There are several special concerns or considerations when breast augmentation is performed in an athlete or fitness enthusiast. This topic arose when I recently performed a breast augmentation and breast implant revision for Vida Guerra, an internationally known model who has also been successful in professional fitness competitions. In the past, I have also done breast augmentations for female weightlifters and boxers, a college soccer goalie, many marathon runners, and countless other athletes. There are factors to consider for each of these patients and activities, requiring a plastic surgeon who understands the patients’ needs, and who will adapt the procedures accordingly.

First, it’s important to understand that breast implants are actually very strong and durable. They can withstand major trauma (such as slamming the chest against a car steering wheel in an accident) without rupturing in many instances. Participation in a highly physical sport should not prevent any woman from seeking breast augmentation.

I usually place breast implants in a subpectoral position (underneath the chest wall muscles). The muscle cushions and pads the implants, giving a more natural look and feel. Weightlifters or athletes who use their chest muscles in competition need to understand that contraction of the pectoralis muscles can distort or shift the implants temporarily. This is not harmful, but those women may not like the appearance of the breasts when the muscles are maximally contracting. One option would be placement of the implants in a subglandular position (above the muscle). The breast appearance would therefore not change much when the muscles are used. Each patient needs to weigh the advantages and disadvantages (with my help, of course) of subpectoral versus subglandular augmentation based on her needs and desires.

Fitness competitors and runners, who are often very thin, may want to consider silicone implants rather than saline implants to maintain a more natural appearance, especially during the activities involved in competition. Silicone is softer than saline, and tends to look more natural, especially in women with little fat or breast tissue to soften or cushion the implants.

I have operated on many runners who specifically request that I avoid excessive fullness on the sides of the breasts, in order to minimize any problems with arm movement while running. One of my patients, an avid marathoner, was “scared of losing my running stride and ability” after breast augmentation, yet she wanted “to look more feminine.” We discussed her concerns and developed an excellent surgical plan for her. She wrote me 2 ½ months later to say “I feel great. I just completed the L.A. Marathon and the twins (my new breasts) were great!”

It’s also important to remember that larger implants are heavier, which can be an issue for marathon runners and others. Using an implant size that’s appropriate for the patient’s anatomy can help to prevent unwanted stretching of the tissues or discomfort related to sports and training.

Any woman may seek breast augmentation regardless of her athletic activities or physical demands. It’s important to select a plastic surgeon (certified by the American Board of Plastic Surgery, of course) who will take the time to understand your specific needs and desires, and who will then create the ideal surgical plan. I’m sure Vida Guerra will grace many more magazine covers, but I also know that she will feel comfortable and confident in her appearance during her upcoming fitness competitions.

Gynecomastia, or male breast enlargement, often causes significant physical and emotional distress. This condition may develop during teenage years or earlier, when it can be especially traumatic, but also occurs later in life. Patients are usually embarrassed to remove their shirts in public, and sometimes have such severe gynecomastia that the breasts appear feminine even in a shirt. Fortunately, treatment such as male breast reduction surgery by an experienced plastic surgeon certified by the American Board of Plastic Surgery frequently results in substantial improvement.

Gynecomastia can be caused by drugs (such as marijuana or anabolic steroids used for bodybuilding), medications, hormonal imbalances or genetic conditions. Often, the condition is idiopathic, meaning that it arises for no clear reason. A properly trained physician, usually the plastic surgeon, should evaluate the patient for possible presence of underlying or treatable causes.

The first line of treatment for gynecomastia, or male breast enlargement, usually involves use of liposuction. Many patients obtain excellent results with liposuction alone, which can be performed using very small, usually inconspicuous incisions. There are various techniques to make it easier for the plastic surgeon to remove the fat and breast tissue during liposuction, including ultrasound-assisted liposuction, power-assisted liposuction, and others.

Sometimes the breast tissue is too thick and tough to be removed by liposuction alone (especially the tissue directly behind the nipple and areola). This tissue can be excised, or cut out, in combination with liposuction. Frequently, a fairly small incision around the areola can be used, resulting in a very reasonable scar.

Less commonly, some patients may have so much excess skin that a procedure similar to a breast lift or mastectomy is performed, removing the loose skin and tightening the chest. Scars can be more noticeable with such procedures. Even for patients who seem to have too much skin, it is usually advisable to begin with aggressive liposuction, reserving a second surgery to remove extra skin for later if necessary.

It is extremely important to consult a plastic surgeon certified by the American Board of Plastic Surgery, such as Orange County and Newport Beach area plastic surgeon Andres Taleisnik, M.D., when seeking evaluation and treatment for gynecomastia. For a free consultation, please call Dr. Taleisnik’s office at 714-835-6500.

In recognition of Breast Cancer Awareness Month, I think it is appropriate, and very important, to discuss the impact of breast implants and breast augmentation on mammograms and breast cancer detection.

Breast implants do interfere slightly with the ability to visualize ALL of the breast tissue during a mammogram. Reputable breast care centers and mammography centers are very familiar with the techniques necessary to obtain the highest quality mammograms. Mammograms are still important and helpful for patients with breast implants. The likelihood of damaging the breast implants or the breast augmentation surgery during a mammogram is extremely low.

Perhaps most important is the fact that large scientific studies have documented that the outcomes for women with breast cancer are similar whether they’ve had a breast augmentation or not. The size of the tumor when first detected, the staging of the cancer (how advanced it is, and how much it might have spread), and the survival rate are comparable for women with breast implants and those without implants.

In summary, most physicians believe that breast augmentation is not excessively risky from the standpoint of cancer detection. Indeed, implants are often used to reconstruct the breasts after mastectomies for cancer, in women who are truly at higher risk. It remains important for women to perform monthly self-exams of the breasts, and to obtain annual exams from their physician, in addition to regular mammograms.

Breast augmentation is an extremely popular procedure for good reason: most women are very happy with their results, and with their decision to undergo this surgery. One of the conditions that can lead to dissatisfaction is capsular contracture, although this too can often be treated and improved.

The human body will naturally form a membrane or tissue layer around any foreign object. We call the layer that forms around a saline breast implant or silicone breast implant the “capsule.” There is always a capsule around any breast implant, but usually the capsule remains thin and soft. Occasionally, the capsule tightens and thickens, or “contracts,” around the implant. This can cause the implant, and the breast, to feel too hard. Capsular contracture can push an implant out of its proper position, creating a breast asymmetry. It can also produce an abnormal breast shape, or a very unnatural appearance to the breasts. At times, capsular contracture can be painful.

The cause of capsular contracture is not fully understood, despite extensive research on this topic. Certain factors that increase the likelihood of developing capsular contracture have been identified, however. Excessive bleeding around the implants immediately after surgery, touching the implants with gloves that are coated with powder, and patient smoking are some of these factors. Some surgeons believe that, if a breast implant is placed in front of the muscle, a textured implant may have a lower contracture rate than a smooth implant. Some surgeons also recommend massaging the implants after surgery, although it’s not established that implant massage makes a measurable difference. Clearly, there are things that your surgeon can do, and things that you can do (avoid smoking!), to decrease the chances of a capsular contracture.

Even when all precautions are taken, however, some women will still develop capsular contractures. As a plastic surgeon specializing in breast augmentation and breast revision surgery, I frequently treat patients for this problem. A “capsulectomy” is a surgical procedure that involves cutting out the capsule and scar tissue, leaving behind soft breast tissue. It’s basically like starting over. Some women may again develop a capsular contracture after the capsulectomy, but many will not. It’s very important to avoid smoking if you are undergoing a capsulectomy. Some surgeons prescribe a medication called Singulair when operating on a patient with a capsular contracture. This is actually a medication for asthma, but many doctors believe that a beneficial “side effect” of Singulair is a reduced rate of capsular contracture. When undergoing a capsulectomy, the implants may also be replaced, so that they are brand new, with no wear or bacteria. The implant size can be changed too if desired. Sometimes, the capsular contracture may be holding the implants and breasts up, giving a perky appearance even though the breasts are too hard. Once the scar tissue is removed, the breasts may look more ptotic, or droopy. To counteract this, it may be helpful to use a larger implant, or to include a mastopexy, or breast lift.

To give yourself the best chances for a great outcome after breast augmentation, or to obtain treatment if you’ve already developed a capsular contracture, it’s critical that you consult a plastic surgeon certified by the American Board of Plastic Surgery, the only organization that board certifies fully trained and experienced plastic surgeons. I treat patients with capsular contracture (and other problems after breast augmentation) from throughout Orange County, Los Angeles County, Riverside County, San Bernardino County and elsewhere. If you’d like to schedule a consultation to meet with me, either for a first-time breast augmentation or a revision surgery, please call my Newport Beach area office at 714-835-6500. Please also visit my website for more information: ataleisnikmd.com.

Serving Newport Beach, Riverside County, San Bernardino County, Los Angeles County

Unfortunately for our bodies, gravity is always pulling. This leads to drooping eyelids, drooping faces, drooping tummies, and yes, drooping breasts. Big breasts tend to droop or sag more than small breasts as time passes, but no breast is immune. There are other important reasons that breasts can droop. Pregnancy is a major cause of breast drooping (medically referred to as “ptosis”). I’ve recently written several articles about “The Mommy Makeover,” a combination of procedures (including breast enhancement) designed to counteract the effects of pregnancy and breastfeeding. Some women develop breasts with unsatisfactory shapes, often with ptosis, right from the start, during puberty. Other women experience severe breast drooping after losing large amounts of weight. Fortunately, procedures are available to improve all of these problems.

Breast drooping, or ptosis, is usually improved with a surgery known as a mastopexy, or breast lift. A mastopexy can raise the nipple and the areola (the darker skin around each nipple) to the appropriate height. It can help to restore cleavage, lift the breast off the chest wall, and improve the appearance and feel of breast fullness. If the areola diameter is too big, the areolas can be reduced to a more pleasing size. Many women tell me that it’s much easier to find properly fitting bras, and attractive swimsuits or clothing, after undergoing a breast lift.

The first step is to determine whether you actually need a breast lift, or if your breasts are simply “empty” or “deflated,” as can often occur after pregnancy and breastfeeding. Many patients who see me in my Orange County office requesting a breast lift actually benefit more from a breast augmentation. It’s important to consult a plastic surgeon certified by the American Board of Plastic Surgery if you’re thinking about enhancing your breasts. Your surgeon must have the necessary education, training, experience, and judgment to help you to decide which procedure will provide the improvement you desire. Certainly, there are many women who do require a lift, and others who benefit most from breast augmentation in combination with a breast lift. A breast lift alone may not be able to restore the volume and upper breast fullness that some women seek. For such patients, adding implants to a breast lift can produce beautiful results.

Any breast lift will create come scarring on the breast. In most patients, the scars fade and become fairly inconspicuous with passage of time. Some patients, however, will form scars that remain more visible (but not in clothing or a swimsuit). There are different types of lifts, each producing different degrees of scarring. Many factors determine which type of lift is appropriate for any given patient.

When ptosis, or breast drooping, is quite severe, patients require a traditional type of mastopexy, or lift. This type of lift creates more scars, but is also very powerful. The breasts can be totally reshaped and repositioned with a full mastopexy. Once again, it may be helpful to add implants as well to improve upper breast fullness and cleavage.

I often perform a modified type of breast lift for my patients undergoing breast augmentation who also require slight tightening of the breast skin and slight elevation of the nipples and areolas. This is referred to as a “concentric mastopexy.” This type of lift creates a scar around the areola only. Since the scar is at the border of two different colors and textures of skin, it tends to blend in well. Photos illustrating this can be seen on my website

If your breasts are heading south, or if you’re unhappy with them in any way, please don’t hesitate to contact my office at 714-835-6500. We can arrange a free consultation, where I can help you to decide the best way to obtain the improvements you want. I evaluate and treat patients from all over Newport Beach and Orange County, Riverside County, San Bernardino County, and LA County, as well as patients from other states, who are dissatisfied with their breasts. I look forward to helping you too.

As many women know so well, there can be a physical price to pay for having children. Unfortunate changes often occur in the breasts, abdomen (tummy), or other areas. I recently wrote an article about The Mommy Makeover, a combination of plastic surgical procedures designed to help women to regain their pre-pregnancy figures (or even better). A Mommy Makeover almost always includes a tummy tuck (or abdominoplasty), and procedures to improve the breasts. I also wrote recently about the tummy tuck component of The Mommy Makeover in greater detail. This article addresses the enhancement of the breasts after pregnancy.

Many women who were entirely satisfied with their breast size and shape prior to pregnancy complain of decreased volume, emptiness of the breasts, or sagging afterwards. Fortunately, I can offer surgical options to improve each of those problems. It is important to consult a plastic surgeon certified by the American Board of Plastic Surgery, as I am, since the surgeon must have the training, knowledge and experience to provide an individualized plan for every patient, since every woman’s needs and desires are unique.

Some women complain to me that their breasts are “saggy” after pregnancy, when they are actually just “empty.” Such patients may do extremely well with breast augmentation alone, using either saline or silicone implants (I’ve discussed the differences in a prior article). The implants can restore fullness, which is usually quite lacking in the upper breast and cleavage area in particular. There may be choices as to the final size or volume of the breasts as well. When you meet with me for your consultation, I will help you to determine whether augmentation alone will achieve your goals.

While augmentation alone may be sufficient for many women, there are certainly others who might benefit from a lift, or mastopexy, with or without implants. If the nipples are on the lower part of the breasts, or point downwards, a lift could be helpful. A lift is often beneficial if the nipples are near or below the level of the inframammary fold, which is the crease or fold beneath each breast.

If the breasts already have enough volume, a lift alone may be fine. Often, however, it’s not possible to restore the degree of fullness in the upper breasts that many women want without using implants. Such patients are candidates for an “augmentation mastopexy,” or lift plus implants.

There are also different types of lifts that can be used. If there is significant drooping (breast “ptosis”) or laxity of the breasts, a larger, more traditional type of mastopexy, or lift, must be used. Such lifts create more scars (which usually fade and become fairly inconspicuous as time passes), but are also more powerful, reshaping a severely saggy breast very nicely. If a more minor degree of lifting or tightening is required, there are lifts that involve, for example, scars only around the areolas. These are known as “concentric mastopexies,” “crescent lifts,” and others.

The good news is that a caring, well-trained plastic surgeon can improve MANY of the unwanted body changes that accompany pregnancy, childbirth and breastfeeding. As you might imagine, it’s critical to seek a surgeon who is not only well-trained and certified by the American Board of Plastic Surgery, but who will also take the time to evaluate your specific issues and desires, and to review them with you in an understandable fashion so that you can make the best possible choices. I take pride in caring for my patients with more individualized and complete attention than can be found anywhere else, as you’ll discover when we meet. Please call my office at 714-835-6500 to schedule your free consultation.

Orange County, Newport Beach, Riverside County

Having children is a wonderful experience for most women, but it often leads to many undesired changes in their bodies. Some women are fortunate (not many!), since their bodies recover almost to the pre-pregnancy shape. Most never quite regain the figures they had before giving birth.

Common unwanted changes include deflation or emptying of the breasts, sagging of the breasts, and development of stretch marks or loose skin and muscles on the tummy. These problems can develop even with an excellent diet, vigorous exercise, or use of creams and other “potions.” Fortunately, as a plastic surgeon certified by the American Board of Plastic Surgery, Andres Taleisnik, M.D. frequently helps women in Orange County to regain their more youthful, pre-pregnancy bodies.

The popular term today for a combination of surgeries designed to reverse or improve the damaging effects of pregnancy is “Mommy Makeover.” Dr. Taleisnik often performs abdominoplasties (tummy tucks) together with breast surgery (breast augmentation, breast lift, or both) to provide a rapid and dramatic appearance improvement. Liposuction, such as for the hips or flanks, can be added as well.

For most women who are in reasonable health, it’s reasonable to do the various procedures at once. This results in a single anesthetic, a single recovery period or absence from work, and a lower overall cost than doing procedures separately. Dr. Taleisnik will help you to determine which procedures will be most beneficial for you, and whether you’re a candidate for the full “Mommy Makeover.” Please call his assistant Linae at 714-835-6500 to schedule your free consultation with Dr. Taleisnik.

Please watch for future articles on the individual surgeries that make up the “Mommy Makeover.”

Differences in size are often improved with the use of breast implants. Different volumes or implant shapes can be used on each side, generally improving the symmetry. Usually, other modifications are needed a the same time in order to maximize the results. The position of the inframammary fold (the crease beneath the breast) may need to be raised or lowered. Changes might be necessary within the breast tissue itself, such as to allow a “cone-shaped” breast  to become more rounded. 

Some Orange County patients benefit from a mastopexy, or breast  lift. There are different types of mastopexies that are possible. Some patients may require a lift on both sides, with one side lifted or tightened more than the other. Some patients may require a lift on one side only. Yet other patients may benefit from a reduction on one side, and a lift or even augmentation on the other side.

Surgery for breast asymmetry is specialized, and every patient in Orange County is completely unique. It’s important to consult a plastic surgeon certified by the American Board of Plastic Surgery, as I am. It’s just as important to find a surgeon who will take the personal time with you to determine the best way to address your asymmetry.

Dr. Andres Taleisnik

Most implants used for breast augmentation are round, whereas a smaller percentage have a “teardrop” shape. The “teardrop” implants, sometimes referred to as “anatomic” implants, are thicker (project or stick out more) towards the bottom of the breast, and thinner (project less) at the top of the breast. In theory, this could provide a more natural breast shape. In actuality, other factors are far more important in determining whether the breast appearance looks “natural.” Round implants don’t mean that the breast will look round. If the space for the implant (the implant pocket) is created properly, and the size chosen is appropriate, the round implant can provide an extremely natural appearance. I’ve stopped using the teardrop implants in recent years, mainly because the teardrop implant must have a textured, or rough, outer surface. The textured surface is necessary to keep the implant from rotating in the pocket, which might put the thicker and thinner parts of the implant in the wrong places. In my experience, the textured implants don’t settle into the breast as easily and naturally as the smooth implants. As a result, I mainly use smooth round implants. It doesn’t matter if a round implant rotates in the breast pocket, since this would not affect breast shape.

Another factor to consider is the “profile” of the implant. This term refers to the relationship between the diameter of the implant and its projection (how far it protrudes from the chest). The standard implant  has a “moderate” profile. There are also “high profile” implants that have a narrower diameter, with greater projection, for any given volume as compared to the moderate profile implant. A high profile implant might be ideal, for example, for a patient with a narrow chest wall. The high profile implant would allow such a patient to use the desired volume without the implants being too wide for her chest. There also exists a profile in between the high and moderate profile implants, referred to as “moderate plus profile.”

The “art” of breast augmentation involves consideration of implant texture, shape, and size among many other factors. Every patient is unique, and requires an individualized assessment and plan to achieve the best possible results from surgery. During your consultation, I’ll discuss these and other issues and decisions that will help you to achieve the appearance you’ve dreamed about.

Andres Taleisnik, M.D. is a board certified plastic surgeon in Orange County who offers a wide range of cosmetic plastic surgery procedures, such as liposuction, tummy tuck surgery (“abdominoplasty”), breast lift surgery, and breast augmentation surgery. To learn more, contact Dr. Taleisnik to schedule a complimentary consultation.

Silicone implants can often look and feel a little more “natural” than saline implants. Since a silicone implant is pre-filled, a larger incision is needed to insert a silicone implant than a saline implant, which can be inserted partially filled. A woman with small areolas (the dark skin around the nipple) may not be able to receive silicone implants through an incision around the areola, and instead may require an incision in the crease under the breasts. There have been questions in the past regarding possible effects of silicone if it leaks. For this reason, silicone implants were available only to women who met certain criteria, and who were enrolled in the large silicone implant studies, until Fall, 2006. After years of extensive testing, including evaluation of the many women who received silicone implants as part of the study, the Food and Drug Administration (FDA) now allows any woman 22 or over to receive silicone implants. The FDA also recommended that women undergo an MRI examination of the breasts 3 years after receiving silicone implants, then every other year thereafter. Silicone implants are significantly more expensive than saline.

Saline implants remain the most popular choice in my practice. I can obtain very natural and beautiful results with saline implants too in most patients. Many of my patients prefer the firmer look and feel of the saline implants, which may result in a more “youthful” outcome. Most patients choose the peri-areolar incision, which generally is very inconspicuous (more on incisions for breast enhancement in another article). If a saline implant leaks, there are no concerns regarding a foreign substance in the body, since the implants contain only salt water. Saline implants may also be more helpful than silicone to counteract mild drooping or shape abnormalities of the breasts.

During your consultation with me, I will help you to decide which implant type will be best for you. There are a number of other decisions to make as well, including the shape or “profile” of the implants, the incision to use, the size, and others. I will guide you through the entire process, so that you will feel comfortable with your choices, and very happy with your results.

To schedule your consultation to meet with me (no charge), please call my office at 714-835-6500. Please also visit my website at www.ataleisnikmd.com.