Dr. Medalie is an expert in breast augmentation and enhancement. Breast augmentation with implants is a very popular procedure for women and among the most commonly performed cosmetic surgery procedures. Either a silicone or saline-filled implant is placed under the breast tissue or beneath the chest wall muscle. After surgery, breasts will appear fuller and more shapely in contour. Incisions can be placed in the armpit, around the areola, or under the breast. Sometimes a patient’s fat can be injected (autologous fat transfer) into the breast to provide smaller changes in superior or medial fullness. Dr. Medalie typically performs breast augmentation and enhancement as an outpatient procedure in Cleveland, Ohio.
The Consultation at Cleveland Plastic Surgery
- When you schedule a breast augmentation consultation with Dr. Medalie, he will go over the procedure in depth, show you numerous patient pictures and let you feel the different types of implants to get an idea of what is the best fit for your body.
- This will gives you an opportunity to see if you can communicate well with Dr. Medalie.
- Dr. Medalie can assess you for any issues that may complicate or prevent breast augmentation.
- You can learn how different choices may impact your result.
- You can learn about different types of breast implants (saline vs. silicone, moderate vs. high profile)
- Together, you and Dr. Medalie will come up with a plan for surgery (above or below the muscle, implant size and profile). You will review the "Rice Test" which is a good way to evaluate implant size in the comfort of your own home.
- You can ask what to expect during your recovery from breast augmentation
Breast Augmentation Steps
Step 1 – Anesthesia
Medications are administered for your comfort during the surgical procedure. Dr. Medalie prefers light general anesthesia with the patient breathing fully on their own.
Step 2 – The incision
Incisions are made in inconspicuous areas to minimize visible scarring. We will discuss which incision options are appropriate for your desired outcome. Incision options include: along the areolar edge (peri-areolar incision), the fold under the breast (inframammary fold) and in the armpit (axillary incision). I prefer the IM fold approach because recent literature suggests that it is associated with a lower incidence of capsular contracture. The incision for a silicone implant is by necessity larger than one for a saline implant because the silicone implant is pre-filled and the saline implant starts empty.
Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy and patient-surgeon preference.
Step 3 – Inserting and placing the breast implant
After the incision is made, a breast implant is inserted into a pocket either:
A. Under the pectoral muscle (a submuscular placement)
B. Directly behind the breast tissue, over the pectoral muscle (a submammary/ subglandular placement)
C. Dual-plane which is partly under the muscle (in the upper pole) and partly under the breast (lower pole). This procedure is more frequently used in women who have had children and have some droop to their breasts.
The method for inserting and positioning breast implants depends on the type of implant, degree of enlargement desired, your body type and your surgeon’s recommendations.
Step 4 – Closing the incisions
Incisions are closed with layered sutures (that dissolve) in the breast tissue and with sutures, skin adhesive and surgical tape to close the skin.
Over time the incision lines will fade. The quality of scar depends on many things, including your genetics, exposure of your body to nicotine, and infection.
Step 5 – See the results
The results of breast augmentation are immediately visible. Typically, they start high and then over time settle to a lower and more natural appearance. I usually tell patients that what they see is not what they get until 3 months after the surgery.
*Plastic surgery results can vary from patient to patient and are not guaranteed
Breast Augmentation Surgery FAQ
Do I Need General Anesthesia?
Yes-Breast Implant surgery needs to be performed with the patient asleep.
How long does it take?
Typical surgery time is around 1 hour.
What is the chance of infection?
I typically give my patients antibiotics for 5 days around surgery. I have never had a post-op infection or an implant extrusion.
Are there bleeding risks?
During the surgery, local anesthetic is injected into the tissue-this blocks the sensation and also constricts blood vessels. As a result, there is very little bleeding during the surgery. I have NEVER had a patient have a severe bleeding complication post-op, but it is not impossible and a return trip to the OR may be necessary. No one has ever needed a blood transfusion for this procedure.
What is the recovery?
This is a fairly small operation and requires a short recovery. Pain that may require narcotic pain medicine typically lasts 3-4 days. After that, ibuprofen (Motrin and Advil) is sufficient. I recommend that patients take at least 1 week off from work. The post-op care involves support bras for several weeks and scar massage after that. Most of the swelling and all of the buried stitches have disappeared by 3-4 months.
When can I resume my normal activity?
I recommend that patients refrain from exercise for at least 2 weeks after surgery. Even after 3 weeks, the incisions may be sensitive and patients need to use caution (focus on leg work more than arm work). Full activity can resume by 6 weeks post-op.
When will I be completely healed?
Some of the deep sutures under the skin can take up to three months to completely dissolve. For this reason, some patients may report sensitivity issues such as itching for up to three months post-op. Breast and nipple sensation can take longer to normalize. Typically my patients have resumed full activity by 3 months and have the appearance that will be with them for many years to follow.
Saline vs. Silicone?
When choosing between saline and silicone breast implants for breast augmentation surgery, it’s important to understand the advantages and disadvantages of each option. Saline breast implants are filled with a sterile saltwater solution, offering the benefit of smaller incisions and easy detection if a rupture occurs, since the implant deflates naturally. They are typically less expensive, but some women feel they look and feel less natural compared to silicone. My ideal saline implant candidate is a mom who has a full B or C cup of breast tissue, but now has some droop and wants more superior fullness. I frequently combine full breast lifts with a small saline filled breast implant and it achieves a very natural result. Silicone breast implants, on the other hand, are filled with cohesive silicone gel that closely mimics the look and feel of natural breast tissue, making them the most popular choice today. However, they usually require a slightly larger incision, are more expensive, and ruptures can be harder to detect without imaging. The best choice depends on your body type, cosmetic goals, and personal preferences, which is why a consultation with Dr. Medalie is essential to determine the right implant for you.
Saline vs. Silicone Breast Implants: Table of Pros and Cons
| Feature | Saline Breast Implants | Silicone Breast Implants |
|---|---|---|
| Filling Material | Sterile saltwater solution | Cohesive silicone gel |
| Look & Feel | Less natural, may ripple | Very natural, soft, and smooth |
| Incision Size | Smaller (implant filled after insertion) | Larger (pre-filled implant) |
| Rupture Detection | Immediate (implant deflates) | Harder to detect, may require MRI or ultrasound |
| Cost | Generally lower | Typically higher |
| Safety | Saline is safely absorbed by the body if ruptured | Silicone is safe but requires monitoring for “silent ruptures” |
| Popularity | Less commonly chosen today, but still a good choice for smaller implants | Most popular option worldwide |
| Ideal For | Women wanting lower cost or smaller incisions | Women prioritizing natural look and feel |
Is it possible to lose nipple sensation?
The surgery is designed to preserve blood supply and sensation to the nipple. The implant typically goes under the muscle and does not affect the nerves to the nipple. A large implant however can stretch the tissue and the nerves and there may be transient sensation changes. It is very rare but not impossible to lose full sensation though.
Will I be able to breast feed after a breast augmentation?
The surgery is designed to preserve the integrity of the breast glandular tissue. Patients typically are able to breast feed after a breast augmentation surgery.
Can other procedures be performed at the same time as breast augmentation?
Yes – I frequently perform multiple procedures on breast surgery patients. Frequently, I perform liposuction or tummy tuck. Sometimes, I also perform breast procedures such as breast lift. Many of my patients ask for vaginoplasty or labiaplasty as well.
What does it cost?
A breast augmentation with silicone implants costs around $8500 (saline is around $7500) at Dr. Medalie’s outpatient surgery location. All procedures are less expensive when combined with other procedures such as labiaplasty or liposuction.
What if I am from out of town?
I frequently perform breast surgery on patients who live out of town and are unable to easily to see me in consultation prior to the procedure. I have several requirements for these patients: I must see pictures of them prior to scheduling surgery. They need to contact my office and have my patient care manager email them a medical history form to be filled out and sent back. Typically, the patient will come into town 1 day prior to the procedure, and I will see them the day of surgery. I will perform a phone consultation about 3 weeks prior to surgery. I will then perform the operation and patients can usually return home the day after surgery. Your post-op visit will be a virtual visit with my nurse, Michelle, about 10-14 days after surgery. I will then follow the progress of the patient via e-mailed pictures. My patient care manager has information about hotels in the area as well as financing. You may contact her at valerie@clevelandplasticsurgery.com.
What Patients are Saying
" Dr. Medalie did a tummy tuck on me as well as arm lifts and breast lifts with breast implants. This was a very big day for me and one that I had been waiting for for a long time. I have three kids and gained a lot of weight during and after my kids. When I lost some of that weight I ended up with loose skin and really saggy boobs. My right boob was also much bigger and droopier than my left one. I also had lots of stretch marks on my belly. I was so nervous on the day of surgery but Dr. Medalie is cool as a cucumber and seemed completely sure of himself. The operation took around 6 and a half hours, but I was only in recovery for about an hour after that. I had drains in my belly and arms but none in my boobs. I will not lie, that first week was not fun! But I got better pretty quick and his nurse Michelle was super helpful with all my questions. Long story short, I look great! My boobs are even and perky! I actually was not expecting my final results. How can you really picture what you are going to look like after so much time looking a different way. I am so happy. I can not recommend Dr. Medalie and his team enough. You will not go wrong!"
-Sonia B
Where can I get more information?
Please call Dr. Medalie at 216-393-9924. You can also e-mail his patient care manager, Valerie, at valerie@clevelandplasticsurgery.com.
