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Breast Augmentation (augmentation mammaplasty) is a surgical procedure performed to enlarge the breasts for a number of reasons:
The average plastic surgeon performs about 30 breast augmentations each year. In contrast, Dr. Friedman performs an average of 125 augmentations annually. He has performed well over 2000 breast augmentations.
Breast implant types
Saline-filled breast implants are widely available for breast enlargement. Saline implants are filled with the saline salt water solution used in I.V. fluids. If a saline implant leaks, the saline contents are released and absorbed by the body within hours. Saline (salt water) is harmless to the body. Saline implants are covered with a plastic shell made of solid silicone.
Silicone gel implants were restricted by the FDA in 1992 due to concern regarding possible side effects. They were approved by the FDA in 2006 following many years of study. There remains no conclusive evidence of a link between silicone gel and any autoimmune disease.
Unfortunately, there is no perfect breast implant.
The advantages of silicone gel include:
The advantages of saline include:
The bottom line: from a purely cosmetic standpoint, silicone gel may be a better implant than saline. From a medical standpoint, it is difficult to argue with the safety of a bag of salt water. In women with a reasonable amount of breast tissue and subcutaneous fat, Dr. Friedman feels that saline is a good choice. In women with minimal breast tissue, poor breast tone, and/or minimal subcutaneous fat (and therefore a greater risk for significant rippling with saline implants), silicone gel may be a good choice.
Breast implant position
Implants may be placed above (subglandular) or below (submuscular) the pectoralis major muscle. Dr. Friedman places the vast majority of implants in a submuscular position, as it has the following advantages:
On the downside, placing implants below the muscle requires greater surgical time, effort, and skill and often causes greater discomfort immediately after surgery. In athletes, implants below muscle may sometimes weaken the pectoralis major muscles.
Dr. Friedman performs breast augmentation under general anesthesia on an outpatient basis. The procedure is performed in his AAAASF-accredited surgical facility, the West Plano Plastic Surgery Center, which is located on the campus of Texas Health Presbyterian Hospital of Plano. He strictly uses physicians—not nurses or technicians—to administer your anesthesia.
Most surgeons perform breast augmentation using a technique called “blunt dissection.” They use a blunt instrument or a gloved finger to tear the pectoralis major muscle off the ribs. Then they put in your breast implants. Blunt dissection is fast. (Some surgeons can complete your procedure in less than 30 minutes.) Unfortunately, it causes significant tissue trauma and bleeding and may lead to increased complication rates and reoperations. To reduce bleeding, many surgeons use surgical drainage tubes, compression bras, and/or ACE bandages following surgery.
In contrast, Dr. Friedman uses electrocautery to perform your surgery. This involves use of a thin, long, matchstick-shaped instrument that heat-seals the tissues as they are elevated. This reduces bleeding (Dr. Friedman’s average blood loss is under an ounce), virtually eliminates bruising, and makes drainage tubes, ACE bandages, and compression bras unnecessary. All stitches are internal. There are no stitches to remove. In addition, Dr. Friedman uses “sizers,” which are sterile sample implants, to preview your results before selecting your final implants. These maneuvers add time to the surgery but reduce reoperation rates. It takes Dr. Friedman about 1.5 to 2 hours to perform breast augmentation. He believes that there are no shortcuts to obtaining a good result.
Complication and reoperation rates
According to data submitted to the FDA by breast implant manufacturers:
2% of women undergoing breast augmentation experience postoperative bleeding
2% of women undergoing breast augmentation experience postoperative infection
Dr. Friedman’s numbers are:
According to the same data, among women undergoing breast augmentation with saline implants, 26% underwent further breast surgery within 5 years. Dr. Friedman’s 5-year reoperation rate is 8%.
Many physicians also refer patients to Dr. Friedman for breast implant revision. Dr. Friedman performs revisions to increase or decrease implant size, remove and replace deflated or ruptured implants, soften breasts that have become hard (capsular contractures), and improve breast implant position and shape.
When you visit our office, we will be happy to show you a variety of “before and after” photos of breast enlargements performed by Dr. Friedman. You will also be able to see and feel the differences between saline and silicone gel implants. If you wish to speak to other women who have undergone the procedure, we will be happy to provide phone numbers.Back To Top
Dr. Friedman explains breast augmentation, and a patient describes her experience.
Dr. Friedman explains breast augmentation techniques.
Your implants will probably not last as long as you do. It is likely that one or both of your implants will require replacement at some point in your lifetime due to deflation (saline) or rupture (silicone gel). Most implants will last at least 10 to 15 years. In the absence of an implant-related problem, there is no need to "change out" your implants (i.e. if it isn’t broken, don’t fix it).
Saline implants are filled with sterile saltwater. Upon deflation, the saline is absorbed harmlessly. There is no known health risk associated with deflated saline implants.
The FDA has determined that intact silicone gel implants are safe. However, they have not made a determination regarding the safety of ruptured silicone gel implants. Therefore, the FDA currently recommends that any ruptured silicone gel implant be removed.
Multiple published studies demonstrate absolutely no link between breast implants and the development of breast cancer.
Implants may reduce the sensitivity of mammograms. This is a greater concern for implants placed above muscle than those placed below muscle. In order to better visualize the breast tissues, additional mammography views (such as the Eklund displacement view) are recommended. Of interest, implants may actually make it easier to detect breast lumps on physical exam.
All saline implants ripple. Most surgeons overfill implants (for example, fill a 300 cc implant to 330 cc) to reduce rippling. Overfilling does not compromise the integrity of the implant. However, overfilling a 300 cc implant to 450 cc is not reasonable, as it will make the implant look and feel "hard."
One week before surgery
The evening before surgery
Day of surgery: before you leave home
Day of surgery: at the facility before surgery
Day of surgery: at the facility after surgery
At home after surgery
Instructions for your first postoperative visit (about one week after surgery)
1 Week after surgery: you may resume casual walking but must not engage in vigorous exercise that increases your blood pressure or heart rate. You may resume driving once you are off of your pain medication. Avoid freeways until you are comfortable with city driving.
3 Weeks after surgery: you may resume jogging (with a jog bra) or an elliptical trainer but must avoid vigorous use of your chest or arms.
6 Weeks after surgery: you may gradually resume exercise involving the chest and arms. Only now you may lift more than 5 pounds.
Please sleep on your back (flat or elevated) or part way over (pillow under your shoulder and hip). Do not sleep on your side until about 3 weeks after surgery. Unless otherwise instructed by Dr. Friedman, do not sleep on your stomach until about 6 weeks after surgery.
You have a layer of tissue glue to seal your incision. After this peels off (about 2 weeks after surgery), begin scar massage with Mederma twice daily. Mederma is available at our front desk or over-the-counter at your pharmacy. If you prefer, you may use Vitamin E or Aloe Vera. Continue scar massage for about 3 months.
Breast exercises and bra usage
Your implants are high and tight, as expected. Dr. Friedman will instruct you on exercises to mobilize the implants (usually up and in) until they have softened and settled to some degree. Final settling will take about six months. Once you feel that the implants are no longer "way too high," you begin use of a bra to reduce further downward settling of the implants. If you have an incision in the breast crease, you should avoid an underwire bra for at least 3 months. Even after the implants have settled, you should push them up and in about 2 to 3 minutes per week (for the rest of your life) to help keep them soft.
You may begin light showers but should avoid scrubbing your incisions. Do not immerse your breasts under water in a bathtub for 4 weeks. Avoid immersing your breasts in a pool, lake, or ocean for 6 weeks.
One week after surgery, you may resume use of any medications or supplements that you discontinued prior to surgery. However, for at least 3 weeks, you should avoid Motrin, aspirin, and any other product that may thin your blood.
Do not smoke for at least one month (and preferably much longer) after surgery. Smoking may increase your risk of infection, lung problems following anesthesia, and wound healing problems.
You may tan your breasts whenever you like. However, you should avoid tanning directly over your incisions for at least 6 months. Premature tanning of the incisions may cause them to darken permanently.
You may resume intercourse in a non-weight bearing position (i.e. on your side) about 3 weeks after surgery. You may not bear weight on your chest for at least 6 weeks.
Avoid dental cleanings/fillings for 6 weeks, as bacteria in your gums can be transmitted to your implants via your bloodstream.
Please feel free to ask Dr. Friedman or his staff about any additional questions or concerns.
Plano breast surgery physician, Dr. Ronald M. Friedman, is one of the top 10 breast implant specialists in the Dallas Fort Worth (DFW) area. D Magazine has repeatedly selected Dr. Friedman as a "Best Plastic Surgeon" in both Dallas and Collin County. Texas Monthly Magazine named him a "Texas Super Doctor" for four consecutive years. He has more than 17 years of experience and is board certified by the American Board of Plastic Surgery (ABPS). Dr. Friedman is also a member of the American Society of Plastic Surgeons (ASPS), the Texas Society of Plastic Surgeons (TSPS), and the American Society for Aesthetic Plastic Surgery (ASAPS). Furthermore, Dr. Friedman is the former Chief of Plastic Surgery at Parkland Memorial Hospital, has made various media appearances that include FOX-4 TV, abcnews.com, and the "Dallas Morning News," and has earned multiple awards.
Many women with small, drooping, and/or asymmetric breasts turn to plastic surgery in order to achieve a more aesthetic appearance. Those who wish to undergo breast augmentation in Plano may consult Ronald M. Friedman, M.D. of the West Plano Plastic Surgery Center. Located on campus at the Presbyterian Hospital in Plano, patients are provided with quality care in a safe environment. He also has a Flower Mound office for your convenience. Prospective Plano and Frisco breast augmentation patients may view before and after plastic surgery photos to see examples of Dr. Friedman's results. To gain insight to the care provided at the West Plano Plastic Surgery Center, patient testimonials are available. Q&As and educational videos provided offer further breast surgery information. Every year in the thriving southern metropolis of Plano, thousands of women choose to have breast enlargement surgery. As an experienced plastic surgeon, Dr. Ronald Friedman performs breast implant procedures in Plano, for both cosmetic and restorative purposes. As a wood and marble sculptor, Dr. Friedman brings an artistic eye to breast augmentation ("augmentation mammaplasty") in order to help patients achieve the look they desire. In addition to breast augmentation, some patients may wish to undergo breast lift surgery ("mastopexy"). This procedure is designed to lift the breasts to a higher position on the chest wall in order to provide patients with a more youthful appearance. Dr. Friedman can perform this surgery with the combination of breast implants surgery or by itself. Dr. Friedman is also well-regarded as a breast implant revision specialist. Read more about breast augmentation from the American Society of Plastic Surgeons.
Those in the Plano and Frisco area who are interested in breast augmentation may call (469) 467-0100 to schedule a complimentary cosmetic consultation. Contact Dr. Friedman regarding your plastic surgery questions about breast augmentation procedures.Back To Top