Breast augmentation provides improved volume, cleavage, and upper breast fullness in women with naturally small breasts or volume loss from pregnancy, weight loss, or aging. Breast augmentation can also provide improved self-image, clothing choices, and confidence.
With 30 years of experience as a wood and marble sculptor, Dr. Friedman finds that breast enhancement surgery comes naturally. The average plastic surgeon completes about 35 breast augmentations per year. In contrast, Dr. Friedman performs about 130 augmentations annually. Since 1996, he has placed over 5000 breast implants.
Silicone gel implants were approved by the FDA in 2006 following many years of study. The FDA temporarily restricted their use in 1992 due to concern regarding possible side effects. There remains no conclusive evidence of a link between silicone gel and any autoimmune disease. Approximately 85% of breast implants currently placed in the U.S. are silicone gel.
Saline-filled breast implants are filled with the salt water solution used in I.V. fluids. If a saline implant leaks, the harmless salt water contents are released and absorbed by the body. Saline implants are covered with a plastic shell made of solid silicone.
Unfortunately, there is no perfect breast implant.
Advantages of silicone gel:
Advantages of saline:
The bottom line: From a purely cosmetic standpoint, silicone gel is probably 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 either saline or silicone gel 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 better choice.
Determining the "right" breast implant size can be a major challenge.
Let's discuss the most frequent methods and their pitfalls.1. Going by bra cup size: "I’m an A cup, and I want to be a full C cup."
The problem: There is no standardization of cup size among bra manufacturers. A Playtex B is frequently a Victoria’s Secret C. A woman who fits a 34 D cup may also fit a 36 C. So cup size is imprecise, at best, and sometimes closer to a guess.
It has become popular among breast implant surgeons to measure the width of the base of the breast, find an implant with the same diameter (based on a chart provided the implant manufacturers), and then tell the patient that this is the magical "right size."
The problem: Although this is reasonable anatomically, your desires regarding breast size are much more important than the manufacturer’s or the surgeon’s. While a surgeon can and should provide guidance regarding implant size, the ultimate choice should be yours. If your “right” size is different from his, your surgeon should be flexible (rather than mindlessly following his breast diameter chart).
This is great for marketing purposes. You get to "try on" different implants until you find the right size.
The problem: The actual implants go under the breast tissues, not over them. Superimposing the implants on top of your breasts creates a snowman effect (one sphere stacked on top of the other), which exaggerates the projection of the breasts relative to what will actually happen in the operating room. Women commonly choose implants that are smaller than they actually wanted.
Dr. Friedman thinks in terms of implant volumes: 330 cc, 360 cc, 390 cc, etc. You think in terms of cup sizes. Neither of these allows effective communication. So Dr. Friedman uses the one thing that both you and he can see: photos. Although no sizing method works perfectly, photos work better than anything else we have tried.
You can choose among the before and after photos of breast augmentations on our website, among the hundreds of photos in our office photo albums, or among any photos from any magazine or internet site. Although you might not know the cup size of the women you choose or the number of cc's, it really doesn't matter. You simply look through breast photos and categorize them as "too big," "too small," or "about right." We will analyze the photos with you. Dr. Friedman believes that there is a range of acceptable sizes, rather than a specific “correct” size.
As long as your photo choices are reasonable for your frame, the choice of breast implant size is yours.
Implants can be placed either above (subglandular) or below (submuscular) the pectoralis major muscles.
ADVANTAGES OF SUBMUSCULAR (BELOW MUSCLE) POSITION:
ADVANTAGES OF SUBGLANDULAR (ABOVE MUSCLE) POSITION:
The bottom line: Dr. Friedman places nearly all breast implants beneath the pectoralis major muscles. He feels strongly that this leads to better long term results in most women. He even published an article about this in Plastic Surgery Practice, a national plastic surgery journal: plasticsurgerydallas.com/one-surgeons-opinion.php#news
Beyond implant size and contents (saline or silicone gel), multiple other variables affect breast implants.
Breast implant profile
The profile of a breast implant describes the ratio of the projection of the implant (how far it sticks out) to the diameter of the implant (how wide it is).
Implant Profile• Low Profile
Implant projection• Small
Implant diameter• Wide
In most women seeking augmentation, a moderate or moderate-plus profile breast implant (moderate projection, moderate diameter) provides the most natural look. This is Dr. Friedman’s preference in the vast majority of breast augmentations.
However, in women with narrow chests who desire very large implants, a high profile breast implant (large projection, narrow diameter) may be a reasonable choice, though it may project enough to look a little artificial.
In rare patients who have a wide chest wall and desire a small implant, a low profile breast implant (small projection, large diameter) may be worth consideration.
Breast implant shape
Dr. Friedman exclusively uses round breast implants. They accentuate the fullness of the upper breast by equally augmenting the upper and lower breast.
Teardrop or anatomical breast implants preferentially enlarge the lower breast, providing less volume along the upper breast. If a teardrop implant rotates, it distorts the shape of the breast. (If a round implant rotates, breast shape remains unchanged.)
Breast implant surface
All saline and silicone gel breast implants have an outer shell that is made from solid silicone. As the name implies, smooth implants have a smooth, slick surface. Textured implants have a rough, clingy surface.
Right after breast augmentation surgery, almost all breast implants look too high and too tight. Smooth breast implants are "slippery," and their weight will cause them to settle after surgery. This is desirable when the implants are below muscle, assuming the pectoralis major muscles have adequate bulk to hold up the implants. Textured breast implants tend to cling to the surrounding tissues,. As a result, textured implant are more likely than smooth implants to remain too high and tight on a long term basis. Dr. Friedman limits their use to women whose tissues provide inadequate implant support.
Recent FDA data suggest an association between textured implants and the development of a rare cancer, called breast-implant associated anaplastic large cell lymphoma (BIA-ALCL). No such association has been definitively established for smooth implants.
For these reasons, Dr. Friedman uses smooth breast implants in approximately 97% of his breast augmentation patients.
Dr. Friedman performs an average of 130 breast augmentations annually (vs. about 35 for the average plastic surgeon), and he has been in practice for well over 20 years. He has placed over 5000 breast implants.
Beyond his decades of experience as a plastic surgeon and wood and marble sculptor, before-and-after results, and outstanding patient reviews, here are some important reasons to choose Dr. Friedman for your breast augmentation:
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.
Most surgeons “release” the pectoralis major muscles by cutting the entire lower portions in half to accommodate the implants. This frequently results in excessive descent or “bottoming out” of the breast implants in the months and years following surgery.
In contrast, Dr. Friedman releases little or none of the pectoralis major muscles in most women. A largely intact pectoralis major provides better implant support and “perkier” long-term results.
Most surgeons choose implant size based on dimensional charts from implant manufacturers or based on women “trying on” sample breast implants. Neither of these methods works particularly well.
In contrast, Dr. Friedman encourages you to choose photos of women with the breast size you desire. After creating “pockets” for your implants, Dr. Friedman places “sizers,” which are sterile sample implants, and temporarily sits you up on the operating table (while you are asleep under anesthesia). This enables him to preview and adjust your results before selecting the implants that best match your anatomy and the photos of desired size that you have chosen.
These technical modifications add time to the surgery. But they provide improved results and reduced complication and reoperation rates. Dr. Friedman looks at it this way: “It may be a couple hours out of my life, but it’s the rest of yours.”
Your safety is our highest priority.
Unlike the vast majority of surgeons who claim that they can “sculpt” your breasts, Dr. Friedman is actually an experienced and respected wood and marble sculptor whose work has been displayed in galleries and is part of many private collections. He was an accomplished artist well before he attended medical school. For Dr. Friedman, breast and body contouring surgery represents the synthesis of his talents as an artist and a plastic surgeon.
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 breast augmentation, we will be happy to provide phone numbers.
Your anatomy. Regardless of your breast size, you can probably look at your breasts in the mirror and see whether they are close together (figure 1) or far apart (figure 2). The distance between your breasts before surgery strongly influences the distance between your breasts after surgery.
Figure 1: More cleavage before surgery--and after surgery.
Figure 2: Less cleavage before surgery--and after surgery.
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
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 at least 3 weeks after surgery. Unless otherwise instructed by Dr. Friedman, do not sleep on your stomach until about 6 months after surgery.
You have a layer of tissue glue to seal your incision. After this peels off (about 3 to 4 weeks after surgery), begin scar massage twice daily with Prosil (available at our front desk) or Recedo (available by prescription). 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. Please avoid an underwire bra for at least 3 months, as it may irritate your incisions. Even after the implants have settled, you should push them up and in about 2 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, wound healing problems, breathing problems following anesthesia, and blood clots.
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 any weight on your chest for at least 6 weeks and should avoid full weight bearing on the chest for 6 months.
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.