Breast Augmentation in Denver, CO

• 1-1.5 Hour Surgery
• Back to Work: 3-5 days

The decision to undergo breast augmentation is a very personal one. Some women are looking to achieve volume they never got as their breasts developed, while others are looking to add back the volume that was lost after pregnancy, breast feeding, or weight loss. Regardless of the motivation, breast augmentation surgery requires an individualized approach to help the patient achieve her goals. There are many different types of implants on the market, each with its own advantages and limitations. The surgery itself can be done different ways, depending on patient anatomy and motivation, with variability in incision location, implant plane (above or beneath the muscle), and the possible addition of a breast lift. Fat grafting to the breast is sometimes used to correct asymmetries or soften the contours of an implant. In some cases, fat grafting may be the sole method of adding volume to the breast instead of using an implant.

Given all these variables, it is vital to choose a surgeon with significant expertise and experience in breast augmentation surgery in all its forms. At the Center for Cosmetic Surgery, our renowned augmentation surgeons draw patients not only from the Denver Metro area, but from surrounding communities like Colorado Springs, Fort Collins, Vail, the Aspen Valley, and Cheyenne, WY. Our passion for impeccable results, outstanding patient care, and an experience that exceeds expectations attracts patients from the entire Mountain West region.

WHAT IS BREAST AUGMENTATION SURGERY?

Breast augmentation is a cosmetic surgery that increases breast size, usually with a silicone or saline implant, although fat grafting can be used to add volume in some cases. When an implant is used, a surgical pocket is created underneath the breast. This pocket can be either above or beneath the chest muscles, depending on the patient’s anatomy, activity level, and other factors. Incisions can be located around the nipple, in the armpit, or, most commonly, in the fold underneath the breast. Each approach has advantages and potential drawbacks.

The procedure has evolved over more than a half-century, and modern techniques and new, improved implants allow patients to achieve better results than ever before, all with improved safety. In the past few years, breast augmentation with fat transfer has become a viable option for augmentation for some patients. Some patients are excellent candidates for augmentation with fat alone. These patients need to be content with a modest increase of ½ to 1 cup size and must have an area or areas elsewhere in their bodies from which sufficient fat can be harvested for the procedure. It is important to understand that the results of fat grafting can be unpredictable due to variability in the survival of the transplanted fat, and some patients may require subsequent repeat grafting to obtain their desired outcome. Fat grafting can also be used with implants in a so-called “hybrid breast augmentation.” In these cases, fat is used to add targeted fullness or soft tissue enhancement, while the implant provides the majority of the desired volume. This can be an excellent choice for some patients but requires deep expertise in all facets of augmentation surgery.

In some women, implants and/or fat alone create beautiful, filled-out breasts. In others, an enhancement with a breast lift (or mastopexy) is necessary to reshape and reposition the breast in addition to the addition of volume. When expertly performed, the results can be transformative, but this can be a challenging combination with compromised results in the hands of a less talented surgeon. Our skilled breast enhancement surgeons will guide you through all the decisions involved in creating your ideal results.

BENEFITS OF BREAST AUGMENTATION

Breast augmentation offers benefits that are psychological as well as aesthetic. The enhancement of breast volume and shape can significantly improve body proportions and boost self-confidence. For some women, breast augmentation can play a vital role in regaining their femininity and self-image after pregnancy or weight loss. For others, the procedure can help correct asymmetry or congenital breast deformities or may simply add volume that nature never provided. Many patients report improved psychological well-being following augmentation, as the procedure can alleviate feelings of insecurity or dissatisfaction with their bodies. Overall, breast augmentation can be a multifaceted solution that blends aesthetic enhancement with emotional and psychological benefits.  Its wide appeal has made it the most popular cosmetic surgical procedure in the United States.

ARE YOU A GOOD CANDIDATE FOR BREAST AUGMENTATION?

If you are unhappy with your natural breast size, asymmetry, or the shape of your breasts after pregnancy or weight loss, you may be a good candidate for breast augmentation. You should be a healthy non-smoker at a stable weight. Our experienced surgeons carefully evaluate your health and lifestyle factors to ensure you are a good candidate for breast augmentation.

CONSIDERATIONS FOR CUSTOMIZING YOUR BREAST AUGMENTATION

You have more options than ever before in terms of implant selection, placement, and surgical techniques. Our breast augmentation specialists, Dr. Andrew Wolfe, Dr. Steven Vath, Dr. Paul Steinwald, Dr. Matthew Freeman, and Dr. Teresa Cunningham, can help you decide which options will work best for you.

CHOOSING IMPLANTS

Saline vs. Silicone

At the Center for Cosmetic Surgery, our surgeons use both saline and the latest silicone gel breast implants; both types are safe, and each device has advantages and drawbacks.  

Saline implants offer the advantage of easier detection of a rupture, as the leaking saline would leak out of the implant and is harmlessly absorbed by the body.  There are two types of saline implants available in the U.S. The more commonly used standard saline implants have a single silicone plastic shell that is filled via a fill tube after they are inserted into the breast. They are straightforward devices that have been in use for decades, and many patients are happy with them. They perform best in patients with adequate tissue to hide them and are usually placed beneath the muscle. Because of their lack of structure, however, they tend to be more noticeable in the breast, both in terms of look and feel. They are more likely to ripple, especially in those with less soft tissue coverage due to thinness, pregnancy, or weight loss. The implants may be palpable to the patient or her partner and may feel “sloshy” in some cases. Finally, standard saline implants have a rupture rate higher than that seen in other devices.

To address the drawbacks of standard saline implants while maintaining the safety and ease of use, engineers created the Serene breast implant (formerly the “Ideal Implant”). This is a multi-lumen saline device that has 2 saline chambers and multiple baffles that make them feel better and move more naturally than other saline implants. They also have a lower rupture rate than many implants. There are limited sizes and shapes available, however, and the implants have a relatively high price. For patients who prefer saline, can find an implant that fits their dimensions, and are OK with the price, Serene implants may be an excellent choice.

Silicone breast implants are far more commonly chosen than saline. They offer a more natural feel and appearance for many patients; the less breast and body fat the patient has, the bigger the benefit she will get with silicone. Silicone implants have evolved from less cohesive, underfilled devices to the more cohesive “gummy” implants with ideal fill ratios that we have today. The first “gummy” implants to be released in the U.S. were shaped, textured devices. The textured surface was later found to be associated with a rare but potentially dangerous condition called BIA-ALCL. Due to concerns surrounding texture, the U.S. augmentation market shifted dramatically back to smooth, round implants, and the manufacturers responded by creating round implants with the more modern “gummy” silicone fill. In late 2024, the FDA approved Motiva implants for U.S. distribution. These novel implants are next-generation devices and have lower rates of rupture and capsular contracture. Importantly, Motiva implants behave well both beneath and above the muscle, opening up new opportunities for many patients. We have been working with these implants since 2018 and are well-versed in their use.

Although they have many advantages, silicone breast implants are more expensive and are more challenging to evaluate for rupture, as they don’t change in volume if the implant is compromised. Both MRI and ultrasound are recommended modalities to evaluate the integrity of silicone implants. Ultrasounds, in particular, are quite useful and convenient. At the Center for Cosmetic Surgery, our commitment to state-of-the-art technology means that we offer in-office ultrasound as a part of our consultation process for patients with preexisting breast implants.

How Do I Choose My Breast Implant Size?

Aesthetic goals for breast augmentation surgery vary from patient to patient and are an intensely personal decision. No two patients are alike, and an individual evaluation of each patient’s anatomy and an exploration of their preferred breast size and shape are an important part of the consultation. We offer both in-bra sizers and Vectra 3D imaging as resources for helping patients choose their implants. Of course, our clinical expertise is vital to guide patients with respect to developing and delineating appropriate implant volume ranges, setting realistic goals, choosing incisions and the implant plane, and deciding on a variety of other details that can impact the long-term success of the procedure in both aesthetic and functional terms.

You can read more about selecting your best implant size on our blog.

How Do I Know Which Implant Profile and Shape Are Best for Me?

In addition to implant volume, choosing an implant with appropriate dimensions is of paramount importance. A patient with wider breasts tends to need a wider implant, while narrower breasts do better with implants with smaller base diameters. To accommodate a variety of different body types and aesthetic goals, implants come in different profiles, which are different base-diameter-to-projection ratios. Simply put, lower-profile implants are flatter and have less projection, while higher-profile implants have more projection relative to their base width. Patients desiring a more subtle augmentation or those who already have significant breast volume may do better with lower-profile implants. Those wishing for a more augmented look will usually prefer the additional projection and roundness that high-profile implants confer. In addition to helping choose volume, our Vectra 3D imaging system can simulate before and after photos of our patients with different shapes and profiles of implants, an invaluable asset when making such an important decision.

As noted earlier, we rarely recommend shaped implants due to the risks of ALCL with textured implants. These devices remain approved for use, however, and in some cases, they may be an appropriate choice. For those patients who already have textured implants, the decision to keep or replace them is a personal one, and a variety of factors must be taken into account when recommending a course of action. Our expert surgeons are experienced in all forms of primary and revisionary augmentation surgery and can advise you based on your individual circumstances.

You can read more about selecting implant profile and shape on our blog.

INCISION OPTIONS

There are 4 possible incisions for breast implant insertion:

• Inframammary (breast crease)
• Periareolar (along the border of the areola)
• Transaxillary (armpit)
• Transumbilical (TUBA)

While there are advantages and limitations with every surgical approach, data gathered over the last 10 to 15 years strongly supports the inframammary incision. From a cosmetic standpoint, a small (2.5-4cm, depending on implant size and type) scar hidden right in the fold is a minimal scar burden and is typically only visible as a faint line when the breast is lifted up. Even if the incisions don’t heal perfectly due to genetic tendencies to make thicker scars, they would be hidden in the fold. The risk of capsular contracture (a thickening of the scar that the body forms around the implant) is significantly lower when the implants are placed through the fold. Because the approach completely avoids the breast gland, the implant has less exposure to the normal bacteria that live in the breast ducts. Implant colonization with these bacteria is thought to be a primary cause of capsular contracture. Finally, sensation and breastfeeding tend to be protected with the inframammary approach, again due to less trauma to the breast gland.

Although the inframammary approach tends to be the best fit for most patients, we are well versed in all approaches and can thoroughly discuss your options with you. (We do not perform augmentations via the belly button, the TUBA.)

IMPLANT PLANE

Like most aspects of breast augmentation surgery, the choice of which implant plane to use is complex. Implants can be placed above (subglandular or subfascial, both considered prepectoral) or beneath the pectoralis muscle (subpectoral). There are nuances to each of these options, however, that bear further discussion.

Subglandular placement:

The earliest breast augmentations with implants were done in the subglandular plane. After all, this is where the breast is, so it was a natural location for the implant. The operation had a short recovery time due to the lack of muscle trauma, and the implants were not affected by the activity of the chest muscles. There were limitations, however. In particular, capsular contracture was a common complication. This is a distorting and sometimes painful tightening of the scar capsule that the body forms around all breast implants and is a common cause of reoperation. In addition, thin patients may notice rippling or other implant visibility challenges. Textured implants did afford some measure of protection from capsular contracture when implants were in the subglandular plane.

In the early 2000’s, some surgeons began placing implants above the muscle, but beneath the fibrous fascial covering of the muscle. This subfascial approach was an attempt to add soft tissue cover and perhaps decrease capsular contracture. It had some measure of success but was not completely protective of rippling or thick capsules.

Subpectoral placement:

In an effort to improve upon the shortcomings of prepectoral augmentation, surgeons began to place implants beneath the muscle in increasing numbers. Initially, implants were totally covered by muscle, but this led to various distortions of the breast. The procedure became more nuanced with the broad adoption of dual-plane augmentation as described by famed breast surgeon John Tebbetts in 2001. In a dual plane procedure, the muscle is released along its lower margin and to varying degrees onto the sternum, with the release of the overlying gland in the more aggressive dual plane 2 and 3 procedures.  This allows the implants to sit down in the breast in a more natural position. One significant advantage of the submuscular approach is that the muscle provides soft tissue cover, resulting in a more natural feel and appearance for some patients. This is especially valuable with saline implants but can be beneficial in thin patients with any device. Another benefit of subpectoral placement with some implants is a reduced risk of capsular contracture, as documented in numerous published studies. Although textured implants were somewhat protected from this, texturing has been largely abandoned in the U.S. due to the risk of ALCL, and thus surgeons were left with few good subglandular options. The subpectoral plane became the default option.

Subpectoral implants do have challenges, though. The surgical dissection to create the implant space releases muscle fibers off the ribs and sternum, resulting in some postoperative discomfort that typically requires narcotic pain medication for a few days. Long-term studies do show some decreased strength in the chest muscles because of this release. One of the bigger downsides is the action of the muscle on the implant. Because the implant is partially covered by the muscle, flexion of the pectoralis muscle can impact the shape of the breast, resulting in so-called animation deformity. The severity of this animation can range from a mild, subtle shift in the breast shape to a dramatic and unattractive deformation of the entire breast. Finally, a constant downward push of the muscle over time can lead to bottoming out or lateralization of the implants.

Despite these downsides, most U.S. surgeons have predominantly used the subpectoral plane. It was felt by many to be the best compromise, given the limitations of our implants with regard to rippling and capsular contracture.

Latest advances

There are recent advancements in implant technology that may upend much of this accepted dogma and change augmentation surgery trends. In October of 2024, the FDA approved Motiva breast implants. (The Center for Cosmetic Surgery is a Motiva FDA trial location). These implants are a departure from the implants made by Mentor, Allergan, and Sientra, which we have been working with in various forms for the past 30 years. Although new to the U.S., these Motiva implants have been in use in 83 countries for the past 10 years, with more than 4 million implanted devices. There are several key advances in their design. The surface of Motiva implants is a proprietary 4-micron “SilkSurface” designed for increased biocompatibility. Indeed, several studies have shown very low levels of fibrosis and inflammation around these implants. This increased compatibility leads to very low capsular contracture rates for these devices. Importantly, the low capsular contracture rates appear to be consistent in both subpectoral and prepectoral planes. The mechanical properties of the shell and the gel and their interaction as a “True Monobloc” construction lead to low rupture rates, natural feel, and low incidence of rippling. Given these advances, Motiva implants behave well in all surgical planes and afford patients more flexibility in choosing an implant plane. The only real limitation to prepectoral placement is now a very thin soft tissue envelope that may favor more muscle coverage. The 3-year FDA trial data (the publication of which was coauthored by a CCS surgeon who is also a Primary Investigator in the ongoing FDA trials) can be seen here. It shows capsular contracture rates of less than 1% in primary augmentations and very low rupture and rippling rates. Our surgeons have more experience with Motiva implants than anyone else in the entire Mountain West region.

If you’d like to learn more, read our blog post about breast implant placement options.

WHAT TO EXPECT FROM YOUR BREAST AUGMENTATION SURGERY

At your initial consultation, your surgeon of choice will have a detailed discussion of the various options available to you based on your history, anatomy, and aesthetic goals. A physical exam will be followed by a detailed and highly accurate sizing process utilizing both in-bra sizing implants and Vectra 3D imaging. The Vectra can also simulate a breast lift, if indicated. You will leave the consultation with a thorough understanding of your recommended course of action, including available surgery dates and detailed pricing.

A history and physical exam with one of our highly trained R.N.s takes place roughly 2 weeks prior to your scheduled surgery. At this meeting, you will be given all the information you need to feel comfortable and confident on the day of your surgery. Consents will be explained and signed, photos will be taken, and prescriptions will be electronically submitted to your pharmacy of choice. If lab work is indicated, we will draw your blood.

On the day of your surgery, you will arrive at Apex Surgical Facility, our AAAHC accredited surgical location.  After a nurse inserts an IV, your surgeon will meet with you and mark the breast. You will meet with one of our board-certified anesthesiologists who will explain the anesthesia process. After being transported into tehthe operating room, you will be placed under general anesthesia, our preferred method of anesthesia for breast augmentation. Because you’re completely asleep, you’ll feel nothing, and the surgery can proceed efficiently and safely. The surgery itself takes approximately 1 hour for a breast augmentation, while an augmentation with breast lift takes around 2 1/2 hours. Upon completion of the surgery, sterile dressings and a surgical bra will be placed, and you’ll be transported to recovery. After an hour or so, once you’re feeling ready your ride can pick you up and take you home.

WHAT IS BREAST AUGMENTATION RECOVERY LIKE?

PAIN/DISCOMFORT AFTER BREAST AUGMENTATION

Augmentation surgery does have some discomfort, although many patients are surprised with how easy the recovery is. If the implants are placed beneath the muscle, then the pain typically requires narcotic medication for 1 to 4 days. Muscle-relaxing medications can help with muscle spasms. If the implants are placed above the muscle, some patients require nothing more than Tylenol to control the mild discomfort, while others require stronger medication for a few days.

BREAST AUGMENTATION RECOVERY TIMELINE

Even though healing after breast augmentation surgery is different for everyone, here is a typical postoperative timeline:

• First 24 hours post-op: Patients are typically fatigued from surgery and anesthesia. Some experience nausea, which can be treated with medications and tends to resolve fairly quickly. The chest can feel tight, especially of the implants are submuscular. It is common to have sensory changes after surgery, and some parts of the breast may be numb or oversensitive. The implants start high and will settle with time. This can be pronounced during the first week. Bruising is typically mild. If a mastopexy was performed, the longer incisions and more involved surgery may lead to more significant bruising.
• 5 to 7 days post-op: By the end of the first week of recovery, most patients are back to non-strenuous work. Driving can also resume, provided the patient is not on any narcotics or muscle relaxants. Many people will begin going for walks to ease back into physical activity. Heart rate and blood pressure should remain normal for 2 weeks after surgery, however.
• 2 to 4 weeks post-op: The acute discomfort after surgery is typically gone by this point, though the breasts can remain tender for weeks. Patients should continue wearing a supportive bra for the first month. Light exercise that doesn’t involve the upper body is also permitted.
• 4 to 6 weeks post-op: More vigorous activities can resume after the first month. The breast implants will have started settling, although final shape can take months to evolve. Scar creams can be applied to healing incisions as soon as the surgical tape falls off. Patients can start more aggressive scar therapies like microneedling or fractional laser treatments at 6 weeks.

Patients are encouraged to contact our office at any point after surgery if they have questions or concerns.

POST-OPERATIVE CONSIDERATIONS

Thereare a few issues to plan for after augmentation surgery. Attention to these considerations can enhance recovery and avoid postoperative setbacks.

 The Best Sleeping Positions

It is important to get lots of sleep after any surgical procedure. Your body will be stressed from surgery and needs extra rest for healing. For most patients, sleeping on the back with the torso in a mildly elevated position works best. This can be in an adjustable bed, in a recliner, or simply propped up on a few pillows. As the breasts heal, patients can transition to side sleeping if preferred, so long as undue pressure is not applied to the breasts. A good bra should be worn for the first 4 to 6 weeks to support the breasts. Stomach sleeping is possible for many women once the breasts are fully healed in a few months.

Bathing and Swimming

Depending on the type of dressings applied after surgery, showering may be fine immediately or may be avoided for 24 to 48 hours. These instructions will be provided at the preoperative history and physical, but patients can always contact the office for questions. Swimming is typically fine once incisions are well healed, with no open areas of delayed healing. This can take a few weeks.

The Right Bra

It’s important for the breasts to be supported properly in the weeks following breast augmentation. For the first 6 weeks, we recommend avoiding any underwire bras, as they can irritate healing incisions. Pushup bras are also discouraged since they can affect implant placement during the healing process. A medical-grade bra that supports the breasts as they heal is generally the best choice. These bras generally close in the front, allowing for easier access while patients are stiff, sore, and healing.

Exercise After Surgery

Mild, non-strenuous activities that don’t involve the upper body are fine during the first few weeks after surgery. This could be a relaxed walk or a gentle spin on an exercise cycle. Heart rate and blood pressure should remain normal for the first 2 weeks to avoid stressing healing blood vessels, which can result in postoperative bleeding that might need urgent surgical intervention. At 2 weeks, mild cardio workouts can begin but patients should always pay attention to their bodies and not overdo it too soon. More strenuous upper body activities can begin at 6 weeks, with a gradual increase in intensity as the body gets back to normal. It may be months before the upper body feels normal, so patients should not be discouraged if they remain stiff or feel a bit weak for quite some time. Recovery will generally be quicker with implants placed above the muscle, but these general guidelines apply to all surgical approaches.

WHEN WILL YOU SEE YOUR FINAL RESULTS?

It takes months for the breasts to evolve into their final form after surgery, and a variety of factors affect this process. Smooth implants tend to drop a fair bit after surgery, so they will begin in an elevated position and settle over 3 to 6 months. The tighter the breast, the longer this “drop and fluff” may take. Additional procedures like a breast lift or the addition of mesh support can alter this timeline one way or another. In some patients, the breast may be attractive right away with a mildly elevated implant, while in others the breast may look a bit odd until the tissues settle. Either way, the breasts will look great in clothes or even a bikini soon after surgery.

ABOUT BREAST AUGMENTATION SCARS

Scars are a necessary component of any breast surgery. Our surgeons place incisions in the most inconspicuous locations and perform precise, meticulous closure with long-lasting but dissolvable sutures to support healing. The incisions are typically covered with surgical tape for 3 to 6 weeks, and scar creams can be applied once the tape falls off. For most people, incisions start as fine, pink lines that may take 18 to 24 months to fully fade. During the healing process, our nurses and surgeons will monitor the evolution of scars and can intervene if appropriate.  Surgical technique is an important component of scar formation, but patient genetics play a significant role, as well. Some people simply make better scars than others. In rare cases, scars can thicken as they heal, resulting in a hypertrophic or keloid scar. This can be treated with silicone sheeting, local steroid injections, or laser therapy to calm them down but may ultimately require a formal scar revision, where the scar is excised and the wound allowed to heal without the additional trauma of surgery. In patients known to form true keloids, we will generally recommend silicone sheeting application very soon after surgery, with local steroid injections as soon as 3 weeks after the procedure. Steroid injections may be repeated in 10-week intervals.

COMBINING BREAST AUGMENTATION WITH OTHER PROCEDURES

It is very common to combine breast augmentation with a variety of other procedures. Liposuction, tummy tucks, facelifts, and virtually any other procedure can be performed under the same anesthetic. Many patients choose to have multiple procedures at once to save time, money, and recovery intervals. There is a limit to how much can be done at one time, however, based on a variety of factors. Our knowledgeable staff can help guide you should you wish to add on additional procedures.  

BREAST AUGMENTATION VS. BREAST LIFT

A breast augmentation adds volume. Implants or fat alone work well in a breast with a pleasant shape, where the nipple is appropriately positioned on the breast, and the skin envelope is not too stretched out. The breast will look fuller and may seem perkier with additional volume, but it is not actually lifted. On the contrary, adding weight to the breast will weigh it down over time. For this reason, it is generally a bad idea to try to “fill out” the breast in someone who has excess skin and a truly relaxed breast. In these cases, adding large implants without a lift can be a disaster. Performing a mastopexy at the same time as an augmentation is very common and can give patients a perky, pretty breast with appropriate volume that will stay well-positioned over time. We are experts at this demanding procedure and can explain all surgical options during a consultation. At CCS, we perform all varieties of lifts, from small to more aggressive, depending on patient anatomy and aesthetic goals.

See our section on mastopexy for more information.

BREAST AUGMENTATION REVISION SURGERY

Most patients who get breast augmentation are happy with their results. Unfortunately, a significant number will need some sort of revision. Even if everything goes perfectly, implants don’t last forever and will need to be replaced at some point. Revision implant surgery is generally more complex and challenging than primary cases and requires special expertise. In revisions, we are often dealing with capsular contracture or implant displacement, there may be ruptured implants to deal with, and the blood supply may be compromised by previous operations. Fortunately, the surgeons at CCS have performed thousands of revisionary implant surgeries and are well-versed in state-of-the-art techniques such as mesh reinforcement, fat grafting with implants, and site change from above to beneath the muscle or vice-versa. From minor revisions to complete breast reimagination, we can help patients achieve the results they love.

Read more on our breast augmentation revision page.