Breast Augmentation (Augmentation Mammaplasty)
Breast Augmentation, Serving Littleton and Denver, CO.
Board Certified Denver Plastic Surgeon Dr. Paul Zwiebel can help you have the beautiful, shapely breasts you desire with minimal scarring.
We know that full, shapely breasts can make women feel more confident, feminine, and beautiful. Our practice believes that every woman should love her body; that’s why we offer breast enlargement services to our patients. Breast enhancement is a cosmetic procedure designed to increase the size, shape, and curve of a woman’s bust line.
Breast enlargement begins when the surgeon creates a small incision in the fold, or crease, of the breast. In Denver, breast augmentation expert Dr. Zwiebel makes only a ¾ inch incision, half the size of the common breast enhancement incision. Once the incision is made, the breast implant will be placed inside the breast, below the pectoral muscles. The incision is then stitched closed.
In Denver, breast augmentation is performed under IV sedation, and it takes approximately one hour to complete. During recovery, our patients typically experience breast sensitivity, soreness, swelling, and possible temporary decreased sensation, but most side effects subside as your breasts heal (usually within three to six weeks).
We would like to emphasize that breast enhancement is a surgical procedure and, as such, carries with it some risk. We encourage all patients to learn as much about the process before undergoing the procedure. Our patients should gather as much information as possible and also direct questions to our friendly staff. Unlike most practices, breast implants patients will be provided with anesthesia pumps following an operation. An anesthesia pump drips local anesthetic into the treatment area for several days and numbs the surgical site to reduce pain and the need for other pain medication. In Denver, breast augmentation patients are much more comfortable with this device and have experienced easier recovery.
Breast Augmentation Before & After Photos
Breast augmentation is a surgical procedure performed to enlarge and shape the breasts, using breast implants that are filled with medical grade silicone gel or with saline, a balanced salt solution that is used in intravenous fluid. Some surgeons have begun to use fat grafting as a method of enlarging the breast.
Women may choose to have breast augmentation to enlarge smaller breasts, enhance the shape of the breasts, or to improve the symmetry of the breasts.
Breast implants will fill breasts deflated by weight loss, pregnancy or aging, but breast implants do not lift the breast; a breast lift procedure is needed for a drooping breast. If the bottom of the breast is too low on the chest (medical term =“ptotic”), or if the nipple position is too low or pointing downward, a breast lift is required. Performing breast lift with placement of breast implants is common to improve the ptotic breast, enhancing breast position, shape and size in a combined procedure.
There are many good reasons for wanting breast augmentation with breast implants.
- you feel your breasts are too small
- your breasts are different in size and/or shape (asymmetry)
- restore loss of size after weight loss or breast feeding
- your breasts are sagging or have lost firmness
- to help you look or fit better in clothes
- for reconstructive purpose to correct deformity
Breast implants can change how you feel about- and view your body (body image). Feeling good about the way you look (self image) can enhance your self confidence. Our patients continue to tell us that breast augmentation surgery has had a very positive impact on their lives.
For an elective cosmetic surgery such as breast augmentation, it is important that you be in good health.
It is also very important that you have some specific goals and realistic expectations for your results from breast augmentation. Ask yourself:
- Why do I want to have breast implants?
- How do I expect to look after breast augmentation?
- How do I expect to feel after breast augmentation?
- Why do I want to have breast augmentation at this particular time in my life?
- Is this a good time to take the time for surgery and a proper recovery?
Breast augmentation surgery should not be done during times of emotional stress or instability, active disease or acute illness, infection, pregnancy or within 3 months of breast feeding. Certain medications may interfere with healing or react with anesthetics. A history of radiation treatments to the chest area can pose important risks to breast augmentation.
The decision to undergo breast augmentation is a very personal and individual choice. There are no specific age restrictions for adult breast augmentation. The right time to go through surgery and recovery is more important than a specific age. Unless breast augmentation is being considered for failure of normal breast development, deformity or asymmetry, it is wisest to time augmentation when natural breast development is complete. For most women, this will be at some time after age 20.
Dr. Zwiebel evaluates each breast augmentation patient as a unique individual. During our consultation, Dr. Zwiebel will provide your assessment based upon your individual factors, such as your unique desires, body and breast size, and shape, as well as age.
During your consultation at the Zwiebel Center for Plastic Surgery, you will have the opportunity to meet with the members of our friendly, experienced and professional team of who will care for you throughout your pre-op, surgery, and post-op experience. We will review your goals for breast augmentation and answer your questions. We know how important it is for you to be sure you are making the right choices for something as important as breast augmentation. It is important for you to openly discuss your previous medical history, cosmetic surgery goals and any concerns you have so that we can help you to make an informed decision to have surgery. During your consultation and examination, Dr. Zwiebel will answer your questions and advise you about your candidacy for breast augmentation surgery.
If you are a good candidate for breast augmentation, we will review various options in breast augmentation and Dr. Zwiebel will make specific recommendations for you based on your goals and the build of your body and natural breasts.
We will review:
- implant sizing
- incision placement
- anatomic position (under- or over-the-muscle)
- saline-filled vs. gel-filled implants
- shaped implants (round vs.tear-drop)
- implant profiles (low, medium, high, ultra-high)
- smooth- vs. textured-surfaced implants
Choosing the right breast implant size is one of the most important decisions you will make leading to your satisfactory outcome from breast augmentation surgery. It is uniquely personal: your sense of aesthetics and proportion affect how you see yourself and how you want to balance your figure. How do you want to fill out your clothes? How do you want to look undressed?
These decisions may seem daunting, at first, but we are here to help!
Sizing: First, we will let you try on breast sizers in a bra, based upon your goals for cup size. We know that how you look in the mirror and your sense of a well proportioned figure is more meaningful than the labelled size in your bra. Trying on implants can be very telling by providing you with a concrete image of how you look to yourself and in the mirror.
Fitting: Next, after hearing your goals, likes and dislikes, Dr. Zwiebel will examine you and take detailed measurements to determine what implants will actually fit your breasts and frame. In addition to the implant volume, it is critical to have the right dimensions of the implant for a fit that looks great and minimizes risks of undesirable complications.
Shaping: At this point, Dr. Zwiebel will review with you your best options for implant sizes, shapes and profiles that will work to give you the optimal result based upon your goals. If there are any particular trade-offs to consider, Dr. Zwiebel will discuss these with you so you can make the best choice for yourself.
Imaging: Finally, we will integrate all of this information into a three-dimensional digital image of your own body, showing you the specific alternative sizes, shapes and profiles of the implants that would work best for you. You can see the differences for yourself, and choose which produces the image closest to the result to you want!
We have found this process has helped hundreds of women understand what they can realistically achieve with breast augmentation surgery and has taken away much of the fear from uncertainty about right-sizing and their final post-op appearance.
At the Zwiebel Center for Plastic Surgery, breast augmentation surgery is performed as an out-patient procedure with intra-venous sedation in our accredited surgical suite located in our office building. On the day of surgery, you will be greeted by familiar faces, as our clinical staff are all members of our surgical team!
You will be scheduled to arrive about 45 minutes before the actual start of the procedure, to allow adequate time for pre-op preparation:
- We will have you change into a comfortable gown, robe and slippers.
- We will check your blood pressure, temperature and pulse.
- Dr. Zwiebel will meet with you to review and confirm the details of the surgical plan and answer any last minute questions;
- Dr. Zwiebel will place pre-op markings on your chest while you are sitting up to help guide placement of incisions and implant positioning.
- You will meet our Anesthetist and Operating Room Nurse.
- We’ll then walk into the operating room and start your IV (intravenous) after applying a local anesthetic to the IV site.
- The local anesthetic is the only needle pinch you’ll feel, because all the other medications will go in through the IV.
- The sedatives work very quickly and you will drift off to sleep; you will be completely unaware of the surgery and the passage of time. When you wake up, you won’t first realize that you’d been asleep and the procedure is already over.
- Once you are asleep, we use generous local anesthetic in the surgery site (the breast), because we want you to wake up pain free. Most patients wake up noticing only a sense of pressure or tightness in the chest or breasts.
- After you are asleep and Dr. Zwiebel has injected the local anesthetic, he will make the smallest incision possible for the size and type of implant you have chosen.
- Through the incision, Dr. Zwiebel makes a precisely dimensioned pocket or space for the implant, behind the breast, usually beneath the pectoralis muscle.
- After assuring there is no bleeding (typical blood loss during surgery is about one or two tablespoons), the pocket is rinsed with antibiotic solution, before the implant is placed into the space.
- To minimize trauma to the incision and to the implant, and to reduce the risk of capsule contracture, we use a specially designed funnel to insert the implant (“No Touch Technique”).
- Dr. Zwiebel makes certain the implants are positioned properly and symmetrically, and that the breast tissues are draping properly over the implants, before closing the incisions with four layers of dissolving stitches.
- To optimize the scarring, reinforced paper tapes are applied to the incision.
- With the close coordination between surgeon and anesthetist, you will be able to sit up as we apply dressings and assist you to walk to recovery room.
- You’ll stay in recovery until you are ready to go home, usually about 30- to 45 minutes.
Breast augmentation surgery does not have to be painful! For your comfort, we use a generous dose of local anesthetic to be sure you wake up comfortably from surgery. To make sure you stay comfortable even after that dose of local anesthetic wears off, we place a small catheter into each implant pocket during surgery and attach the catheters to an anesthesia pump, an ingenious device that continuously drips a measured amount of local anesthetic into the implant pocket to keep you comfortable for days after surgery. We easily remove the catheters at your third day post-op visit.
With all surgical procedures, there is some level of risk. Fortunately, modern techniques, technologies and medications all contribute to the high degree of safety with elective breast augmentation, one of the most frequently performed cosmetic surgery procedures.
To reduce your chances of complications:
- Educate yourself about breast augmentation;
- Inform your surgeon about all your past medical history and all medications (including birth control, over-the-counter medicines, herbs, vitamins and supplements)
- Follow all of your doctor’s pre- and post-operative instructions; carefully prepare for surgery and a good recovery.
- Take no short cuts on your recovery!
- Make sure your surgery will be performed in a surgical suite accredited by one of the national organizations that inspect and certify operating room safety: AAAASF, AAAHC, or JCHO.
The American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgery recommend that people select a breast augmentation surgeon who is board certified and has operating privileges at accredited hospitals and medical centers:
- Choose a surgeon Certified by the American Board of Plastic Surgery;
- Choose a surgeon respected in the medical community and with a solid reputation;
- Choose a surgeon with lots of experience in breast augmentation;
- Look at your surgeon’s results: does he/she have lots of before and after photographs that demonstrate the kind of results that appeal to you?
- Do you feel comfortable and confident with the doctor and medical staff that will perform your breast augmentation?
- What do you feel about the surgeon’s practice environment?
- Does your “chemistry” with the surgeon and the staff feel right?
- Do you feel the surgeon and staff are attentive to you and patient with your needs, or do you feel rushed, not seen or heard as an individual?
- Does the surgeon have a cohesive team? What’s “the vibe” in the office?
- Does the team seem dedicated to your needs and safety?
Dr. Zwiebel is Certified by the American Board of Plastic Surgery and a member of both the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgery.
Dr. Zwiebel’s 30 years of experience includes performing about 100 breast augmentation procedures a year, and is known for performing breast augmentation with very natural appearing results. In addition to reading professional journals and publications, Dr. Zwiebel stays current with new developments consistently with more than 50 hours of continuing education seminars and courses annually.
Our patients consistently tell us they chose Dr, Zwiebel because of his natural appearing breast augmentation results; we are fortunate to have so many before-and-after photos because our patients are so happy with their results that they wish to share their photos with other women considering breast augmentation.
We are proud to say that our patients often say how great our staff is, “from front to back.” We want our practice to be a place where we enjoy coming to work, love taking care of our patients, and our patients sense that. We are often complimented by our patients asking to join our team as employees.
Preparing for breast augmentation surgery is critical for you to achieve great results and a positive experience. The process starts with a consultation in order for you to thoroughly understand what the breast augmentation procedure involves, what is necessary for optimal recovery and what results you can expect.
At the Zwiebel Center for Plastic Surgery, we will review your health history, answer your questions, give you detailed instructions on surgery preparation and recovery. We will not only tell you what to expect, with the aid of the latest digital imaging technology, we will also show you a simulated before-and-after of your own body with breast augmentation, using the specific implant sizes and shapes best suited for your body and goals.
Because we want to answer all your questions, our diligent and attentive consultation process typically takes one-and-a-half to two hours, so please plan your schedule accordingly. We also recommend you arrange care for young children for the time you come for consultation, so you will not be distracted during your consultation with us.
For the 14 days before surgery, it is important to stop aspirin, ibuprofen, multiple vitamins, fish oil and herbal supplements, which can interfering with normal clotting (“thin the blood”). Review all your medications, including over-the-counter drugs, supplements and naturopathic medications with your surgeon to be certain none will cause bleeding problems or cross react with your prescriptions or anesthesia. Even a single baby aspirin taken days before surgery can cause undesirable oozing during surgery.
Smoking has a definite detrimental effect on healing. Stopping completely is best; otherwise cut back as much as you can. Be honest about your smoking habit with your surgeon.
To minimize the risk of complications, you should be in the best health possible for your surgery.
Nutrition and hydration are important to prepare your body for healing. Be sure to have adequate protein in your diet to aid healing and resistance to infection. Exercise also helps prepare the body for the stresses of surgery. If you develop any rashes, pimples, infections, cough, cold or any change in your health, notify your surgeon immediately. You may need treatment to get you back in shape, or it may be necessary to postpone or reschedule your breast augmentation surgery to avoid complications.
At the Zwiebel Center for Plastic Surgery, we normally schedule a pre-op visit 2weeks before your surgery. At this visit we provide very detailed written instructions for your pre-op preparations and recovery. We also provide you with all your prescriptions so you may have them filled at your convenience before surgery.
Be sure to arrange for your caregiver well before surgery and share with them the instruction booklet we give you. For your surgery appointment, coordinate a ride to and from our office. We will give you an estimated arrival and discharge time. You will be very drowsy after your procedure and won’t remember the instructions: whoever picks you up should feel comfortable discussing your post-op instructions and medications with our nurse. You will need your caregiver to stay with you a day or two, after surgery, and to drive you to our office for your post-op appointment on the first day after surgery.
Preparing well for recovery is critical to achieving a good result: don’t cheat yourself of the time your body needs to heal! You get only one chance to recover well! Be sure to follow your recovery instructions diligently.
Although you will not need to be on bed rest right surgery, you will need to take it easy for a few days.
Depending on the amount and nature of physical activity you do in your work, you will need to take at least a week off from work.
During the six weeks after breast augmentation surgery, the tissues around the implants are healing and making a capsule or lining around the breast implant. The capsule is a barrier protecting the tissues (breast and muscle) from any irritation from the foreign object (the implant). If there is too much activity, too soon, the irritation in the tissues leads to increased inflammation and scar formation. During the six weeks after breast augmentation, refrain from high impact activities (jumping, jogging), arm swinging activities (tennis, golf), or lifting more than ~15-20 pounds. Mom’s can lift their infants by keeping elbows close to your sides as you lift.
During the first weeks after surgery, we use tape to protect and splint the scar.
At about 6 weeks after surgery, we recommend using scar therapy cream daily, continuing for 6 months post-op.
There is a new form of topical silicone sheet treatment called Embrace, which appears to give the best scar therapy. The adherent sheet is applied weekly for 8 weeks, starting 2 weeks post-op, then scar therapy creams are used until 6 months.
Protecting the scar from any form of ultraviolet exposure or sun tanning is very important during that first 6 months. Ultraviolet exposure can cause permanent thickening and darkening of the scar and the chest skin is more sensitive and can burn more easily. Be sure to apply sun block under t-shirts or swim suits and do not tan the chest during that first 6 months.
The cost of elective cosmetic breast augmentation surgery is not covered by insurance. If the surgery is for reconstructive purposes (repairing deformity or injury), insurance may cover some of the costs of your procedure.
Though complications of elective cosmetic breast augmentation are rare, they can occur and it is wise to be prepared. Check with your insurance company to see what coverage is available for complications of breast augmentation surgery. The Zwiebel Center for Plastic Surgery recommends you take advantage of CosmetAssure, a supplemental insurance that is designed specifically to assist covering expenses of complications of cosmetic surgery. Please be sure to inquire about the specifics of this supplemental insurance plan.
Breast augmentation procedures are performed on an outpatient basis in our accredited surgical suite.
It is necessary for you to arrange for your caregiver, a responsible adult who will drive you home and who will stay with you for at least the first twenty-four hours, for your safety, care and comfort. The post-operative care is not complicated and is mostly supportive: making sure you are comfortable, drinking enough, helping you take your medications as directed, and making sure you have any assistance you may need.
If you do not have someone who can care for you, we can help arrange a professional caregiver for you.
If you are one of our many out-of-town patients, very close and convenient to our office, we have excellent lodgings used regularly by our post-op patients.
The three most common incision sites:
- Axillary: the incision is made in the armpit. Some like that this incision is away from the breast and can be more discrete. Dr. Zwiebel no longer uses this incision, because it is harder to properly drape the breast tissue around the implant from this approach, resulting in an increased risk of implant malposition.
- Periareolar: an incision is made at the edge of the areola, where the scar can be quite discrete. However, because of its location and the need to cut through breast tissue to make the implant pocket, the periareolar approach is associated with a higher risk of loss of nipple sensibility, difficulties with nursing and a higher rate of capsule contracture,
- Inframammary: the incision is placed along the crease under the breast. This incision is used most commonly and preferred by Dr. Zwiebel because it is the most direct incision to create the implant pocket for either subglandular/pre-pectoral or subpectoral breast augmentation, and is associated with the fewest risks. The inframammary scar is concealed by the breast unless the breast is lifted or when lying supine.
- Transumbilical: the incision is made at the belly button and the surgeon has to make the implant pocket by tunneling through the abdomen. Dr.Zwiebel (and most surgeons) doesn’t recommend this option because of the difficulty in making an adequate precise implant pocket through this approach and the potential for damaging the implant during insertion through a long tunnel.
Breast implants should not be considered lifetime devices, and it is wise to be emotionally- and financially prepared for the possibility that you may need additional unplanned surgeries at some time in the future. The additional surgery may be for complications or unacceptable cosmetic outcomes, implant removal or replacement.
Data suggest that saline implants have a risk of the occurrence of deflation of about 1% per year; silicone gel-filled implants appear to have a lower incidence.
Although some have suggested replacing implants every 10 years, this is not common practice. Dr. Zwiebel recommends you need not replace implants if you are happy with your breasts, are not having problems, and without evidence of implant leakage.
If saline implants leak, the fluid is harmlessly absorbed by the body and the saline is eliminated by the kidneys.
If a silicone implant leaks, the gel may be contained in the space around the implant defined by the capsule. If the gel leaks outside the capsule, the body will usually isolate the gel with scar as a result of a foreign body reaction.
The cost for breast augmentation surgery varies based upon the choice of implant and the surgeon’s experience and expertise.
Saline implants are the least expensive. Highly cohesive gel implants (“gummy bear” or “form stable”) are more expensive than cohesive gel implants.
Be certain to include all associated costs when estimating your total expense for your breast augmentation surgery:
- Hospital or surgical facility fees
- Anesthesia fees for surgery
- Prescriptions
- Post-surgery garments/bras
- Laboratory fees for medical tests
- any other miscellaneous costs
We have a number of financing options to make your breast augmentation surgery affordable.
When it comes to an important event like breast augmentation surgery, low price should not be the priority. Living with or repairing an unsatisfactory result is far more expensive than a great result and surgical experience. Remember that the surgeon’s breast augmentation experience and skill, and your comfort with him or her are the most important factors for successful results.
The tentative answer is that you might be able to augment your breasts with implants and get a satisfactory result without a lift. It depends on what results would satisfy you.
Implants will fill out a breast deflated by aging or pregnancy, will shape the breast by creating fullness in the upper chest and projection behind the nipple, but implants do not lift the breast.
If the nipple falls below the breast crease, you will most certainly want a lift; if you want more breast volume/increased size, then implants together with your lift.
There are a number of techniques that can be used in the right individual to avoid the full breast lift procedure (fewer scars and expense).
The best way to learn if you are a reasonable candidate for breast augmentation with implants without a breast lift is to have a personal consultation with a plastic surgeon well experienced in breast implant and lift procedures.
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