Breast Augmentation

How is Breast Revision Performed?

When a woman undergoes a breast augmentation surgery, most of the time, she does not plan on getting a second surgery for some time. However, it is good to be aware that breast implants are not lifetime devices. Breast implants can last for 10 years or longer, but eventually, a revision may be required.

Most of the time, a breast implant revision requires getting rid of the breast implants and placing new implants. Usually, the goal is to improve or change the appearance of your breasts while updating the material of the implants. The changes sought by a breast revision surgery include:

  • A concurrent reduction or breast lift
  • Reshaping of the breast implant pocket in order to reposition the implants in the chest
  • Decreasing and increasing the style, shape, and size of breast implant

The Desire to Undergo a Breast Revision Procedure May Stem from:

  • Desire of changing the breast size
  • The pain caused by capsular contracture
  • Concern of migration or rupture of the implants
  • Desire for a different implant type

Breast implant revision must be tailored according to the desires and goals of the patient. The surgery should also always be performed by a board-certified plastic surgeon with experience and training in different types of breast surgery procedures. Your surgeon should start by listening to your desires and goals and then developing a surgical plan to address the issues arising from the first surgery.

What to Expect from a Revision Surgery

A revision breast augmentation can offer certain challenges due to the scar tissue present from the initial procedure. The surgeon will be dealing with tissue stretching and an anatomical change that took place because of the old implants. A skilled surgeon like Dr. Salzman has the experience necessary to deliver safe and satisfying results from your revision procedure.

Are you interested in learning more about breast revision surgery? Contact our office today to schedule your consultation appointment!

Why Choose Breast Revision?

Despite yours and your plastic surgeon’s best efforts, sometimes complications still happen. This can happen after a breast augmentation procedure, even though breast augmentations are some of the most popular and often-performed plastic surgeries. Although the chances of breast implant surgery going wrong are very low, in very sparse percentages it does go wrong. During a breast revision surgery, a new or different type or size of implant is surgically-placed with correction to the breasts if needed.

Why Choose Breast Revision Surgery?

Dr. Salzman is an expert consultant for breast revision candidates and has plenty of experience in improving the results of an already-completed breast augmentation surgery. A few of the reasons for which people often go for breast revision include:


Although your plastic surgeon may be an expert breast surgeon, the chance of complication is never zero. Your body may respond in unpredictable ways and cause capsular contracture, which is the most common form of complication from implant surgery. This occurs when scar tissue forms around the implant and results in a hard shell encapsulating the breast implant. This can cause it to shift out of place or migrate around the breast. Rotation of the implant or rupture are also common reasons for undergoing breast revision.

Unfavorable Results

Technology has come a long way, but it can still be difficult to judge how your final results will look. This can change over time, with the implants eventually becoming unfavorable due to the way your body changes. You may even realize that your implants are too small or too large as your results become apparent, or that you prefer a different shape. In any case, Dr. Salzman can help you select a better-suited implant or treatment plan during a breast revision consultation.

New Technology

Because breast implants are so popular, the technology is constantly developing, meaning new implants may be available at any point in the future. Sometimes, new and better implants come along that may be better suited for your goals and anatomy, in which case they can be swapped out during a breast revision.

Scheduling A Consultation

Whatever your reason for opting for breast revision, you can achieve a second chance at your cosmetic goals. Dr. Salzman can help you plan your ideal procedure during a consultation at our Louisville office. To schedule a consultation, contact our office by calling or filling out our online form.

Moms, It’s Time for Your Makeover

Spring is the time of year for flowers, rain showers, and celebrating what makes mommies great. the Moms make a lot of sacrifices, but feeling great in their body shouldn’t be one of them. Many women experience pregnancy and childbirth but feel resigned to the toll that it can take on their body. A mommy makeover is a set of procedures that can restore and rejuvenate the body to its pre-pregnancy state. Here are some of the things that can be included in your customized treatment.


The breasts play an important part in pregnancy and nursing, but they can, unfortunately, change permanently in shape, size, and position during the process. Many women find their breasts have grown to an uncomfortable size or become stretched out and saggy. A mommy makeover can include a breast procedure to lift, reduce, or augment the breasts to restore them to their natural shape. It can sometimes even be performed with a combination of two techniques, like a reduction and lift. Dr. Salzman can help you plan your treatment techniques to ensure you get the breasts you want.


Perhaps the most affected area during pregnancy and childbirth is the stomach, which can be left with excess skin or pockets of fat due to the way the female body stores fat during pregnancy. Diet and exercise sometimes aren’t enough, so a tummy tuck can restore a slim, contoured abdomen. Many women also struggle with loss of muscle tone in the abdomen, which can be corrected by tightening and suturing the abdominal muscles, which is commonly practiced during the procedure. These can become stretched and ineffective during childbirth and are unable to be restored through exercise.


Although the breasts and stomach are the two most commonly treated areas, many women opt for additional procedures to add the finishing touches to their new body. Whether it’s additional liposuction, fat transfer, vaginal rejuvenation, facial procedures, or non-surgical rejuvenation techniques, it can be a great way to feel like a new, better you.

To begin your mommy makeover journey and discuss any questions you may have, contact our office and schedule a consultation with Dr. Salzman.

Breast Ultrasound

Today’s modern high-strength silicone gel breast implants have an excellent track record for longevity. Because a small break in the shell of an implant may go undetected by physical exam, symptoms, or even mammograms, it has been recommended that the surveillance of breast implants be done with MRI. MRI tests are quite costly in the $1500-$2500 range and can take up to an hour to do. Recently, ultrasound has been looked at as a possible alternative. I have been doing in office ultrasound of the breasts for over four years now and have found that it is very close in its positive predictive value to that of MRI. Meaning, if we find that is broken on ultrasound, it is broken in the operating room almost all the time. An ultrasound examination of the breast takes about 10 minutes. At our office, we recommend that patients have ultrasound whenever they feel like there has been a change in the shape, or feel of their breast implant. We also recommend that they have ultrasound at year six and year nine after surgery even if they are asymptomatic. I have used ultrasound in many ways in cosmetic breast surgery. Most commonly, we use ultrasound and examination of breast implants for rupture. Small blood or fluid collections can easily and safely be removed with small tubes under ultrasound guidance to not damage the underlying implant. We have also used ultrasound in the diagnosis of rotation of shaped silicone gel implants. At no cost to our patients, who have had implants placed by us, ultrasound represents an easy, quick, and cost-effective way for surveillance of cosmetic breast surgery implants. Contact our office today to learn more about a breast ultrasound.

The Benefits of Breast Augmentation Beyond just Breast Size

A survey from, an online community to learn and share about cosmetic surgeries, showed the women who underwent breast augmentation surgery have significant benefits that go far beyond an improved physical appearance.

Breast augmentation surgery remains the most popular cosmetic surgical procedure since 2006, with more than 275,000 procedures performed last year. Some common reasons women opt for this surgery include:

  • Improve the fullness and shape of underdeveloped breasts
  • Correct asymmetrical breasts
  • Restore their figure due to changes after pregnancy or nursing

However, it was found that there were more benefits than just aesthetically pleasing breasts. The RealSelf survey shows that 70 percent of those who receive breast augmentation saw a significant improvement in their overall sex life satisfaction. Additionally, 61 percent of patients said they have it more frequently with their newly found confidence.

Most surgeons witness a transformation in patients and how they carry themselves after their breast augmentation. It is no doubt that women feel more confidence after the procedure, which will eventually lead to more improvements in other areas of their life, including personal relationships or maintaining a healthy lifestyle.

RealSelf reports that the majority of women that get breast enhancement surgery are completely satisfied with their results. So if you are considering a breast augmentation in Louisville, Kentucky, you can most likely expect more than just improving the fullness and shape of your breasts. You will receive a more proportional figure and improved self-esteem with just one procedure.

If you would like to learn more about breast augmentation to improve various aspects of your life, contact Salzman Cosmetic Surgery & Spa today for more information.

Thinking About a Breast Augmentation?

Breast augmentation comes with many choices, which sometimes makes it difficult for patients to know where to start. With our personalized consultations at Salzman Cosmetic Surgery and Spa, we provide an opportunity for you to learn about the different options and discuss your ideal breast shape and size. We want to provide you with the best, realistic outcomes based on your desires by providing the following customizable, individualized services.

Vectra 3D Computer Imaging

We utilize effective, breakthrough technology to make sure you are getting implants that fit your unique figure. Vectra 3D computer imaging allows us to show a visual representation of your results before you have to commit to surgery. This technology enables us to place all of our different implant options on a 3D rendering of your body, showing which implants would complement your physique and reach your cosmetic goals. Breast augmentation is truly a customized approach for each patient.

Types of Breast Implants

At Salzman Cosmetic Surgery and Spa, we offer many types of breast implants, all specifically chosen based on your expected results.

  • Saline Implants – With a rubberized silicone shell, a saline implant is placed in the chest empty and filled with a sterile saltwater solution during the procedure. Since it comes with no filling, the amount of volume can be customized to the patient during the implant placement, allowing for more symmetric However, the general offset of saline implants is they are filled with a water-like substance, which feels less like a natural breast.
  • Silicone Gel Implants – Silicone implants are pre-filled with a silicone shell and mimic the feel and shape of a natural breast. These implants are known to be longer lasting and supply more upper breast volume than saline implants. However, no adjustments can be made during the procedure, but Vectra 3D computer imaging and the expertise of Dr. Salzman can ensure an excellent balance can be achieved.
  • Gummy Bear Implants – Also known as “form stable” implants, gummy bear implants are shaped implants, rather than being round, and have various height, width, and projection ratios. This implant is highly customizable with three different modifications, with a silicone-like gel that is not as stiff. Additionally, it mimics the natural breast feel you may desire.
  • Textured Implants – Textured implants have a rough shell characteristic, which may be more resistant to capsular contractures or the hardening of scar tissue around the implant.
  • Smooth Implants – Unlike textured implants, smooth implant shells are just that: smooth. These may feel more comfortable than the textured shells and cause fewer

Whichever implant you may choose, here at Salzman Cosmetic Surgery and Spa, we are highly dedicated to providing the best fit implant for your particular needs and desires. To schedule your personalized consultation with Dr. Salzman at our Louisville, KY office, contact our office today!

How to Pick the Right Size and Shape of Breast Implants

One of the questions I’m asked most as a plastic surgeon by patients considering breast implants is, “how do I know what size and shape I need?” The answer has changed dramatically throughout the 25 years that I’ve been performing breast augmentations.

Along the way, I’ve learned that the words that our patients use to describe what they want or don’t want can be completely misleading into what I interpret their meaning to be. Therefore, if you are considering breast augmentation, I like to request that you bring in photos of what you like and don’t like. Fortunately with the internet, there is a multitude of sources where these photos can be downloaded. By looking at your desires, I can get a better understanding of what you want.

As for trying implants “on”, we no longer recommend that you place the exact implant on top of your breasts and then place a stretchy bra over it to give you an idea what that implant under the muscle would look like after surgery. That method will always exaggerate what the actual result will be. However, if you are going to use a sizing type method, then Mentor makes a shell sizing system that accommodates for the sizing difference between the actual implant and what it would like.

Our preferred method is a 3-D imaging system called Vectra® that we have been using since it started. At your visit, a three-dimensional photograph of you is taken and you and I are able to review your options together using your image on a large television. We can place all of the different implants that are available and decide what size, shape, fill ratio, and height to base width relationships will look best for you.

Silicone gel breast implants come either round or shaped. They also come with either a textured or smooth surface. There are advantages and disadvantages of every scenario and combination of those choices, and I specially tailor my choice to each patient. Most of the time a round smooth implant placed under the muscle works very well for breast augmentation patients. Sometimes we choose a textured implant, as they tend to migrate less in the pocket due to some frictional resistance to motion, which is why all shaped implants are textured. An added reason to choose textured implants is that the capsular contracture rate is less than for smooth implants, especially when implants are put above the muscle.

We like to start with a measurement of the base width of the breast. We then subtract about a centimeter and a half off of that number to ensure enough coverage of breast tissue over the implant, and use that number to find corresponding implants. If we go larger than that number, which sometimes patients will want, we know that it increases the risk for more problems. For instance, larger implants may migrate below the natural breast crease and when that happens, they can create a second crease in what we call a “double bubble.” Large implants can also thin out the breast tissue, because of the added pressure.

After we have the base width, our next choice is the projection to correspond with our decision. There are typically four choices ranging from fairly flat (low-profile) to progressively more height (ultrahigh-profile). More commonly used for a natural look are the ones in between: moderate profile and moderate profile plus. We would choose the taller profiles for patients who want a larger look than their natural base with would allow or have a fair amount of loose overlying skin that we’re trying to hold up.

Patients will often present with breasts that are different sizes. One of the options to correct this is to use breast implants of different sizes in order to create a more symmetrical appearance. A newer method is to do a hybrid breast augmentation, where the patient has matching silicone gel implants placed and the overlying breast tissue can be made to look the same in volume and shape by using fat grafting. This allows for the patient to fluctuate more in weight and age and the breasts are more likely to have the same or similar sizes. When it comes to symmetry, I like to tell our patients that they should consider their breasts to be sisters that live across the railroad tracks from each other rather than twins.

There are also shaped implants. Rather than being perfectly round, these implants can either be taller than they are wide or wider than they are tall. For patients with very widely spaced breasts and a large breastbone, a shaped implant that’s wider than it is tall can help hide that a little bit. Shaped implants are also an option for a patient with skin laxity after childbirth or great weight loss; when the nipple is just at the level of the inframammary crease, we can sometimes get away with a tall implant to give the appearance of a slight lift without having to do a mastopexy.

A new style of silicone gel implant has recently surfaced that is filled to a higher volume in the shell. This allows for a round smooth implant to collapse less in the upright position mimicking more of the look of the shaped implant. When patients show me a photo of a very rounded upper part her breast, I would likely choose one of these higher volumes implants such as the Natrelle Inspira® silicone gel breast implant.

By spending some time before the operation takes place, using the Vectra® 3-D imaging method with computer animation, we can decide what type, shape, and ratio of width to height would best serve your needs. Doing this avoids the placement of sizers at the time of surgery, which, in my opinion, have a few negative implications, including additional cost and unnecessary disruption to the breast pocket, increasing bleeding risk.

With proper preoperative planning and flawless execution of breast augmentation, this can be one of the most satisfying aesthetic plastic surgery outcomes for both patients and physicians.

Your Fat May Be Your Best Filler

We all have often thought, “If only I could move this stubborn fat around my waist to somewhere else where it might look better.” That concept today in Plastic Surgery is becoming more of a reality. The process is called fat transfer and has exploded in its usefulness in our Plastic Surgery practice. The technique involves removing fat from where it is in excess, like around the midsection and transferring it to where it may help increase the size or fill in areas where fat has been depleted. Common areas to place fat are for increasing breast size, matching size or shape of breasts, making buttocks larger, and filling out of the face that has sagged with weight loss or age. Several rather new modalities have made fat grafting better over the last few years. We now know that the addition of growth factors from platelets, when added to fat grafts make the fat grafts heartier and more likely to gain a blood supply and survive the transfer. In our office, we have used PRP (platelet rich plasma) as a source of these growth factors for over 2 years now and have seen better results with fat grafting since its implementation. Also, it has been recognized that placing fat into muscle which has a better blood supply makes it easier for the fat to survive. We have used ultrasound now to actually see where the fat goes and place in places that will make it more likely to survive. There have also been fair amounts of research into better ways to both harvest the fat and separate out those components that represent the cells most likely to survive.

At the Salzman Institute of Plastic Surgery in Louisville, KY we have been utilizing these advanced techniques with great success in the last few years. One of the new concepts this fat grafting has helped is in High Definition Liposculpting. The fat is removed from the areas where it is in excess and replaced into where accentuation of natural underlying muscle mass is needed. Under ultrasound guidance, these fat grafts can by placed directly into the underlying muscles safely. We also use this same technique in reshaping of the breast. Rather than relying on breast implants alone, fat usually taken from around the belly and hips can be placed into the breast to enlarge and reshape it. Nice contours of natural feel and look can be accomplished in this way.

Fat, it turns out, can be a nice commodity if moved to a more desirable location with newer plastic surgery techniques.

New Natrelle 410 Form Stable Breast Implants are FDA approved

The Allergan Natrelle highly cohesive gel 410 breast implant was approved by the FDA last night for use by plastic surgeons in the United States as a new option for cosmetic enhancement of the female breast. It is also being referred to as the “gummy bear” breast implant because the feel of it resembles the consistency of the candy.

As one of the original investigators for this study in the Midwest region, our practice in Louisville, Kentucky has had extensive experience over the last 10 years with this revolutionary breast implant. This implant is truly transforming the way in which I can customize the best fit for a particular woman’s needs in regards to making her the breast size and shape that she desires.

These 410 implants are a new type of silicone gel that is “form stable,” meaning that, if the outside shell were removed, the gel inside would still retain its shape. One of the advantages of this implant is that it wrinkles much less than a round, responsive gel implant (more liquid). The shape of the implant can be controlled in multiple parameters; the height, width, projection and overall size are all customizable. Because the scar tissue surrounding the implant can grow into the shell, the implant does not move inside of the pocket created for it. This gives this implant a “one breast feel” where it is not easy to detect that an implant is underneath the natural breast and muscle. The data presented to the FDA also shows that this implant breaks less frequently and has less capsular contracture than round, smooth implants.

I like this implant for breast augmentation, especially for women with mild droopiness of the breasts after pregnancy or weight loss. The taller, more teardrop shape with more projection at the bottom fills out the stretched soft tissue sometimes making a breast lift unnecessary.

Allergan has recommended to new surgeons that they not only have to take online courses about the nuances of this implant, but they should also attend a teaching course taught by the few plastic surgeons with experience in placing this new breast implant. I have performed numerous surgeries with the 410 gel breast implant and will be teaching some of these courses throughout the US.

In our office, we can show the prospective patient how these new implants can reshape the breast using the exciting Vectra 3D imaging software. A life-like image of the actual patient on a large monitor can quickly demonstrate the shape and size differences when this and other types of breast implants are used, helping the patient be more secure in her decision.

Anatomically Shaped Cohesive Silicone Gel Breast Implants are Back

About 10 years ago, I was chosen to participate in an FDA study utilizing the then new anatomically shaped Inamed 410 silicone breast implant. The trial included initially about 25 surgeons across the USA. There was a short period of time after the initial patients were enrolled that more patients were able to be included. Over 900 patients in the USA were implanted with the shaped cohesive gel implants. Now the implant, although still seeking FDA approval, is again available for use by the initial group of plastic surgeons credentialed to use this new type of silicone gel breast implant. This imlant is different than what is being used presently in the USA, although it is quite popular in Europe where it has been available for some time. This implant is rather than round in shape, shaped like a breast, like a teardrop .Instead of sizing the patient with a volume like a number of cc’s, this implant has three different parameters that need to be adjusted based on the unique needs of each patient. The height, width and projection are all variables that can be adjusted to meet the needs of many different women’s breast shapes. We refer to this implant as a “form stable” implant. This means that if the shell of the impant is removed, the silicone material in the inside would still retain the intended shape of the implant.The lay description of the implant is the “gummy bear implant” relating its feel to that of the gummi bear candies. Having used this novel implant over 10 years now I feel I have a keen understanding of its merits. For the patient with ample breast tissue that has relaxed after childbirth or weight loss and settled to a lower position on the chest wall, this implant has the unique capability to internally replace the missing volume in the upper aspects of the breast and push the nipple and areola back up to a more youthful position on the chest wall.For the women with little overlying breast tissue and never having the skin of the breast being stretched before, the shape of this implant would be too overbearing and a round implant would still give a more flattering look. Since limited numbers of these implants will be available to be implanted, we will select those women who we believe will benefit most from the advantages of a shaped implant. I don’t expect the availability of this implant to last more than a few weeks.

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