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Breast Augmentation

For women who want larger, more shapely breasts, breast augmentation with implants can be an effective way to achieve the look they desire. This popular procedure involves the enhancement of the breasts to add volume and shape, as well as contribute to a feminine, curvaceous physique. Candidates are often women who have lost a significant amount of weight, have sustained changes in the shape or symmetry of their breasts as a result of pregnancy or menopause, or are simply dissatisifed with their breast size.

Our board-certified plastic surgeon, John M. Sarbak, MD, is experienced in many breast augmentation techniques and implant placement methods. In fact, he is among the only plastic surgeons in the southeast to offer the full breadth of breast enhancement procedures. Learn more about the different types of breast implants we offer at our practice and the various surgical approaches Dr. Sarbak offers to accomplish breast augmentation:

Am I a Candidate for Breast Augmentation?

Typically, candidates for breast augmentation are looking to address one or more of these cosmetic issues:

  • Small breasts and the desire for a larger size
  • Breasts that have lost volume
  • Asymmetry between breasts
  • Breasts of irregular shape
  • Breasts that are disproportionately sized compared to the rest of the body

In many cases, breast augmentation benefits mothers who have lost volume from pregnancy and breastfeeding. Additionally, patients who have lost a substantial amount of weight may see their breasts have changed shape and decreased in size. No matter the reasoning, breast augmentation can lead to a boost in confidence for patients.

Breast Augmentation Before & After Photos

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*Individual Results May Vary

What Is Transumbilical Breast Augmentation (TUBA)?

At Premier Plastic Surgery & Aesthetics, we regularly utilize the transumbilical breast augmentation (TUBA) approach. This innovative method, often referred to as “scarless breast augmentation,” gives women the opportunity to avoid scars directly upon the breast. Scars are placed within the belly button and tend to heal extremely well, leaving little to no evidence of surgery.

In general, Dr. Sarbak has found transumbilical implant placement to be more accurate than the other approaches, which require the surgeon to create the pocket (space for the implant) while looking inside the body underneath the breast. An attempt to match the opposite side is made by a combination of memory and feel. The transumbilical approach, on the other hand, allows the surgeon to watch the pocket form from the outside as well as the inside. This establishes a more specific placement of the implant in relation to the nipple and provides the opportunity to compare both breasts directly.

As the only plastic surgeon in the Vero Beach, FL area who offers the TUBA technique, Dr. Sarbak provides a unique service that many in the field do not. This option is critical to those who want to leave behind minimal, virtually undetectable scarring while receiving the same efficient results of a traditional breast augmentation procedure. By eliminating the need for incisions near the breasts, patients’ minds can be put at ease knowing that there will be no obvious scars on their chest after the surgery. While this particular process is more complicated and rare, Dr. Sarbak has much experience providing patients with breast implants using the TUBA technique and is highly educated and trained in breast enhancement surgical methods. He can go over all of your concerns about using this option during your initial consultation when your comprehensive treatment plan is created.

At the current time, transumbilical breast augmentation is limited to saline implants. As long as the implant diameter does not exceed the breast tissue diameter and the patient has a reasonable amount of breast tissue, these implants can provide a very natural-looking result. This approach does not void the patient’s warranty.

If you are looking for a plastic surgeon who offers this unique breast augmentation technique, Dr. Sarbak is the sole doctor in Vero Beach who is able to provide a practically “scarless” outcome. While many people desire to improve the shape and size of their breasts, they are often concerned with any potential scarring that will be visible post-surgery. With the TUBA method, those fears can be laid to rest as this specific type of breast augmentation can achieve your goals while leaving behind essentially no signs of surgery.

How TUBA is Performed

What Are the Different Breast Implant Types?

Dr. Sarbak offers a range of implant types to deliver the best possible results for his patients. During the consultation, he can review the benefits of one placement technique over another, and help patients decide which size and type of implant is most suitable for achieving the look they desire. At Premier Plastic Surgery & Aesthetics, we offer saline and silicone implants.

Diagram of silicone implant within a breast structure

Silicone Implants

Silicone implants are available for patients who are at least 22 years old. They provide a very natural feel, especially for patients who have a limited amount of breast tissue.

Multiple scientific studies have shown the safety of silicone implants. Silicone gel implants were introduced in 1963 and used routinely by plastic surgeons until January of 1992 when they were taken off the market for cosmetic patients (not reconstructive patients). At that time, there were concerns about the potential causal relationship between certain diseases, such as lupus and rheumatoid arthritis, and breast implants. Further research in both the United States and throughout the rest of the world (where silicone implants were not removed from the market) showed that these diseases were common in women and so were breast implants, but there was no causal relationship between the two. There was even a study of multiple sets of twins in which each twin had lupus but only one of the two had implants.

Silicone implants require a slightly larger access incision than saline implants – 4.6 cm to be exact. This limits the incision choice to the inframammary (beneath the breast) and in some patients the areolar (if the pigmented area around the nipple is large enough) approach.

Historically, the capsular contracture rate (scar tissue formation around the implant) of silicone implants is slightly higher than saline implants.

Diagram of a saline implant within a breast structure

Saline Implants

Saline implants have improved significantly over time. It is very rare that we see an implant failure due to a manufacturing defect.

It is important for patients to choose a saline implant that fits well with the existing breast dimensions. If the implant is wider than the patient’s native breast, then it is more likely that the implant will be felt and possibly seen in its lateral aspect. This can occur even when the implant is placed beneath the muscle (which does not extend into the lower lateral chest).

Saline implants are flexible in their fill volumes which is nice, especially when there is a size difference between breasts. The smaller side then can receive more fluid in the operating room. Silicone implants come pre-filled and can’t be adjusted. If a saline implant is filled too much, it can feel hard. Saline implants can be placed through smaller incisions than silicone implants.

In most cases, saline implants can provide a very nice result; however, if patients have a bare minimum of their own tissue, then silicone implants are probably a better option.

Saline implants are the only option for patients younger than 22 years old. They are also less expensive than silicone implants.

Should I Get My Breast Implants Over or Under the Muscle?

Breast implants can be placed in a few different positions – subglandular (above the muscle), submuscular (below the muscle), or dual plane (below the muscle and underneath the breast gland). While most patients prefer placement at least partially below the muscle, the ultimate location will be determined based on individual needs, goals, and anatomy.

Typically, implants placed under the muscle will have a more natural-looking appearance, as there is more tissue to disguise the shape of the implant. This submuscular placement may also be recommended for patients who plan to breastfeed in the future, as it has less risk of affecting the milk glands. On the other hand, for patients who train their pectoralis major muscles quite extensively, the subglandular position can help prevent the implant from moving when the muscles contract.

Both subglandular and submuscular implant positions can be beneficial for the right candidates. During your consultation with Dr. Sarbak, he can explain the pros and cons of each approach based on your unique needs and preferences.

What Are My Breast Augmentation Incision Options?

There are multiple areas where an incision can be placed during the breast augmentation procedure, including:

  • Transumbilical Incision: Dr. Sarbak is the only board-certified plastic surgeon in the Vero Beach area that offers and performs the transumbilical breast augmentation (TUBA) technique. The method is also called a “scarless breast augmentation,” as scars are placed within the belly button. At the moment, TUBA is limited to saline implants.
  • Inframammary Incision: The inframammary approach is typically considered a more traditional incision method. The incision is placed underneath the natural breast crease, making it easy to hide.
  • Periareolar Incision: The incision for the periareolar technique is performed around the perimeter of the areola. This allows the incision to blend seamlessly into the areola outline. Periareolar incisions are typically better for saline implants.

What Does the Breast Augmentation Procedure Involve?

Our plastic surgeon walks each patient through a one-on-one consultation, which includes a thorough physical examination and a discussion of the patient’s goals, to develop a custom-tailored breast augmentation approach. After you are determined to be a good candidate for breast augmentation, Dr. Sarbak can help you choose whether silicone or saline implants are your best option using the Mentor Corporation’s sizing system, which has been known to dramatically reduce the need for reoperation.

The surgery typically begins with the application of general anesthesia. When performing the transumbilical approach, Dr. Sarbak places incisions inside the belly button. Otherwise, he may place them under the arm pit (an axillary incision); beneath the breast fold (an inframammary incision); or encircling the nipple (a periareolar incision). While the implants can be placed above (subglandular) or below (subpectoral) the muscle, the vast majority of women choose an implant position at least partially below the muscle.

In many cases, patients choose to incorporate additional treatments, such as a breast lift, into their augmentation surgery for comprehensive breast enhancement. Dr. Sarbak may also employ liposuction with fat grafting to further improve contour. Rest assured that he will discuss your wide range of breast enhancement options during your consultation.

Natural Breast Augmentation

In addition to the techniques discussed above, natural breast augmentation can be an effective method for adding volume to the breasts. Natural breast augmentation involves fat grafting, or the harvest and transfer of one’s own fat, to add shape and fullness to the breasts. Because natural breast augmentation does not involve incisions, the opportunity for scarring is generally much smaller, and the recovery process tends to be quicker. If you are interested in natural breast augmentation, Dr. Sarbak would be happy to determine your eligibility for this method.

Patient Testimonials

“I decided to go with Dr. Sarbak because of the trust and confidence he made me feel even before surgery. If I could suggest an office for plastic surgery, I would suggest Dr. Sarbak. This took it to the next level. I couldn’t ask for better results. Dr. Sarbak is a cut above because of his intelligence and his honesty.”

View more patient testimonials here.

What Is Breast Augmentation Recovery Like?

Dr. Sarbak has developed his advanced breast augmentation techniques to account for as low-stress and relaxing a recovery period as possible. While it is important to keep in mind that every patient heals according to their own timeline, recovery times tend to be quicker with the transumbilical approach, which does not include an open incision on the breast. The addition of other procedures may also alter the specifics of your recovery.

Our patients go home after surgery and should rest for two hours. Afterwards, they can eat a light meal and take their prescribed amount of oral pain medication. Many of our patients will then jump in the shower, wash their hair, and go out of the house for an hour or two (usually for dinner or shopping). Patients should feel fairly normal approximately three days after subpectoral placement, or about one day after surgery, if a subglandular placement was used. In most cases, Dr. Sarbak encourages patients to return the day after surgery for an additional evaluation.

Will I Have Breast Augmentation Scars?

Certain breast augmentation methods can leave at least slight scarring on the breast. That said, one of the advantages of the transumbilical approach is that the incision is made in the navel, allowing for a virtually invisible scar. The only other approach that avoids scars on the breast is the axillary (arm pit), which normally heals well. If it does not, this scar can be visible in certain styles of clothing (e.g., tube top).

How Long Do Breast Implants Last?

High-quality breast implants often last for at least a decade; however, the FDA recommends MRI evaluations of silicone implants over time to monitor for possible rupture. This is not a requirement, but a suggestion. During your consultation, we can discuss warranty information relevant to the implants you choose.

How Much Does Breast Augmentation Cost?

The cost of your breast augmentation is contingent upon a number of factors, not limited to:

  • The type of implants 
  • The surgical techniques utilized
  • Associated fees for the anesthesiologist, surgeon, and/or hospital
  • The incorporation of additional treatments

Dr. Sarbak would be glad to go over pricing during your one-on-one consultation. Meanwhile, feel free to explore our plastic surgery financing options. We proudly partner with CareCredit® and Alphaeon Credit, two third-party lenders which offer helpful installment plans for eligible patients.

If you have questions about breast augmentation and breast implants, we encourage you to contact our practice for more information, or to schedule your consultation with Dr. Sarbak.