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A woman’s femininity is expressed in her smile, her attitude and her demeanor, but it also manifests in her body. Full, well-rounded and well-positioned breasts are one of the greatest symbols of womanhood there is, yet not everyone is lucky enough to have been born with these attributes. Sometimes surgical enhancement with implants is required to achieve a larger, more attractive breast shape and size. In some cases, a woman who started out with such full breasts will undergo a shift in their appearance following breastfeeding and pregnancy, or will lose breast volume as part of the natural aging process. Sometimes a woman will lose breast fullness due to breast cancer and will require implants as part of the reconstructive process.
Note that while breast augmentation can provide you with a more filled out silhouette, it often doesn't adequately address breast sagging and droopiness, which are addressed through a breast lift. Read More >>
Breast augmentation is one of the most popular procedures performed at Dr. Rapaport’s New York plastic surgery facility. This procedure is consistently one of the top cosmetic plastic surgery procedures performed by members of the American Society of Plastic Surgeons. Dr. Rapaport offers both saline and silicone breast implants. David P. Rapaport, a board certified plastic surgeon, is a world recognized expert who specializes in breast augmentation and breast implant revision for women who have had previous breast surgery.
Breast augmentation incision techniques and scarring
The scar for our NYC breast augmentation can be placed either in the underarm, under the breast itself, or at the lower border of the areolus (the pigmented skin surrounding the nipple). Many patients, when given the option, prefer an underarm scar because it removes all scarring, and anxiety relating to scarring, from the breast. Top New York City plastic surgeon Dr. Rapaport performs this procedure using an endoscope. 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.
"Throughout my years of practice, it has been very satisfying to achieve a natural-appearing breast appearance without any scar on the breast," says Rapaport. "It is very rewarding to see these patients both early after surgery and years after their operation, maintaining their results, and all without any breast scars."
Before & After
Endoscopic Breast Augmentation
Dr. Rapaport has been performing underarm, endoscopic breast augmentation for over 25 years, and is a pioneer in endoscopic breast surgery. This technique, combined with Dr. Rapaport’s experience, has drawn patients locally, nationally and internationally to New York City to seek out Dr. Rapaport for silicone breast augmentation without breast scars.
Board Certified Plastic Surgeon David P. Rapaport, MD has more experience at the endoscopic underarm technique of breast augmentation (breast implants) than any other plastic surgeon in the New York area and has in fact been a pioneer in the development of the endoscopic breast implants technique, as well as other endoscopic procedures.
NO BREAST SCAR Implants - The Underarm Approach
Your customized breast augmentation plan and breast implant sizing
The breast augmentation/breast implant plastic surgery operation involves several important choices on the part of the patient. What size would you like your breasts to be after the surgery? Are you interested in saline or silicone breast implants? Where would you like the incisions to be placed? Should you have the implants placed above or below the muscle (pectoralis muscle)?
Implant size is selected based on a thorough consultation as well as obtaining a full understanding of the patient’s goals and concerns. Implant size will also depend on the patient’s individual anatomic considerations including skin laxity and chest diameter.
"There are two general ways to perform breast implant sizing," says Dr. Rapaport. "One method is for the doctor, based on his or her experience, to select the size that he or she feels would look best on the patient. Although I will always share my aesthetic opinion with the patient, I do not like this technique, and I do not want to be the one to decide what looks best for the patient. Ultimately, I feel that this is a very personal decision and my aesthetic taste may not match the patient’s. Clearly, the patient’s preferences are the ones that matter."
For this reason, Dr. Rapaport has his assistants perform very careful sizing with the patient, trying on a variety of breast implant sizes and profiles. With the doctor’s expert guidance, the patient herself decides which size is best for her. Dr. Rapaport will clearly indicate if a patient’s request for size is not compatible with her anatomy and will review in great detail what tradeoffs may be involved in her particular size selection.
These decisions may seem overwhelming, but board certified NYC plastic surgeon, David P. Rapaport MD will discuss all your options with you during your consultation.
Breast implant position
With regard to breast implant position when undergoing breast augmentation, Dr. Rapaport generally recommends positioning the implants under the pectoralis muscle. The muscle covering the top part of the implant results in a more natural appearing breast with less likelihood of a visible implant edge or visible rippling.
Secondly, there is a reduced likelihood of capsular contracture, or hardness, developing over time. This is believed to be due to the massaging action of the muscle on the scar tissue surrounding the implant. Finally, the submuscular implant position allows for a better view of the breast when a mammogram is obtained. Just like the fact that other choices noted above involve tradeoffs, implant position also does involve a trade off. The dissection required to place the implant under the muscle does result in increased postoperative discomfort. Patients commonly take pain medication prescribed by Dr. Rapaport for two or three days after surgery and find the discomfort to be quite tolerable.
A final trade off with the implants being positioned under the muscle is that when the patient flexes her pectoral muscles, the breasts will actually move upward. This is generally an unflattering situation, but this muscle action only happens rarely when one is out of clothing. The overwhelming majority of patients enjoy the advantages of submuscular implant placement and accept the tradeoffs noted above.
Recovery following breast augmentation
The following are general guidelines. Specific instructions are given to each patient and individualized for each patient
Patients who have non-physical jobs, such as desk/computer activities, can commonly return to work about 5 days following surgery. As noted earlier, patients can expect to avail themselves of prescription pain medication for 2-3 days following surgery, and certainly must keep their activities at a low level for that period.
For their safety, all patients must have an adult spend their first night with them. Most patients do not require prescription pain medicine after 2-3 days, and will be fine with just Tylenol. Many patients find that they benefit from placement of ice in the cleavage area during the first post-operative night, of course avoiding any direct application of ice to the skin.
Despite being allowed to return to work after 5 days, patients are strictly prohibited from engaging in aerobic activity, including sexual activity, for 10 days. Mild aerobic activity such as brisk walking is generally permitted after about 10 days, and full aerobic activity is generally permitted after 3 weeks. Similarly, Dr. Rapaport does not advise any leisure travel for vacation less than 3 weeks after surgery.
For out of town patients, Dr. Rapaport strictly requires a 10 day stay in New York, but prefers a 14 day stay.
Potential complications of breast augmentation:
- Capsular contracture
- Permanent nipple areolar numbness
- Breast implant migration
- Bleeding/infection
- Unfavorable scarring
- Asymmetry
How to Perform Post Surgery Breast Augmentation Massage
Dr. Rapaport's Guide to A Successful Recovery After Breast Augmentation
"Preparing for breast augmentation recovery actually starts several weeks before the breast augmentation. I say this because the overwhelming majority of breast augmentations are performed in the dual plane position, commonly simplified as the ‘under the muscle’ position. When implants are placed this way, the lower part of the pectoralis major muscle is actually divided by the surgeon. I have been advising my patients for many years to avoid directly exercising their pectoralis muscle for 4 to 6 weeks before surgery. The reason is simple. By allowing the muscle to become more ‘lazy’, it will be less bulky and therefore bleed less and cause less pain after surgery.
"Another key factor in postoperative breast augmentation recovery that I think many patients do not understand is that even a very small amount of blood around the breast implant can cause capsular contracture (hardness) of the final result. This is very well demonstrated in animal studies. The amount of blood that can cause a contracture would not necessarily be detectable to the patient at all. For this reason I emphasize that patients must truly take it easy for the first two weeks after their surgery, particularly for the first few days. This is because any activity which causes their blood vessels to dilate or their blood pressure to rise significantly can cause bleeding. It is for this reason that I advise my patients to avoid all of the following for the first two weeks after surgery because each one in its own way can cause bleeding: any form of sexual activity including or not including the breasts, any aerobic exercise (walking is fine and encouraged), taking a hot bath or long hot shower, consumption of alcohol.
"The above is also the reason why I have always been skeptical about surgeons who advertise that somehow after their surgery you can go out to dinner and resume normal activities. Some call this rapid recovery breast augmentation. This simply doesn’t make any sense because in order to create the space in which the breast implant will reside (the pocket), blood vessels must be cut and coagulated, as well as muscle if you are going under the muscle. No matter how gentle one’s technique and no matter how brilliant one is as a surgeon, this is the reality and therefore caution should be exercised."
- Dr. David P. Rapaport
Discussing Implant Texture
A word about capsular contracture
Definition: Whenever an implant is placed into the body, the body recognizes that it is a foreign substance, and essentially walls it off with what is called a capsule. A capsule is a glistening layer of tissue that creates a barrier between the implant and the rest of the body. As stated, all patients with implants will have capsules. A normal capsule should wall off a pocket which is larger than the implant, and therefore the implant will feel soft to touch. Capsular contracture occurs when, for reasons frequently not completely understood, the capsule contracts and squeezes the implant. This is the cause of women with implants having breasts which appear round and high, and may feel very hard to touch. Fortunately, during recent years, there is increased understanding of this phenomenon and the incidence of capsular contracture has been reduced significantly, basically by following two principles.
One is exercising extreme care in minimizing bleeding: it is well established that blood around the implant can lead to capsular contracture. Of note, it is also for this reason that Dr. Rapaport advises his patients not to engage in aerobic activity, including sexual activity, for 10 days following surgery, so as to minimize the risk of small amounts of bleeding, which can lead to contracture. The second improvement in breast implant surgery in recent years has focused on paying meticulous care to avoid any contamination of the operation with particles or bacteria. All gloves are powder free, and Dr. Rapaport uses the "no touch" technique for augmentation, whenever physically possible. This means that he uses a specially designed insertion funnel (Keller Funnel) for his implant insertion so that the implant is transferred from its box after soaking in antibiotic solution, directly into the funnel and then into the body without ever touching the surgeon’s glove or the patient’s skin. Finally, because the nipple is not considered sterile, Dr. Rapaport generally advises against the periareolar scar, and uses sterile plastic covers over the nipple area when performing breast augmentation to avoid that source of bacterial contamination.
Your confidential consultation in Manhattan
If you are eager to learn about one of the best endoscopic breast augmentation New York City has to offer, do not hesitate to schedule a private consultation today. The consultation will yield the answers to all your most pressing questions and concerns, and you may use the time to review with Dr. Rapaport photos and images of your ideal breast aesthetic so that you can arrive on the same page in terms of expectations for your results.