Johnny Franco, MD, FACS

Breast augmentation is most commonly placed under the muscle for multiple reasons, however occasionally patients do benefit from the implant placed over the muscle. Let’s start with reasons why the breast implants are placed under the muscle. The first, is that the risk of capsular contracture has been found to decreased when the implant is placed below the muscle. It is believed that the constant motion of the muscle keeps the implant moving just subtly and thus keeping it soft. The second reason is that the muscle provides additional coverage over the breast implant, giving it a softer feel and decreases the appearance of rippling from the breast implant. The new gummy bear (highly cohesive) breast implants have helped with many of the issues that placing the implants under the muscle have treated. The gummy bear implants have decreased the rippling that can be seen when compared to saline breast implants. Also, the advent of the Keller funnel and antibiotic solutions used during a breast augmentation have decreased the risk of capsular contracture. The benefit of placing the breast implant in the subglandular (above the muscle) is that it prevents something called animation deformity. This is when the breast implant moves as the muscle is flexed. Remember a little movement is great to prevent capsular contracture, however if the implant moves a significant amount it can be disturbing to the patient. If the breast implant is over the muscle, then there is very little movement of the implant when the muscle is flexed. I typically will place the gummy bear breast implant over the muscle if someone has animation deformity. This will reduce the movement of the implant when the patient is moving and flexing. Bodybuilders and other patients that are at risk of animation deformity I may also place the implant over the muscle during their breast augmentation to avoid this issue. There are pros and cons to both a subglandular and submuscular placement of the breast implant. It is important to discuss both of these options during your consultation with your Board-Certified Plastic Surgeon. The highly cohesive breast implants have given patients and plastic surgeons more flexibility in the placement of the breast implant.

Breast augmentation is most commonly placed under the muscle for multiple reasons, however occasionally patients do benefit from the implant placed over the muscle. Let’s start with reasons why the breast implants are placed under the muscle. The first, is that the risk of capsular contracture has been found to decreased when the implant is placed below the muscle. It is believed that the constant motion of the muscle keeps the implant moving just subtly and thus keeping it soft. The second reason is that the muscle provides additional coverage over the breast implant, giving it a softer feel and decreases the appearance of rippling from the breast implant. The new gummy bear (highly cohesive) breast implants have helped with many of the issues that placing the implants under the muscle have treated. The gummy bear implants have decreased the rippling that can be seen when compared to saline breast implants. Also, the advent of the Keller funnel and antibiotic solutions used during a breast augmentation have decreased the risk of capsular contracture. The benefit of placing the breast implant in the subglandular (above the muscle) is that it prevents something called animation deformity. This is when the breast implant moves as the muscle is flexed. Remember a little movement is great to prevent capsular contracture, however if the implant moves a significant amount it can be disturbing to the patient. If the breast implant is over the muscle, then there is very little movement of the implant when the muscle is flexed. I typically will place the gummy bear breast implant over the muscle if someone has animation deformity. This will reduce the movement of the implant when the patient is moving and flexing. Bodybuilders and other patients that are at risk of animation deformity I may also place the implant over the muscle during their breast augmentation to avoid this issue. There are pros and cons to both a subglandular and submuscular placement of the breast implant. It is important to discuss both of these options during your consultation with your Board-Certified Plastic Surgeon. The highly cohesive breast implants have given patients and plastic surgeons more flexibility in the placement of the breast implant.

Breast augmentation is most commonly placed under the muscle for multiple reasons, however occasionally patients do benefit from the implant placed over the muscle. Let’s start with reasons why the breast implants are placed under the muscle. The first, is that the risk of capsular contracture has been found to decreased when the implant is placed below the muscle. It is believed that the constant motion of the muscle keeps the implant moving just subtly and thus keeping it soft. The second reason is that the muscle provides additional coverage over the breast implant, giving it a softer feel and decreases the appearance of rippling from the breast implant. The new gummy bear (highly cohesive) breast implants have helped with many of the issues that placing the implants under the muscle have treated. The gummy bear implants have decreased the rippling that can be seen when compared to saline breast implants. Also, the advent of the Keller funnel and antibiotic solutions used during a breast augmentation have decreased the risk of capsular contracture. The benefit of placing the breast implant in the subglandular (above the muscle) is that it prevents something called animation deformity. This is when the breast implant moves as the muscle is flexed. Remember a little movement is great to prevent capsular contracture, however if the implant moves a significant amount it can be disturbing to the patient. If the breast implant is over the muscle, then there is very little movement of the implant when the muscle is flexed. I typically will place the gummy bear breast implant over the muscle if someone has animation deformity. This will reduce the movement of the implant when the patient is moving and flexing. Bodybuilders and other patients that are at risk of animation deformity I may also place the implant over the muscle during their breast augmentation to avoid this issue. There are pros and cons to both a subglandular and submuscular placement of the breast implant. It is important to discuss both of these options during your consultation with your Board-Certified Plastic Surgeon. The highly cohesive breast implants have given patients and plastic surgeons more flexibility in the placement of the breast implant.

Breast augmentation is most commonly placed under the muscle for multiple reasons, however occasionally patients do benefit from the implant placed over the muscle. Let’s start with reasons why the breast implants are placed under the muscle. The first, is that the risk of capsular contracture has been found to decreased when the implant is placed below the muscle. It is believed that the constant motion of the muscle keeps the implant moving just subtly and thus keeping it soft. The second reason is that the muscle provides additional coverage over the breast implant, giving it a softer feel and decreases the appearance of rippling from the breast implant. The new gummy bear (highly cohesive) breast implants have helped with many of the issues that placing the implants under the muscle have treated. The gummy bear implants have decreased the rippling that can be seen when compared to saline breast implants. Also, the advent of the Keller funnel and antibiotic solutions used during a breast augmentation have decreased the risk of capsular contracture. The benefit of placing the breast implant in the subglandular (above the muscle) is that it prevents something called animation deformity. This is when the breast implant moves as the muscle is flexed. Remember a little movement is great to prevent capsular contracture, however if the implant moves a significant amount it can be disturbing to the patient. If the breast implant is over the muscle, then there is very little movement of the implant when the muscle is flexed. I typically will place the gummy bear breast implant over the muscle if someone has animation deformity. This will reduce the movement of the implant when the patient is moving and flexing. Bodybuilders and other patients that are at risk of animation deformity I may also place the implant over the muscle during their breast augmentation to avoid this issue. There are pros and cons to both a subglandular and submuscular placement of the breast implant. It is important to discuss both of these options during your consultation with your Board-Certified Plastic Surgeon. The highly cohesive breast implants have given patients and plastic surgeons more flexibility in the placement of the breast implant.

One of the most common questions I get during a breast augmentation consultation is whether a patient can avoid doing a lift if they just get a larger implant. This is a difficult question as it depends on the specific situation, however there are several guidelines. First of all, if you need a breast lift then you need a breast lift. Often patients will use a much larger breast implant for their breast augmentation then they wanted to avoid doing a lift and the result is a large saggy breast. The size of the implant can be taken into consideration when determining the type of lift that is being performed. The breast implant can be combined with a peri-areolar lift, vertical or full (anchor) lift. In certain situations you may be able to decrease the scaring needed from the lift when adding an implant. A good discussion for another time! The biggest determination if an implant can be used instead of a breast lift is the amount of ptosis and asymmetry the breasts have on the specific patient. A breast implant at most can lift the breast about an inch. I truly believe wish pictures are priceless when discussing your aesthetic goals with your plastic surgeon. For patients that are on the fence if they need a lift, it can be helpful to your plastic surgeon to know your goals so that they can help guide you to a result you are going to love for years to come. Often when I see a patients wish pictures it is obvious which procedure is going to help them achieve the result they desire. If patients are truly anxious about doing a breast lift, they can do the breast augmentation, let the breast settle for three months and then decide if they want to perform the breast lift. Plastic surgeons try to guide patients to avoid patients having to come back several months later because they are unhappy with the results of their breast surgery. Please discuss your breast augmentation options with your Board-Certified Plastic Surgeon.

One of the most common questions I get during a breast augmentation consultation is whether a patient can avoid doing a lift if they just get a larger implant. This is a difficult question as it depends on the specific situation, however there are several guidelines. First of all, if you need a breast lift then you need a breast lift. Often patients will use a much larger breast implant for their breast augmentation then they wanted to avoid doing a lift and the result is a large saggy breast. The size of the implant can be taken into consideration when determining the type of lift that is being performed. The breast implant can be combined with a peri-areolar lift, vertical or full (anchor) lift. In certain situations you may be able to decrease the scaring needed from the lift when adding an implant. A good discussion for another time! The biggest determination if an implant can be used instead of a breast lift is the amount of ptosis and asymmetry the breasts have on the specific patient. A breast implant at most can lift the breast about an inch. I truly believe wish pictures are priceless when discussing your aesthetic goals with your plastic surgeon. For patients that are on the fence if they need a lift, it can be helpful to your plastic surgeon to know your goals so that they can help guide you to a result you are going to love for years to come. Often when I see a patients wish pictures it is obvious which procedure is going to help them achieve the result they desire. If patients are truly anxious about doing a breast lift, they can do the breast augmentation, let the breast settle for three months and then decide if they want to perform the breast lift. Plastic surgeons try to guide patients to avoid patients having to come back several months later because they are unhappy with the results of their breast surgery. Please discuss your breast augmentation options with your Board-Certified Plastic Surgeon.

One of the most common questions I get during a breast augmentation consultation is whether a patient can avoid doing a lift if they just get a larger implant. This is a difficult question as it depends on the specific situation, however there are several guidelines. First of all, if you need a breast lift then you need a breast lift. Often patients will use a much larger breast implant for their breast augmentation then they wanted to avoid doing a lift and the result is a large saggy breast. The size of the implant can be taken into consideration when determining the type of lift that is being performed. The breast implant can be combined with a peri-areolar lift, vertical or full (anchor) lift. In certain situations you may be able to decrease the scaring needed from the lift when adding an implant. A good discussion for another time! The biggest determination if an implant can be used instead of a breast lift is the amount of ptosis and asymmetry the breasts have on the specific patient. A breast implant at most can lift the breast about an inch. I truly believe wish pictures are priceless when discussing your aesthetic goals with your plastic surgeon. For patients that are on the fence if they need a lift, it can be helpful to your plastic surgeon to know your goals so that they can help guide you to a result you are going to love for years to come. Often when I see a patients wish pictures it is obvious which procedure is going to help them achieve the result they desire. If patients are truly anxious about doing a breast lift, they can do the breast augmentation, let the breast settle for three months and then decide if they want to perform the breast lift. Plastic surgeons try to guide patients to avoid patients having to come back several months later because they are unhappy with the results of their breast surgery. Please discuss your breast augmentation options with your Board-Certified Plastic Surgeon.

Breast augmentation is the most popular aesthetic procedure year after year. Patients can have the procedure and be back to work within a week depending on their specific occupation. However, just because they can return to work, doesn’t mean the implants have settled and the swelling has resolved. It typically takes three to six months to see your final result, however after two weeks most patients will see the breast implants settling and the swelling starting to resolve. The breasts have a high and square appearance initially after the surgery. There are several factors that contribute to this shape. The majority of breast implants are placed under the muscle. The pectoralis major muscle swells which holds the implants high, and gives the additional swelling in the upper pole of the breast. As the swelling in the muscle starts to go down the implant will “drop” giving the breast a round, softer appearance. Also as the muscle swelling goes down the fullness in the upper pole will decrease and the breast will have a more natural appearance. As the breast implant settles down into its proper position and the swelling resolves the breast will have a perky perfect position! The process of the swelling decreasing and the implants “dropping” starts a week after surgery and will continue for several months. The majority of the swelling will be gone after about two months. However, patients can still see some swelling for an additional couple months after exercise or extreme activity. There are several other factors that can prolong the swelling and settling of the breast implant. Some of these items include the size of the breast implant and if the breast augmentation is done in combination with a breast lift. Please discuss your specific breast augmentation recovery with your Board-Certified Plastic Surgeon!

Breast lift (mastopexy) is a surgery where patients have typically thought about the procedure for years prior to coming into the office.  The vast majority of patients want to be able to exercise and wear clothes without their breast limiting those activities.  However, patients often do worry about the sensitivity of their nipples after a mastopexy (breast lift surgery).  It is import to remember that many patients have decreased nipple sensitivity when they have very large or ptotic breasts.  This comes from the fact that the nerves have been stretched over a period of years.  It is impossible to predict if patients will lose sensitivity in their nipples after a breast lift, but the majority of patients return to their baseline in terms of sensitivity several months after surgery. Patients typically go through a several phases in terms of sensitivity after their breast reduction surgery.  Patients can lose sensitivity initially after their surgery as the nerves are stretched and moved by the lift and re-arrangement of the breast tissue.  However, the majority of the breast lift techniques are designed to protect the glandular tissue below the nipple areolar complex.   Protecting this glandular tissue below the nipple areolar complex does two things, one it protects the blood suppler to the nipple and areola, it also protects some of the nerves going to the nipple areolar complex.  The nipple sensation typically starts to return over the next couple months, but can vary greatly from patient to patient.  Patients can also experience a period of hypersensitivity after their mastopexy.  This hypersensitivity is typically the period when the nerves are “waking” back up and are sensitive to any type of contact.  During this period of hypersensitivity, it is important to massage the breasts as this will help the nerves return to baseline.  The nerves need to adjust to being touched again.  Wearing a soft, sports bra typically helps until the sensitivity returns to baseline, however massaging the nipple areolar complex is key to helping calm down the hypersensitivity of the area.  It is important to touch them or the hypersensitivity can linger for a period of time.  Some initial nerve sensation changes initially are normal in a mastopexy; however, the majority of patients return to their baseline in terms of sensitivity several months after their surgery. It is important to discuss this risk with your Board-Certified Plastic Surgeon.  They can help guide you through the process and further discuss the risks of losing sensation after your breast lift surgery.

Breast reduction is a surgery where patients have typically thought about the procedure for years prior to coming into the office.  The vast majority of patients want to be able to exercise and wear clothes without their breast limiting those activities. .  However, patients often do worry about sensitivity of their nipples after breast reduction surgery.  It is import to remember that many patients have decreased nipple sensitivity when they have very large breasts.  This comes from the fact that the nerves have been stretched over a period of years.  It is impossible to predict if patients will lose sensitivity in their nipples after breast reduction, but the majority of patients return to their baseline in terms of sensitivity several months after surgery. Patients typically go through a several phases in terms of sensitivity after their breast reduction surgery.  Patients can lose sensitivity initially after their surgery as the nerves are stretched and moved by the reduction and re-arragement of the breast tissue.  However, the majority of the breast reduction techniques are designed to protect the glandular tissue below the nipple areolar complex.   Protecting this glandular tissue below the nipple areolar complex does two things, one it protects the blood suppler to the nipple and areola, it also protects some of the nerves going to the nipple areolar complex.  The nipple sensation typically starts to return over the next couple months, but can vary greatly from patient to patient.  Patients can also experience a period of hypersensitivity after their breast reduction.  This hypersensitivity is typically the period when the nerves are “waking” back up and are sensitive to any type of contact.  During this period of hypersensitivity, it is important to massage the breasts as this will help the nerves return to baseline.  The nerves need to adjust to being touched again.  Wearing a soft, sports bra typically helps until the sensitivity returns to baseline, however massaging the nipple areolar complex is key to helping calm down the hypersensitivity of the area.  It is important to touch them or the hypersensitivity can linger for a period of time.  Some initial nerve sensation changes initially are normal in breast reduction surgery; however, the majority of patients return to their baseline in terms of sensitivity several months after their surgery. It is important to discuss this risk with your Board-Certified Plastic Surgeon.  They can help guide you through the process and further discuss the risks of losing sensation after your breast reduction surgery.