Breast augmentation surgery involves the placement of custom-fitted saline breast implants or pre-filled silicone implants. This procedure allows women of all ages to select the bust line they have always desired or restore the youthful contour of the breasts they once had. In addition to enhancing the size and shape of the breasts, this procedure improves firmness.  Most of our patients undergo breast augmentation to:

  • Increase the size of naturally small breasts
  • Increase the projection of the breast by restoring breast volume
  • Correct asymmetry (uneven breasts)
  • Lift sagging breasts after pregnancy or weight gain or loss

Breasts may require an additional procedure called mastopexy (breast lift surgery), which repositions the breasts to a higher position on the chest.

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Advantages and disadvantages of each incision location

The vast majority of implants are placed underneath the pectoralis muscle. Whether they are fully under the muscle or partially under the muscle (dual plane approach)  depends on each patient’s personal anatomy. The incision can be placed in the armpit, around the nipple or under the breast. Each of these usually heals very well with minimal scarring. There are advantages and disadvantages to each of these incision locations. We will discuss these with you. The decision where to place the incision is made at your preoperative visit and depends on your wishes and goals for the surgery.

Inframammary Incision
Inframammary Incision


Across the nation the most common incision for breast augmentation is the incision in the lower part of the breast, which is located just above the inframammary fold on the breast.   This incision allows the most direct access to the chest wall and gives the most predictable results.  This incision, when meticulously closed, is very faint well fully healed.  We will place this incision so that it is near the fold, but on the lower portion of the breast.  In this location, it is usually not visible even when wearing very small bikini tops.  This incision has the benefit of being the “most sterile” which likely gives the lowest rate of capsular contracture.





Periareolar incision
Periareolar incision

Periareolar Incision:

This incision is placed on the lower portion of the nipple/ areolar complex. This approach gives direct and close access to the underlying pectoralis muscle and can allow for very accurate implant placement as well.  The incision can be nearly invisible in women who have a sharp color change between the areola and the surrounding skin.  However, many women have a less sharp color change in the area which will increase the visibility of this scar.    This incision will also have a somewhat higher incidence of loss of (or decreased ) sensation in the nipple after surgery.  Lastly, there is some evidence that this incision may have a higher rate of capsular contracture after surgery than an inframamamry incision. This is probably due to contact of the implant with bacteria in the milk ducts within the breast.





Transaxillary incision
Transaxillary incision


This incision, in the armpit is clearly the least likely to be seen.  Through this approach, we use very small incision and an endoscope to visualize the under surface  of the pectoralis muscle and to meticulously create a pocket for the implant underneath the muscle.  Once the pocket is created a saline implant is placed in the pocket and filled once in place. This can create a very natural look with an incision that can be nearly impossible to see.  Unfortunately, there are a couple of tradeoffs with this approach.  Although revision for implant malposition is rare, studies have shown it is higher with a transaxillary approach than with the other approaches.  Also, silicone implants frequently can not be placed through this small incision as they are prefilled, and need a more direct approach. Capsular contracture rates are slightly higher than with an inframammary incision.



Choosing Your Implant

Breast implants are designed to give extra volume to a breast. This is achieved through implants filled with either saline (salt-water solution) or silicone. All implants have a silicone shell, but the material filling the implant gives different


Most of the implants we are placing for breast augmentation are silicone implants.   This is because these implant have the most natural feel to them.   In most women, silicone implants are nearly impossible to feel when placed correctly.  Silicone implants contain a silicone gel that feels very natural even outside the body. The silicone implants do allow a more natural feel to the breasts in all women, but this is more pronounced in women wanting larger implants or women who are very thin prior to surgery. These can be placed through small incisions, but these incisions are slightly longer as the implant manufacturer pre-fills the implants with silicone gel. Silicone implants may also have a lower rupture rate than saline breast implants, but there is a bit more intensive follow up as rupture of these implants may not be as obvious.


These implants are filled with a salt-water solution and were the dominant implant used from the early 1990s through about 2006. These implants can be placed through very small incisions as they are filled with saline after being placed under the breast. In women with more tissue coverage over implants, these feel and look very natural. The saline implants also have the advantage of being more economical than silicone implants.

We use the Keller Funnel to place silicone implants in the pocket.  This gives several important advantages. 

  • This funnel allows the implants to be placed through significantly shorter incisions (although not as small as saline implant incisions)
  • Eliminates contact of the implant with the surrounding skin.  This decreases the chance of bacterial contamination from the skin
  • Decreases shear forces on the implant shell which will potentially increase the lifespan of the implants

Size and Shape

The MENTOR® Volume Sizing System enables you and your patient to select the implant volume that best meets her desired result.

The Sizing System includes a set of 18 uniquely shaped volume sizers, (nine per breast) and provide a realistic preview of the breast size.

Implants come in a wide range of sizes and shapes. The sizes range from about 100cc to 800cc. (For reference, a 12oz can of soda is 330cc). We will help you decide which implant size is best for you.

If you have a size goal, it is helpful if you bring in pictures of a woman with breasts that you like. The shape of the implants affects the overall appearance of your breasts as well. We will discuss the implant shapes with you as well and guide the decision based on you specific chest wall and breast shape.

We use the Mentor Volume Sizing System to assist in the sizing of implants.  These specially tapered “trial” implants are specifically designed to be placed underneath a thin bra, and in doing so, each person can get a very accurate representation of the effect of the different amounts of volume on their breast shape.  We believes this is the most accurate way to predict post operative size.

Breast implants come in different profiles: moderate, moderate plus, and high profile.  Some are taller and narrower, and some are lower and wider for a given volume. It is very important that this matches your chest wall.  Once you have picked your volume it is our job to ensure the implant fits your chest wall and the given profile will give you the best look for your body.

Will anesthesia and pain relief be used during / after surgery?

You will be made comfortable throughout the whole procedure. Most people have a general anesthetic for their surgery, but the surgery can be done with Iv sedation if there is a desire or reason to avoid a general anesthetic. After surgery, you will be given instructions on pain relief medication, if required.  

What happens immediately after surgery?

Once the incisions are closed with sutures, surgical garments are wrapped around the chest to protect the treatment area. Our breast augmentation patients initially recover in the recovery room, observed by our licensed nurses. After a short period when they are awake and comfortable, they will be able to go home to rest.

How long will complete recovery take?

We suggest taking a week off of work, but some patients will return to work faster assuming that they do not have to perform any heavy lifting. Full recovery takes two to four weeks.

Your first post-operative visit will be scheduled about two to four days after the procedure and you are then seen a few more times during the recovery period. In the first few days you may experience mild discomfort, bruising and swelling, all of which are considered normal and treated with prescription medicine. You should wear a special supportive garment for five to seven days after which you may resume wearing normal bras. Detailed instructions on how to care for the incisions, when to resume exercise and other pertinent facts are provided prior to surgery.

Your relationship with us will not end after the surgery. We will see you frequently in the next weeks and months and will want to see you back one year after surgery as well. We will continue to advise you on activity, exercise, breast self-examination and the future need for mammography, as you require.

Am I a Good Candidate for Breast Implant Surgery?

The most suitable breast augmentation candidates are generally healthy individuals who have concerns about the size or shape of their breasts. After a careful physical exam and assessment of your medical history, we will determine each patient’s candidacy on a case-by-case basis.   It is rare that someone who is interested in a breast augmentation is not healthy enough to have this operation.

What are the Risks of Breast Implant Surgery

Check Accreditation

With any surgical procedure there are risks that you must be aware of.  To minimize the risks, ensure your surgery is conducted in a safe and secure environment using the latest surgical techniques by checking the certifications and accreditation of your surgeon.   Accreditation boards and bodies are there to protect you.  Dr. Gordon Lewis has 9 years surgical experience and is affiliated to several important professional organizations.

  • He is board certified by the American Society of Plastic Surgeons www.plasticsurgery.org
  • Affiliated to the Richmond Academy of Medicine www.ramdocs.org and the Medical Society of Virginia www.msv.org
  • He is also an associate member of the American Society for Aesthetic Plastic Surgery www.surgery.org and the American College of Surgeons www.facs.org
  • A candidate member of the American Society for Surgery of the Hand www.assh.org

Possible Complications

During your initial consultation, we will discuss every possible outcome of your procedure including possible complications.  Swelling and bruising may be present for up to two weeks. The final shape and feel of your breasts will not be seen for two to three months after the breast augmentation surgery.  Although infrequent, breast implant surgery risks may include (but are not limited to);

  •     Desire for a different size
  •     Numbness of the breast
  •     Swelling
  •     Bleeding
  •     Rupture and leakage
  •     Poor aesthetic scar healing
  •     Assymetry
  •     Capsular contracture (scar tissue around the implant)
  •     Changes in nipple / breast sensation

Post-operative complications are rare but may occur in some patients. If you experience any alarming symptoms, please contact us right away.

During a comprehensive one-on-one consultation at Lewis Plastic Surgery, you will learn about:

  • The difference between saline and silicone breast implants and actually touch both types of implant
  • Breast implant sizes and shapes
  • Breast implant placement: behind, in front of or partially behind the pectoral muscle
  • Incision types: under the breast, around the nipple or in the axilla (arm pit)
  • Surgical facility and anesthesia
  • Breast augmentation cost and financing options

Surgical procedures are performed at an accredited outpatient surgical center or a local hospital. Dr Gordon Lewis is affiliated with several local medical centers where his patients undergo surgery. He primarily operates at these locations:
⦁    Johnston-Willis Hospital
⦁    Stony Point Surgery Center
⦁    Chippenham Hospital
⦁    Parham Surgery Center

He also has privileges at St. Mary’s Hospital and Henrico Doctors Hospital, but operates there less frequently.

Initial consultations, follow up appointments and all non-surgical treatments and minor surgical procedures are performed at Lewis Plastic Surgery practice which is located in the grounds of the Johnston Willis Hospital, Richmond, VA.

We will provide a detailed estimate of pricing if you contact us by email, or call the office.  This price given prior to a consultation is usually very accurate, but is an estimate. This will not but confirmed until you have a visit with Dr. Lewis and get a written quote at that time.   The total price given is all inclusive and will include:

  • Surgeon fee
  • Operating room fee
  • Anesthesia fee
  • Cost of implants
  • Cost for cosmetic protect


Every patient is required to attend an initial consultation before a procedure can be booked.  Once you decide to proceed with surgery, we will assist you in finalizing a date and getting everything ready for surgery. We try to be as flexible as possible and will make arrangements to see you at Lewis Plastic Surgery, in the grounds of the Johnston Willis hospital, within a few days of you contacting us.  Depending on your requirements, we can normally perform your procedure within 2 weeks.   You can book a consultation online or by calling 804 267 6009.