With over a decade of experience, hundreds of breast cases, and extensive experience in revision and reconstructive breast surgery, Dr. Wesley Schooler offers an exhaustive level of excellence in breast surgery to mirror the beauty of the California Central Coast and Southern California. Dr. Schooler insists on providing an inviting, thorough consultation to answer all questions and give patients the confidence and knowledge to make an informed decision. Whether you’re filling out that bikini top for the SoCal beaches, looking for improvement in an elegant evening gown, or simply desire subtle contour improvements in a fitness outfit for the gym, breast augmentation can help take the guesswork out of looking great in any fashion choice. We take great pride in offering many options to patients from all walks of life, from young adults looking to boost their confidence with breast enhancement, mothers looking to correct the effects of pregnancy after childbirth, middle-aged women who have always considered breast augmentation, or the senior patient who is interested in replacing older implants to restore the breast shape she once had.
Breast augmentation is a wonderful and relatively simple procedure that builds confidence, enhances fashion choices, and can help reverse the effects of pregnancy on a woman’s body. Dr. Schooler, our experienced plastic surgeon, understands that you have many choices when it comes to breast implants and breast augmentation in California. Santa Barbara Plastic Surgery Center strives to thoroughly inform and consult prospective breast augmentation patients so they can make educated, confident decisions about their breast surgery options. We insist on achieving natural-looking, beautiful breast augmentation results that will last for years to come while operating in the safest environment possible. Dr. Schooler has extensive experience in aesthetic and reconstructive breast surgery and can utilize all of these tools for both first-time and revision breast augmentation surgery.
- What is Breast Augmentation?
- Breast Augmentation Benefits
- Breast Augmentation Consultation
- Types of Breast Implants
- Ethnic Considerations for Breast Augmentation
- Breast Implant Placement
- Breast Augmentation Incisions
- Breast Augmentation Surgery
- Breast Augmentation Recovery
- Breast Augmentation Scars
- Breast Augmentation Cost
- Breast Augmentation Revision
What is Breast Augmentation?
Breast augmentation is a surgical procedure designed to increase breast volume and improve the shape of the breasts through the addition of implants. The techniques and implant devices utilized during the procedure have evolved significantly over the last 50 years. Many women undergo the surgery to achieve a fuller breast appearance and enhanced body contour, as well as to correct physical changes in the breasts experienced after pregnancy, nursing, or after significant weight loss. The “in” look has changed with the times, from the “Baywatch” full look to the more subtle, natural elegance of today. With this in mind, we are able to offer patients an aesthetic that mirrors the subtle beauty of the Central Coast of California. With a range of implant types, sizes, shapes, and degrees of projection to choose from, breast augmentation can be completely tailored to attain your desired look. Similar surgery is also utilized as part of breast reconstruction to restore a normal breast appearance and volume after mastectomy for cancer removal.
The reasons to pursue breast augmentation are personal to each patient, and Dr. Schooler meticulously develops each treatment plan around your unique cosmetic goals. Breast augmentation is one of the most popular aesthetic surgeries performed in the United States and the world, and has improved the quality of life of millions of women through long-lasting breast enhancement for generations.
What are the Benefits of Breast Augmentation?
Breast implant placement can achieve many goals, including enlarging the breasts by one or two cup sizes; adjusting the positioning of the breasts; correcting asymmetries that were present at birth or developed after pregnancy and breastfeeding; and balancing one’s profile with a full, natural look and feel to improve fashion choices and the fit of clothing. In general, the benefits yielded by breast augmentation may include:
- Added breast volume and fullness
- Corrected asymmetry
- Improved breast shape
- More defined breast profile
- Correction of some sagginess and loss of volume
There are many breast augmentation and breast implant techniques we perform at our practice that can help you achieve the results you desire. During your initial consultation, Dr. Wesley Schooler will present you with a range of options and answer any questions about the techniques and devices available; together, you can decide the best approach.
Breast Augmentation Consultation—Choosing the Right Breast Implants
Before your consultation, Dr. Schooler recommends becoming familiar with the information located on our website, as well as TouchMD, to develop some ideas about the look you wish to achieve. There are many questions that patients have for their cosmetic surgeon when they are seeking breast augmentation. Pre- and post-operative information, the cost of breast augmentation, the type of breast implants available, the benefits of breast implants, and the health concerns associated with surgery are a few topics that will be covered during your consultation with Dr. Schooler at the Santa Barbara Plastic Surgery Center. While “in person” consultations offer the best, most comprehensive information to tailor a plan for your procedure, we also offer phone and internet consultations.
During your consultation, you will also learn about the types of breast implants available to you. Dr. Schooler has extensive experience with all current FDA-approved implant brands, styles, and types available on the U.S. market. Silicone implants were re-approved by the FDA in 2006 for cosmetic procedures in women 22 years of age and older, as well as for patients of any age undergoing breast reconstruction. Santa Barbara was the epicenter for the design and manufacture of silicone breast implants, and the founding location of all current U.S. breast implant brands. After decades of research and modification, cohesive gel implants have become the standard for safety. Cohesive gel silicone implants are known to have a “smooth, soft and natural feel,” and the silicone filler is semi-solid— almost like a gummy bear if an implant were cut in half. These features in advanced gel technology have helped improve safety, and decrease the chance of silicone migration in the rare event of a rupture.
Anatomic shaped implants are a more recent advance that has significantly helped improve the natural look in breast reconstruction and has also proved beneficial for thin patients in breast augmentation surgery. Currently, all shaped anatomic silicone breast implants are textured, although this may change in the future with the recent concerns about particular types of textured implants.
Saline breast implants are FDA-approved for patients 18 and older and have been used for safe, cost-effective breast augmentation for decades. They can be teardrop-shaped or round, as well as smooth or textured. More recently, double-chamber saline breast implants (IDEAL™ implants) have been introduced, offering a more natural feel that is closer to silicone implants. Dr. Schooler also has experience with this improved variation of the saline implant. You will have the opportunity to see and feel different implant types and sizes at our office. Dr. Schooler will go over all of your options and the benefits of each implant at your consultation. You will be able to visualize the best choice for your goals by trying on implant sizers as well as by using the 3D imaging technology available (Crisalix™), which offers augmented and virtual reality imaging.
Types of Breast Implants
At our practice, patients considering breast augmentation can choose between all of the current types of silicone or saline breast implants. Each implant type offers distinct advantages, and the decision of which implant is best mainly depends on your personal breast enhancement goals and unique physical needs. At your consultation, our plastic surgeon will go over your options thoroughly and explain the distinctions, giving you an opportunity to touch, feel, and try on different implant sizes.
Silicone implants have been used for decades since their conception in the 1960s. After the transient moratorium in the 1990s, silicone was re-approved by the FDA and has been proven to be safe for breast enhancement and reconstruction. Silicone technology has continued to evolve with cohesive gel technology improvements by all brand manufacturers. Dr. Schooler has served as a clinical consultant for the three largest breast implant manufacturers in the United States. Needless to say, Dr. Schooler is highly skilled and experienced in the initial placement and revision of longstanding silicone breast implants.
Although there was a brief time between 1992 and 2006 when silicone implants were not in use while the FDA conducted in-depth studies on the risks and safety of the implants, they have since been deemed safe by the FDA for breast augmentation. Today, numerous brands of silicone breast implants are popularly used by plastic surgeons all over the world.
Silicone is lightweight and closely resembles the look and feel of actual human breast tissue. It has been used safely in various medical devices, from brain shunts to penile implants with very few side effects. It is also hypoallergenic and maintains shape and consistency over time. As a result, silicone implants are often called the “gold standard” of breast implants because they are designed to create high-quality, beautiful, and realistic results that look and feel natural. The evolution of silicone implants has been a dynamic process over the last 50 years, similar to cellular phones and music players. There have been numerous modifications to both the shell—which has ranged from thick to thin—and silicone filler, which has gone from syrupy liquid to the current cohesive gel that maintains a higher degree of cross-linking. This provides a jello-like consistency that stays together in the event of a rupture. With rupture rates of 5 to 10 percent at the ten-year mark with all brands, it is generally recommended to have silicone implants checked between 7 to 10 years and at the first signs of late capsular contracture.
Saline implants are FDA-approved for use in patients 18 years and older, and have been a popular choice for plastic surgeons and breast implant patients for decades. Saline implants are unfilled at the time of insertion, allowing for a smaller incision to insert the outer silicone shell. Once in position, the implants are then filled with a saline solution. The smaller incision associated with saline implants often leaves minimal visible scarring after surgery. Saline implants can be a great option for natural-looking, appealing results. The saline is held inside with a small valve.
Form-Stable (Shaped) Silicone Implants
Shaped or form-stable silicone breast implants, sometimes referred to as “gummy bear,” “teardrop,” or “cohesive gel” implants, are FDA-approved for use in patients for both cosmetic and reconstructive surgery. They have been available in much of the world for over 25 years, but have only been available in the U.S. for clinical trials since the early 1990s, and fully available in the U.S. since 2012. Most of our experience with these implants has been with textured shaped implants. They have proven beneficial in controlling the breast shape around the implant, often creating a more natural look, decreasing rippling, and providing a more natural appearance in the thin or small cup-sized patient. Form-stable implants have also been shown to greatly benefit breast reconstruction patients, offering a better and longer-lasting shape over time, less rippling, and less contracture. The challenges of form-stable implants include the firmer feel, potential for rotation, and—more recently—the concerns about the risks of textured implants and rare ALCL syndrome. Dr. Schooler mostly reserves the use of shaped implants for reconstructive cases and difficult revision reconstruction cases. We offer shaped implants for cosmetic augmentation if requested after an extensive education on the benefits and challenges of their use.
Smooth Breast Implants
Smooth silicone breast implants are FDA-approved for use in patients 22 years and older, and have been a popular choice for plastic surgeons, especially in the U.S. The outer shell of smooth implants has been improved and made stronger to resist rupture, even when a massive amount of force is exerted on it. The filler in smooth silicone implants is now a cohesive gel that sticks together, preventing migration. It still remains soft and subtle compared to the highly cohesive gel in form-stable shaped implants.
Textured Breast Implant
Textured silicone breast implants have also been approved for use in patients aged 22 years and older. They have the same cohesive gel filler as the smooth silicone implants. The textured shell has been available for years and is generally proven to be safe. Each manufacturer has created the texturing on the surface through different proprietary methods, with each offering a different degree of bonding with the surrounding breast tissue to help keep the implant in place. Textured implants have been the most commonly used silicone implant in Europe and much of the world, previously providing the benefits of less capsular contracture, less bottoming out, and an increased tendency to remain in place. They require a more precise pocket creation at surgery and generally will not move after placement.
Recently, a very rare condition known as ALCL (Anaplastic Large Cell Lymphoma) has been associated with longstanding textured implants. The condition, while extremely rare, affects between one in 500,000 women with breast implants and has been described as a cancerous condition that is usually cured with the removal of the implants and surrounding capsule. While the causes remain under investigation, recent theories include a rare genotype and a rare bacteria in association with a particular type of texturing process. While this has only been presented in the lay press for the last couple of years, Dr. Schooler has been aware of this rare disease and considered its effects for the last decade, ever since working as a professor at the Keck School of Medicine at USC with Dr. Gary Brody, a professor emeritus at USC, who first noticed the condition in his research. With this in mind, Dr. Schooler has chosen to refrain from using textured implants that use the “lost salt” technique during production, and generally has not used textured implants for breast augmentation in recent years. Lately, certain implants created with this manufacturing technique were banned from further use in the European Union.
Our goal is to create beautiful breasts with the safest methods and products possible. Whether you choose a saline or silicone breast device, your needs and goals will be at the forefront of selecting the best choice to give you the look and feel you desire. Dr. Schooler uses a combination of breast sizers, as well as three-dimensional computer imaging simulations, to help you find precisely the appropriate size and type of implant to meet your expectations.
Ethnic Considerations for Breast Augmentation
Latina Breast Augmentation
California is a melting pot of cultures and has a broad population of numerous ethnicities, with Latin patients as the predominant minority. Many Latina women seek cosmetic procedures, especially breast enhancement surgery. Dr. Schooler has created long-lasting and beautiful breast results in hundreds of Latina patients. Many have had family members or friends who chose to pursue surgery in other countries, but who personally have preferred surgery in the U.S. with the comfort of knowing the rigorous standards of care required here. Dr. Schooler takes numerous unique considerations into account, including pigmentation changes and the differences in body and breast shape to create the best aesthetic result for every patient.
Asian Breast Augmentation
Asian patients often have skin that ranges in complexion from very fair to a darker tone. Therefore, incisions can lighten or darken and may possibly produce raised hypertrophic scars. Dr. Schooler takes this into consideration and formulates a plan that may include several postoperative treatments, including silicone tension strips and other modalities to diminish the chances of a raised or hyperpigmented scar.
African-American Breast Augmentation
African-American patients have many unique considerations when planning incisions for breast augmentation, especially considering the possibility of hypertrophic and keloid scarring. The inframammary scar has usually proven to be the best choice in hiding scars, even in cases where the scar thickens. Dr. Schooler employs several additional modalities to decrease the chances of a thickened or unsightly scar. All sutures are internal buried dissolvable sutures, and steroids are used at the first sign of scar overgrowth.
Breast Implant Placement
Should the implant be placed above or below the chest muscle?
Breast implants can either be placed above or below the chest muscle (pectoralis), with the best position determined by factors such as the quality of your skin and the amount of natural breast tissue available. Positioning the implant over the muscle (subglandular) is typically most appropriate for women who have enough breast tissue to provide coverage for the implant, usually a large B to C cup. An above-the-muscle approach may also be beneficial for patients who extensively train their pectoral muscles, as this location can minimize movement of the implant when the chest muscle contracts. The challenges with subglandular placement include increased capsule contracture over time and a potentially artificial look in thinner women with small native breasts.
In most cases, placement below the chest muscle (submuscular) is the preferred breast augmentation technique. If you have thin breast skin or a limited amount of breast tissue in the upper breast to cover the implant, positioning the implant under the muscle can create a more natural aesthetic and lower the risk of implant rippling— an issue that causes the edges of the implant to be seen or felt through the skin. Numerous studies have also demonstrated lower capsular contracture, or hardening rates, with submuscular placement. With that said, it is important to remember that the best implant location for one patient may not be the most ideal choice for another. Dr. Schooler will evaluate your needs and help you determine which technique can achieve a naturally beautiful breast look.
Where are the Incisions for Breast Augmentation Made?
There are three primary incision locations that Dr. Schooler can use to place breast implants. The incision options for breast augmentation include:
- Periareolar: The incision is made around the lower borders of the areola.
- Inframammary: A small horizontal incision is placed along natural contour of the breast crease.
- Transaxillary: The incision is made along a natural fold in the underarm.
The periareolar incision is typically best for patients seeking a mild to moderate breast enlargement and can offer the benefit of discreet post-surgical scarring in some patients. For saline implants it is relatively easy to introduce any size of implant with even a small areola, while the more recent cohesive silicone gel implants require a larger periareolar incision in patients with larger areolas.
For most patients today, especially those who wish to have larger breast implants, the inframammary incision usually provides a wider access point for the implant. Plus, the scar can easily be hidden in the natural contour of the breast fold. This has again become the most common incision location with cohesive gel implants, and has been reduced in size to a small incision under the breast that is easily hidden in the bra crease— especially with the accepted use of a funnel to insert the implant.
With the transaxillary approach, special surgical tools and an endoscopic camera are typically used to place the implant through an incision in the underarm, leaving the breast itself unscarred. This technique, however, was very popular with saline implants only and the incision usually cannot be re-used in the event of future breast revision surgery. Dr. Schooler usually utilizes the short scar inframammary incision or the periareolar incision when performing breast augmentation, as these locations can offer a greater degree of surgical control when positioning the implant.
How is Breast Augmentation Surgery Performed?
The breast augmentation process will start with a consultation in which you and Dr. Schooler will discuss the most ideal implant type, placement location (under the chest muscle vs. over the chest muscle), and incisional approach. During this time, you will also be able to try on different implant sizers to find the right fit, and see a 3D simulation to solidify your choices of implant type and size. Once all the details of your breast augmentation plan are formulated, the procedure will take place at our outpatient surgery center under general anesthesia.
Depending on the nature of your enhancement and your unique needs, an incision will usually be made below the breast fold, or sometimes around the areola or within a natural fold of the underarm. Dr. Schooler takes great care to make sure surgical incisions are as inconspicuous as possible. Through your incision, Dr. Schooler will carefully place and position the implants to achieve the desired result.
Funnel Use in Breast Augmentation
The Keller Funnel® and, more recently, the INPLANT® funnel have been statistically shown to improve delivery of the breast implant through the incision into the breast pocket, offering a decreased risk of infection and capsular contracture. Dr. Schooler has utilized the funnel to decrease trauma to the incision, allow smaller incisions, and decrease traumatic deformity of the implant during insertion.
We generally do not use drains for first-time breast augmentation. We have been on the forefront of the latest trends in limiting the use of heavy duty narcotics to control pain, with fast-acting general anesthesia and several other medications used to ensure a pathway for rapid recovery and a return to normal activities in just a few days. After completion of surgery, as well as placement of dressings and a recovery bra, you will be moved to our state-of-the-art recovery area where you will have the opportunity to rest under close post-operative observation before being discharged home.
What is Recovery from Breast Augmentation Like?
Dr. Schooler follows the established surgical techniques and the latest trends in perioperative pain management to ensure a rapid recovery after breast augmentation. Following breast augmentation surgery, you will initially be able to recover in our state-of-the-art recovery suite until fully awake and stable with well-controlled pain. Then, you will be discharged to complete recovery in the comfort of your own surroundings after being driven home by a friend or family member. Minor bruising, swelling, or tenderness is normal for several days after the procedure; however, these reactions should quickly subside as your healing process progresses. Most patients can resume work and normal activities in just a few days. Any discomfort can usually be managed well with oral non-opiate pain medication.
While most patients can resume light activities within a few days, including work and mild exercise, you may experience roughly one to two weeks of muscle soreness before you can return to your daily routine if submuscular implant placement is chosen. Jogging is permitted after two weeks, but strenuous upper body activity should be avoided for four weeks, or until cleared by Dr. Schooler. It occasionally takes several weeks for the implants to settle, but your new body contour should be noticeable soon after surgery. The final outcome of your enhancement typically improves in the months following breast augmentation. We take care in limiting pocket dissection to ensure long-lasting results and reduce the chances of bottoming out 2 implant displacement.
What Will My Scars from Breast Augmentation Look Like?
The shape and size of your scar from breast augmentation surgery will depend on which incision technique was used to place your implants. If the incision was made around the areola, the scar should blend in with the natural transition in pigmentation from areola to breast skin, creating a virtually undetectable result. With an incision made along the breast inframammary crease, the resulting scar is generally limited to 3-5 cm long and easily concealed in the fold under a bra or bikini top. The scar from an incision placed within the armpit (axillary) will usually not be visible unless the arms are raised, offering the advantage of an unscarred breast appearance. In all three of these locations, proper incision care after surgery can optimize the healing process and increase the chances of the scar fading over time. In the rare instance of hypertrophic scars, we tailor a treatment plan to correct the deformity with silicone gel, silicone strips, Embrace™ tension dressings and corticosteroids when needed.
How Much Does Breast Augmentation Cost?
Given the highly individualized nature of the procedure, the cost of breast augmentation will be calculated according to the details of your treatment plan, including:
- The type of implants utilized
- The surgical technique used
- The complexity of your procedure
- Whether your treatment was a revisional procedure
While it is impossible to determine your procedural expenses without knowing the specifics of your surgical plan, we maximize efficiency and cost-effective care. We can deliver a state-of-the-art surgical experience at a fraction of the cost at a hospital facility. Our cosmetic coordinator will provide you with a personalized quote after your needs are assessed during a consultation. In addition to accepting most major payment methods, we work with CareCredit® and Alphaeon™ Credit—some of the leading plastic surgery financing companies in the country. Once approved through the simple application process, patients can enjoy a range of low- to no-interest payment plans that can be chosen to suit one’s budgetary needs. Please do not hesitate to raise any questions about the cost of breast augmentation to a friendly member of our team.
Breast Augmentation Revision
With the abundance of innovative and figure-flattering options for breast implants now available, many patients who have previously had a breast augmentation procedure wish to exchange their current implants for a different size, shape, or type. In other cases, individuals may require a breast implant replacement if they experience problems related to capsular contracture, deflation, or asymmetry. Regardless of the motivation, our skilled plastic surgeon can help women interested in breast augmentation revision to achieve their enhancement goals.
For more information about implant exchange, please visit our sister site to read more about breast augmentation revision.
Please contact us today for more information, or to schedule a consultation. We will be happy to answer your questions about breast augmentation or other procedures you are considering.