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

Gummy Bear Breast Implants – Just Say Wait

The new Natrelle 410 cohesive gel implants have been conditionally approved by the FDA, but Dr. Widder explains why his practice is taking a wait and see approach. The natural look and feel of silicone and saline implants are an important consideration for those seeking cosmetic improvements.

gummy bear implants

Q: What do you think of the new breast implants, commonly known as the “Gummy Bear” implants?

They have been gaining a lot of interest lately, but for the most part, I really recommend people stick with the softer silicone or saline implants for a natural look and feel.

Q: What exactly are the “Gummy Bear” implants?  How do they differ from the implants you prefer?

The “Gummy Bear” type of implants are made of what is called cohesive gel.  Their official name is the Natrelle 410 Highly Cohesive Anatomically Shaped Silicone-Gel Filled Breast Implant.  They are considered form-stable, which means the gel substance makes them firmer than can either silicone or saline.  They are being manufactured by the healthcare company Allergan, Inc.  What they claim is that the implants will provide a natural “tear-drop” shape and that there will be less leakage in the case of rupture.  These claims are not yet proven.

Q: Do the “Gummy Bear” implants have official approval for use?

The Food and Drug Administration (FDA) gave them conditional approval in February of this year, which sparked the current buzz about them.  What people don’t realize is that the FDA’s conditional approval is not an endorsement.  Jeffrey Shuren, M.D., who is the director of the FDA’s Center for Devices and Radiological Health said, “We will be looking at the results from post-approval studies that will focus on their long-term safety and effectiveness.”  So Allergan, Inc. will be conducting a study that will follow 2,000 women and will take ten years.  Basically, the “Gummy Bear” implants are just entering a major trial stage.

Q: Do you have a sense of what the popularity or importance of these new implants might be in the future?

I believe they may show some promise for reconstructive surgery.  I don’t prefer them for the cosmetic surgery I do.  They are firmer and because of that, a larger incision is needed.  They can’t be inserted through a subareolar incision, which is the method I prefer to use.

I’m not the only surgeon who is wary of taking up the “Gummy Bear” fad.  Many doctors want to take their time to learn about them and to be sure they are making the right decision for each patient.  Dr. Oren Lerman of Lenox Hill Hospital in New York City commented on this to CBS in February.  He said, “These new form-stable implants are not necessarily a better product or a better choice for all women.”

I agree with that statement.  I still believe that for augmentation, saline implants are the best.  There is less scarring and they have the feel of a natural breast.  My patients love the results they get from saline implants.

Dr. Shlomo Widder, the “D.C. Butt Doctor,” offers premium services to fit every cosmetic surgery need in Northern Virginia, the Washington, D.C. metropolitan area, and beyond. To find out more about the Widder Cosmetic & Plastic Surgery Center, stop by during office hours: 9 – 5pm, Mon – Fri, or visit our website at: www.widderplasticsurgery.com.

 

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