Breast Augmentation

Augmentation Mammoplasty with Implants

Breast implants surgery or augmentation mammaplasty is the process of inserting an implant (saline or silicone gel filled), or transferring fat to a surgically formed pocket in the breast in order to increase size & volume, improve symmetry or reconstruct lost breast tissue. A typical breast implants procedure is performed with the patient under anesthesia and normally takes 1-2 hours to complete.

Breast Surgery Specialist

A widely recognized international expert on breast augmentation, Dr. Michael Pasquale has been performing breast implant surgery for over 30 years. Dr. Pasquale has vast experience in Caucasian, African American and Asian breast augmentation here in Hawaii and around the world. Dr. Pasquale is consulted worldwide by other plastic surgeons for his knowledge on breast reconstruction & and breast revision surgery. He frequently is asked to speak about his breast augmentation techniques and experience, lecturing in Japan, Korea, China and the mainland. After 1000’s of satisfied patients and 30 years of performing the procedure he is also well known for correcting botched breast implant surgery and performing difficult, complicated breast revision surgery.

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Dr. Pasquale has been involved in breast implants surgery for many years, first as a general surgeon taking care of breast disease and cancer patients, and then as a plastic surgeon reconstructing the breast. Such extensive experience is unique among plastic surgeons and has paved the way for Dr. Pasquale to move into his cosmetic surgery practice. This has produced a confidence in our practice to handle most any problem ranging from the saggy breast to one breast being larger than the other. It’s only through this type of experience that we are able to obtain the results that are pleasing to you and to us. Today, Dr. Pasquale’s talent for cosmetic breast surgery is well known both in the islands of Hawaii and on the mainland. From Waikiki to the beaches of Thailand many women have achieved their goals with Dr. Pasquale’s talents in cosmetic breast surgery.

What Is the Cost of Breast Implants in Hawaii?

At our Honolulu Hawaii clinic, breast augmentation surgery will cost between $5000.00 – $10,000.00 which includes all fees. This wide range can depend on a great many variables. To determine more closely how much breast augmentation surgery will cost you, please refer to our Breast Augmentation Cost page.

How to Choose the Size of Your Breast Implants?

Breasts are a distinguishing characteristic of the female form in art and culture. That’s why having a breast size and shape that you feel comfortable with is so important to many women. Of course the definition of a desirable shape and size may vary with culture, time and geographic location. In beach communities like Waikiki, Hawaii, a woman who fills out her swimwear is often seen as the ideal. In some cultures, however, the smaller yet shapely breast is preferred. Only through allowing you enough time for meaningful discussion can we reach a your goal, as each person has their own vision of what the perfect breast is. What ever that is for you we will do all we can to achieve your vision.

As a specialist in breast augmentation Dr. Pasquale can help you obtain the size, shape and look you desire. The natural look or the high profile look will be your choice, as will be size. We will work with you to make the right decision drawing from his many years of helping woman just like you. We consider breast augmentation to be an art as much as a surgical science. We seek to integrate your vision of the final outcome with what is possible. All of this is done in a warm and comfortable atmosphere to enable you to openly discuss your desires in regards to your body.

Breast Augmentation Surgical Incisions

Breast implant surgery can be performed through several different incision sites. Each incision or approach has its pros and cons. Its important to understand not all surgeons are able to perform breast implant surgery proficiently using each approach. When it comes to breast augmentation, one of the most important questions faced by the patient and the surgeon is that of the breast augmentation incisions. This is where the cut is made in order to create the breast pocket and insert the breast implants. When selecting from the various types of breast augmentation incisions available it is vital that the surgeon you choose be competent and experienced in that particular incision.

Some surgeons are more comfortable with one or two types of breast implant surgeries, and they try to push you towards these types. An experienced breast augmentation specialist will be fully competent and confident in any of the three major types (trans-axillary, periareolar, Inframammary). Different areas scar differently and carry different risks. Some scars are also more noticeable than others. Talk to your plastic surgeon and listen to their opinion, as well as do your own research to help make this decision.

Periareola Incision

Periareola or around the areola -nipple incision is becoming the choice of a large population of women who are having their breasts enlarged. The incision is made at the outer edge of the areola and not within it as otherwise the incision could heal and leave an obvious white scar on the areola. All types of implants, above and below the muscle, can be placed and removed by this method of breast augmentation incisions. One of the biggest advantages of the areola incision is that the surgeon is able to work closest to the breast, thus in many ways making it less invasive as compared to, say, a TUBA incision. This incision site is easy to conceal as it appears on the already darkened tissue of the areola or nipple which easily hides the scar. The incision is generally no longer than an inch long. There is increased potential for damage to milk ducts which can cause difficulty breast feeding. This incision is in the armpit and the creases hide the incision very well. The incision is generally no longer than an inch long. Surgeons may or may not use an endoscope to perform this surgery depending on experience.

Trans-axillary Incision

The trans-axillary incision is also called an armpit incision and is considered to be ideal for hiding away breast augmentation incisions in the folds of the skin in the armpit. In this case the surgeon is working away from the breast and may or may not require the use of an endoscope. It is vital that you speak to your surgeon about his experience in breast augmentation incisions at the armpit site. Dr. Pasquale has performed thousands of successful breast augmentations through the axillary incisions. In fact Dr. Pasquale has invented an instrument just for this incision he named this the Boob-a-Rang as its shape is similar to the Australian hunting tool called a boom-a-rang.

Inframammary Fold Incision

The inframammary or crease incision is one of the most common of all the breast augmentation incisions available. This incision is the easiest to perform as it is directly underneath the breast in the natural fold. The incision is more difficult to conceal and scars are often visible in this area. Breast feeding problems are less probable with inframammary incisions. It allows the placement of implants both over and under the muscle and allows the surgeon to work close to the breast. The incision is made at the inframammary fold which is also called the crease and with proper placement the breast augmentation incision will practically invisible. The problem arises only when there is less or thin breast tissue but nonetheless a reputed and experienced surgeon will be able to perform this breast augmentation incision. This is an older incision and not our favorite due to some possible scar problems.

TransUmbilical Incision

Transumbilical Breast Augmentation (TUBA), places the implant through the navel or belly button. This type of approach garnered popularity more so as a fad as opposed to a scientifically viable option. Transumbilical breast implant surgery is generally not recommended to patients. Like the trans-axillary incision this breast augmentation incision is also away from the breast and would require the expertise of an experienced cosmetic surgeon. Essentially this breast augmentation incision requires the use of an endoscope which creates a tunnel through the subcutaneous fat to position the implant at its correct position. This type of breast augmentation incision is only meant for implants that are filled once placed in the body. The recovery from TUBA is quicker but a partial muscular placement of the implant may be difficult. For TUBA incision it is vital that you select a surgeon who is experienced and in this breast augmentation incision. We feel this incision is not the best due to the fact that in most cases you are placing an implant so far away that placement in the correct position is not accurate. Also one cannot use silicone breast implants with the TUBA. Finally there is some evidence that pushing a implant through a metal tube may lead to higher deflation rates and damage to the breast implant.

Breast Implant Placement Over or Under the Muscle

When considering breast augmentation, the breast implant can be placed under or over the pectoralis muscle. It is wise to inform oneself of the pros and cons of both options and discuss it with the cosmetic surgeon who will help in making a decision that suits the individual’s body and her lifestyle the most. Dr. Pasquale ensures that his patients understand the options and implications regarding implant placement and that they make an informed decision. Most of the muscle beneath the breast tissue is the pectoralis major, which is similarly shaped as an oriental fan attached at the upper arm bone, the sternum or breast bone and at the ribs. This provides space for an implant to be set right behind the muscle.

The image above illustrates the 2 common placements of the breast implant for breast augmentation surgery. Subglandular or subpectoral. Note how the implant appears either above or below the pectoral muscle.
The image above illustrates the breast first without a breast implant and also the 2 most common placements of the implant for breast augmentation surgery – subglandular or subpectoral. Note how the implant appears either in front or behind the pectoral muscle.

Breast augmentation under the muscle (Submuscular)

Generally speaking, most breast implants are placed behind the muscle. By and large, it is fairly rare that breast implants are placed over the muscle, although we still see it happen unfortunately. The advantages of getting breast augmentation under the muscle is a more natural look and feel to the enlarged breast and a clearer mammography as compared to breast augmentation over the muscle. The implant edges are less visible because the implant is further from the skin surface. There is therefore less of an occurrence of rippling which can be a common and difficult risk. The implant is held in place by the muscle itself so it tends not to sag with time like the breast implants placed above the muscle. This extra support of the implant can be very helpful & important with regards to large heavy implants pulling down on thin skin.

Breast augmentation over the muscle (Subglandular)

Placement of the breast implants in front of the muscle can lead to a quicker recovery with less pain and discomfort to the patient post operatively. This is due to the fact that the muscle tissue is left alone and only the fat and skin are cut to place the breast implant. Muscle stretching is what causes pain. If you have minimal breast tissue, over the muscle can lead to a higher chance of visual rippling. The chance of rippling may be lessened by the usage of gel / silicone implants or a high profile shape. Some surgeons believe that a woman with ptosis or sagging of the breasts and sufficient breast tissue should have over the muscle placement of the implants. Others believe this leads to more sagging as the skin stretches over time and that a breast lift is required in addition to the breast augmentation as a long term fix.

Submuscular placement of the breast implants (under the pectoralis muscle), is for the most part, the preferred method of placement for the majority of our patients. Breast tissue can become stretched and thinned, resulting rippling (among other problems) due to the breast implant being placed above the muscle.

Breast Augmentation Risks & Complications

Every surgery carries with it risks and complications and breast augmentation is no different. Breast augmentation is a cosmetic breast surgery procedure that increases the shape and size of the breasts. Whether it is because of naturally asymmetrical breasts, losing a breast to cancer or simply because a woman wants to acquire breasts of a shape and size that she desires breast augmentation provides the perfect solution. Breast augmentation requires surgery and is oftentimes performed under general anesthesia. Having an experienced and skilled board certified plastic surgeon drastically reduces the risk of infection and complication rate. Post operative care can greatly reduce the risks of breast augmentation risks or complications. All patients are drastically different in their anatomy, their ability to heal, scar or recover from surgery, therefore it isn’t possible to guarantee a specific outcome. The most common risk or complication associated with breast augmentation (with breast implants) is capsular contracture (described below).

  • Breast Implant Deflation & Rupture

    Breast Implant Deflation or Rupture is a fairly common complication. Breast implants can rupture or deflate and it is important to understand that most likely the implant will not last you a lifetime. Deflation of saline filled breast implants is usually noticeable as the implant will empty itself in a couple of hours. As the saline solution is similar in consistency as what occurs naturally in the human body there is no risk from the leakage but the implant would need to be taken out or replaced.
  • Capsular Contracture

    This condition is primarily due to the breast tissue growing around and onto the implant, squeezing and contracting it. Capsular contracture is the most common complication associated with breast augmentation surgery. Usually a scar develops around the implant making it firm and often painful. This condition doesn’t really have a cause other than the natural action of the breast tissue growth. Also there is no way of ensuring that it will not occur again.
  • Implant Displacement

    The breast implants may move out of position. Fortunately this condition is fairly rare and occurs usually in women with rather large implants. The cause of implants shifting or moving out of what is considered the optimal position is more often that not caused by the surgeon overdissecting or creating a breast pocket which is too large. The implants may drop too low below the inframammary fold, they may shift too far apart, or they may appear too close to the middle of the chest. All of these problems can be corrected with breast revision surgery
  • Interference with Mammograms

    Breast augmentation may interfere with mammograms, though the interference is lesser when the implant is placed under the muscle.
  • Loss of Sensation

    While this may occur soon after the breast augmentation it usually disappears with time. However numbness of the nipple area is a breast augmentation risk.
  • Infection

    Infections can be avoided by selecting a good surgeon in a regulated country. It is vital that you don’t compromise on the quality of the surgeon and post operative care by reducing the cost of breast augmentation. Any infection suspected by the patient must be reported to the surgeon and will most likely be treated by antibiotics.
  • Calcification

    Calcification of the capsule may occur around the implant and in case the woman is lactating, galactorrhea is also a breast augmentation complication.
  • Reaction to Anesthesia

    A negative reaction to anesthesia could occur during any surgical procedure and should also be considered as a breast augmentation complication. Ensure that you are as honest and thorough as possible regarding your medical history as well as when speaking with your anesthesiologist prior to surgery.
  • Breast tissue Atrophy

    Atrophy of the breast is essentially the shrinking of breast tissue and can be caused due to the pressure of the breast implants.
  • Extrusion

    Extrusion is considered a rare and extreme breast augmentation complication wherein the body rejects the implant as it would a thorn and attempts to expel it. The implant may be visible under the skin and would require to be removed. Although extrusion or rejection of the implant is rare, it does occur in around 2% of breast augmentation patients.

Recovery from Breast Augmentation

Upon completion of the breast implants surgery the patient will wake up with dressings and their breasts wrapped. Patients are kept under observation in recovery for the next 2 hours after which they are allowed to go home. Patients are given pain medication and instructions about how to care for their breasts. All surgery patients are given appointments to see the plastic surgeon the following day of surgery to ensure everything is going perfectly.

Patients are also given specific instructions in regards to their particular incision sites and wearing of a breast band. In most cases, you will go home the same night of your surgery. This will be your “sore night,” but we provide you with adequate pain medication so that you are very comfortable. Over the next 48 hours, your discomfort should decrease significantly. Minor aches and funny sensations may continue for some time as your body adjusts to the new size and shape of your breasts. However, even when you start to feel good, we advise you not to lift your arms above your breasts in order to avoid putting undue stress on your surgery site. You will most likely be able to resume normal activities after about 10-14 days. Depending on the procedure and techniques we choose, you may be asked to wear a breast garment or bra following surgery. If you have breast implants placed, we will give you special exercises to perform as you heal. These exercises are very important for maintaining soft, natural feeling breasts. You will see Dr. Pasquale the first day after your surgery and again in the coming weeks and months. We will instruct you along the way and always make time to answer your questions.

Breast compression wrap after breast implant surgery.
Breast augmentation patients have their breasts wrapped with bandages to provide compression to the chest. Patients are encouraged to not remove or change the compressive bandages themselves as they are often applied in a particular manner specific to the surgery and patient.

IMPORTANCE OF POST OPERATIVE BREAST CARE

The proper recovery from breast augmentation is essential to ensure that the outcome of the procedure is successful. To a large extent it is the post operative care that ensures smooth recovery from breast augmentation. Therefore our staff and Dr. Pasquale will make sure you have clear instructions and guidance.

WHAT TO EXPECT DURING BREAST AUGMENTATION RECOVERY

Breast augmentation is a surgical procedure and should be treated as such. Pre and post operative care greatly influence the recovery and success of your breast implant outcome. As a patient you need to be clear on what to expect from the procedure and the effects it will have on your body after the surgery. It is vital that you select a surgeon who is board certified and experienced in all aspects of this surgery. So one of the few doctor’s to have completed a full residency in plastic surgery, Dr. Michael Pasquale has also completed a 2-year training certificate in cosmetic surgery under New York’s finest cosmetic and plastic surgeons in NYU Downtown Hospital at Manhattan. Realize you can find no better trained or experienced. At Dr. Pasquale’s clinic in Honolulu, Hawaii it is our priority that the our patient understands all aspects related to the procedure and the recovery from breast augmentation. It is vital that your surgeon discuss important issues such as anesthesia, pre and post operative care as these play a strong role in recovery from breast augmentation as we do. After surgery it is usually recommended that the patient takes minimum 48 hours of rest and a number of precautions. The breasts are usually swollen, firm and sore during this period and compressive bandages would be applied and in some cases use of a surgical bra or ace wraps may also be suggested. The breasts will probably be swollen even after the stitches are removed and this should not be a cause of worry. Our recovery process in Hawaii makes this a wonderful place to recover from your breast augmentation surgery. It not only gives you an opportunity to have breast augmentation at one of the most scenic places in the world but also provides a perfect climate to recover from breast augmentation.

STEPS TO HASTEN THE RECOVERY FROM BREAST AUGMENTATION:

  • Ice packs may be applied after the surgery and would help with the discomfort and swelling.
  • Sleeping on your stomach should be avoided and it is preferable to sleep in an upright position.
  • Precautions suggested by the cosmetic surgeon must be followed and required antibiotics and analgesics taken.
  • After 1-2 weeks one can go back to daily routine but strenuous work must be avoided for at least a few more weeks or as advised by the surgeon.
  • For patients with smooth implants massaging should be done after after stitched come out.
  • At our clinic at Honolulu, Hawaii it is ensured that all clients are clear on the post operative care and precautions be taken for a speedy recovery from breast augmentation.

FACTORS EFFECTING RECOVERY FROM BREAST AUGMENTATION:

  • Patients will usually be advised about the recovery period depending on the age, body shape, whether the implant is placed below or above the muscle, etc.
  • Younger patients usually have a faster recovery from breast augmentation.
  • Implants placed under the muscle would may require more a longer time for the soreness to go away which is normal.
  • Rushing the recovery from breast augmentation can only make the situation worse and thus it is wise to take the surgeon’s advice and suggestions seriously. Straining and doing strenuous activities can cause harm and actually increase the recovery from breast augmentation. It is advised that you take the initial period of the recovery from breast augmentation easy.
  • We will guide you every step along the way, make changes depending on how your recovery progresses.

The average cost for breast augmentation surgery in our clinic is $8500.00. This includes all fees such as surgeons fee, breast implants, OR fee, etc. Price differs based on breast implant type, surgical placement, scheduling, patient health, etc.

Why Choose Dr. Pasquale for Your Breast Augmentation?

Dr. Pasquale has performed thousands of breast procedures over the last 30 years. From breast augmentation, breast lift, breast reduction to many complicated breast revisions of breast surgeries done by other plastic surgeons. His expertise and experience in breast augmentation, breast surgery and confronting breast augmentation complications is extensive.

COSMETIC SURGEON OR PLASTIC SURGEON?

There are physicians who perform breast augmentation who are not plastic surgeons, nor are they board certified plastic surgeons. The surgeon you choose DOES make a difference, and having met the certification criteria is one way to assure your best chance of obtaining the plastic surgery results you desire. Dr. Pasquale is board certified in Plastic Surgery and has additionally earned a certificate for two years of specialized cosmetic surgery training. This is unique among plastic surgeons, and a testament to his commitment to plastic surgery. Aside from the years of experience and expertise of Dr. Pasquale, his staff – who will be helping with your care, is well trained and caring. Many of the staff members have had breast augmentation by Dr. Pasquale as well and would be happy to share their experiences with you.

THE CHEAPEST OR MOST EXPENSIVE PLASTIC SURGEON

When you’re looking for a breast augmentation surgeon, cost should not be the only consideration. You only want the best result from your breast surgery. Surgeons who cut costs to save money and pass that savings on to you may be cutting corners that can affect your final breast augmentation result. One should wonder why one surgeon’s fee is cheap. You have to pay for a quality breast augmentation.

THE MOST EXPERIENCED PLASTIC SURGEON

Experience should be considered as well. How many breast augmentations does the surgeon perform a month? Is he or she new to practice, and will they have the good judgment to customize your result or deal with special issues you may have? Finally, you need to feel comfortable with simply talking with your plastic surgeon and their staff. We do all we can to let our patients know we care, and we really do. That is why we have such a huge breast augmentation practice. We really want you to be happy and we will do all we can to serve your needs. Cheap breast augmentation & breast implants in other countries Cheap breast augmentation can be something of great interest for many women in the world. Breast implant surgery can have an incredibly profound effect on a woman’s life when performed by a skilled, experienced cosmetic surgeon. There are many realities patients are not aware of in regards to plastic surgery and breast augmentation, and it is this very ignorance that makes them easy prey for plastic surgeons, clinics and their marketing schemes. Only by educating themselves can patients make a truly informed and well thought out decision. Your health and the outcome of your surgery is the most important factor of all. Not the cost. As you may know, there are many types of breast implants, breast augmentation approaches (incision sites), implant placements, and even more plastic surgery techniques promising fuller, more firm and natural looking breasts with that all important “low complication rate”. You may find a surgeon who will give you breast implants for a third of the average national cost, but your odds of having some sort of complication increase dramatically. We regularly perform breast augmentation redo / revisions on patients of other plastic surgeons. These patients have meaningless implant incision sites and innapropriate implant placement. Did you ask your plastic surgeon how he would perform a correction or revision if you had a Transumbilical Breast Augmentation or TUBA? Would he go back through your belly button a second time to make a pocket revision?…or remove a capsule? Would you actually be able to see a scar on your nipple if the incision was made there? Why do I need to have an inframammary incision as opposed to an axillary incision? For what reason is he choosing a particular incision site or implant placement? He or she should be able to tell you these things with confidence, based on your physical needs and their extensive experience and surgical training. Does your plastic surgeon perform breast augmentation through the axillary, perithelial, periareolar and inframammary?…or does he just offer all his patients the one option he is comfortable with? Your surgeon should select the incision site based on your body type, your desires and concerns, and the types of implants that you have chosen based on his consultation. Your cosmetic surgeon must have all the tools and skills necessary to make these choices with your best interests in mind.

Breast Implants in Non-regulated Countries

  • Breast implants in non-regulated countries may be cheaper but it is vital to understand the risks and complications associated with this procedure which are increased tremendously if the procedure is performed by a surgeon who is not well qualified or experienced.
  • Breast implant surgery is a serious medical procedure that may go seriously wrong without the experience and expertise of a good plastic surgeon.
  • The techniques used to place the implant such as areola incision, TUBA, trans-axillary incision and infra-mammary fold are complicated and need the expertise of a reputed cosmetic surgeon. In fact improper handling of the implant is found to be one of the causes for the deflation of implant.
  • Risk of infection and complications is increased when you are getting breast implants in non-regulated countries.
  • Some of risks and complications involved with a breast implant procedure that is not performed well include loss of sensation around the areola and nipple, bleeding, infection, deflation of implant requiring the removal and replacement of the implant.
  • Quality of breast implants and medical care is not very consistent or reliable in non-regulated countries. When it comes to cosmetic surgery for breast implants it is essential that you have a surgeon that you can depend on for advice and consultation. Surgeons such as Dr. Pasquale ensure that their clients are clear on every aspect of the breast augmentation procedure and also that they have realistic expectations of the procedure.

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Honolulu Hawaii Plastic Surgeon

500 Ala Moana Blvd #4-470 Honolulu Hawaii 96813