Breast augmentation is one of the most frequently performed cosmetic procedures in my practice. Women usually schedule a consultation and want to enhance their breasts for a number of reasons:

1. To correct flattening of their breasts following pregnancy and breast feeding.
2. To enhance curves and give proportion to a woman who feels her breast size is too small.
3. To balance a difference in breast size.
   
   

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I like to take into consideration the woman's body type when discussing the size and type of the breast implant. Height and body weight are certainly important elements to consider. The width of the shoulder and the chest wall have a very important barring on how a particular breast implant will look on a particular woman. The waistline is critical to the size of the breast implant I recommend. My goal is to create female curves that are elegant and pleasing, starting from the armpit, gently curving outwards and then back into the waistline. A well shaped breast is one that gives curves to a woman that is balanced with the waist and hips, without being distracting, uncomfortable and looking awkward in clothing.

There are a number of different incisions that can be used:

1. Circumareolar. In the lower part of the nipple areolar complex between the colored portion of the nipple and normal skin. The incision I use is only 1 inch long.
2. Inframammary. Along the breast crease. I prefer this incision when placing silicone gel implants (they are pre-filled, requiring a larger incision than the diameter of the nipple areolar complex), or performing implant exchange where I have to remove the implant capsule (scar tissue).
3. Transaxillary. Through the arm pit. I prefer to use the endoscope (a small camera that is inserted in the chest wall to assist in creating the implant pocket more delicately and precisely.
4. Transumbilical (through the belly button). For specific indications. Nipple areolar complex too small or someone who is not a candidate for transaxillary approach.

There are many other issues surrounding breast augmentation that are important, such as longevity of the breast implants, health concerns of silicone gel, capsular contracture, sensitivity, breast feeding, scarring. I like to have detailed discussions of these issues at the time of initial consultation, so please feel free to ask questions.

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