Breast augmentation · New York and New Jersey
Breast Augmentation
Breast augmentation uses implants to add volume and shape to the breasts. Dr. Steven Ovadia is a board certified plastic surgeon who performs breast augmentation for cosmetic and gender-affirming patients, with offices in New York City and New Jersey.
Overview
What breast augmentation is
In breast augmentation, an implant is placed behind each breast through a short incision. The implant adds volume, and it changes the shape of the breast, most of all the fullness of the upper part.
There is not one right implant or one right size. The plan depends on your chest measurements, the tissue you have, and the look you want. Dr. Ovadia goes over the options with you, and the two of you decide on the plan together.
Why people choose it
More volume
Breasts that have always felt small for your frame, or out of proportion with the rest of your body.
Volume that has been lost
Pregnancy, breastfeeding, and weight loss can leave the breasts smaller and less full, especially in the upper part.
A difference between the two sides
Most breasts are not identical. When the difference is larger, implants of different sizes can bring the two sides closer. Some difference usually remains.
Gender-affirming care
For transgender women and nonbinary patients who want more breast volume and shape than hormone therapy has given them.
Is it right for you
Before breast augmentation
These are the things Dr. Ovadia goes over with you when planning surgery.
Breasts that have finished developing
Surgery is done once the breasts have stopped growing. Saline implants are FDA approved for breast augmentation at age 18 and older, and silicone gel implants at age 22 and older.
Good overall health
Dr. Ovadia reviews your health history and medications with you as part of planning your surgery.
A break from nicotine
Nicotine affects how well incisions heal. If you smoke or vape, Dr. Ovadia goes over taking a break from nicotine before and after surgery.
Breast screening up to date
Depending on your age and history, a mammogram may be requested before surgery.
Pregnancy and weight changes
Pregnancy and changes in weight after surgery can change the size and shape of the breasts. It helps to share your plans at your consultation.
Clear goals
Photos of results you like, and of results you do not, help Dr. Ovadia understand the look you want and tell you what is realistic for your frame.
An implant adds volume. It does not raise a breast that sits low on the chest. When the nipple sits at or below the fold under the breast, a breast lift, alone or together with implants, may be the better plan.
Implants
Silicone gel or saline
Both types of implant have a silicone shell and are approved by the FDA. They differ in what fills them.
| Silicone gel | Saline | |
|---|---|---|
| What is inside | A soft silicone gel, inside a silicone shell | Sterile salt water, inside a silicone shell |
| How it feels | Closest to the feel of breast tissue | Firmer. Rippling can be easier to see or feel when there is little tissue over the implant |
| The incision | Slightly longer, because the implant comes already filled | Shorter, because the implant is filled once it is in place |
| If the shell leaks | Often there are no symptoms, so imaging is used to check the implants over time | The implant deflates and the body absorbs the salt water, so it is noticed quickly |
| FDA approval | Breast augmentation at age 22 and older | Breast augmentation at age 18 and older |
The other choices
Size
Implants are measured by volume, in cubic centimeters (cc), not by cup size. The width of your chest and the amount of your own tissue set the range that fits. Dr. Ovadia measures your chest and goes over that range with you.
Profile
Profile is how far an implant projects forward for its width. Two implants of the same volume can look different: one wider and flatter, one narrower and fuller. The profile is matched to the width of your chest.
Shape and surface
Implants have either a smooth or a textured surface. Dr. Ovadia uses only smooth implants. He goes over the implant he recommends for you and why.
Placement
Over or under the muscle
The implant sits in a pocket behind the breast. The pocket can be made in front of the chest muscle or partly behind it. Which is better for you depends mostly on how much of your own tissue there is to cover the implant.
Over the muscle
Also called subglandular or prepectoral
The implant sits behind the breast tissue and in front of the chest muscle.
- Less soreness in the first days for many patients
- The implant does not move when the chest muscle tightens
- Needs enough of your own tissue to cover the implant
Under the muscle
Also called submuscular or dual plane
The upper part of the implant sits behind the chest muscle. The lower part is covered by breast tissue.
- More coverage over the upper part of the implant
- Helpful when there is little tissue of your own
- The implant can move when the chest muscle tightens
Where the incision goes
In the fold
Under the breast
The most common choice. The scar sits in the fold under the breast.
At the areola
Along its lower edge
The scar sits where the darker skin of the areola meets the lighter skin around it.
Dr. Ovadia goes over the incision and the placement he recommends for you, and why.
Gender-affirming care
Gender-affirming breast augmentation
Hormone therapy leads to breast growth, but for many patients the growth is less than they hoped for. Breast augmentation adds volume and shape that hormones alone did not.
Dr. Ovadia completed a fellowship in gender-affirming surgery at Johns Hopkins. The operation uses the same implants, and it is planned for a chest that has a different shape.
A different starting point
The chest is often wider, with the nipples set farther apart and a shorter distance from the nipple to the fold. The chest muscle is often thicker and the skin tighter. The width, position, and placement of the implant are planned around these differences.
Timing with hormones
Breast growth from estrogen is gradual. Current guidelines suggest at least six months of hormone therapy before breast augmentation, unless hormones are not part of your care, and some insurance plans ask for longer. Waiting lets your own tissue develop, which gives the implant more coverage.
Part of a larger plan
Breast augmentation can be planned on its own or along with other gender-affirming surgery. If you are planning more than one operation, Dr. Ovadia goes over the order and timing with you.
More about gender-affirming surgery with Dr. Ovadia.
Real results
Breast augmentation before and after
These are Dr. Ovadia's own patients. Each case notes how far out from surgery the "after" photo was taken, because implants take months to settle.
Before-and-after photographs
This section contains before and after photographs of real surgical procedures.
You must be 18 years or older to view this content.
Recovery
What to expect after surgery
Swelling is normal and expected
The breasts are swollen at first, and the implants sit high and feel firm. Over the following weeks and months the swelling goes down and the implants settle into position.
The surgical bra is important
You wear a surgical bra after surgery. The compression helps prevent and minimize swelling and supports the breasts while they heal.
Tightness across the chest
A feeling of pressure or tightness is common in the first days, more so when the implant is under the muscle. It eases as the tissue relaxes.
Walking starts early
Short walks begin right after surgery. Lifting, reaching overhead, and exercise come back in steps, as Dr. Ovadia advises.
Changes in feeling
Changes in nipple or breast feeling can happen after surgery. They usually improve over time. Permanent changes are less common.
Scars fade
The incisions are short and placed where they are hard to see. Scars are pink at first and fade over a year or more.
Call the office right away if one breast becomes much more swollen, firm, or painful than the other, or if you notice spreading redness, warmth, or a fever. These are best taken care of early.
A general timeline
This is a general guide. Everyone heals differently. During your recovery, Dr. Ovadia will review your timeline with you.
Living with implants
What to know for the long term
Breast implants have been studied for decades, and most patients do well with them. They also need attention over time. These are the points every patient should understand before surgery.
Implants are not lifetime devices
The longer implants are in place, the more likely it is that they will need to be removed or replaced. You should expect that you may need another operation at some point.
Capsular contracture
The body forms a thin layer of scar tissue around every implant. In some patients it tightens, which can make the breast feel firm, change its shape, or cause discomfort. It can be treated with surgery.
Rupture
An implant shell can develop a tear. A saline implant deflates. A silicone gel implant can leak without symptoms, so the FDA recommends imaging with ultrasound or MRI starting five to six years after surgery, and every two to three years after that.
A rare lymphoma
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare cancer of the immune system that can develop in the scar tissue around an implant. It is not breast cancer. It has been linked mainly to implants with a textured surface. Dr. Ovadia uses only smooth implants. Other cancers in the scar tissue have been reported and are rarer still.
Symptoms some patients report
Some patients with implants report symptoms such as fatigue, joint pain, and trouble with memory or concentration, sometimes called breast implant illness. It is not fully understood and is being studied. Some patients report that symptoms improve after their implants are removed.
Mammograms
You continue screening for breast cancer on your regular schedule or as your primary care doctor recommends. Tell the imaging center that you have implants, so that additional views can be taken.
New swelling, a lump, or pain around an implant should be checked, even years after surgery. Before your operation, Dr. Ovadia reviews the implant's patient decision checklist with you. The FDA requires this for every breast implant patient.
Cost and insurance
Cost and insurance coverage
Breast augmentation done for cosmetic reasons is not covered by insurance. The cost depends on the implants and on the plan for surgery, and we go over it with you after your consultation.
Breast augmentation may be covered when it is done for symmetry in breast reconstruction: an implant placed in the other breast so that it matches a breast reconstructed after a mastectomy. Federal law requires most health plans that cover mastectomy to cover surgery on the other breast for symmetry.
Gender-affirming breast augmentation may also be covered by insurance when a plan's medical criteria are met and it is a covered benefit of your policy.
Common criteria for insurance coverage
Gender-affirming breast augmentation
- A letter of support from a qualified mental health professional
- Documented gender dysphoria that has been present over time
- A period of feminizing hormone therapy, often six to twelve months, unless hormones are not desired or not medically appropriate
- The capacity to make an informed decision about surgery
Every plan sets its own criteria, and some plans do not cover breast augmentation. Coverage is not guaranteed.
If you have questions about possible insurance coverage for surgery, call or email us and we will go over it with you.
Your surgeon
Board certified and double fellowship-trained
Dr. Ovadia is board certified by the American Board of Plastic Surgery. After his plastic surgery training he completed two fellowships: gender-affirming surgery at Johns Hopkins, and craniofacial and pediatric plastic surgery at UT Austin / Dell Children's Hospital.
He performs breast augmentation for cosmetic and gender-affirming patients, and he uses implants in breast reconstruction after mastectomy. His published research includes a study of the risk factors for capsular contracture after breast implant surgery. He sees patients in New York City and in Jersey City and Millburn, New Jersey.
Questions
Common questions about breast augmentation
Silicone or saline: which is better?
Neither is better for everyone. Silicone gel feels closer to breast tissue and is chosen more often. Saline needs a shorter incision, and a leak is noticed quickly because the implant deflates. Dr. Ovadia goes over both with you.
Should the implant go over or under the muscle?
It depends mostly on how much of your own tissue there is to cover the implant. With little tissue, placing the upper part of the implant under the chest muscle gives more coverage. With enough tissue, the implant can sit over the muscle. Dr. Ovadia examines you and explains which he recommends and why.
How do I choose a size?
Implants are measured by volume, not by cup size, and the same implant looks different on different frames. The width of your chest and the amount of your own tissue set the range that fits. Within that range, the choice is yours. Photos of results you like are a helpful place to start.
Where are the scars?
Most often in the fold under the breast, where the scar is hidden by the breast itself. The other option is along the lower edge of the areola. Dr. Ovadia goes over the incision he recommends for you.
How long do breast implants last?
Breast implants are not lifetime devices, and the longer they are in place the more likely it is that they will need to be removed or replaced. There is no set date for replacing them. Implants that are not causing a problem do not need to be exchanged because of their age alone.
Can I breastfeed after breast augmentation?
Many women breastfeed after breast augmentation. Some studies have found that women with implants are less likely to breastfeed exclusively, and it is not clear how much of that is due to the surgery. Not everyone can breastfeed, with or without surgery. If you plan to breastfeed, tell Dr. Ovadia at your consultation.
Do implants interfere with mammograms?
You can still have mammograms. Tell the imaging center that you have implants, so that additional views can be taken. You continue screening for breast cancer on your regular schedule or as your primary care doctor recommends.
Can breast augmentation be combined with a breast lift?
Yes. An implant adds volume, but it does not raise a breast that sits low on the chest. When the nipple sits at or below the fold under the breast, a lift, alone or together with implants, may be the better plan.
How long do I need to be on hormones before gender-affirming breast augmentation?
Current guidelines suggest at least six months of feminizing hormone therapy first, unless hormones are not part of your care. Some insurance plans ask for longer. Breast growth from hormones is gradual, and waiting lets your own tissue develop before the size of the implant is chosen.
Is breast augmentation covered by insurance?
Breast augmentation done for cosmetic reasons is not covered by insurance. Gender-affirming breast augmentation may be covered when a plan's medical criteria are met and it is a covered benefit of your policy. Breast augmentation may also be covered when it is done for symmetry in breast reconstruction after a mastectomy. Each plan sets its own criteria, and coverage is not guaranteed. If you have questions about possible insurance coverage for surgery, call or email us and we will go over it with you.
Can I have a consultation without coming to the office?
Yes. Phone and video consultations are available, in addition to in-person visits in New York City, Jersey City, and Millburn, New Jersey.
Next step
Start with a consultation
Dr. Ovadia will examine you, take measurements, go over the look you want, and explain which implant, placement, and incision he recommends.
225 Broadway, Suite 3100, New York, NY
377 Jersey Ave, Suite 440, Jersey City, NJ
90 Millburn Ave, Suite 206, Millburn, NJ
Phone and video consultations available · info@ovadiaps.com