Breast augmentation is one of the most commonly performed cosmetic procedures in the world, which means there are also a great many mediocre results. What separates an exceptional breast augmentation outcome from an average one is not the implant itself but the surgeon’s judgment, technique, and commitment to individualized planning. Dr. David E. Kim, a board-certified plastic surgeon serving Beverly Hills and the greater Los Angeles area, approaches every breast augmentation with a level of precision and aesthetic attention that reflects his standard of care across all procedures.
The Anatomy-First Philosophy
The most common mistake in breast augmentation, and the root cause of most revisions, is choosing an implant based on a desired cup size or volume number rather than the patient’s specific anatomy. Chest wall width, existing breast tissue, skin thickness, and the distance between breast landmarks all determine the appropriate implant dimensions for any given patient. Choosing an implant that exceeds what the anatomy can safely support leads to complications including rippling, malposition, and accelerated capsular contracture.
Dr. Kim uses tissue-based planning principles for every breast augmentation: the anatomy tells us what implant is appropriate, and patient preference is refined within that range.
Implant Type: Silicone vs. Saline
Modern cohesive silicone gel implants are the most popular choice for breast augmentation because they mimic the natural feel of breast tissue more closely than saline. Highly cohesive (gummy bear) implants maintain their shape well over time even if the shell is compromised. Saline implants are filled with sterile saltwater after placement and allow for minor size adjustments during surgery, which can be useful for patients with mild asymmetry.
Implant Profile: An Important and Often Overlooked Decision
The profile of a breast implant, low, moderate, moderate-plus, or high, determines how far the implant projects forward relative to its base diameter. Patients with narrower chests typically benefit from higher-profile implants (which project more but have a narrower base); patients with wider chests can accommodate lower-profile implants with a wider footprint. Choosing the wrong profile for a patient’s chest dimensions is a common source of implant malposition or unnatural appearance.
Incision Placement Options
Inframammary Fold (IMF)
The most commonly used approach. The incision is placed in the fold beneath the breast, where it is well concealed and provides direct access to the implant pocket. Most surgeons, including Dr. Kim, prefer this approach for its precision and the ability to create a well-defined pocket.
Periareolar
An incision placed along the lower border of the areola, where the color transition camouflages the scar. Appropriate for certain patients but associated with a slightly higher rate of sensation changes to the nipple and a possible effect on breastfeeding.
Transaxillary
An incision placed in the armpit, leaving no scar on the breast itself. Technically more demanding and less commonly used but appropriate for select patients.
Placement: Above or Below the Muscle?
Submuscular placement (beneath the pectoral muscle) provides more soft tissue coverage over the implant, particularly in the upper pole, and is associated with lower capsular contracture rates and more natural-appearing results in most patients. Subglandular placement (above the muscle) may be appropriate for specific anatomical situations. Dr. Kim will discuss the recommended placement for your specific anatomy.
Recovery and What to Expect
Breast augmentation is performed as an outpatient procedure under general anesthesia. Most patients return to desk work within five to seven days. Upper body exercise restriction lifts at four to six weeks. Implants take two to three months to fully settle (drop and fluff) into their final position. Final results are visible at three months.
Dr. Kim provides breast augmentation to patients in Beverly Hills, Los Angeles, West Hollywood, Santa Monica, and throughout Southern California. To begin planning your procedure, schedule a consultation with Dr. Kim today.
Schedule a Consultation with Beverly Hills California Plastic Surgeon Dr. Kim
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