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Breast Augmentation Specialty Center
of Thousand Oaks & Dr. Costanzo

Over 5000 Breast Augmentations

Breast Enlargement, Breast Enhancement
Breast Augmentation, Breast Lift, Breast Implants

More Patient Comments

Kindra:  It was worth coming all the way from Sweden to have my breast implants done by you.  Your staff was so kind and helpful and my boobs are perfect!

Catherine:   My results are beyond phenomenal!  You are so very talented Dr. Costanzo.  You truly are an artist.  Thank you for transforming my breasts into a thing of beauty.  I couldn't be happier with my results.  You are an amazing doctor with such a caring and friendly staff.

Special Breast Implant offer

Read How Dr. Costanzo Gets Amazing Results

Measuring Your Breasts

Join the 5,000+ Happy Women who had Breast Implants by Dr. Costanzo

When I evaluate you, I will take three measurements that will help me determine what breast implant you will need to get the shape and size you are requesting


Using the photo above for help - Take a ruler in centimeters or inches

While standing in front of a mirror write down the following measurements.   Then go below to match your measurements with the description that fits you

(1) Measure the distance from the red rectangle to your nipple = DISTANCE FROM THE BASE OF THE NECK TO THE NIPPLE

(2) Measure the distance between the 2 yellow lines = DIAMETER OF THE BREAST

(3) Measure the distance between the 2 green lines = HEIGHT OF THE BREAST

If your measurements are between 16 - 21 centimeters or 7 - 8 1/4 inches from the base of your neck to the nipple, your going to look best with your implants under the muscle (Submuscular).

Before a Submuscular / Dual Plane Breast AugmentationAfter a Submuscular / Dual Plane Breast Augmentation

I know with the right measurements I can get to this!

Call for a Free Breast Augmentation Evaluation

However, if your nipple distance is lower!

If you've found your nipple position to be 22 - 23 centimeters or 8 1/4 - 9 1/4 inches, then you may need your implant placed on top of the muscle (Subglandular) or need a Nipple Lifting procedure (Crescent Lift).

Subglandular (on top of the muscle)

Before a Subglandular Breast AugmentationAfter a Subglandular Breast Augmentation

or a Crescent Lift with Breast Implants

Before a Crescent Nipple Lift with ImplantsAfter a Crescent Nipple Lift with Implants

If your measurement falls below 23 centimeters, you probably need a shaping Breast Lift.

Now let's take your measurements and figure out what might be best for you

Start with your nipple distance in centimeters (2.5 cm = 1 inch).

  • 20 cm or less - you should have a Submuscular / dual plane Breast Augmentation

  • 21 cm - most likely I'll still recommend a Submuscular Implant

  • 22 cm - usually you will need either a Subglandular Implant or a Crescent Lift with a Submuscular Implant

  • 23cm - usually you will need either a Subglandular Implant and a Crescent Lift or Breast Lift

  • 24 cm or more - generally I would recommend you get a Breast Lift with or without an Implant

Here are some other factors that can change my recommendations for you

  • Skin Tightness - if you have a very low nipple position with loose skin, you may require a Breast Lift.  On the other hand, if your breast skin is tight, you might look better with a Subglandular Implant alone or in combination with a Crescent Lift.

  • A Breast Larger than a B Cup - if your breast is a C cup or greater to begin with, I might suggest you have a Subglandular Implant placement or possibly a 2-stage surgery, with a Breast Lift first for shaping, followed by Breast Implants months later.

What about the diameter I just measured and why it is important?

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.

What value is the height I just measured?

The height is of value when using shaped, form stable breast implants (gummy bear implants). Because the shaped implants come in many different heights and widths, the height and diameter measurements help determine which shaped implant will fit you the best.

Breast diameter: Mine is small, I want to be rather full. What can I do?

Allergan Natrelle, Mentor Memory Gel and Sientra Breast Implants are now manufactured with different 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 Implant profiles.

Frequently Asked Questions: My Response

Fat - I heard I can use my own body fat instead of Implants?

Fat Transfer - Many centers are working on transferring fat from your body to the breasts to enlarge them.  Although this may be a viable option some day, there exists many issues that need to be worked out.

Problems with using your own fat:

  • Most importantly - The fat injected breast does not give the upper breast fullness that most women want and get with a breast implant.

  • Symmetry of the 2 sides is more difficult when injecting fat rather than placing two similar size and shaped breast implants.

  • All of the fat injected into the breast may not stay soft and lead to areas of unwanted hardness.

  • Some centers are using pre-expansion breast plates to stretch out the breasts before the fat transfer.  This device needs to be worn many weeks before and after surgery.  They can be quite cumbersome and uncomfortable to wear.

  • There has to be a marked over injection of the fat as this will shrink in size quite dramatically, making it difficult to know your final cup size.

Incisions - Pros and Cons

Incisions for Breast Augmentation

Transaxillary (armpit) - A good incision if you don't want a scar on your breast.   The drawback is that another incision may need to be used to remove the implant at a later date.

Inframammary (inferior fold) - May be necessary if you want larger Silicone implants.

Periareolar (around the nipple base) - A good choice for hiding the incision if you have a darker complexion.

TUBA (belly button) - 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 incision (Transumbilical Breast Augmentation - TUBA):

  • 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.

Submuscular or Subglandular: Which is best for me?

This is the most misunderstood 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 - 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


  • 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 movement of the muscle massages the implant, which can help keep the breasts softer after a Breast Augmentation.

Subglandular - I love to use a Subglandular position on a more mature breast. I might suggest this to you if you are; not too thin, have sagging breast tissue with a low nipple position or are on the heavier side in weight.

If you fit the above body and breast type avoiding going under the muscle, will give you a better shape.

That is because the Pectoralis muscle is located high on your chest and placing the breast implant under your muscle will create your fullness above the nipple, rather than under the nipple. This can result in your natural breast rolling off and falling below the implant, pushing your nipple downward.  This is called a "Puppy Dog" appearance. Putting the implant under the muscle can also make the breast shape look more like a pair of "Bullets" coming off the chest with the implant position too high. 

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.


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

  • You get better cleavage with a Subglandular implant

  • You can fit bigger implants with a Subglandular position

  • 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

Smooth or Textured implant surface:  How I decide

For Subglandular (on top of muscle) - Textured coating:

Generally, I use the Textured coating which is designed to adhere to the implant capsule and inhibit the capsular contracture (hardening of the tissue around the implant).

Using a Textured implant allows me hold the implant in the position I want it under the breast.  This is especially beneficial in women who need the implant lowered to improve droopiness.

For Submuscular (under the muscle)- Smooth coating:

In most women I like to use smooth implants because they move around in the implant pocket and are less likely to be visible.  Sometimes, if there is mild sagging of the breast tissue, I will use a textured coated implant because of it's ability to maintain better positioning in the early stages of healing.

Once the breast implant pocket has formed and the implant has been in place for some time, the textured coating is no longer necessary.  Therefore, a smooth implant can be used to replace a textured implant, such as in the case of a rupture.

Are there new implants on the horizon?

Formed Stable Highly Cohesive Gel Implants released for use in 2013

Mentor, Sientra and Allergan have shaped implants approved by the FDA. Mentor's implant is called "MemoryShape CPG", Sientra's implant is referred to as Shaped, while Allergan's implant is called Natrelle Shaped 410 Gel.

These implants sometimes called "Gummy Bear" by the public are designed maintain their shape.  These contour shaped implants will have different heights and widths.

Shaped vs Round Implant
Shaped vs Round Implant

Pros, Cons and Advantages of the Highly Cohesive Shaped Gel Implants:

Reconstructive Breast Surgery

These implants provide the surgeon with an implant that maintains it's shape, particularly at the base of the breast.

They resist folding and may provide a longer time before replacement is necessary.

Will probably be the implant of choice for most Reconstructive surgeons following Breast Cancer

Cosmetic Breast Surgery

These implants are designed to fit the measurements of a women's breast width and height. Therefore, the Plastic Surgeon will instruct you as to the size implant that will be the right fit for you.

These implants will be not be the implant of choice by most for the following reasons:

Much more expensive

These implants are not appropriate for women with some sagging of their breast

If you want very full breasts, then round implants would be a better choice

In addition these Shaped Implants have the following disadvantages:

More difficult technique and longer incisions - making experience more important

Firmer feel

Increased risk of the implant rotation when compared with round implants

Cannot be used if you want a very large breast implant

More difficult corrective surgery

What Else is on the Horizon for Implants?

Allergan purchased a bioengineered silk-based biodegradable mesh called SeriScaffold which may be incorporated into their implants to help maintain the implant position over time.

Look for more of these types of engineering developments in the future.

Sientra Breast Implants manufactured in Brazil by Silimed received FDA approval to sell their cohesive gel implants in the USA in 2012

I prefer to stay with the two leading American Companies Mentor and Allergan, who have long term proven track record of providing the best Silicone and Saline Breast Implants on the market. Silimed Brazilian made implants are still too new in the USA

Different shaped implants: Which shape is best for me?

Shaped (Gummy Bear)

The shaped implants have a thicker silicone gel filling along with a textured coating.  These implants are designed for those women who don't want much fullness in the upper part of the breast.  They will be used mainly for reconstructive surgery after removal of the breast for cancer. They should not be used in a woman who needs a Breast Lift along with Breast Implants

Round - either a Cohesive Gel or Saline filled

These implants look the most natural and I use them most of the time.

Implant profile: Which implant profile for me?

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


High Profile Silicone - I like to use these 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 - I rarely use these implants, because on most women it is too narrow and doesn't give as natural a look.


Mid Profile Silicone - This is the most common silicone implant I use.  Like the higher profile, I would use these mid-profile implants 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 - I use these implants occasionally if you are very petite, with a very narrow breast diameter and are requesting a saline implant.


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

Low Profile Saline - If you want a saline implant, this is the most common profile I like to use.  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.

Ultra High

Ultra High Profile Silicone - These implants by Allergan (Natrelle) and Mentor (Memory Gel) which have a very narrow diameter coupled with ultra-high projection are used in woman who want a great deal of fullness in the upper part of their breasts.

Does my own body shape affect how my implants will look?

The answer to this is "YES".  Here are examples of how your chest and body shape will affect how implants look on you:

If you have a rounded rib cage or a more severe condition called Pectus Carinatum (pigeon chest), your implants will want to stay wider apart creating less cleavage.

If you see that your own natural breasts have a wide separation and your nipples seems to point away from the center, than you may fit into this category.

You may also have a wide sternum or breast bone between your breasts.

If you have a sunken chest or a more severe condition called Pectus Excavatum (funnel chest), your implants will want to stay closer together.

I have found this improves cleavage and softens the sunken look of the rib cage.

Asymmetrical rib cage projection outward (1 side sticks out further than the other)

Most women don't even realize they have this.

Sometimes they think one breast is bigger, when in fact one side of the rib cage sticks out (projects outward) further and pushes the breast out, giving the appearance of a larger breast.

If you notice this asymmetry on you, than you should expect one implant to stick outward further than the other side.

I commonly see that the left side of the rib cage projects out further and believe this is because the heart lies under the left ribs.

Severe cases of this, where one side of the rib cage sticks out much further than the other side:

I have improved the look by placing a lower (flatter) profile implant on that side and a higher (elevated) profile implant on the flatter side.

Different levels of the inframammary or submammary folds at the bottom of your breasts

Stand in the mirror and draw an imaginary line parallel to the floor along the bottom of your breasts.  If the folds don't line up, you have one inframammary fold higher that the other.

If you have one fold that is at a higher position than the other, this may remain after surgery causing that implant to remain a little higher than the other side.

Other conditions such as Scoliosis and Poland Syndrome can also affect the way implants look on your body. ( see the Breast Asymmetry page)


Size: What is the best size for my body?

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.

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.

My suggestion is to focus on "fullness" at the top of the breasts rather than cup size.  Since you will not fit into a bra the same way after having a breast enlargement that you would if you didn't have breast implants. 

Large breasts: I have them and still want breast 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 want implants:

Probably the best choice in most cases is to perform a Breast Lift first, followed by placement of an implant under the breast at a later date.  Because implants have the effect of pushing your natural breasts outward, they will take a poor shaped breast and make a bigger, poor shaped breast.

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

If your concerned about Breast Lift scars, they 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 as the Lift causes stretching of the incision.

Lastly, sometimes I suggest a Breast Reduction first.  If your own breast in rather large, heavy with very little projection outward, then a combined Breast Reduction/Lift can help the shape by removing this heavy non-supportive tissue.  Then I can do a Breast Augmentation months later using a Breast Implant to replace the tissue removed during the Breast Reduction/Lift.

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

Safety: Are breast implants safe?

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.

FDA report from January 2010 - The FDA issued a report that breast implants may have a very small increase in the risk of a very rare lymphoma (ALCL) found in the scar capsule.  ALCL is so rare in the breast that only 3 cases out of 100 million are diagnosed each year in the USA.  Since 1997 the FDA has identified 34 unique cases of ALCL in women with breast implants throughout the world.

In summary:  This is extremely rare, 3 per 100 million women per year.  The FDA currently has no  plans to restrict or limit implants again and does not recommend any woman remove their implants. 

PIP and ROFIL Breast Implants - French manufacturer Poly Implant Prostheses (PIP) and the Dutch company Rofil Medical used inferior, industrial grade, silicone in the breast implants they produced and sold.

These products have a higher rupture rate than other available implants and are sold in countries that include England, France, Argentina, Venezuela, Brazil, Germany or the Czech Republic.

Recommendation: Is that women who had PIP or Rofil breast implants have these removed and replaced with the proper Medical Grade (safe) Silicone Gel Implants, such as Mentor or Allergan.

PIP and Rofil breast implants were never recommended by the FDA.

Saline or Silicone - What are the pros and cons of each type?


  • If you are very thin with no significant breast tissue, then a silicone implant can produce a softer and more natural feel and appearance.

  • Costs more money, but will last longer than saline.

  • 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.


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

  • If this 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.

Cohesive Silicone Gel & Gummy Bear breast implants

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 Allergan (formerly Inamed and McGhan) Corporation's Natrelle Silicone implant, Mentor Corporation's Memory Gel implant.   I like to use either of these two companies because they have been manufacturing breast implants for many years. 

Gummy Bear like breast implants - 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.

Allergan Natrelle Contour and Mentor's CPG Cohesive Gel implant will avoid the firmness of a Gummy Bear, yet will be able to maintain a more contoured look.

You should keep in mind that Cohesive Gel implants are the latest technology.   I will continue to use these implants

Cohesive Memory Gel Silicone breast implants - What should I know?

Gel Bleed - Today's gel implants differ from the earlier generation silicone breast implants, because they do not leak if the breast implant shell is ruptured.  The old style silicone implants had a liquid center and this could leak through the surrounding shell.

Although never demonstrated harmful, silicone gel bleed into the surrounding tissue was not desirable.

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.

Warranty - Do the implant companies guarantee my implants?

All implant companies carry a warranty and therefore guarantee replacement implants for life.  And for a period of time, usually 10 years they will also pay money to the surgeon to have them replaced should they become defective.

Currently, I do not use Sientra's Brazilian manufactured implants because they have no long term history of being in business in the USA.  I have seen many companies begin manufacturing Breast Implants only to go out of business and the woman to lose their lifetime replacement guarantee.

So I recommend you get Mentor or Allergan Breast Implants, two companies who have been in business for decades.

Breast Feeding - Is it still possible after implants?

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

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. 


I may have you get a screening mammogram prior to a Breast Enlargement, 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.

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.

Most of the time breast implants make it slightly more difficult to visualize the mammogram.   Saline implants make it easier for the radiologist to interpret your mammogram, because they allow penetration of the x-ray better than silicone.

Rupture - What are the causes?

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 inside the breast implant shell.

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

Partial Loss of Saline Solution from one Breast Implant

Only one of the above Saline Breast Implants lost it's volume when the fill valve failed to hold all the saline solution.

Capsular contracture (hardness) - Why does it happen?

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 contracture" and can lead to distortion of breast shape and hardness to touch.

Capsular Contracture and Mal-postioned ImplantCorrection of Capsular Contracture and Re-shaping

Baker's Grading System

Grade I - the breast is normally soft and looks natural

Grade II - the breast is a little firm but looks normal

Grade III - the breast is firm and looks abnormal

Grade IV - the breast is hard, painful, and looks abnormal

Causes of Capsular contracture

  • Infection and the formation of a bacterial Biofilm within the implant pocket or blood-borne infections

  • Hematoma (blood) or Seroma (serum) within the implant pocket

  • Following breast feeding, which may result from bacterium passed through the milk ducts

  • Radiation therapy

  • Autoimmune disease

  • Traumatic injury to the breast implant

  • Silicone Gel Bleed

The Good & 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 women like how this tightness helps create more fullness in the upper breast.

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

Treatment of severe capsular contracture

Surgical release of the breast capsule (capsulotomy) or complete or partial removal of the capsule (capsulectomy) around the breast implant. This should be the first choice for treating the undesirable effects of capsular contracture.

Wrapping the implant in Acellular Dermis (ACD) (donated human or bovine skin treated to remove all cells but leave the collagen matrix) has been shown to be valuable in treating severe cases of capsular contracture. This Acellular Dermal Matrix acts as a scaffold for integration of the body's natural tissue.

Medications such as Accolate (Zafirlukast) or Singular - in some instances combining these medications with their anti-inflammatory effects and surgery can be helpful in eliminating undesirable firmness and distortion around a breast implant.

What is a pocket protector?

A breast pocket liner made of Gore-Tex like material (Polytetrafluoroethylene-PTFE) similar to what I've used for lip augmentation is inserted into the pocket made for the breast implant.  The idea behind the liner is to reduce the possibility of capsular contracture.

However, in my opinion the Cons out-weight the benefits

There is no proof that this actually works.

The FDA has not approved this material for use with breast implants.

Using Gore-Tex type material increases the risk of infection.

Rippling - How does it happen?

Rippling or visible waves in the breast skin can happen on rare occasions.  This rippling is caused by the implant folding on itself 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 help hide the implant folds.

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

Double Bubble Look

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.

Double Bubble 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 by a Breast Enhancement with Implants

  • Sometimes a Sub-Pectoral placement with 1/2 the implant under the muscle will avoid this.

Double BubbleDouble bubble side view

Double Bubble caused by loose full breast tissue sitting upon an implant
To correct this she would need the implant moved upward and secured in place

Synmastia - The one boob look

Synmastia, sometimes called the Uni-Boob is the result of trying to gain cleavage by moving the implants close together.  The implants should never be placed on top of the sternum or breast bone, which results in the skin being lifted off of the bone and creating this condition.

SynmastiaA way to avoid Synmastia

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

  • Using an experienced Plastic Surgeon

Bottoming Out of the Breast Implants

Bottoming Out of the breasts is a condition when the skin around the implant stretches 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.

Bottoming Out of the Implant Reasons for Bottoming Out

  • Requesting implants too large for your frame

  • Early use of the Pectoralis muscle may push a submuscular implant downward

  • Enlargement of the implant pocket downward

Bottoming Out of the ImplantCorrection of Implant Bottoming Out

39 year old 5' 3" 112lbs. 1 month after correction of bottoming from too large of implants for her size frame
Implant size reduced from 450cc to 400cc on the left side and 425cc to 375cc on the right side

Incorrect Myths About Breast Implants

Implants Require Replacement Every 10 Years

Not true: Implants will only require replacement when they are ruptured or broken.

I have seen breast implants last over 35 years.

Saline filled implants will generally not last as long as silicone implants because the valve on the implant used to insert the solution is a potential source of failure.  Silicone implants do not have a valve and are sealed at the factory during manufacturing.

Gel Filled Silicone Implants Feel Softer & More Natural Than Saline Filled Implants

This is incorrect:  I have performed thousands of Breast Augmentations with both types of implants and a woman can be soft and natural looking with either type of implant.

The most important factor (other than a experienced Plastic Surgeon) for you to achieve a soft and natural looking breast after Breast Enlargement is how soft and pliable the capsule remains.  The capsule is the tissue your body forms to encapsulate the breast implant. 

Implants Look Better When Placed Under The Muscle

It is important to recognize there are many shaped breasts and that placing them all in the same position (under muscle) will not look good on all women.

I place implants both on top the muscle (subglandular) and under the muscle (submuscular or sub-pectoral).

Generally, a heavier woman with more breast tissue, sitting lower on the chest will look better on top the muscle (Subglandular), while a thin woman with small breast will look better under the muscle (Submuscular).

The inexperienced Plastic Surgeon frequently makes a mistake in the proper positioning of the breast implant.

See this example of - Implants improperly placed under the muscle

Gel-Filled Sizing Bras Will Tell Me The Right Size Implant For Me.

Not so:  In fact it may give you a false impression that this is the best size for you, when another breast implant size might actually be better suited for your shape.

The reason for this is that the breast implant looks different once under the muscle and breast tissue.

Generally, I find several implant sizes will look good and could be used on each woman.  That is why I don't use sizing bras but ask women to show me photos of breast augmentations that they like.  This gives me a better idea of how large and how much fullness they want following Breast Augmentation.

Shaped Silicone Breast Implants ( "Gummy Bears") are the best Implants for Breast Augmentation

Unfortunately these implants are more expensive and do not provide an advantage over round silicone implants for most women.  The will be certain women who will benefit from these.

For me, I like round implants in most women who are looking for fullness and they can give the natural look that most want.

Five Things You Must Know Before a Breast Augmentation

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 is Board 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.

Understand if a Breast Lift is Necessary for a Good Shape

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.

Understand the Limits of the Size and Shape Implant for Your Body

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.

Ask if You Should Have a Submuscular or Subglandular Implant Placement

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.

Find Out Which Implant, Either Saline or Silicone is Right for You

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;

Sometimes a 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 Information About My Breast Augmentation Procedure

Anesthesia - General

Procedure Time - 1-1.5 hours

Typical incisions - Transaxillary, Periareolar & Inframammary

Placement of the breast implant - Submuscular or Subglandular

Return to activities - Gradually, with unrestricted activities resumed after 4 weeks

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 and is option to help reduce the pain

Choose a Pain Pump for Greater Post Operative Comfort

This passive pain pump is one of many different pain pumps available and is worn 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 reduce the pain and is highly recommended for this type of surgery.

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Breast Enhancement Consultation with
Dr. Costanzo of Thousand Oaks, California

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805 / 373-9919

Thousand Oaks Breast Augmentation with Silicone or Saline Breast Implants, Beverly Hills, Los Angeles, Calabasas, Ventura, Santa Barbara by Thousand Oaks Board Certified Plastic Surgeon Dr Costanzo. Mayo Clinic trained and Board Certified in Plastic Surgery in 1987, Christopher Costanzo MD gives his opinions on TUBA incision, Gummy Bear Implants, Silicone and Saline Breast Implants. He performs Cosmetic Surgery and Breast Augmentation Beverly Hills Style for patients in California, serving Thousand Oaks, Beverly Hills, Los Angeles, Calabasas, Ventura, Santa Barbara, Encino, Sherman Oaks, Tarzana, Chatsworth, Canoga Park, Granada Hills, Woodland Hills, West Hills, Malibu, Agoura, Oxnard, Moorpark, Simi Valley, Camarillo, Westlake Village, Los Angeles County, Ventura County and Santa Barbara County. View Beverly Hills Style Breast Augmentation with Silicone and Saline Breast Implants.

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Disclaimer - The information about Cosmetic surgery contained in this web site is for
informational purposes only and does not constitute medical advice.
Call to schedule an appointment with Thousand Oaks Plastic surgeon Dr. Costanzo,
2190 Lynn Road, Suite 380, Thousand Oaks, CA 91360