Breast Augmentation in Washington DC
Breast augmentation is a popular surgical procedure whereby silicone gel or saline implants are placed beneath breast tissue to enhance breast size and improve shape. Whether your breasts have deflated post-pregnancy, or genetically your breast and body proportions have not had the balance you desire, Dr. Rad’s Washington DC breast augmentation patients seek the most natural proportions rather than a an overly augmented “done” look. Dr. Rad performs breast augmentation for patients who travel to Washington from the northeast corridor, from northern Virginia, Maryland, New York City and nationally.
BEFORE + AFTER
Photos are of patients who have given explicit written agreement to have them displayed. For patient privacy reasons, the majority of Dr. Rad's patients prefer their before/after photos to remain off-line. However, Dr. Rad will be happy to show you, in the setting of a confidential consultation, a series of before/after photos, not displayed here, to address your specific concerns.
*SHERBER+RAD cannot guarantee specific results. Individual results may vary.
+ IS BREAST AUGMENTATION RIGHT FOR ME?
Body proportions change with age, pregnancy and weight fluctuations. No matter how fit and healthy you are, your breast and body shape may not be exactly how you'd like. Breast augmentation offers immediate improvement and, while a strong self confidence comes from within, improved body proportions can help your self image. Particularly in Washington DC, women choose breast augmentation for many different reasons: some women wish a better fit and feel in clothes or to have more options in their fashion choices. Others who have had one or more pregnancies have found that their breasts have lost fullness once breast feeding has ended. Or, patients may genetically have small breasts relative to their height, or hereditary asymmetry of breast size, shape and nipple position, or tuberous (constricted) breasts. Other patients leading a healthy lifestyle may find their breasts to be out of proportion with their otherwise fit and toned bodies. Patients with breast cancer who’ve had reconstructive surgery on one side may meed an augmentation on the other side for symmetry. Finally, many women may want to feel more desirable to their partners. The common thread running through each woman’s decision is the desire to improve their breast and body proportions, not to look obviously “done,” and to improve self confidence. While not a replacement for healthy relationships or self esteem, breast augmentation offers significant improvements that can lead to major improvements in how you feel about your body, and Dr. Rad carefully considers your unique goals in order to determine the best options to meet them. While each patient's reasons to have a breast augmentation are varied and deeply personal, they are all valid. And when one feels self-confident in his or her personal appearance at any age, inevitably it has a positive effect on all aspects of life.
+ HOW IS BREAST AUGMENTATION DONE?
There are 2 ways to perform breast augmentation: (1) with implants, either saline or silicone, and (2) with your own fat. There are advantages and disadvantages to each. Breast augmentation with implants offer a virtually unlimited increase in size and shape (within reason, of course), although some patients wish to avoid implantation of silicone (although silicone implants are FDA approved and highly cohesive “gummibear” gel does not leak). Breast augmentation with one’s own fat involves liposuction of areas where fat is not desired, and then careful injection of purified fat into the breasts; this offers the most natural approach, but the limitations are several: the maximum size increase is usually less than 1 cup (on average), the volume of fat transfer depends on whether one’s breasts are mostly fat (in which case more fat volume can be transferred) versus “fibroglandular” breasts (breasts which have more breast gland tissue into which fat transfer is more limited). For women seeking the most natural augmentation and with small volume incase, fat transfer is a good option; for larger volume increases, particularly for patients who have small fibroglandular breasts, implants are the best option. If fat transfer is selected, Dr. Rad uses suction-assisted liposuction (SAL) or power-assisted liposuction (PAL) which prevents damage to delicate fat cells. Avoid Vaser-assisted or laser-assisted liposuction which destroys fat cells prior to liposuction.
+ AM I A GOOD CANDIDATE FOR BREAST AUGMENTATION?
If you are in good health, have reasonable goals for size increase, and you’ve not had radiation treatment of your chest for cancer, then you are likely a good candidate procedure. Your understanding of the limitations of breast augmentation is important and Dr. Rad will review these on an individual basis.
+ HOW DO I CHOOSE IMPLANT SIZE FOR BREAST AUGMENTATION?
Breast implant sizes range from 100 cc to 800 cc. A 100 cc implant is a small A cup, and an increase of 1 cup size corresponds to approximately 140 cc increase in implant volume. The most commonly selected implant for augmentation is 400 cc which will increase breast cup size by 2-3 cups, depending on your starting bra cup size. In your consultation with Dr. Rad you will have the opportunity to use breast implant "sizers" which simulate an augmentation so that you can see your breast shape and size before making your decision.
+ HOW MUCH DO BREAST IMPLANTS COST?
Breast implant cost depends on choice of silicone gel or saline, round or teardrop, and the manufacturer (Mentor, Allergan, Sientra). Round saline implants are cheapest at $400-$600/pair, whereas round silicone gel implants are $800-$1,200/pair, and teardrop silicone implants are $ $2,000-$2,400/pair. In general, most patients choose round silicone for the most natural feel. Teardrop implants are rarely selected because of their high cost and the improvement in shape does not justify the extra spend. Therefore, because of variable implant cost, the total cost of expert breast augmentation in our Washington DC office is $6,500 to $8,000. The implant cost is passed directly to you (i.e. it is not marked up). Also, the total cost of surgery is determined by the implant type, as well as which hospital surgery center you elect to have your procedure (fees vary). Perhaps most importantly, you're buying expertise. Surgery should be performed by a skilled and qualified plastic surgeon who has done hundreds of breast augmentations, and corrective work ends up being more complicated and costly. The cost is one one of several factors, and it is not the most important.
+ WHICH IS BETTER FOR BREAST AUGMENTATION: SILICONE OR SALINE?
This decision depends on your anatomy, goals and cost. Women with A or B cup sized breasts benefit from silicone for a more natural feel and softness. Women when C or larger breast size can choose either saline or silicone because their breast tissue gives a natural feel. Saline implants are much less expensive (~$400-$600 per pair) as compared with silicone (~$800-$1,200 per pair) implants. However, saline implants have a firm and relatively unnatural feel (called “palpability”) to the touch. Patients who have C cup breasts or larger may have saline implants without the downside of palpability, whereas patients with A or B cup breasts should consider silicone implants due to the palpability problem. Furthermore, placement of implants below the muscle may offset the downside of saline because the added layer of tissue softens the feel. Saline implants have the advantage of very small and hidden incisions, sometimes in the armpit, but ultimately natural feel is most important and justifies a slightly longer incision. Dr. Rad will carefully weigh each of these factors with you to determine the best implant type.
+ WHICH BREAST IMPLANT IS BETTER: ROUND OR TEARDROP?
Teardrop implants were developed for breast reconstruction surgery (for mastectomy) because they offer the most natural shape. However, for breast augmentation Dr. Rad rarely recommends teardrop implants for many reasons: (1) teardrop implants are much more expensive (twice the cost) than round implants, and (2) it is now scientific fact that even plastic surgeons can't tell whether round implants or teardrop implants have been used when shown before/after photos. Furthermore, teardrop implants can potentially rotate which, although very rare, may require surgery to correct. Because beautiful results are achievable with round implants just as much as with teardrop, spending thousands of dollars more on teardrop implants is not justified. Therefore, unless there are compelling reasons to choose teardrop implants, and Dr. Rad will guide you, then his preferred implant is round.
+ WHICH APPROACH IS BETTER: ABOVE MUSCLE OR BELOW MUSCLE?
Neither is superior and each has advantages and disadvantages. In general Dr. Rad’s decision is based on numerous factors, including your lifestyle (for example, if you’re a body builder or very physically active, then sub-muscular placement may not be right due to “animation deformity”), your pre-augmentation breast size (if you have A cup breasts and choose saline implants then sub-muscular may be preferable), desire for fullness in certain areas of your breasts (sub-muscular placement gives more upper breast fullness), your choice of silicone versus saline (for patients desiring the most natural feel, silicone implants are superior to saline), incision placement (the safest approach in the natural underfold), and cost (silicone implants cost twice as much as saline but the difference in feel and appearance may be worth it for patients with A or B cup breasts). Dr. Rad will carefully weigh each factor and guide you to the best decision.
+ WHAT CAN I EXPECT DURING MY CONSULTATION WITH DR. RAD?
You will have Dr. Rad’s unhurried attention. Dr. Rad does not advise a “cookie cutter” approach, nor is his practice an "assembly line," as is common in other practices that perform as many surgeries as possible. Dr. Rad endeavors to understand your preferences, goals and natural anatomy. Dr. Rad will guide your decision so that you have the highest likelihood of a successful result that meets most, if not all, of your goals. Dr. Rad performs a careful history and physical exam wherein he carefully examines your breasts for abnormalities such as lumps or masses. Dr. Rad measures your breast width, height, projection and other lengths (such as sternal notch to nipple, nipple to inframammary fold, and inter-nipple distance). Dr. Rad will then synethesize all this information in order to guide vis-à-vis: incision placement, breast shape and symmetry, cup size, appearance of scars and scar therapy, implat type, size and location (above or below muscle), the length of surgery, expectations for recovery and physical restrictions after surgery. You'll also have the opportunity to try on "implant sizers" which are silicone mimics or augmentation, and which will give you a sense of your breast size after augmentation. Dr. Rad will answer all of your questions and he will also review the safety aspects of surgery. Dr. Rad thoroughly reviews expectations before and after surgery, and he takes time and gives unhurried attention to your questions.
+ HOW IS BREAST AUGMENTATION PERFORMED?
Dr. Rad performs surgery in a hospital-based surgery center where very experienced staff (nurses and technicians) provide support so that he is able to focus exclusively on performing surgery. Breast augmentation surgery takes 1 hour. However, you should expect to be in the surgery center a total of 4 hours which includes check in processes and post-operative recovery. Surgery is performed under light general anesthesia: you’re breathing on your own but you don’t have any memory of the actual procedure, a delicate balance requiring expert skill in anesthesia. For this reason, Dr. Rad works exclusively with Board certified anesthesiologists. This is a detail about which few patients know to ask. More commonly, particularly in office-based surgery centers, nurse anesthetists (called Certified Registered Nurse Anesthetists, “CRNA”) provide anesthesia without anesthesiologist (MD) oversight. Be sure to ask whether your surgeon uses an anesthesiologist (specifically a doctor) versus a CRNA.
Dr. Rad plans precise placement of a small incision in the natural underfold of each breast through which he creates a pocket either above or below the chest muscle. He then double and triple checks the pockets for symmetry. The final step is placement of the implants. To place silicone implants, Dr. Rad uses an innovative device called the Keller Funnel™ which allows a smaller incision and avoidance of the implant touching the skin (i.e. the “no touch technique” which helps to avoid bacterial colonization of the implant which can lead to capsular contracture or inflammation or infection). He closes the incisions perfectly and then injects numbing medicine around the intercostal nerves so that your initial post-operative recovery is as comfortable as possible. A surgical surgical bra is placed and you are taken to the recovery room. Dr. Rad works with the anesthesiologist to ensure a rapid recovery: pain is minimized with a special pre-operative pain medicine regimen based on “Enhanced Recovery After Anesthesia” (ERAS) protocol, and also with anti-nausea regimen comprised of an anti-emetic (Zofran), a steroid (Dexamethasone), and anti-vertigo medicine (Scopolamine patch) so that your recovery from anesthesia is smooth and uneventful. We are proud that our patients are able to recover usually within 24 hours after which they are able to return to routine daily activities.
+ WHAT CAN I EXPECT FOR RECOVERY AFTER BREAST AUGMENTATION SURGERY?
Breast augmentation recovery lasts 1-3 days for above-muscle implant placement and increases to 5-7 days with below-muscle implant placement. Most women can return to work after a long weekend. High-performance athletes may require up to 3 weeks to return to unrestricted athletic activity.
Breast augmentation surgery is not extremely painful and discomfort is well tolerated. Much of the discomfort is a function of how active you are, and shortly after surgery you should not engage in physically strenuous activity such as unnecessary heavy lifting. You may conduct your normal “activities of daily living” such as eating, showering and sleeping, and walking is encouraged. Your length of time off work depends on your level of activity. If you have a physically demanding job, such as in mail or UPS package delivery, then you’ll need several weeks off (if you’re able to return to “light duty” where you can avoid heavy lifting then returning to work sooner is possible), whereas if you work at a desk then returning to work after a long weekend may be possible. You should refrain from driving if you’re taking strong pain medicine which usually lasts only a few days. Dr. Rad will guide your physical limitations in advance of, and following, surgery.
Dr. Rad checks in with you both the night before and the night of surgery to ensure you’re comfortable leading to, and following, surgery. At your first follow up Dr. Rad will examine you and review detailed instructions for optimal scar healing, implant/brast massage and physical restrictions. Generally, your limitations are a function of your level of physical activity before surgery and Dr. Rad will guide you.
Strenuous exercise can begin approximately 2-3 weeks after surgery but should begin with activities outside the chest area. Therefore, pushups or bench press, chest fly activity is discouraged, as is jumping or running, for approximately 4-6 weeks. However, you may work your core, arms and legs in the early phase and then ease into chest activities and, at the 8 week mark, unrestricted exercise. If you have specific concerns Dr. Rad will be happy to consider your unique exercise regimen.
+ HOW WILL MY SCARS LOOK AFTER BREAST AUGMENTATION?
Scars after breast augmentation are very small and Dr. Rad ensures they are well hidden either in the natural breast underfold (most common), the areola or armpit (rare). Surgical scars should be well moisturized at all times and protected from sunlight (i.e. ultraviolet rays). Dr. Rad recommends alternating Aquaphor ointment in the evening with Biocorneum at night. For enhanced results, application of vetted topicals such as La Mer The Concentrate and laser scar therapy performed by world renowned expert, Dr. Sherber, can make scars fade and soften rapidly. With diligent scar therapy Dr. Rad's Washington DC patients enjoy results with minimal visible scarring.
+ HOW LONG WILL MY RESULTS LAST?
Implants do not need to be replaced routinely and they are designed to last many years, if not decades. After many years (sometimes 10 - 15 years) saline implants may rupture, which is not dangerous to you, and the rapid absorption of saline causes your breast to deflate. This requires replacement of the implant. However, silicone implants employing "gummibear" cohesive silicone gel technology (i.e. implants manufactured in the US by Mentor, Allergan and Sientra) will not to leak. Generally, if you are pleased with your breast implants and have no concerning symptoms then you do not need routine surgery to modify them and you may enjoy your results for decades.
+ WILL I NEED A BREAST LIFT AND A BREAST AUGMENTATION TOGETHER?
This depends on how low your nipple position is. If your nipples fall below the level of your “inframammary fold” (IMF, the natural under-fold of your breast) then Dr. Rad may recommend a breast lift or “mastopexy.” This procedure involves a lollipop shaped scar around your areola and down the center of your lower breast. However, this decision also depends on how large your implants will be. Larger implants may eliminate the need for a lift, or at least reduce the length of the scars. Dr. Rad always endeavors to minimize visible scarring and he will guide you as to the best approach to achieve your goals.
+ IS BREAST AUGMENTATION SAFE?
Breast augmentation surgery is very safe. During your pre-surgical consultation, Dr. Rad will assess your individual risks to determine the best path for you. By following Dr. Rad’s specific instructions your safety and optimal results will be ensured. While risks are associated with every surgery, keep in mind that the risks associated with breast augmentation are not life threatening. In fact you have a much higher chance of injury driving a car every day as compared with the risk of undergoing surgery by a Board certified plastic surgeon in a hospital-based surgical facility. However, we don’t think of risk before getting behind the wheel. Similarly, through careful planning and preparation Dr. Rad will guide you through your surgery safely and effectively.
+ ARE IMPLANTS SAFE?
Silicone and saline implants are very safe and are FDA approved for safety. Silicone used today is "medical grade" and are "form stable," meaning that the chance of leakage of silicone into tissues is extremely small. If a break or tear develops in the implant shell (a very unlikely event) then the internal silicone likely will stay where it is within the shell. If you have silicone gel-filled breast implants, the FDA still recommends MRI scans to screen for silent (i.e. no symptoms appear) rupture 3 years after receiving your implant and every 2 years after that. Based on current information, the FDA states that there is no association between silicone gel-filled breast implants and connective tissue disease, breast cancer, or reproductive problems. For more information read the FDA's "5 things to know about breast implants."
What Patients Are Saying
"We consulted with three plastic surgeons before choosing Dr. Rad for my 17 year old son's rhinoplasty and chin implant in March 2017. From the first meeting, we felt confident that Dr. Rad is a skilled, experienced and talented surgeon who pays attention to every detail. He is also a super guy - warm, caring, attentive and welcoming. Everything went smoothly and we are extremely happy with the results. We are very pleased with the whole experience and recommend him without hesitation."
Esther Alpert | July 2017
"I would (and have) recommended Dr. Rad to my family and friends. Dr. Rad is extraordinarily talented. He is extremely professional, articulate and patient. He is singularly focused on ensuring the very best results for each of his clients. I put my trust and confidence into Dr. Rad and his interactions with me and the results of my surgery greatly exceeded my expectations."
Lisa Kay in Arlington, VA | May 18, 2017
"I am so grateful I chose Dr. Rad to perform my surgery. From the moment I walked in, I felt at ease & comfortable. The office is very clean & creative. He took time to answer all my questions, I didn't feel rushed as I did w/ other surgeons I met. His staff was prompt to respond & very friendly. Post surgery I called over a holiday weekend w/ a question & he called me back quickly. It has been an easy recovery & trust him fully. My scars are fading quick & it's only been 5 weeks! He's the best!"
Jennifer W in Germantown, MD | Jun 22, 2017
"Dr. Ariel Rad is the finest physician I've ever met! I've worked with Dr. Rad over the last five years and he encompasses everything you'd hope from a physician and much more. He possesses the highest intellect, expertise, sophistication, dedication, and compassion. I can't say enough about Dr. Rad. Every appointment I've had with him has exceeded my expectations. He's the absolute best! I wouldn't hesitate to recommend Dr. Ariel Rad to my family and friends for medical care."
KVR in Pennsylvania | Jan 10, 2017
"My goal was to be a refreshed, happy, more confident version of "me." As I prepared for surgery I had no unanswered questions and was totally confident about Dr. Rad's skill and judgment. Interactions with Dr. Rad and his team at the time of surgery and follow up were efficient, expert, and delivered with compassion and kindness. I recommend him without qualification."
Cathy in Washington, DC | Dec 04, 2016
"Had a facelift with Dr. Rad. Not only did he do a magnificent job, but he was extraordinarily attentive and caring when I experienced an acute complication from surgery. He has an outstanding bedside manner. In his office, he never makes you feel rushed. Explains everything carefully. And is all around extremely kind and very talented. I have referred several people to him."