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Breast Augmentation in Manhattan

breast augmentation surgery

Why Choose Dr. Greenwald?


Dr. Greenwald's Awards and Memberships

Joshua A. Greenwald, MD, FACS, is a board-certified plastic surgeon. Breast augmentation surgery is not a simple procedure, and your result depends on the experience and skill of your surgeon. Each patient is different and requires a unique procedure to achieve optimal results. Dr. Greenwald has significant experience in breast implant surgery, and performs many primary and revision breast augmentation surgeries yearly. He offers a choice of breast implant types, incisions and placement options. Most patients have minimal or no pain, minimal or no bruising, and a prompt return to normal activities. There are no drains and, typically, no sutures to remove.

Dr. Greenwald is proud to have been selected to the Mentor® LEAD Program Advisory Board in 2012 and 2013. Mentor Corporation is one of the leading manufacturers of breast implants in the United States, and each year Mentor invites a select group of plastic surgeons to discuss new products, programs and innovations in breast augmentation surgery. Dr. Greenwald also was selected as a Best of Westchester Plastic Surgeon by Westchester Magazine in 2012 and 2013, as well as a Top Doctor by his fellow physicians (as reported via Castle Connolly in 2012 and 2013). He is a member of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.

Dr. Greenwald performs his surgeries at the state-of-the-art Plastic and Ocular Surgery Center of Westchester. He helped design this facility from the ground up. The facility meets and often exceeds hospital safety standards. Anesthesia is provided by board-certified anesthesiologists, and all of the nursing staff has significant experience caring for plastic surgery patients. 

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Overview of Breast Augmentation

At the practice of Joshua A. Greenwald, MD, FACS, many women request augmentation mammoplasty, or breast augmentation surgery, with saline or silicone breast implants to enhance their breast profile. Dr. Greenwald performs breast augmentation surgery for patients who would like to:

  • Increase their breast cup size
  • Improve the appearance of sagging breasts that look flattened or deflated (often due to major weight loss or pregnancy/breastfeeding).
  • Improve undesirable shape or contour of their breasts
  • Improve breast asymmetry

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Who Is a Suitable Candidate?

Only a board-certified plastic surgeon such as Dr. Greenwald is qualified to determine if someone is an appropriate candidate for breast augmentation. Nevertheless, in general, suitable breast augmentation candidates include those who:

  • Desire larger or fuller breasts
  • Desire a greater degree of cleavage or of outward projection from the chest wall
  • Desire breasts that appear higher up on the chest wall
  • On the whole, have a positive self-image, but are frustrated with certain aspects of their breasts
  • Are in good physical and mental health overall
  • Have sensible expectations for the outcome of breast augmentation surgery, and are seeking aesthetic improvement — not necessarily perfection
  • Are pursuing breast augmentation of their own volition
  • Are not breastfeeding (Women who are currently nursing should wait 12 weeks after they have stopped breastfeeding to undergo breast surgery, so their true breast size can be established.)

Video: What to Expect from Breast Augmentation with Dr. Greenwald

Hear about the breast augmentation experience at Dr. Greenwald’s practice from one of his many satisfied NYC breast augmentation patients.

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Saline vs. Silicone Breast Implants

Dr. Greenwald offers his breast enhancement patients saline and silicone breast implants.

Saline breast implants have a silicone outer shell but are filled with saline solution, or sterile saltwater.

The main benefits of saline implants are that:

  • Dr. Greenwald can use smaller incisions with saline implants (than he would with silicone implants) because they are filled after they are inserted into the implant pocket.
  • The body can safely absorb the saline filling material in case the implant ruptures.

The principal drawbacks of saline implants are that:

  • They do not resemble the look and feel of natural breast tissue as closely as silicone implants do.
  • They are more prone to folding or wrinkling in the implant pocket.
  • They may be visible under the surface of the skin, especially in women with thin skin or little body fat.

In contrast, silicone breast implants have both a silicone outer shell and a silicone-gel filling. The greatest advantage of silicone implants is that they more closely look and feel like natural breasts than their saline counterparts. MemoryGel® breast implants are composed of an outer silicone shell and filled with a cohesive gel formulation that acts as a solid rather than a liquid, and holds together uniformly. Numerous studies have demonstrated the safety of silicone implants.

The principal disadvantages of silicone implants are that:

  • They arrive from the manufacturer pre-filled, so the Manhattan breast augmentation surgeon must use slightly larger incisions through which to insert them.
  • Patients with silicone implants are at risk of “silent rupture,” a condition in which the breast implant has ruptured, but the patient is not aware of it because the body cannot absorb silicone, causing the filling material to remain intact inside the implant pocket.

Because of the risk of silent rupture, the FDA recommends that women with silicone breast implants undergo a breast imaging exam such as an MRI or mammogram every three years, starting the third year after the initial breast enhancement procedure.

Silicone Breast Implants

Mentor® manufactures two main types of silicone breast implants: MemoryGel implants and Contour Profile Gel (CPG) implants. Both these implants are made of a cohesive silicone gel (not liquid silicone!). The MemoryGel implants are smooth, round implants that are available in various degrees of projection, or profiles. Dr. Greenwald prefers the MemoryGel implants in cosmetic breast augmentation for their superior and more natural feel, once inserted into the implant pocket. The CPG implants have a textured outer shell and are available in anatomical shapes. They feel much firmer than the MemoryGel implants.  The CPG implants have gained some popularity in the reconstructive market, but play a lesser role in cosmetic breast surgery, except perhaps in complicated revision procedures. Both of these types of silicone gel implants are variations of what are more popularly referred to as “gummy bear” implants.

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Summary of differences between saline and silicone

 

Saline

Silicone

Incision length

Approximately 2.5 cm

Approximately 3.5 to 4 cm

Outer shell

Silicone

Silicone

Implant Fill

Saline

Silicone

Implant Surface

Smooth and textured surfaces available. Dr. Greenwald places all implants in a submuscular pocket and uses primarily smooth implants. 

Smooth and textured surfaces available.  Dr. Greenwald places all implants in a submuscular pocket and uses primarily smooth implants. 

Risk of “rippling”

Rippling more common than with silicone implants especially in very thin patients

Less rippling than with saline implants

Feel

Soft particularly in patients that are not very thin.  In thin patients, may feel firmer and ripple more than silicone implants.

Soft and more natural feeling than with saline implants.  Consistency more like breast tissue. 

Average implant lifespan

Implants are made to last a lifetime and are warrantied by the implant company for life.  Patients are told there is .5% chance per year of having an implant-related issue.

Implants are made to last a lifetime and are warrantied by the implant company for life.   Patients are told there is .5% chance per year of having an implant-related issue.

Rupture

Easy to detect

Harder to detect

Cost

Cost less than silicone

Costs slightly more than saline implants

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Breast Implants Placement Options

Dr. Greenwald offers two breast implant placement options: subglandular and submuscular.

With submuscular placement, Dr. Greenwald positions breast implants under the pectoral, or chest, muscle. Dr. Greenwald places more than 95 percent of his implants in the submuscular position. A lower incidence of capsular contracture, the ability to obtain high-quality mammograms and a more natural look are some of the reasons he prefers the submuscular position over the subglandular position.

With subglandular placement, Dr. Greenwald positions the breast implants under the glandular, or breast, tissue. However, subglandular placement may not be a suitable option for women with thin skin or little body fat because, in this case, the implant might be visible under the skin.

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Incision Approaches

Dr. Greenwald offers three incision approaches: inframammary (crease incision), periareolar and transaxillary.

The inframammary approach – Dr. Greenwald makes the inframammary incision in or near the breast’s natural crease. This incision is easily concealed by the overlying breast and is rarely visible during normal activities. The inframammary approach allows for the precise creation of the implant pocket and the cleanest entry for the implant. It is associated with the lowest incidence of capsular contracture and the lowest incidence of sensory changes of the nipple-areola complex.

The periareolar approach - With this incision option, the breast plastic surgeon creates an incision around the outer perimeter of the areola (the darkly pigmented skin encircling the nipple). The periareolar incision is perhaps the least visible in properly selected patients because it is concealed by the darker skin of the areola. The incision can be reused if the patient requires revision surgery for bleeding or capsular contracture. It is the preferred approach if a mastopexy (breast lift) is needed. It has similar rates of capsular contracture to other incisions and a comparable rate of decreased nipple sensation.

The transaxillary approach - With this approach, Dr. Greenwald positions the incision required for breast augmentation in the armpit area. He utilizes an endoscope, or lighted camera, to help tunnel through the fat that is found under the skin (i.e., subcutaneous fat), creating an implant pocket behind the breast tissue. He typically uses this incision approach to insert unfilled saline implants.  One of the drawbacks of this is incision is the increased incidence of implant malposition (i.e., lateral displacement of the implant pocket). If breast lift is also required, it cannot be done through an axillary approach. 

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How to Choose Breast Implants

Aside from choosing the size and type of breast implants, the implant placement method and the incision approach, breast augmentation patients must also choose the shape and texture of breast implants. Dr. Greenwald prefers smooth round implants. The different profiles (i.e., moderate, moderate plus and high profile) available will be discussed during your consultation.

During your consultation, Dr. Greenwald will review the patient’s unique anatomy and aesthetic desires, and will help her decide on a suitable surgical treatment protocol that will best meet all her needs. This includes making decisions about the size, shape and texture of breast implants as well as the incision approach and placement method.

Dr. Greenwald will review before-and-after photos of breast augmentation surgery patients with you during your consultation to help educate you on sizing and expectations. He also utilizes the Mentor® Volume Sizing System to help you determine what size implants will work best for you.  This will help you get an excellent idea of what your new breasts will look like. 

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Recovering From Breast Augmentation Surgery

Video: Breast Augmentation Recovery

Learn more about the expected breast augmentation recovery time after breast implants surgery in New York City with Dr. Greenwald.

Before breast augmentation surgery, patients receive comprehensive pre- and post-surgical care instructions. Following breast augmentation surgery with Dr. Greenwald:

  • Most patients are able to resume normal activities within days of their surgery.
  • Many patients require a small amount of or no pain medication.
  • Most patients have little or no bruising.
  • Some patients experience temporary or possibly permanent changes in breast and nipple sensation; this may include pain, tenderness, a tingling sensation or numbness in the treated area. Nipple sensation returns to normal in the majority of cases. 
  • Patients are permitted to go the gym at three weeks.
  • Patients are encouraged to sleep in a sports bra for three months.
  • It is also important to keep in mind that some patients look great immediately following their surgery while other patients’ implants take time (up to eight weeks) to settle into a more natural position.

Breast Augmentation Recovery Chart

Preoperative

Patient’s preoperative testing and mammogram (if needed) is reviewed. Patient will have filled prescriptions for pain medications, antibiotics and muscle relaxants. Meet with Dr. Greenwald, our anesthesiologist and nurses.

Day of Surgery

A primary augmentation takes between 45 and 60 minutes. Patient receives an intravenous antibiotic prior to beginning procedure.  

Recovery Room

Approximately 1 hour - you must be sent home with a responsible adult who should plan on spending the night with you.

After Surgery

Patients are sent home in a surgical bra with incisions covered with steristrips and gauze.  No heavy lifting or exercising. ABLE TO SHOWER 36 hours after surgery after removing the gauze but leaving the steristrips in place (usually the night after)

Postoperative Visit #1

Typically 5-7 days after surgery.  Any sutures requiring removal are removed.  Steristrips are replaced on the incisions as needed.  Continue to wear a soft bra or underwire bra depending on implant position. Begin medial massage of implants.  

Postoperative Visit #2

Typically 18-21 days after surgery.  Incisions are checked.  Silicone scar therapy is begun.  Able to return to gym.  Typically underwire bra during day and soft supportive bra at night.  Begin medial and superior-inferior massage of implants. 

Postoperative Visit #3

Patient’s are typically seen 3-4 months after surgery and then yearly. 

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What Does Breast Augmentation Cost?

The overall cost of breast augmentation surgery includes the plastic surgeon’s fee, the anesthesiologist’s fee, the operating room fee, the cost of breast implants and the miscellaneous costs associated with breast augmentation surgery (e.g., the cost of: any needed lab testing, the surgical bra, pain medication, etc.). The final cost of breast augmentation may vary, depending on the patient’s unique anatomical needs and aesthetic desires for surgery, the complexity of the surgical procedure, if an adjunct procedure is being performed at the same time (e.g., breast lift surgery) and the type of breast implants chosen.

That said, Dr. Greenwald is temporarily offering special prices on breast augmentation surgery. For a limited time, primary breast augmentation surgery with silicone breast implants costs $5,995; primary breast augmentation surgery with saline breast implants costs $4,995.00. (These prices include the plastic surgeon’s fee, the anesthesiologist’s fee, the operating room fee and the cost of the breast implants.)

To schedule a consultation, or to learn more about breast augmentation surgery, contact the practice of Dr. Greenwald by calling (914) 421-0113 or (212) 518-1642 today.

For more information about a specific procedure, please click below.


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166 5th Ave
New York, NY 10010
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440 Mamaroneck Ave #412
Harrison, NY 10528
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686 Stoneleigh Ave.
Carmel, NY 10512
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officeDr. Greenwald is excited to serve patients at his state-of-the-art plastic surgery facility in Harrison, New York. He and his staff members are proud of the beautiful, comfortable and safe space, which is accredited by the American Association for Accreditation of Ambulatory Facilities (AAASF). Please contact Dr. Greenwald's practice to schedule a cosmetic surgery consultation and tour the facility.
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166 Fifth Avenue, Second Floor, New York NY 10010 (212) 518-1642
440 Mamaroneck Avenue, Suite 412, Harrison NY 10528 (914) 421-0113
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