- Monday – Friday
- 9:00 AM – 5:00 PM
Breast augmentation is a surgical procedure that uses breast implants to increase breast volume and improve breast shape and proportion. While choosing an implant is an important part of the process, successful breast augmentation involves much more than selecting an implant size.
Every patient begins with different breast anatomy, chest wall anatomy, body proportions, tissue characteristics, and aesthetic goals. In my practice, breast augmentation begins by understanding both the patient and her anatomy. From there, we develop an individualized plan for implant size and shape, incision location, implant position, and surgical technique.
My goal is not simply to make the breasts larger. It is to create breasts that are proportionate to the patient’s body, consistent with how she wants to look, and planned with long-term stability in mind.
to address breast size, shape, position, proportion, and changes from aging, pregnancy, weight loss, or previous surgery. I offer a comprehensive range of breast procedures, including breast augmentation, breast lift, breast augmentation with lift, breast fat grafting, and revision breast surgery for patients throughout Walnut Creek, the East Bay, and the San Francisco Bay Area.
My approach begins with understanding how each patient wants to look and feel in her body. Whether the goal is to add volume, restore a more youthful breast position, improve shape and symmetry, use a patient’s own fat for natural enhancement, or correct the results of previous breast surgery, the procedure is tailored to the patient’s anatomy, proportions, and individual goals.
The goal is not simply to make the breasts larger or higher, but to create a balanced, natural-looking result that complements the patient’s body and feels right for her.
The first step is understanding what you want.
I want to know not simply how much larger a patient wants to be, but how she wants her breasts to look and how she wants to feel in her body.
Does she want a subtle increase in volume or a more noticeable augmentation? Does she prefer a natural slope or greater upper-pole fullness? Does she want more cleavage? Is she trying to restore breast volume lost after pregnancy or weight loss?
Words such as natural, full, proportionate, or even small C cup can mean very different things to different patients. Photographs are often helpful because they allow us to communicate visually and establish a shared understanding of the desired result.
The breasts are part of the overall body, and I do not evaluate them in isolation.
I consider height, shoulder and chest width, torso, waist, hips, overall build, and existing breast dimensions. An implant that looks proportionate on one woman may look too wide, too narrow, too prominent, or too small on another.
The goal is not to choose an implant based solely on cup size or volume. It is to determine what breast dimensions and volume will complement the patient’s body while still achieving the appearance she wants.
Careful analysis of the existing breast and chest wall is one of the most important parts of breast augmentation planning.
The amount, quality, and distribution of natural breast tissue affect implant coverage and influence the final breast shape.
I evaluate the position and direction of each nipple and areola and their relationship to the breast mound and inframammary fold. This also helps determine whether breast augmentation alone is appropriate or whether a breast lift should be considered.
Almost every woman has some degree of natural breast asymmetry. One breast may be larger, wider, lower, or shaped differently from the other.
Recognizing these differences before surgery allows us to determine which asymmetries can reasonably be improved and which are likely to remain to some degree after augmentation.
The breasts sit on the rib cage, so chest wall shape directly influences breast and implant position.
Some patients have a relatively flat chest wall. Others have chest wall asymmetry or a more prominent, outward-sloping chest, including pectus carinatum, sometimes called a pigeon chest.
These differences can influence cleavage, implant direction, projection, symmetry, and the tendency of the breasts to sit more centrally or laterally.
An implant cannot change the underlying rib cage. Understanding chest wall anatomy before surgery allows us to plan around it.
The inframammary fold (IMF) is the natural crease beneath the breast and an important structural landmark in breast augmentation.
I evaluate its height, symmetry, and relationship to the nipple and breast footprint. Depending on the patient’s anatomy and the implant selected, the fold may be preserved or carefully adjusted.
Once I understand the patient’s goals, body proportions, breast anatomy, and chest wall, we can develop the surgical plan.
The major decisions include:
These decisions are interconnected. Changing one can influence the others.
Breast implant size is measured in cubic centimeters (ccs), but volume alone does not determine how an implant will look.
Two implants containing the same volume can have different widths and different amounts of projection. The same 300 cc implant can also look very different on two women because their breast dimensions, tissue coverage, chest width, and body proportions are different.
I therefore consider:
Volume — the overall amount of augmentation.
Width — how the implant fits the natural breast footprint and chest wall.
Projection — how far the implant projects forward.
Profile — the relationship between implant width and projection.
The goal is to select an implant whose dimensions work with the patient’s anatomy and create the proportions she wants.
Breast implants are available in different profiles, generally ranging from lower and moderate profiles to moderate-plus and higher-profile implants.
A wider implant with less projection creates a different breast than a narrower implant with greater forward projection, even when the implants have similar volumes.
Profile should therefore be selected in relation to breast width, chest width, existing tissue, desired upper-pole fullness, and overall body proportions, rather than chosen in isolation.
Both saline and silicone breast implants have a silicone outer shell, but they differ in what fills the implant.
Silicone implants contain silicone gel and are commonly selected because of their feel and the wide range of available implant dimensions and profiles.
Because rupture of a silicone implant may not always produce an obvious change in breast appearance, appropriate long-term implant surveillance is important.
Saline implants are filled with sterile saline after they are inserted. Their volume can be adjusted to some degree during surgery.
If a saline implant ruptures, the saline is absorbed by the body and the breast generally becomes visibly smaller.
Neither implant is automatically right for every patient. Implant selection should consider anatomy, tissue thickness, desired appearance and feel, incision preference, and long-term considerations.
Round implants are commonly used for cosmetic breast augmentation and are available in many combinations of width, volume, and projection.
Anatomically shaped or “teardrop” implants have a predetermined distribution of volume and may be appropriate in selected situations.
Importantly, choosing an implant labeled anatomic does not by itself create a natural-looking breast. The relationship between the implant and the patient’s existing anatomy is more important than the name or shape of the implant alone.
Breast implants can be positioned in different tissue planes. The best position depends on the patient’s anatomy, amount of breast tissue, implant characteristics, lifestyle, and desired result.
An implant placed above the pectoralis muscle avoids interaction between the implant and a contracting pectoralis muscle.
However, adequate natural breast tissue is needed to provide implant coverage. In a thin patient with limited tissue, an implant above the muscle may be more visible or palpable.
Placing part or all of the implant beneath the pectoralis muscle provides additional soft-tissue coverage and may be useful in patients with limited natural breast tissue.
Because the pectoralis is an active muscle, however, contraction can sometimes move or distort the implant. This is known as animation deformity.
In selected patients, an implant can be positioned beneath the fascia covering the pectoralis muscle while remaining above the muscle itself.
This provides another option for implant placement without positioning the implant beneath an actively contracting muscle. Whether it provides adequate coverage depends on the patient’s individual anatomy.
Dual-plane augmentation combines elements of submuscular and subglandular placement. It can provide additional upper implant coverage while allowing greater control over the relationship between the implant and the lower breast.
There is no single implant position that is best for every patient. Implant placement should be individualized.
Every breast augmentation requires an incision and therefore creates a permanent scar.
There are four potential incision locations:
The incision is placed within or near the natural fold beneath the breast. This provides direct access to the implant pocket and allows precise control of implant and inframammary fold position.
The incision is placed along the border of the areola, where the transition in skin pigmentation may help camouflage the scar.
The incision is placed within the natural folds of the armpit, avoiding a scar directly on the breast.
For selected patients who are particularly concerned about a visible breast scar, this can be an important option when their anatomy and implant choice make the approach appropriate.
In selected circumstances, saline implants can be introduced through an incision at the umbilicus. This approach has limitations and is not appropriate for many implant types or surgical situations.
There is no universally best breast augmentation incision. Scar characteristics, breast anatomy, implant selection, surgical access, and the patient’s priorities should all be considered.
Breast asymmetry is normal, and most patients have some difference between their two breasts before surgery.
Asymmetry may involve:
Depending on the cause, treatment may include different implant volumes or dimensions, adjustment of the inframammary fold, modification of breast tissue, fat grafting, breast lifting, or a combination of techniques.
Breast augmentation can often improve asymmetry but cannot guarantee perfectly symmetrical breasts.
Identifying these differences before surgery is an important part of setting realistic expectations.
The inframammary fold is more than the location of a potential incision. It helps define the lower border and shape of the breast.
Depending on the desired breast dimensions and implant selected, the existing fold may need to be maintained or carefully repositioned.
The relationship between the implant and the original fold is particularly important because inappropriate positioning can contribute to implant malposition or a double-bubble deformity.
For this reason, I consider the inframammary fold part of the structural planning of breast augmentation.
I do not want the final implant decision to be based on measurements or numbers alone.
During the consultation process, patients can try breast implant sizers in the office and evaluate how different volumes and profiles affect their overall proportions.
We also use photographs to discuss breast shape and aesthetic preferences.
This provides another opportunity to make sure that what I understand the patient wants and what the patient is visualizing are the same thing before surgery.
Breast implants are excellent tools for increasing volume and changing breast shape, but they cannot correct every breast concern.
An implant does not reliably correct significant breast drooping. If the nipple and breast tissue have descended substantially, using an increasingly large implant in an attempt to avoid a lift can create a larger breast without adequately correcting its position.
In these patients, a breast lift or breast augmentation with lift may provide a better solution.
Similarly, implants cannot completely correct every difference in nipple position, breast shape, inframammary folds, or underlying chest wall anatomy.
Part of good breast augmentation planning is recognizing when an implant alone is enough—and when it is not.
Breast augmentation can produce significant and long-lasting improvements in breast shape and proportion, but it is surgery and breast implants are medical devices. Patients should understand both the benefits and potential complications before deciding to proceed.
Every breast augmentation creates a permanent scar. Scar location and visibility vary according to the surgical approach and the patient’s individual healing characteristics.
Temporary changes in breast or nipple sensation can occur after surgery. Persistent decreased, increased, or altered sensation is also possible.
Surgery can often improve existing asymmetry, but perfect symmetry cannot be guaranteed.
Bleeding, infection, wound-healing problems, and other general surgical complications can occur and occasionally require additional treatment or surgery.
An implant can move from its intended position over time. Displacement can occur downward, upward, inward, or laterally and may alter breast shape or symmetry.
Underlying breast and chest wall anatomy, tissue characteristics, implant dimensions, and the implant pocket can influence this risk.
A double bubble occurs when the implant and the patient’s original inframammary fold create two visible contours along the lower breast.
Careful assessment of the original breast fold and appropriate implant positioning are important in reducing this risk.
An implant may become visible or palpable, particularly when the patient has limited tissue covering it.
When an implant is positioned beneath the pectoralis muscle, contraction of the muscle can sometimes move or distort the breast or implant.
Breast implants are not lifetime devices. Both saline and silicone implant shells can eventually fail.
A saline rupture usually results in noticeable deflation. Silicone implant rupture may be less obvious and therefore requires appropriate surveillance.
The body normally forms a layer of scar tissue, called a capsule, around a breast implant.
In most patients, this capsule remains soft. In some patients, however, it tightens excessively around the implant. This is known as capsular contracture.
Capsular contracture can make the breast feel firm, alter breast shape or implant position, create asymmetry, and sometimes cause discomfort. Significant capsular contracture may require additional surgery.
There are uncommon but important conditions associated with certain breast implants and implant surfaces. These risks and current implant-specific recommendations should be discussed as part of informed consent and implant selection.
Breast implants should not be considered lifetime devices. Some patients will eventually undergo additional surgery because of implant rupture, capsular contracture, implant position, changes in natural breast tissue, or changing aesthetic preferences.
There is no predetermined expiration date at which every breast implant must automatically be replaced.
Breast implants are not lifetime devices, however, and both the implants and the breasts surrounding them can change over time.
If an implant remains intact, the breast remains soft and attractive, and there is no implant-related problem, replacement solely because a particular number of years has passed may not be necessary.
Long-term follow-up is important, and patients with silicone implants should follow appropriate recommendations for implant-integrity surveillance.
Recovery depends on the surgical approach, implant position, extent of surgery, and the individual patient.
Swelling, tightness, soreness, and temporary changes in breast shape are expected during the early healing period. The breasts may initially sit higher or look different from their eventual position.
Patients generally begin appropriate light activity early while avoiding heavier exercise and activities that place excessive stress on the healing breast and chest.
Postoperative restrictions are individualized according to the operation performed.
It is important to understand that the appearance of the breasts immediately after surgery is not the final result. Breast shape continues to evolve as swelling resolves, tissues relax, scars mature, and the implants settle.
Before-and-after photographs are valuable for understanding what breast augmentation can accomplish, but I encourage patients to look beyond simply finding a breast they like.
The most useful comparisons are often patients who started with similar anatomy.
A result in a patient with a narrow chest and substantial natural breast tissue may not translate directly to someone with a broad chest and very little breast tissue.
When reviewing photographs, we can discuss what was created by the implant, what came from the patient’s natural anatomy, and which elements of a particular result may or may not be achievable for her.
Implant selection begins with the desired appearance and then considers breast width, existing breast tissue, chest dimensions, skin characteristics, and overall body proportions. Measurements, photographs, and in-office implant sizing help determine an appropriate range rather than relying on cup size or implant volume alone.
There is no reliable universal cc-to-cup-size conversion. Bra sizing is inconsistent, and the appearance created by an implant depends on the patient’s starting anatomy as well as implant width, profile, and projection.
Neither is best for every patient. Silicone and saline implants have different characteristics and tradeoffs. The choice should consider anatomy, tissue coverage, desired appearance and feel, incision preference, and long-term surveillance.
Neither position is universally superior. The appropriate plane depends on tissue thickness, breast anatomy, implant dimensions, activity, desired appearance, and the advantages and disadvantages of muscle coverage for that particular patient.
An implant primarily adds volume. When there is significant breast or nipple descent, an implant alone may not adequately restore breast position. In these situations, breast augmentation with a lift may be more appropriate.
Breast augmentation can often improve breast asymmetry, particularly when differences involve volume or dimensions. However, differences caused by nipple position, breast shape, folds, or chest wall anatomy may not be completely eliminated.
Yes. A natural breast augmentation result depends on much more than choosing a small implant. Implant width, projection, tissue coverage, chest anatomy, breast shape, implant position, and overall body proportions all influence how natural the result appears.
Changes in nipple or breast sensation are a recognized risk. Many sensory changes are temporary, but persistent changes can occur.
Not automatically. Breast implants are not lifetime devices, but an otherwise intact implant does not necessarily require replacement simply because it has reached ten years. Long-term follow-up and appropriate implant surveillance are important.
A capsule of scar tissue normally forms around every breast implant. Capsular contracture occurs when that capsule becomes excessively tight, potentially making the breast firmer, changing its shape or position, or causing discomfort.
Yes. Both saline and silicone implants can rupture. Saline rupture usually causes visible deflation, while silicone rupture may not be immediately apparent, which is one reason surveillance of silicone implants is important.
For me, successful breast augmentation begins before an implant is selected.
First, I need to understand what the patient wants. Then I need to understand her anatomy—her build, breast dimensions, breast tissue, nipple position, inframammary folds, existing asymmetry, and underlying chest wall.
Only then do we determine the appropriate implant size and dimensions, incision, implant position, and surgical technique. We confirm those decisions through measurements, photographs, implant sizing, and continued discussion.
The goal is not simply to place an implant or achieve a particular cup size. The goal is to create a breast that fits the patient’s anatomy, complements her body, reflects how she wants to look, and is planned thoughtfully for the long term.
Dr. Afshin Parhiscar is a double board-certified plastic surgeon performing breast augmentation and aesthetic breast surgery in Walnut Creek, California, for patients throughout the East Bay, San Francisco Bay Area, and beyond.
With more than 20 years of experience in breast surgery and over 2,500 breast procedures performed, Dr. Parhiscar brings extensive surgical experience, careful planning, and attention to detail to each breast augmentation. His approach is individualized, with the goal of creating results that are natural, proportionate, and appropriate for each patient’s body and aesthetic preferences.
Breast augmentation consultations include a detailed discussion of aesthetic goals, body proportions, breast and chest wall anatomy, implant size and shape, incision options, implant position, expected recovery, and the potential risks and tradeoffs of breast implant surgery.
The goal is to develop a surgical plan that reflects both what the patient wants and what her individual anatomy allows us to achieve safely and predictably.
