Lewis Plastic Surgery
2331-A Robious Station Circle
Midlothian, VA 23113
Like many of Dr. Lewis’ Richmond, VA, breast augmentation patients, you probably have highly personal reasons for wanting breast implants. Whether you have always had small breasts, want to restore volume lost after having children, or you want to make both breasts the same size, Dr. Gordon Lewis and our team create a positive, trusting environment where your needs are a priority.
Gordon Lewis, M.D.
Dr. Lewis, a native of Richmond, prioritizes building honest, trusting relationships and providing personalized care for his patients.Meet Dr. Lewis
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Breast augmentation surgery involves the placement of either
- saline breast implants that are filled after being inserted, or
- pre-filled cohesive silicone gel implants
Women of all ages can select the breast size 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, breast augmentation creates firmer breasts that still feel natural.
Good Breast Augmentation Candidates
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 whether or not you’re a good candidate for the procedure. It is rare that someone who is interested in a breast augmentation is not healthy enough to have this operation.
The vast majority of implants are placed underneath the pectoralis (chest) muscle. Whether they are fully under the muscle or partially under the muscle — called the dual plane approach — depends on the patient’s personal anatomy. The incision can be placed in the armpit, on the lower edge of the nipple, or under the breast. Incisions usually heal very well with minimal scarring. There are advantages and disadvantages to each of these incision locations. We will discuss these with you. The decision of where to place the incision is made at your preoperative visit and depends on your wishes and goals for the surgery.
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 when 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.
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 inframammary incision. This is probably due to contact of the implant with bacteria in the milk ducts within the breast.
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 undersurface 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 cannot 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.
Silicone or Saline?
Breast implants are designed to add volume. This is achieved through implants filled with either saline (salt-water solution) or silicone gel. All implants have a silicone shell, but the material filling the implant is different.
Cohesive Silicone Gel
Most women choose the newer generation of cohesive silicone gel implants because they tend to look and feel more like natural breasts. 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. Silicone implants 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 before surgery.
These can be placed through small incisions, but these incisions are slightly longer as the implant manufacturer pre-fills the implants. They may also have a lower rupture rate than saline breast implants, but it can be difficult to notice without an imaging test.
We use the Keller Funnel® to place silicone gel implants in the pocket. Using the Keller Funnel:
- Allows the implants to be placed through significantly shorter incisions (although not as small as saline implant incisions)
- Eliminates the implant coming into contact with skin, decreasing the chance of bacterial contamination
- Decreases shear forces on the implant shell, which may increase the implants’ lifespan
These implants are filled with a saltwater solution and were the dominant implant used from the early 1990s through about 2009. Dr. Lewis can place these implants through very small incisions because he fills them after they’re inserted. In women with more existing breast tissue to cover the implants, these feel and look very natural. The saline implants also have the advantage of being more economical than silicone implants.
Implant Size and Shape
The MENTOR® Volume Sizing System enables you to select the implant volume that best meets your desired result. The sizing system includes a set of 18 uniquely shaped volume sizers (9 per breast) which 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 12-ounce can of soda is 330cc). We will help you decide which implant size is best for you.
Coming to your consultation with pictures of breasts you like is helpful. 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 your 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. By doing that, each person can get a very accurate representation of the effect of the different amounts of volume on their breast shape. We believe this is the most accurate way to predict postoperative 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.
Cost of Breast Augmentation
We provide a detailed estimate of pricing, but this is only an estimate until you consult personally with Dr. Lewis. The total price given is all inclusive and will include:
- Surgeon fee
- Operating room fee
- Anesthesia fee
- Cost of implants
- Cost for CosmeticProtect™
Dr. Lewis and his medical staff strive to make you 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.
Once the incisions are closed with sutures, surgical garments are wrapped around your chest to protect the treatment area. Our breast augmentation patients initially recover in the recovery room, observed by our licensed nurses. Once you’re awake and comfortable, you can return home.
We suggest taking a week off work, but some patients may return to work earlier if they don’t perform any heavy lifting. Swelling and bruising may be present for several weeks, but you should be fully recovered in 2 to 4 weeks.
Your first postoperative visit will be scheduled about 2 to 4 days after the procedure. A few more follow-up appointments are scheduled 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 5 to 7 days after which you may resume wearing soft, non-underwire bras. Detailed instructions on how to care for the incisions, when to resume exercise and other pertinent facts are provided prior to surgery.
It typically takes about 2 to 3 months before the final results of your procedure become apparent, which happens once the tissues have softened and all swelling is resolved.
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 1 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.
Reducing Risks & Complications
All surgical procedures include some inherent risk. 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 of surgical experience and is affiliated with several important professional organizations, including:
- American Society of Plastic Surgeons (ASPS).
- Richmond Academy of Medicine
- Medical Society of Virginia
- American Society for Aesthetic Plastic Surgery (candidate member)
- American College of Surgeons (associate member)
- American Society for Surgery of the Hand (candidate member)
During your initial consultation, we will discuss every possible outcome of your procedure including possible complications. All breast implant surgery risks may include (but are not limited to);
- Dissatisfaction with size
- Numbness of the breast
- Rupture and leakage
- Poor aesthetic scar healing
- Capsular contracture (scar tissue around the implant)
- Changes in nipple/breast sensation
- Anesthesia-related risks
Post-operative complications are rare but may occur in some patients. If you experience any alarming symptoms, please contact us right away.
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:
Stony Point Surgery Center
Parham Surgery Center
He also has privileges at St. Mary’s Hospital and Henrico Doctors Hospital, but he 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 on the grounds of Johnson-Willis Hospital in Richmond, Virginia.
During a comprehensive one-on-one consultation at Lewis Plastic Surgery, you will learn about:
- The difference between saline and silicone gel breast implants (and you will actually get to 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