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Daniel Careaga, MD
Paul Durand, MD
Karl William Schwarz, MD

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Breast Augmentation

Posted May 07, 2019 in Breast Augmentation

Breast augmentation is about confidence! Having full perky breasts gives a woman confidence, whether it‘s in a couture gown at a cocktail party or a sexy bikini on South Beach. Dr. Careaga takes his time during each consultation to get to know you and the goals you have for the appearance of your breasts. With so many options to choose from, it’s no wonder that there is no such thing as a “cookie cutter” breast augmentation. There are many decisions that go into individualizing your breast enhancement surgery.   

Seven decisions to achieve your ideal breasts

Decision one: Implant type

There are currently three categories of implants: saline, silicone gel, and cohesive gel (gummy bear). Saline implants have a silicone shell and are filled with saline fluid. Saline implants are a good option for patients that have enough breast tissue to conceal the visibility of the implant.  
Silicone gel implants have been the gold standard for breast augmentation since they were re-introduced to the market in 2007. They are FDA approved for patients 22 and older. They provide a more natural look and feel than saline implants.
Cohesive gel implants (gummy bear) were approved by the FDA in April 2013. Dr. Careaga was the first plastic surgeon in South Florida to utilize them for cosmetic purposes. They are soft, solid implants that provide the most natural look and feel of all breast implants. They are also the most durable, with a negligible rupture rate.
Your consultation with Dr. Careaga will include a discussion of all the implant types to help you decide which implant will most fulfill your aesthetic breast goals.

Decision two: Implant shape

There are two implant shapes to choose from: round and anatomical (teardrop). Your choice of implant shape means taking into consideration the shape and size of your breasts as well as your desired look. For example, a thin patient who desires a natural look is the ideal candidate for a teardrop-shaped implant.

Decision 3: Implant profile

Implant profiles can be classified into moderate and high profile. The profile that best suits you will depend on how wide your breasts are and how much projection you want. Projection is how far forward the implant brings your breast. A patient with a narrow breast that wants more projection might be better suited to a high profile implant, whereas a patient with a wider breast that mainly wants more fullness and cleavage might be a better candidate for a moderate profile implant. At your consultation, Dr. Careaga will take your breast measurements and recommend a profile type.

Decision 4: Implant size

There is no “one-size-fits-all” in breast augmentation. Choosing a size without taking careful measurements of your breasts runs the risk of abnormal-looking breasts, lack of cleavage, or the feeling that the implant spills over too much on the sides. Choosing the size is where true artistry comes into play. Dr. Careaga will take detailed measurements and then, based on your desired cup size, will choose the implant best suited to give you the exact look and size you want.

Decision 5: Implant position

There are two commonly used implant positions: sub-glandular (above the muscle) and dual-plane (below the muscle). The majority of breast augmentations in the United States are dual plane (below the muscle). The muscle is gently opened on its lower border to allow the implant to descend and give the breast a natural look and shape. Occasionally a sub-glandular position is chosen for a patient whose breasts have fallen a small amount and desires a little more upper fullness.

Decision 6: Incision placement

There are three currently accepted incision options: trans-axillary (in the armpit), peri-areolar (under the nipple) and infra-mammary (in the breast fold). All three incision choices are easily concealed. Based on your goals, Dr. Careaga will recommend the ideal incision for you. TUBA (Trans-umbilical breast augmentation) is not an accepted approach to breast augmentation and will void the manufacturer’s warranty on your breast implants. It is for this reason that Dr. Careaga has chosen not to utilize this approach.

Decision 7: To lift or not to lift  

An implant alone will not lift the breasts. If your breasts have fallen due to pregnancy, breastfeeding, or weight fluctuations you may need a procedure to lift and firm the breasts in addition to the implant. There are three main categories of lift: peri-areolar (around the nipple), vertical (lollipop), or invertedT. The type of lift will be determined by how far your breasts have dropped. A breast lift can give your breasts a much more youthful, perky appearance. An aggressive post-operative scar protocol, such as the one Dr. Careaga recommends to his patients, will minimize the scarring involved with your procedure.

Common Patient Questions

How long is my recovery period?      

The recovery from breast surgery is faster than one may think. Most patients can be back to work in well under a week and back at the gym in two weeks.

What are my arm limitations and for how long?  

The first two weeks I limit big shoulder movements and heavy lifting. Work involving typing and writing is permitted, but not lifting objects over your head.

When I first look at my breasts, how will they appear?

In the first one to two weeks, your implants will appear high and “fake” looking. The gentle pressure of the compression garment on your breasts causes them to descend for a more natural-looking breast contour. This process usually takes approximately two weeks.

How long before I can bathe and wash my hair?

It is ok to shower after five days. You can gently wash your hair, trying to lower your head to minimize shoulder movements.  

How long before I can exercise? 

allow my patients to return to the gym at two weeks and begin low-impact cardio such as elliptical, stair master, stationary bike, and treadmill on an incline. At four weeks they can carefully resume their normal routine.

When can I wear a regular bra?

I have my patients use a sports bra that gives firm support for two months. At that point any bra is acceptable.

When can I go to the pool or the beach?

In most cases two weeks is adequate before a patient can submerge her breasts in pool or sea water.  

What can I do to address the scars, if any, after my procedure?

I have my patients follow a very aggressive scar protocol. The first four weeks I generally tape the incisions with a special porous tape. At four weeks I have them use a special silicone sheet that covers the incision during the day. At night I have them use liquid silicone and massage the scar. For lifts and reductions, I have my patients undergo four laser scar treatments at onethreesix, and 12 months.

Do I need to change my implants out every ten years?

There is no recommendation to change any of the three types of implants (saline, silicone gel, or gummy bear) at any point. If they are intact and you are pleased with their appearance, there is no need to replace them.  

How will I know if there is a rupture? What are the chances and what happens then?  

If a saline implant ruptures, you will notice a reduction in the size of the breast. Silicone ruptures are more subtle and have to be visualized by radiologic studies to confirm. High resolution mammograms will usually detect implant failure, but MRI is still considered the best test.
The rate of rupture of saline and silicone gel implants is one percent per year. Gummy bear implants have a negligible rupture rate.
Many patients have concerns regarding the safety of silicone breast implants. They are the most studied medical implantable device that exists. If a silicone implant fails, the silicone will stay within the capsule of scar tissue that your body creates around it until a surgeon replaces your implant. The silicone does not get absorbed by the body and does not cause any disease such as cancer, lupus, or other auto-immune disorders.

What to expect

Day of consultation:

At your consultation, you will meet Dr. Careaga. He will ask you questions about your medical history and your goals for breast enhancement. After examining you and taking careful measurements of your breast, Dr. Careaga will involve you in the process to choose which implant will give you the exact look you desire.  

Pre-op appointment:

The day of your pre-op visit you will have blood work done. Patients over 40 will need an EKG. Patients over 50 will need a clearance letter from their doctor. Dr. Careaga will order a mammogram in any patient over 35 or in those at any age with a family history of breast cancer. You will sign the consent forms for surgery and have the opportunity to ask Dr. Careaga any additional questions you may have. You will be given your prescriptions to have them ready for you on your day of surgery.

Surgery day:

You will be scheduled to arrive at the center approximately 30 minutes before your scheduled procedure. After changing into a gown, Dr. Careaga will confirm with you the procedure to be done and the implant that you have chosen with him. He will take your before pictures and place marks on your breasts to guide him in surgery. Any last minute questions will be answered.  
After surgery you will be in the recovery room with your personal nurse until Dr. Careaga and your anesthesiologist allow you to be discharged.

At home:

Dr. Careaga wants you up and walking around every hour with assistance the first night of your surgery. He will personally call to check in on you and you will be given his personal cell phone number for any questions you may have. There are no diet restrictions, although most patients are not very hungry after surgery. Chicken soup is a great post-surgery recovery food! Drink lots of liquids to keep hydrated.

About Careaga Plastic Surgery

Founded by Dr. Daniel Careaga in 2012, Careaga Plastic Surgery & Medspa is a modern facility in Coral Gables that utilizes the latest and most innovative technology in the aesthetics industry. The center is dedicated exclusively to surgical and non-surgical procedures, and is consistently ranked among the top Med Spas and Plastic Surgery facilities in South Florida. Dr. Careaga is an award-winning plastic surgeon who holds a double board certification by the American Board of Plastic surgery and the American Board of Surgery. As a highly sought-after expert, Dr. Careaga has performed more than 8,000 aesthetic operations in private practice with impeccable results. 

Contact Us Today

If you want to learn more about your options for breast augmentation, call us today at (305) 960-7511 or fill out our online contact form today.


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