BREAST AUGMENTATION

Breast augmentation, sometimes called a boob job is a time-tested, safe, and predictable way to increase your breast size or improve symmetry when breasts are uneven. The procedure often takes 90 minutes or less, and the result can last for decades. You may hear about trends or fads that exist in breast augmentation, but in Dr. Zelken’s experience, every woman wants something different. While patterns or trends may exist, your voice deserves to be heard. Dr. Zelken appreciates natural appearing breasts and will try and avoid a breast lift unless it is absolutely necessary. If natural is the look you are going for, or not, call (949) 432-4730 to schedule your consultation with Dr. Zelken today.

At Z Plastic Surgery, you will have the opportunity to talk to Dr. Zelken about what you want. Alternatively, if you are like 50% of the patients we treat, you may just leave it to Dr. Zelken’s artistic discretion to choose a size that looks natural, harmonious, and suits you best. Dr. Zelken has performed breast augmentation across the United States and the world, and he has observed important cultural differences; he will be happy to discuss these observations and respects cultural and ethnic diversity. In 2015, Dr. Zelken published a systematic review of breast augmentation tendencies in Asia. At Z Plastic Surgery we welcome patients from across the world and there is a Mandarin Chinese translator available. If you are interested in exploring this further, call (949) 432-4730 and press option 3 for our Chinese hotline to speak with a Mandarin-speaking physician and schedule your appointment.

Read Dr. Zelken’s article of Asian breast augmentation.

Your consultation will be broken up into three parts: a brief history and physical to make sure surgery is safe for you, a discussion of your options, and a thorough review of the risks and benefits of breast augmentation. You have so many options, and Dr. Zelken will do his best to handpick a subset of these options to make your decision easier. Ultimately, you have five decisions to make:

1. Silicone versus saline. Saline implants are silicone balloons that are filled with salt water (saline). The benefits of saline are that they can be finely adjusted in the operating room to optimize symmetry, they tend to be less expensive, and they require a smaller scar. If saline implants rupture, you will know it immediately, and your body reabsorbs the salt water. Despite these benefits, Dr. Zelken and most plastic surgeons prefer to use silicone implants for the majority of cases, if not exclusively. This is because silicone implants are softer, feel more natural, look more natural, and, most importantly, are safe. Silicone implants are filled with a highly cohesive gel, meaning that if you were to cut or tear the shell the silicone would not ooze. For this reason, modern implants are known as gummy bear implants, since the cut surface of a highly form stable cohesive gel implant resembles a cut gummy bear. In fact, even if you squeeze a ruptured implant, the inner gel would simply bulge out, not bleed, from the intact shell. The FDA overturned a moratorium on silicone a decade ago, as there was insufficient evidence that silicone implants put women at risk.

2. Round versus anatomic (shaped, teardrop). If you are among the 95% percent of women we treat at Z Plastic Surgery, you will opt for a silicone implant. And if you do, you have even more choices. You can choose an implant that is anatomic (shaped like a teardrop). You can also choose a round implant. Like everything, there are pros and cons to each. Round implants are easier to place, do not change shape when they rotate, and maximize upper pole fullness. In thin women, they may create a more noticeable transition from the chest wall to the breast. Teardrop implants like the Allergan 410 and Mentor MemoryShape create a more natural ski slope appearance where the lower pole is projected more than the upper pole of the breast by design. Many surgeons shy away from modern shaped implants for fear of deformity if and when the implants rotate. Fortunately, Dr. Zelken has access to tools that facilitate precise placement of these implants in proper position without the need for a longer scar. He dissects only as much as he needs to, for a hand-in-glove fit that prevents rotation. Furthermore, shaped implants often have a textured surface that, like sandpaper, will prevent implant migration. Dr. Zelken prefers to use shaped implants in the majority of cases.  Since these may be more expensive than round implants and the difference may be subtle in women who are overweight, obese, or thick-skinned he will not always recommend them. Many women who like a made or artificial look will choose round implants.

3. Implant placement – above or below the muscle. Breast augmentation involves placing an implant under the breast. Under the breast can mean the implant is placed above chest wall muscles or below them. Placing the implant above the muscles is technically easier and is generally less painful than placing them below the muscle. However, without the overlying muscle, the implants may be easier to see, feel, and may even add risk for complications like capsular contracture. In the majority of his patients Dr. Zelken places implants below the muscle. This adds additional protection, enhances the overall appearance of the augmented breast, and may reduce long-term complications. Submuscular breast augmentation is technically more difficult, may incur more early postoperative pain, and can lead to animation deformities (when the chest wall muscles contract, the implants shift). Still, Dr. Zelken will remind you that submuscular breast augmentation is the most popular choice among plastic surgeons all over the world for a reason, and in most cases, will encourage that option.

4. Scar location. Breast augmentation that involves implants necessitates a scar. The scar can be positioned in the armpit, at the areolar border, the fold beneath the breast, or even the belly button. Of these options, Dr. Zelken will most likely encourage you to choose between the areolar border (periareolar incision) or at the lower breast fold (inframammary fold, or IMF incision). In his systematic review, Dr. Zelken observed that women in Asia most often chose incisions in places other than the lower breast fold for fear of a visible scar on the breast. In the United States, most surgeons prefer the IMF incision and this is one that is most commonly used. There are pros and cons to each and at Z Plastic Surgery, you have the right to choose which you prefer. If you have really small areolas but really do not want a scar in the fold or in the armpit, Dr. Zelken described a novel technique developed in Taiwan that may help a small subset of women and it will be published later this year.

See Dr. Zelken’s illustration of the transareolar-periareolar incision.

5. Size. This is the hardest decision for some women. As a rule of thumb, Dr. Zelken will estimate that for every 150cc or so you can expect an increase of one cup size. The average implant volume we use at Z Plastic Surgery is somewhere in the 300-400cc range. In other words, for a small framed woman, breasts may increase from an A or small B to a full C or D. The smallest commercially available implants are smaller than 200 cc, and the largest are 800 cc. You will have the opportunity to try on several different sizes and pick Dr. Zelken’s brain as to which size he thinks is best for you.

Finally Dr. Zelken will review all the risks of surgery, among the greatest of which is postoperative pain. Dr. Zelken will perform a targeted nerve numbing procedure at the end of every case to ease the transition from asleep to awake. Most women complain of pain that is greatest in the first day or two, but some women have little to no pain and some may not even take narcotic pain medication at all. The procedure will always be performed at an accredited outpatient surgery center, under general anesthesia, and using meticulous technique. Dr. Zelken believes gentle soft tissue handling, minimizing dissection and operative time, and a nerve block is the secret to easing pain during recovery.

Times are changing, and the women seeking breast augmentation are becoming younger and younger. The Food and Drug Administration (FDA) approves saline implants for women 18 years and older, and silicone implants for women 22 and older. Younger women who want silicone implants will need to sign a waiver stating that they understand it’s an off-label use in order for Dr. Zelken to proceed. Breast augmentation, even though it is purely elective, is still surgery. There will be downtime, time off from school and work. In the long run, implants should not affect work, weightlifting, or heavy lifting; some of Dr. Zelken’s patients are fitness models and bodybuilders.

Exercise can be an issue. The same women who exercise often are often the types who seek augmentation to enhance body image. For fitness junkies, it can be challenging to take a vacation from the gym for weeks- or months. And while walking is encouraged as soon as the day after surgery, young women may need ongoing counsel to avoid dancing, running, and upper body exercise for six weeks. The concern is that these activities could cause the implants to shift position early, put too much stress on healing wounds, or cause internal bleeding. All these things will impact the final result, and young patients who tolerate pain well may require ongoing guidance.