Breast Augmentation

Breast Augmentation in Maryland, Washington, D.C., and Virginia (Northern) Breast Implants Information

Plastic surgeon Adam Tattelbaum, M.D., performs breast augmentation for Maryland, Northern Virginia, and Washington, D.C., patients utilizing a wide selection of breast implants. Continue reading to learn more about Dr. Tattelbaum's specific approach to breast augmentation. Washington, D.C., Maryland, and Virginia (Northern Area) residents are also welcome to discuss their goals in person with Dr. Tattelbaum. Contact the practice of Dr. Tattelbaum today to set up your personal consultation or to learn more about the cost of breast enhancement surgery.

Are You Thinking About Breast Augmentation?

Breast augmentation is not a one-size-fits-all operation. Every breast augmentation patient who walks into my offices in Maryland and Northern Virginia wants to be not too big, certainly not too small, and as natural looking as possible. In order to accomplish this goal, the breast augmentation surgeon has to take into account a variety of factors, including:

  • Patient health
  • Patient goals
  • Patient height
  • Width of chest and breast
  • Amount of existing breast tissue
  • Degree of droop of the breast

My patients frequently ask me why photographs on the Internet show the same volume breast implants in patients with strikingly different looking results. The reason is that each patient has a different starting point. 400 CC breast implants on a five-foot-ten-inch-tall patient will look like a moderate or full-size C cup. The same breast implants on a five-foot-three-inch patient will look like a double D. Photographs that show only the upper body just don't show the entire picture.

In my office, I carry a full spectrum of breast implant sizers. Patients can try on a variety of shapes and sizes until we find the one that achieves their goal. I try not to focus specifically on the cup size but rather on how the patient looks with the breast implant sizers in place, both in a bra and in clothing.

I feel that it is the overall appearance that leads to the cup size and not the other way around. My breast augmentation patients in the Washington, D.C., area are often surprised to find out that the breast implants they like the most during sizing is larger than the cup size they originally envisioned.

When the breast implants are placed underneath the pectoral muscles, they lose a small amount of projection compared with implants placed above the breast and bra. This is taken into account as well.

Obviously, the goals of the patient are the most important, but in order to achieve the best aesthetic outcome, all factors must be considered. As a general rule, the taller the patient, the more options available. A taller patient can carry larger breast implants, and larger implants can allow more lift and, therefore, more flexibility. This is particularly true if there is drooping.

I encourage patients considering breast augmentation to contact our practice about breast enlargement and set up a consultation to discuss the breast implant options most suited to their particular figure and goals.

Our three offices are conveniently located for breast augmentation patients from Baltimore, Annapolis, Washington, D.C., Arlington, McLean, Reston, Herndon, Rockville and surrounding locations.

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Breast Implant Types

In my Washington, D.C., area offices, I keep closets full of breast implants in various sizes and types both Saline and Silicone.

High Profile Implants

When they first came out, I was concerned that high profile implants would create the look of a torpedo breast. Fortunately, this has not been my experience. By giving more frontal projection and having a narrower base diameter, they tend to give a fuller figure without making breast augmentation patients look too wide or heavy. They ar particularly helpful in patients with a moderate amount of droop to the breast as they give more lift.

Moderate Profile Implants

For the wide-chested patient, the moderate profile breast implant is still an excellent choice, but because of its shape, it can tend to have more rippling or waving in saline than high profile implants.

Low Profile Implants

These are similar to moderates but with less projection. Most of my patients go with a moderate or high profile but these are available for patients wanting a more minimal change. I happen to prefer the aesthetic shape of moderate profile implants more.

Textured Breast Implants and Teardrops

While some people believe that textured breast implants have a lower rate of capsular contracture, I don't think it makes a significant difference when implants are placed under the muscle. I simply don't like the way they feel in the breast. The shell of the implant is somewhat thicker and more noticeable and, because they are textured, these breast implants stick to the internal tissues. I feel that when patients move, textured breast implants do not move as nicely with them, giving a less natural result.

Although I have used anatomic, or shaped, breast implants such as the teardrop shape in past breast augmentation procedures, I rarely use them now. These breast implants must be textured so they do not turn around in the breast implant pocket. They must stick to the internal tissues and, for the reasons outlined above, I simply think they look less natural.

If you live in Washington, D.C., Maryland, or Virginia (Northern Area) and would like to learn more about our various breast implants, please contact the practice of Dr. Adam Tattelbaum today.

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Silicone or Saline?

In November of 1996 the FDA allowed the use of silicone gel breast implants for cosmetic enhancement in women over 22 years of age. Below is a summary of the pros and cons of silicone gel implants.


  • Softer and more natural feeling.
  • Less likely to ripple or wave.


  • Silicone Gel implants need a slightly bigger incision to be placed because they are already inflated before insertion.
  • Manufacturers recommend MRI screening for leakage of the implants 3 years after surgery and then every 2 years therafter
  • Gel implant volume can not be adjusted because it is pre-filled.
  • Silicone gel implants are more expensive.

I tell my patients that if they are looking for the most natural feeling breasts, barring capsular contracture, silicone wins.

If they are looking for the implant that requires less thinking about or surveilence - saline breast implants win.

While I tend to favor the look and feel of Gel implants it is important to me that my patients are well informed and make an educated decision. Patients who start with a fuller breast will hide either implant well. I personally feel that more slender patients with less breast tissue will look more natural in gel silicone breat implants.

For more information about implants the FDA is a good resource.

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Breast Implant Location

I place about 99 percent of my breast implants underneath the chest wall muscle. My goal is always to give the most natural breast augmentation results possible, and the more tissue between the outside world and the implant, the more natural the result. With the implant placed beneath the chest wall muscle, there is a gentler slope or transition in the upper pole of the breast.

There are other reasons that breast implants are better beneath the muscle. Evidence shows that breast implants placed underneath the muscle have a lower rate of infection and a lower rate of capsular contracture. When breast implants are placed under the muscle, the normal activities of daily living are always massaging the implants. In addition, this placement allows a better mammogram, and this is perhaps the most important reason to place breast implants underneath the chest muscle.

Although I will occasionally place breast implants underneath the gland of the breast, it is not my preference. In some situations, an implant placed under the gland will give more lift to the breast and will minimize the need for mastopexy (breast lift). But because of the reasons listed above, I generally prefer a sub-muscular breast augmentation, even if a new mastopexy is required.

I encourage my Washington, D.C., Virginia (Northern Area), and Maryland area patients who would like to discuss the placement of breast implants with me further to contact the practice today.

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Incisions for Breast Implants

While there are four approaches through which breast implants can be placed, I use only two in my practice. I prefer either the periareolar (around areola) or the inframammary (under breast) approach. I use them interchangeably, and I may direct my breast augmentation patients to one or the other depending upon their existing anatomy.

For example, a breast augmentation patient with a well-defined fold of the breast and a small amount of droop is an excellent candidate for an inframammary incision. The incision is well hidden underneath the fold of the breast and, as the breast regains some if its laxity when the implants drop and then settle, the incision is extremely hard to find.

On the other hand, for breast augmentation patients with too much laxity or no fold at all, I prefer an incision around the bottom portion of the areola. In a situation where patients have no fold at all, a fold must be created as the implant is placed into the implant pocket. If the incision is placed on the chest too high or too low, it can be visible. In such instances, I find that placing the incision around the areola negates that risk.

In patients who may require a breast lift in three to six months after the implants have settled, I prefer to go with the periareolar approach as well. If a small lift is required, the periareolar scar is already in the right position for a periareolar lift. On rare occasions I will place breast implants through a supraareolar incision (on top of the areola), which allows me to take out a small amount of tissue above the nipples and perform a crescent lift at the time of surgery.

While I have performed many axillary (underarm) implant procedures in the past, I feel that the scar is more visible in bathing suits and lingerie. Furthermore, with the advent of shows like Extreme Makeover, I feel that most people know what the axillary scar is all about.

While the trans umbilical approach (through the navel) is intriguing, most physicians performing this approach place the breast implants above the chest wall muscle. For reasons listed above, I believe that sub-muscular placement of implants is superior. I also feel that the trans umbilical approach lacks the kind of precision that I can offer my breast augmentation patients with the periareolar or inframammary approaches. Silicone gel implants, because they are already inflated cannot be placed through the navel.

Lastly, for an appropriate patient who is considering abdominoplasty at the same time as breast augmentation breast implants can be placed through the abdominoplasty incision into a sub muscular pocket. Patients must have the right anatomy for this procedure, but when this is the case, it is a very nice way to perform abdominoplasty and breast augmentation, leaving absolutely no scars on the breast. This is generally performed with a saline implant only.

If you would like to discuss the surgical approach that might be the most appropriate for your breast augmentation, please contact one of my Maryland, Washington D.C. or Virginia (Northern Area) offices today.

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Types of Patients and Examples

I generally classify my breast augmentation patients into four categories:

  • Those with no drooping of the breast whatsoever
  • Those with a small amount of droop
  • Those with a moderate amount of droop
  • Those with an excessive amount of droop

The Patient with No Droop

In a patient with virtually no breast tissue, any size or type of breast implant can generally be used, but there are trade-offs. When there is little starting breast tissue, the larger the volume of implants used, the less natural the ultimate result. Breast tissue acts as camouflage on top of the implants to give a more natural result. A slender patient may wish to strongly consider a silicone gel implant. Silicone implants will ripple less and look more natural when there is little breast tissue to hide the implant. If a slender patients wants a saline implant, high profile implants tend to ripple less than low or moderate because of their shape.

The Patient with a Small Amount of Droop

In my mind, the best aesthetic outcomes are derived in patients with a relatively broad-based, moderate B size breast. A small amount of droop allows the breast implants to fill out the skin envelope nicely. The B size breast gives good camouflage and a very natural result.

The Patient with a Moderate Amount of Droop

There is a group of breast augmentation patients in what I call the gray zone. These are patients with an intermediate amount of drooping of the breast. In these cases particularly, the volume of the breast implants is important. If these patients go with larger breast implants, they will get more lift and probably not require a tightening procedure. If some situations, in three to six months, these patients will come back and get a mini-lift or periareolar tightening in the office. Even at six months, with a small amount of droop underneath the existing implant, the aesthetic appearance is good and I do not recommend the additional scars that would be required for mastopexy. In the moderate group of patients, I perform an additional lift in only about 10 percent of patients.

The Patient with a Large Amount of Droop

Patients with a large amount of droop will generally require a tightening procedure. If the drooping is not addressed, the implant will make the breast look full but, eventually, the natural breast tissue will drape unaesthetically off the bottom of the breast implants. These patients require formal mastopexy at the time of their breast augmentation surgery.

Contact our practice for a comprehensive breast augmentation consultation at my Maryland and Virginia (Northern Area) offices. During your appointment we can discuss the various options available for breast implants, including the size, type, and location of implants.

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The Paradox of Augmenting a Large Breast

Sometimes patients walk into my office who already have a full C or D size breast. While patients of this size can be augmented, in these situations, the natural breast always wins. Natural or not, many patients wish to have breast that are high and full. When a full-figured woman is implanted, however, the natural breast will droop eventually, even if a mastopexy is performed, because gravity will always affect the natural breast tissue.

Paradoxically, a breast reduction (minimizing the natural breast weight) followed by a large augmentation would most likely give these patients the full and high-breasted appearance they are looking for. However, ethically and emotionally this sequence is hard to justify.

If you would like a personal assessment of your breast augmentation options and live in Washington, D.C., Maryland, or Virginia (Northern Area), contact the practice of Dr. Adam Tattelbaum today. We have three office locations conveniently located for patients interested in breast implants in Baltimore, Annapolis, Washington, D.C., Arlington, McLean, Rockville, Reston, Herndon and surrounding areas.

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Contact us If you are interested in having breast augmentation in Washington DC, Maryland, or Northern Virginia. Dr. Tattelbaum would be happy to meet with you. Use our contact form to schedule a consultation today!

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As you research your cosmetic surgery procedure, before and after photos can often help you understand your options and assist you in setting realistic expectations of your surgical outcome.

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Read What Our Patients Had to Say

Thank you Dr. Tattelbaum for my surgery, I cannot thank you enough. Thank you for being patient. Thank you for the work you did on me, I no longer have to wear those uncomfortable enhancers I used to stuff in my bra. Thank you!! You and your staff and the nurses at the center where I had the surgery performed are the most professional and friendly people I have ever met. I was made very comfortable and happy at all times. Thank you Dr. Tattelbaum for what you did for me. May God bless you. Thank you for your care.