Breast Augmentation

Learn About the Most Popular Variations of Breast Augmentation in Ohio

Breast augmentation is one of the most popular cosmetic procedures in the United States as well as Cleveland, Ohio and is associated with a high satisfaction rate among patients. There are many nuances to a breast augmentation procedure. The patient and her doctor must make choices relating to:

  • Optimal implant size
  • Saline versus silicone implants
  • Under the muscle (subpectoral) versus on top of the muscle and directly under the breast tissue (subglandular)
  • Incision placement in the belly button (transumbilical), under the breast (inframammary), at the edge of the aereola (periaereolar), or in the arm pit (transaxillary)
  • Smooth or textured implants
  • High or low profile or height implants
  • Round or teardrop implant shape

Choosing the right doctor.

With all these choices, clearly the patient must choose the right doctor. Choose a physician who has real credentials, including Board Certification in Plastic Surgery and preferably membership in the American Society of Plastic Surgery. Most plastic surgeons who have a special interest in cosmetic surgery are also members of the American Society of Aesthetic Plastic Surgery. (See our section on Choosing a Surgeon/Safety for more details.)

But board certification and society membership alone are not enough. Patients want a surgeon who is adept at breast augmentation in Ohio, a surgeon with excellent experience in cosmetic breast surgery. Reputation and word-of-mouth referrals are an excellent way to assess expertise in a specific area. The internet also provides a unique opportunity to view the doctor’s work before ever stepping into his or her office; specifically, choose a doctor who has many before-and-after photos available on his or her website for review.

The consultation then becomes the critical step in choosing a plastic surgeon and in making decisions regarding your actual breast augmentation in Ohio. The doctor (and his or staff) must take the time to answer all of your questions thoroughly and to explain all the options and nuances of breast augmentation of Cleveland Ohio to you. The difference between a good result and a truly beautiful, natural, artful, and attractive result is in the nuances.

Why choose Dr. Goldman?

Dr. Goldman has a special interest in breast augmentation. He has extensive experience in plastic surgery of the breast that began with breast cancer (mastectomy) reconstruction, which he performed while he was acting Chief of Plastic Surgery at University Hospitals of Cleveland. The challenge of rebuilding breasts removed because of cancer gave Dr. Goldman a comprehensive understanding of the subtleties of breast anatomy and form, an understanding and experience that allowed Dr. Goldman to establish a reputation for excellence in cosmetic breast surgery. A large part of his practice actually involves revising or correcting previous breast augmentations in Cleveland Ohio.

Dr. Goldman’s credentials are detailed on the “Dr. Goldman page.” Very few plastic surgeons in the region have his training, experience, and expertise. He is double Board Certified, in Plastic Surgery and Otolaryngology/Head and Neck Surgery. He is a member of all the major medical societies related to plastic surgery, including the American Society of Plastic Surgeons and the American Society of Aesthetic Plastic Surgery. Credentials aside, Dr. Goldman cares deeply for his patients. His philosophy of plastic surgery is that the surgeon must help his patients feel an improvement in their quality of life.

There is no better way to evaluate a doctor than to meet him or her in person, in consultation. But prior to this, reviewing their credentials and their work is essential. Reviewing before and after pictures has become an essential part in researching plastic surgeons. The photos on our site show that Dr. Goldman’s results are superior and consistent with breast augmentation in Ohio and other services.

Please feel free to email Dr. Goldman ( or call our office at (216) 514-8899 with any questions or to schedule a consultation. A formal consultation is really the only safe way to determine what choices are most likely to produce the ideal result for your specific goals and physical characteristics, nonetheless a general discussion of various issues related to your breast augmentation in Cleveland Ohio is useful prior to consultation, so several topics are discussed below.

Implant and cup size.

Cup size is not scientific nor standardized. One bra company’s C-cup is usually not the same volume as that of another company, for instance. One woman may prefer a tighter fit than another, so two different women with the same breast size may wear different size bras. Furthermore, the more the chest diameter increases, the larger the cup becomes; so a 32-C has a much smaller cup volume than a 42-C. When a surgeon and patient discuss cup size, these inconsistencies must be taken in to account: bra sizes are not standardized and patients (and their surgeons) are subjective in what they consider a given cup size.

Another important consideration that may or may not be immediately obvious is that the breast size after the breast augmentation in Ohio depends on both the chosen implant size and the pre-existing breast volume. So a 360 cc implant may produce a small C-cup breast size in a patient who starts out with a relatively small amount of breast tissue, but may result in a D-cup breast in a patient who started out as a small C.

It is important not to make size the only consideration. Ultimately, the best result will come from an improvement in size, shape, and contour. An augmented breast should look youthful (full, high, even “perky”) and proportional.

Saline versus silicone.

The importance of silicone versus saline implant has been overemphasized. This is only one of the many choices and technical aspects of breast augmentation in Cleveland Ohio. Choosing the right size and shape of implant and placing it with precision in the right location under the breast, are even more important. The main advantage of silicone is that it has less tendency to produce rippling (the appearance or feel of ridges along the side of the implant) than saline. Silicone does look and feel more natural than saline, but saline implants also look and feel very natural as long as they are used properly, artfully, and with precision. With either type of implant, the majority of patients have an obvious improvement in the look and feel of their breasts. The primary disadvantages of silicone breast augmentation in Ohio are increased cost ($1000-1500 more than saline), need for a larger incision, and the potential for unrecognized leakage, which has an increased potential for capsular contracture.

The Food and Drug Administration recently re-approved the use of silicone implants in this country because they feel there is no statistical evidence linking their use to diseases such as breast cancer, rheumatoid arthritis, or lupus. They did recommend that patients undergo MRI scans 3 years after a breast augmentation in Ohio and every 2 years thereafter, but only in patients with silicone implants to look for leaks. The main potential side effect of leak in some patients is capsular contracture.

Capsular contracture refers to hardening of the scar tissue envelope that surrounds the implants. Any synthetic implant in the body (e.g., an artificial knee, a pace maker, or a breast implant) is covered by a capsule, or a layer of scar tissue. In a small percentage of breast implant patients, this capsule thickens, or contracts, causing pain and distortion of the breast in severe cases. When silicone leaks, it produces capsular contracture in some patients, which can in turn necessitate removal of the implants.

Saline implants for breast augmentation in Ohio can also produce capsular contracture, but probably at a lower rate than silicone. (This is currently being studied in large numbers of breast implant patients.) If saline leaks, the body just absorbs the salt water and excretes it in the urine. The patient notices a decrease in breast size and returns to her surgeon.

So the primary benefit of silicone is less rippling and a potentially more natural look and feel. The primary disadvantages are cost, need for a larger incision, and the potential for leak and capsular contracture. The primary advantages of saline implants for breast augmentation in Cleveland Ohio are that they can be placed through a belly button (transumbilical) incision, use smaller incisions, lower cost, and less concern medically about leaking. Furthermore, many patients do prefer the look of saline, which gives more fullness, especially in the upper breast, than silicone. This effect is most noticeable when small to moderate implant sizes are used. The main disadvantage of saline is more potential for visible rippling than silicone. Saline implants allow for smaller incisions (less than 1 inch for Dr. Goldman’s technique) in breast augmentation in Ohio because they are inserted deflated and rolled-up, and then inflated using a fill-tube. Silicone implants for breast augmentation in Ohio come pre-filled and completely intact from the factory, and thus require a fairly large (approximately 2.5 inch) incision

Under versus over the muscle.

The pectoralis major muscle is the large muscle on the front of the chest that is easily seen in male body builders. The female breast rests on top of this muscle. Subpectoral breast implants are placed below the muscle and on top of the rib cage. Subglandular implants are placed under the breast (mammary gland) and on top of the muscle. It is generally accepted that submuscular implants are less likely to develop capsular contracture. Dr. Goldman, and others, also feel that the breast has a higher, more youthful appearance with more natural and noticeable cleavage when under the muscle placement is used. Most augmentations in the United States use subpectoral placement with round, smooth saline implants. Some surgeons will place the implants over the muscle in female body builders on in women with some degree of droop. These are the most common reasons to use subglandular placement for breast augmentation in Ohio.

Choice of incision site.

The available incision sites for breast augmentation in Cleveland Ohio are: inframammary (in the crease below the breast), transumbilical (through the belly button), periaereolar (through the outer edge of the aereola, the pigmented circle of skin around the nipple), and transaxillary (through the arm pit). The inframammary fold is the most common choice in this country. Dr. Goldman uses an incision less than 1 inch long. This “keyhole” approach leaves a minimal scar that is well hidden in the fold underneath the breast. The transumbilical approach clearly give the least noticeable scar. This procedure affords a little less precision than the other techniques because of the remote incision. The periaereolar incision can occasionally heal with a thick scar, but is the incision of choice when a breast lift is performed at the same time as the augmentation, since both procedures use the same incision. The transaxillary incision keeps scars off the breast, but can yield a scar that is visible in the arm pit when the arms are raised.

Ultimately, like all of the choices in breast reduction, the best option depends on the specific goals and physical characteristics of the patient.

Smooth or textured.

The actual shell of the breast implant is always silicone plastic (soft and malleable), regardless of whether saline or silicone gel fills the implant. Most surgeons favor smooth implants for breast augmentation in Ohio because they have a little mobility in the pocket created for the implant, so rippling is less likely to occur. Textured implants have some adherence to the surrounding implant capsule, so they move less. This can be advantageous in patients who are having prior augmentation revised, in patients who require a concurrent breast lift, and in some other situations.

High, moderate, or low profile.

The profile of the implant basically refers to how flat (low profile) or tall (high profile) the breast augmentation in Ohio implant shape is. Moderate implants are used most commonly. High profile implants can allow a larger implant to be used in a patient who has a narrow rib cage or breast.

Round versus tear-drop shaped.

Round implants are most commonly used with breast augmentation in Cleveland Ohio. A tear-drop or anatomic implant may be used when the patient or surgeon are concerned about too much fullness to the upper part of the breast, but fullness here is generally desirable, so anatomic implants are used more commonly for reconstruction than cosmetic breast surgery. If anatomic implants shift or tilt postoperatively, they can also distort the breast.


There are many choices to make when considering a breast augmentation, but the decision to undergo this procedure cannot be made without adequate consideration of the risks of the procedure.

~ Medical and anesthetic risks:

Every surgery carries risks of bleeding, infection, and anesthetic complications. Bleeding after breast augmentation in Ohio can require a return to the operating room to stop bleeding and can even require transfusion. Infection around a breast implant can require removal of the implant, which has to be left out for weeks to months to ensure that the infection clears. There have even been case reports of implants becoming infected years after augmentation. Anethetic complications can involve allergic reactions to medications, pneumonia, blood clots, heart attacks, and other issues. All of these types of complications are rare, but real with surgery.

~ Implant leak and longevity:

As a rule of thumb, implants leak at a rate of about 1% per year per implant. If saline implants leak, the patient sees deflation and urinates out the fluid. If silicone leaks, the implant usually will maintain its size, and the leak will go unnoticed until a change in shape occurs or until capsular contracture develops.

Realistically, most patients must consider that breast augmentation in Ohio implants will not last the patient’s lifetime. So almost every breast augmentation in Ohio patient will require further breast surgery over her lifetime following augmentation. This may be due to implant leak, breast aging around the implants (requiring breast lift), capsular contracture, or other causes.

~ Nipple sensitivity:

Changes in nipple sensitivity are common after breast augmentation in Ohio. Many patients note hypersensitivity, which usually subsides after several weeks. A small percentage of patients will experience permanent nipple numbness in one or both nipples. This is more common if a breast lift is performed with the augmentation.

~ Mammography after breast implants:

Mammography is more difficult to read once breast implants are placed. Special views are required. No large study has shown a delay in breast cancer diagnosis in augmented patients, but patients are more likely to require ultrasonography or MRI if any abnormalities are seen on mammorgram.

~ Breast feeding after breast augmentation:

Breast augmentation does not interfere with breast feeding as long as nipple sensation is normal, however, patients who have implants are more likely to require subsequent breast lift if their breasts enlarge with pregnancy and lactation because the combination of breast enlargement from an implant and lactation causes more stretch on the skin.

~ Cosmetic issues and revisions:

The most common issues affecting patient satisfaction after breast augmentation relate to size, shape, symmetry, and contour. A large proportion of Dr. Goldman’s patients have had prior surgery elsewhere and seek correction of various problems. Some of these patients have implant malposition (distortion of the breast because the implant is not placed in the ideal location or pocket). Some of these patients have leak or capsular contracture. Photographs of some of these patients are in our before and after gallery and can provide an idea of the kinds of cosmetic and long term problems implants may have. While many patients do feel that they may have “gone a little larger,” this reflects the fact that their breast feel natural after augmentation. Most patients are at or near their original size goal, if they had a specific size goal, but patient satisfaction depends on the overall appearance of the breast—size, shape, and contour.

At Beachwood | Westlake Plastic Surgery and Medical Spa, we offer Sientra silicone gel breast implants. 

Sientra implants are FDA approved and have an unrivaled safety profile, with some of the lowest complication rates clinically shown through a robust 10-year study*. Not only are Sientra implants safe, but they are also backed by their Platinum 20™ year warranty which provides the longest length of coverage, most financial assistance, and least restrictions in the industry. 

Sientra implants are designed to hold their shape while maintaining a remarkably soft feel. With two surface types, over 340 implant options, and 5 projection levels, Sientra breast implants can help you see the look you’ve always wanted. 

* Stevens WG et al. Ten-year core study data for Sientra’s Food and Drug Administration—approved round and shaped breast implants with cohesive silicone gel. Plast Reconstr Surg. 2018;141(4S):7S-19S. 



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