Breast Augmentation Los Angeles, CA
- BEFORE & AFTER PHOTOS
- PATIENT EVALUATIONS
- TYPES OF INCISIONS
- TYPES OF IMPLANTS
- IMPLANT PROFILE
- IMPLANT VOLUME
- WHAT IS THE COST OF BREAST AUGMENTATION
- DAY OF SURGERY
- CAPSULAR CONTRACTURE
- DERMAL MATRICES
- ADDITIONAL READING
- PRE-OP INSTRUCTIONS
- POST-OP INSTRUCTIONS
- CONTACT US
Breast Augmentation Los Angeles with Dr. Kenneth Hughes
Dr. Kenneth Hughes has performed thousands of breast augmentations throughout his career, and he offers patients from all over the world the ability to choose among the many options in breast augmentation based upon patient anatomy and goals.
Breast Augmentation with Breast Implants
Dr. Kenneth Hughes in Los Angeles can perform breast augmentation or breast enhancement with any available implant through any incision. Dr. Kenneth Hughes performs breast augmentation through the belly button (transumbilical augmentation, TUBA). This approach allows breast augmentation to be performed without any scars on the breast. The scar is hidden inside the belly button.
Dr. Kenneth Hughes achieves fantastic results with this technique four or five times a day. Few people have the training to perform this type of breast augmentation, and that is the primary reason why many surgeons perform augmentation through other incisions.
Dr. Kenneth Hughes also performs breast augmentation through the armpit (transaxillary). This incision also allows for placement of implants without any scars placed on the breast. The scar is placed in the natural underarm crease, making it virtually undetectable.
Dr. Kenneth Hughes also performs breast enlargement through the most common incisions made under the areola (infraareolar) or in the fold of the breast (inframammary fold). Whatever you as the patient want, Dr. Hughes can deliver.
Dr. Kenneth Hughes in Los Angeles has performed breast augmentation both above the muscle (subglandular) and under the muscle (submuscular), and he offers saline and silicone implants in a broad array of types and profiles.
During the consultation, Dr. Hughes will discuss your unique anatomical details, and he will suggest an approach and an implant for you. If you are confused or undecided on breast augmentation, Dr. Kenneth Hughes will make everything about your surgery clear and formulate a plan just for you.
DR. KENNETH HUGHES VOTED AMONG BEST BREAST AUGMENTATION DOCTORS IN LOS ANGELES
BEFORE & AFTER GALLERY
Evaluation of the Breast Augmentation Patient with Dr. Kenneth Hughes
In order to help choose the best breast implants for a patient, Dr. Kenneth Hughes will evaluate the patient’s chest wall and breast form. He will point out chest wall asymmetry or deformity as well as breast asymmetry or deformity and nipple areola complex (NAC) asymmetry as well as NAC deformity. Chest wall issues cannot be changed, and Dr. Hughes will advise the patient on what breast issues can be affected for the better.
He will also comment on relative level of breast droop or ptosis, and he will advise the patient as to whether a breast lift is necessary and the type of breast lift needed.
In many cases, a breast lift and implants can be combined for a procedure known as a breast augmentation with lift. This allows for fuller and perkier breasts that do not droop. When a patient desires a reduction in droop without an increase in fullness, it is best to choose a breast lift without implants.
Dr. Kenneth Hughes will point out if the skin envelope is loose and whether or not stretchmarks are present. Stretchmarks frequently remain the same or become worse with breast augmentation. Very few breast augmentation patients have enough breast tissue to permit a subglandular augmentation. Most patients with small breasts or hypomastia are better served by a submuscular augmentation to permit a more natural breast takeoff and better camouflage for the implant.
Dr. Kenneth Hughes will determine your preference for saline or silicone implants. He will inform you of the positives and negatives of each so that you can make an informed decision about the type of implant. In general, silicone implants are more expensive than saline implants.
Silicone implants require MRIs to monitor for rupture. Silicone implants feel more natural and show less rippling through the skin. The rippling is frequently only observed after years of having implants, as the implants thin the breast and subcutaneous tissue.
Conversely, saline implants are cheaper. If the saline implants rupture, the body will absorb the saline and the deflation will become evident to the patient. During the consultation, Dr. Hughes will explain the differences in as much detail as you wish.
It is important that patients have realistic expectations for this procedure. Viewing breast augmentation before and after photos is an excellent way to visualize your potential results.
Discussion of the Four Incisions Used for Implant Based Breast Augmentation
IMF (inframammary) Incision (Incision in the Breast Fold, Under the Breast)
The inframammary incision is placed underneath the breast within the breast fold. This is the most common approach to breast enlargement, because it is technically the easiest method to perform. The incision is made, the inferior border of the pectoralis major muscle is identified, and the pocket is dissected.
It may be necessary to use this incision for larger implants or gummy bear implants, which are more difficult to mold due to its higher molecular cohesion. Saline or silicone implants can be placed through this incision.
Periareolar Incision (Incision under the Areola)
The periareolar incision is performed for women who may not have a well defined inframammary fold or who are not good candidates for the transumbilical or the transaxillary approaches. The incision can be made at the top of the areola or at the bottom of the areola. The areolar size must be large enough to allow placement. This may be a limiting factor in women with smaller areolae who want larger silicone or gummy bear implants.
The incision generally heals well as it is placed in a natural pigment transition zone. A property executed periareolar breast augmentation should have no impact on breast feeding or lactation as the ducts should not be disturbed. The plane of dissection runs parallel to the ducts and not perpendicular.
Sensation is always a concern with any form of breast augmentation. The incision may compromise small portion of the cutaneous sensitivity to the areaola and nipple. In addition, the rates of infection and capsular contracture may be higher for this approach due to the proximity to the bacteria present in and below the nipple areolar complex.
Once again, this all comes down to weighing the risks and benefits for each individual and Dr. Hughes is an expert at helping you understand all of these elements.
Transumbilical Breast Augmentation (Through a Belly Button Incision, Only for Saline)
This method involves making a hidden incision in the hood of the belly button (umbilicus). The great thing about this approach is the no one will know you had this done. Despite the naysayers, this technique allows for very precise pocket dissection.
Most surgeons have never been trained nor have they performed this method and have no expertise or knowledge with regard to the procedure. Dr. Hughes offers all alternatives to breast augmentation so that each patient can have what each patient wants. This method has an extremely low rate of hematoma and infection. This method can be used for saline breast implants.
Transaxillary Breast Augmentation (through the armpit)
This route involves making an incision in the armpit (axilla). From this point a tunnel is created underneath the pectoralis major muscle and the implant is inserted through this tunnel.
This procedure can be performed bluntly or under direct or endoscopic visualization. Both saline and silicone implants can be placed through this method. The rates of infection and capsular contracture may be higher for this method due to bacterial translocation from incision.
I am proud of my body shape and size, but I always felt as if I was missing something — bigger breasts! I decided to have a breast augmentation about a year ago, and ever since I made my life-changing choice, I knew I was going to consult with Dr. Kenneth Hughes. […] I feel very happy and satisfied with my new breasts! I finally feel that my body is complete! Thank you so much Dr. Hughes! You are the BEST!
Types of Breast Implants: Saline, Silicone, and Gummy Bear Implants
Breast implants typically consist of saline, silicone, and gummy bear implants. Saline implants consist of a silicone shell into which a saline solution (salt water solution) is placed or filled. Silicone implants consist of a silicone shell and a prefabricated silicone matrix. Silicone breast implants largely fall into two groups: cohesive gel and gummy bear implants (which are solid in their truest sense).
Different companies make different types of gummy bear implants with varying amounts of silicone crosslinking or cohesivity so it can be confusing. Dr. Hughes in Los Angeles prefers Allergan overfilled silicone cohesive gel implants to minimize rippling and maintain softness and offers all three types of form stable (gummy bear) implants available from Allergan/Natrelle.
The form stable implants are indeed harder as the silicone becomes more and more solid. Dr. Hughes has used Mentor and Sientra as well and thinks all companies make reasonable implants.
Smooth or Textured Implants?
Dr. Kenneth Hughes in Los Angeles usually places smooth implants and does not routinely place textured implants, as they offer no advantages and may have a risk that is higher for implant related breast cancer. Textured implants were originally developed to reduce the rate of capsular contracture in above the muscle (subglandular) breast implant augmentation.
There are almost no indications to performing this subglandular procedure but may include animation deformity correction and professional athlete muscle performance concerns following submuscular implant augmentation.
Round or Teardrop (Anatomic) Implants?
In almost all women, round implants will produce a better result as the mass of most breast tissue is located in the inferior aspect of the breast. Thus, round implants give more upper pole fullness, which is usually lacking due to involution or lack of development.
Teardrop or anatomic implants were developed for women after mastectomy to reapproximate the shape of breast if starting with nothing. Thus, if used in most women, the result is a more matronly look with less upper pole fullness.
What Breast Implant Profile is Right for Me?
This factor actually has very little to do with the result. Almost no low profile implant is ever utilized. Almost all implants placed are moderate, moderate plus, or high(full) profile. Very few ultra high profile breast implants are used as they may have a higher probability of thinning tissue over time.
The difference in diameter and implant height among moderate, moderate plus, and high(or full) profile implants is very little and may be less than a centimeter in diameter for a given volume. Dr. Hughes will help you determine what profile may be best for your chest wall and breast imprint measurements once a volume is selected.
How to Select Breast Implant Volume
While large breast implants make sense for certain patients, others may benefit more from small breast implants. Dr. Hughes in Los Angeles can assess very quickly what range of volumes would be reasonable based upon patient breast width compared to implant diameter for given profiles.
Dr. Hughes can offer a relatively narrow range of volumes to produce the best fit for an individual. In addition, looking at the various implants and trying them on in the office can help allay some of the patient trepidation associated with this decision.
What is the Cost of Breast Augmentation
- $7000 (saline), $8000 (silicone), $9500 (gummy bear)
Please note that pricing for Breast Augmentation may vary based on the individual needs of the patient.
Your Surgery Day for Breast Augmentation with Dr. Hughes
Dr. Hughes frequently sees patients for 1) initial consultation and 2) preoperative appointment and finally 3) on the surgery day to address any additional questions or concerns.
The anesthesiologist will discuss with the patient the type of anesthesia administered, which is usually general anesthesia so that the patient is comfortable and completely unaware. The patient is taken to the operating room, wherein an IV is started and the patient is put to sleep. The procedure takes about 30 minutes to perform.
Patients typically remain in recovery for 1 to 2 hours and then depart for home or the hotel. Patients are asked to get all of their prescriptions filled well in advance of surgery so that pain medications, nausea medications, and antibiotics will be available upon departing from the surgery center. Dr. Hughes does not recommend a surgical bra as this can irritate incisions.
Breast Implant Surgery Recovery
Dr. Hughes typically sees patients within the first few days to a week following surgery. The patient usually has 2 to 3 days of pain during which the patient takes pain pills to provide relief. Thereafter, most patients do not need the narcotics.
Patients can return to work within 1 to 3 days or whenever they feel is appropriate. Dr. Hughes recommends no breast massage and does not want patients to exercise for 4 weeks after surgery. Some patients may find that the implants are in perfect position almost immediately or the implants may take a few weeks to settle.
Breast Implant Augmentation Complications
Complications of breast enlargement surgery include hematoma, seroma, wound infection, alterations in nipple sensation. (In Dr. Kenneth Hughes’s extensive experience, these represent less than 1% of cases).
Implant complications include displacement, rippling, and rupture. Implant rupture occurs at a rate of 1% per implant per year.
Hematoma development after breast augmentation has both short-term effects (pain, disfigurement, blood loss) and long-term consequences (capsular contracture). The best treatment of hematoma development is prevention. Should a hematoma develop, the area should be drained and irrigated and any bleeding, controlled.
Wound infections can range from mild cellulitis of the breast skin to an implant pocket infection. Infections should be treated early with broad-spectrum antibiotics rather than to let the infection go unchecked to the point where the implant has to be removed. However, removal of implants has been reported in aggressive infections. Although this complication has not been observed by Dr. Hughes, this may occur in 1% of cases.
A persistent seroma or fluid collection may require aspiration or, for refractory cases, placement of a drain.
The periareolar approach is generally associated with the highest rate of changes in nipple sensation. However, this has less to do with the incision and more to do with the dissection.
The most common implant-related complication remains implant displacement with subsequent breast asymmetry. This complication ranks second only to capsular contracture as the major source of dissatisfaction.
Rippling may be observed in both saline and silicone implants. This may be more prominent in saline implants, but rippling usually occurs after a period of years after breast augmentation as the breast tissue is thinned by the implant.
Silicone is regarded to have less rippling. However, changing the implant is frequently not enough, and the revision breast augmentation may require fat grafting (a form of natural breast enlargement that we offer) or placement of a dermal matrix to camouflage the implant. In addition, gummy bear implants do not have the issues of rippling and should be considered for any patient who has rippling issues.
MORE SPECIFICS ABOUT CAPSULAR CONTRACTURE IN BREAST AUGMENTATION
Capsular contracture results from an exaggerated scar response to a foreign prosthetic material. The amount of capsular contracture can be graded according to severity:
No palpable capsule
The augmented breast feels as soft as a natural one.
The breast is less soft; the implant can be palpated, but it is not visible.
The breast is harder; the implant can be palpated easily, and distortion can be seen.
The breast is hard, tender, painful, and cold. Distortion is often marked.
Capsular contracture remains the most common complication of breast augmentation, with rates reported between 0.5% and 30%. Despite extensive research, the cause of capsular contracture remains unknown. Two main theories address the underlying cause: subclinical infection and hypertrophic scarring. Hypertrophic scarring is thought to be secondary to a hematoma, seroma, or silicone gel bleed.
Surgical placement of the prosthesis in a retropectoral pocket has repeatedly been proved to decrease the risk of capsular contracture. This has led many surgeons to preferentially use the subpectoral plane.
DERMAL MATRICES IN BREAST AUGMENTATION REVISION FOR CAPSULAR CONTRACTURE
Complicated breast augmentations, particularly secondary, may require dermal matrix coverage. Revision augmentation that may require more soft tissue coverage from tissue thinning may be good candidates as well. Various types of dermal matrices exist that differ in intraoperative preparation, method of storage and price.2
TYPES OF ACELLULAR DERMAL MATRICES
- a) Alloderm®
AlloDerm® (LifeCell Corp., Branchburg, NJ) incorporates skin from a human cadaver that undergoes removal of the epidermis and other cells; this reduction in antigenicity provides for a negligible incidence of graft failure and tissue rejection. 3 The resultant product is a biological acellular matrix that favors cell repopulation and rapid revascularization.3
During the process of regeneration, Alloderm® is incorporated into the pre-existing tissue in four stages 1) Damaged tissue is targeted by circulating stem cells 2) Once damaged tissue is located, stem cells are deposited and proceed to adhere to the matrix 3) Differentiation into tissue-specific cell types occurs 4) A new matrix is formed from the differentiated cells which allows for tissue regeneration.4
AlloDerm® has been commonly employed for wound coverage, fascial defect repair, and post-mastectomy breast reconstruction uses, but its indications are rapidly expanding into a multitude of areas in which soft tissue camouflage is required for contour defects.
- b) Strattice®
Strattice® is porcine dermis denuded of cells that contributes to the propagation of an antigenic response. Strattice is a reconstructive tissue matrix that supports tissue regeneration used primarily in implant based/tissue expander reconstruction of the breast.6
- c) DermaMatrix®
DermaMatrix® is human skin in which both the epidermis and dermis are removed from the subcutaneous layer of tissue in a process utilizing sodium chloride solution while preserving the original dermal collagen matrix. This reduces the incidence of rejection and inflammation. Once DermaMatrix® is transferred to the patient; the collagen matrix is infiltrated by the host cells promoting neovasularization and fibroblast deposition.
Acellular cadaveric dermis has remarkably lower levels of inflammatory parameters like capsule fibrosis, vessel proliferation, granulation tissue formation, fibroblast cellularity, chronic inflammatory changes, and foreign body giant cell inflammatory reaction than native breast capsules.
This suggests that acellular cadaveric dermis exhibits certain properties that may reduce formation of a capsule and therefore provides an excellent alternative to total submuscular implant placement.
Article 2: The Evolution of Saline and Textured Implants
Article 3: Silicone Implants and Implant Controversies
Article 4: Evaluation of the Breast Augmentation Surgery Patient
Article 5: Determining Implant Size and Incisions in Breast Augmentation: Inframammary and Infraareolar
Article 6: Incisions and Approaches to Breast Augmentation: Transaxillary and Transumbilical
Article 7: Capsular Contracture in Breast Augmentation
Article 8: Complications of Breast Augmentation
Part II: Dermal Matrices in Breast Augmentation
Part III: Complications of Dermal Matrices in Breast Augmentation
Part IV: Dermal Matrices in Breast Reconstruction
Part V: Dermal Matrices in Breast Augmentation Summary
Article 3: Breast Reconstruction after Mastectomy
Article 6: Desmoid tumors of Bilateral Breasts
Dr. Hughes’s Videos of Breast Augmentation with Implants
Breast Augmentation Pre- and Post-Opt Instructions
CONTACT US TO LEARN MORE
Breast augmentation is a popular procedure that can deliver impressive results. To find out more about breast augmentation in Los Angeles, schedule a consultation with Dr. Kenneth Hughes by contacting our office.