Breast Augmentation

My Number One Goal: Beautiful And Long Lasting Results For Your Breasts

My number one goal for your breast augmentation is to get you beautiful and long lasting results. Breast augmentation is actually a very picky surgery: there are ways to perform a breast augmentation so that your chances of revision become very, very low. In many cases, I will use a dissolving internal bra to keep your breast implants exactly where we want them to be!
Before & Afters

Breast Surgery Videos

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Do I Need an Internal Bra with my breast augmentation?

There are several types of patients who benefit from additional support of their breast implants to prevent "bottoming out" and to maintain "upper pole fullness" after breast augmentation. If you have one of the following breast or chest shapes, an internal bra with dissolving mesh will be helpful to keep your implants in good position:
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  • A prominent breastbone or steep chest wall
  • Very small or absent breasts
  • No breast fold (or only a minimal breast crease)
  • Previous massive weight loss (or a very stretchy breast fold)
  • A desire for a perky and high breast without a bra

If you simply want a more "push-up bra" look with more fullness, especially without the need to wear a bra, then adding an internal bra is your best option.

The internal bra material is made from the same suture that I use to close the breast implant pocket: polydioxanone aka "PDS."
The entire mesh dissolves in about 3 months but has lasting support of the breast. It truly acts like an internal bra, giving you support without needing an external bra!  To learn more about my internal bra material, DuraSorb, please visit here, and to get more information about my approach, click HERE or the button below.
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295cc high profile implants with dissolving internal bra @ 3 months #postOPP

How long do breast implants last?

While your implants may not last forever, the issue with today's modern implants is NOT that the breast implants themselves rupture or leak. The issue is most often one of the two problems:
  1. Breast implants are contaminated with bacteria during placement. This leads to capsular contracture or hardness of the breast.
  2. Breast implants aren't placed in the right pocket. This leads to asymmetry and uneven breasts after breast augmentation.
Since both of these are technical issues that are able to be controlled, my number one goal is to be an expert technician for your breast implants.
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Breast Implant Technical Key Number ONE: Truly Sterile Technique.

There are dozens and dozens of medical journals that discuss all of the ways to avoid complications after breast augmentation. All of the critical factors involve avoiding bacterial contamination of breast implants. Not only does this decrease infection, but bacteria on the surface of the breast implant can lead to chronic inflammation and capsular contracture. Here are the many steps that I take to maintain Truly Sterile Technique during breast augmentation.
  • Preoperative IV antibiotics
  • Chlorhexidine skin prep
  • Nipple shields
  • Inframammary breast crease incision
  • Submuscular or dual plane (under the muscle) approach
  • Bloodless dissection
  • Triple antibiotic irrigation
  • Betadine skin re-prep
  • Changing gloves
  • Keller Funnel for "no-touch" technique
Each of these technical steps has been shown to decrease capsular contracture after breast augmentation. That means the OPPOSITE is also true. If any of these steps are NOT done, your surgeon is doing you a disservice during your breast surgery. This is what I call "cutting corners to cut costs." If the surgery costs less elsewhere, they are most certainly not doing everything they can in order to maximize your long term safety during breast augmentation. Please go back through this list. Is your doctor using a nipple approach? The nipple incision is not the safest option! Is your doctor placing your implants over the muscle? Bad idea for your longterm safety!

Breast Implant Technical Key Number TWO: Meticulous Blueprints

Blueprints are my mantra for breast augmentation. Precision marking leads to precision surgery. Symmetry. Balance. And Even appearing breasts. Breast augmentation requires a very meticulous and OCD surgeon to get it right. Implants are easy to just put in, but hard to place precisely. I am obsessive with the details! When the markings for breast augmentation are symmetrical, the breast augmentation comes out symmetrical. This sounds super logical, but it requires an expert technician! One who is ready to focus on every last detail. That's me.

We choose your breast implants together.

There are many different versions of beautiful breasts. Together we will select implant size and shape, allowing you to get the look you want. 

Options for a Natural Looking Breast Augmentation:

The best option for natural looking breasts are moderate profile implants
It's worth noting here that the lower profile implant--namely the moderate implant--is more likely to create a slightly wider breast shape. This wider breast is responsible for more "sideboob." While I don't like that term, it does best describe the smooth outer breast curve of a slightly wider breast.

Options for a Fuller and Rounder, more "augmented" look:

High profile is a the best option for a full, round, "augmented" look after breast implants. These implants settle less than other options and contribute to more fullness at the upper pole of the breast. In addition, an internal bra may help to support your breast implants and keep them higher up on your chest.
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Crease Incision, 385cc, high profile implants
breast aug by Dr. oppenheimer
320cc Ultra high profile implants for a "fake" augmented look. Nipple Incision.

Choosing the right size breast implants

Choosing the right breast implant requires an understanding of your existing breast size in addition to your goal cup size. A full C is the most commonly requested final cup size after breast augmentation. While it depends on your height and weight, I like to use the 200 rule to connect breast implant size to breast cup size.

The 200 Rule: 200cc equals one cup size

For example, if you are a small B cup looking to get to a small C cup, you should use a 200cc implant.
If you are a small B cup looking for a full C cup you may need an implant closer to 300cc. This would give you a cup size "and a half" to get you to the full C cup look.

Gummy Bear Breast Implants are more cohesive (firm)

Summary slide: Gummy bear breast implants are more firm than traditional silicone breast implants. Unfortunately there are a lot of different opinions on what a gummy bear implant actually means. Gummy bear implants are just a more firm gel. For example, Allergan Inspira implants come in three different types of firmness: SRF (responsive gel, the softest), SSF (SoftTouch gel, ironically named because it is HARDER than the SRF), and SCF (Cohesive, the most cohesive silicone and therefore the hardest and firmest to the touch). Implants come in two types of silicone cohesivity or "firmness," essentially closest to the SSF and SCF for their softer and firmer silicone gel breast implants.
Cohesive implants (some say gummy bears because of the firm gummy bear feel) were used in this patient's revision breast augmentation because she had thinner skin. A firmer implant is less likely to ripple or wrinkle.

Incision Placement

My incisions for breast implants are about 1.5 inches long, and they hide right in the crease. Incisions in the armpit and the nipple causes several problems, in addition to increasing the chances of developing firm breasts (capsular contracture). While it seems appealing to have a "hidden" incision, a nipple approach can actually make the scar more obvious. Furthermore, a nipple incision can actually indent, leading to a depressed nipple near an implant, which is precisely the opposite of a hidden scar. Crease incisions, on the other hand, hide the best, are placed in a wrinkle under the breast, and have the lowest risk of capsular contracture.

Don't fear the gap!

Cleavage is everything with breast augmentation, and one of the key elements of breast implant surgery is close cleavage. I often hear about how nervous patients are about a wide gap between their breasts after implants. While some cleavage is genetically determined, in most cases the cleavage can be closely spaced with very little gap between the breasts. The cautionary step to avoid is symmastia, or breasts that touch across the midline. Close but not too close is the goal. 
A great example of close cleavage after breast augmentation. Don't fear the gap!
The best way to get the right amount of cleavage is to mark the cleavage goal beforehand, and to dissect just that amount in surgery. It sounds simple to get the cleavage right after breast implants, but it requires a bit of obsession in surgery and in markings! Implants should STILL be placed under the muscle, but that muscle needs to be divided in the midline to just the right amount during breast augmentation to get the cleavage right.

Implant placement: The meaning of "dual plane"

Everyone has heard of "overs" and "unders," but I get a lot of questions about Dual Plane. I think of Dual Plane breast augmentation as the best of both worlds. Think of it this way: women don't come in asking for "pec" augmentation, so why is the implant placed under the pec? Ideally, the implant should be placed under the breast to augment the breast. There are two problems with this. The first is that implants placed over the muscle can look too round for some patients' goals. The second problem is that implants placed over the muscle have a higher risk of hardness (capsular contracture).
The solution is the best of both worlds: a dual plane breast augmentation. In this approach, the muscle is released slightly to allow it to "window shade" upwards. This makes the implant under the muscle up high, providing coverage of the upper pole of the breast. That upper pole coverage creates a smooth transition of the breast (instead of a stuck on look that you sometimes can see in fitness model competitions) AND it also protects the implants against capsular contracture. The lower pole of the breast has direct contact with the implant, creating a nice full round shape below. This allows the breast to be augmented where it should be: at the level of the breast and not the pec! If you think about it, the breast is ever so slightly lower than the pec muscle. Voila. Dual Plane Breast Augmentation explained.
Here is a beautifully settled look of dual plane breast augmentation. Note the smooth slope transition of the upper breast (implant covered by muscle) and the nice full and round look of the lower breast (implant covered by breast only).

The Consultation

There's nothing easy about sharing your insecurities, even if it is with me, your doctor. I do everything I can to make this process as easy as possible for you. First, you will talk with my nurse and she will help to fill out your medical intake. We are a paperless office and we like to keep things lean and save a tree! Next, you'll probably have been given this iPad to look through our website. If you're reading this far, thanks!
I like to make sure that we address all of your concerns and goals, so I'll then come in the room and you can share any wish pics or goals for your breasts. I will definitely ask you:
  • Your current cup size
  • Your goal cup size
  • Your goal look: natural, full, or augmented (very round)
Next, I will step out and you can get changed. My patient care coordinator and I will come back into the room to do a basic breast exam, take some measurements and look at your overall breast shape. I then will do a scan of your breasts with a virtual reality camera. My patient care coordinator will help with some in-office sizing, using silicone gel inserts ("cutlets") and you'll be able to look in the mirror and see what sizes work best for you. Based on that, I can perform "virtual surgery" and show you what the results could look like with the shape and style of implants that you like!
Each patient undergoes this "virtual surgery" to make sure that your goals match the plan.
before and after breast implants
Before and after breast implants. The results match very closely to the simulated virtual reality video above. Results at 1 month will continue to settle.

The Price of Breast Implants

Our goal is to be fully transparent when it comes to the surgery pricing and what is included. That's why we make our price list easily accessible for our patients to review. Everything is included with us. To see our pricing click HERE.

Comparing Apples to Apples

My goal is to give you the best results, and safely. Doing a breast augmentation the right way costs more up front. There are corners that can be cut to make it cheaper. I don't cut corners. Trust me when I say it's worth investing in results you'll love. 

There are added benefits to having surgery with me.
  1. I use a Keller funnel to place the implant via No Touch technique.
  2. I have an accredited surgery center with all of the safety mechanisms in place. Proper staffing. Sterilization. Monitoring. Care.
  3. We provide all the #postOPP necessities. Two bras for recovery and beyond, skin care and scar care, nerve blocks, 24/7 on call services, and unlimited follow ups.
  4. Our revision rate is so rare (1 in 100 cases) we never charge surgeons fees in those rarest of circumstances where a revision is required.

Scheduling Surgery

I'm ready to work, and I'm more than willing to meet the demands of YOUR schedule. To learn more about our scheduling policies and procedures, click HERE.

The most common question I'm asked about scheduling is "how far are you booked out Dr. Oppenheimer?" 
While I never answer the question (sorry) the short answer is "not long". Because I have full control over my schedule, because I am the only surgeon in my surgery center, and because I am obsessed with helping women achieve their goals, "not long."

Breast Implants: Things to know the day of surgery

Don't worry. I'll do that for you. It's literally my job to worry about the results of your breast augmentation. I will stress about the markings, the cleavage, the sterility, the incisions, the scars, the anesthetic. It's my job to make this right for you.
Since we have our own facility, it will be a super private and confidential experience. There will be no "check in" process. You'll come to the surgery entrance, my nurse Lae'l will let you in and she will get you into a gown. The urine pregnancy test and IV is next. Your spouse, girlfriend, mom, or family member can stay with you in the room for as long as you want (or don't want!)
I will come in smiling and ready with my sharpies to make all the required marks. Answer any questions, and go over the gameplan for your size and profile and any other details or questions you have. I'm never in a rush!
Once we get the sharpies on, we will walk you back to the OR where you'll be gently sedated by my anesthesiologist. "Pick out a nice dream!" you might hear me say. You'll wake up in a jiffy. Even if you haven't had anesthesia before, we will make sure your breast augmentation is super safe. That's the number one goal. The surgery takes about 1.5 hours total from in the room to recovery, and your family can see you right afterwards.

Recovery from breast augmentation

The flash recovery breast augmentation sounds great, go out to dinner that night! While my patients have all of the elements of a flash recovery breast augmentation (bloodless surgery, gentleness to the rib cage, no bruising, nerve blocks, and rapid recovery anesthesia) please don't go out to dinner the night of your breast augmentation. It's best for you to lay low and take it easy at home. While problems are rare after surgery, overdoing it can be one of the causes of bleeding or infection.

Time to the final result

It takes 3 months for your implants to settle to their final place after breast augmentation. Early on, your implants will sit high and the nipples will be pointing low. Sometimes one breast will settle quicker than the other, which can be related to your dominant hand. If the implants are sitting too high we may provide you a recovery band or bra bandeau, but this is very uncommon. The "drop and fluff" takes about 3 months to finish, which is the settling and filling out of the implants in the breast.

One month to the gym, three months to the ring

This may sound like a joke, but since we have treated many women of the WWE (professional wrestlers) as well as bodybuilders and crossfit athletes, we like to be very clear. One month is ok for light cardio in the gym. Six weeks to light weights. And really 3 full months before resuming crossfit after your breast augmentation. Enter the ring at your own risk.
I have lots of crossfit athletes in my practice. Please go easy for the sake of your breasts (and my sanity).

Breast Lift with Implants

In cases where there is drooping of the breast, a lift may also be required.

Fighting gravity isn't easy and it takes a thoughtful approach! The answer is not "we'll just put in a bigger implant" so beware of doctors who offer that as an option.
Unfortunately, gravity always wins. 

There are really two options to fight gravity when it comes to breast surgery. Each option is PERFECT for the right person. It just depends on your current breasts and your goals.

Option 1: Breast Lift/Reduction 
​Option 2: Breast Lift/Reduction with Breast Implants
1. Breast Lift/Reduction is a perfect option for women who don't want implants and who prefer a more natural look. This will lift the breast and hold it in place temporarily. But gravity can still pull the breast down over time. The smaller the breast, the less gravity will have an effect.

2. Breast Lift/Reduction with Implants is the best way to trade drooping breasts for fuller, rounder breasts. In some cases we ALSO will use an internal bra to support the implant!
If the skin was a good bra then you wouldn't need a bra."  - Dr. OPP

Breast Lifts Require Scars

Unfortunately, breast lifts require scars. In my practice, the only scar patterns that work well long term are the anchor scars: a lollipop scar around the nipple and down the front of the breast, and a scar in the breast crease. Donut scars (the Benelli mastopexy) around just the nipple sound really appealing, but they end up stretching the nipple over time, causing problems with the scar appearance and breast shape. I try to avoid scars on the breast whenever possible, but if you need a lift, it's most likely going to be an anchor scar pattern.

When performing a breast lift with implants, the implant pocket must be made tightly, to avoid the implant and breast stretching over time. Implants with a lift when placed tightly under the muscle will stay in place and will not slide off the chest or bottom out. This is particularly important in women who have a prominent breast bone. This is sometimes referred to as pectus carinatum (bird chest deformity). Patients with pectus carinatum are at risk for breast implants sliding into the armpits. In these patients we often recommend an internal bra.

Scars can heal beautifully in all skin types.

Understandably, women of color are more fearful of scarring. This is because keloid scars tend to be more common in darker skin tones, particularly in women of African-American descent.
That said, the appearance of scars can be drastically reduced with good surgery by a good surgeon! Here is a young mom who underwent a breast lift and reduction with implants. Her scars are still healing at 3 months #postOPP.

Anchor scars are the most reliable way to lift the breasts.

Women with drooping breasts most often want two things:
  1. A lifted and full upper breast
  2. A smaller areola
Anchor scars are the most reliable way to lift the breasts and make the nipples smaller.
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Hyper-meticulous suture work

It's a hard truth, but all surgeons are not created equal. Just like some tattoo artists have unique skill, so too do some surgeons have unique gifts with their hands. If you're reading this far, you can already tell that it's true. I place every stitch by hand using absorbable sutures buried underneath the skin. This means no suture marks, and the thinnest scar possible.

The Journey: Breast lift with implants

Breasts should always look good, really at every part of the journey. Because of that, I'm never afraid to share the journey.
Above was one day #postOPP and below, at 1 week out from breast lift with 505cc textured round hi profile implants.

The nipple stays attached with a breast lift and does not loose sensation in the vast majority of cases.

The nipple stays on your body, attached, during a breast lift surgery. Sensation is preserved by keeping the nerves connected during a breast lift. Some women actually have more nipple sensation after a breast lift surgery.

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