World-Class Services Helping to Sculpt the Body You Want
In 2012, over 286,000 breast augmentation (breast enlargement/breast enhancement)
procedures were performed in the United States, making breast augmentation
the most popular surgical procedure for the sixth year in a row. Advances
in breast implant technology and surgical techniques have made breast
augmentation an extremely safe and effective procedure, and have enabled
patients to achieve beautiful, natural-looking results*. At Gabbay Plastic
Surgery, Dr. Joubin Gabbay M.D. knows that considering breast augmentation
is a very personal choice and that each woman has unique and individual
needs and goals for her breast augmentation surgery. For this reason,
he takes the time to thoroughly educate and inform his patients, so that
they can make a well-informed decision when contemplating their Beverly
Hills breast enlargement surgery.
Things to Consider When Choosing Implants
Selecting the perfect size, profile, and type of implant for your surgery
may feel like an overwhelming task; however, you do not need to make these
important decisions on your own. During your initial consultation at Gabbay
Plastic Surgery, Dr. Gabbay will offer his professional recommendations
for your breast augmentation surgery, taking into account all of the pertinent
details about your specific case (ie. current breast size, height, weight,
skin quality, individual preference).
When considering breast augmentation surgery, it is important to truly
trust your plastic surgeon and to feel confident in his/her abilities
to select bring your aesthetic goals to fruition.
There are many factors and choices to think about when considering whether
or not to undergo a breast augmentation surgery, including:
Implant size: Implants are measured in cubic centimeters (ccs) and range from approximately
120cc to 960cc.
Implant profile: The profile specifies the distance the implant projects from the body–higher
profile implants result in more prominent silhouettes than lower profile
implants. Implant shapes can vary between round and tear-drop shaped.
Incision pattern: Inframammary (Under the the breast), Periareolar (Around the lower half
of the areola), Transaxillary (In the underarm), Transumbilical or TUBA
(In the navel area).
Implant placement: Submuscular placement: under the chest muscle, Submammary or Subglandular
placement: between the chest muscle and breast tissue.
Implant type: Saline implants are inserted into the body in its empty form, and filled
with a sterile, saline solution after it is in place. Silicone implants
are pre-filled with a silicone gel (viscous fluid that simulating the
texture and feeling of human breast tissue).Standard versus cohesive (gummy
bear) silicone gel.
Before & After Photos
Dr. Gabbay is a highly experienced plastic surgeon, who believes that the
doctor/patient relationship is crucial to achieving successful surgical
outcomes, and invests the time needed to determine his patients’
expectations and goals. From the moment you enter the doors of Gabbay
Plastic Surgery’s state-of-the-art facility, you will feel a sense
of calm reassurance and know that you have chosen the best possible location
for your cosmetic surgery. If you would like additional information about
breast augmentation surgery, please contact Gabbay Plastic Surgery today.
We will be happy to answer any and all of your questions and to schedule
an initial, complimentary consultation with Dr. Gabbay.
What is a Normal Breast?
The incredible variety of breast sizes and shapes, along with differences
in personal aesthetic preferences make it impossible to define the “perfect”
breast; however, some of the characteristics most often used to describe
‘ideal’ breasts include: symmetrical, full, balanced, “soft
yet firm,” and having a gentle sloping projection. The ideal nipple/areola
complex is often described as being circular, symmetrical, pointing up
slightly, the same color, and proportionate to overall breast size.
Anatomy of the Breast
The female breast contains two main tissue types: glandular tissues, and
stromal (supporting) tissues. The glandular part of the breast includes
the lobules and ducts. In women who are breastfeeding, the cells of the
lobules make milk, and the milk moves through the ducts to the nipple.
The support tissues of the breast include fatty tissues and fibrous connective
tissues that give the breast its size and shape.
Adipose tissue (fatty tissue) accounts for a large part of the female breast
composition and plays a major role in determining breast size. The proportion
of fatty and glandular tissue varies among different women, and over a
woman’s life. The breast itself does not contain any muscles; however,
there are muscles under each breast, over the ribs. Each breast is attached
to the dermis of the overlying skin by connective tissue structures known
as “Cooper’s ligaments,” which provide support to the
breasts. As time passes however, gravity has a detrimental impact on the
strength of these ligaments, and as they weaken, the connecting skin stretches
and the breasts begin to sag.
Is Breast Augmentation Right for You?
Breast augmentation surgery is one of the most common cosmetic procedures
performed today and is undertaken for a number of reasons, including (but
not limited to)*:
Increase breast size
Correct asymmetrical breasts
Enhance lost breast volume after pregnancy and breastfeeding
Augment breast size after significant weight loss
Correct imbalanced body proportions
In conjunction with breast reconstruction surgery after mastectomy or injury
to the breasts
In conjunction with breast revision surgery after complications from a
previous breast surgery
In conjunction with a breast lift, to add volume and fullness while correcting
breast ptosis (sagging)
What to Expect from Your Consultation
If you are considering breast augmentation, scheduling a personal consultation
with Dr. Gabbay at Gabbay Plastic Surgery is a great first step. During
this initial consultation, Dr. Gabbay will go over any concerns you have
about the appearance of your breasts and why you are considering breast
Following your medical history evaluation, if Dr. Gabbay determines that
you are a good candidate for breast augmentation, he will then discuss
your breast augmentation options, including incision type, implant placement
position, implant size and shape, potential complications, and implant
profile. In order to help you get a true sense of what your new implants
will look like and feel like, you will be able to test various implant
sizes and weights in order to determine which specific implant would be
the best fit for your body. It is important to tell Dr. Gabbay if you
are planning to lose a significant amount of weight, or if you think that
you may want to become pregnant in the near future because both of these
events can alter your overall breast shape/size.
There are many choices and options to consider when undergoing breast augmentation
Texture: breast implants are encased in a solid silicone rubber outer shell (lumen)
that may either be smooth or textured.
Shape: implants can be round or anatomical (tear-drop). Tear-drop implants (also
called shaped or contoured implants) create a natural sloped shape when
placed over the chest muscle, and are considered to bear the closest resemblance
to the natural breast shape. Tear-drop implants must be positioned precisely
in order to prevent implant rotation, which is why they are only offered
as textured implants, as the rougher texture helps the implant adhere
to the breast tissue. Round implants are spherical in shape and create
fuller breasts with a higher lift and a greater amount of cleavage. Round
implants are offered in both smooth and textured choices, because if the
round implant moves inside the breast pocket, it will not change shape,
unlike the teardrop implants.
Composition: implants can be composed of either saline or silicone. Saline implants
are filled with a sterile saltwater solution that is non-toxic to the
body. All silicone breast implants are pre-filled with a cohesive gel
(holds together in a semi-solid mass). Newer highly cohesive silicone
implants (“gummy bear” implants) are also available and have
added options for patients to choose from. Silicone implants are less
likely to ripple than saline implants, and many patients believe that
silicone implants more closely resemble the feel of natural breast tissue;
however, the ultimate choice of saline vs silicone comes down to personal
preference and determining which option is best for each patient’s
Profile: The profile of a breast implant determines how far the implant will protrude
from the chest wall. Implants are offered in four different profiles:
low, moderate, moderate plus, and high. The higher the implant profile,
the more they will project from the chest. In general, high profile implants
are best suited for women with narrow chests and low profile implants
are better choices for women with wider frames.
Size: implant size refers to volume, and is not measured in terms of bra cup
size (A, B, C, D etc), but rather in cubic centimeters (cc), which are
the are the metric volume measurement used to define the capacity of a
breast implant, with one cubic centimeter being equal to one milliliter.
Breast implant sizes for both saline and silicone implants range from
There are several options for implant placement which can impact the size
and shape of the final aesthetic. These options include:
Sub-Glandular (Over the Muscle): for this technique, the implant is placed directly behind the mammary
gland and under the fatty breast tissue in front of the pectoral muscles.
The sub-glandular option typically provides more projection and is suitable
for women who have a sufficient amount of natural breast tissue to cover
the edges of the implant.
Sub-Facial: for this placement option, which is a variant of sub-glandular placement,
the implant is placed beneath the fascia of the pectoralis major muscle.
Sub-Pectoral/Sub-Muscular (Under the Muscle): with this technique, the implant is placed underneath the pectoral muscle.
This option is better for women who do not have sufficient natural breast
tissue to cover the edges of the implant.
Details of the Breast Augmentation Procedure
Breast augmentation is typically performed as an outpatient procedure following
Mark for Surgery: Dr. Gabbay will mark your breasts for incision locations
and general measurement guidelines that will serve as a visual aid during surgery.
Administer anesthesia: Anesthesia will be administered and you will be
prepared for surgery. General anesthesia is typically used for breast
augmentation; however, in some cases, “twilight” sedation
with an IV may be used. The surgery site will be thoroughly cleaned and
disinfected before a topical antibiotic solution is applied.
Make Incision: once you are comfortably anesthetized, Dr. Gabbay will make
an incision using one of the four techniques discussed above.
Create an Implant Pocket: after the incision is made, Dr. Gabbay will use
a special surgical tool to create a pocket for the implant to be inserted
into and will place the implant
Place Implant: once the implant pocket is created, the implants will be
inserted into position.
Check for Proper Placement: after insertion, Dr. Gabbay will check for
symmetry and proper placement.
Close Incisions: after Dr. Gabbay is satisfied with the placement and symmetry
of your breasts, he will perform a multiple layer suturing procedure,
first closing the deeper tissue, and finally the surface incision itself.
A surgical bra and compression band will be applied over the top of the
breasts, which will stay on for 1-4 weeks to help the breast implants
settle properly into their new pockets.
Rest in Recovery Room: Breast augmentation surgery generally takes 1-2
hours (depending on the complexity of your procedure or combination of
procedures) and you will spend the first few hours after surgery in the
recovery room. When you are fully alert, you will be released to a family
member or friend who will drive you home. Patients are advised to arrange
to have someone help them for at least the first few days after surgery*.
Breast Augmentation Recovery
Because Dr. Gabbay uses state of the art techniques for breast augmentation
surgery, many of his patients have a minimum of pain and are active very
shortly after surgery*. Many patients have gone out to dinner the very
night they had surgery*. Discomfort following breast augmentation surgery
is generally mild to moderate and easily managed*. After your surgery,
you will notice more tenderness and fullness around the chest region as
the tissues adjust to the presence of the breast implants*. You will be
advised to sleep with your head and back elevated to reduce the swelling
in your chest region. Many patients choose to take pain medication to
increase comfort levels during the first few days, although after three
days most patients find that they no longer need the pain medication,
and most patients need very little over the entire recovery period*.
Shortly after surgery, you will be allowed to remove your surgical bra
and dressings to shower, but may need to wear the supportive bra for several
weeks. You will have a follow-up appointment with Dr. Gabbay one to three
days after your surgery to ensure your breasts are healing properly. During
this visit, you will be instructed on daily breast massage techniques
to soften and relax the breast implant pocket, which will help optimize
Most patients are able to resume daily activities (including work) shortly
after surgery (generally, within several days to one week)*. Light exercise
may be resumed within one to two weeks, although lifting heavy objects
and strenuous exercise should be avoided for 4-6 weeks, as this can slow
the healing process*.
Although rare, there are risks associated with breast augmentation surgery.
Dr. Gabbay follows all his patients very closely to ensure that they have
a very successful postoperative course. Some of the complications associated
with breast augmentation include: hypertrophic scarring, hematoma (bleeding
inside wound), seroma (fluid around implant), dehiscence (wound separation),
infection, inflammation of blood vessels, breast asymmetry, capsular contracture,
implant rupture and deflation, contour problems, altered breast/nipple
sensation, implant mal-rotation*.
The Beverly Hills breast augmentation procedures we provide can help our
patients to feel more confident than ever. Call Gabbay Plastic Surgery
today at (310) 928-2558 to get started.
Frequently Asked Questions
What is breast augmentation?
Breast augmentation is also known as augmentation mammaplasty, and it is
designed to enhance a woman’s bust size. Using breast implants,
Dr. Gabbay will create more attractive breasts (shape and size) making
you feel more confident about your femininity*.
What decisions will I have to make when I decide to have breast augmentation?
In addition to the type and size of breast implant, you will have several
other options to consider including where to place the incision. Dr. Gabby
will place incisions either under the breast, around the nipple, in the
navel, or in the armpit depending on your anatomy, and the type of breast
implant chosen. The placement of breast implants is another factor to
consider, and implants are most commonly placed underneath the chest wall
muscle, although, some women choose to have the implants placed above
the muscle. For breasts that are beginning to sag, a breast augmentation
can improve the shape of the breasts, however; for optimal results, it
may be necessary to combine a breast lift with your breast augmentation*.
How long will my breast implants last?
No cosmetic surgery can be guaranteed to last forever, and a possible complication
from breast augmentation is that both saline and silicone implants may
leak or rupture*. Your chest is constantly moving (repetitive breathing)
so it is safe to assume that your implants may eventually wear out, although
there is no set timeframe for when this will happen. Although studies
show that by fifteen years 25% of women need breast implant replacement,
there is no danger in not replacing older implants that are still intact*.
The FDA does recommend regular MRI testing for silicone gel implants,
and if a breast implant does need replacement, a new implant is inserted
through the original scar. This procedure is less involved than the first
augmentation if the same size is involved*.
Do implants affect having a mammogram?
If you have breast implants, you should tell your mammography technologist
before the procedure so your exam can be evaluated by a radiologist who
is experienced in the evaluation of women with breast implants. Due to
the popularity of breast implants, this is a relatively common situation.
When did silicone gel-filled implants become available for plastic surgeons to use?
Silicone gel-filled implants were introduced in 1991, however, the FDA
concluded that the breast implant safety date provided was not adequate
when determining the benefits and risks involved over an extended period
of time. After 10 years of continuous safety data, in 2006, the FDA approved
silicone gel-filled implants for use in breast augmentation surgery, although
for 25 years they were used in over sixty countries around the world,
with safety profiles evaluated for over one million women.
Who is a good candidate for breast augmentation?
Breast augmentation is one of the most popular cosmetic procedures performed
on women today and each patient has their own personal reasons for wanting
their breasts enhanced.
Some of the most common reasons include:
Women who are embarrassed because they feel their breasts are too small
Women who feel that their breasts are disproportionate to the rest of their body
Women who want larger, fuller, and rounder breasts
Women who have lost breast volume after pregnancy, nursing, or significant
Women who have one breast larger than the other (asymmetrical)
What should I expect from my consultation with Dr. Gabbay?
Your consultation is important because it will help determine if breast
augmentation is right for you. Dr. Gabbay will discuss all of the pertinent
details involved with breast augmentation, and he will also provide a
comprehensive health examination to rule out any possible complications
What causes my breasts to sag?
Ptosis is simply a medical term for sagging of the breast, and while some
women inherit this condition naturally, most often it occurs after pregnancy,
breastfeeding, weight loss, or the force of gravity during the aging process.
When women with extreme ptosis have breast implants, a mastopexy or breast
lift is often performed in conjunction with the breast augmentation, and
if a woman opts not to have a breast lift, implants are typically placed
above the muscle to fill out the breast skin and tissue. In some cases,
this placement (submuscular), can result in a “double-bubble”
effect, where the implant appears to be a higher breast while the natural
breast tissue hangs down, making it look like a separate breast.
Is it true that saline-filled breast implants harden?
Capsular contracture can occur when scar tissue forms around the implant,
becoming hard, and this condition can occur with both saline and silicone-gel
filled breast implants*.
What is the difference between smooth and textured breast implants?
The outer surface of breast implants can be either smooth or textured,
and there are pros and cons to each type. Textured implants have a sandpaper-like
surface and they were designed to lower the risk of capsular contracture,
(although this has not been proven)*. Also, they sometimes take longer
to drop into a more natural position, making the breast appear to sit
higher on the chest. Smooth implants have a balloon-like surface with
a thinner shell, so they feel more natural; and since they can move freely
about in their pocket, they are less likely to ripple*.
What are the differences between round and anatomical (tear-drop) implants?
Although breast implants come in a variety of shapes, the two major types
are round and anatomical, also called shaped, tear-drop, or contoured.
Anatomical implants are flatter on the top than the bottom, and they were
designed to create a more natural-looking breast. Tear-drop implants are
only available with a textured surface that prevents them from rotating,
and by contrast, round implants are flat on the back and round on the
front, and they do not change their shape with movement*. Women who want
a round, fuller “model” look choose round implants, while
those who are looking for the most natural results, typically decide to
use anatomical breast implants*.
Is it true that fungus can grow in a saline-filled breast implant?
The saline in saline implants is sterile, so the chance of fungus growing
inside the implant is a very rare occurrence. In the past, when an implant
was filled with an open technique, the saline made contact with air. Today,
plastic surgeons use a closed technique when filling a saline implant,
and this means the saline is injected directly from the bag, into the
implant, without being exposed to air. The saline breast implant is sterile
when it is inserted, so it should not become contaminated within the body*.
What is the difference between saline and silicone gel-filled implants,
and is one safer than the other?
Both saline and silicone filled implants are basically shaped silicone
envelopes that are filled with silicone gel or salt water (saline). Silicone
breast implants are filled either with cohesive gel or with “highly”
cohesive gel, which is referred to as “gummy bear” implants
due to their consistency. The Food and Drug Administration (FDA) has approved
both silicone and saline-filled breast implants, although, the FDA did
remove silicone-filled breast implants from the market in 1992 after claims
were made that they increased a woman´s risk of autoimmune and connective
tissue diseases. After a thorough investigation, the FDA declared in 2001
that silicone implants do not place women at increased risk of disease.
In 2011, the FDA issued a safety report stating that implants are safe,
although they are not meant to last a lifetime, and they may need to be
removed or replaced after 10 years*.
Since implant volume and size is measured in cubic centimeters (cc), how
many cubic centimeters make up a cup size?
Breast implant volume or size is measured in cubic centimeters (cc) and
one study says that an average of 189 cc of saline is needed to fill one
bra cup size. If a woman wants to go from an A cup to a C cup, 391 cc
is required, and a B to a D requires 448 cc. It is important to remember
that bra cup sizes are not standardized, and they vary from brand to brand.
I hear that sometimes overfilling is a problem so what does this mean?
Overfilling occurs when too much saline is added to the breast implant
than manufacturer recommendations, and overfilling is only involved with
saline breast implants because they are filled after implantation. Saline
implants come in a wide range of sizes and overfilling makes the implant
feel firmer (it does not affect the size) while increasing the risk of
deflation in the future.
What are expandable breast implants?
Expandable saline-filled implants are implants that can be adjusted by
adding more saline through a special valve. Expandable implants were originally
used for women who had undergone breast reconstruction after breast cancer
surgery, but they can also be used for cosmetic breast augmentation. For
expandable breast implants, a syringe is used to inject or extract saline
through a valve that is located beneath the skin, where the implant was
originally inserted. Expandable breast augmentation allows a woman to
try out different breast sizes without undergoing additional surgery.
What are “gummy bear” implants?
The FDA has approved two types of highly cohesive gel or “gummy bear”
implants that include the Sientra Silimed implant and the Allergan Natrelle
410 breast implant. These implants are approved for augmentation in women
at least 22 years of age, and reconstruction for women of any age. A third
“gummy bear” implant is being investigated, and “gummy
bear” implants are made of silicone gel with a consistency that
will not leak if they are cut in half.
How is a saline breast implant inserted?
Saline breast implants are inserted through the crease beneath the breast,
navel, areola, or under the arms (armpits), and once in place, they are
filled with the designated amount of saline to make the breast look natural.
Filling the implants after they are inserted allows Dr. Gabbay to make
both breasts more symmetrical, and because the implant is empty when inserted,
the resulting scars are much smaller and less conspicuous*. Many patients
say that saline does not provide the natural results that silicone implants
Will I still be able to breastfeed after breast augmentation surgery?
The type of implant surgery you have will determine if you should breastfeed
or not after breast augmentation, and your concerns should be discussed
with Dr. Gabbay during your consultation.
How long does it take to recover from breast augmentation?
Breast augmentation recovery depends on each patient’s capacity to
heal. The stitches will be removed within 7-10 days and typically by one
month, most women are able to resume light physical activities*. Total
healing may not happen for several months after your breasts have adapted
to their new shape and your scars have faded*.
Is there a lot of pain after breast augmentation surgery?
As with any surgery, discomfort may be involved depending on your threshold
of pain. Typically after breast enhancement, the pain subsides in a few
days and can be easily controlled with medication*.
Will my scars look bad after breast augmentation?
Immediately following your breast augmentation, your scars will be visible
and pink but over time, they will fade and become unnoticeable*. To prevent
visible scarring, when possible, Dr. Gabbay makes the incisions in locations
that will be hidden.
What are the risks involved with breast augmentation?
Although rare, as with any surgery there are risks involved, and some possible
complications from breast augmentation include*:
Interference with mammogram readings
Deflation and rupture
Can a mammogram cause a breast implant to rupture?
This is rare but it can occur when the pressure on a breast during a mammogram
causes the implant to weaken*. Older implants are more susceptible to
trauma, but this should not keep you from have mammograms. Make sure you
tell the technician that you have implants, and they will take the extra
care necessary to prevent a rupture from occurring.
What is fat grafting breast augmentation?
Fat grafting breast augmentation is taking fat from other places in the
body where it is plentiful (buttocks, thighs, or abdomen) before implanting
it into the breast. The process involves using a liposuction procedure
to harvest the fat before injections augment and shape the breast. This
technique is complicated, and there are pros and cons, so if you are interested
in fat grafting breast augmentation, you can discuss this with Dr. Gabbay
during your consultation.
If I have breast augmentation, will I ever need additional surgery?
If complications from breast augmentation occur, you may need additional
surgery following your initial breast augmentation*. Some of the complications
that require additional surgery include implant rupture, capsular contracture,
or the development of breast asymmetry. As you age, your implants will
age along with the rest of your body, and for this reason, some women
choose to have additional operations to correct the results of gravity*.
What kind of anesthesia is used for breast augmentation?
Typically, general anesthesia is most often used meaning that you are asleep
throughout the procedure and you will have no memory of the surgery. In
some cases, other methods are available and all options will be discussed
during your consultation.
How long does breast augmentation surgery take to perform?
The time it takes to complete a breast augmentation depends on the type
of implant surgery you are having and where the incision is made. Generally,
breast augmentation surgery lasts between 1-2 hours*.
Is it true that my nipple will lose sensation after breast augmentation surgery?
Most women will experience a change in nipple sensation after a breast
augmentation, but this varies from patient-to-patient*. On average, women
report that any loss of feeling lasts from 6-12 months before it returns
to normal, and 15% say they have permanent alterations in nipple sensation*.
When will I be able to drive after breast augmentation?
You must arrange for someone to drive you home after your breast augmentation,
as you will not be allowed to do so because of the after-effects of anesthesia
and pain medication. Most women start driving one week after surgery if
they are no longer taking pain medication*.
I am physically active so will having implants limit my activities?
Depending on the size of the implant and the procedure performed, after
the healing process is complete most women have no trouble resuming their
physical activities*. Weight lifting, extreme exercise, or lifting heavy
objects will not affect the implant once the scar has properly healed*.
Will I be able to go home the same day as my breast augmentation surgery?
Breast enlargement is performed as an outpatient surgical procedure, meaning
that you will be able to go home the same day as your surgery. Within
the first week following breast augmentation, you should be able to return
to most of your normal activities, adding in exercise and other activities
once your healing is complete*.
Will I be pleased with my breast augmentation?
Most women at Gabbay Plastic Surgery are very pleased with the results
of their breast enlargement and they are extremely proud of their sensuous
figure*. Many claim that they have a newfound confidence, and they love
showing off their look with a variety of clothing that is meant to flatter:
something they were never able to do before*.