Breast Augmentation Los Angeles, CA
Breast Augmentation in Los Angeles and Beverly Hills with Dr. Kenneth Hughes, MD
Dr. Kenneth Hughes, MD 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 Procedure Information
Dr. Hughes can perform breast augmentation or breast enhancement with any available implant through any incision. Dr. 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. 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. Hughes also performs 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, MD 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, MD 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. Hughes will make everything about your surgery clear and formulate a plan just for you.
If you have a particular way you would like your breast augmentation performed, Dr. Hughes has done it for other patients.
Best Breast Augmentation Doctors in Beverly Hills
Cosmetic Town readers can be sure they are getting accurate and unbiased information about Beverly Hills physicians, as well as doctors in the surrounding areas of Los Angeles, Hollywood and Santa Monica, because the doctors have no influence, or input, on our lists.
Evaluation of the Breast Augmentation Patient with Dr. Hughes
Dr. 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.
Dr. 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. 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.
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 augmentation, 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.
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 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. 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 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?
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.
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. Dr. Hughes recommends not wearing a bra after surgery until Dr. Hughes tells you to do so. The bra can irritate or possibly open the incisions.
Breast Implant Augmentation Complications
Complications of breast augmentation surgery include hematoma, seroma, wound infection, alterations in nipple sensation. (In Dr. 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 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
Grade I
No palpable capsule
The augmented breast feels as soft as a natural one.
Grade II
Minimal firmness
The breast is less soft; the implant can be palpated, but it is not visible.
Grade III
Moderate firmness
The breast is harder; the implant can be palpated easily, and distortion can be seen.
Grade IV
Severe contracture
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.
Antibiotic irrigation of the implant pocket arose in response to the infectious theory of the cause of capsular contracture and the theory of biofilm as the genesis of 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 cost.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; capsule fibrosis, vessel proliferation, granulation tissue formation, fibroblast cellularity , chronic inflammatory changes, and foreign body giant cell inflammatory reaction than native breast capsules suggesting 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.
Breast Augmentation
BEFORE & AFTER GALLERY
Dr. Hughes can perform breast augmentation or breast enhancement with any available implant through any incision.
View Gallery
Additional Breast Augmentation Articles at Hughes Plastic Surgery:
Dermal Matrices in Breast Augmentation Revision Articles:
Other Scholarly Articles Authored by Dr. Hughes Related to Breast Augmentation:
Dr. Hughes’s Videos of Breast Augmentation with Implants
PRE-OP INSTRUCTIONS
PREPARING FOR SURGERY
- STOP SMOKING: Smoking reduces circulation to the skin and impedes healing. It is best to avoid smoking, second hand smoke and cigarette replacements, such as nicotine patches or gum, in the perioperative period. While you should ideally stop smoking for 2 weeks before and after your surgical procedure, YOU MUST NOT SMOKE FOR A MINIMUM OF 24 HOURS BEFORE AND 24 HOURS AFTER SURGERY.
- TAKE MULTIVITAMINS: Start taking multivitamins twice daily to improve your general health once you have scheduled your surgery.
- TAKE VITAMIN C: Start taking 500 mg of Vitamin C twice daily to promote healing.
- START TAKING AN IRON SUPPLEMENT: A good iron supplement, such as Feosol, is required starting one week before surgery and four weeks following surgery. Bowel movements may appear darker than usual as a result. Feosol is available without prescription.
- DO NOT TAKE ASPIRIN OR IBUPROFEN: Stop taking medications containing aspirin or ibuprofen. Review the list of drugs containing aspirin and ibuprofen carefully. Such drugs can cause bleeding problems during and after surgery. Instead, use medications containing acetaminophen (such as Tylenol).
- LIMIT VITAMIN E: Limit your intake of Vitamin E to less than 400 mg per day.
- FILL YOUR PRESCRIPTIONS: You will be given prescriptions for medications. Please have them filled BEFORE the day of surgery and bring them with you.
- CONFIRM SURGERY TIME: We will call you to confirm the time of your surgery. If you are not going to be at home or at your office, please call us to confirm at (310) 275-4170.
- PRESCRIPTIONS: Make sure that you have filled the prescriptions you were given and set the medications out to bring with you tomorrow. Make sure to have the number for your pharmacy ready so that if Dr. Hughes and associates need to call in any special medications for you on your day of surgery they will have that information readily available.
- CLEANSING: The night before surgery, shower and wash the surgical areas with an antibacterial soap such as Dial, Safeguard, pHisoHex, or Phase II I.
- EATING AND DRINKING: Do not eat or drink anything after 12:00 midnight except for a small amount of water to rinse your mouth while brushing your teeth.
- SPECIAL INFORMATION: Do not eat or drink anything! If you take a daily medication, you may take it with a sip of water in the early morning.
- ORAL HYGIENE: You may brush your teeth but do not swallow the water.
- CLEANS ING: Shower and wash the surgical areas again with an antibacterial soap such as Dial, Safeguard, pHisoHex, or Phase Ill.
- MAKE-UP: Please do not wear moisturizers, creams, lotions, or makeup.
- CLOTHING: Wear only comfortable, loose-fining clothing that does not go over your head. NO TIGHT PANTS. Remove hairpins, wigs, and jewelry. Please do not bring valuables with you.
- CHECK IN/PREPARATION: Surgery Time:
- You should plan to arrive 45 minutes earlier than your scheduled surgery time. Patients less than 18 years old must be accompanied by a parent or legal guardian. When you arrive at our office on the day of your surgery, give the receptionist the phone number of the pharmacy you would like us to call for any special medications Dr. Hughes and associates might prescribe.
- CARETAKER: Someone must spend the first night after surgery with you.
BREAST AUGMENTATION POST-OP INSTRUCTIONS
ACTIVITY
- The first week you will need to rest frequently. You need to walk around the house every 2 hours as tolerated. Avoid stairs if possible.
- For the first week post-op, sleep on your back with your head elevated.
- Avoid picking anything up greater than 5 lbs for 4 weeks.
- DO NOT EXERCISE FOR 4-6 WEEKS.
- You may not drive the first week or while you are taking pain medication. After that it will depend on your ability to handle a car without causing any discomfort.
- Do not engage in sexual activity at least 4-6 weeks after your surgery.
- No smoking. This will interfere with your healing.
DIET
- Eat light the first 24 hours, clear liquids advancing to a regular diet as tolerated.
- If you have persistent nausea stick to a bland diet until it subsides.
- Avoid foods that can cause a lot of gas. This can cause abdominal distention and undue discomfort. Small frequent meals are best.
- The pain medicine may cause constipation. Drink plenty of fluids. You may take any over the counter laxatives or stool softeners as needed.
DRESSINGS
- It is normal to have numbness over the surgical sites for several weeks or months.
- Do not use a heating pad or ice around the surgical sites. It could cause a burn.
- You may shower on postoperative day 2.
- It is normal to see dried bloody drainage on the pads.
- Do not remove surgical tape under breasts.
MEDICATIONS
- Take your antibiotic until it is completed. Antibiotic should be taken with food at each dose.
- If the pain medication is a narcotic it should be taken as prescribed. Do not take any Tylenol while on pain medication. The medication we prescribe may already have Tylenol in it.
- Do not drink alcohol or drive a car while taking pain medication.
- The pain medication may cause nausea and should be taken with food at each dose.
- You may resume your regular medication after your surgery except for Vitamin E, Fish oil and Aspirin (wait at least 5 days post-op).
- If you take aspirin or coumadin check with the doctor to see when you may resume them.
CALL THE OFFICE IF YOU HAVE:
- A temperature greater than 101.5 degrees.
- Excessive bleeding from the incision.
- A sudden increase in drainage, pain, or swelling around the incision site or the surrounding area.
- If you have persistent vomiting.
