Breast Augmentation in NYC

Modern Breast Augmentation

In recent years, breast augmentation techniques have undergone significant advances that prioritize patient comfort, aesthetic outcomes, and quicker recovery times. One of the most groundbreaking changes in plastic surgery is the ability to perform breast augmentation under local anesthesia on selected candidates, without disrupting muscle tissue. This approach, combined with novel implant placement methods and the use of advanced implants, has redefined breast enhancement to be less invasive and more elegant.

Why Local Anesthesia Changes Everything

Traditional vs. Modern Approach

Historically, breast augmentation typically required general anesthesia and involved cutting beneath the muscle to create a pocket for the implant. This not only extended recovery times but also increased discomfort, risk, and limitations on physical activity during healing.

In contrast, the modern method uses local anesthesia and utilizes a preservé technique that:

• Avoids muscle disruption entirely
• Creates only a minimal tunnel to accommodate the implant
• Allows outpatient procedures with faster recovery and reduced pain

The Preservé Technique Explained

The preservé technique is a holistic approach respecting the natural female anatomy. Instead of cutting or lifting the muscle, the surgeon creates a precisely measured tunnel matching the implant length. A small balloon is then inserted and inflated to gently stretch the tissue to form a pocket. After deflating and removing the balloon, the implant is inserted using a Keller funnel—a “no-touch” technique that minimizes contamination risk.

This process results in:

• Less trauma to surrounding tissues
• Preservation of natural muscle function and aesthetics
• A softer, more natural breast feel

Implant Innovations: Motiva® and Contraure Resistance

Choosing the right implant is essential for both safety and natural appearance. This technique often incorporates Motiva® ergonomics implants, renowned for:

• Surface characteristics that discourage fibroblast adhesion (cells responsible for collagen production and scarring)
• Enhanced contracture resistance, which reduces excessive fibrosis and capsular contracture
• Soft, natural breast texture and movement

These implants complement the preserve technique, working synergistically to maximize comfort and minimize postoperative complications.

Pain Management and Patient Comfort

Handling pain and patient anxiety is crucial, especially when opting for local anesthesia. Modern protocols include:

• Use of JOURNAVX®, an advanced pain control agent, for targeted anesthesia
• Valium or similar medication is also used to enhance relaxation and create a positive experience during the procedure

Patients report surprisingly comfortable surgeries with minimal pain and fast recovery periods.

Advantages of the Underarm Incision: Achieving Elegance in Surgery

Avoiding Scars on the Breast

A key element in what the surgeon terms “elegant breast augmentation” is the incision location. Many patients prefer to avoid scars on the breast itself, which can be conspicuous and take up to a year to fade from bright pink to less visible tones.

The transaxillary (underarm) approach offers these benefits:

• No visible scars on the breast mound
• Scar hidden naturally in the crease of the underarm
• Maintains breast aesthetics without compromising implant placement quality

The incision for breast augmentation can be placed in the underarm, under the breast itself, or within the areola (the pigmented skin surrounding the nipple). The best incision placement will depend on each patient’s needs and preferences. For example, only patients who choose to have silicone implants will require an incision under the breast or areola. With that said, Dr. Rapaport prefers to shy away from making incisions through the areolas during breast implant procedures. He explains why in the video below:

When given the option, many patients prefer an underarm incision because it removes all scarring from the breast. Top New York City plastic surgeon Dr. Rapaport uses an endoscope to perform this scarless breast augmentation procedure. This means that instead of bluntly tearing the lower border of the muscle and risking implant malposition due to incomplete muscle division, the muscle is precisely divided under magnified endoscopic visualization, allowing for control of any bleeding and precise implant positioning.

The Dual Plane Approach Explained

Historically, the dual plane technique involves partially inserting the breast implant beneath the pectoralis major muscle. Specifically, surgeons cut the bottom of the muscle, allowing the implant to sit covered by the upper portion of the muscle while the lower part remains free. This method provides several benefits:

• The muscle acts as a buffer, softening the implant’s appearance.
• Reduced implant hardness.
• Improved overall breast shape.

Despite these advantages, the dual plane technique has a significant downside: animation deformity.

What Is Animation Deformity?

Animation deformity occurs when the pectoralis muscle contracts during activities like pushing, lifting, or dancing, causing the breast implant to move or distort visibly. This effect can be mild or severe, but often it is cosmetically undesirable and can impact patient confidence.

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The Problem with Going Under the Muscle

Muscle Alteration and Its Consequences

Performing dual plane augmentation requires cutting or separating the pectoralis major muscle. This separation leads to permanent alteration:

• The muscle retracts and never fully reunites.
• Potential weakening of muscle function.
• Possible discomfort or unnatural sensations during muscle use.

While patients retain other muscles for activities like push-ups, the alteration remains significant and irreversible.

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The Motiva® Ergonomics Implant

Key Features of the Motiva Implant

The Motiva ergonomics implant represents a significant shift in breast augmentation practices. Unlike traditional implants, it offers:

• A uniquely designed nano-textured surface with approximately a 4-micron variability.
• A smooth feel combined with a surface that discourages capsular contracture formation.
• Reduced incidence of post-surgical complications.

Why Motiva Over-the-Muscle Is a Game Changer

Motiva ergonomics implants combined with the over-the-muscle placement technique represent a revolutionary step forward in breast augmentation. By addressing longstanding issues like animation deformity and capsular contracture, this approach prioritizes natural aesthetics, patient safety, and comfort.

For those considering breast augmentation, understanding these advancements can empower informed decisions that align with individual goals and body types.

Breast Implant Options

A woman considering breast augmentation will have multiple choices regarding the implants, including different shapes, sizes, and textures. Dr. Rapaport offers breast augmentation with both saline and silicone implants. Each has its own advantages and disadvantages, so the best choice is a personal decision for the individual patient.

Saline implants can be filled after placing them, making them suitable for Dr. Rapaport’s scarless breast augmentation technique. However, silicone implants typically have a more natural look and feel. Dr. Rapaport will discuss these options with you and help you determine the best type of implant for your anatomy and aesthetic goals.

Learn more about the most common incision locations for breast augmentations.