits are important and initially scheduled for one day, one week, and one, three, and twelve months after surgery. Additional visits are made as necessary.
A breast augmentation in Beverly Hills will make your breasts fuller and enhance their shape. You will find it easier to wear certain styles of clothing, and like many women, have a boost in self-confidence.
The results of your breast augmentation surgery will be long lasting. However, implant deflation, the effects of gravity, and aging will eventually alter the size and shape of your breasts. If after a period of years you become dissatisfied with the appearance of your breasts, you may undergo a breast lifting procedure to restore their more youthful contour.
CONTACT OUR OFFICE
To contact the Beverly Hills Breast Augmentation Specialist, please call our office at (310) 275-0040 or send us an e-mail. Dr. Minniti would be happy to meet with you to discuss your breast enhancement goals and the cost of breast implants in Beverly Hills.
Dr. Gerald Minniti