Breast augmentation consistently ranks as one of the top procedures performed by plastic surgeons across the country. The reason they are so popular is because our culture in America is very breast-oriented. Men see breasts on a woman as attractive and sexy. Women often see attractive breasts as self-esteem building and also powerful. I once performed a breast augmentation on a female attorney and asked her what breast implants meant to her. Her reply was, “Now I can negotiate better.”
Modern breast augmentations have come a long way since they were invented in Houston, Texas in the early 1960’s. The quality of the implant has also improved tremendously. There are two basic types of implants – silicone and saline. Each has its purpose, and in the hands of a well trained, Board Certified Plastic Surgeon, one or the other will be used correctly to get the best possible results. Breast implants are used for either purely cosmetic reasons or in breast reconstruction. Dr. Schlesinger does not perform breast reconstruction, but we are fortunate in Hawaii to have several excellent reconstructive breast surgeons.
Over more than 30 years, Dr. Schlesinger has experienced most of the innovative procedures, techniques, and implants. Based on this experience, this is what he tells all his patients:
Implant Style or Variation:
Dr. Schlesinger does not like anatomic or teardrop-shaped breast implants because if they rotate, which sometimes they do, it gives a very strange breast shape. He does not use textured breast implants because he feels they do exactly what they are not supposed to do – lead to hard breasts. Dr. Schlesinger believes round, smooth implants give the patient the consistently best breast augmentation in the short and long run. From 1991-2006 silicone breast implants were unavailable for breast augmentation except when done by an FDA investigator. Saline was the only implants that were used routinely at that time. Saline has many problems and it rarely is as good as silicone in cosmetic breast augmentation. In a thin-skinned woman with small breasts, silicone is always the implant of choice. Preferably the new Natrelle Inspira silicone implants by Allergan.
Incisions for Breast Augmentations:
Breast augmentation through the belly button is a bad idea. None of the Board Certified Plastic Surgeons in Hawaii use this technique. The results are very unpredictable and uncontrollable, and implants can only be placed on top of the muscle.
Incisions in the crease at the bottom of the breast, called inframammary incisions, leave an unacceptable scar and should only be used in very unusual circumstances for cosmetic breast enhancement. Incisions at the edge of the areola are acceptable, especially for redo’s, but they can leave a scar on the breast. Any visible scar takes away from the beauty or aesthetic appearance of the breast.
Transaxillary incisions (incisions in the armpit) are his favorite route of entry for breast augmentations for the following reasons: (a) armpit scars tend to be very thin and fine because the lower part of the skin, the dermis is thin, and, in general, the thinner the dermis, the finer the scar as long as it is sewn up correctly; (b) no one, not even your mother, has ever intentionally looked into your armpits.
Positioning of Implants:
Implants can be placed above or below the pectoralis (chest) muscle. 98 percent of the time, Dr. Schlesinger prefers going below the pectoralis muscle because: (a) it gives an extra layer of covering over the implant, therefore making the implant less obvious; (b) it is common knowledge in plastic surgery that implants under the muscle tend to stay softer over time; (c) the pectoralis muscle originates on the humurus (bone of the upper arm) and inserts on the clavicle (collar bone) and on the sternum, therefore, with the implant underneath the pectoralis muscle, the breast appears to originate in an unbroken line from the collarbone to the nipple, whereas if you go on top the muscle, the breast implant appears to start much lower, giving it a less natural look; (d) mammography of the breast is made easier if the implant is behind the muscle because the radiologist sees the muscle density and knows that all the breast tissue is above this muscle density and the implant is below.
Like most plastic surgeons in the U.S., Dr. Schlesinger goes partially subpectoral, cutting a small strip of pectoralis muscle off the fifth rib. he feels if the implant is completely subpectoral, this does not give a natural, or teardrop shape to the breast.
He does all of his transaxillary breast augmentations using an endoscope, just like gynecologic belly button or arthroscopic knee surgery. Because he has a camera inside and under the breast and muscle and he operates using a monitor, any excessive bleeding is easily stopped. Endoscopic breast augmentations lead to less bruising, less hard breasts, less swelling, and quicker recovery.
Size of Implants:
Dr. Schlesinger has no difficulty getting large implants, even up to 800cc, through a relatively small incision throughout the armpit using the Keller funnel. The funnel also allows for a no-touch approach. The implant travels from a sterile box into a sterile funnel, then into a sterile subpectoral pocket below the breast tissue. The number two reason for breast implants hardening is the implant is inserted while touching the skin, thus dragging bacteria with it into the subpectoral pocket. Skin bacteria does not cause infection, however, it does cause the body to form a thick capsule around the implant, therefore leading to hard breasts.
In the majority of breast augmentations, one should use a smooth, round silicone implant put in through the armpit partially under the pectoralis muscle using an endoscope for the most aesthetic results.
The Breast Implant Center offers a full range of plastic surgery services for all of our Honolulu patients. We offer breast enlargement, breast enhancement, implants and augmentation along with many other procedures. Your safety and well-being is our top priority. S. Larry Schlesinger, MD, FACS performs his surgeries personally. Other professionals in Honolulu are offering procedures by non-Board Certified or junior doctors. S. Larry Schlesinger, MD, FACS maintains an office and a full staff. Board Certification in plastic surgery is much more than a professional affiliation: Board Certification requires years of surgical experience, years of residency in accredited hospital surgical programs, intensive board examinations, and stringent peer review. Is your plastic surgeon Board-Certified by the American Board of Plastic Surgery, the only plastic surgery board recognized by the American Board of Medical Specialists?
We invite you to review S. Larry Schlesinger, MD, FACS’s qualifications below especially if you are looking to have a procedure or two done. If you’d like to schedule a confidential consultation to talk about any of our procedures like our breast augmentation Honolulu procedure, please feel free to fill out the contact us form to the left of your screen or give any of our office locations a call. We look forward to hearing from you.
I went to Dr. Schlesinger for a Mommy Makeover surgery package (Breast Augmentation, Lipo, and Tummy Tuck) and could not be any more satisfied with the results. Dr. Schlesinger and his staff are friendly, professional, and honest. Dr. Schlesinger provided an in depth pre op consultation that lead to the right decisions for surgeries specially tailored to my body type and desired outcome. After my two pregnancies, I had extra skin and stretch marks that could not be worked out regardless of my efforts; I was told by my primary care physician and obgyn that no amount of exercise would get rid of it. Dr. Schlesinger was able to give me a great body and I feel and look great. I can finally go to the beach in a bikini! I would definitely recommend him.
S. Larry Schlesinger, MD, FACS’s Technical Skill and Experience
- Surgical Experience: More than 30 Years in Hawaii & 19,000 procedures
- Former President of the Northwest Society of Plastic Surgeons
- Visiting Professor of Surgery, University of Oklahoma
- Hawaii Medical Association Physician of the Year 2000-2001
- Board Certified by the American Board of Plastic Surgery since 1985
- First in his class in medical school
Ultrasound After Capsular Contracture
Once the body has formed a tight scar circumferentially around an implant, it is called a capsular contracture. There are three known treatments for this – surgery to remove the capsule, Accolate by mouth to decrease the immune response leading to a softer breast S. Larry Schlesinger, MD, FACS wrote the original article on Accolate), and ultrasound to the breast. In our practice, Accolate plus ultrasound has shown great success in non-surgical intervention. We highly recommend this to go along with Accolate as a first line of defense once capsular contraction occurs.
Breast Augmentation FAQ
Why do you prefer silicone over saline?
Silicone is preferred for a number of reasons:
1. Because saline implants have a valve, it is the number one reason for leakage. Silicone implants do not have a valve, which means it has a much less chance of leaking.
2. Saline implants automatically set you up for a second surgery. The silicone implants of today are created with memory gel and are not liquid. If the implant ruptures, it won’t leak. If saline breaks, it deflates quickly and becomes an urgent surgery.
3. Saline implants are harder than silicone implants.
4. The Allergan Natrelle Inspira implants do not show any rippling due to their thicker outer shell.
Will I need to have someone stay with me after my breast augmentation surgery?
What can I expect of the recovery after a breast augmentation?
Take it easy for three days to prevent excess bleeding. You can typically drive after 3-4 days after surgery.
– After one week, you can take long walks.
– After 2 weeks, you can go swimming.
– After 3 weeks, you can work out at the gym.
– After 4 weeks, you can go running.
How long after surgery do I have to wait to shave?
Typically seven days.
How long after surgery do I have to wait to use deodorant?
Typically seven days.
Why choose a plastic surgeon who is Board Certified versus one who is not?
Board certification means the individual has taken 3 or more years of general surgery, and 2-3 years plastic surgery training. They also have intense scrutiny by professors. Board certification does not guarantee artistic ability but assures the surgery’s safety.
Some surgeons in Hawaii who claim to be plastic surgeons are not M.D.s. Some who claim to be board certified may be certified in a specialty other than plastic surgery. Look for a surgeon who is certified by the American Board of Plastic Surgery and a member of the American Society of Plastic Surgeons.
What can I expect directly after my procedure? Will a hospital stay be needed?
Breast augmentations are most often done in surgery centers and rarely in hospitals. 99% of all patients go home with a caregiver the same day after surgery. Hospital stays are not typically necessary.
How long does Breast Augmentation surgery take?
Approximately 2-3.5 hours
How long does it take to fully recover from a Breast Augmentation?
Full recovery is normally at one month; meaning full physical activity with no restrictions occurs about a month after surgery. Also around the same time, you feel like the implants are emotionally and physically a part of your body, and not something foreign.
When can I return to work after undergoing a breast augmentation?
Desk jobs with minimal mobility: Typically in about 5 days.
Physically demanding jobs: Typically 9-10 days.
Schedule a consultation with breast augmentation specialist, S. Larry Schlesinger, MD, FACS.RealSelf Q&A with S. Larry Schlesinger, MD, FACS