Cleveland_Clinic_Host:  Breast augmentation is the most popular cosmetic surgery procedure in the United States, with approximately 307,000 performed in 2007. In the last few years, cosmetic procedures and breast reconstruction surgery have improved considerably, offering more options than ever before, less invasive procedures, and better results. 

With one of the largest and most comprehensive aesthetic surgery programs in the country and high patient satisfaction rates, Cleveland Clinic’s board-certified plastic surgeons offer extensive skill, experience and innovation in breast augmentation, breast lift and breast reduction surgery procedures that can enhance the appearance of your breasts and improve body image and self-confidence. 

Our plastic surgeons are actively involved in a number of studies conducted with the FDA and implant manufacturers, including an ongoing nationwide study of a new cohesive gel (“Gummi Bear”) breast implant.  These, and many other innovations undertaken by Cleveland Clinic plastic surgeons, have a positive impact on patient safety and satisfaction.

Raymond Isakov, MD, is a board certified plastic surgeon who specializes in cosmetic procedures and breast reconstruction surgery.  A graduate of Orange High School in Cleveland, he received his medical degree from Chicago Medical School in Illinois and completed both his residency and a fellowship in Plastic and Reconstructive Surgery at Cleveland Clinic.  He later completed an additional aesthetic surgery fellowship at Zeeba Clinic in Cleveland.  After private practice in Austin, Texas, Dr. Isakov is now part of our Cleveland Clinic team of plastic surgeons, providing comprehensive aesthetic care at one of America’s top 4 hospitals.

Take advantage of this unique opportunity to chat live with Dr. Isakov in a secure, confidential online setting.  This is your chance to get answers to the questions you have always wanted to ask a plastic surgeon!

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Raymond D. Isakov, MD. We are thrilled to have Dr. Isakov here today for this chat. He is considered an expert in the field of cosmetic surgery, breast enhancement procedures and breast implant technology. Let’s begin with some general questions.

Speaker-_Dr__Raymond_D__Isakov: Thank you for having me today. Let me look at some of the questions and get started.

Breast Enhancement  Implant Choice

powerup: I’m considering getting breast implants. How do I know what size implant to select?

Speaker-_Dr__Raymond_D__Isakov: Deciding on breast size is a personal decision, and having a clear idea of the size you want before your surgery will go a long way toward your satisfaction with the results.

There are some important questions to keep in mind, with the answers varying based on your anatomy and goals.

  • Your anatomy -- Each woman brings her unique anatomy to the table. There is no substitute for accurate measurements. Your surgeon must determine how broad your chest is, the base width of your breasts and the distance between your breasts. Another important factor is skin laxity or looseness. To achieve successful augmentation, you must have enough tissue to cover the breast implant.
  • Your goals -- Talk to your surgeon about your preferences regarding breast size. Bring in pictures of breasts that you find appealing. Tell your surgeon what you like about these breasts, being as specific as possible. This discussion will help your surgeon get an accurate idea of what you want out of your breast enhancement surgery, and more importantly, whether it is feasible. Because there is no real standardization in bra size or fit, telling your surgeon you want to be a C or a D does not mean all that much. These are relative terms that can start a discussion, but are by no means the final word in deciding on breast implant size. Breast implant volume or size is measured in cubic centimeters (cc). Breast implant sizes run the gamut from 120 cc's to 850 cc's.

Talk, and listen, to your surgeon and make sure you communicate well to come up with a plan that is right for you.

powerup: I know that there are two types of breast implants, silicon and saline. What are the pros and cons of each? Is one is better for me?

Speaker-_Dr__Raymond_D__Isakov: Up until 2 years ago the FDA only allowed saline implants for cosmetic surgery. Now we use silicone for augmentation on anyone over 22 years.
Silicone and saline each have their advantages.

Saline: These implants require smaller incisions for access, have range of adjustability for size, If they rupture, the salt water is only absorbed by your body and just need to be replaced. However saline filled implants feel less normal and can be more visible by the way of rippling.

Silicone filled implants require a larger incision for access, however they feel better, have less rippling and over all give nice results.

powerup: What are the differences between smooth implants and textured implants and how do I figure out which one is best for me?

Speaker-_Dr__Raymond_D__Isakov: Textured implants feel rough and the roughness allows the scar capsule to stick to the implant. This theoretically decreases capsule contractures or excessive scar tissue but may increase rippling.

For round devices, I use smooth implants so they can move around and have less rippling.
For a tear-drop shape implant they need to be textured so they do not change position.

The newest generation of silicone implants are the only textured implants that I use because they are tear drop shaped.

can2: I have heard that silicon breast implants can leak and make you sick. If that’s true why do they still use silicon breast implants?

Speaker-_Dr__Raymond_D__Isakov: It is true that silicone implants have been criticized as a possible health risk if ruptured. The final analysis of studies attempting to link silicone to connective tissue diseases and certain autoimmune diseases, failed to show any connection. There have been other studies to show that silicone implants are safe, and the FDA has approved them for breast augmentation.

plainj: What exactly are high profile breast implants?

Speaker-_Dr__Raymond_D__Isakov: High profile implants can allow you to have more volume in a narrower width. Like implant volume, this decision is based on your anatomy. If a woman chooses a 350 cc, a high profile implant will offer a lot of projection, but if she is too broad in the chest, the implant will not be wide enough. A skilled surgeon can guide these decisions and make sure you get the desired aesthetic result.

plainj: How do I determine if I need low profile or high profile breast implants?

Speaker-_Dr__Raymond_D__Isakov: High profile implants give you more volume for a narrower width or the breast. They also give you more outward projection for a given volume. Therefore, your anatomy i.e. a thin woman with small breast may require a high profile implant. These can look a little less natural and more round, but some women need this.

Lower profile implants are better for women with broad breasts who do not care for an -operated on' look.

Again, each person's anatomy and goals are important and therefore it is important to communicate with their surgeon.

funcity: I have heard that there are round breast implants and shaped breast implants. What are the differences between the two?

Speaker-_Dr__Raymond_D__Isakov: The shape of the implant is another factor for you and your surgeon to discuss. The decision on implant shape is also based on individual factors such as body size and shape, skin quality and goals.

Breast implants can be round or tear-drop shaped. Round implants are circular, meaning that they provide similar degrees of projection on the upper and lower parts of the breast. The tear-drop shaped implant is considered more anatomically correct. The tear-drop shaped implants must use a textured surface to prevent the implant from rotating. The textured surface creates an adherence between the implant and your breast tissues, enabling it to stay in place.

Silicone implants of today are much better than 20-30 years ago. There remains a low incidence of rupture, but when this does occur it does not cause systemic illness or cancer but might make the breast hard due to capsular contracture. In this instance, removing the implants and scar tissue is needed.

Implant Technique

how2: What are the circumstances in which I would have my breast implants placed above or below the chest muscle?

Speaker-_Dr__Raymond_D__Isakov: If one has a fair amount of breast tissue to cover an implant, a subglandular (under the breast and above the muscle) implant is a viable option. This may also add a little more lift to a slightly drooping breast.

The submuscular position is usually only partially submuscular as the bottom portion of the implant may not be covered by the muscle.

The benefit here is to give more coverage of the implant at the top of the breast to make a smoother transition. This also may decrease capsular contractures. It may take a little longer for the swelling to decrease, but I find it the most advantageous to place the implant submuscular in most women.

trustme: I have heard that there are four types of incisions to choose from when having breast implants put in. What are they and what are there advantages and disadvantages?

Speaker-_Dr__Raymond_D__Isakov: Periareolar - just under the nipple which heals very well

• Inframammary - in the fold under the breast
• Axillary (armpit incision)
• Belly Button incision

The belly button incision can only be used with saline filled implants. Since silicone has been approved, this incision is used less often. It is also more possible for the implants to move too low with time.

The axillary incision is also difficult to use with silicone implants. Often times it needs endoscopic equipment but is an accepted way to perform the surgery.

The inframammary and periareolar incisions are most commonly used, give you more precision and heal extremely well.

Therefore choice of the type of implant and communicating with your surgeon is important.

Mastopexy or Breast Lift

treetops: What is a mastopexy?

Speaker-_Dr__Raymond_D__Isakov: Mastopexy is another name for 'breast lift'.

lanina129: When a "lift" is done, is it necessary to have implants put in due to low muscle tissue?

Muscle has very little to do with the breast itself. As you age and /or after breast feeding, you have stretched out skin and often times a decrease in breast tissue. Based on your desires and the extent of your need, a lift can be performed just to reposition the breast. But if you desire more fullness, an implant can be done at the same time or at a later time.

lanina129: What is the recovery time when a 'lift' is performed?

Speaker-_Dr__Raymond_D__Isakov: Generally speaking the incisions of the breast lift operation heal very well and the recovery for a lift alone (without implants) is usually fairly fast. Adding implants does increase the amount of surgery and adds a little bit of discomfort postoperatively, but generally speaking with in 1-2 weeks you should be feeling fine. We recommend that you wait about a month before resuming significant exercise. Walking and normal daily activities is encouraged.

lanina129: What is the average cost for a 'lift'?

Speaker-_Dr__Raymond_D__Isakov: Average cost is based on your needs, the extent of the lift, whether or not you have implants placed and the type of implant you choose. Without seeing you for an evaluation it is difficult to provide a fair estimate.

Limitations and Complications

SallyB: My breasts are asymmetrical. One of them is larger and shaped different than the other. What type of breast implants can fix this?

Speaker-_Dr__Raymond_D__Isakov: This is a potentially complex question, but most women are asymmetric naturally. When placing breast implants the difference might be magnified but usually the result is aesthetically pleasing.

If the degree of asymmetry becomes greater, different size implants may be needed.
Sometimes one breast will need to be lifted to match the other. In the most extreme cases of breast asymmetry, a more reconstructive type process may need to be done.

verily: I want breast implants but I want my breasts to look normal. Are there some implants that look more natural than others?

Speaker-_Dr__Raymond_D__Isakov: There is truly no 'normal' breast appearance. All breasts appear different but to avoid an operated on appearance, the smaller implant might be a better option.

Black_1122: I have read that a woman can develop capsular contractures with breast implants. What is that and what can I do to prevent it?

Speaker-_Dr__Raymond_D__Isakov: Any foreign body whether it is a pacemaker or a breast implant will form scar tissue around it. In some breast implants, the scar tissue gets "overactive" and can make the implants feel hard.

There are many potential reasons for this. Submuscular position of the implant decreases capsular contracture. Subclinical infection may be a cause of the contracture.

But as for what you can do to prevent this, massage might help but it is difficult to predict who this will occur in or how long after surgery.

triedbuttrue: I have seen breasts on some women who have had breast implants that have a rippled look. Why is that and how can I avoid getting it when I have my breasts done?

Speaker-_Dr__Raymond_D__Isakov: Thin women with saline filled implants are more likely to have more rippling. This is especially at the outside bottom half of the breast. This is where there is less soft tissue covering the implants. It occurs more dramatically with saline implants than with silicone. This is also a down side for using too large of an implant for someone's anatomy.

nunny3: I really want to have breast implants put in but I really don’t want to have scars. What are my options?

Speaker-_Dr__Raymond_D__Isakov: All surgeries create scars. The scars with breast augmentation no matter which incision is used are rarely a problem and with time are barely visible.

goodnus: If I have breast implants put in, will my breasts and nipples still have the same sensitivity after surgery as I they did before the surgery?

Speaker-_Dr__Raymond_D__Isakov: There is a slight decrease in sensation in the short-term ( for a couple of months post-operatively) This usually comes back to normal. With any surgery there is some unpredictability and although rare there is a chance that the sensation will not return to the previous level of sensation.

Breast Reduction

LD: Dr. Isakov, Can you please tell if I would be a good candidate for a breast reduction and what steps to take for the process. I'm 46 yrs old, 5"3, 160lbs and a 32DD cup. I'm looking into a breast reduction, preferably a size C. Thank you in advance.

Speaker-_Dr__Raymond_D__Isakov: Based on your cup size and frame, a C sounds reasonable. Virtually all women with large breasts get aesthetic and symptomatic relief from breast reductions.

mrietou: I been having back pain for about 5 years and was told to make it better I probably need to have breast reduction but my concern is that I don't know if I can breast feed if I decide to have children in the future and what the down falls for this procedure. I am constantly in pain to the point that I am taking Neurontin® and Vicodin® to help with the pain unfortunately hasn't been working for me. My breasts feels so heavy to the point I sometimes just lift them up to feel the weight off my chest and able to breath easily. One more question, after the surgery would you be able to feel any sensation around your nipples?

Speaker-_Dr__Raymond_D__Isakov: If the upper back and neck problems are due to large breast or if you experience rashes under the breast, then breast reduction surgery can improve those symptoms. We usually leave the nipples attached to the ducts, but there remains a possibility that you may not be able to breast feed after the procedure. Many patients can though.

sunterH: My breasts are too big and I want to make them smaller. Would I have to get breast implants if I had surgery to reduce their size?

Speaker-_Dr__Raymond_D__Isakov: No. Standard breast reduction techniques do not use breast implants.

Breast Cancer

BrownK234: I have breast cancer and my doctor has explained that during the surgery to remove my tumors they can put in breast implants. But I’m afraid that the implants might hide cancer if it comes back. Is this a valid concern? What exactly do you recommend for women like me?

Speaker-_Dr__Raymond_D__Isakov: Today's chat is a completely different topic; however breast reconstruction after mastectomy is very commonly performed with implants. The final implant is the same type of implant that we use for aesthetic surgery but for reconstruction you need to 'build' a breast through stretching out the tissues first. Overall, it is a very common and safe way to perform and therefore consultation with a plastic surgeon can answer all of  these question.

Because the implant goes under the muscle, a reoccurrence of the cancer is usually not hidden by the implant. Also a complete mastectomy for which implants are used most often in breast reconstruction results in lower local recurrence.


Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Isakov is now over. Thank you again Dr. Isakov for taking the time to answer our questions about breast augmentation and enhancement procedures today.

Speaker-_Dr__Raymond_D__Isakov: Thank you for having me here today.

More Information

  • To make an appointment with Dr. Raymond Isakov, or any of the other specialists in the Dermatology and Plastic Surgery Institute at Cleveland Clinic, please call 216-444-4646 or call toll free at 800.223.2273 ext. 44646.  You can also visit us online at :
  • A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit
  • If you need more information, contact us, chat online or call the Center for Consumer Health Information at 216.444.3771 or toll-free at 800.223.2272 ext. 43771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!
  • Some participants have asked about upcoming web chat topics. If you would like to suggest topics for 2009, please use our contact link

This health chat occurred on September 25, 2009.

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