Breast Augmentation

Women from all walks of life and all parts of the country are choosing breast augmentation. In fact, the women who visit me from Scottsdale and Phoenix, AZ, as well as other nearby cities and beyond, have made breast augmentation one of the most popular cosmetic procedures I perform. Most women I see at my office who are considering breast enhancement feel that their breast size is disproportionately small compared with the rest of their body, however those patients aren't the only good candidates for this procedure. Other women are concerned that their breasts have lost volume after childbirth and would like that volume restored. Some women are unhappy with the shape of their breasts, would like to increase breast fullness, or are concerned about breast asymmetries (size and shape differences between sides).

Request a cosmetic consultation with Dr. Cohen or Dr. Sigalove or call (480) 423-1973 to learn more about breast augmentation. Our facility is conveniently located for patients living in Tempe, Paradise Valley, and other areas of Greater Phoenix. Dr. Cohen and Dr. Sigalove often serve patients from throughout North America and overseas.

Your Personalized Breast Augmentation Consultation

I am able to improve a woman's breast appearance through surgery that is carefully planned and performed. Proper breast enlargement is not a "cookie-cutter" procedure where the same technique is applied to every patient — every woman who comes to my practice near Scottsdale and Phoenix, Arizona, has unique needs and different goals for her breast augmentation. As a board-certified plastic surgeon, I always listen carefully to each woman's concerns and thoroughly discuss the key points of the procedure.

Dr. Cohen explains what to look for when choosing a breast augmentation surgeon in Phoenix

Physical Considerations

Examples of the factors I consider when developing a personal recommendation for a patient include:

  • Overall height and weight
  • Size and shape of the underlying chest and ribcage
  • Tightness and elasticity of the skin
  • Amount of natural breast tissue

Desired Results

Just as important as the physical factors are the goals and expectations each patient has. I do not have an agenda to make every woman considering breast augmentation into a C cup. Some women prefer smaller augmentations and wish to end up with a modest B cup, while others feel more confident with a D cup.

My role as a plastic surgeon is to help my patients achieve their ideal appearance using my experience, in-depth knowledge of anatomy, and understanding of the latest implant technology and surgical advances to advise them on how best to reach that goal during their consultations. You can see the results of my surgical philosophy when you view photos of some of my breast augmentation patients to compare their pictures before and after surgery.

Our Surgeons

Medical director Dr. Robert Cohen and his associates, Dr. Steven Sigalove and Dr. Josh Olson, are certified by The American Board of Plastic Surgery. These talented surgeons are leaders in the field of plastic surgery and the proof is in their results.

Before and After Photo Gallery Stay Up To Date On Dr. Cohen's Blog
Dr. Sigalove, Dr. Cohen, Dr. Olson

Breast Augmentation Choices

There are many choices you need to make before your breast augmentation surgery, explained in the sections below, including the location of the incision, whether to place the implant under or over the chest muscle, and what type of implant to use. I offer multiple types of silicone gel breast implants, as well as saline implants. You can learn more about breast implants by exploring my Breast Implant Options page and by talking with me personally.

With regards to implant selection, I am not committed to any specific implant, because each patient will have a array of implants that will work for them. My job is to understand each patient's goals and use my knowledge to help her select the implant that will allow me to achieve the finest possible results with her breast augmentation. This includes considerations of shape, size, symmetry, and longevity. During the consultation, I have a lengthy discussion about breast enlargement choices with every patient so that they feel confident about their decisions.

watch dr cohen explain breast enhancement video

Breast Enhancement Revealed

Watch as Dr. Cohen explains popular breast enhancement procedures such as augmentation and how he uses a variety of techniques to meet the individual needs of patients. Watch Video »

Breast Enhancement Revealed

Watch as Dr. Cohen explains popular breast enhancement procedures such as augmentation and how he uses a variety of techniques to meet the individual needs of patients.

Implant Placement

In my practice, almost all of my patients have their breast implants placed underneath the pectoralis major (chest) muscle. In reality, when surgeons say "under the muscle," they generally mean "partially under the muscle," as the pectoralis covers the upper and inner part of the breast, but not the outer and lower part. This is a more meticulous and advanced technique than placing the implant over the muscle, but it provides some major advantages. Placing the implant under the muscle:

  • Allows extra padding and soft tissue coverage over the upper and middle parts of the implant. This creates a natural slope at the top of the implant rather than a more pronounced shelf and also reduces the risk of visible wrinkling or rippling. I believe this is a very important factor, particularly in thin patients, with regard to obtaining the most natural and aesthetic final result.
  • Creates a situation where the implant is constantly "massaged" by the muscle. This has been shown to reduce the risk of capsular contracture, a condition in which tightening of the scar tissues around the breast implant makes the breast look or feel firmer than it should.
  • Can make it easier to get an accurate mammogram as there is less distortion of the breast tissue itself.

Incision Placement

Although plastic surgeons offer many options for incision locations, I have a few strong preferences. The most common routes are through the:

  • Inframammary fold (the fold under the breasts)
  • Areola (the pink area surrounding the nipple)
  • Axilla (armpit)
  • Umbilicus (belly button)

I personally do not like to place implants through the armpit or through the belly button for a few reasons. Most important, both these approaches represent an indirect means of creating the breast pocket, the space that is surgically created to fit the implant. In my opinion, extreme accuracy in creating a breast pocket is the key to a natural and symmetric final result. When creating a breast pocket from a distance (i.e., the belly button or armpit), the surgeon relies on a long metal instrument or an inflating device to stretch and create the pocket. In my view this is a less accurate technique than performing the dissection directly with your hands. Additionally, armpit scars can sometimes be visible and are associated with a higher capsular contracture rate, while the belly button approach does not allow the option of using silicone implants and is by far the least accurate approach.

Advantages of the Inframammary (Breast Crease) Incision

With the vast majority of my patients, I use an inframammary approach to placing implants. This involves a fine incision along the lower crease of the breast. Although I used to perform mostly periareolar incisions, new data has shown that the inframammary incision has the lowest risk of capsular contracture. When textured implants and a Keller Funnel™ (implant placement device) are added, the risk of capsular contracture is even lower. This technique has a number of advantages:

  • The incision is blended in along the natural crease under the breast, which helps to camouflage it.
  • The skin in this area tends to heal with a very fine scar.
  • The breast tissue, milk ducts, and lymphatics of the breast are not significantly affected by this approach.
  • If simultaneous (or future) breast tightening procedures need to be performed, these scars will rarely get in the way of further surgery.

The periareolar approach is still a good technique, particularly for patients with tuberous breasts or the need for areolar tightening, and I am very comfortable using it as long as the patient understands she will have a modestly higher risk of capsular contracture. I do want to clarify one common misunderstanding of this technique: The majority of the nipple/areola is left untouched during the periareolar approach, and the nipple/areola is NOT flipped up or removed during this type of surgery. The technique involves an incision halfway around the areola that is carried straight down to the chest muscle, creating a tunnel though which an implant can be placed. Because of this, the technique is better when patients have larger areolas and relatively smaller amounts of breast tissue.

Does Incision Placement Affect Nipple Sensation or Breastfeeding?

This is a major concern for my breast augmentation patients. Nipple and areola sensation is primarily provided by a branch of the fourth intercostal (between the ribs) nerve. This nerve starts at the lateral part of the chest on each side (where your arm would normally rest when it is hanging down) and travels toward the breast. Studies have shown that placing implants over the muscle and the placement of excessively large implants increase the risk of nerve damage; however the location of the incision (periareolar versus inframammary) is not a significant factor. Obviously, any time a woman has breast surgery, there is always a possibility of damage to nipple sensation, however the risk is very low (less than 1% chance of permanent numbness) if performed by an experienced surgeon.

With regard to breastfeeding, women who have never had breast surgery have, on average, an approximately 70% chance of being able to breastfeed successfully. For various reasons, some women are unable to produce enough milk to support a baby's needs. With breast augmentation surgery, the chance of being able to breastfeed may go down slightly (by less than 5% or so), but most women with breast implants (saline or silicone) are able to breastfeed successfully. The location of the incision is not a significant factor as the majority of the milk ducts are left unharmed regardless of the surgical approach.

What to Expect After Breast Augmentation

If you are interested in learning about what to expect during the recovery process following breast augmentation, I encourage you to read my cosmetic surgery FAQ about postoperative issues such as care for incisions, time away from work, and ability to engage in exercise and other activities.

You can also find further information about breast augmentation on my breast surgery specialty site.

Back to Top

Dr. Cohen's Staff
Phoenix Magazine Top Doctor

Contact Us