Breast Augmentation Miami

 

If you are dissatisfied with your breast shape and/or size, you may consider breast implants surgery. In Miami, Florida, plastic surgeon Leonard M. Hochstein, M.D. specializes in breast augmentation surgery ("augmentation mammaplasty") and other procedures for the face and body. Dr. Hochstein is board certified by the American Board of Plastic Surgery (ABPS).

If you are interested in any of our cosmetic surgery procedures, Dr. Hochstein offers a professional staff, including a board certified anesthesiologist, registered nurse, and other staff members who will provide you with quality care. He also offers board certification from the American Board of Plastic Surgery (ABPS).

If you want to yield fuller and firmer breasts, you may consider breast enlargement surgery. Breast augmentation is the surgical procedure where an implant is placed to increase the breast size, as well as to improve the shape of the breast and provide increased fullness at the superior aspect of the breast and the cleavage. When deciding to undergo breast implant surgery, you will need to choose the type of implants and incision type. Breast implants can be placed either above (subglandular) or below (submuscular) the muscle. I use the submuscular position.

There are two types of implants available, saline or silicone. The shells in both are made of silicone. They only differ in that saline implants have a valve that can be inflated once they are positioned. The shells are smooth or textured. Texturing is a process where smooth implants are given a rougher feel. The idea here is to decrease the risk of capsular contraction. The downside is that by making the shell thicker, it also raises the risk of rippling or wrinkling. I do not use textured implants unless there is a significant risk or history of contractor. In this situation, they are indispensable. The main difference is what the implants are filled with. One is filled with saline solution and the other with silicone gel. There are subcategories of each. They come in round or teardrop and the silicone also varies in level of cohesiveness. I prefer the round because they allow for better cleavage and more fullness superiority, but mainly because the teardrop implants tend to shift, which can create an unnatural appearance. I also prefer silicone as they feel much more like breast tissue and have much less wrinkling or rippling than do the saline counterparts. All silicone implants today are cohesive, meaning the silicone will maintain its shape even if there is a defect in the integrity of the shell. But there are now two levels of cohesiveness, namely Level 1 and Level 2.

The Level 1 implants which are currently used in the United States are semi-liquid whereas Level 2 (gummy bear) are semi-solid. The level 2 implants, which come in teardrop shape only are currently unavailable in the United States as the study is now over (there is a prominent plastic surgeon in the Los Angeles area who advertises that he is still using these implants, which is not true – so do not be fooled). I have had the opportunity to work with some of these Level 2 implants and have found them to be unsatisfactory for two reasons. The first is that they are too firm and also require a very large incision or scar to place as that they are not malleable and cannot be bent to place requiring the opening to be almost as wide as the implant itself. This also limits access to the inframammary fold. I believe these implants may have a role for reconstruction in the future, but for aesthetic purposes, I prefer the Level 1's. I still see hesitance towards silicone implants due to safety issues or leak detention. But these concerns are unwarranted. Silicone implants were taken off the market in 1991, not because they were found to be unsafe, but rather because the FDA deemed them to be inadequately studied. Since that time, there have been multiple studies which have unequivocally found them to be safe and without any links to autoimmune diseases. Simply, the women who developed these illnesses would have developed them whether they had implants or not.

Breast Augmentation ModelThe other issue I regularly hear about is the risk of deflation and its treatment. Over the course of 7 years, the deflation rate for saline implants is 15% whereas silicone is only 2%; thus making silicone more durable. If there should be a leak, it is much easier to diagnose the saline implants as they simply go flat. Silicone leaks cannot be diagnosed by physical exam, but rather requires an MRI. The treatment for each is much different. Since the shape or volume of a silicone implant does not change it is very easy to replace and could be done simply under local anesthesia. Saline implants are much more difficult to replace as the capsule begins to contract immediately after deflation. This is much harder and requires a general aesthetic with reconstruction of the pocket. I use Mentor implants, as I believe they are the best implant available in the market and currently they come with a lifetime warranty.

There are several access points for implant placement including transaxillary, periareolar, inframammary fold, and transumbilical. All these access points are available for saline implants but limited to periareolar or inframammary fold for silicone. I prefer the periareolar approach because the scars tend to heal better and are less visible when wearing a bathing suit. It is also possible to use permanent makeup to camouflage the scar. It also allows direct access to the inferior insertion of the pectoralis major muscle, the proper release of which is crucial to perfect placement.

The last discussion is the size of the implant and the profile, low, medium, or high. When I determine the implant size, I begin by talking about the patient's desired cup. I need to stress that this is only the starting point of the discussion as I do not create a cup size, but rather a look. We decide this by looking at some of my postoperative pictures, as well as having the patient bring in pictures of looks they like and then trying on an implant. Trying on an implant is more useful in smaller breasted women and less so in women who have more breast tissue or are in need of a lift as well. When the patient likes the look of an implant on her chest, I add 50 cc to it and that is the volume I use in the submuscular location. There is no perfect way of picking the size, but this has worked well for me.

I choose the profile depending on the patient's desired size and chest width. The three profiles are moderate (low), moderate plus (medium), and high (high). I typically use the moderate plus because it gives the best combination of projection, which gives more defined cleavage, and enough width of diameter to avoid cleavage separation. For my patients who have narrow chests or wish to have a large cup size I choose the high profile implant. I rarely use the low profile implant as the only indication is for models who wish to have a very small augmentation and need the greatest diameter width as possible to avoid cleavage separation.

The recovery period is less than a week. Most of my patients are able to drive on the fifth day and return to work after one week as long as no heavy lifting is required. I allow my patients to reach above their head as long as they are not stretching to reach a distant object. I allow aerobic workouts as long as they limit to lower body after 4 weeks and full gym workouts after six weeks. I do have patients perform massaging exercises to stretch the muscle in the medical location by squeezing the implants together. This also helps with settling which is usually a four month process and rarely can take longer. I also recommend that a moisturizer be used on the incision after three weeks of healing and on the breast itself immediately after surgery. Scars do not create moisture on their own and they need help.

Breast implant maintenance is a topic which seems to be misunderstood. The biggest misconception is that implants should be replaced every ten years. This is simply not true and came about based on the data that the old (prior to 1991) silicone implants had a significant leak rate after ten years. By mistake this has been extrapolated to the current saline and silicone implants used today. The current silicone implants made by Mentor are warrantied for life and require replacement only if a defect should develop. This is the same case for saline implants which are currently warrantied for ten years (extended warranty is available for purchase from Mentor). Simply put, if there is no problem, precautionary replacement is not required.

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Saline versus Silicone

Another big decision is the type of implant: saline versus silicone. Saline implants were the most common in the U.S. until silicone was re-introduced into the market a few years ago. At this point in my practice, my patients choose silicone over 90% of the time. I believe saline implants have too much rippling upon palpation. The only positive aspect is that they require a smaller incision for placement. As for silicone, I find them to feel the most natural. Silicone implants are much different than the ones which were taken off the market in the early 90s. The shells are much thicker and the silicone gel is sticky (cohesive). "Cohesive" is a term for all silicone and is confusing because there are varying degrees of cohesiveness or stickiness. The old implants were cohesive but in such a state that they would leak with little retention of shape. The new implants (cohesive I) will not leak, and if cut in half and squeezed it will return to the original shape. I would liken the consistency to something like Jell-O ®. The other is cohesive II (gummy bear), which is thicker. When cut in half, they have the consistency of the gummy bear candies, hence the name. I have some experience with these primarily from my Latin and Canadian patients and I have been very disappointed. I find them to be very firm and unnatural. They also require a very large incision to place, which limits the opening to the lower breast fold; I believe this is less desirable and twice the size of a level I implant. I think these implants will have a place in breast reconstruction surgeries but not for cosmetic purposes.

Location of Implant Position

The last point is the implant position - over or under the muscle. This is an easy question as I firmly believe there is never a good reason to place an implant over the muscle (subglandular) rather than under (submuscular). There are just too many problems with the subglandular position, such as rippling, artificial appearance, greater likelihood of contracture, etc. I am shocked that there are still surgeons who do this as this is the most common breast implant revision surgery that I perform.

View The New You in 3D

BREAST IMPLANTS

During your consultation with Miami Breast Implants specialist, Dr. Hochstein, you will learn of the various types of implants available. Depending on numerous factors, he will suggest one that is most suitable for your body. This includes the type of breast implant, method of insertion, and placement.


MemoryGel (Gummy Bear) Breast Implants - FDA Approved

This type of breast implant is filled with Mentor's Proprietary silicone gel - MemoryGel - that holds together uniformly while retaining the natural consistency that resembles breast tissue. Memory Gel implants have a set fill volume and come in three projections: Moderate, Moderate Plus, and High Profile. There are two shell surfaces available: smooth and textured.

"Gummy Bear" implants require a slightly larger incision size with various options for incision placement. Dr. Hochstein will discuss these during your consultation.

Saline Breast Implant - FDA Approved

Filled with saltwater solution similar to the fluid that makes up most of the human body, saline implants are slightly firmer than natural breast tissue. Their flexible fill volume ability allows the surgeon to adjust volume during the procedure. This is especially helpful if the patient has one breast bigger than the other and requires asymmetry correction.

Saline implants come in three projections: Moderate, Moderate Plus, and High Profile; and in two shell surface options: smooth and textured. This type of breast implant is filled once inserted, which means that a smaller incision can be used for various options for incision placement.

SALINE IMPLANTS

During breast augmentation, the most commonly used implants are saline-filled. These silicone shell implants are placed in the desired location prior to being filled. Because of this, most incisions are minimal. Two major advantages of saline breast implants are that they carry little controversy and patients can easily detect if they should rupture or leak. Made of a saltwater solution, saline breast implants are generally considered safer than silicone; should the fluid enter the bloodstream, the body will absorb it. However, their appearance and quality are frequently major disadvantages as they often feel and look less natural than silicone implants.

SILICONE IMPLANTS

In the early 1990s, silicone breast implants were reported as a probable cause for connective tissue diseases in some patients. Since then, researchers have been conducting scientific studies to investigate the safety of silicone gel breast implants. In 1999, a landmark report, undertaken by the Institute of Medicine (IOM), concluded that silicone implants do not cause major health problems such lupus or rheumatoid arthritis. There have been numerous major studies that have not found an association between implants and autoimmune diseases or cancer. In addition, while silicone - and saline - breast implants may cause localized problems for some patients, various scientific studies have shown over the years that silicone gel-filled implants are both safe and effective for breast augmentation as well as for breast reconstruction.

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SILICONE (COHESIVE-GEL) Also known as "Gummy Bear Implants"

STYLE 410 HIGHLY COHESIVE SILICONE - THE NEXT GENERATION OF BREAST IMPLANTS

The Style 410 highly cohesive silicone matrix is the only shaped breast implant matrix of its kind, offering the widest selection of implant options to allow for individualized aesthetic results. With a global track record and more than 10 years of sales in over 60 countries, the Style 410 utilizes highly cohesive silicone technology. Designed to be used with easy-to-adopt planning principles to ensure predictable results, the Style 410 highly cohesive silicone matrix mirrors the aesthetics of the natural breast with a sloping upper pole and fuller low pole.

The Style 410 highly cohesive silicone matrix incorporates patented BIOCELL® surface technology promoting tissue adherence to help maintain proper implant positioning, an essential feature when using shaped breast implants. Choose from 12 product cells, each with a unique height and projection ratio that extends across a range of base widths to meet a variety of patient needs and deliver the results you expect.

CAUTION: Investigational Device. Limited by Federal (or United States) Law to Investigational Use.

Cohesive-gel Breast ImplantsThe term "cohesive" is used to describe the nature of the fill compared to the more liquid fill that may have been used in silicone implants in the early 1970s. This is regarded as a new science or technology - cohesive simply describes the "sticking together" nature of the gel. It acts as a unit rather than a liquid. It is a gel that holds together uniformly and retains the natural give that resembles that of breast tissue. Because the gel is thicker than traditional silicone, these implants are less likely to leak, rupture, or tear.

A great advantage of cohesive-gel breast implants is their natural feel, which may be especially noticeable when compared to saline-filled implants. Both implants have the possibility of rupture; however, some plastic surgeons will state that silicone implants are less likely to produce rippling.

The Gummy Bear implants are used in various parts of the world, including Europe, but still have restrictions in the United States. Cohesive gel implants are the latest types of silicone implants available on a restricted basis; they were originally developed to help prevent the rippling effect and reduce the rupture rate.

This type of implant is textured, anatomically shaped, with a firm feel that has lead to its nickname. Cohesive gel implants typically create a firmer feel than traditional silicone. They are still a relatively new breast implant on the market and hold restrictions similar to traditional silicone. There are advantages and disadvantages to any type of implant; therefore, it is import to speak with a qualified plastic surgeon to find out what works best for you.

During an initial consultation with Dr. Hochstein, you can learn if you qualify for the use of silicone breast implants.

FDA Approves Silicone Gel Breast Implants

The FDA approved silicone gel implants on November 17, 2008. The FDA will continue to monitor them by requiring each breast implant manufacturer (Mentor and Inamed) to conduct a large post approval study, which will follow about 40,000 women for 10 years after receiving breast implants. Once a product is in broad use, the FDA often requires post-market studies to address important questions, such as the incidence of rare adverse events.

The FDA's decision to approve these implants was based on a thorough review of each company's clinical (core) and preclinical studies. In addition, the FDA conducted inspections of each company's manufacturing facilities to ensure that they comply with the FDA's Good Manufacturing Practices. Some of the complications reported in the core studies included hardening of the area around the implant, breast pain, change in nipple sensation, implant rupture, and the need for additional surgery. However, the majority of women in these studies reported being satisfied with their implants.

In the past decade, a number of independent studies have determined whether silicone gel-filled breast implants are associated with connective tissue disease or cancer. The studies, including a report by the Institute of Medicine, have concluded that there is no convincing evidence that breast implants are associated with either of these diseases. These issues will be addressed further in the post-approval studies conducted by the companies.

About Silicone Gel

Silicon is the second most abundant element on earth next to oxygen. Silicones are actually a family of chemical compounds. They are made of silicon, which is naturally occurring element found in sand, quartz and rock. When silicon is mixed with oxygen, hydrogen, and carbon, it becomes silicone. Silicone can be made in a variety of forms. Low molecular weight silicones form oils. Middle molecular weight forms gels, and high molecular weight forms elastomers and rubbers. Silicone is found in many other types of implants, such as facial implants, artificial joints, drainage systems, etc.

Currently, Mentor and Inamed silicone implants have three layers of shell surrounding the silicone gel. This reduces the amount of gel bleed. It does, however, make the implants a bit firmer than they were years ago, but this is attributed to the thicker shell. Silicone gel breast implants, the silicone implants of today, are still very soft and natural-feeling.

The only disadvantage of silicone gel breast implants is that they come pre-filled, which means that the incision will have to be a bit longer, depending on the size of the implant to be inserted. This is especially true for textured silicone, which is slightly firmer than the smooth silicone due to the thickness of the shell. Because silicone gel breast implants come pre-filled, they cannot be inserted through then transumbilical breast augmentation (TUBA) incision (nor can any other type of pre-filled implant).

Information courtesy of National Library of Medicine.

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IMPLANT SHAPE

Breast implants come in more than one shape. Based on the patient's goals and Dr. Hochstein's suggestion, the appropriate one will be chosen. Each patient considering breast augmentation should be individually evaluated regarding the implant shape that is best for them - round or anatomic. Anatomic breast implants, also referred to as "teardrop" breast implants, are fuller in the lower half. They are designed to look as natural as possible. While this shape may work well for a select group of patients undergoing breast augmentation surgery, the anatomic implant is used sparingly. Patients must be aware that due to the distinct vertical orientation, should the implant rotate, the appearance may become distorted.

Round breast implants are the leading style used for breast enhancement today. They are known to create a fuller look throughout the breast and there is generally no adverse consequence should the implant rotate. Due to gravity alone, the bottom portion of the breast will look fuller once the filler settles. This creates contour similar to that of the anatomic breast implant, without the possibility of distortion.

SELECTION OF IMPLANT SIZE

Determining the appropriate implant size is a critical step in breast augmentation. An implant that is too small or too large can produce an unsatisfactory result. Dr. Hochstein believes that the best and most natural results are achieved by selecting an implant that is proportional to a woman's anatomic features. During each consultation, Dr. Hochstein devotes much time to this process and together, with his patients, finds an appropriately sized implant to help them achieve optimal results.

The best way to determine the most appropriate and preferred size is by providing the surgeon photos of what you would like to achieve. In addition, showing Dr. Hochstein images of what you would not consider satisfying results would be of great benefit.

In order to accomplish your ideal appearance when wearing a bra, add 15-20% of volume to get the same look after surgery, especially if you are going under the muscle. For example, if you are interested in a 300cc breast implant, you'll need 345 to 350cc. Also, projection is less than what you see in the bra; implants tend to be rounder and fuller. This is particularly true with sub-muscular placement. However, anatomical do have more projection than rounds.

Due to the fact that the same-size implants appear differently on everyone, it is important to not be too set on the cc measurement. Factors to consider when choosing a size:

Breast Implant Pre-Consultation Kit
  • Chest shape
  • Rib size
  • Breast shape
  • Breast base dimension
  • Breast volume
  • Breast Width
  • Tissue stretch characteristics
  • Sternal depth
  • Pregnancy history
  • Weight
  • Other

LOCATION OF INCISION

Dr. Hochstein offers various incision locations for breast augmentation, including:

  • At the edge of the nipple (on the areola)
  • Between the crease underneath the breasts
  • Under the armpit
  • Through the belly button (transumbilical incision)

He usually reserves the incision under the breast for patients who have a pre-existing scar in this location. During an initial consultation, along with Dr. Hochstein, you will decide what type of incision and implant you will prefer for your breast enhancement.

IMPLANT PLACEMENT

Dr. Hochstein can place the breast implants either under the breast tissue and over the pectoralis muscle, or under both the breast tissue and pectoralis muscle. The most common location is under the muscle; this provides the most natural-looking results from the added tissue covering the implant, along with a lower rate of complications.

RECOVERY

As with any type of surgery, healing from breast augmentation is a gradual process and everyone recovers at a different pace. In general, the recovery period following this procedure is not difficult. Typically, patients will experience some pain and discomfort, which can be alleviated with the use of pain medication for two to three days following surgery. Depending on the individual's occupation, most patients can return to work four to five days after surgery. Non-impact lower body exercise can be resumed in approximately one to two weeks, while impact exercises may be resumed in four weeks. Upper body exercise can resume six weeks following surgery. Addition information on pre- and post-operative care is available in our "Before Surgery Care" section.

RESULTS

Patients will see results immediately following the procedures; however, swelling may be present for the first week after surgery. The implants will appear high and the nipples will point downwards; this is all very normal. Swelling will subside over the course of several weeks and the breast tissues will stretch to accommodate the implant, which will result in a more natural appearance. It is also common for the areola to stretch during recovery; if your areolas are large prior to surgery, you may wish to have them reduced at the time of your procedure. Refer to pictures below.

Weeks After Breast Augmentation Surgery      Months After Breast Augmentation Surgery

COMPLICATIONS

As with any surgery, complications can develop following breast augmentation. Although they are rare, the most common problems include bleeding, infection, capsular contracture, and deflation. Dr. Hochstein will discuss these potential risks during your consultation.

For optimal results, breast implant surgery in Miami may be performed along with breast lift surgery ("mastopexy"), to learn more about either one of these procedures, view our before and after photos and procedure pages.

FOLLOW UP

Dr. Hochstein and his staff are committed to your well-being and care. He follows his patient's progress for an extended period, is always willing to ease concerns, and answers any questions that may arise.

Miami breast augmentation specialist, Dr. Hochstein can be contacted by our online consultation form or by calling (305) 931-3338. Contact us today to schedule a complimentary consultation for breast implants surgery in Miami.

CONTACT US FOR A FREE CONSULTATION

If you are undergoing breast augmentation surgery to correct dissatisfying results with a previous surgery, Dr. Hochstein is also a professional in breast implant revision in Miami.

To learn more about the procedures we offer, such as nose surgery ("rhinoplasty") and liposuction ("lipoplasty"), view our procedure pages and before and after photos.

If you are interested in breast augmentation surgery with breast implants, Miami breast augmentation surgeon, Dr. Hochstein, can be contacted by using our online contact form or by calling (305) 931-3338 to schedule a free consultation.

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Welcome to Breast Implants Specialist Miami

Miami Florida is home to world renown and board certified plastic surgeon Leonard M. Hochstein. Specializing in all forms of breast augmentation, breast reduction, breast lifts, and breast revision, Dr. Hochstein also specializes in delivering the service and quality you deserve.

Conveniently located 20 minutes South from Fort Lauderdale International Airport and 20 minutes North from Miami International Airport, Dr. Hochstein welcomes patients from as far away as Australia, Europe, Canada , South America, and the Caribbean.

This website was designed to keep patients up to date with the latest information and techniques regarding breast implants. Feel free to explore the site and return to see updates as they are made.

We also encourage you to visit Dr. Hochstein's other website www.lhochsteinmd.com for information concerning other procedures you may have interest in.

Our Location and Address

Leonard M. Hochstein, M.D.
585 NW 161st Street
Miami, FL 33169

Tel: (305) 931-3338
Fax: (305) 931-3324


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Office Hours

Monday 9:30 - 5:30
Tuesday 9:30 - 5:30
Wednesday 9:30 - 5:30
Thursday 9:30 - 5:30
Friday 9:30 - 4:00

Dr. Hochstein is on call 24 Hrs a day.


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