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Dr. Cohen's Perspective: Breast Augmentation & Enhancement

In Los Angeles, cosmetic breast surgery, such as breast augmentation, is quite common. With years of experience performing all types of breast enhancement surgery, I wanted to highlight some of the patients whose results demonstrate the possibilities of these procedures. These women had unique concerns about their appearances and underwent procedures that included breast reduction and breast lift. At my Los Angeles practice, I'm able to share my perspective as a plastic surgeon who has performed thousands of aesthetic breast surgeries.

Here are some of my favorite cases:

Breast Augmentation

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One of the common goals of breast augmentation patients is for their results to look both beautiful and natural. It's much rarer these days to meet a woman who wants her breasts to be disproportionately large for her body. This 24-year-old told me she wanted breast enhancement surgery to balance her figure. She chose the popular Sientra "gummy bear" implants, which, in this case, had an anatomical shape that created roundness in the lower two-thirds of the breasts while tapering out naturally in the upper third. I used inframammary incisions (in the fold underneath each breast) and inserted the implants under her chest muscles.

Breast Augmentation

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BeforeAfter

As a breast augmentation specialist in the Los Angeles area, I see many patients who have careers in modeling or the entertainment industry. Their appearances are an important part of their careers. This woman is a professional model in her early 20s. She told me she wanted an enhanced figure with very natural-looking results. After discussing breast implant options, she chose to have silicone implants placed under the chest muscle. As you can see — or, more accurately, can't see — there are no obvious incisions. Even though incisions made at the folds of the breasts are barely visible after they fade, some patients choose instead to have incisions made around the areolas. Those are the incisions I used in this procedure.

Breast Implant Revision

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While most breast augmentation patients are very pleased with their results, complications sometimes occur. This 58-year-old woman underwent breast augmentation with another surgeon and came to my office hoping to improve the appearance of her widely-spaced breasts that looked very unnatural.

It is very gratifying for me to help women such as this patient regain aesthetically pleasing breasts using multiple advanced surgical techniques. In this case, I redesigned the implant pockets with a neo-subpectoral pocket technique and replaced her implants with textured, anatomically-shaped implants to create a more natural shape and stable results. Fat grafting helped improve the cleavage and softened her breasts. I used fat harvested from her flanks and inner thighs via liposuction and processed with the Revolve fat grafting system. The patient's recovery went well, and she was extremely happy with the outcome.

Breast Implant Revision/Breast Lift/Tummy Tuck

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Revision breast augmentation procedures can be some of the most complicated surgeries performed by plastic surgeons. They require extensive experience and the ability to effectively use many advanced techniques that aren't employed during the initial breast enhancement procedures. In this case, a 40-year-old patient arrived at my practice after having undergone multiple surgeries performed by other physicians. The most recent procedure was performed by a doctor who wasn't a plastic surgeon, leading to the severe implant malposition shown in the photos.

I reconstructed the breast implant pocket and replaced the saline implants with silicone implants, removed old scar tissue, and used an "internal bra" to reinforce the repairs and to support the implants. I often use Strattice, an acellular dermal matrix, to help stabilize repairs — in breast revision and other breast enhancement procedures.

I also performed a tummy tuck for this patient, who was thrilled with the dramatic improvement in the appearance of her breasts and body.

Breast Lift/Fat Grafting/Mommy Makeover

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Combining multiple procedures is a great way to produce dramatic, comprehensive results. That's especially true for patients such as this 39-year-old woman who wanted larger, perkier breasts along with a tummy tuck and liposuction. I enjoy using innovative techniques when appropriate, and in this case, I recommended using the patient's own fat to augment the breasts instead of inserting breast implants. I felt this would be the best option because she already had a fair amount of breast tissue, and fat grafting to the upper breasts would provide the aesthetic results she desired without requiring the use of implants. Plus, I planned to perform liposuction, as part of her tummy tuck, so instead of discarding the fat, I re-purposed it to create upper breast fullness.

To create the perky appearance she wanted, I performed a breast lift, in addition to the fat grafting. These types of mommy makeover procedures are very gratifying because patients typically regain the confidence in their bodies that they had lost after having children.

Breast Reduction/Breast Lift

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This is another case in which the patient, a 37-year-old woman, told me she was disappointed with the way her breasts sagged after having children. She wanted perkier breasts with improved symmetry, but didn't want to reduce the size of the breasts very much. Based on our conversation, I recommended that a breast lift would be the best approach. During surgery, I rearranged and compacted her breast tissue into a rounder, more aesthetic shape and removed a small portion of tissue from the left breast to create better symmetry.

I also reduced and repositioned the nipples (without detaching them from the underlying breast tissue), minimizing the risk of the patient losing nipple sensitivity. She was incredibly happy with her rejuvenated breasts and improved body aesthetics.

Breast Augmentation/Breast Lift/Mommy Makeover

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Creating a surgical plan for mommy makeover patients is a rewarding part of my job because I can envision the results and have confidence that my patient will be happy. Like many women who have had children, this 33-year-old patient wanted her pre-pregnancy body back. Her breasts lost volume and sagged after breastfeeding, and she did not like the loose and wrinkled appearance of her abdominal skin.

By combining breast augmentation with a circumareolar breast lift (using incisions around the areolae), I was able to create a dramatic improvement with minimal breast scars. In addition to the breast lift and silicone augmentation, I performed an abdominoplasty with liposuction of the flanks. She was very pleased with the vast improvement in her physique.

Breast Reduction

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It's very gratifying to help women relieve the discomfort associated with overly large breasts. Persistent back, neck, and shoulder pain bothered this 31-year-old woman, and she had difficulty participating in any physical activities. Her bra straps also caused significant grooves in her shoulders.

I used an anchor incision during the surgery, but you can see that the scars on the underside of the breasts are barely visible. The patient was thrilled with both the aesthetic outcome and the dramatic improvements in her physical symptoms. (I do want to point out that the appearance of the abdomen is the result of overly-aggressive liposuction performed by another surgeon.)

Breast Reduction

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I really enjoy helping young women who make the decision to get breast reduction surgery. Like many women considering breast reduction, this 23-year-old female suffered from neck and back pain, discomfort from bra straps, and had a hard time being physically active because of the size of her breasts. Scars are the primary worry of most breast reduction patients, but in most cases meticulous surgical technique and proper incision care minimize the appearance of scars over time.

The patient's reduced breast size gave her a slimmer, longer waisted appearance and she told us that she is also very happy because she can now exercise much more easily.

Breast Augmentation/Breast Lift

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This is the kind of case that really demonstrates how breast augmentation can boost a patient's confidence. This patient is a 31-year-old woman with a variation of tuberous breasts, a condition characterized by narrow, cylindrical breasts, often with "puffy" areolae. She wanted to improve the breasts' shape and increase their size so to make them proportional to her body.

Using silicone implants and a circumareolar mastopexy, I was able to create both rounder and larger breasts and correct the tuberous condition, resulting in an aesthetically-pleasing result that is more feminine, youthful, and proportionate to her body.

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Dr. Robert Cohen

Certified by the American Board of Plastic Surgery

Dr. Cohen is a leader in the field of aesthetic plastic surgery whose expertise is highly regarded by both patients interested in improving their appearance, and plastic surgeons seeking to improve their techniques by attending his lectures. Dr. Cohen's goal is to understand your specific concerns, evaluate your anatomy in detail, and create a customized plan to help you achieve the best results possible based on the most modern techniques and materials available. Let him put his experience and aesthetic insight to work for you.

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