Come to Thousand Oaks for the Most Beautiful Breasts with Breast Implants

Why Waste Your Money Going to Beverly Hills for a Breast Augmentation, Enlargement or Enhancement? Where Submuscular, Dual Plane or Subglandular
Get My Experience with Breast Implants without paying exorbitant fees!

Make a Free Appointment to see the Breast Implant Plastic Surgeon and Specialist of Southern California, Dr. Costanzo of Thousand Oaks Who has placed 1000's of Implants for Breast Augmentations, Breast Enlargements, Breast Enhancements and Breast Implant Revisions and Corrections

Before and After Breast Augmentation Photos, Pics, Saline or Silicone Breast Implants, Dual Plane, Submuscular (under muscle) or Subglandular (on top of muscle) Trained at the Famous Mayo Clinic serving Thousand Oaks, Beverly Hills, Los Angeles, Encino, Calabasas,Ventura, Santa Barbara, Oxnard, Simi Valley, Westlake Village, Riverside County & Orange County

I know that the best distance is 17 - 20 centimeters (7 - 8 inches). This distance is usually found in A cup and small B cup breasts.  If your breast fits this measurement, then a submuscular implant (under the muscle) will be best for you.

As the nipple position gets lower, say 21 centimeters (8 1/4 inches), most women can still have the implant placed submuscular.

However, if your nipple position has dropped to 22 - 23 centimeters (8 1/4 - 9 1/4 inches), I might suggest you have either a subglandular Breast Augmentation (on top the muscle) or a submuscular or subglandular Breast Augmentation combined with a Crescent Lift to raise your nipple position.

The second measurement I will take is the diameter of your breast ( width between the yellow lines )

Most breasts measure between 11 to 15 centimeters in diameter. The breast looks more natural when I use an implant diameter that is similar to or slightly less than that of your natural breast. Breast implants come in different volumes, such as 250cc or 425cc. The larger the volume, the wider the implant. A large volume may mean the implant diameter is to wide for you.

Let me give you an example of what I mean. You come into my office requesting a D cup and upon examination I find your own breast measures 12 centimeters across. To enlarge your breast to a D cup I determine I need a 475cc breast implant volume. But because this implant is 15 centimeters in diameter, it is too big for your 12 centimeter diameter breast.

Too large of an implant can overstretch the skin and lead to bottoming out (see description below), where your breast implant seems to fall out from under your breast. Sometimes with the skin stretching the implant can bulge into the arm pit or ride upward towards the shoulders ( high riding implant ). Any of these scenarios can lead to a very unnatural look.

As an alternative, if you have a small breast diameter, breast implants come in narrow shapes, such as a Mentor Moderate Plus or High Profile (see description below). These narrower diameter implants will me to give you a bigger cup size. However, in some women these implants can also take on an unnatural appearance.

Of course, if your diameter is wide, such as 15 centimeters, there is no problem using larger implants. In general, I like the standard profile, round breast implants and reserve the narrow implants for specific circumstances.

FAQ / My Response and Recommendations

This is the most understood concept about Breast Augmentation. Women will come to my office requesting submuscular (under the muscle) implant placement without knowing why and whether it is appropriate for them. If you are seeking beautiful breasts in addition to larger breasts, then sometimes it is better to place the implant subglandular (on top the muscle).

Submuscular (under the muscle) I will place your breast implants under the muscle if your natural breast and nipple measurements are high. An example of this would be; if you have small breasts, say an A or B cup, almost no looseness, with a nipple distance of 19 centimeters (described above).

Submuscular will provide you with the following advantages:

This additional layer to cover the implant makes it less likely to see or feel the implant.

Submuscular implants make it easier to read a mammogram for breast cancer detection.

During normal activities the contraction of the muscle massages the implant, which can help keep the breasts softer after a Breast Augmentation.

Dual Plane = Sub-Pectoral (partially under the muscle and partially on top of the muscle)
A new name and catchy phrase for the way I have done all of my Submuscular Breast Augmentations since I began practice in 1986. Basically this is a Sub-Pectoral Augmentation which in my opinion is always the been the best way to perform a Submuscular Breast Augmentation.

Here is what I learned early on in my technique of Breast Enlargement, which has now been reaffirmed after performing 1000's upon 1000's of Breast Implantations.

The reason Dual Plane or Sub-Pectoral Augmentation works the best for me:

By placing the Implant Under the Muscle the Implant edge is softened, but the Muscle inhibits the Implants ability to create any beautifying shape to the Breast.

But when the Implant is placed touching the Gland (on top the muscle), it will help spread the Breast Tissue out by exerting pressure on the tissue.

So the Dual Plane or Sub-Pectoral Breast Augmentation works by placing the upper part of the Implant under the Pectoralis Muscle for softening the the Implant edge and placing the lower part of the Implant in direct contact with the Gland to tighten and drive the Breast Tissue upward.

Now that you understand if the Implant is actually touching the Breast Tissue it will create some shaping of a loose Breast, you will be able to understand the Concept of going Subglandular (completely on top the muscle).

The Subglandular Placement will give the Implant its maximum ability to shape your Breast and possibly avoid a Lift.

Subglandular (on top the muscle) If you are a little older, heavier, had children and your breast tissue has sagged to the bottom of your breast, you may need a subglandular breast implant placement. Because your Pectoralis muscle is located high on your chest, if the breast implant is placed under your muscle it will not be low enough to shape you properly. This can result in your natural breast rolling off and falling below the implant, pushing your nipple downward. Sometimes this is called a double bubble. An example would be: if you have a small C cup, 10 pounds heavier than you want to be, with a nipple distance of 22cm.described above

Subglandular will provide you with the following advantages:

Give you a better shape than submuscular if you fit the criteria described above.

Subglandular can help even out your breast shape more than submuscular if your breasts sag.

Cleavage - you can get better cleavage show on top the muscle than under the muscle.

I can fit you with larger implants when placed on top of the muscle.

You will have less pain and easier recovery.

You may be able to avoid a full Breast Lift (Mastopexy), by placing the implant subglandular.

I frequently combine this with a Crescent Lift, as a good alternative to you getting a full Breast Lift.

The TUBA technique is done by making an incision in the belly button and inserting a long dissecting rod under the skin. Once the breast is reached, a pocket is made for the implant. Through a long tube a saline breast implant is inserted and inflated.

Problems with the belly button (Transumbilical Breast Augmentation - TUBA) incision include:

A thick scar may develop in the belly button and be visible when wearing a bikini.

Visible rippling of the abdominal skin (cellulite) may develop from passing the dissector rod under the skin.

It is more difficult to position the implant properly under the breast with this incision.

Testing different sizes to see which look better on you is not done through this incision.

Silicone implants cannot be inserted through this incision.

Instead, I would suggest a Transaxillary (arm pit) approach, if you do not want an incision on your breast.

For Subglandular Breast Enhancement- Textured Coating: Generally, I use the textured coating which is designed to adhere to the implant capsule and inhibit the capsular contraction (hardening of the tissue around the implant).

For Submuscular Breast Enhancement- Smooth Coating: I like to use smooth implants because they move around in the implant pocket and are less likely to be visible. Textured coating is unnecessary because the contraction of the muscle massages the breast implant and helps to keep it soft. Smooth implants also last longer than textured implants.

I like to replace ruptured textured implants that are subglandular with new smooth surface implants. I won't have to use textured implants again because the implant capsule has already formed.

Teardrop, Anatomical and Contour: These are some of the names given to implants that were designed to create a more mature or sloping look at the top of the breast. I rarely use these implants because once inserted under the muscle they don't seem to maintain that sloped look and don't appear as natural looking as the round implants.

Round or Standard: These implants look the most natural and I use these most of the time.

The profile refers to the width and projection outward of the implant. Each of the implant companies has a different name for their profiled implant, but basically there are 3 different profiles available; high / mid / low .

High Profile Silicone: The high-profile silicone implant I like to use if you are thin, petite, with a narrow rib cage and small breast width (diameter). On the right woman, the silicone high-profile implant can really enhance the look.

High Profile Saline: The saline high-profile implant I rarely use, because on most women it is too narrow and doesn't give as natural a look.

Mid Profile Silicone: The mid-profile silicone implant is the most common silicone implant I use. Like the higher profile, I would use this mid-profile if you are more petite and need smaller width implants. I might also use a mid-profile silicone implant, if you have a slightly larger frame and requesting a very full breast.

Mid Profile Saline: The saline mid-profile implant, I use occasionally if you are very petite, with a very narrow breast diameter and are requesting a saline implant.

Low Profile Silicone: The low-profile silicone implant I only use if you have a larger frame and a very wide breast that needs large width implants to create a more natural look.

Low Profile Saline: This is the most common profile I use if you wish to have saline implants. I like  the look of these on most woman.  With overfilling, they take on a similar appearance to the mid-profile silicone implant, which is the profile I most commonly use in silicone.

The most common requested cup size is a C. However, if you are a petite woman or a large woman, than a full B cup or D cup respectively, may produce a more natural look.

What I like to do is first hear what shape and cup size you are looking for and then describe what implant I need to use to give you the best results.

Both saline and silicone Mentor brand breast implants now come in several profiles; moderate, moderate plus and high. If you take each breast implant profile with the same volume (e.g. 300cc) and set them all on a table next to each other, you would notice that the moderate profile breast implant is the widest and lowest and that the high profile breast implant is the narrowest and tallest. The moderate plus profile breast implant falls in between the other two.

If you have a small diameter breast and ask for a bigger cup size, than I may need to use one of these narrower implants.

If you have larger breasts, say a full C or D cup and you want to be a larger cup size, it is very common to need shaping first (see my Breast Lift and Breast Reduction pages to determine this). That's because large breasts usually have fallen, lost support and have very wide diameters. These combined features are not ideal for using breast implants.

Here are some options if you have fairly large breasts and what implants:

Probably the best choice in most cases is to do the Breast Lift first, before placing an implant under the breast at a later date. That is because implants will be under yours breasts pushing them outward. If you have poor shaped breasts to begin with and get implants, you will have poor shaped breasts that a bigger.

Sometimes after a Breast Lift, the shape is so great, some women opt not to get implants.

Also Breast scars tend to be less visible when you wait and perform the Breast Implant surgery at a later date. That's because placing the Breast Implant at the same time causes stretching of the incision.

Lastly, sometimes I suggest a Breast Reduction first. If your own breast in rather large, heavy with very projection outward, then a Breast reduction will remove this non-supportive tissue and shape you. This is followed months later by a Breast Augmentation to build the breast back up to a bigger cup size.

This procedure is particularly advantageous if you have rather large and wide breasts.

All breast implants have a silicone outer shell and some type of filler. The filler material is either saline used in intravenous solutions or silicone gel.

Although there has been much controversy about silicone gel, current studies do not demonstrate a causal relationship between silicone and diseases such as Rheumatoid Arthritis or cancer. The FDA released silicone implants for general use in November of 2006, after years of restrictions and further testing.

Silicone:

In some women, a silicone implant can produce a softer and more natural feel and appearance.

Costs more money, but tends to last longer.

Because of the gel center, it is more difficult to replace if there is a rupture of the outer shell.

Can provide less fullness at the top of the breast, for women who like a more sloped look.

In rare instances a visible change in the implant can be seen due to fracture of the gel.

Best choice for very thin women with very little breast tissue.

Saline:

Adjustable, which especially valuable if you have two different size breasts.

If a saline implant ruptures or deflates, it is very easy to replace.

When having a mammogram, the saline implant makes it easier to see the breast tissue.

A saline implant can be inserted through any incision.

Softness can be similar to a silicone implant in most women.

Results equal to silicone can be achieved in most women seeking Breast Enlargement.

The Silicone Gel Breast Implant is different now, then prior to 1990. That is because the gel is cohesive, rather than liquid. Cohesive gel breast implants are semi-solid and range in viscosity from a soft pliable gel to a very gummy consistency. The most widely used Cohesive Gel breast implants are Mentor Corporation's Memory Gel implant and Allergan (formerly Inamed and McGhan) Corporation's Natrelle Silicone implant. I like to use either of these two companies because they have been manufacturing breast implants for many years.

Gummy Bear Breast Implants:  The implant companies are in development of these shaped and firmer implants. There main purpose will be to improve or eliminate rippling that has developed in some women. Because they will be firmer, these implants will not have the softness that the Cohesive Gel or Saline implants have.

These gel implants tend to feel softer and more natural than saline breast implants.

These gel implants differ from the earlier generation silicone breast implants, because they do not leak if the breast implant shell is ruptured.

Because they are jello like in consistency, on rare occasions a piece of this gel can break off inside the implant and show as a visible indentation on your breast.

The answer for you is most likely. However, some women are unable to breast feed after having an enlargement.

I do think it is best not to get a periareolar incision if you are thinking about breast feeding, because this incision requires more cutting of ductal breast tissue needed during milk distribution.

Most of the time breast implants make it slightly more difficult to read a mammogram. Saline implants are easier for the radiologist to interpret your mammogram, because they block the x-ray less than silicone.

In some women who are very flat, a breast implant will actually aid in performing a mammogram by allowing the x-ray unit to hold, compress and position the breast better.

I may have you get a screening mammogram prior to a breast augmentation, generally around 35 years of age. After surgery it may take up to 6 months before the effects of surgery will allow for an accurate reading of a mammogram.

Implant failure or deflation can result from the following:

Normal wear and tear as the implant folds on itself with movement of the body.

Failure of the valve to hold the saline in the breast implant shell.

Trauma or injury to the breast and compression during a mammogram.

After placement of an implant, your body will form a barrier around the implant called a capsule. This natural tissue is your bodies normal response to breast augmentation. If the capsule stays soft and pliable, your breast implants will feel soft to touch. If the capsule tightens a little, your breast implants may feel a little firmer to you, while still maintaining a good shape. Severe tightening of the capsule, is most often associated with the term "capsular contraction" and can lead to distortion of breast shape and hardness to touch.

The good and bad of varying degrees of capsular tightness:

Sometimes it is beneficial to have a little capsular tightness.  Even though it may feel a little firmer, some of the women like how it creates more fullness in the upper breast.

Severe capsular contraction can make the breast shape distorted or too round and unnatural looking, requiring additional surgery.

Treatment of severe capsular contraction:

Surgical release (capsulotomy) or removal of the capsule (capsulectomy) around the breast implant.

Accolate (Zafirlukast)- a medication which I have used successfully in women who have come to me seeking correction of capsular contraction. In some instances combining this medication with surgery can be helpful in eliminating undesirable firmness and distortion around a breast implant.

Rippling or visible waves in the breast skin can happen on rare occasions. This rippling is caused by the implant folding as you move or lean forward. If you are extremely thin and have very little breast tissue to cover the implant when it is folding, you have a greater chance of developing rippling.

Ways to minimize rippling:

Smooth implants, unlike textured implants move around in the breast pocket and are less likely to show a visible fold.

Overfilling saline implants helps to avoid implant folding.

Submuscular placement: This extra layer of coverage over the implant may also help to hide the implant folds.

Silicone implants have a thicker inner core and are less likely to be visible

A double bubble is seen when the implant is placed under the muscle in sagging breast. The breast tissue rolls off the top of the implant and implant is seen as a bulge under the natural breast at the very bottom. Sometimes accepting a small double bubble is a reasonable compromise, if you do not want to have additional scars from a Breast Lift.

Ways to minimize a double bubble:

A subglandular (on top the muscle) placement may avoid this.

A Breast Lift first, with good shaping, followed a few months later with a breast implant.

Sometimes a sub-pectoral placement with 1/2 the implant under the muscle will avoid this.

A double bubble is seen when the implant is placed under the muscle in sagging breast. The breast tissue rolls off the top of the implant and implant is seen as a bulge under the natural breast at the very bottom. Sometimes accepting a small double bubble is a reasonable compromise, if you do not want to have additional scars from a Breast Lift.

Way to avoid Synmastia:

Avoiding lifting the skin on the sternal bone to create cleavage. If your breasts are wide apart or you have a wide sternum, you will have to be accepting of the fact that the implants cannot be placed close together.

Bottoming out of the breasts is when the implants stretches out the skin too much. This results in the implant looking too low on the chest and the nipple being pushed too far up on the breast mound.

Ways to avoid bottoming out of a breast implant:

Do not request larger implants than your body can handle.

Strenuous flexion of the muscle during the early healing phases after surgery, can stretch the thin capsule surrounding the breast implant.

Avoid working out the chest muscles for a few months after breast implant surgery.

Sometimes going under the muscle can help.

This is not always preventable.

KNOW YOUR DOCTOR

I rank this as number 1, because picking the right Plastic Surgeon will assure you a great outcome and happy results.

Some tips on getting to the right Breast Augmentation surgeon are: Ask around, I've found the best referrals come from nurses who work with different doctors and can compare their surgical skills.

Also, make sure your Breast Augmentation surgeon isBoard Certified by the American Board of Plastic Surgery. Most persons don't realize that there is "NO" recognized Board Certification for Cosmetic Surgery by the American Board of Medical Specialties or the State of California. This is important, because only Plastic Surgeons certified by the American Board of Plastic Surgery learn how to perform Breast Augmentation surgery while in hospital residency training prior to starting private practice.

An additional factor to help find the right Plastic Surgeon is to inquiry of about length of time in practice.  An experienced surgeon is a valuable asset.

IF YOU NEED A BREAST LIFT ?

This is important because breast implants look the best if you have good shape to your breasts. If your breasts have stretched out or fallen, then a shaping lift may be necessary before or at the same time as a Breast Augmentation. Go to the Breast Lift page on my website for information on the Breast Lift.

WHAT SIZE AND SHAPE IMPLANT IS RIGHT FOR YOU ?

The more detailed in your discussion with me, the easier it is for me to match the breast implant size and shape to your new look. Specific things I find important include, a cup size, whether you want to be on the fuller or smaller side and photos of women who have already had Breast Augmentation.

WHETHER THE IMPLANT SHOULD BE PLACED ON TOP OR UNDER THE MUSCLE ?

If your nipple position is high and your breasts have not stretched out, then I will place the implant under the muscle. This places an additional layer over the implant to reduce visibility. However, if your breasts have dropped somewhat, your skin is loose and you are not very thin, then I will place the implants on top of the muscle. This subglandular placement of the implant may mean you can avoid a Breast Lift.

WHAT TYPE OF IMPLANT SHOULD I HAVE, SALINE OR SILICONE ?

Here are some of the differences:

Saline implants have the following advantages; lower cost, ease of replacement, less interference with a mammogram reading and the most important of all, overfill and adjustability. Overfill means I can add more saline if you're petite and want more fullness. Adjustability on the other hand gives me the ability to add more saline to one implant, if one of your breasts is smaller that the other.

Silicone implants have these advantages; softer and more natural feel, less chance of visibility of the implant edge and better durability. Silicone implants on average last longer than saline implants.

General anesthesia Surgical time: 1 hour
Typical incisions: Transaxillary Periareolar Inframammary
Placement of breast implant: Submuscular or subglandular
Return to activities: Gradually, with unrestricted activities resumed after 1 month
Time off work: Typically 1 to 2 weeks off, depending on the physical demands at work
Pain pump: This is available for use at home. Request this for less pain

Thispassive pain pump is one of many different pain pumps available and is worn in a fanny pack around the waist. During the first 3 days following surgery the pain pump will deliver small amounts of local anesthetic into the implant pocket through the small catheters which have been inserted through the skin. This additional medication helps to greatly reduce the pain and is highly recommended for this type of surgery.