Breast Augmentation

Good Breast Augmentation Candidates

The best breast augmentation candidates are generally healthy individuals who have concerns about the size or shape of their breasts. After a careful physical exam and assessment of your medical history, we will determine whether or not you’re a good candidate for the procedure. It is rare that someone who is interested in breast augmentation is not healthy enough to have this operation.

What Is Breast Augmentation?

Breast augmentation surgery involves the placement of either

• saline breast implants that are filled after being inserted, or
• pre-filled cohesive silicone gel implants

Women of all ages can select the breast size they have always desired or restore the youthful contour of the breasts they once had. In addition to enhancing the size and shape of the breasts, breast augmentation creates firmer breasts that still feel natural.

Cost in Richmond

The cost of breast augmentation surgery at our Midlothian practice varies. We provide a detailed estimate of pricing, but this is only an estimate until you consult personally with Dr. Lewis who will evaluate your specific breast enhancement surgical goals. The total price given is all-inclusive and accounts for the following:

• Dr. Lewis’ fee
• Operating room fee
• Anesthesia fee
• Cost of implants
• Cost for CosmetAssure®

Qualified patients can take advantage of our patient financing options if interested.

Additional Information

Breast Augmentation Surgery Incision Options

The vast majority of implants are placed underneath the pectoralis (chest) muscle. Whether they are fully under the muscle or partially under the muscle — called the dual plane approach — depends on the patient’s personal anatomy. The incision can be placed in the armpit, on the lower edge of the nipple, or under the breast. Incisions usually heal very well with minimal scarring. There are advantages and disadvantages to each of these incision locations. We will discuss these with you. The decision of where to place the incision is made at your preoperative visit and depends on your wishes and goals for the surgery.

Inframammary Incision

Across the nation, the most common incision for breast augmentation is the incision in the lower part of the breast, which is located just above the inframammary fold on the breast.   This incision allows the most direct access to the chest wall and gives the most predictable results.  This incision, when meticulously closed, is very faint when fully healed.  We will place this incision so that it is near the fold, but on the lower portion of the breast.  In this location, it is usually not visible even when wearing very small bikini tops.  This incision has the benefit of being the “most sterile” which likely gives the lowest rate of capsular contracture.

Periareolar Incision

This incision is placed on the lower portion of the nipple/areolar complex. This approach gives direct and close access to the underlying pectoralis muscle and can allow for very accurate implant placement as well.  The incision can be nearly invisible in women who have a sharp color change between the areola and the surrounding skin.  However, many women have a less sharp color change in the area which will increase the visibility of this scar.    This incision will also have a somewhat higher incidence of loss of (or decreased) sensation in the nipple after surgery.  Lastly, there is some evidence that this incision may have a higher rate of capsular contracture after surgery than an inframammary incision. This is probably due to contact of the implant with bacteria in the milk ducts within the breast.

Transaxillary Incision

This incision in the armpit is clearly the least likely to be seen.  Through this approach, we use a tiny incision and an endoscope to visualize the undersurface of the pectoralis muscle and to meticulously create a pocket for the implant underneath the muscle.  Once the pocket is created, a saline implant is placed in the pocket and filled once in place. This can create a very natural look with an incision that can be nearly impossible to see.  Unfortunately, there are a couple of tradeoffs with this approach.  Although revision for implant malposition is rare, studies have shown it is higher with a transaxillary approach than with the other approaches.  Also, silicone implants frequently cannot be placed through this small incision as they are prefilled, and need a more direct approach. Capsular contracture rates are slightly higher than with an inframammary incision.

Silicone or Saline Implants?

Breast implants are designed to add volume. This is achieved through implants filled with either saline (saltwater solution) or silicone gel. All implants have a silicone shell, but the material filling the implant is different.

Cohesive Silicone Gel

Most women choose the newer generation of cohesive silicone gel implants because they tend to look and feel more like natural breasts. In most women, silicone implants are nearly impossible to feel when placed correctly. Silicone implants contain a silicone gel that feels very natural even outside the body. Silicone implants allow a more natural feel to the breasts in all women, but this is more pronounced in women wanting larger implants or women who are very thin before surgery.

These can be placed through small incisions, but these incisions are slightly longer as the implant manufacturer pre-fills the implants. They may also have a lower rupture rate than saline breast implants, but it can be difficult to notice without an imaging test.

We use the Keller Funnel® to place silicone gel implants in the pocket. Using the Keller Funnel:

• Allows the implants to be placed through significantly shorter incisions (although not as small as saline implant incisions)
• Eliminates the implant coming into contact with skin, decreasing the chance of bacterial contamination
• Decreases shear forces on the implant shell, which may increase the implants’ lifespan

Saline

These implants are filled with a saltwater solution and were the dominant implant used from the early 1990s through about 2009. Dr. Lewis can place these implants through very small incisions because he fills them after they’re inserted. In women with more existing breast tissue to cover the implants, these feel and look very natural. The saline implants also have the advantage of being more economical than silicone implants.

Implant Size and Shape

The MENTOR® Volume Sizing System enables you to select the implant volume that best meets your desired result. The sizing system includes a set of 18 uniquely shaped volume sizers (9 per breast) which provide a realistic preview of the breast size.

Implants come in a wide range of sizes and shapes. The sizes range from about 100cc to 800cc. (For reference, a 12-ounce can of soda is 330cc). We will help you decide which implant size is best for you.

Coming to your consultation with pictures of breasts you like is helpful. The shape of the implants affects the overall appearance of your breasts as well. We will discuss the implant shapes with you as well and guide the decision based on your specific chest wall and breast shape.

We use the Mentor Volume Sizing System to assist in the sizing of implants.  These specially tapered “trial” implants are specifically designed to be placed underneath a thin bra. By doing that, each person can get a very accurate representation of the effect of the different amounts of volume on their breast shape. We believe this is the most accurate way to predict postoperative size.

Breast implants come in different profiles: moderate, moderate plus, and high profile. Some are taller and narrower, and some are lower and wider for a given volume. It is very important that this matches your chest wall. Once you have picked your volume it is our job to ensure the implant fits your chest wall and the given profile will give you the best look for your body.

Location

Dr. Lewis performs surgical procedures at an accredited outpatient surgical center or a local hospital. He is affiliated with several local medical centers where his patients undergo surgery. He primarily operates at these locations:

Johnston-Willis Hospital
Stony Point Surgery Center

Initial consultations, follow up appointments and all non-surgical treatments and minor surgical procedures are performed at Lewis Plastic Surgery in Midlothian, VA.