Breast Augmentation

Breast Augmentation

Breast augmentation (also known as augmentation mammoplasty, breast enlargement or breast enhancement) is the surgical procedure that allows a woman to increase the size and improve the shape and appearance of her breasts. Many women undergo the procedure because they either had little breast development or never attained the size that they desired. Others lost volume and firmness following weight loss or pregnancy. Regardless of the underlying reason, it is perennially around number one or two as the most popular cosmetic procedure being performed and has among the highest satisfaction rate of any procedure. In fact, on the website RealSelf.com, 98% of patients rated the procedure as well worth it.

The concept and the procedure of inserting breast implants to obtain the breast enlargement sounds rather simple and straightforward to many people but this is most definitely not the case. Many options and factors must be considered and decisions made prior to surgery so as to maximize the likelihood of you obtaining the desired results.

The goals of breast augmentation surgery are to select the appropriate implant for volume and profile in order to obtain the desired breast size, shape and projection and do so with incisions that are as inconspicuous as possible. To achieve this, the plastic surgeon must have an exceptional eye for aesthetic norms and issues, an appreciation of each patient’s tissue characteristics, an understanding of the three dimensional effects of the implants on the tissues, consideration for the changes over time, extensive experience and superior surgical skills. Equally important, he must be able to thoroughly understand and interpret his patient’s goals, needs and concerns so as to be able to deliver the desired outstanding results (see blog: Breast Augmentation and “Natural” Looking Breasts). Dr. Steven H. Turkeltaub always strives to ensure that the results he creates for his patients are exactly what they desire.

Breast Implant Options

Today, breast implants are available in a seemingly limitless array of sizes, shapes, projections, fill material—including different degrees of silicone gel cohesiveness—and even surface textures. At the Arizona Center for Aesthetic Plastic Surgery, Dr. Turkeltaub makes available to his patients most of these implant choices so that they can have the opportunity to achieve the beautiful, natural-looking breast enhancement results that they desire. Selecting the right implants for your goals will be based on several different considerations that include your specific needs, the characteristics of your breast tissue, your unique anatomical indicators and the overall outcome that you are envisioning. During the consultation with Dr. Turkeltaub, all of these factors will be examined and discussed thoroughly with you so as to be sure that the breast implants selected for you can effectively deliver the results you desire.

Silicone or Saline Breast Implants

The two types of breast implants available for breast enlargement are silicone and saline. The silicone implants are the “gold standard” with regard to the aesthetic outcome: they feel and can look more natural and generally last significantly longer than the saline implants. In addition, they are available in three degrees of cohesiveness which allows even greater finesse and customization based on a patient’s specific situation and tissue characteristics that can lead to results that are even more superior.

Saline implants are frequently associated with skin rippling or implant palpability especially in those with thin skin and minimal breast tissue. Furthermore, the results don’t age as well as those who have silicone implants.

Virtually one hundred percent of Dr. Turkeltaub’s patients select the silicone implants for their breast augmentations. It is extremely rare anymore for a patient to specifically request a saline implant. Anecdotally, those patients who have had both types of implants at different points in time, every single one of them preferred, by far, the silicone implants over the saline ones.

Breast Implant Size

The number one thing that people think and talk about regarding breast augmentation is size and, more specifically, implant size. Though it is not the only important factor, size really does matter. When women are not thoroughly satisfied with their results following a breast enlargement, the number one reason relates to size and it is usually because they wanted to be larger. Therefore, it is crucial that the patient has an idea of the look that she wants to achieve, how it impacts the appearance and harmony of her body size and shape, the effects that the enhanced breast size may have on other aspects of her lifestyle and the image that will be projected.

In Dr. Turkeltaub’s experience, most women today prefer to be proportional or slightly larger than proportional though there are others who request to be double “D’s” or larger. But what is “proportional”? This is an ambiguous term which will mean different things to different women. What is proportional to one woman may be either too small or too large (rarely) for another. Compounding this problem is the confusion as to what appearance different cup sizes represent since there are no universal standards. Consequently, bras of a specific cup size manufactured by different companies often do not fit the same. One company’s “C” cup may be the same size and shape as another company’s “D” cup.

Dr. Turkeltaub finds that trying on implants and reviewing photos are very helpful though there are limitations. In the end, he finds that selecting the most appropriate size is both a science and an art.

For additional information about the importance of implant size, read Dr. Turkeltaub’s blog post: “Size Really Does Matter.”

Breast Implant Profile

Another important factor to consider when selecting the most appropriate implant is its profile.

What is an implant’s profile?

An implant’s profile is the ratio of its relative projection to its base width for a given volume. In English this means that at a given cc volume it can be broader with less projection or narrow with more projection. This is a very important parameter that must be considered in order to be able to obtain the best possible results. Though terminology can vary, implants come in ultra-high, high, moderate and low profile.

High profile breast implants will have greater projection and less width for a given size compared to moderate profile ones which are broader and less projecting. The style that would be most appropriate for you depends on many factors including your chest width and configuration; amount of breast tissue present; and the ultimate size, projection, shape, cleavage and overall appearance that you desire. (See Figure 1a and 1b.)


Figure 1a. This is a side view of implants of the same volume but different projections. The implant on the left side is a high profile implant and the one on the right is a moderate profile implant. Note the greater projection and narrower width of the high profile implant.


Figure 1b. Frontal view of the implants in Figure 1a. Note the greater width of the moderate profile implant on the right which projects less than the narrower high profile implant.

Breast Implant Shapes

The vast majority of the breast implants used today for breast enlargement are round in shape. There may be certain situations related to anatomy, preferences and other factors where tear-dropped shaped silicone implants may be “better” suited. The “anatomic” style implants, of which the Natrelle® Style 410 (“gummy bear” implants) is one example, have a wedge shape that can be of varied vertical height and width that can provide for a more customized result in certain situations. They also cost substantially more than round implants.

At one point in time, these anatomic implants seemed to be quite promising for their potential to allow for even more refined results. However, due to some untoward issues including relating to their necessary surface texturing, it is Dr. Turkeltaub’s opinion that their usage should be considered in only a very small minority of patients and with most of those related to breast reconstruction.

Breast Implant Surface Textures

For several good reasons, most breast implants placed in the United States now are smooth surfaced ones where the outer shell (envelope) around the implants has no texturing. Many years ago, before several significant technological advancements were made, it was a common experience and opinion held by many that using textured surfaced implants (where there were small 3D elevations on the implant surface) reduced the incidence of capsular contracture especially in higher risk patients (See Figure 2). Present scientific studies do not support this relationship. Furthermore, because there are some negative consequences specifically associated with textured implants, their widespread usage is inadvisable though they may still have a place in very limited situations.


Figure 2. The Silicone breast implant on the left is a smooth surface implant while the one on the right is a textured surfaced one.

Dr. Turkeltaub has been performing breast surgery with implants for many years and has the knowledge, skill and experience to precisely evaluate all variables and help you select the implants that can most effectively achieve the results that you desire.

Your Breast Augmentation Procedure

Breast augmentation surgery is performed under general anesthesia as an outpatient. The procedure typically takes around an hour followed by approximately one to one and a half hours in the recovery room. Dr. Turkeltaub uses a very gentle and precise technique which helps to minimize postoperative discomfort and the risk for non-ideal outcomes.

If your breasts are sagging, you may also need to have a breast lift (mastopexy) done as well. Tummy tucks and liposuction are commonly done at the same time as a breast augmentation as part of a “Mommy Makeover.”

Incision Location

There are three acceptable locations of the incisions for the insertion of the breast implants in breast augmentation. Each has advantages and disadvantages based on individual factors. (The belly button incision, also known as the transumbilical approach, is not considered for a variety of reasons.) These insertion sites are:

  1. Inframammary. This is the most common approach and involves an incision placed at the bottom of the breast, in or near the fold where it arises from the chest. This location provides the most flexibility both short- and long-term, superior visualization and exposure for surgery, more predictable results and a lower risk of developing capsular contracture compared to the other sites.
  2. Periareolar.The incision is placed at or near the margin of the lower half of the areola where it borders normal breast skin. Some women indicate a preference for this location but they do need to consider some important issues before selecting it such as an increased risk for loss of sensation of the nipple, an elevated risk for the development of capsular contracture, postoperative scarring that can cause contour irregularities of the breast and scars that may be fairly conspicuous. Women with smaller sized areolas either cannot or should not consider this approach especially if using silicone implants.
  3. Transaxillary. Implants are inserted through an incision in the armpit with the big selling point being that there will be no scar located on the breast itself. When performed endoscopically, results can be good but there are several important issues and risks, such as an increased incidence of capsular contracture and implant malposition that must be discussed and considered before electing this option.

The incision chosen for the insertion of the breast implants can impact the ultimate sensation of the nipple after surgery. For more on this, read Dr. Turkeltaub’s blog post on breast augmentation incisions and nipple sensation.

Behind or in Front of the Muscle

Breast implants can be placed in a “pocket” either behind (deep to) the pectoralis major muscle on the chest wall (subpectoral or submuscular) or directly in front of it (submammary). The appearance and dynamics of the breasts are quite different between these two locations as are the consequences of gravity, weight fluctuations, implant size and time. The most significant advantages for placing the implants in a submuscular pocket include:

  1. Mammograms are usually more easily and accurately read versus when implants are situated in front of the muscle (submammary).
  2. The risk for developing capsular contracture (hardness of the breast caused by the formation of scar tissue around the implants) is lower.
  3. There is a greater amount of soft tissue coverage of the implant which translates into a decreased risk and extent of visible rippling as seen on the skin as well as buffering the ability to feel the implant.
  4. A superior and more natural interface is present between the implant and chest wall allowing for a more normal appearance rather than a fake, very round look.
  5. The muscle provides significantly better long-term support of the underlying implants as compared to skin only support when the implants are situated above the muscle. In a submammary location, the weight of the implant will cause a greater degree of stretching and thinning out of the skin over time resulting in more substantial drooping. This problem is exacerbated with very large implants.

Because of these important advantages of having the breast implants in a submuscular location, this is Dr. Turkeltaub’s recommendation for most of his patients.

Recovery from Your Breast Augmentation

A surgical dressing is placed following your breast augmentation that provides compression and more comfort for two to three days. This is then replaced by a sports type bra which is worn day and night for a week or more. A regular, comfortable and supportive bra can then be worn. Dr. Turkeltaub recommends that patients with relatively large implants wear a supportive bra on a regular basis to help maintain the breast shape and minimize drooping from the increased weight over time.

During the first few days after surgery, discomfort may be mild to moderate. Analgesics and a muscle relaxant are prescribed which will help make you more comfortable. Most patients can return to a non-strenuous job or school within five to seven days. If your job requires heavy lifting or repetitive upper extremity movements (such as a hairdresser), modifications of your activity or greater time off from work are strongly recommended. You should avoid vigorous activities such as sports, aerobics and heavy lifting for three to four weeks and certain other exercises and activities (such as pectoralis major muscle exercises) for eight weeks. It is not uncommon to experience muscle tightness and even spasms early on but these usually resolve fairly quickly.

Your breasts initially will be swollen, firm and may appear larger than you were anticipating. Much of the swelling will subside after several weeks resulting in a more defined shape and a size closer to what you can expect long-term. With additional time, the skin and muscle (if the implants are in a submuscular location) will relax even more resulting in a softer, more natural feel and appearance.

Whether or not to pursue a breast augmentation is a highly personal decision that a woman must make for herself. There are clearly many long-term benefits of having a breast enlargement. Some of these include looking better, feeling more feminine and attractive, having greater self-esteem and being able to find clothes that fit and that are more complimentary. As stated already, the overwhelming majority of breast enlargement patients are extremely happy with their results.

Breast Augmentation Scars

The greatest determinant of the visibility of breast augmentation scarring is the incision technique utilized to perform surgery. Most commonly, Dr. Turkeltaub employs an inframammary incision that is made in or near the natural crease beneath the breast. The resulting scar is typically quite short in length and remains hidden underneath the breasts themselves. Other incision locations include inside the armpit (transaxillary) and around the lower perimeter of the areola (periareolar). While these two methods also yield relatively inconspicuous scars, Dr. Turkeltaub seldom uses them due to various risks and potential issues that can be covered in full detail at the time of your consultation.

Along with the specific incision method utilized, the overall appearance of breast augmentation scarring is also influenced by factors such as:

  • Your plastic surgeon’s technical skill
  • The incision closer method your doctor utilizes
  • How strictly you adhere to post-operative care instructions
  • The type and quality of scar management products you use
  • Your genetic makeup and natural response to healing
  • Your diet and various other lifestyle habits

Ultimately, Dr. Turkeltaub has found that his breast augmentation patients seldom have any issues concerning scarring—especially when all post-surgical advice is closely followed and scar management treatments are employed as directed.

Cost of Breast Augmentation

According data gathered by RealSelf.com, the cost of breast augmentation in the Scottsdale area ranges from approximately $3,800–$8,600, with the average price being $5,925. While these numbers can give you a general idea of what you might expect to pay for treatment, exact pricing for breast augmentation will be impacted by a variety of different factors that include:

  • The specific implants selected
  • Whether or not a breast lift is also performed
  • The credentials, surgical skill and experience of the plastic surgeon
  • The facility in which the procedure is performed
  • Anesthesia fees
  • Any necessary preoperative mammogram screenings
  • Any medications needed during recovery

If you are interested in breast augmentation, Dr. Turkeltaub will be glad to meet with you at our practice for an in-person consultation. After evaluating your needs and goals and developing a personalized treatment plan, he can provide you with a price quote that includes an itemized breakdown of all associated fees. During your visit, a member of our staff can also introduce you to various breast surgery financing options we have available if desired.

Breast Augmentation Before and After Photos

Click here for our full gallery.

Breast Augmentation Patient Testimonial Videos

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Frequently Asked Questions

Q: Do silicone breast implants feel significantly more natural in general compared to saline implants for a breast enlargement?

A: Silicone breast implants are constructed with a thick, cohesive gel that simulates the feel of a breast. In contrast, saline implants are filled with salt water which doesn’t have the viscosity and other important characteristics of silicone implants translating into a in a less natural result. On average, silicone implants do last longer than the saline ones. We have using them for well over 20 years with excellent results.

Q: Will I need to have my breast implants replaced sometime in the future?

A: Breast implants should not be expected to last forever. They may last 5-30 years, possibly less or even longer, but expect that at some point in time they will need to be replaced or removed. Saline implants deflate usually rather quickly and noticeably in size in the affected breast. Loss of integrity of silicone implants is more difficult to detect since there is no real change in volume and often no change in shape. You may experience some unusual mild discomfort or develop firmness of the affected breast. An MRI may be needed to help make the diagnosis though this isn’t 100% accurate. Please click here to read more about breast implant durability.

Q: Which type of implant lasts longer, silicone or saline?

A: Silicone implants do last longer, on average, compared to the saline ones which means that you may require fewer implant replacement procedures in your lifetime. Dr. Turkeltaub has been using them for well over 25 years with excellent results.

Q: Do most of your patients choose silicone implants over saline?

A: In excess of 96% of our patients select silicone implants over saline implants for their breast augmentation. They want an implant that will provide them with the most natural appearance and feel and silicone is the one that meets those criteria.

Q: Will I still have sensation of my nipples?

A: Immediately following surgery, your breasts may “feel” somewhat numb. Most patients do ultimately regain most if not all of the sensation of their nipples and breasts. It would be extremely rare to lose total sensation in both of your nipples.

Q: Will I be able to breast feed?

A: Breast augmentation surgery should not have any impact on the ability to breast feed particularly if the periareolar approach is not employed.

Additional Information About Breast Augmentation from Dr. Turkeltaub

Read more about breast augmentation from Dr. Turkeltaub’s breast surgery blog.

Specific Information About the Allergan Breast Implant Warranty

Contact Dr. Turkeltaub

For more information about breast augmentation, or if you are interested in scheduling a consultation, please contact Dr. Turkeltaub today.

Dr. Turkeltaub’s offices in Scottsdale and Glendale are conveniently located near the following: