Breast Augmentation St Louis

Discover the perfect balance of art and science with Dr. Michele Koo, a board-certified plastic surgeon specializing in Breast Augmentation and Breast Implants in St. Louis.

Dr. Michele Koo, MD, FACS, Board Certified Plastic Surgeon creates uniquely beautiful, natural looking breasts that place your body in perfect harmony and balance.

I truly understand what a woman wants — fullness, sexiness, and cleavage for your breasts without them looking fake or being the center of attention as you walk into a room. I understand the fine line between achieving large enough breasts versus feeling overwhelmed, self-conscious, and fake.

I use both silicone and saline breast implants for your breast augmentation and will determine the perfect implant type, shape, and size based on your height and weight, as well as how much breast tissue you have, the quality of your skin, and your ultimate cosmetic desires. I take into consideration the uniqueness of the size and shape of your native breasts and whether you have had children, or will have children, and your age.

About the Breast Augmentation Procedure

Breast augmentation is one of the most frequently performed cosmetic surgery procedures in the U.S. and one of our most popular services. Breast augmentation can give women with small or unevenly sized breasts a fuller, firmer, better-proportioned look through the placement of saline or silicone implants in the breast.

My patients elect to undergo breast augmentation for many different medical and aesthetic reasons, including balancing breast size, compensating for reduced breast mass after pregnancy or surgery, and correcting a congenital breast defect. Under my expert care, patients enjoy great-looking, natural-feeling breasts that are one or more cup sizes larger after the operation.

Fully Customized Breast Enhancement

I know that every woman is unique in both her desires and her body shape. With that in mind, I take the time during the pre-operative consultations to learn what each patient hopes to gain from breast augmentation surgery and to decide which implant type and implant placement is best. In this way, every one of my patients enjoys completely customized treatment designed with her specific goals in mind.

Saline and Silicone Gel Breast Implants

Breast implants are silicone shells filled with either saline (salt water) or silicone gel. Both implant types are very safe, and each offers its own advantages. I will help you decide which kind is right for you. During surgery, I’ll place the implants behind each breast, underneath either breast tissue or the chest wall muscle.

After many years, the U.S. Food and Drug Administration (FDA) has approved silicone breast implants for breast augmentation surgery. We are proud to offer patients the option of silicone gel-filled breast implants, since they are much softer and feel more natural than saline-filled breast implants. Another very attractive appeal of breast augmentation using breast implants is the results are so instant and very affordable.

Some women may feel it is wrong to put something “unnatural” in their body, but breasts that are enhanced using breast implants can look and feel completely real. Many of my patients have informed me that their significant others including fiancés have never asked if their breasts are real. They simply assumed they were. As far as placing an “unnatural” implant in a body is concerned, think about those who need a total knee replacement or a hip replacement, those implants are not “natural” either. The breast implants enhance your own breasts. Some women never have had breasts and want a little shape to feel comfortable in clothes and more confident during intimate times.

Breast implants can provide that shape and confidence by simply providing some breast tissue, going from an A/AA to simply a B cup. Some women have lost the firmness of their youthful breasts and have too much skin or the skin is stretched and thin after children or weight gain and loss. A breast augmentation with a breast lift (mastopexy) is an excellent way of regaining shape and repositioning the nipple to a more youthful “perky” position. The breast implants then provides the “umph” for the breasts creating the round full look and feel of a denser more youthful breast.

There are also those women who have very asymmetric breasts or tuberous breasts (coned narrow breasts with large herniated areola) who would significantly benefit from a breast enhancement with breast implants. While this is still considered elective, the change in my patient’s attitude, general demeanor and happiness is tremendous. Their self-confidence is boosted more than I could possibly explain. The breast augmentation becomes truly a life enhancing procedure.

Some of my patients feel guilty about spending money on themselves for something trivial and “meaningless” but I will tell you that the change you will feel about yourself, your confidence and your interaction with others will be more than you could possibly imagine. You will love how you look in and out of clothes and that happiness within will translate to a desire to improve other aspects of your life. I’ve had patients be more motivated to exercise, to complete projects, and seek jobs they wouldn’t have previously considered. There are very few patients that ever miss the money spent, or regret having invested in improving their self-image and confidence with a breast augmentation.

Let me share an anecdote when my husband and I were out to dinner at a local small restaurant. A former breast augmentation patient of mine said hi to me in passing when she was with her husband and two kids at the same restaurant. A few minutes later after she told her husband who I was, he came over to our table and went on and on and on about what an awesome person I was and what an amazing job I had done, and how he absolutely wanted to thank me for creating such wonderful beautiful breasts and how that had changed their lives. My husband, who is an orthopedic surgeon (who saves professional athletes’ careers and keeps people running and walking), turned to me and said “Wow, I NEVER get that kind of response from my patients and I make them pain free and mobile!”

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Saline Breast Implants

Saline breast implants are “salt water” filled breast implants in a silicone envelope. They are made in different projections of moderate, high, and extra high profiles. In the past these different profiles have been referred to as “tear drop” shaped implants. A saline implant has a lower incidence of “capsular contracture” which is the scaring that your body makes around a breast implant. This may not be the optimal choice of a breast implant if you have very little breast tissue or very little subcutaneous fat on your chest. The saline breast implants tend to not age as well as a silicone breast implant. By that, I mean the saline implants can show ripples that can be seen and felt under the breasts after a few years. The thinner you are, the more likely there will be significant rippling that becomes quite noticeable with time.

The life of the saline implant can range from 10-25 years. Similar to silicone breast implants, a breast augmentation with saline breast implants is not a “one and done” procedure. The implants will need to be replaced when there is a rupture (deflation) of the implant or when the breasts become misshapen from the firming from the capsular contracture. Also if your breasts age and start to droop and there is a disconnect between where the implant sits on your chest and where your nipple is, the breasts will have to be lifted and the implants will have to be changed. All breast implants have a lifespan that can range 5-30 years, but typically around 10-20 years.

Silicone Breast Implants

Silicone breast implants are also very safe and have approximately the same lifespan as a saline implant. I personally feel silicone implants will age better than a saline implant and probably has a little longer lifespan. The capsular contracture rate is higher for a silicone implant but if the implant is placed under the muscle, the rate of capsular contracture is only slightly higher with a silicone breast implant than a saline breast implant.

I personally prefer silicone breast implants for my patients and almost always place the implant partially under the muscle for two very important reasons. 1-it is better for future mammograms and 2-the breasts will remain soft longer (less capsular contracture). Silicone breast implants are also made in different projections or profiles ranging from moderate to extra high profile. I typically will choose the type, size, and shape of the implant based on my patient’s body habitus, personal preferences, and anatomy of the breasts (how much breast tissue, fat and skin is present).

Cohesive Gel Breast Implants

Cohesive gel breast implants sometimes referred to as “gummy bear” breast implants have the lowest incidence of capsular contracture and offer a “shaped” implant for women who may want a very gentle slope (gradual) rise of the implant on the chest wall. This type of implant is not for every body type. I will often use this type of implant if the breasts have a particular shape that may need a little more expansion such as a tuberous breast (narrow base, herniated areola) or if the woman has a small rib cage (circumference) and little breast tissue.

Because the implant is actually “shaped” meaning it has a height and a projection, I can create a natural fall of the breast rather than an abrupt edge of the implant at the upper portion of the breast. This is what I term the ‘baseball stuck on the chest look.” Augmented breasts can be very full and voluptuous and do not have to look like they are stuck on your chest. Cohesive gel breast implants as well several of the other implants currently available can be used to create completely “natural” looking breasts that feel real and move when you move.

The key to a successful breast augmentation is to determine what you want your breasts to look like and then to find the plastic surgeon that truly understands and can deliver that look. Your actual breasts will often determine the best type of breast implant to use and I will guide my patients on which procedure and as well as which implant to choose based on my extensive experience with all different types of breasts and patients.

My patients in different decades and stages of life will desire different looks and I am particularly sensitive of that taking into account my patient’s lifestyle and comfort level as well as her age when I determine the perfect surgery for her desires.

Breast Augmentation Surgery – Incision Techniques

The breast augmentation procedure lasts one to two hours and is typically performed with general anesthesia. Incisions are made in inconspicuous places on the breast to minimize scar visibility. These may be located:

• In the armpit (transaxillary),
• In the crease on the underside of the breast (inframammary), or
• Around the areola, the dark skin around the nipple (periareolar).

The breast is then lifted, creating a pocket into which the implant is inserted.

Saline implants may also be placed endoscopically through an incision in the navel. This minimally invasive breast enhancement technique is known as a transumbilical breast augmentation or TUBA approach.

Breast Augmentation Surgery – Placement Options

Implant placement beneath the muscle of the chest offers a few advantages over placement beneath the breast tissue only. These include reduced risk of capsular contracture (post-operative tightening around the implant) and less interference with mammogram examinations. Possible disadvantages include need for drainage tubes and elevated pain in the first few days following surgery. We will discuss which option may be best for you.

In the TUBA procedure, implants cannot be placed beneath the chest wall.

After the implants have been inserted and positioned beneath the nipples, the incisions are stitched closed, then taped and bandaged. In a few days, these bandages may be replaced with a surgical bra.

Breast Implant Ruptures

If you have had a breast augmentation with a breast implant, you will at some point need to have your implants replaced. Breast implants like all implants have a lifespan.

Saline breast implants may last approximately 10-20 years. One day you may wake up and think one breast is slightly smaller than the other but the change is so subtle you ignore it. Eventually over the course of a week to two weeks, the one breast will definitely seem smaller and lower than the other breast. This is an indication that the saline is leaking out of the implant and your body is reabsorbing the fluid. This is the natural course of events for saline implants.

You will want to contact your plastic surgeon for a consultation. You have the choice of replacing the implants, removing the implants, or having a breast lift or not along with the implant replacement or removal. I guide my patients on which choice to take based on their desire to maintain a certain size and shape breast and how much the breasts have dropped and stretched over the years.

Silicone breast implants may last approximately 15-25 years. Silicone implants rarely have a frank rupture unless they are very old and have had significant trauma. A very old (20 years or older) silicone implant might even rupture after a mammogram. With the passage of time there may be microscopic leakage of the silicone, which is insignificant to the size of the breasts, but this tiny leakage can cause the body to create a “capsular contracture” around the breast implants. This capsule will harden and thicken with time as more silicone permeates through the weakened shell of the breast implant. When your breasts become too firm or start becoming misshapen, you will want to have the implants removed, the scar capsule completely removed, and either replace the implants or if not have a breast lift to remove the excess skin.

Be reassured that a rupture of a saline or silicone implant is NOT a medical emergency. Do not fret if the mammographer tells you one day after a mammogram that it looks like you have some “intra capsular” or “extra capsular” leakage of silicone around your implants. If this is the case, contact your plastic surgeon and determine the next best course of action.

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