Breast Augmentation Surgeon in New York

Serving Manhattan, New York City (NYC), and greater New York

Breast Augmentation Before & After Gallery

The Breast Implant Operation

Your augmentation mammoplasty (breast augmentation surgery) operation can be done in an office or hospital operating room under general anesthesia or local anesthesia with intravenous sedation. Local anesthesia with intravenous sedation is Dr. Bellin’s preference because there is much less bleeding with local anesthesia and little, if any, nausea after the surgery. It is also a safer method. Your procedure usually takes 1 to 1½ hours. After a short recovery period you can go home with two small bandages and return one week later for removal of your sutures.

While breast augmentation will enlarge your breasts, it will not change basic irregularities in your breast shape or form. Major differences may be improved, but will not be exactly perfect. Minor differences in the size or shape of your two breasts are considered normal, and shouldn’t be a reason for concern. Dr. Bellin’s extensive experience with breast enlargement surgery gives him a proven track record of extremely pleasing results for the majority of his patients who are considered appropriate candidates for breast enhancement surgery.

What Should Happen before I Get Breast Enlargement Surgery?

At the initial consultation, your physician should thoroughly explain the operative procedure, the postoperative course, and the possible risks and complications. And of course you must discuss the size of your desired implant. You should also be shown many before and after photographs of other patients your doctor has treated.

Choices of Incisions

The implants can be placed using one of four options:

• in the breast fold,
• around the nipple, or
• in the armpit (axilla).

Your surgeon may give you a choice of where to place your incision once you understand the implications of each.

In the breast fold: This is Dr. Bellin’s preference since it hides your scar well if it should thicken. It is the most commonly used incision because it provides the easiest and safest approach for your surgeon. Dr. Bellin is able to do your surgery through an incision measuring only one inch.

Around the nipple: This incision often leaves a very thin scar. If not, however, it will be very visible around your nipple. Loss of feeling in your nipple is the main risk of utilizing this incision, and may happen up to 50% of the time.

In the armpit (axilla): This means of access is often used when your implant is put under your muscle, but it can also be used for over your muscle. Dr. Bellin’s feeling is that most people are now aware of the implications of a scar in your armpit area. If your scar thickens, raising your arm on the beach or in a low-cut gown will make it obvious that you have breast implants. This incision location also makes correct placement of your implant extremely tricky. Unfortunately, Dr. Bellin has seen many patients with implants placed too high on the chest using this incision, and he does not use it very often.

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Placement of Your Implant

Your breast implant can be placed:

• behind your breast above your muscle (submammary placement),
• behind your pectoralis major muscle in your chest (subpectoral placement), or
• with your smaller chest muscles covering the implant entirely. This third method is used because your pectoralis muscle does not completely cover your implant. However, this variation is rarely done.

About 60% of plastic surgeons in America place your implant above your muscle. The other 40% place it behind your muscle. Dr. Bellin believes, along with the majority, in placing your implant above your muscle (directly behind your breast) except in extremely rare circumstances.

Submammary Placement

The reasons for Dr. Bellin’s preference for placing your implant over your muscle are as follows.

• It is more aesthetically pleasing. The most important feature of your implant (when done correctly) is that it looks perfectly natural over your muscle. That is, of course, where nature put your breast. Placement behind your muscle often gives you too much upper fullness that not only looks unnatural, but may sometimes cause your nipples to appear to point down. This effect is more likely to happen if your breast implants are placed from an incision under your arm.
• You have the option of local anesthesia. Over your muscle, your breast augmentation surgery can be performed with intravenous sedation and local anesthesia which is safer and less expensive. (Of course, general anesthesia is also available.) However, placement behind your muscle always requires general anesthesia or a complex sequence of nerve blocks.
• You preserve your pectoralis major muscle. When your implants are put behind your muscle, the inner attachment of your muscle must be cut to allow space for your implant. Not only does this create an increased risk of bleeding, but it also severely weakens your pectoralis major muscle, your main chest muscle. Previously Dr. Bellin has removed sets of implants placed behind the pectoralis major muscle (by other surgeons) and put them in front of the muscle because they looked so abnormal. In each of these cases, the pectoralis muscle was paper thin, having been destroyed by either the pressure of the implant underneath it, or by the muscle becoming detached. If your muscle is not attached at both ends it cannot contract, cannot be exercised, and then it is severely weakened. Cutting your muscle also increases your risk of bleeding after your surgery.
• You feel natural. The only reason for placement behind your pectoralis is that advocates of this method think that it causes less capsular contracture or apparent hardening of your implants (see risks). This is very controversial as some studies have shown this to be true and others have shown no difference in the hardness of breast implants no matter where they are placed. A colleague of Dr. Bellin’s says that he has done over 5,000 augmentations, which is probably more than anyone other plastic surgeon in the country. He has placed implants in both positions and strongly believes that there is no difference in the hardness of the breast implants. He currently places them exclusively above the pectoralis muscle, as does Dr. Bellin. Also, due to the anatomy of your pectoralis muscle, it can only cover about half of the implant. Since the capsule surrounds the implant completely, it makes no sense that submuscular placement can prevent capsular contracture. The same is true about the complication of rippling (see risks).
• You have minimal pain. You will experience minimal postoperative pain when your implant placed above your muscle. Strong painkillers aren’t typically needed. You usually take medication for pain just the first two days, and you can normally return to work in two or three days. Under-the-muscle placement is very painful necessitating strong narcotics for a week and frequently two, as well as a week away from work.

To summarize the advantages of putting your implant under your breast (submammary) or above your muscle, your muscle won’t be virtually destroyed, it won’t appear very unnatural, you won’t have increased risks of bleeding, you won’t be in pain for a week or two, and your implant won’t only be about half covered by the muscle. Also, in Dr. Bellin’s opinion, submammary placement doesn’t make your breast feel any harder or cause rippling.

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Subpectoral Placement

With this placement method, you can still practice breast self-examination, and use other breast cancer detection methods like X-rays which can be pursued with complete safety. If a tumor did have to be biopsied, it could be done without ever disturbing your implant.
However, as discussed above, Dr. Bellin prefers submammary placement.

Issues which Breast Augmentation Surgery Helps

Very Small or Nearly Absent Breasts

This is a rather unusual issue, since most women have at least some amount of breast tissue. However, if you're among those few women who have extremely flat chests, breast enlargement surgery will really help you.

Your incision will have to be made around your nipple due to the lack of your breast fold. However, your breast implants will usually create a nice cup. Your surgeon will not attempt to make your breasts too large, though, because the edges of your implants might show through your skin. If you still want further enlargement after your initial operation, allow your implants to stretch your skin for about one year. Then have them replaced with larger implants.

Small to Moderate Breasts

If you have some breast tissue but want to be larger, breast enhancement surgery will undoubtedly generate satisfying results. You can choose the type and size of your implants. You may also choose the location of your incision. While you're almost sure to be satisfied with the resulting enlargement, a further increase can be obtained as mention in the previous section regarding very small or nearly absent breasts. However, one procedure is usually all that is necessary to provide you with a thoroughly pleasing improvement.

Loss of Breast Tissue from Aging or Pregnancy

Your breasts constantly go through natural changes. They enlarge and diminish each month. During pregnancy, your breasts grow larger. However, hormonal changes following pregnancy and breastfeeding cause them to shrink. Unfortunately, your breasts may end up smaller than before your pregnancy. The same kind of reduction often occurs due to aging. Unfortunately, your loss of breast tissue is usually the most noticeable in the upper part of your breasts. You have no reason to suffer from this, however, since breast implants will help you tremendously. The partly empty sacs of skin at the top of your breasts can be successfully filled to their previous size (or even larger), and your breasts will be restored to their former beauty.

Sagging Breasts

This particular issue may also result from aging or pregnancy, but it can also affect younger women as well. Mild to moderate sagging is usually improved through breast implants which gently raise up your breasts as they continue to fill out. If you suffer from medium to severe sagging, you'll need a breast lift to correct it. Simply adding a breast implant to your badly drooping breast will only create LARGER badly drooping breasts. Your surgeon should tell you which operation should produce the best results. In some cases you might need both breast augmentation surgery with breast implants and breast lift surgery.

Stretch Marks

Stretch marks are a form of scar tissue resulting from the deep layers of your skin getting torn during pregnancy or extreme weight gain. If your stretch marks are accompanied by loose skin, you may be able to attain a slight improvement. (Otherwise, no treatment will help you.) When you have excess skin, your wrinkling is more pronounced. By adding breast implants, your skin becomes tighter, pulling your stretch marks tighter as well. While still present, your stretch marks should be flatter and more taut (less visible) than before. Of course, when your operation is over you'll also have larger breasts, which may be a factor in your decision. Discuss your stretch marks with your surgeon to be sure your questions about treatment outcomes are answered.

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Unequal Breasts

Women naturally have breasts that are slightly unequal in size and shape. However, you may have breasts that are noticeably out of proportion. You can always improve this imbalance, if not almost completely correct it. An implant in one of your breasts can produce instant similarity, or both of your breasts can be augmented with different-sized implants to achieve the same result. However, if one of your breasts is practically nonexistent while your other is large and drooping, your correction may be more complicated to make. It may be necessary to augment one of your breasts while reducing and/or reshaping your other one. It is even possible to repair defects in your chest wall simultaneously by using an additional custom-made implant.

Any of the issues listed above can be emotionally shattering. You may begin to doubt your femininity and even your sexuality and your relationships with men. However, you have an alternative.

Most of these issues can be helped through the use of cosmetic surgery. While any particular surgery may not cure your previous emotional trauma, it should certainly help you to see yourself in a whole new light.
A woman with beautiful breasts acts beautiful. She is sure of her appeal. She carries herself better and relates to other people with more confidence. A woman chooses to improve her breasts not just to please men, but also to please herself.

You, too, can look and feel beautiful, appealing, self-confident, and self-assured by choosing breast augmentation surgery to help yourself.

Recovery

All of the surgeries for the breast issues discussed above (Issues which Breast Augmentation Surgery Helps) have essentially the same recovery period and the same possible risks.

If your implants are placed above your breasts there is only moderate pain after your surgery, much like muscle pain you experience after you perform too many pushups.

After your procedure, you will be advised regarding wound care, bra selection, and follow-up instructions. You may be asked to rest and remain quiet the night of your surgery since bleeding around your implant may occasionally occur. It usually takes about 2-4 weeks for any swelling or discoloration to subside, and for you to return to your normal activity level.

You will typically take mild pain medication for the first two or three days. You can usually have your surgery done on Friday and go back to work on Monday. You may still be a bit sore, but you will be perfectly able to function.

If you have under-the-muscle incision placement, your recovery is a little more painful and requires at least a week of immobility. However Dr. Belllin advises no vigorous exercise such as jogging or workouts for three weeks. (After breast enhancement surgery, many patients have even breast fed without difficulty.) After that, virtually nothing you do will injure your implants!

Once you decide to have your breasts enlarged, there are several options regarding your actual procedure and the type of implant that's best for you. These options should be thoroughly discussed during your consultation, and you should be at ease with your choices and your plastic surgeon before you undergo your operation. The end result of all your open discussion with your surgeon is that you will almost certainly be happy with your "new" breasts after your breast enhancement surgery!

If you are considering breast augmentation (enhancement or enlargement) surgery in Manhattan, New York City (NYC), or greater New York, contact CosMedica. Our experienced Plastic Surgery Center in New York will give you a free consultation.

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