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GET YOUR FREE CONSULTATION Breast Augmentation Revision CASE STUDIES See More → See More → See More → See More → See More → See More → See More → See More → Call Us Consultation breast augmentation revision Surgery CASE STUDIES SEE MORE PHOTOS Treatment of Bottoming out following breast augmentation SEE MORE PHOTOS Breast Augmentation Revision Surgery SEE MORE PHOTOS Breast Augmentation Revision Surgery Recovery SEE MORE PHOTOS Top Breast Revision Surgeon SEE MORE PHOTOS Breast Augmentation Revision in Los Angeles SEE MORE PHOTOS Breast Augmentation Revision in Beverly Hills SEE MORE PHOTOS Breast Augmentation Revision to Correct Breast Size Asymmetry and Scarring SEE MORE PHOTOS Breast Augmentation Revision to Go Bigger SEE MORE PHOTOS Breast Augmentation Revision Surgeon in Newport Beach SEE MORE PHOTOS Breast Augmentation Revision of Surgical Error in Pocket Dissection SEE MORE PHOTOS Breast Augmentation Revision Surgeon In Orange County SEE MORE PHOTOS Breast Augmentation Revision To Correct a Snoopy Deformity SEE MORE PHOTOS Breast Lift Implant Revision SEE MORE PHOTOS Breast Augmentation Revision Of Severe Capsular Contraction SEE MORE PHOTOS Capsular Contracture and Asymmetry SEE MORE PHOTOS Breast Augmentation Revision Of Aged Breast Implant SEE MORE PHOTOS Correction Of Implant Deflation SEE MORE PHOTOS Breast Augmentation Revision Of Deflated Implants SEE MORE PHOTOS Renuvion Reviews SEE MORE PHOTOS Breast Augmentation to Go Bigger SEE MORE PHOTOS Breast Augmentation Revision Specialist SEE MORE PHOTOS Breast Augmentation Smaller SEE MORE PHOTOS Breast Augmentation Revision Recovery SEE MORE PHOTOS Breast Augmentation Revision Cost Breast Augmentation Revision Breast Augmentation Revision Natrelle™ focuses on improving your breast appearance if you have previously undergone breast augmentation surgery but may be experiencing any one of the concerns below: You wish to have larger breasts following primary augmentation. You feel your breasts are asymmetric following primary augmentation. You have breast implants and have noticed tightening, firmness, and distortion of your breasts. You have noticed deflation and/or rupture of your implants following breast augmentation. You have noticed drooping of your nipples off of your breast implants and/or mounds due to the natural aging process. You have noticed malposition of your breast implants resulting in breast asymmetry (i.e. breast implants that have lateralized, i.e. displaced into the armpits) especially noticeable when lying on your back. You who have noticed the loss of your inframammary crease (i.e. bottoming out) with the resulting dropping of your implants below the breast mound. Orange County breast specialist Dr. Mowlavi and his staff are dedicated to helping you to restore your natural and aesthetically pleasing breast shape that may have been distorted following a previous breast augmentation surgery. Did you know that your insurance company could help with your breast augmentation revision surgery? Please contact our office to determine if you can qualify. Why you should choose Dr. Mowlavi for your breast augmentation revision Dr. Mowlavi is an experienced and trusted plastic surgeon located in Newport Beach, Orange County and is considered an expert in breast augmentation. He developed Breast Augmentation Revision Natrelle™ to ensure you reach your maximum potential following breast augmentation revision surgery. Breast Augmentation Revision Natrelle™ optimizes all aspects of your breast augmentation revision experience including your initial confidential consultation, an anxiety-free operation, comfortable postoperative recovery, a speedy return to full activity, and long term results. During your initial consultation with Newport Beach, Orange County Plastic Surgeon, Dr. Mowlavi, you will have the opportunity to convey exactly what your concerns are. Dr. Mowlavi will complete a thorough history and physical examination, as well as examine your breasts and take detailed notes and measurements, which will ensure your optimum results. Dr. Mowlavi’s Breast Augmentation Revision examination will take into account: Your breast mound size and any asymmetry Your nipple-areola complex positioning and any asymmetry; Your medial cleavage fullness or lack of; Your breast implant malposition when compared to breast mound positioning; Your inframammary crease definition and any asymmetry; Your breast projection and breast to abdomen silhouette; Your nipple-areola complex to inframammary crease distance and any asymmetry; Your breast skin and soft tissue thickness; Your pectoralis muscle tone and any asymmetry You are encouraged to bring in your operative note and implant ID Card if these are available to you, in order to assist Dr. Mowlavi in determining your customized breast augmentation revision surgery. You will have the opportunity to try on a full array of breast implant sizes and shapes so that you can determine the appropriate size and style of replacement implants. As part of your Breast Augmentation Revision Natrelle™ experience, Dr. Mowlavi and your patient coordinator will spend ample time detailing to you the preoperative planning and preparation that you will require, your customized operative plan, and your postoperative recovery and expectations. These steps are critical to ensuring optimum breast augmentation revision results. Preoperative planning for your Newport Beach Breast Augmentation Revision procedure includes: Arranging for time off of work during your recovery period. Preparing meals and routine daily needs ahead of time. To wash with antimicrobial soap starting 4 days prior to surgery. Providing anti-anxiety medications on the night prior to as well as on the day of surgery. Administering long-acting anesthetic medications to minimize your postoperative discomfort Planning for a responsible adult to accompany you to and from surgery and for the first 72 hours following surgery. Breast Augmentation Revision Natrelle™ focuses on several operative measures that are taken by Newport Beach, Orange County Plastic Surgeon Dr. Mowlavi to optimize your results. Use of only FDA approved breast implants to ensure the longevity of your implants. Provide perioperative antibiotics through your IV to minimize the risk of infection. Utilize extended surgical drapes to ensure sterility throughout your case. Utilize nipple-areola shields in order to avoid contamination of your implants from endogenous bacteria that normally live within the breast glands. Use of anatomic landmarks for pectoralis muscle release in order to ensure the symmetric release of muscles and subsequent symmetry of proposed breast implants pocket position. Use of non-powdered gloves as well as irrigation of surgeon’s gloves with antibiotics solution to avoid all irritants that could cause capsular contracture. Use of antibiotic solution to irrigate the surgical breast pocket and breast implants in addition to the surgeon’s gloves to minimize the risk of infection. Use of minimal touch technique when handling breast implant replacements prior to implantation. Use of sterile breast implant sizes prior to committing you to your final replacement implants. Maintaining an array of breast implant sizes and shapes on consignment at our surgery center so that adjustments in size can be considered during your operation should unexpected intraoperative findings be made. Placement of specialized breast garment, i.e. breast band, which ensures the maintenance of breast implant position and avoids implant malposition. Finally, Orange County Breast Augmentation Revision Natrelle™ focuses on providing you a comfortable immediate postoperative period, speedy recovery, and long-lasting results. Use of long-lasting numbing solution instilled into your pocket prior to closing your incision lines so that you have a comfortable immediate postoperative recovery. Provide your superior grade anesthetic medications during your surgery in order to avoid postoperative nausea and grogginess. Provide you with generous bandages and garments that won’t have to be replaced until you dispense with them at your first postoperative visit. Educate you and train you to perform breast massage exercises, which will minimize the incidence of scar tissue formation, i.e. capsular contracture, and ensure long-term aesthetically pleasing breast shape. It is not uncommon for Breast Augmentation Revision Surgery to require a simultaneous breast lift during your breast augmentation revision. By employing a simultaneous breast lift procedure, it is possible to correct breast mound shape asymmetry, to raise the position of the breast mound, to improve medial cleavage, and to ensure an optimum nipple-areola position. Breast augmentation cost is affected by multiple factors including implant style selection, the severity of breast deformity, the need for breast lift, and whether insurance coverage can be secured for your surgery. We encourage you to take advantage of our complimentary consultation so that you can be provided an accurate estimate for your breast augmentation revision surgery. We also encourage you to view Dr. Mowlavi’s breast augmentation revision before and after photographs so that you can appreciate the improvements that are feasible for you. Arian Mowlavi, MD, FACS is a Board Certified Plastic and Reconstructive Surgeon who has dedicated his practice to providing prospective patients the breast shape they deserve. Breast Augmentation Revision Natrelle™ is dedicated to restoring your natural breast shape following prior breast augmentation surgery. Dr. Mowlavi is Board Certified by the American Board of Plastic Surgery, Fellow of the American College of Surgeons, as well as Member of the American Society of Plastic Surgeons, Alpha Omega Alpha Honor Medical Society and Orange County Society of Plastic Surgeons. Dr. Mowlavi has published over 50 nationally recognized scientific articles, received several nationally distinguished awards in the field of plastic surgery, and been featured in the Los Angeles Times, Orange County Register, The Washington Post, Self, and Orange Coast magazines. Natrelle™ is a trademark of Allergan Corporation. Breast Augmentation Revision Procedure Enlargement of the female breasts using breast implants made of saline and/or silicone in order to enhance the breast to body size proportions. Length 1 to 2 hours of operative time. Anesthesia General anesthesia (if the implant is placed under the muscle) or conscious sedation (if the implant is placed over the muscle). Place of Treatment Outpatient surgical suite or hospital operating room. Side Effects 1) Due to the extent of redundant skin excised, patients may experience increased tightness surrounding skin incisions and should expect a longer period for incision redness to dissipate (on average 6 months). Despite attempts to remove all redundant skin, patients may develop recurrent skin laxity following surgery, described as “Recurrent skin laxity Syndrome.” This return of laxity is due to the loss of skin elasticity, a direct result of prolonged skin stretching throughout the years of obesity. Differences in laxity in local regions of the body may be responsible for slight asymmetry that develops following surgery. This phenomenon is responsible for more frequent revision surgeries. 2) Prolonged swelling up to 3 months is not uncommon due to poor lymphatic drainage following extreme weight gain and loss. Lymphatic drainage is further compounded by extended surgical incisions required to remove the redundant skin. Lymphatic drainage is promoted by mechanical massage, body wraps, and external ultrasound treatments. Risks 1) Deep vein thrombosis (DVT) may occur in the legs immediately following surgery. DVT refers to the clotting off of leg veins which may result in compromised blood flow return from the legs; a more critical consequence may develop from this clot if it is dislodged and travels to the lungs causing pulmonary emboli. Although rare, pulmonary emboli are the leading cause of death following surgery. 2) Wound breakdown is more common in these patients secondary to several metabolic and physiologic disorders. Diabetes and nutritional deficiencies are largely to blame for the difficult healing of these patients. 3) Seroma formation refers to the accumulation of plasma fluid in pockets created by the surgical elevation of the soft tissue. This fluid accumulates due to a low blood count and protein deficiency both of which are often present in Breast Augmentation patients. This fluid can be a nuisance to patients requiring several aspirations in the office prior to their resolution. More importantly, these plasma fluid pockets may harbor bacterial growth and result in a clinical infection. 4) Local skin infection is not uncommon in a patient who has diabetes, iron deficiency anemia (low blood count), and protein deficiency. 5) Pressure sores may develop in patients following prolonged surgical cases due to the increased weight of the patients on an operating room table. Fortunately, pressure sores rarely develop due to the precautions that are taken by the operating room staff to properly cushion all bony prominences. 6) Breast Augmentation patients are more susceptible to hypothermia (loss of body temperature) due to their larger body surface area to body volume ratio. Hypothermia may lead to arrhythmias and blood clotting difficulties in the operating room. Fortunately, patients’ body temperatures rarely fall due to the precautions taken in the operating room which include: heating of the room, heating of the intravenous fluids, and using special heating blankets. Recovery The recovery period for breast augmentation with a return to daily activities is usually 1 week. Patients are asked to forego physical activities and exercise for approximately 4 weeks. Duration of Results Patients who have undergone breast augmentation surgery can expect aesthetically pleasing results for several decades. Early revisions are due to implant deflation (1 % per year). Late revisions are needed if the breast becomes distorted (due to thickening of the capsule surrounding the implant) or sagging of breast from the normal aging process and increased weight of the implants. BREAST AUGMENTATION REVISION - FREQUENTLY ASKED QUESTIONS What is the history of breast augmentation surgery? The first reported breast augmentation was performed by Czerny in 1895 using the patient’s own fat. He actually used fat that he had removed from a fatty tumor called a lipoma. In the early part of the century synthetic injections were attempted by Gersuny in 1899 (paraffin) and by Pangman in 1951 (synthetic polyvinyl alcohol and formaldehyde polymer). In 1963, two United States physicians named Cronin and Gerow introduced the popular silicone implants that are used today. Are silicone implants allowed in the United States? In 1991, a moratorium was placed by the F.D.A. for the use of silicone implants. This decision was based on a concern from numerous women across the country who felt that their implants were responsible for development of immune disorders and breast cancers. Although the move to halt all silicone implants was controversial, the physicians agreed that further testing should be performed to determine the safety of silicone implants. Over a decade of studies has shown that, in fact, silicone implants have no relation to development of immune disorders and that women who have silicone implants are less likely to develop breast cancer. In March of 2007, the F.D.A. re-approved the use of silicone implants in all women aged 22 years and older. If I have breast implants, can I receive silicone implants? Prior to March 2007, silicone implants could only be placed in women who needed replacement of their implants (saline or silicone), in women who had sagging of the breast requiring a breast lift, in women who had chest wall deformities, in women who had breast asymmetry, and in women who needed breast reconstruction for breast cancer. For all other patients considering breast augmentation for the first time, only saline implants are allowed. As of March 2007, the F.D.A. has approved the use of silicone implants in all women aged 22 years and older. Am I a good candidate for breast augmentation surgery? Most women who desire enlargement of their breasts are good candidates for breast augmentation surgery. In general, it is safer to place implants in patients who have not previously had breast symptoms such as: breast tenderness, breast lumps, nipple areola discharge, and breast infection. In addition, if the patient has had a family history of breast cancer, this can be concerning because it may increase the likelihood of breast cancer in the patient. If you have experienced any of the above concerns, a mammogram is recommended so that any breast abnormality can be detected prior to breast augmentation surgery. Indications for having breast augmentation include inadequate breast volume and developmental delays in breast growth. Additionally, breast augmentation has proven to benefit psychological conditions such as: low self esteem, lack of self-confidence, or sexual inhibition. Finally, small degrees of breast droop (up to 2 cm) can be corrected with a breast implant placement. What does breast augmentation surgery involve? The surgery involves placement of accurate preoperative markings including: the midline of the chest, the incision line (determined by the approach used), the inframammary crease (fold under the breast), as well as the pocket that is going to be dissected to fit the implant. The pocket size is determined by the implant size selected. Following placement of the implants, the patient is sat upright so that breast symmetry can be confirmed. If there are asymmetries, the patient is placed back down and either pocket dissection or implant volumes are adjusted until symmetry is achieved. Finally, the incision is closed in multiple layers and using plastic surgery closure techniques to ensure protection of the implant and an aesthetically pleasing incision line. The various approaches to breast augmentation include: inframammary crease(in the breast fold): this approach provides the surgeon the best visualization of the breast pocket that he/she is dissecting thus ensuring breast symmetry following breast augmentation surgery. The most important advantage of this approach is that it provides the most direct access to the surgical pocket in the event that revision surgery is required. periareolar (around the areola): when this incision heals well, can be very well camouflaged. However, this incision is associated with several disadvantages including: surgical trauma to the breast glands, increased potential for nipple numbness, and poor scarring in the event revision surgery is required. Since the incision is circular, if opened a second time, it tends to contract into a straight line when healed thus distorting the areola. transaxillary (in the armpit): This incision tends to hide well as long as you don’t have to raise your arms as part of your occupation. However, it has several disadvantages including: more difficult dissection resulting in more difficulty obtaining symmetrical pockets, potential for arm numbness, potential for damaging large veins to the arm which if damaged could result in prolonged arm swelling, and a necessity to convert to another incision if a revision is necessary (revisions may include correcting asymmetry or to remove a thickened capsule scar). Breast implants using the armpit technique are usually placed under the pectoralis muscle. How do I plan for breast augmentation surgery? On your initial visit, your surgeon will evaluate your health status by obtaining blood work. If you are 40 years or older or if you have had a history of breast symptoms (tenderness, lumps, nipple discharge) you will have to obtain a mammogram. If you are a smoker, you should quit for 1 month prior to your breast augmentation surgery to minimize the risks of implant infection. In addition, it is prudent to quit smoking for 6 weeks following surgery to ensure a well-healed surgical incision line. Finally, you will need to arrange for a friend or a spouse to care for any small children who may need to be lifted since you will be sore for the first couple days following surgery. How do I prepare for breast augmentation surgery? Since your surgery will require general anesthesia and/or intravenous sedation, you must take several precautions prior to surgery. First, you will have to avoid eating and drinking after midnight on the day before surgery. This precaution ensures that your stomach is clear of digested foods that could potentially be aspirated into your lungs during induction of anesthesia. Since, you will have anesthetic medications administered throughout the case, you will remain groggy for several hours and will require a ride to and from the surgery center. You should choose a caretaker who is conscientious and who can spend the first night with you. What results can I expect after breast augmentation surgery? Patients who undergo breast augmentation surgery are extremely satisfied with their surgery and will notice immediate improvement in their breast to body silhouette. A thorough preoperative assessment, safe intraoperative course, and close monitoring with frequent postoperative visits ensures that patients experience a speedy recovery and a return to a more productive and rewarding life. Patients are extremely pleased with breast augmentation surgery and radiate increased physical and mental confidence. Where will my breast augmentation surgery be performed? Since breast augmentation surgery will require general anesthesia, it must be performed in an operating room that is part of a hospital institution or outpatient surgery center. Less frequently, patients may be operated on in an in-house office based operating room, but it is of utmost importance for patients to make sure that the office facility is accredited by a surgical accreditation body such as AAAASF. What type of anesthesia will be used for my breast augmentation surgery? For the routine breast augmentation, the implants are placed in a submuscular plane which will require general anesthesia. For certain individuals, a subglandular (over the muscle) plane is recommended for which conscious sedation (sedation through intravenous medications only) will suffice. What should I expect after breast augmentation surgery? Patients will awaken from general anesthesia to find their breasts wrapped with Ace Wraps as well as a breast band. The Ace wraps are to support the implants in their newly created pocket. The breast band is to prevent the implants moving up on the chest wall. Although this is not intuitive, for the first three weeks following surgery, breast implants tend to want to move up on the chest wall against gravity. The band counters this movement and ensures that the breast implant stay in the desired position. Patients will feel sore throughout the first 2 to 3 postoperative days. By placing long lasting local anesthetic solution in the breast pockets prior to closing the incisions, this soreness is minimized . Patients are asked to avoid lifting of weights greater than 15 pounds for the first two weeks. Incision lines will be sealed with special tape (steri-strips) for the first 36 hours so showering is delayed until the 2nd day following surgery. Finally, exercise should be limited for the first 4 weeks until the incisions and the breast pocket have completely healed. When will I be able to return to work following breast augmentation surgery? Patients can expect to return to work at the earliest at 4 to 5 days following surgery if they have a sitting job. In general, patients are recommended to take 1 week off if their work permits. Weight restrictions are set at 15 pounds for the first two weeks to guide patients who may have more physical jobs. Are there any side effects associated with breast augmentation surgery? There are several side effects that have been associated with breast augmentation surgery and these include: High riding implants: Patient’s frequently notice high riding implants in the early postoperative period. The implants will drop into their desired, aesthetically pleasing position within 2 to 4 weeks. The tendency for the implants to sit high is countered by wearing of a breast band which will be provided by your plastic surgeon. The breast band will be worn for approximately 2 to 4 weeks until the implants fall into their desired space. Numbness: Numbness can occur when sensory nerves are inadvertently traumatized during the surgery which requires creating a pocket for the implant to sit in. Since these nerves are extremely small, they are not apparent to the naked eye and so unavoidable. Clinically, the periareolar incision has been associated with increased incidence of numbness since the dissection is closer to the nerves. Fortunately, numbness is an infrequent event and when present resolves itself over 2 to 3 months. Capsule formation: Capsule formation refers to the phenomenon of the body forming a scar around the implant. This is a natural event that occurs as the body tries to wall itself from a foreign body; this occurs when you get a splinter the body forms a scar around it that eventually helps the body spit it out. Usually, the capsule around the implant is thin and soft, and does not cause any problems. However, if the capsule does thicken it can lead to breast distortion and is referred to as capsular contracture. Capsular contracture is an infrequent event that occurs most commonly with silicone implants. The good news is that capsular contracture is rarely observed with saline implants and to be limited with the new generation silicone implants. Since capsular contracture tends to occur years after implant placement, time will tell if the new generation silicone implants prevent the development of capsular contracture. Hypertrophic scar: Hypertrophic scar refers to the development of a thick scar in the skin. Since, most plastic surgeons use a similar technique for closure of their skin incisions, whether or not you are at risk for this depends on the healing capacity of your body. Contrary to common knowledge, the better healer you are Mild asymmetry of breast size: Asymmetry of the breasts is considered a side effect only for the mere fact that most women have some degree of asymmetry. The surgeon must do his/her best to improve on any asymmetry by utilizing different sized implants. Thus, any preoperative asymmetry should be improved upon; as a rule of thumb, the surgeon should be able to get the breasts to a similar size with a less than 5 % difference in size. Deflation: Deflation of the implants can occur and in gen at 1% per implant per year. So in 10 years there is a 10% chance of the implants deflating. Deflation is felt to occur when the shell (or cover) of the implant rubs against itself. In saline implants, this occurs when the implant is under-filled. For example, if you chose a 360 cc implant, then this implant is usually overfilled to 380cc so that there are no creases in the implant. Detection of deflation in saline implants is easy since they deflate like a flat tire. Detection of deflation in silicone implants is more difficult since the silicone implants tend to ooze and minimally deflate. Often a ultrasound or MRI is needed to confirm a break in the silicone implant shell. Are there any risks associated with breast augmentation surgery? Hematoma: Hematoma refers to the accumulation of blood in the early postoperative period which pools into a pocket. When less than 10 % of the breast volume, the hematoma is left to resolve on its own. When larger than 10 % most surgeons will recommend a trip back to the operating room so that this hematoma can be removed. There are two reasons why the hematoma must be removed. First, the hematoma is a perfect medium for harboring growth of bacteria. So if you have an infection anywhere in your body, the bacteria will travel through the blood stream and grow in the hematoma; this can lead to an infection of your implant(covered below). Second, the presence of a hematoma is felt to promote capsule formation (covered above). Infection: An infection is probably the worst complication that can occur following breast augmentation surgery. An infection will require you to remove the implant and get on 1 month of antibiotics. You will have to wait approximately three months before having your implants replaced. This 3 month interim can be quite discomforting for you since you will have to wear a falsy(bra) to make your breasts symmetric. Pneumothorax: A pneumothorax refers to the inadvertent puncturing of the lining that covers your lungs. This is a rare event but can occur since most implants are placed under the pectoralis muscle. Once you are dissecting under the muscle, there is only a few millimeters of tissue between your pocket and the lung lining. Regardless, if this does occur, then the surgery is more complicated as you might assume. The surgeon has to place a catheter into the lung, has to seal the hole created, and then pull the catheter after the case following an X-Ray to confirm proper placement. This will probably mean a trip to the hospital for the X-Ray and an overnight stay. Assymetry of breast shape: Assymetry in shape is very different than asymmetry of size (described above) and occurs when the implant pockets have not been dissected accurately. This is why preoperative marking is so critical (see below). In fact, if the breast pockets are dissected too medially, this can lead to the breast pockets connecting together leading to a condition called symmastia. This can be a difficult complication to fix and will require revision surgery. PATIENT-SPECIFIC QUESTIONS Is breast augmentation coming back into vogue? Breast augmentation surgery has always been a popular procedure. According to the statistics published by the American Society of Plastic Surgeons, nearly 300,000 women undergo breast augmentation each year. On average plastic surgeons perform 2 to 5 breast augmentations per week. Do breast implants last forever or do they have a limited life time? Breast implants are made of a solid silicone shells which may deflate with time. The degree of deflation has been described as a “bleed “(least leak) and as a “rupture” (complete deflation). Saline implants will completely deflate over time even if there is only a bleed; this is in contrast to silicone implants which may look and feel normal when bleeding. Over all, the deflation rate for an implant is 1 % per year. This means that over a 10 year period there is a 10 % chance of your breast implant deflating. Are breast implants safe or are they harmful to your body? Breast implants are not a risk to your body. This was proven as a result of multiple clinical studies that were initiated following the silicone scare in the late 80s. As a result of the “silicone scare” of the late 80s, the FDA moratorium in 1992, and subsequent research and development, far superior implants have been developed. Today implants are made stronger yet they feel softer and more natural than those we were used to in the past. What is the average age group of breast augmentation patients? The age gap for breast augmentation has begun to spread. Plastic surgeons are seeing patients as young as 18 and as old as the 60s. The popularity of cosmetic makeover shows has prompted younger patients, even in their teens, to seek cosmetic surgery. In contrast, surgeons are also seen older patients in their 60s desiring breast augmentation since patients are living longer and wanting to look younger. What about women whose breasts are sagging due to old age or from having kids? The medical term for “sag” is PTOSIS. According to a recent study, regardless of the implant size, at most patients can expect to improve their sag by 1 to 1.5 cm i.e. a finger breadth. In a nutshell, you can only improve minor degrees of sag with a breast augmentation alone. How do I know if I need a breast lift? First, you need to examine where your nipples lie relative to the breast crease by placing your index finger underneath the breast. If the nipples lie below the breast crease, then you need a lift. How do you go about deciding what size implant would be best? The best way to decide what size implants to get is to try out the sizer implants available at your surgeon’s office. Implant sizers range from 200 cc’s to 500 cc’s and go up in 50cc increments. If the client still has a difficult time choosing the implant size, then we recommend that they use sandwich bags filled with sand placed in their bra. When the desired size is determined, then we can calculate the appropriate size by measuring the amount of sand in the bag. How do you decide how to insert the implant? Currently there are three options for inserting breast implants. These include: 1)Inframammary fold (under the breast), 2)Nipple/Areola (underneath the pink portion of the areola), and 3)Trans-axillary (through the armpit). Breasts are an intimate part of a female in that this decision needs to be made together with your doctor. There are pros and cons of each approach and they should all be discussed with patients. Most plastic surgeons prefer the approach from under the breast. This avoids loss of sensation of the nipple, less interference with mammography, avoids a potentially ugly scar on the center of your breast mound. In the event that you don’t scar well, this is the ideal site for a scar; it will be hidden in the shadow of your breast and it can be treated with laser and scar management therapies. Do you recommend inserting through the bellybutton? The consensus among surgeons is that this approach is still in an experimental stage. When more cases have been performed, then we can evaluate whether this approach is more effective than the above options mentioned. From the limited experience gathered, it seems that there may be a slightly higher incidence of asymmetry of breasts associated with this approach due to the fact that dissection of the pockets for placement of implants is performed far from the pocket, i.e. the belly button. What about scarring after surgery? Special plastic surgical techniques for closure of the incisions are utilized to minimize scarring including: closure in multiple layers so that the tension is taken off the skin specialized sutures which will stabilize the incision line for several months specialized bandaid dressings which create a pressure effect on the incision line, thus preventing scar formation. In the event that individuals do develop prominent scarring, we can offer laser therapy, steroid injections, and even medical tattooing. Is it true that breasts sometimes will squeak after surgery when I run? Squeaking of the breasts after surgery is rare. There are two reasons why this occurs: 1) If you had saline implants, it is possible that your implants were underfilled so that the water within the implant is swishing around, but this is probably not the case. 2) The more likely cause is that the dissected pockets are larger than the placed implants and so that the implants are able to move around in the pocket. Within 2 weeks following surgery, the pockets will tighten down around the implants and the squeaking will resolve on its own. How can you tell if your surgeon is an expert? It is easy to pick a qualified surgeon by making sure that he is a plastic surgery trained physician. Unfortunately, there are a few organizations that will give you an impressive certificate claiming that you are a “cosmetic surgeon” but only after a limited amount of training. What clients have to look for is a certificate of completion from a “plastic surgery” training program. I am concerned about my breasts getting harder. I had my breasts done 15 years ago with silicone implants. There are currently several indications for having your implants replaced due to the hardening that you are concerned about. This hardening is nothing to get worried about since it is caused by the body’s own response to having a foreign material implanted in it. If your breasts are being distorted by the hardening or if you are having pain associated with the hardening of your breasts, then you should be evaluated by a plastic surgeon. If your implants are silicone and more than 10 years old, your implants are considered older generation implants which have a higher propensity for leaking and hardening. Hardening of the implants is due to the development of a thick scar which surrounds and squeezes around your implants; this scar as well as the implants need to be removed in order to return your breasts to the soft and aesthetic appearance that you once had. Can breast surgery fix asymmetrical breasts? Plastic Surgeons can fix breasts that are different in breast volume, mound shape, or nipple position. It is critical to assess the reason for the asymmetry so that the proper surgical revision can be performed. I know that implants can be placed either over or under the muscle. It seems like everyone I know is getting implants placed under the muscle. Why is that? When you put an implant under the muscle you benefit from three things. First there is less scar formation around the implant, this is because the muscle continuously messages the implant and breaks up any large scar depositions. In addition, implants tend to tether the overlying skin which is caused by the implant sticking to the skin; The muscle gives a protective layer that prevents tethering of the skin, especially over the upper pole of the breast mound. In addition, going under the muscle gives you a bigger cushion so that you are less likely to feel the implant. But most importantly, by placing the implant under the muscle, you avoid dissection through the breast tissue and subsequently improve detection of breast cancer. What happens if the implant hardens or deflates somewhere down the line? It used to be that deflation rates were 1% per year per implant. That meant that you could tell a client to expect a 20% chance of one of their implants deflating over a 10 year period. However, due to the wonderful improvements in implant technology that we have witnessed over the last couple of years, the most current statistics have shown a 3 to 7 % rate of deflation over 10 years. These studies have been performed by the Mentor and Inamed Corporations, both of which provide extended 10 year implant warranties. HOW OUR PATIENTS FEEL ABOUT US: Breast The best Plastic Surgeon in Orange County. He is a protectionist, and so generous. He said he would take care of me and he has! The first time I came in to see him I cried, he was so helpful and reassuring. He really got me through my breast procedure. Breast Augmentation Revision Im very happy for the way the Staff I feel conf and Stuff treat me very nice trst me I think Dr Mowlavi is the best well thats what i think with my experience to be here and i will came back for shure thank you for been the numer one. and i will refer you to my friends. I love the results and I look forward to seeing further improvement! 800cc Inspira Today was my appointment with Dr Mowlavi. I'm so happy with my implants, theyre soft and feel like real boobies. I decided to go bra shopping as the Brallettes were comfortable but I wanted to wear a bra again.