Breast Procedures » Breast Implants a.k.a. Breast Augmentation

Breast Augmentation with breast implants by female Seattle Plastic Surgeon

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Breast Implants a.k.a. Breast Augmentation

Please read this!  I am retiring in June of 2021 and am therefore not doing any more breast augmentation consultations.  Breast augmentation is a procedure that, IMO, needs careful follow up for several months after surgery.  I won’t be around to do that.   I highly recommend my associate, Dr. Shahram Salemy, my current practice partner or Dr. Hakim Said who will be joining Dr. Salemy in June.

Year after year breast augmentation remains the most commonly performed plastic surgery procedure.  Patient satisfaction with breasts implants is very high.  For the woman with a really flat chest, breast implants are about as close to immediate gratification as one can get.  In fact the only problem with breast implant surgery is, well, the implants.  Implant design and manufacturing has undergone many, many changes since I started practice in 1991.  Current implants are much better than the implants way back then but implants are still not and never will be perfect.  The fact remains that a breast implants are a large foreign body and they cannot be expected to last a lifetime, just like an artificial heart valve or knee joint will not likely last a lifetime (unless of course the recipient is really old).  Most breast implant surgery is done in young women and they must accept the fact that they will likely need implant related surgery in the future.   I feel super luck to practice in Seattle where most women area active and sporty and want a look that “could have occurred in nature on a really, really good day”.  Implants that fit the patient’s chest and lifestyle are the most likely to provide a nice long benefit.  You will notice in my photo gallery that there are no 5’2″ 110 lb. women with 800 cc implants.  I just don’t go there!

Quick Facts about Breast Implants a.k.a. Breast Augmentation

  • Costs: $8600 – $9500 depending on type of implant and length of surgery.  This includes surgeon’s fee, facility fee, breast implants, post op bra and Cosmetassure coverage.  
  • Gel or saline:  It’s up to you.
  • How much it hurts:  Quite a bit the first 2 days.  Usually on the third day, you can’t wipe the smile off your face.
  • Time off work or school:  1 – 2 weeks depending on occupation.
  • Time until driving again: 5 – 7 days or until you are off narcotic pain meds and Valium.
  • Time in post-operative bra: 4 weeks.
  • Time off the gym:  usually 4 weeks.
  • Time off the slopes:  usually 4 weeks.
  • Time off the kite board: usually 6 weeks.
  • How long it “lasts”:  usually 10 – 20 years before implant replacement is needed or wanted.
  • Patient satisfaction : very high.

A before and after is worth a thousand words.  Check out my photo gallery.

And here’s the fine print about breast implants a.k.a. breast augmentation.

I use silicone-filled or saline-filled breast implants. In my Seattle practice, my use of silicone vs. saline is about 60% vs. 40%. I usually place breast implants under the chest (pectoralis muscle). I usually use a 2 inch long incision under the breast but occasionally will use an incision around the areola (the colored area around the nipple) depending upon the patient’s anatomy and wishes. There are many different sizes and several different types of implants available.   I will review these with you at your consultation and make my recommendations based on your anatomy and wishes. Occasionally, if a woman has significant sagging (ptosis) of the breast, a breast lift either with or without implants may be recommended.

I perform breast augmentations in our state-of-the-art and fully certified in-office  Madison Tower Surgery Center.  You will be able to go home the day of surgery. Most patients take about a week off after surgery. During this time, you will be up and about but should avoid heavy lifting, reaching over your head or other strenuous activities. Most patients take narcotic pain medications for 4 or 5 days after surgery.  I also prescribe Valium which is a muscle relaxant.  This often provides a lot of relief for women who have had the implants placed under the muscle.

It is very important for patients to understand that while breast augmentation is a good operation for many women, it is not a perfect operation. Women who choose breast augmentation, especially young women, need to understand that they may need further surgery sometime in the future. Sometimes implants leak or become hard and sometimes breast tissue sags, especially after childbrearing and breast feeding. Surgical procedures such as implant replacement, removal of scar tissue or a breast lift are indicated to help maintain an attractive breast. I have even done a few breast implant removals combined with a breast reduction on a middle aged ladies who became very busty with the onset of menopause!  I would be happy to discuss this issue with you at the time of your consultation.

Alternatives to Breast Implants

Sometimes patients are better served with a breast lift than a breast augmentation.  Breast lifts do not make the breast smaller.  In some cases, the breast looks larger after a lift, especially if the nipple is reduced at the time of the lift.  It’s a beautiful optical illusion!  Please see my page on breast lift for more information.

Also, some patients do better with fat transfer to the breast, especially is they have a generous area of donor fat.  My patients get about a one cup size increase with fat transfer so it’s not for the woman who wants a major increase in size.  Please see my page on fat transfer for more information.   And now for something really out there:  sometimes a woman’s breasts are disproportionately small because she has a really large tummy and/or hips.  If this woman has body contouring to make her below the waist trimmer, her breasts may look more proportionate.  Cool, huh?  It’s not magic.  It’s plastic surgery.

Silicone-Filled Breast Implants

In mid-November 2006, the Food and Drug Administration approved silicone-filled breast implants for use in breast augmentation for women over 22 years of age and for use in breast reconstruction for women of any age. Prior to this decision, silicone-filled breast implants were available only through a clinical study for women who met strict inclusion criteria. I am very pleased to be able to offer silicone-filled implants to all reconstruction patients and all augmentation patients over the age of 22.   I currently use mostly Allergan and Mentor implants.

Saline-Filled Breast Implants

I still use saline implants in quite a few patients.  For patients who have a lot of breast tissue and/or body fat, saline implants can work really well.  Also, for patients with asymmetry, saline implants allow for intraoperative volume adjustment to help even up the breasts.  I recommend saline implants for anyone who is fearful of silicone gel.  You should not have something put into your body that you are fearful of.  Recently, I have been using the Ideal structured saline breast implant.  This is a type of saline implant that feels a lot like a gel.  Check out my blog on the Ideal Implant.

The Keller Breast Funnel – Why this Seattle Plastic Surgeon Uses it For All of Her Silicone-Filled Breast Implant Augmentations

The most common complication follow breast augmentation is capsular contracture. In capsular contracture, the scar capsule that forms around the breast implant becomes thick and tightens around the implant and makes the implant round and hard. For many years, plastic surgeons have known that bleeding around the implant (a hematoma) can lead to capsular contracture and controlling any oozing or bleeding vessels at the time of surgery has always been very important.

Recent research now confirms another suspected cause of capsular contracture – bacterial biofilm. Biofilm is a slime-like matrix that is produced by certain bacteria. It allows low levels of bacteria to hide from the body’s immune system and any antibiotics. This results in low levels of inflammation that cause implant capsules to thicken and contract and tighten.

So where does the biofilm causing bacteria come from? It comes from the patient’s skin. Even the best sterile washing of the skin before surgery will not eradicate every single bacteria, especially those hiding in the pores and hair follicles. When a grapefruit sized breast implant is, for lack of a better word, stuffed through a short incision, the implant rubs against the skin and this is where the bacterial contamination occurs. The Keller funnels allows the surgeon to insert the breast implants without the breast implants ever touching the skin. It works like a giant pastry cone. The surgeon transfers the implant from the implant package directly into the Keller Funnel and then inserts the end of the funnel into the small incision and squeezes the large end of the funnel and the implant extrudes from the narrow end into the implant pocket. The implant never touches the skin.

The other advantage of the Keller Funnel is that inserting the implant is less traumatic both to the implant and the surgeons hands. Silicone implants can take quite a beating especially when a large implant is inserted through a small incision.

The Keller Funnel is not necessary for saline breast implants because saline breast implants are inserted deflated. A deflated saline breast implant can be rolled up like a cigar and inserted though a small incision without touching the skin.

For more information of the Keller Funnel, visit their website at


Q: Why 22 for Silicone Breast Implants?
A: Someone, somewhere decided this was the age that the breast is fully developed. In my opinion, this is an arbitrary age. Anyone who owns a pair of breasts knows that the breasts change over a lifetime with varied responses to weight loss or gain, pregnancy, breast feeding, menopause, hormones for contraception or menopausal symptoms, and those pesky natural laws known as gravity and aging. That being said, if you are under 22 and desire augmentation with gel implants, you it’s best if you wait (we card) or you may proceed with saline-filled implants. If you are under 22 and have a developmental problem such as asymmetry, a concave or convex breast bone (pectus excavatum or pectus carinatum, respectively) or really do have almost no development and are at a healthy weight, this falls under reconstruction and the implants are available to you.

Q:  Do I ever used Silicone Breast Implants for cosmetic augmentation in patients under 22?                                                                                                                                                    A:  Occasionally, if I really feel strongly that saline breast implants will not give the patient a good result.   The use of silicone gel breast implants in women under 22 is considered “off label” use by the Federal Drug Administration.  Another example of off label use is the use of Botox for wrinkles in areas not approved by the FDA or the use of an asthma medication for breast implant capsular contracture.  Using a drug or device off label is legal but in the case of breast implants, off label use may negate any implant warranty by the manufacturer.  So, if you are under 22 and I use gel implants for your cosmetic augmentation, we won’t go to jail!  Check out my blog on this topic.

Q: Are silicone-filled implants better that saline-filled implants?
A: Yes and no. Yes, in that in some women, those who are very thin or have very little or no breast tissue, the implants look and feel more natural and are less likely to have visible or palpable rippling.  No, in that the silicone-filled implants are more expensive and if they leak, this may be a silent leak, meaning that there may be no noticeable changes to the breasts. This is in contrast with saline implants. If a saline-filled implant leaks, your breast shrinks.
Because of the possibility of a silent leak in silicone-filled implants, the manufacturers advise that women with these implants have an MRI three years after receiving their implants and every two years thereafter. The MRIs are the patient’s responsibility and this will likely be an out-of-pocket expense. (See my comments on the MRI recommendations below).  Also, it is possible that some health insurers will charge implant patients more for coverage or may even deny coverage. You should check into this with your insurer before making a decision about silicone-filled implants.

Q: Hey! These sound great! Do I have to do anything other that sign on the dotted line to get these implants?
A: Oh yeah. You need to read the patient information brochure for the implants and be sure you understand the benefits and the risks of silicone-filled implants prior to scheduling your surgery. This information is available on line. Please refer to “Important Information for Women About Breast Augmentation (or Reconstruction) with INAMED Silicone-Filled Breast Implants” at  and “Important Information for Augmentation (or Reconstruction) Patients about Mentor Memory Gel Silicone-Filled Breast Implants”) at   The Ideal implant has a patient resources section  Set aside some time to read this patient information.   Being an informed patient requires a little homework!  These web sites also have a lot of info and FAQ’s as well.

Q: I’m pretty happy with my saline-filled implants. Should I switch over?
A: Every surgeon knows that the enemy of good is better. If you have a good result with saline-filled implants, don’t worry and be happy. Come see me if and when they leak. If you are bothered by palpability or rippling or don’t like the way your implants look or feel, come in and see me for a consultation. I’ll give you my opinion if it is likely worth the additional time, surgery, money and recovery to switch over to silicone-filled implants.

Q: Do I really need to have all those MRI’s if I have silicone gel implants?
A: No one is going to show up at your door and haul you off to the MRI suite. Undergoing the MRI recommendations is a decision every patient will have to make for herself. I have included the following article written by Dr. Thomas Wiender, a Houston plastic surgeon to help each patient make her decision. I cannot improve on his writing so this is an exact copy of his article:

MRI Recommendation After Silicone Gel Breast Augmentation
1. The FDA has recommended an MRI of the breasts at three years post-op and every two years after. You are currently at one of these postoperative time frames.
2. Most silicone gel implant ruptures are silent. In other words, there are no symptoms.
3. MRI is not 100 percent accurate. Some intact implants will appear ruptured, and some ruptured implants will appear intact. This is not a fault of the radiologist or the MRI – this is the limitation of the technology.
4. Over many years of research, there is no indication that a ruptured implant will cause any disease.
5. If an MRI indicates a ruptured implant but at surgery it is found to be intact, for Allergan implants, the manufacturer’s full warranty still applies. For Mentor implants, the manufacturer will provide the implant replacement but no financial assistance.
6. You must understand that because of the limits of MRI technology, you may have surgery for an implant that is found to be intact, but you will still have undergone the possible risks and complications of surgery.
7. In most countries outside of the United States, the equivalent of the FDA does not recommend routine follow-up MRI.
8. The cost of the MRI is your responsibility. You insurance company and the implant manufacturer will not pay for this.*

The decision to proceed with a postoperative MRI must be made by you, the patient, based on the above information and the information provided to you prior to surgery in the manufacturer/FDA brochure.

* Seattle Radiology charges $2216 for a breast MRI to look for implant rupture. If the patient pays at least 1/2 up front, they will drop the fee to $1329.60.   I obtained this information in May, 2017. Their fees are subject to change.


Check out my before and after breast implant photos.

Check out by breast implant blogs.

Check out my blog on breast shape.

Interested in just a little bit more?  Check out my blog on fat transfer to the breast.

If you would like to make an appointment with me, please give my office a call at 206 467-1101.

Follow me on Instagram:  sowdermd and breastimplantsanity.

Interested in an out-of-town consultation?