Dr. Troy Pittman, a board-certified plastic surgeon located in Washington, DC, is one of the nation’s leading experts in breast augmentation and cosmetic surgery of the breast. Breast augmentation is the most common surgical procedure performed by plastic surgeons. According to The American Society of Plastic Surgeons, there were over 300,000 breast augmentation surgeries performed in the United States in 2018.
Women seeking breast augmentation are generally those who are dissatisfied with the size or shape of their breasts or women who have had breast deflation from weight loss or breastfeeding. Commonly, breast augmentation involves placement of a breast implant that contains silicone gel or saline (salt water).
The following sections are meant to demystify the breast-augmentation procedure and help potential patients understand that there are a number of decisions that need to be made before undergoing surgery.
It’s important to remember that breast augmentation with implants is a capital investment of sorts. Patients with breast implants should undergo regular check-ups with their doctors and should be monitored for implant rupture and capsular contracture. It is likely that the implants will need to be replaced at some point in your life. Take a moment to read Dr. Pittman’s blog “I Have 10-Year Old Implants, Now What?”
Breast Augmentation Before-and-After Gallery
The consult for breast augmentation begins the minute you book your complimentary consult. Our Patient Care Coordinator Leeanne will take the time to get a little more information about what you are looking for and will ask a number of questions to help us tailor the consult to your individual needs and desires.
On the day of the consult, you will be brought into our specially designed state-of-the-art breast consult room, complete with The Wall of Implants.
After changing into a robe, you will be escorted into our adjacent private photo room for clinical photos and your Crisalix virtual imaging scan.
Dr. Pittman will then welcome you and discuss your specific desires for augmentation. After a brief discussion, you and Dr. Pittman will review your 3D Crisalix imaging. During your consult, it is important to ask plenty of questions. This is your time that has been specifically reserved for you!
Dr. Pittman is passionate about breast augmentation and is excited to discuss it with patients. There are no stupid questions. Your comfort is a top priority, and the more information you gather during your consult, the more comfortable you will be. Remember, knowledge is power!
The consult concludes with a discussion about post-surgical recovery. You will then have a meeting with the Patient Care Coordinator to discuss scheduling logistics and pricing. You will also be given a folder of information on your breast implant warranty, implant information, and a number of scientific papers that Dr. Pittman has written on the topic of Breast Implant Safety.
Breast-Implant Selection: Silicone vs. Saline, Smooth vs. Textured
Breast-implant selection is probably the most important decision you will make in the breast-augmentation process. Silicone implants are patients’ most common choice.
Dr. Pittman uses the Allergan Natrelle and Sientra 5th-generation silicone “gummy bear” breast implants. These are the best breast implants on the market. Rather than the older implants that are more like a “jelly donut” with a gooey center surrounded by a silicone shell, the “gummy bear” implants’ inside and shell are one and the same. Think of when you bite into a gummy bear and turn it upside down…nothing happens.
Saline implants are comprised of a silicone shell filled with saline solution (salt water). In order to prevent these implants from rippling, they are overfilled. Many patients prefer saline implants because a rupture is obvious. If the shell breaks, the saline leaks out and you look like you’ve gotten a “flat tire.” Other women complain that saline implants feel firm and unnatural.
The outer shell of the implant can be smooth or textured. In the U.S., 90% of implants used are smooth. Outside of the U.S., 90% of implants used are textured. Smooth implants allow the implant to be freely mobile in the pocket and make it easier to create cleavage. Textured implants are designed to move around less.
Implants that are anatomically shaped, or “teardrop”-shaped, have a textured shell in order to prevent the implant from rotating in the pocket. Additionally, women with chest-wall deformities or recurrent capsular contracture may benefit from a textured implant. Recently, textured implants have come under investigation due to an association with a rare condition called BIA-ALCL.
There are certain risks and benefits associated with all types of implants. It’s important to choose the implant that fits your specific needs and desires.
Choosing the Right Breast-Implant Size
The Magic Formula: Implant Volume = Implant “Width” x Implant “Projection”
Implant size depends on your specific breast goals. Selection begins with choosing the right implant width. Choosing an implant that is too narrow leads to a very unnatural look. Conversely, choosing an implant that is too wide will not only make you look wider and heavier at the top, it can also result in visible implant rippling due to lack of breast-tissue coverage.
Once you and Dr. Pittman have decided on the appropriate width, you will choose between low-profile, moderate-profile, and high-profile implants. “Profile” refers to how far out the implant sits from your chest wall. We have found that virtual imaging with the Crisalix system helps patients with picking implant size more accurately than any other means.
Ultimately, your implant size is a personal decision. Dr. Pittman will make recommendations, but the final choice is the patient’s. In our experience, it is more common for patients to wish they would have gone a bit bigger rather than a bit smaller.
Keep in mind that choosing an implant that is too large for your body or overlying soft tissues can cause issues in the future. Extremely large implants (greater than 700-800cc) are not advised for most patients.
The Crisalix Virtual Consult
Have you ever wished that you could see what your results would look like before surgery? Now you can! At your consult, we will create an electronic 3D model of your breast and torso. The Crisalix Imaging System is revolutionary software that allows Dr. Pittman to “virtually” place implants in the 3D model, allowing you to “try on” a variety of implants. The software can also simulate a breast lift, reduction, or enhancement with fat transfer.
During the consult, you will also be able to look into our magic mirror and see the implants virtually placed in real time on your body as you look at yourself in the mirror.
Breast implants can be placed in a submuscular position (under the pec muscle), in a subglandular position (on top of the pec muscle), or in a position called a dual-plane. Placing the implants completely under the muscle can lead to high-riding implants long-term and can decrease the overall projection and roundness of the final outcome.
Conversely, placing the implants in a subglandular position is associated with higher rates of capsular contracture. In thinner patients, this position can lead to a visible upper-implant border, which gives the breast a very unnatural appearance.
Dr. Pittman most commonly places implants in the dual-plane position, where the top of the implant is under the pec muscle and the bottom of the implant is below the breast tissue. Using this technique, you derive all of the benefits of both submuscular and subglandular placement but avoid the common complications associated with those positions.
Breast implants are inserted through a very small 3cm incision in either the inframammary fold (under the breast) or through an axillary incision (in the armpit).
Please note that Dr. Pittman does not recommend implant insertion through a peri-areolar (around the nipple) incision. Peri-areolar insertion of implants is associated with loss of nipple sensitivity, damage to the underlying breast gland, increased visible scarring, and increased rates of capsular contracture.
It is important to discuss your cosmetic desires with Dr. Pittman during your consult to choose exactly which implant position and incision is right for you. Our goal is to provide a customized plan for each patient, as no two patients have the same goals and anatomy.
Minimizing Breast-Enhancement Complications
Your safety and comfort are our top priorities. Every effort is made to avoid complications during and after your surgery. Breast-augmentation surgery is considered to be a low-risk surgery. Dr. Pittman performs his surgeries in surgery centers with the highest accreditation standards, board-certified anesthesiologists, and an experienced nursing staff.
The most common complications immediately following breast-augmentation surgery are hematoma (bleeding) and infection. Every effort is made in the operating room to assure that any bleeding has been stopped.
We encourage patients to take it easy after surgery. You are given an antibiotic in your IV in the operating room to help prevent infection. Dr. Pittman is meticulous about sterility when it comes to handling and insertion of your implant. In his practice, the rates of hematoma and infection after breast augmentation are less than 0.001%.
In the months to years following surgery, the most common complications are capsular contracture, implant rupture and implant malposition. As mentioned earlier, Dr. Pittman uses Allergan and Sientra 5th-generation “gummy bear” silicone implants. Our commitment to those implants comes from their very low rates of capsular contracture and rupture.
Breast augmentation is generally associated with a relatively short and comfortable recovery. Dr. Pittman prides himself on the fact that most patients are able to go out to dinner the night of the surgery.
Patients usually take narcotic pain medication the night of surgery and the day after. You are given a muscle relaxer to help with the feeling of tightness and muscle spasms and a quick-acting anti-nausea medication to help with nausea after the procedure.
Your incisions will have surgical tape on them that will remain for 3 weeks. At 3 weeks post-op, you will be given BioCorneum incision therapy to apply to your incisions to hasten recovery. We also recommend eating fresh pineapple or taking a Bromelain supplement to minimize any bruising after your procedure.
In order to provide you with the best outcome possible, we ask that you take an active role in your recovery. It is important that you understand the importance of taking it easy after your procedure to avoid unwanted complications. The restrictions after breast augmentation are:
No lifting anything heavier than a laptop computer for 2-3 weeks.
No exercise involving your chest muscles or repetitive movement of your arms for 3 weeks.
No running or jogging for 3 weeks.
We encourage you to walk and move around as much as you want after surgery. To see a sample copy of our post-op instructions, click here.
Breast-Augmentation Cost and Financing
As previously mentioned, local breast enhancement is an investment in your future. Pricing for breast augmentation will vary depending on the patient’s needs and desires, the type of breast implant used, and the amount of time needed to safely complete the surgery. Generally speaking, our all-inclusive price for primary breast augmentation ranges depending on the complexity of the procedure.
We offer financing options through Care Credit. You can apply for Care Credit financing by clicking here.
Dr. Pittman’s Expertise
One of the most important variables in a successful operation is the experience of the surgeon. Dr. Pittman received specialized training in cosmetic breast surgery at Georgetown University Hospital under the tutelage of the world-renowned Dr. Scott Spear.
Breast augmentation is one of Dr. Pittman’s most frequently performed operations. Dr. Pittman is board-certified by The American Board of Plastic Surgery. He is frequently asked to give lectures to other plastic surgeons around the world on the topics of breast augmentation, breast-implant safety, and revision breast augmentation.
Fly Private With Us
Breast Augmentation is performed in our all-private, state-of-the-art surgical suite, which is attached to our office. To learn more about the Somenek+PittmanMD Surgical Suite, click here.
Discover the Possibilities of Breast Augmentation in Washington DC
To learn more about Washington DC breast augmentation, schedule your consult with Dr. Troy Pittman today.