Breast Augmentation: What to Expect

Breast Augmentation, Los Angeles

Patients choose to undergo a breast augmentation for many reasons. Whether you are unsatisfied with the smaller size of your breasts or even transitioning to the female gender, breast augmentation is a big decision and should only be performed by a board-certified plastic surgeon. Regardless of why you chose breast augmentation, understanding what to expect before, during, and after the procedure is the most important step.

Before Surgery

During our pre-operative consultations with our patients, we find out what are your personal aesthetic goals such as the type of the implant and the size of implant, and discuss surgical details including incision location and placement of the implant above or below the muscle.  We will also review your health history and discuss successful strategies for getting the best possible result for surgery such as stopping smoking 4-6 weeks before and after surgery and avoiding certain medications before surgery.  We will also give more specific post-operative instructions including dressing care, post-operative bras, and provide your prescriptions that you will need for after surgery.  It is also important to arrange for someone to help you after the surgery (i.e. pick you up after surgery, fill prescriptions and listen to after surgery care instructions). On the day of the surgery, make sure to remove all jewelry and body piercings and wear a comfortable and loose button-down shirt to the surgical facility.

Day of Surgery

After you meet with Dr. Hirsch and he marks your breasts for surgery, you will go to into the operating room where the board-certified anesthesiologist will put you to sleep and keep you comfortable before surgery.  Dr. Hirsch will then perform the procedure, and when you wake up, you will have a new pair of beautiful breasts!

After Surgery

Recovery from a breast augmentation is fairly straightforward. After the surgery, your breasts will be wrapped in an elastic dressing or support bra in order to minimize swelling. Most patients are able to go home within an hour of entering the recovery area. You can expect soreness in the chest that lasts about a week. Most patients describe the soreness to be similar to the soreness after a heavy chest workout. Bruising and swelling are normal and typically resolves within 2-3 weeks. It is recommended to wear a soft, supportive bra with no underwire for at least 2 weeks post-surgery. The majority of patients are able to return to work 3-7 days after surgery and can undergo strenuous activities such as heavy lifting and working out 6 weeks following the surgery.

Results from a breast augmentation surgery can be seen immediately after the surgery is complete. However, final results will take a few weeks while the swelling goes down and the breasts fully heal.

Which Breast Implants Should I Choose?

Breast Implants, Hirsch Plastic Surgery, Los Angeles

One of the most important steps in a breast augmentation or breast implant revision surgery is picking the right type of breast implants. This is not as easy as it sounds, breast implants can have different sizes, shapes, fillings, and textures.  There are so many different breast implant sizes and styles to choose from, it can be overwhelming for patients!

The first thing we like to do is try to hone in on the right size. To do this, we use a sizing system where the patient puts on on a bra, and then we fill it with gel inserts to help simulate the appearance of their breasts with an implant of that size.  For example, we will use a 400cc insert to help show the patient what their breasts will look like with a 400cc implant.  It is also very helpful when patients bring in pictures of breasts that they like, both in terms of size and shape.

Next, we need to pick the shape of the implants.  The first choice is to pick either a round or anatomic shaped implant.  Most of our cosmetic breast augmentation patients will choose a round implant.    For patients who desire a full upper pole of the breast with a more augmented appearance, we recommend either full projecting or extra projecting implants.  Patients who want a more natural appearance usually prefer a moderate to moderate plus style implant.

Most implant manufacturers now have multiple different gels to pick from as well.  In general, the more cohesive the gel is, the firmer it will be.  Firmer gels are good for thin patients with less breast tissue because they have less visible rippling.  Softer gels are better for patients who have more natural breast tissue.  Revision patients or capsular contracture patients may prefer a slightly firmer gel as well.  Most patients will use smooth implants rather than textured implants.

With so many choices, it can be difficult to pick a combination of size, shape, filling and texture!  During your consultation with breast augmentation and revision specialist Dr. Elliot Hirsch, he and his expert staff will help guide you through the maze of choices to a happy, successful result!

Non-Surgical Facial Rejuvenation

Facial Rejuvenation, Hirsch Plastic Surgery

Right now, winter procedures are (literally) in season.  Because the sun isn’t very strong, this is a great time for facial rejuvenation procedures that can have some recovery time and that require minimal sun exposure. Patients are opting towards nonsurgical facial rejuvenation procedures like PRP (or the vampire facial), microneedling, peels, and laser treatments.   There are multiple options for laser resurfacing and peels, most with minimal down time. Three to six treatments are standard for these procedures before patients see significant results, so winter is a great time to start.

Laser hair removal also takes a few sessions to see results, and sun exposure is not suggested during treatments. Kybella for neck rejuvenation is also a popular winter treatment since patients can hide the minimal swelling with scarves.

For 2018, the trend is going to be towards the natural look.  Patients want more subtle, less obvious procedures- everyone wants the effects of plastic surgery without looking like they had plastic surgery!  For example, our breast augmentation patients are asking for smaller, more natural sizes.   Advances in breast implant materials such as gummy bear implants with a more natural projection are popular.

Ambulatory Surgery Centers

As a plastic surgeon in Los Angeles, patients frequently ask me if ambulatory surgery centers are safe. After Joan Rivers died this past year, this question has become even more relevant. The answer, unequivocally, is yes. Ambulatory surgery centers (ASCs) have been present in the United States for over 50 years and have a long and outstanding track record for safety. In order to receive a license, ambulatory surgery centers must undergo a rigid accreditation process by organizations such as the Joint Commission, the American Association for Accreditation of Ambulatory Surgery Facilities, the Accreditation Association for Ambulatory Health Care, and the Healthcare Facilities Accreditation Program. In addition, facilities that submit for insurance reimbursement for procedures undergo an additional evaluation by CMS, the Center for Medicare and Medicaid Services. The accreditation process evaluates not only the healthcare facilities and equipment present in the ASC, but other factors as well such as the emergency plan to transport patients to a hospital, should this become necessary.


Ambulatory surgery centers are attractive options for surgeons and Los Angeles plastic surgery patients because of their efficiency and ease of use. Multiple patients have told me that they have had excellent experiences at ambulatory surgery centers and say that they appreciate how smooth their services are.   They have also told me that they appreciated being able to undergo surgery in a facility where they were able to minimize contact with people with colds and coughs. With flu season coming up, I can empathize with their concerns! From a scheduling standpoint, I rarely experience significant delays at ambulatory surgery centers because elective surgical cases can be scheduled without concern for delay or cancellation due to other emergency cases taking priority. Some of my higher profile patients have told me that they appreciate the opportunity for anonymity that surgery centers offer too.


However, not every patient is a good candidate to undergo surgery in an ambulatory surgery center. Patients with multiple medical problems that place them at higher risk for complications in the early perioperative period could be better served by undergoing their procedure in a hospital where a higher level of care is immediately present (if necessary). In addition, Burbank and Encino plastic surgery patients who are undergoing complicated, higher risk procedures might also be better suited to undergo those procedures in hospitals as well. I also often perform skin cancer treatment and other surgeries in hospitals when I work with a surgical pathologist or other specialist.


Ultimately, the final decision about where to perform a surgical procedure comes down to safety. Above all else, we physicians must first “do no harm,” and that extends to the location of our surgical services as well.