The Art of Breast Augmentation

Breast Augmentation with Dr. Kolker

Breast implants are appropriate for the treatment of a wide array of breast size and shape concerns. Underdevelopment of the breasts, known as developmental breast hypoplasia, is a common indication for breast augmentation. Breast deflation following pregnancy (postpartum glandular hypomastia), after significant weight loss, or simply due to gradual involution can be improved significantly with breast augmentation. Certain breast asymmetries and congenital breast shape deformities can also be corrected through breast augmentation techniques. The technical approach must be meticulously tailored and personalized for every nuance of intrinsic shape and size and for every facet of individual desire.

The plastic surgeon you choose as your breast augmentation surgeon is of paramount importance. What differentiates care by Dr. Kolker and his team is comprehensive:

• Extraordinary finesse, technical skill, and experience,
• Superlative certification, accreditation, and safety standards,
• A deep understanding and perspective of beautiful, natural, and proportional breast and body aesthetics,
• A passion for achieving gorgeous results that can be stunning yet subtle, and
• A connection between patient, surgeon, and staff that is exceptionally warm, intimate, and comfortable.

From the initial consultation at his office on Park Avenue in New York City, through the perioperative phase, and throughout the entirety of your recovery and follow-up, you will experience the thoroughness, attention to detail, and warmth with which Dr. Kolker and his team welcome and care for you. The first visit is an opportunity for Dr. Kolker to get to understand your desires, to examine and evaluate physical requirements, to thoroughly inform you about the procedure(s) or alternative treatments that will suit you best, to answer any questions you may have, and to introduce you to our incredibly warm, professional, caring and compassionate staff.

Planning Your Breast Augmentation

There are four primary components that are essential to consider during the planning phase of breast augmentation:

• Type: the type of breast implants, silicone or saline
• Access Incision: the incision through which the breast implants are introduced
• Position: the pocket placement of the implants relative to the chest muscle
• Style: the shape, profile, texture and size of the breast implants

These choices are predicated on your innate anatomy, on your desired outcome, and on certain personal preferences. New York City Breast Augmentation Surgeon, Dr. Adam Kolker will carefully consider each of these factors with you, and will design the best breast augmentation treatment plan that is personalized to achieve your goals. Click on any of the four components below for more detailed explanation.

Type of Breast Implants: Silicone Gel vs. Saline

The two primary breast implant options available for cosmetic breast augmentation are silicone implants and saline implants. Both breast implants are safe, FDA approved devices that are excellent choices for breast enlargement. The current generation of silicone breast implant is pre-filled with a cohesive silicone gel, and saline implants are filled with salt water solution at the time of surgery. Each has a similar silicone elastomer outer shell. At comparable volumes, the look of each implant is virtually identical. To the touch, the silicone gel implants have a more natural, breast-like feel.

Access Incisions for Breast Enlargement

Breast augmentation can be performed using incisions in the lower crease beneath the breast (inframammary crease incision), along the lowest border of the pigmented areola (periareolar incision), or within the underarm (transaxillary incision). In consideration of a variety of factors including areolar size, breast shape, breast glandular density, inframammary fold definition, size goals, implant selection, and personal preferences, Dr. Kolker will advise you on the best breast augmentation incision options.

To minimize incision length and to gently introduce silicone gel implants with a minimal or “no-touch” technique, a Keller Funnel is uniformly used. The Keller Funnel is an implant insertion device with a slick, low-friction surface that enables the placement of silicone breast implants through smaller incisions. Using these devices since 2010, Dr. Kolker uses the Keller Funnel for every breast augmentation.

Position of Breast Implants

Breast implants can be placed below the muscle (submuscular augmentation), or above the muscle (subglandular augmentation). Submuscular augmentation confers the following benefits:

• Provides increased coverage of the breast implants
• Softens the upper pole of the breast leading to a more seamless, natural transition from collar bone to nipple
• Maintains long term stability of the breast pocket
• Markedly decreases rates of capsular contracture
• Lessens influence on mammography

Dr. Kolker uniformly utilizes a submuscular pocket plane. “Dual plane” augmentation is a form of submuscular augmentation that allows for maximal coverage of the upper pole of the implant by muscle, and direct effacement of the lower breast gland; this maneuver is employed when there is minor lower pole soft tissue excess or mild droop (ptosis) of the breast.

Breast Implant Style, Texture, Profile, & Sizing

Breast implants are available in a wide array of shapes, profiles, shell textures, and sizes. Round implants or anatomical implants can be used. Both implants assume a tear-drop shape when upright. The shells of breast implants can be smooth or textured. Implant profile refers to the projection of an implant for a given base dimension. Choices are made from among three profiles, corresponding to low or moderate projection (less volume and anterior convexity), midrange or moderate plus projection (intermediate volume and convexity), and high profile (maximum volume and convexity). Considering the nuances of your anatomy and the subtleties of your specific desires, Dr. Kolker will advise you on the best breast implant style, profile, and projection options to achieve your goals.

Choosing the correct breast implant size is a process that begins with your initial consultation. Dr. Kolker is fastidious about getting to know the nuances of every individual’s wishes and goals. These desires are married with the careful anatomical measurements and tissue assessment to establish an initial size “range”. At a preoperative visit approximately two weeks before surgery, the goal is further confirmed with a series of neoprene bead-filled sacs used as “sizers” that are placed into a special brassiere; you will try a range of sizes to get a better sense of dimension and proportion. Finally, Dr. Kolker uses silicone gel or saline implant sizers during surgery to confirm the size selection. As a rule in realizing the most beautiful endpoint, Dr. Kolker strives to achieve natural and proportional size and shape, directed by your thoroughly considered desires and goals. With his years of experience and attention to detail, Dr. Kolker has earned a reputation amongst his patients for providing high quality breast implants and cosmetic surgery.

Choosing Your Perfect Breast Implant Size

Choosing the best breast implant size is a multifaceted and seamless process that Dr. Kolker will guide you through during your consultation. Informed by your desires, the selection of the ideal breast implant volume, base width, and projection will be primarily biodimensional, meaning it will be based on the unique qualities of your anatomy that Dr. Kolker gleans by careful breast measurements, evaluation of skin elasticity, breast tissue density, chest wall shape, and body proportions. Once these calculations have been made, you will “size” with breast implant sizers that you will be able to insert into a special bra that help to further approximate your perfect breast implant parameters.

Additionally, Dr. Kolker can assist you in visualizing possible breast augmentation outcomes using the Crisalix 3D platform. Crisalix is an elegant tool that enables Dr. Kolker to render a 3-dimensional template of your anatomy, and then digitally enhance the construct with a variety of breast implant sizes that are appropriately matched to your measurements and desires. Potential breast augmentation “results” can be visualized in Dr. Kolker’s New York City office using an iPad or computer, or in VR with an Oculus virtual reality headset. While the Crisalix 3D predictive outcomes are a simulation only, and no assurances can be made with regard to an exact end result, the following images illustrate a Crisalix 3D simulation of a patient cared for by Dr. Kolker, in addition to the actual results achieved by Dr. Kolker at one year follow up:

Crisalix 3D Renderings and Actual Patient Photos

Actual Patient of Dr. Kolker
31 year old female, 5’2”, 117 lbs.
Breast cup size change: 34B to 34C

240cc silicone breast implants (Allergan Inspira SRM-240 gel breast implants), submuscular position (dual plane), inframammary fold incision (breast augmentation access incision placed in the crease beneath the breast).

Hear From Dr. Kolker's Patients