Delivering breast augmentation with leading expertise and a woman's sensibility

"My goal with breast augmentation is to personally walk you through all of your choices and use my expertise to help you enjoy results that are not just aesthetically pleasing, but truly capture the look you've envisioned for yourself."

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Breast augmentation is about so much more than size. Dr. Cassileth delivers extensive expertise in breast surgery and an essential feminine sensibility to help you make choices that will ensure exceptional results.

Choosing your ideal breast implant size
Breast implant size is primarily a personal decision. There are several important things to remember when choosing an implant size. First, larger implants are also wider, so if you choose a size wider than your chest, your breasts will look unnatural. If you want to go large, you may want to try high-profile implants, which give you more outward projection with a smaller implant width.

It’s important to know that large implants do bad things to your breasts over time. If you are considering a size larger than 500cc, think carefully about what your stretched-out breast skin will look like when you are 50, 60, or 70 years old.

Previewing the results of your breast augmentation with 3-D Imaging Technology
Dr. Cassileth and her team use the state-of-the-art Vectra 3-D imaging system to preview how you will look with implants of virtually any type and size.

More about the Vectra 3-D system.

In addition, you can find hundreds of examples of how various types and sizes of implants look at implantforum.com. To get a rough idea of how your breasts will feel, Dr. Cassileth can also lend you implants to try on in your bra.

Choosing implant shape and texture
Implants come in a number of different shapes. The two most common are:

- Anatomical implants – These are fuller on the bottom, where a breast is naturally fuller, and are intended to look more natural. However, these implants can shift and look extremely unnatural. In addition, having breasts that are full on top is often a desirable look. As a result, round implants are used more than anatomical implants.
- Round implants – These are equally full on the top and bottom of the breast. They have a flat back side that goes against the chest wall (if the implant is placed in the sub-mammary position)

The wall of every implant is made of a silicone polymer that is either smooth or textured. A textured implant is more likely to stay where the surgeon puts it. However, it also sticks to the capsule that surrounds it and is more likely to ripple. Because of the risk of rippling Dr. Cassileth recommends smooth implants for most patients.
Selecting an implant filler

There are two types of implant fillers: saline and silicone. Both are contained within silicone sheeting. Saline implants are filled with salt water that is completely safe to the body. Because they are filled with water, many feel they are more "water balloon"-like in feel and appearance. Silicone implants feel much more like real breast tissue. The current consensus in the medical community is that silicone does not cause autoimmune disease or cancer. For more information on breast implant safety please visit breastimplantanswers.com

Determining the incision location

An incision must be made in order for the breast implant to be inserted. There are four places where an incision can be made to put in an implant:

1. Inframammary — Just above the crease at the bottom of the breast
2. Peri-areolar — At the edge of where the areola meets normal skin
3. Transaxillary — In the armpit
4. Transumbilical Augmentation (TUBA) — In the belly button

The inframammary location is easy for the surgeon, and if placed correctly, will not show when you are wearing a bikini top. There will be a scar on your breast that is 3cm to 4cm long.
The periareolar scar is well-masked because it is located at a natural line. The scar is usually just around the lower half of the areola, right where the pigmented skin meets the normal breast skin. However, very small areolae cannot be used for silicone breast implants.
The transaxillary approach places the scar behind the fold in your armpit crease. This scar is usually very difficult to see and there is, of course, no visible scar on the breasts. Because the implant is placed from the top, the implant will tend to sit higher than if placed using another method.
TUBA places the incision in the top part of your belly button. The whole operation is done through a long tube passed from the belly button to the breast. Placement of the implant is unreliable using TUBA, and for that reason Dr. Cassileth does not offer this method.

Implant Location: Subpectoral vs. Submammary

Breast implants can be placed in two different layers: under the pectoralis (the chest muscle), called "subpectoral," or over the pectoralis muscle, called "submammary." Dr. Cassileth feels that the only advantage of the submammary approach is that it gives the breast more lift if you want to augment a saggy breast. In all other ways, however, this method is inferior.

With subpectoral implants:

- The breast implant tends to stay in its position over the long term
- Mammograms are more accurate
- Visible rippling is less likely
- The breast appears to be more natural, especially in those with thin skin
- The risk of capsular contracture is lower

What to expect after your breast augmentation

Dr. Cassileth will perform your breast augmentation in our on-site surgical suite. You will be closely monitored and cared for until you are ready to go home (usually the same day). When you arrive home, it’s important to lie down and rest with pillows to support your back and arms. Make sure your medications are within reach, and have a bag of ice to place over your breasts during the first 48 hours.

Your breasts will be supported by a surgical bra and/or elastic bandage. For the first few days, leave the bra and or dressings in place and do not shower. Get plenty of rest and do not exercise or lift anything over 10 pounds. You can gently stretch and move your arms to keep your muscles loose and flexible. To promote blood circulation, you can walk around the house when you are feeling up to it.

It’s important to have someone with you for at least the first night after your surgery. Also plan on having a friend drive you to your first post-operative visit. You will be able to drive again when you are off all pain medication and are cleared to do so by Dr. Cassileth or Kristin Polega, PA-C.

At your first post-operative visit, your dressing will be removed, and you’ll get to see your new breasts. They may tend to sit high on your chest, which is perfectly normal. In a few weeks, your implants will settle into their correct position. Some bruising and swelling is also normal and expected.

During your first post-op appointment, Dr. Cassileth will prescribe a bra for you to wear as you continue to heal. It is very important to wear it as directed, as it will help ensure proper implant placement and healing. It is okay to take the bra off for an hour or so each day so you can to shower.

Most patients return to work a week to ten days after surgery. However, you should continue to avoid lifting anything over 10 lbs. for 3-4 weeks. Avoid all strenuous activities for at least a month, and when you do resume these activities, start slowly.

If you notice a loss of feeling in your breasts or nipples during your recovery period, it is most likely due to swelling. Normal levels of sensation usually return after 3-6 months.
To promote excellent healing, we have scheduled a free scar consultation with Shea Kaplan, PA-C who will review and evaluate your skin and help ensure that your scars heal quickly and as invisibly as possible.

Request your consultation with Dr. Cassileth today. Click here or call 310.278.8200.