Breast augmentation is one of the most common procedures performed by Dr. Hsu. Women may choose to undergo breast augmentation because of breasts that are felt to be under-developed, differences in breast size (breast asymmetry), or changes after pregnancy or breast-feeding. Some women may be happy with their breasts but just want them made fuller. In addition, after weight loss, aging, or childbirth, a woman’s breast volume and shape may change. Augmentation can be performed with either saline or silicone implants.

Good candidates for this procedure:

  • Patients looking for more fullness of the breasts

  • Patients who have lost some breast volume due to pregnancy or weight loss, but who do not have much sagging of their breasts
  • Patients who want to correct size differences between the breasts

  • Patients wish breasts that lack substance or firmness

What to expect: Consultation

All cosmetic consultations are complimentary and serve as a great opportunity to gain further insight by voicing your concerns and having questions answered. During the initial consultation, Dr. Hsu will ask some questions to get to know you and determine if you are a good candidate for breast augmentation.

During the consultation, Dr. Hsu will first ask about the area in question, and determine what kind of goals you have for your breasts after surgery. He will also take careful measurements of the dimensions of your current breasts, in order to best select an implant and plan the surgery to give you optimal results. The measurements are an essential part of any breast augmentation consultation and result in a better postoperative appearance. Dr. Hsu will also ask about your medical history, including existing medical conditions, past surgeries, tobacco usage, daily medications, supplements, and allergies. For patients over 40, we will need your recent mammogram results. After giving a thorough examination, Dr. Hsu will go over choosing the location of incision and the size and type of implant that will fit your body based on measurements made during the examination.

Breast Augmentation sports bra.jpg

It is best to come to your consultation wearing a sports bra and a form-fitting shirt to better gauge what size breast implant best suits your body type and ideal shape. Dr. Hsu will choose a couple different sized implants that he thinks will bring you toward your goal while being safe for your body in terms of healing. The most important thing during the consultation is to try on the implants by putting it in your bra and putting your shirt over it to see if you like what you see in the mirror. The exact cup size that you have after surgery is not as crucial -- what matters most is that the implants fits your body well, and you like how you look.

You will also choose between saline or silicone breast implants. Both are very safe and have been rigorously tested by the Food and Drug Administration (FDA). Currently, the FDA allows silicone and saline implants in patients of any age. About 85% of our patients tend to choose silicone because it feels more natural and the other 15% choose saline because it is slightly cheaper.

Breast augmentation incision sites.jpg

There are three different incision sites: inframammary fold, periareolar, and transaxillary. The most common is the inframammary fold where the incision is placed under the breast. About 85% of our patients choose this because the scar is well hidden under the breast as after some time, the implants stretch the breasts so that the breasts hangover the incision. After a year, the scar will fade and barely be noticeable. The periareolar (bottom half of the areola or nipple) incision is not as popular among our younger patients because it can affect breastfeeding. The transaxillary (armpit) incision is the least common because recovery is prolonged due to increased dissection to get under the pectoralis muscle. The implants are also placed further apart, resulting in less cleavage. About 5% of Dr. Hsu’s patients choose this incision site.

If the implant ruptures in the future (whether silicone or saline), the replacement operation is quite straightforward and is usually about 30-45 minutes. The previous incision is used so that there is no new scarring, the old implant is removed, the area is carefully washed out, and a new one is placed.  

You can expect to change your breast implants after ten years. However, each patient is different, and if you have had no problems, you may be able to go longer without changing them. Some patients can go 25+ years with no implant replacement; whereas, other patients switch them before ten years either because the implants have a small leak or have changed position over time. In order to reach your aesthetic goal, both you and Dr. Hsu will work together to decide all the necessary details such as silicone or saline, breast implant size, and incision site in order to give you the best results.

If you feel your breasts are sagging and are also interested in getting a breast lift in conjunction with a breast augmentation, please see our Breast Lift procedure page for more information.

Surgery Details:

On the day of surgery, come in early to fill out paperwork, meet the anesthesiologist, and the staff will prep you for surgery. Dr. Hsu will meet you in the pre-operative area before surgery to make markings on the areas planned for surgery and answer any last questions you may have. 

Breast Implant Placements.JPG

The procedure is straightforward and usually takes about an hour and half to complete. Dr. Hsu will make the incision on the agreed upon location and will dissect under the pectoralis muscle to form what is called the “pocket” for your breast implant. The incision is pretty small, about 5 cm, and is very thin. During the surgery, he will put a temporary implant of the size you chose and raise up the table to see if the implants look symmetrical. Then he will lower the table back down, take out the temporary implant, wash out the area, and put in the breast implants. Dr. Hsu uses a special skin closure technique that involves multiple layers of stitches (all dissolvable) to help achieve the thinnest, most inconspicuous scar.

Recovery & Post-operative Instructions:

After the surgery, you will wear a surgical bra for about a week to aid the healing process. It is not recommended to lift elbows above your shoulders, but you can still use your arms for different things. During the recovery period, walking is encouraged to help quicken the healing process and minimize clots. Dr. Hsu will be available 24 hours after and he always gives out his personal cell number if you want to reach him directly with any pressing questions.

It is crucial to  keep the surgical area dry until Dr. Hsu gives his approval to shower. To clean the rest of your body, you can bathe from the chest down. Swelling & bruising will peak about 48 hours after surgery but will then decrease significantly in the first two weeks. Most patients can return to work after two weeks, but many patients return even sooner. The biggest limitation for post-operative patients is driving, which should be avoided while taking pain medication. Patients usually stop taking pain medication after five to seven days and plan their work schedules accordingly. Six weeks is usually an appropriate time to return to most types of exercise and activity.

Dr. Hsu likes to follow patients after surgery for an extended period of time to make sure the patient is satisfied and healing well. Most follow up appointments are scheduled immediately after surgery and for up to a year afterward.

Dr. Hsu's view on Breast Augmentation.

I’ve found that my approach to breast augmentation is slightly different from that of many of my colleagues -- as a stylistic difference, I tend to favor implants that are on the smaller, more moderate size, in order to maximize the natural appearance of the end result.  I’m not generally a fan of the very large implants.  If patients come to me asking for implants that I feel are too large for them, I will usually refer them to see someone else.

Placement of smaller- to moderate-sized implants requires experience in order to maximize their appearance.  I’ve found that their placement must be done more carefully than that of large implants, but with careful surgical technique and placement, patients can get a very nice result that looks fuller in the breast without being distractingly large.  

In my experience, one of the most important goals from breast augmentation surgery is to achieve an aesthetically pleasing “breast cleavage.”  Many factors are important for this, but probably the most important is the surgeon’s placement of the implant.  The implant size and shape should be carefully selected in discussions between the surgeon and the patient, and then the placement of the implant should be done in a manner that keeps in mind the goals for the patient’s post-operative cleavage.