What is the 14 Point Plan?

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During your consultation, an important question that you need to ask your surgeon is whether or not they follow the 14-Point-Plan. ⁣

What is the 14-Point Plan

The 14-Point-Plan is designed to minimize the number of bacteria that can contaminate breast implants at the time of surgery. It was first published in 2013 and has since been widely adopted all around the world. Bacterial contamination of breast implants at the time of surgery has been shown to cause capsular contracture – hardening, pain, and deformity following breast implant surgery. ⁣

The 14-Point-Plan outlines strategies that can be incorporated into breast implant surgery that reduce the number of bacteria that can contaminate the breast implant surface. ⁣

Here you can see a funnel is being used to place the breast implant into the dissected pocket.⁣

Can I Still Breastfeed with Implants?

You can still breastfeed after breast augmentation surgery. A typical breast implant surgery involves an incision made in the inframammary fold (crease under your breast) to place the implant behind the pectoral muscle which is below the breast tissue. With this procedure, the implant is away from the breast tissue and does not interfere with breast ducts or mammary glands that produce milk. Even in cases where some glandular tissue is removed, enough tissue is left to facilitate milk production after the procedure.

Incision site

If you intend to breastfeed after breast implant surgery, the location of the incision matters. An incision made under the breast, in the armpit, or in the belly button is less likely to damage your milk ducts, nerves or glands.

But an incision made across or around the areola is more likely to damage nerves, affect the sensation of your nipple, interfere with the signals necessary for the letdown reflex, and reduce milk supply. Speak with your plastic surgeon about whether you might still have children so that an incision site is chosen that reduces the need for future adjustments to facilitate breastfeeding.

Implant location

Since breast implants can alter breast tissue, change the sensation of the nipple area, pinch or damage milk ducts, nerves, and milk glands, or reduce milk availability and release from glands, the location of the implant is critical. If you still want to breastfeed after breast implant surgery, you should make this clear to your plastic surgeon. To ensure implants do not interfere with breastfeeding, they can be inserted between your breast tissue and chest muscle or placed under your chest muscle.

Breast implants and milk safety

Breast implants do not make breast milk unsafe for your baby. Saline breast implants are filled with saline water, but there is no significant harm involved if the saline water mixes with breast milk. Likewise, silicone gel-filled implants are not harmful because the gel does not leak outside the implant shell.

There is no need to worry about chemicals in the implants mixing with the milk and making breastfeeding unsafe for your baby. Whatever implants are used, be sure to ask your plastic surgeon if it is safe for you to breastfeed after your implant surgery.

Reason for the surgery

Whether you can breastfeed after breast implant surgery also depends on your reason for the procedure. If your breasts are fairly symmetrical and regularly shaped and you only want a small boost, you are less likely to run into difficulties breastfeeding. But if you have flat or tubular shaped breasts before the procedure, you may already be at risk of low milk supply even without breast implants.

At Politis Plastic Surgery, we generally advise our patients to wait until they have had children before undergoing breast implant surgery. However, we do evaluate and recommend the procedure on a case-by-case basis after a personal consultation with each patient. If we find the procedure ideal for you, even when you still plan to have children, we will ensure that the incision site and implant location have the least possible effect on breastfeeding.

Would you like to enlarge your breasts and enhance your self-confidence but worry that it will affect you in other ways? Consider a private consultation with Dr. Effie Politis to discuss your specific goals and concerns. She will listen and guide you in making an informed decision about the procedure. For more information about breast augmentation and other cosmetic surgery procedures, visit the Politis Plastic Surgery website.

Removing Ruptured Historic Dow Corning Implants

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Removing ruptured historic Dow Corning implants in my patient after 30 years. She presented clinically with hardening of her left breast (capsular contracture). ⁣⁣
Further workup including clinical and imaging examinations revealed extracapsular rupture which means the implant and the shell surrounding were compromised and needed to be removed. ⁣⁣
These implants were taken off the market by the FDA in the 1980s. After the silicone implant moratorium in 1991, extensive premarket approval studies were required by the implant companies prior to the ban being lifted. This has resulted in extensive research and also produced much higher quality silicone cohesive or “gummy” implants with a much more stable shell and gel to shell fill ratio. ⁣⁣
Today’s implants no longer demonstrate “gel bleed” and the increased silicone crosslinking adds stability and a higher safety margin. ⁣⁣
The companies also provide short and long term warranty coverage and as board-certified plastic surgeons, we enter all implantable devices into a databank for better tracking. ⁣⁣

See a board-certified plastic surgeon to discuss treatment options regarding breast implants and safety profiles.⁣⁣
#tbt #implantremoval #explant #capsularcontracture #siliconeimplants

What are breast implants?

A breast implant is a medical device (prosthesis) inserted under breast tissue or chest muscle to change the size, contour or shape of the breast. In plastic surgery, breast implants are used to increase breast size, replace breast tissue removed due to trauma or cancer surgery, or to correct severe birth defects and deformities of the breast and the chest wall. There are three main types of breast implants used in plastic surgery: saline implants, silicone implants and structured implants.

Saline breast implants

Saline breast implants are filled with saline solution. They are placed by means of a less invasive surgery through smaller incisions. During the surgery, empty saline implants are inserted into implant pockets and then filled with saline solution. The incisions made for this insertion are smaller and shorter compared to the relatively longer incisions required to place pre-filled implants. Saline breast implants offer an increased breast size with a realistic texture and smooth contour. However, they are associated with cosmetic problems such as the wrinkling of breast skin and the implant being more noticeable to the eye and touch, particularly in women with less breast tissue. For women with enough breast tissue, saline implants produce aesthetically better results.

Silicone gel breast implants

The current models of silicone gel breast implants are filled with a high-strength, highly cohesive silicone gel which reduces the likelihood of filler leakage to the body. These form-stable implants can retain their shape even when their shells are broken. They are also less likely to wrinkle and tend to feel a bit more like natural breasts. However, they require slightly longer incisions for placement and they can spread into the breasts, causing lumps. Breasts augmented using silicone gel implants require regular ultrasound or MRI images for assessing the condition of the implants.

Structured breast implants

Structured implants incorporate both saline and silicone gel implant technologies. They use the saline solution as the filler while having the natural feel of silicone. Their internal structure consists of a series of nested shells that support the upper pole and two lumens (cavities) where the filler material is added. During surgery, a structured implant is inserted while empty and then filled with saline once placed, requiring a smaller incision than a pre-filled implant. And if one of the lumens ruptures after the procedure, it just leaks and empties, leaving the other lumen intact and the implant only partially deflated. This feature allows for ease of removal and replacement.

How are breast implants placed?

When choosing a plastic surgeon for breast implant surgery, finding someone experienced reduces the risk of complications after the procedure. Before the surgery, you will have an appointment with the surgeon for a medical evaluation. Your consultation will allow you to share your goals and expectations with the surgeon, and learn how to prepare for the procedure. Breast implant surgery is usually carried out under general anesthesia. The plastic surgeon makes a cut in the skin below or next to the breast. The implant is positioned either behind your chest muscle or between your breast tissue and chest muscle. The doctor then closes the incision and covers it with a dressing. The procedure usually takes 60 to 90 minutes. You may be able to return home the same day, or you may need to remain in the hospital overnight if the operation is scheduled late in the day. You will be given pain medication to help manage the discomfort after the anesthesia wears off. Your breasts will be covered with compression garments, and drainage tubes will be applied in order to drain the surgical area. Expect to need rest for a few days after the surgery and avoid heavy lifting for at least 6 weeks.

Are breast implants safe?

Breast implants are quite safe and rarely cause issues. Though it is possible for the implants to rupture and leak, they rarely cause medical problems. When saline implants rupture, the salt solution is safely absorbed by the body. For silicone gel implants, the gel either remains in the shell or leaks out following a rupture that results in no obvious symptoms.

How are breast implants maintained?

Breast implants are, by design, not intended to last a lifetime. They may have to be replaced if there are complications or if the breasts change in size and shape over time. If you have silicone gel-filled implants, you will need an MRI scan three years after your implant surgery, and then MRI scans every two years to check for silent ruptures. Ruptured implants should be removed or replaced. At Politis Plastic Surgery, we offer breast implant surgery to enhance the natural appearance of your breasts, create fuller curves, and give you a more aesthetically pleasing shape. We understand that your breasts are a defining feature of your body and enhance your femininity, sexuality and beauty. Through breast augmentation, you can change the size and shape of your breasts and, in turn, your self-confidence.

Are you considering breast augmentation?

Schedule a private consultation today with Dr. Effie Politis and have your questions answered and concerns addressed. For more information on breast implants and breast augmentation, visit the Politis Plastic Surgery website.

“Breast in a Day” Surgical Technique

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Another ‘Breast in a Day‘ case, but executed differently since she has much larger ptotic breasts (sagging breasts). ⁣

She basically had a mastectomy performed through a Wise pattern skin mastopexy and I kept the nipples on an inferiorly based adipodermal flap. ⁣

I reduced her mastectomy envelope, reduced and repositioned her nipple areolar complexed, and placed a cohesive Natrelle Inspira SCF 520cc implant in the prepectoral position with anterior Galaflex sheet. ⁣

“Wise pattern or inverted-T mastopexy has traditionally been used in patients with severe excess of skin relative to breast parenchyma (tissues of the breast essential for functioning) in a patient with severe ptosis. Incisions are made around the areola with extensions for the vertical limbs as in a vertical mastopexy.” (Qureshi, Myckatyn, & Tenenbaum, 2018)⁣

“The Wise-pattern incision addresses any redundant mastectomy skin envelope and avoids excessive and unsightly scarring on the “social” aspect of the breast mound.” (Newman, 2016)⁣

“The pattern allows removal of skin in both vertical and horizontal dimensions allowing for lifting and coning of the breast into a less ptotic shape.” (Todd, 2016)⁣

“Breast in a day” direct-to-implant breast reconstruction

Surgical Technique


Type of Recon: Single Stage Direct to Implant Breast Reconstruction after Mastectomy⁣⁣⁣, Galaflex Ravioli construct⁣⁣⁣⁣⁣
Type of Mastectomy: Nipple Sparing or Nipple Preserving⁣⁣⁣ through inframammary approach⁣⁣⁣⁣⁣
Implants: Natrelle Inspiration Cohesive SCF 295⁣⁣⁣⁣⁣
SPY Elite Imaging⁣⁣⁣⁣
Breast in a day” direct-to-implant breast reconstruction represents an emerging technique in the field of postmastectomy reconstruction and holds appeal, as it shortens the reconstructive process, eliminates the expansion period, and avoids a second operation.
This case was performed with bilateral nipple sparing mastectomy and single stage reconstruction with cohesive implant and Galaflex ravioli construct placed in prepectoral position.⁣⁣⁣⁣⁣
The advantage of this technique is that it is performed at time of mastectomy whereas traditionally, we place tissue expanders partially under the muscle and expand the patient and then perform a second procedure in 3-6 months where we exchange the expanders for permanent implants. ⁣⁣⁣⁣⁣
Therefore, instead of a staged process, we can achieve stable and long term results with a single stage or direct to implant reconstruction. This requires collaboration with the surgical oncologist, meticulous dissection, scaffold material (Galaflex to stabilize and secure implant in mastectomy pocket ), and cohesive implants, we are able to perform implant based reconstruction in a single stage. ⁣⁣⁣⁣⁣
Also, the implants are typically placed over the muscle, which decreases pain, animation deformity, preserves shoulder/arm strength, and creates a more natural result. ⁣⁣⁣⁣⁣
Please note: These are my individual patients who have provided written photo consent. These photos and posts do not constitute medical advice. Results may vary. See a board certified plastic surgeon for evaluation.⁣⁣⁣⁣

Breast Augmentation With 24-hour Rapid Recovery Method

Here’s a before and after of a primary breast augmentation with 24-hour rapid recovery method. When I was training in my residency at USF, Dr. Tebbetts and Dr. Adams, who pioneered the method, lectured and performed hands-on training demonstrating this method. The 24-hour rapid recovery breast augmentation is a procedure that relies on process oriented steps that maximizes planning, minimizes tissue damage and allows patients to get back on their feet in as little as a few hours after waking up from anesthesia. The recovery time is minimal because the procedure involves no bleeding, minimal tissue damage, and is very gentle and precise. It allows the patient to continue with regular life by that very same evening or the next day. Heavy exercise and intense work should be avoided initially; however, patients are encouraged to get moving right away. Patients who have undergone the 24-hour breast augmentation procedure can manage any lingering pain with over-the-counter painkillers. Will be talking more about this on another Instagram live talk soon. Stay tuned for the annoucement! Have a great week ahead!.

What is 24 Hour Breast Augmentation?

You want to enhance your feelings of attractiveness and positive self-image and you think your small or asymmetrical breasts aren’t helping. You might like to surgically augment your breasts, but you don’t have time for a prolonged recovery period. Besides, you fear the pain and discomfort associated with breast augmentation.

Is this you?

If so, the 24-hour rapid recovery breast augmentation is perfect for you.

The 24-hour recovery breast augmentation is an innovative plastic surgery technique that uses precise and gentle systematic changes with electrocautery forceps to increase breast size. With maximized planning, minimized tissue damage, reduced bacterial load and shorter recovery time, the procedure enables patients to get back on their feet within a few hours of waking up from anesthesia.

Without complications, you can be at work the next day. There are no drainage tubes and no bulky, post-operative dressings—no bands and no massaging of breasts. You may go shopping, out to dinner or dancing soon after the operation. In fact, movement begins right after surgery with arm exercises, walking and showering that night.

Advantages over traditional breast augmentation

Unlike traditional breast augmentation surgery with its fairly large incisions, the 24-hour technique involves making small cuts in strategic locations. This enables patients to return to their normal lives within a day. The traditional procedure results in considerable downtime and soreness, with the first 24-48 hours after surgery involving pain, discomfort and bandages for as long as 10 days, during which time patients are not able to return to work or strenuous daily activities around the house.

In contrast, the new 24-hour technique expedites healing, reduces pain and discomfort to a minimum, and allows you to return to your daily activities faster than ever before. And while those who undergo traditional breast augmentation often require potentially dangerous narcotic pain killers, those who undergo this amazing new technique can usually manage any lingering pain with over-the-counter pain medicine.

Fewer side effects

Recovery after this new surgical technique takes just 24 hours, allowing you to return to regular life the same evening or the next day. The recovery time is shorter because the procedure is gentle and precise with minimal tissue damage and no bleeding.

Our team at Politis Plastic Surgery uses every tool and technique at our disposal to reduce inflammation, bruising and tissue trauma. Our patients often return to work the day after the procedure, although they may do so wearing special support bras for a few days after surgery. Heavy exercise and intense work is avoided initially, but patients are encouraged to start moving right away.

There is minimal post-operation pain with this procedure. Most patients require only over-the-counter pain medication to achieve normal comfort. Also, post-operative bleeding is rare and there are far fewer reported cases of bleeding, capsular contracture, or shifting of the implant.

Who is a candidate for 24-hour breast augmentation?

Like every surgical procedure, some patients are better suited for it than others. Even though the fast recovery time is appealing, the mini-incision approach does not work for every woman who wishes to enhance her bust line. The right candidate for the procedure is a relatively healthy individual with a healthy body weight. If you are a candidate for traditional breast augmentation then you are likely also a candidate for this procedure. During your consultation with Dr. Effie Politis, you will explore your goals and look at the enhancements you wish to achieve. Your body type and other factors may determine whether you are a suitable candidate for the mini-incision approach.

Innovative procedure, amazing results

24-hour breast augmentation surgery is a safe and effective way to achieve an enhanced figure and boost self-esteem. Almost all patients who undergo the procedure can return to regular activities, lift normal objects and drive a car within 24 hours after the operation, without drains, bandages or narcotic medications. And most patients are able to raise their arms above their heads immediately after the surgery.

The decision to undergo breast augmentation should be personal and well-informed. You should not undergo this surgery to please someone else. By consulting Dr. Effie Politis, you can make an informed decision as to whether the 24-hour rapid recovery technique meets your individual goals and suits your body. She applies advanced techniques and is committed to helping patients experience the maximum benefits of the procedure faster and more comfortably.

If you are interested in breast augmentation but concerned about the long recovery period associated with the traditional procedure, meet with Dr. Effie Politis for a consultation about the 24-hour rapid recovery technique. For more information on breast augmentation and other plastic surgery procedures, visit the Politis Plastic Surgery website.

Corrective Surgery for Breast Implant Rupture

This pleasant 46 year old female presented with right breast capsular contracture and pain related to rupture of her textured round implant placed by another surgeon 10 years ago.

Notice the deformity in the device likely leading to malfunction (pocket dissection likely didn’t accommodate implant).

She had the device removed and replaced with a smooth round cohesive implant and enjoyed our 24-hour fast track recovery, which starts preop with our enhanced recovery protocols, meticulous and stepwise surgical execution of exchange and postop recovery protocol.

She was able to get back to her rigorous training schedule (with some limitations) in 24 hours.

What You Need To Know About Breast Augmentation

Do you find your breasts too small or have one that is smaller than the other? Would you like to reduce the size of your breasts after pregnancy? Do you want to correct uneven breasts after breast surgery for other conditions and to improve your self-confidence?

If so, then breast augmentation is a perfect procedure for you.

Also called augmentation mammoplasty, breast augmentation is a surgical procedure to increase the size, shape or fullness of the breasts. During the procedure, the surgeon makes an incision and places a silicone, saline or alternative composite breast implant under breast tissue or chest muscles. Fat from another part of the body may also be used—a procedure called fat transfer breast augmentation.

What are breast implants made of?

A breast implant is a medical prosthesis placed inside the breast to create, reconstruct or augment the physical form of the breast. There are three main types of breast implants used in breast augmentation.

1.     Saline implants

These are implants filled with sterile saline solution. The salt solution is contained within an elastomer silicone shell. The amount of saline that your surgeon will allow in the elastomer depends on the goals of the surgery, including the firmness, shape or size to be achieved. If the saline implant leaks, the salt solution is absorbed and expelled naturally by your body.

2.     Silicone gel-filled implants

These are implants made of a silicone outer shell and filled inside with a silicone gel. Again, the amount of silicone gel added into the silicone shell depends on the shape, size or firmness of breasts to be achieved. If a silicone-filled implant leaks, the gel either stays in the shell or escapes into the breast implant pocket. Since leaking silicone-filled implants may or may not collapse, you will need more regular checks with your doctor for this implant than if you choose saline-filled implants.

3.     Alternative composite implants

Breast implants may also be filled with soy oil, polypropylene or other material. When choosing an alternative composite material, your plastic surgeon will consider whether you have adverse reactions or allergy to any of these materials. In the end, the material chosen should not cause problems if it leaks into your body.

What can breast augmentation do for you?

  • Increase the fullness and projection of your breasts
  • Improve the balance of your breasts and your hip contours
  • Enlarge breasts that are naturally smaller
  • Restore breast shape and size after weight loss, pregnancy or breastfeeding
  • Restore your breast symmetry when your breasts are asymmetrical
  • Reconstruct your breast(s) after mastectomy, injury or various conditions
  • Boost your self-image and self-confidence

When considering breast augmentation, you will first discuss your goals with your plastic surgeon. The goals should be realistic and informed by what the procedure can do. Your surgeon will also help you understand the possible risks, complications and follow-up care. A typical breast implant lasts 7-12 years on average.

Breast augmentation does not correct severely drooping breasts. Actually, drooping breasts require a different procedure called breast lifting. The breast lift can be performed along with breast augmentation to make your breasts both fuller and lifted, but it can also be a separate operation. Your plastic surgeon will guide you in making this decision.

How should you prepare for breast augmentation?

You will start by choosing a surgeon to help you with the procedure. A skilled and experienced plastic surgeon such as Dr. Effie Politis will offer good advice and perform the procedure with a higher chance of success. So if you are considering the operation, speak with your plastic surgeon about it and be specific about your preferences for breast size, feel and appearance. Once you choose to have breast augmentation surgery, your plastic surgeon will help you choose the size and shape of implant you need by putting different sized implants into your bra to see how they fit and feel. 

The surgeon will describe the specific types of implants that may be used—textured or smooth, round or shaped like a teardrop, saline or silicone—together with options for surgical techniques. It is your responsibility to review information provided to patients by the manufacturer of the implant. You will also need to keep copies of this information for your records.

Before you undergo the procedure, consider the following:

  • Breast implants do not last a lifetime; the average life span is 10 years.
  • Breast implants do not prevent breasts from sagging; you may need a breast lift in addition to breast augmentation to deal with sagging.
  • After breast augmentation, mammograms might be more complicated.
  • While most women are able to breastfeed after the procedure, some find it a challenge.
  • A routine MRI is necessary three years after a breast augmentation—though studies are yet to demonstrate the usefulness of the imaging.
  • If you change your mind and opt to have breast implants removed, you will need a breast lift or other corrective surgery to restore the appearance of your breasts.
  • Breast implants and the related surgeries and imaging tests are not covered by insurance.

Your plastic surgeon may recommend that you have a baseline mammogram before the surgery. If you are on certain medications, such as aspirin or other medications that increase bleeding, your doctor may adjust them. If you are a smoker, you will have to stop for a while before the procedure. Likewise, you should arrange for a friend or family member to drive you home after the surgery and even stay with you for a day.

What should you expect during the procedure?

This is a surgical procedure. A general anesthetic will be used so that you are asleep during the operation—though local anesthesia may also be used, which means you would be awake during the procedure.

There are three incision options your surgeon will consider.

  1. Incision in the crease under your breast (infra-mammary incision)
  2. Incision in the armpit (trans-axillary incision)
  3. Incision around the nipple (periareolar incision)

The choice of incision depends on the type of implant, surgeon-patient preference, your anatomy, and how much enlargement is involved.

After making the incision, your plastic surgeon will insert the implant into a pocket. 

There are two ways of placing the implant.

  1. Sub-mammary (sub-glandular) placement behind the breast tissue, over the pectoral muscle.
  2. Sub-muscular placement under the pectoral muscle—recovery may take longer and there may be slightly more pain after the procedure.

To close the incisions, your plastic surgeon will apply layered sutures or stitches in your breast tissue. The stitches, surgical tape or skin adhesives will help to close the incisions and keep the skin closed. While the incision lines will be initially visible, they will fade in time. Swelling caused by the surgery will resolve within two weeks.

How long does recovery take?

Soon after the surgery, the anesthetic will wear off and your surgeon will provide medicine to relieve the pain. The sutures are made of absorbable or dissolvable material and will disappear within 6 weeks. But if your sutures do not dissolve or if drainage tubes are placed near your breasts, you will need a follow-up appointment to remove them.

Your surgeon will also provide information on how to care for your breasts after the procedure, how to take prescribed medication, when to schedule a follow-up visit and when to call your doctor for help. You will be advised to seek immediate medical help should you experience any sign of infection, such as chest pains, shortness of breath, unusual heart beats, fever, warmth or redness in the breast area.

Your doctor will also advise you on what type of brea to wear and post-operative exercises, such as moving and flexing the arms to relieve discomfort and pain. You should not engage in strenuous physical activity for the first 6 weeks after the surgery.

What are the risks and complications of breast augmentation?

Every surgical procedure has risks, including breast augmentation. Among patients who undergo breast reconstruction, 46% of those with silicone gel implants and 21% of those with saline implants typically require at least one additional surgery within 3 years. Likewise, 25% of women with silicone implants and 8% of those with saline implants change their mind and undergo surgery to remove the devices.

It is not uncommon for breast augmentation patients to have some kind of complication.

The common risks and complications include:

  • Need for additional surgeries
  • Breast pain or changes in nipple and breast sensation
  • Infection, bleeding, fluid accumulation or leaking of the implant
  • Systemic symptoms, commonly known as Breast Implant Illness (BII)
  • Rupture (tears or holes in the shell) of saline-filled and silicone gel-filled implants. The rupture can be a deflation (with visible change to breast size of saline filled implants) or a silent rapture (without visible change to breast size of silicone filled implants).
  • Capsular contracture, which is the hardening of the area around the implant and which can distort the shape of the implant by becoming red, thick and painful.
  • Breast-Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL), a rare cancer of the immune system. The Food and Drug Administration (FDA) believes women with breast implants have a very low but possible risk of developing ALCL, though further research is still necessary to fully understand how breast implants are related to ALCL.

Breast augmentation is a great option for enhancing the size and shape of your breasts, improving your body image and boosting your self-confidence and self-esteem. At Politis Plastic Surgery, we offer the procedure to women who want to increase the fullness and projection of their breasts, enlarge small breasts, restore breast symmetry, reconstruct their breasts after mastectomy or injury, restore breast size and shape after breastfeeding, pregnancy or weight loss, and to boost their self-image and self-confidence.

If you are dissatisfied with the appearance of your breasts and considering breast augmentation, contact Dr. Effie Politis for a consultation. For more information on breast augmentation, visit the Politis Plastic Surgery website.