Natural Breast Augmentation Surgery
in Denver, Colorado

There are two important reasons to spend time reviewing before-and-after pictures when considering plastic surgery. The first is to determine what procedure, if any, actually serves to improve your undesired appearance. The second is to distinguish which surgeon performs the best work.

There are many procedures discussed on the web and touted by the cosmetic surgery community and media as aesthetic dream-makers. Often, however, they are not. Be skeptical and use before-and-after pictures to determine which procedures will actually address your concerns. If an operation works well, there will be thousands of pictures demonstrating its success. If it's hard to find good before-and-after pictures of a procedure used for the problem you're trying to address, then it probably doesn't exist. Remember to be honest with yourself about your appearance when evaluating web pictures. The mirror lies. We recommend that you take pictures of yourself and set them in front of your computer while you do your research. Make sure that the "befores" look like you and then determine what procedures work. Just because the media or some web site states that fat injection to the buttocks will lift the butt, that doesn't make it so.

Second, once you've identified the best operation for you, it's easy to determine which surgeons achieve the most natural and attractive results. All people are hard-wired to appreciate natural attractiveness. Fortunately, it's easy for you to identify who can meet your highest expectations simply by reviewing before-and-after photo galleries.

Many plastic surgeons perform cosmetics surgery procedures such as breast augmentation. But few specialize in the cosmetic, rather than reconstructive side of plastic surgery and dedicate their entire practice to aesthetic procedures. Because Dr. Vath and Dr. Wolfe practice cosmetic plastic surgery exclusively, they perform hundreds of breast augmentations per year and can assure each patient that she will get the most beautiful aesthetic transformation possible.

Seek a surgeon who upholds the proper credentials including certification by the American Board of Plastic Surgery (ABPS), membership in the American Society of Plastic Surgeons (ASPS) and the American Society of Aesthetic Plastic Surgeons (ASAPS). Learn more about selecting a surgeon here.

Your breast augmentation procedure will be performed in our AAAHC certified Apex Surgical Facility in Golden, Colorado. Apex is owned and operated by Dr. Wolfe and Dr. Vath, and is used exclusively for aesthetic surgery patients. Anesthesia is used to ensure that you feel no discomfort and that your breathing is maintained and controlled for the duration of your procedure. We use only board certified anesthesiologists, including Dr. Joseph Carpenter, the medical director of Apex Surgical Facility. Learn more about the Apex Surgical Facility here.

Perhaps the most important criterion for choosing a plastic surgeon is your intuitive sense of comfort with the physician as a person. Cosmetic surgery is an emotional and personal experience. After all of your research into credentials and before/after pictures, ultimately, you must feel good about trusting the plastic surgeon to care for you and your aesthetic results.

Breast implants do not improve the shape of sagging breasts. When needed, a breast lift avoids an ugly, fake shape and creates much more natural appearance.

Breast augmentation surgery will fill out breasts without changing their position. If the breasts sag below the creases, implants will not rotate them upward into an attractive position. Rather, they will fill out the upper poles leaving the remainder of the unlifted breasts sagging off of the implants creating an unattractive, misshapen appearance.

When necessary, a breast lift, or mastopexy, will tilt the sagging breast upward into a perky position and create a much more natural contour along with the implants.

Silicone gel implants are not dangerous, do not leak around the body, and do not cause medical illness or disease.

Silicone gel implants are made of cohesive gel which is a semi-solid and does not leak throughout the body if the shell breaks. Despite their temporary ban by the FDA, silicone implants have never caused the autoimmune illnesses as was claimed in many lawsuits. They have definitively been proven safe and hence, reapproved in 2006 for everyone's use. Gel implants have three main advantages over saline implants:

• Softer, more natural feel
• Less rippling or wrinkling
• Lower risk of rupture

Round implants achieve a natural contour and do not inherently create a fake, "boob-job" appearance. Tear-drop implants usually do not create a more natural shape.

There are essentially two implant shapes available, round and contoured (teardrop). Round implants are most popular; however, contoured implants may be a good option for some women. When upright, round implants take on a natural tear drop breast contour and their shape changes with positional movement as natural breast tissue would. When they rotate, there is no problem with distorting the breast shape. Contoured implants were created in an attempt to provide a more natural looking option to round implants but most evidence does not support this assertion. These implants can be helpful for women with small breasts and very tight skin. Contoured implants are manufactured with a textured surface to help resist rotation. Nonetheless, these implants can spin causing breast distortion and occasionally the need for surgical correction.

Breast enhancement surgery does not require a 6 week recovery. Normal activity, working, and driving are generally permitted within 3 to 5 days after surgery.

The recovery from breast augmentation is faster and simpler than most people initially surmise. Soreness mainly stems from implant placement behind the pectoralis muscle, but dissipates rather quickly over the first few days. Most people are off of pain medication within one to five days. After this, returning to work at a non-strenuous job is permitted as is driving and normal activities that don't require exertion.

After two weeks, light cardiovascular activity is generally acceptable but patients are advised to "listen to their bodies". If something doesn't feel right, it's recommended to back off. All pre-surgical abilities without discomfort will return, but the timing to get there varies from person to person. High-impact activity such as running and heavy lifting should not be resumed until after a month.

The aesthetic recovery can be an evolution. Some patients' breasts look terrific and natural directly after surgery while others need some time for the lower pole breast skin to relax and allow the implants to drop into a more natural position. This can vary from a few weeks to even a couple of months. Either way, the breasts will look great in clothes, a dress, or even a bikini right after surgery.

Finally, precise, fine line scars are placed in the most inconspicuous location possible, but they take up to two years to fade completely. At the Center for Cosmetic Surgery, Dr. Vath and Dr. Wolfe perform any scar revisions at no cost in the rare event it is helpful in achieving an improved, thinner, flatter scar appearance. The color of a scar is determined by the individual genetics of the patient and only time can allow for fading of this color. Scars creams and topical therapies such as silicone sheeting can help reduce the thickness of a hypertrophic or keloid scar, but actually offer no long-term benefit in normal scar appearance as compared to time

Breast massage after surgery may reduce capsular contraction. The purpose of massage is not to improve breast shape during the recovery.

Capsular contraction is when the capsule that your body forms around the implant becomes thick and heavily scarred. This is not dangerous to you but can cause the breast to become tight, hard, and unattractive. Evidence supports breast expansion exercises (massage) after surgery to decrease the tendency towards capsular contraction. Additionally, submuscular implant placement can reduce the incidence of contracture.

Four incision options exist: inframammary (breast crease), periareolar, transaxillary (armpit), and transumbilical (TUBA). The inframammary incision is the most frequently chosen approach. There are many advantages to this location. The resulting scar hides well in the breast crease and is inconspicuous after it fades. The inframammary approach provides an extremely reliable, safe means of accurately inserting implants. It allows for tunneling behind the breast to get to the muscle while only minimally disrupting the milk ducts.

The tunnel made for implant insertion from the breast crease incision goes beneath the breast tissue causing minimal disruption of the milk ducts. At the Center for Cosmetic Surgery, Dr. Vath and Dr. Wolfe believe that tunneling behind the breast rather than through it reduces the risk of capsular contraction and infection.

Breast implants can be placed subpectoral (beneath the pectoralis muscle) or subglandular (in front of the pectoralis muscle). There are several advantages to placing the implants beneath the muscle. The extra coverage of the implant in the upper portion of the breasts assists in achieving a more natural contour and appearance. Visible rippling in the upper pole of the breast is significantly reduced while implant palpability is also less likely with implants positioned behind the muscle. There is maximal preservation of the nerves that supply nipple sensation. There is evidence that capsular contraction (heavy scar tissue forming around the implant) is reduced. Lastly, there is less interference with mammography because the implant is partially separated from the breast tissue by the muscle. For these reasons, we generally feel that it is advantageous to place the implants behind the pectoralismuscle.

Each plastic surgery procedure has one critical pearl that is essential to creating the most natural, attractive result. For breast augmentation, the implants must be placed precisely and accurately behind the natural breast position. This may seem obvious but it is not uncommon that women hope that breast augmentation will give them someone else's breasts. This is not the case. The breast crease, or inframammary fold determines where the breasts naturally reside on a woman's chest and this should rarely be manipulated. This crease determines the space between the breasts and their inherent shape that is not fundamentally altered during augmentation, but merely enhanced. When reviewing before and after photos, it quickly becomes clear that post-augmentation pictures have an undeniable similarity to the pre-surgery photos. This is the key to creating the most natural, attractive breast enhancement.

All too often, this basic premise is not followed. Common mistakes include

• dividing the pectoralis muscle attachments to the sternum which can centralize the implants creating a fake, circular cleavage
• over-dissecting the pocket laterally (to the sides) causing the implants to move too far apart
• disrupting the inframammary folds (breast creases) which can cause bottoming out or a "double-bubble" deformity
• inserting an implant diameter or profile (link to profile and shape above) that does not match the patient's breast width

Placing breast implants into a subpectoral (behind pectoralis muscle) position generally achieves a more natural, tear drop, sloping breast contour with less implant rippling and palpability in the upper pole. In some patients, subglandular (above the muscle) placement can lead to a fake, circular appearance due to less tissue coverage in the upper pole.

The best breast implant choices for each woman are those that have a diameter that matches the full width of her natural breast base. Implants that are too narrow fail to take full advantage of the breast width and fall short of creating the best shape possible. Implants that are overly wide extend too far to the side and detract from the overall breast aethetics.

The scars from breast augmentation should be nicely hidden. The inframammary scar should be placed within or slightly above the breast crease so that it is covered by a bra or bikini. Over time, once faded, they should be imperceptible naked. Alternatively, if the periareolar scars are chosen, they should hide nicely at the precise edges of the areolae so the eye does not pick them up.

Breast implants do not lift breasts nor do they help "hold up" breasts undergoing a lifting procedure. Implants will create larger breasts and fill deflated upper poles. A breast lift serves the purpose of improving the shape of sagging breasts. If a woman needs a breast lift and only has implants, the results will suffer considerably. It is critical that a mastopexy is performed when indicated to create beautiful breasts.