Board Certified
Plastic Surgeon
Since 1989

Is Breast Augmentation Right for You?

Considering breast augmentation? Before diving in, it’s important to know the facts and what to expect.

Read on below to hear from plastic surgeon Dr. Shlomo Widder on everything you need to know about breast augmentation.

breast augmentation

Q&A with Dr. Shlomo Widder

breast augmentation

Read the Q&A with plastic surgeon Shlomo Widder as he answers questions about breast augmentation and how to decide if it’s right for you.

Q: What is breast augmentation?

A: Breast augmentation is a cosmetic surgery for women who want to increase the size of their breasts. Also known as “augmentation mammaplasty,” breast augmentation enhances both the size and shape of the breasts.

Q: What are the top reasons for breast augmentation?

A: Breast augmentation is one of the best investments a woman can make for herself. It increases self-esteem, confidence, their sense of femininity, and more.

It’s a symbol that is being being portrayed in the media all over, so women without sizeable breasts often feel deficient. At the end of the day, you deserve to feel good about yourself and your body – not for others, but for you.


You deserve to feel good about yourself and your body – not for others; for you.


I had one patient who was in high school. She didn’t participate in gym, never took off her shirt, and never went to the beach – because she was, in her words, “almost flat” and felt self-conscious.

She was very young – only 15 years old – but the negative psychological impact on her was so significant that her pediatrician and parents supported her without any hesitation.

So I did the surgery for her. I didn’t make them too big, just a full B, which is a moderate size. She was extremely happy after that. In fact, a few years later when she finished college, she came to my office out of the blue and thanked me for the positive change in her life. It was a wonderful feeling to know I had helped her.

Q: How often do you do breast augmentation?

A: I do it on a weekly basis. Breast augmentation is actually the most popular procedure in the United States. Millions of women have it done – millions.

I do maybe 2 or 3 breast augmentation surgeries per week for patients.

breast augmentation

Q: Who is your typical patient?

A: While typically our average patients are young women in good health, all sorts of people get breast augmentation done. We’ve helped breast cancer patients, women with different size breasts, transgender and transitioning patients, and women of all ages.

We absolutely do breast augmentation on transgender patients. It’s not a huge percentage of our surgeries, but I’ve done quite a few of them.

I had one patient – she had a very small breast on the right side, and the left side was large and droopy. So I did breast augmentation on the right side and a lift on the left side. So again, you have to deal with whatever comes to you, whatever the patient requires.

In plastic surgery, we say that breasts are sisters, not twins. That means they’re not identical. And most of the time, it’s a small discrepancy (25-50 CCs), but sometimes it’s larger and that’s when you have to use different implant sizes.


In plastic surgery, we say that breasts are sisters, not twins.


A few weeks ago, I worked on a patient who didn’t want to be too big on one side – she just wanted to be a full B size. I was surprised, as she was American, and typically my American patients have asked for C cups or larger.

She was a nurse and she told me she would feel uncomfortable going any bigger than a B. She was asymmetrical, so one one side I used 200 CCs. On the other breast, I used 275 CCs, so there was a 75CC difference. Now she’s almost perfectly symmetrical!

Again, it all depends on the clinical judgment of the surgeon, your chest size, and your desires.

breast augmentation

Q: What are the different types of breast implants?

A: There are three main types of breast implants:

  1. Saline – My preferred implant.
  2. Silicone Gel
  3. Gummy Bear – A base of silicone. It’s not gel, but it’s very soft.

There is also a new type of saline implant out there, which is highly sophisticated and has all kinds of compartments in it. As it is quite recent, I have not yet used it, but I know the technology is out there.

Q: Why do you prefer to use saline implants?

A: The reason I use the saline implant is that it costs less. Plus, you can use the subareolar incision instead of making an incision in the crease of the breast.

An incision in the crease is not the best in my opinion because the skin is thick and it can produce a thick scar, whereas most of the time, skin under the areola is very thin and heals very nicely. It’s barely visible because it’s along the line of the areola, which is also dark – darker than the skin.

The technique of using the subareaola is much better than the technique of using the crease because it allows for easier and better exposure of the cleavage area. If you look at results of doctors who use the crease incision, you can see that many of their patients end up with wide cleavage. The reason for it is that there are big blood vessels in the cleavage area that are going to the pectoral muscle, and it’s very difficult to control bleeding from the crease incision if you hit the blood vessel. When you use the subareolar incision, it’s very easy to control it because you see it. From the crease, it’s very difficult, it’s very far away, and overall technically difficult.

breast augmentation

Women’s main concern with breast augmentation is the cleavage area. They want volume and shape, but they also want nice cleavage. If you can’t deliver them nice cleavage, they’re disappointed. So the saline gives you a huge advantage by being able to use the subareolar incision as opposed to the crease incision to create better cleavage for the patient.

Another advantage with saline implants is that you have less capsular contracture with saline implants than with silicone implants.

Also, if you have a saline implant leak, you can exchange the implant with local anesthesia. You don’t need to go to sleep. With silicone implants, the patient must go to sleep because these leaks are difficult to clean under local anesthesia. It’s very uncomfortable for the patient as you scrape the silicone from the tissue.

So in my opinion, there are more advantages to the saline implant, and it costs less!

Did you know?

It is a myth that silicone implants are more natural. I have replaced lots of silicone implants with saline implants, to the delight of my patients.


Saline implants cost less than silicone implants.


Finally, silicone implants are still under investigation; the study wasn’t finished, so you don’t know what the final outcome is. With saline, we know it’s salt water and it doesn’t impose any risk to patients, whereas with the silicone you never know.

In addition, they just discovered that textured breast implants are associated with breast lymphoma (ALCL), which is a kind of cancer, though not breast cancer. This cancer is not associated with smooth implants such as saline. I use only smooth, so I don’t worry about that issue, but it just tells you to be careful – sometimes risks are discovered later on.

In my opinion, why use the silicone gel, which can theoretically cause a serious problem in the future instead of saline, which we know has no risks?

I don’t want to take any risks with my patients, and I want to give them great results, so the gel implant makes no sense to me. Saline is much better.


Q: How do you choose your new breast size?

A: Size preferences vary upon different people and even different cultures. In my experience, my Asian patients typically prefer small to medium-sized breasts. My American patients have typically requested larger breasts, especially those from Texas.

And there’s nothing wrong with either choice! It’s all up to the patient.

As plastic surgeons, we’re in the business of pleasing people. That’s what we’re supposed to do: please people. We’re not doing these surgeries for ourselves; we’re doing them for the patient.


Plastic surgeons are in the business of pleasing people.


You know, somebody recently defined plastic surgeons as psychiatrists with a knife. Because that’s what we do, right? We help build our patients’ confidence and self esteem.

So we try to deliver to the patient whatever they want, within reason, obviously. The way I select the size depends on the chest size, anatomy, and the desires of the patient.

The anatomy dictates the size of the implant as well, because the bigger the chest, the more volume you need to increase the breast size by cup size. For example, if you are a 32A, you need 125 CCs per cup increase. If you’re a 34A, you need 150 CCs per cup size. If you are a 36A, you need 175, and so on. So the chest determines the amount of volume you need to put in the implant to reach the goal.

A patient who’s an A cup and wants to be a D cup – that’s a 3 size increase- so you multiply it by the volume and the chest size. If you’re a 34, each cup size is 150 CCs, so the implants will be 450 CC.


150 * 3 = 450


That’s how I determine the size of the implant that the patient needs.

Not all doctors use that formula. Many of them use sizes, which means that during surgery they take different sizes, put them in, and then figure out which one looks the best and which one piques the patient’s desire. But that’s not as precise as my technique. My technique is more precise and more predictable.

It’s very rare that I have to replace implants because of not delivering the size the patient requested. It’s extremely rare that I’m incorrect.


Q: Who is a good candidate for breast augmentation?

A: In order to qualify for augmentation, you must have small breasts and be healthy. Most women are young, healthy women and there are no issues.

You cannot be on blood thinners. Some patients may have heart disease that requires treatment with blood thinners. Obviously, you cannot operate on those people as they can bleed.

Every patient with any medical problems, like diabetes, must be cleared by their physician for breast augmentation.

After the age of 45, all my patients have to get a physical and get approval from their family doctor on whether it’s safe for them or if they are low risk for the surgery.

Finally, the patient must have reasonable expectations and no serious psychological issues. If any of my patients takes anti-psychotic medication, I always send them to the psychiatrist to get clearance. Their psychiatrist will make sure they can get through the surgery safely.

Every surgery is stressful, so if they cannot tolerate the stress of surgery due to psychological reasons, they’re not a good candidate for breast augmentation surgery.

That’s why I send them to the psychiatrist to make sure they understand that if the result is not perfect, they’re not going to have a seriously negative reaction, such as suicide out of frustration. So that’s why it’s very important to get the psychological evaluation and clearance for surgery.


Q: Do most people need breast lift with augmentation?

A: Now, when you’re young you typically only get breast augmentation. However, sometimes you can have some droopiness when you’re young. That droopiness needs some kind of breast lift.

Typically you’ll need either a mini lift or a donut lift, with an incision around the areola. There’s no incision below the areola or under the breast, in the crease. But that’s usually for what we call level 1 or level 2 droopiness.

If you’re at level 2 or 3, for example, you’ll need to have a full lift, also called a keyhole lift. This usually only happens later in life, though I have seen this on young people if they’ve lost a lot of weight. After losing a tremendous amount of weight, the breasts may droop and hang, so they need the full lift.

Usually patients with significant weight loss also need the implants because the breast is not only droopy, but also volume was lost. The breast implants will add that necessary volume to their breasts.


Q: Do you have patients come in asking for you to fix breast implants other doctors did badly?

A: Many, many people come in asking for this. I have done hundreds of re-dos after another doctor botched the breast implants, or patients had complications.

Schedule a Breast Augmentation Consultation with Dr. Widder

Interested in breast augmentation? Then call the best plastic surgeon practice in Vienna, VA: Widder Cosmetic & Plastic Surgery Center. Simply call us at 703-506-0300 or click the button below to schedule your initial consultation.

breast augmentation

Is Breast Augmentation Right for You? | Widder Cosmetic and Plastic Surgery Center – Vienna, VA

Tummy Tuck Expectations

It’s the beginning of another year and many men and women are thinking about how they will enhance their appearance. For many, their stomachs can be the problem area they want to focus on changing.  Unfortunately, our bodies often don’t always respond to diet, exercise and dramatic weight loss in the way we would like. The abdominal area is particularly vulnerable to pregnancy, childbirth and other stresses that put a lot of strain on your muscles and skin, which can leave you frustrated and dissatisfied with your figure.  When it comes to the abdominal region, the tummy tuck is a plastic surgery procedure that will tone and tighten that area of the body where diet and exercise alone could not.

The American Society of Plastic Surgeons, ASPS, defines the procedure, “A tummy tuck (also known as an abdominoplasty) is a cosmetic procedure that reshapes and flattens the abdominal area. It does so by removing excess fat and skin, as well as tightening the muscles in the abdominal region, the end goal being a tighter and firmer abdomen.”

Not all tummy tucks are alike.  Discussing overall aesthetic goals with Dr. Shlomo Widder of Widder Cosmetic & Plastic Surgery in Vienna, VA, will provide the opportunity to address all questions and concerns. Dr. Widder has been in practice for over 31 years and performed well over 1,000 patients.  His experience, technical skill, and aesthetic eye are critical for a good outcome.  The most performed tummy tucks are 1. Full Tummy Tuck and 2. Mini Tummy Tuck, though much less frequently chosen.  What is the difference?

Full tummy tucks are for patients that want to address the sections above and below their belly button, the full length of the abdominal wall. Patients who opt for a full tummy tuck often want to resolve general roundness and excess skin. Full tummy tucks present the most natural-looking outcome, and include a much firmer abdomen, narrower waist, nice belly button, improved body posture and are commonly associated with weight loss due to the muscles tightening that reduces the amount of food that can be consumed and sense of hunger.

Mini tummy tucks are for patients that are only concerned with “the belly pooch” or tiny bulge in the lower abdominal region.  Dr. Widder will remove excess lower abdominal skin, resulting in a firmer, smoother lower belly.

While these are the two most performed tummy tucks, only during a consultation with Dr. Widder, will it be determined if these procedures alone will provide the aesthetic goals desired?  Deciding which procedure is right for you will be contingent upon several factors that include; your desired results, overall skin quality, body type and location of excess skin on the body. The amount of excess skin will also determine which procedure is most appropriate. Finally, any scarring attained from a previous cosmetic procedure or surgery can determine which kind of tuck the patient qualifies for.

To schedule your consultation, call 703-506-0300.  Dr. Widder and staff look forward to working with you obtain your aesthetic goals.

Does a Breast Lift Without Implants Achieve Good Results?

For many women seeking to enhance the appearance of their breasts via breast lift surgery, deciding whether or not to also receive implants can be a tough choice to make. A breast lift without implants works well in patients who are satisfied with their breast size but not satisfied with sagging and excessive overhang of their breasts and a low nipple position.  Usually, patients with breast size under a B cup request implants.

A breast lift will reshape the breast, raising the nipple to a better position and reducing the overhang of the breast.  The breast will not be smaller than it was before, just more youthful and with tighter skin.  There will be better fullness of the breast behind the nipple as the tissue is pushed upward and held in a tighter “skin envelope”.  Undergoing breast lift surgery without the placement of implants will typically leave patients with a little less upper pole fullness in the breasts, but will provide an easier recovery.

However, there is no way of creating more fullness in the upper pole of the breast without using an implant in small breasted women.  Restoring volume in a truly deflated breast is only achievable with an implant.

To have implants or not?  If a patient is undecided on what to do, Dr. Widder could recommend receiving a breast lift without implants.  Why?  Implants can usually be placed easily at a later date, giving the patient time to be absolutely certain about whether or not they want breast implants in addition to their lift.  It’s extremely important to discuss your overall aesthetic goals with Dr. Widder during your consultation to determine the most effective surgery plan for you as there are 3 types of breast lifts, and options for implants.

Dr. Shlomo Widder is a highly rated plastic surgeon serving the Washington DC and Northern Virginia area.  His office and private surgical suite is conveniently located in Vienna, close to Tyson’s Corner Mall.  Call 703-506-0300 to schedule your free consultation with Dr. Widder.  If you book your procedure before December 31, 2018, you will receive 5% discount on your surgical cosmetic procedure.

Preparation For Breast Augmentation Surgery

Q: Planning to have breast augmentation soon and had one consultation. The clinic did not need any mammograms or cardiogram. Is this normal?

Congratulation on your upcoming breast augmentation surgery, which is one of the best investment that you can make for yourself. It will increase your confidence, your self-esteem, your sense of femininity and will make shopping fun…

As far as tests before surgery, in my practice, if you are under the age of 45, healthy with no bleeding issues, no tests are required for breasts augmentation surgery. The only preparation that is required, is to comply with diet, supplements and medication sheet, to avoid bleeding and compromise of anesthesia.

You have to realize that not all results are the same, because experience, technical skills, and aesthetic eye are critical for good outcome. So, do your due diligence carefully and choose your surgeon wisely, to avoid bad result and need for corrective surgery.

Always, consult with experienced board-certified plastic surgeons who operate in an accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent and attractive with nice cleavage, perky, symmetrical and natural looking.

Redo Breast Augmentation With Lift

Q: Should I add more saline to my breasts? I got a breast augmentation 7 months ago (36DD before surgery, 36DDD after). The purpose of the surgery was to make my breasts more round and lift them. The surgery plan was to put in 550cc. When I woke up, I was told he only put in 300cc because that’s all he could fit in the pocket. I have gone back to him multiple times and said, “I don’t like them. They are still saggy.”  He told me he could go back in and overfill the implants, and it would add more profile to the top of my breast.  Have you heard of this happening?

Before and after pictures from the front and side view would have been very helpful. Based on your story, it appears that you did not have an experienced surgeon perform your breast augmentation surgery. Consequently, it will be in your best interest to consult with experienced, board-certified plastic surgeons, who will be able to assess your situation and offer corrective options.

Most importantly, check the before and after pictures of “redo” AKA revision breast augmentations in the photo gallery. Make sure that they are numerous, consistent, and attractive, with nice cleavage, perky, symmetrical shape, and natural looking.

Severe Capsule Contracture Of Right Breast

Q: I am 6 weeks post-operation from my breast augmentation (545 XHP silicone round smooth unders). I have been doing aggressive massage for 2 weeks on that side. When I massage, I don’t really feel the implant move around like I do on the left. My surgeon said it’s kind of “up in the air” if the right side will drop on its own, or if he will need to go back in. What is your take?

Thanks for posting your before and after pictures, and sorry for your problems. From observing your before picture, you appear to have had level 2 ptosis. In my practice, I would not have done breasts augmentation on you without a mini-lift, because:

1. The ptosis can get worse, as happened to you.

2.  There is high probability of developing double bubble deformity when the surgeon lowers the submammary crease excessively (in order to create perkiness), but the old crease does not stretch.

As far as your right breast, you appear to have severe capsule contracture—most likely due to the hematoma. I would recommend aggressive implant displacement 3 times a day (3 repetitions each time, in 3 directions, and holding for 30 seconds each push) for 2–3 months. If no improvement occurs after that period of time, you have “Biofilm”, which requires capsulectomy (scar excision) and implant replacement.

Always consult with experienced, board-certified plastic surgeons who operate in an accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, to make sure that they are numerous, consistent, attractive, have nice cleavage, and are perky, symmetrical, and natural looking.

Breast Asymmetry

Q: I have slightly asymmetrical breasts. When I originally told my plastic surgeon, he said the asymmetry was minor, and that he did not recommend using two different sized implants. At my pre-op appointment, he said that we could use 304 and 339 natural style 15 implants to try to even them out. I am worried about having implants with different dimensions. I want to call him and ask him if we can just do the same size implants on both breasts. What do you think?

Thanks for posting your picture. From observing your picture, you appear to have size asymmetry (right breast bigger) and submammary crease asymmetry (right crease lower, bottoming out).

For symmetry purposes, I would recommend a larger implant on the left side (25cc more), and raise the right submammary crease. Not raising the crease will worsen the bottoming-out after surgery.

I have been in practice for over 30 years, and my preferred implants are smooth, round, moderate profile saline implants. One of the many advantages of these implants is the easy flexibility of size asymmetry correction.

Another important note: your cleavage is wide with irregularity. The most predictable way to achieve nice and symmetrical cleavage is by sub-areola incision, which allows easy dissection under direct vision and feel. A submammary incision is simply too far to reach to your upper cleavage.

Always consult with experienced, board-certified plastic surgeons who operate in an accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery to make sure they are numerous, consistent, and attractive, with nice cleavage, perkiness, symmetry, and a natural look.

Breast Implants Size

Q: How come every doctor uses Mentor and Allergan but not Motiva Plus?

When you decide to have breast augmentation surgery, you should not choose the type of implants or the tools for surgery; but rather, choose a quality surgeon to avoid bad results and risking the need for corrective surgery.

Always consult with experienced, board-certified plastic surgeons, who operate in an accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, and make sure that they are numerous, consistent, and attractive, with nice cleavage, perkiness, symmetry, and a natural look.

The goal of surgery is to increase your confidence, your self-esteem, and your sense of femininity. The type of implants are irrelevant for those goals. You should select the surgeon that achieves the most attractive results to your liking.

Breast Implants Size Selection

Q: How many CCs should I go to get my desired look? I just went in for my pre-op appointment and loved the look of 300s using the sports bra method. But my doctor said I should order 385–415s to get the look I desire. I am currently a 34A, but DO NOT want to be a D cup. I desire to be a 34C, or large 34B. I am scared the 385–415s are too big! Help!

Front and side view pictures would have been very helpful. Breasts implants size selection depends on the patient’s desire, as well as chest and breasts circumference measurement.

So, if you are indeed a 34A cup size currently, you need 300cc implants to become 34C cup size. However, in my experience, many patients who wear A cup size bra are toward the smaller end of an A cup size.

If that is your situation, you might need 375–425cc, depending on your measurement.  Your surgeon has to take a direct measurement of your chest and breasts circumference in order to make the correct recommendation for your implants’ size.

Not all results are the same! Experience, skills, and aesthetic eye are critical for a good outcome. Do your due diligence carefully, and choose your surgeon wisely to avoid bad results and the need for corrective surgery.

Always consult with experienced, board-certified plastic surgeons from an accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery and make sure that they are numerous, consistent, and attractive, with nice cleavage, perkiness, symmetry, and are natural-looking.

Breast Asymmetry

Q: I had a revision surgery one year after the initial augmentation. I am now almost four weeks post op and am completely asymmetrical in size. The swelling has not gotten worse, but has not gotten better by any means. Is this normal? Should I be concerned?

Posting of front and side view pictures would have been very helpful.

It is difficult to opine without seeing your pictures or examining you. However, “I am completely asymmetrical in size” one month after surgery reflects something wrong with your recovery. If you have saline implants, one might have deflated; if you have silicone implants, you might have a hematoma.

In any event: yes, you should be concerned! Contact your surgeon as soon as possible for assessment, as it may be possible to take appropriate action (if determined by your surgeon).

 

Male-to-Female Breasts Augmentation

Q: I’m a male that wants to have more female looking breasts. How hard would this be to do?

Thanks for posting your pictures. From observing your pictures, you appear to be small A cup size with level 2 ptosis. Whatever cup size you elect to have, you should request a mini lift (donut, Benelli) at the same time, in order to get beautiful, perky, and youthful looking breasts.

Another strong recommendation would be to get saline implants, because they can be inserted through the sub areola incision, which allows for easy dissection of the muscles in the midline, under direct vision and feel that creates predictable, nice cleavage. Large silicone implants require long incision in the submammary crease, which is too far from the cleavage area and too close to the crease.

As far as implants’ size selection, you did not provide your chest circumference measurement in inches, which is critical for the correct implants’ size selection according to your desire. If you are currently 40 small A cup size, to become 40 C cup size, you will need implants with volume of 500 cc.

You have to realize that not all results are the same; because experience, technical skills and aesthetic eye are critical for good outcome. So, do your due diligence carefully and choose your surgeon wisely.

Always, consult with experienced, board-certified plastic surgeons who operate in accredited surgery center for your safety. Most importantly, check the before and after pictures in the photo gallery, and make sure that they are numerous, consistent, and attractive, with nice cleavage, perkiness, symmetry, and look natural.

Redo Breast Augmentation

Q: My breast augmentation was just 15 months ago. The right breast never seemed to fully “drop”, however, and I’ve been told I need revision. The original doctor said he would go in and cut/release the muscle to let implant drop. A 2nd opinion said it is contracture and should score the tissue instead. Are these two ways to get same result? Are these diagnoses very different? I cannot tell and don’t know what to do.

Thanks for posting your pictures. From observing your pictures, you have significant problems on both sides:

  1. Left side: medial capsule contracture creating wide cleavage and lateral displacement of the implant. The corrective procedures are medial capsulotomy (scar release) and lateral capsulorrhaphy (internal bra).

  2. Right side: severe capsule contracture and smaller breast. If the breast is very hard, you will need capsulectomy (scar excision) and replacement of implant due to ‘biofilm’. If it is not very hard, just capsulotomy will suffice. The implant should be replaced anyhow, for size symmetry.

The procedures on both breasts should be done through sub areola incisions, which make the maneuvers and the dissections easier and more predictable, since they are done under direct vision and feel. Submammary or axillary approach is too far for comfort and consistency.

As you can see from your own experience, not all results are the same. Experience, technical skills, and aesthetic eye are critical for good outcome. So, do your due diligence carefully and choose your surgeon wisely.

Always, consult with experienced, board-certified plastic surgeons who operate in an accredited surgery center for your safety. Most importantly, check the before and after pictures of redo breasts augmentation in the photo gallery, to make sure that they are numerous, consistent, and attractive, with nice cleavage, perkiness, symmetry, and natural looks.

Breast Augmentation Post Surgery | Capsule Contracture

breast-augmentation-post-surgery

The following interview focuses on questions related to breast augmentation and a post-surgery condition called capsule contracture specifically. Dr. Widder’s shares his experience and insights with women who are considering plastic surgery for the first time or are looking to explore a higher level of care and quality results. Subscribe to our blog for weekly insights and feel free to suggest topics or questions you would like answered.

Q: How often are your breast surgeries purely cosmetic and how often are they done for medical reasons?

I don’t usually do reconstructive surgery.  I mainly do cosmetic surgery.  There is sometimes a reconstruction aspect of cosmetic surgery.  When you have a capsule contracture that occurs from a cosmetic surgery, you have to fix it.

Q: What is capsule contracture?

When we put any foreign body into our bodies, the tissue around it will encapsulate it – that is, it will surround it with scar tissue.  This is a protective mechanism of the body and it’s normal.  After surgery, this is expected, but what you want to have is a soft capsule.  A soft capsule allows the implant to move within it and it gives the appearance and the feel of a natural breast.  Once in a while, a patient will develop hardening of the breast, or capsule contracture.  Most of us have seen people with a burn on the arm or the neck where the scar has contracted noticeably in one direction.  The same thing can happen with the breast.  It’s very devastating to the patient – they are expecting to have natural looking breasts and instead they get two hardballs or two apples sitting on their chest.  It’s very disappointing.  So in this case, some breast reconstruction is the remedy.

Q: What do you do to repair capsule contracture?

The way to relieve it if the contracture is not very severe is to do a capsulotomy.  This is a surgery during which I cut the scar tissue in multiple directions to enlarge the space and reduce the tightness or the tension.  After surgery, the patient is instructed to do massage – to move the implant in different directions so it maintains a relaxed position in the capsule.  Without the massage, the scar, by its nature, will contract.

But in the condition where there is biofilm – bacteria embedded in the scar tissue and also on the implant – to get a nice, natural looking breast, you have to remove the implant and the scar tissue.  You literally have to shell or scoop out the whole area, which is a difficult and tedious procedure.  This procedure takes a long time, but it is the best technique to recreate a natural looking breast and avoid the recurrence of capsule contracture.  If you were to just do a capsulotomy and leave the implant in place, it is almost guaranteed that the condition will recur.  The way to avoid that is to do the capsulotomy and replace the implant.

Q: What are some of the causes of capsule contracture?

Probably the most common is not doing the massage.  But a few patients will have some bleeding or some develop an infection.    I always tell my patients that whenever they have any dental procedure to take antibiotics because bacteria from the mouth can enter the bloodstream, seed on the implant, and start the process of capsule contracture. Also if the patient is having any gastrointestinal procedure like an endoscopy or colonoscopy, they also have to take antibiotics. That’s part of my discussion with my patients in the beginning so they know what to do in the future to avoid complications.

Q: What made you choose to focus your practice mainly on cosmetic surgery over reconstructive surgery?

Those choices go with one’s personality.  I love surgery and I love medicine and everyone has their own strengths and limitations.  I decided a long time ago to be a happy surgeon and deal with happy situations.  I enjoy giving people the bodies that make them feel great about themselves and boost their confidence and self esteem.

To find out more about the Widder Cosmetic & Plastic Surgery Center stop by during office hours: 9 – 5pm, Mon – Fri, or contact us today! Office Phone: 703.506.0300.

*Individual results are not guaranteed and may vary from person to person. Images may contain models.