Breast Augmentation with Implants
$5900 saline implants
$6500-$7500 silicone implants
cohesive gel implants ("gummy bear" implants) are
higher in price than regular gel implants
Who is a good candidate?
Patients who want larger, fuller and more lifted breasts
are good candidates for a breast augmentation with
implants. While fat transfer to the breasts can bring
patients up one cup size, implants can bring someone
1 or more cup sizes larger. For patients with some
degree of breast ptosis (sag), implants can provide
enough of a lift to avoid having to do a full breast lift, however if there is enough extra skin that the implant will not lift the breast enough to reach your aesthetic goals, then a breast lift with implants can be considered.
How to choose the right size?
Everyone has different shaped breasts and different degrees of ptosis (sag). This does influence how you will look post operatively. Sizing in our office is done first by asking your current size and seeing what your goal size is. On the day of your consultation, we will go over this, and we can size you as well. Bring a sports bra and clothing such as a tank top, as this will help most with seeing your appearance with different sized implants. We will try on various sizes under your clothing to help narrow down the range. We usually order a range of sizes on the day of your surgery, so you are not committed to any number until the day of surgery. Photos of desired size/shape as well as what you think is too small or too large is helpful.
Our sizing policy: if you want to upsize or downsize within 1 year after your surgery you just cover the cost of the implants and operating room/anesthesia, and your surgeon's fee is waived. Our primary goal is to ensure you are happy with your results.
Breast augmentation with implants is done as an outpatient procedure in an ambulatory surgery center. The procedure is done under general anesthesia and takes a little under 1 hour. An incision is made either under your breast (inframammary fold) or around the nipple (peri-areolar), and a saline or silicone implant is placed either above your muscle (subglandular) or below your pectoralis major muscle (subpectoral). You and Dr. Kayan will have a discussion at your initial consultation regarding the pros and cons of each incision and under or over the muscle type. Your incisions are closed with dissolvable sutures and skin glue, and you are wrapped in a compressive ACE wrap. The length of your incisions depend on what type of implant you are receiving, as well as how large the implant is. Saline implants require smaller incisions (4 cm or less), and most silicone implants between 225-325 cc can be done through an incision <4 cm. For silicone implants in the 325-450 cc range, the incision is between 4.5 - 5 cm, and larger implants above that will require incisions >5 cm. Very slightly larger incisions are needed for more cohesive gel implants because these implants are less deformable and do not fit through a smaller incision as easily as standard gel implants.
Both saline and silicone implants are commonly used, and both are FDA approved and safe. In addition to the price difference (saline implants are less expensive), there are other important differences. Both have an outer shell made of silicone. Saline implants come deflated, and are filled with sterile saline during your surgery. Silicone implants come pre-filled and with set sizes. Projection refers to how much the implants stick out from your body - moderate, high and extra high. We have sizers for each one, so you can determine what your goal look is. Silicone also comes in different levels of cohesivity and in textured and anatomic types. The most commonly used implants in our practice are smooth round silicone implants, and among this group, it is the patient's choice if they want regular gel, the most cohesive gel, or the hybrid type. Prices differ between each type, with the a higher price for each level of extra cohesivity. The advantage of a more cohesive implant is less likelihood that if it ruptures, silicone gel can escape. More cohesive implants also have less tendency to ripple, which is advantageous if a patient is very thin with very little breast tissue. The only difference in feel is that more cohesive implants can feel more firm. Textured implants are also available and used upon specific request of the patient.
You can remove all the dressings and shower 48 hours after your surgery. After showering, most patients will either re-wrap in the ACE or put on a tight, front closure sports bra. These can be purchased online or at any sports apparel store. We advise patients not to do any overhead reaching for 1 week or lifting more than 5 lbs or high end exercise for 4-6 weeks after surgery, as this can disrupt healing and cause bleeding. You will wear a sports bra 24/7 for the full 4-6 weeks, then may look to be fitted for a bra after 6 weeks or when your incisions are fully healed. The implants will appear to sit very high up on your chest at first, and will start to settle down into place starting around 1 month after surgery. It takes anywhere from 3-6 months or longer for the implants to settle into their final position.
Long term maintenance of implants
If a saline implant ruptures, it is noticeable quite quickly as the breast will return very quickly, usually in less than a week, to its original size. If a silicone implant ruptures, it is not obvious. The FDA recommends that patients with silicone breast implants get an MRI 3 years after their initial surgery, and every 2 years thereafter to screen for implant rupture. The lifespan of a breast implant is 10-15 years. Other risks that are commonly mentioned are capsular contracture, which is a process by which the scar capsule around the implant thickens or hardens, and causes a sometimes noticeable asymmetry in the breasts. Capsular contracture will often require an operation to remove the implant and abnormal capsule around it.