Breast Augmentation in Beverly Hills

Dr. Killeen uses silicone implants only; she no longer offers saline. Silicone looks and feels more natural and ripples less, and today's cohesive gel tends to stay inside the shell even if the implant ruptures. Because a silicone rupture is often silent, silicone implants are checked with imaging over time.

Dr. Killeen uses only smooth implants, including Motiva's SmoothSilk surface, and does not use macro-textured implants, which are linked to a rare lymphoma called BIA-ALCL. Today's silicone gel is cohesive (the "gummy bear" consistency people ask about) and comes in a range of firmness: firmer gels ripple less but feel firmer. Round implants hold a fuller, rounder shape, while Motiva's Ergonomix implants settle into a softer, more natural slope.

Learn why she uses smooth implants and how Round and Ergonomix implants compare.

You choose the volume; the profile is then matched to your chest width. Higher-profile implants project more but take up less chest width, while lower-profile implants spread wider and project less.

Implants are measured in cc, and the cup size that results is essentially unpredictable, so Dr. Killeen does not promise one. As a rough average, about 150 cc is one cup. Sizers in the office, 3D imaging, and trying volumes at home all help you choose, and small implants can make a big difference. See how many cc make a cup size.

There is no animation deformity, the visible movement of the implant when the chest muscle flexes, and recovery is generally easier. The trade-off is that the implant edge can be a little more visible in thin patients. In her experience, patients are bothered less by a slightly more visible implant than by muscle movement.

The muscle adds a layer of coverage over the upper implant, which can help very thin patients hide edges and rippling. The recovery is more painful, the implant can move when the muscle flexes, and implants under the muscle tend to drift farther apart over time.

There is no perfect solution; it comes down to which trade-off would bother you more. A small amount of fat grafting, as little as 10 to 20 cc per side, can soften implant edges and smooth the transition. More on placement when you have very little breast tissue.

Concealed in the crease under the breast, this is Dr. Killeen's preferred incision. It gives direct access for precise placement, avoids cutting through breast tissue and milk ducts, and carries a lower risk of capsular contracture and infection than the alternatives.

Made at the edge of the areola. Because it cuts through breast tissue, it is more likely to affect milk ducts, nipple sensation, and breastfeeding, and it carries a higher risk of capsular contracture and infection. Dr. Killeen does not recommend it for augmentation.

Made in the armpit, so there is no scar on the breast, but the scar can show in a sleeveless top, and this approach also carries a higher risk of capsular contracture and infection. It is not Dr. Killeen's preferred approach.

The nipples are covered, the pocket is rinsed with antiseptic solution, gloves are changed and the skin is prepped again right before the implant goes in, and the implant is placed with a Keller Funnel so it is never touched directly. Learn how infection risk is lowered in the operating room.

Women with implants breastfeed at rates similar to women without implants, though they tend to make less milk and are more likely to supplement with formula. The incision matters most: the crease incision minimizes disruption of the milk ducts, while an incision around the areola is the one most associated with breastfeeding trouble. Learn how incision choice affects breastfeeding.

Implants do not raise your risk of ordinary breast cancer, and you should keep up with routine screening. Implants can make mammograms less sensitive, so tell the technician you have implants and ask for displacement views, which move the implant out of the way to image more breast tissue. A mammogram checks the breast tissue, not the implant itself. See mammograms with implants.

Implants are not lifetime devices, but there is no set expiration date. The old advice to replace them every 10 years came from older implants, and with today's implants Dr. Killeen favors monitoring over routine replacement. Silicone implants should be checked with ultrasound or MRI starting about five years after surgery and every other year after that. Learn whether implants need replacing at 10 years.

• Rippling or visible implant edges, most often in thin patients
• Implants that sit too high, drop too low, or drift apart over time (see breast revision)
• Capsular contracture, a tightening of the scar tissue around the implant
• Rupture, which is often silent with silicone implants
• Infection, bleeding, or a hematoma (a collection of blood around the implant)
• Changes in nipple or breast sensation
• Stretch marks, which are permanent but fade with time
• Rare implant-associated cancers: BIA-ALCL, linked to textured implants, and the even rarer BIA-SCC
• Future surgery: implants are not lifetime devices, and many patients will have another operation at some point, such as a revision or implant removal

Normal swelling and soreness improve day by day. Swelling, pain, or redness that gets worse, or one breast suddenly becoming larger than the other, should be checked right away.