Breast Augmentation

One might assume breast augmentation is a “simple” surgery because of its widespread popularity. This is not true. While techniques have been refined, it is a procedure that involves great attention to detail and strong aesthetic judgment.

— Haideh Hirmand / MD

There is no parallel to the role that breasts play in women’s sense of femininity and sexuality. This is why breast augmentation is perennially one of the top three cosmetic surgeries. Breasts are an integral part of a woman’s self-image and when ideally enhanced, bring tremendous satisfaction.

Some women are simply born with very small breasts. Others lose breast volume and shape due to pregnancy and breast feeding. Still others have achieved significant weight loss at the expense of their breasts. There are some developmental conditions such as tuberous breasts or syndromes resulting in underdevelopment of the breast that benefit from augmentation for reconstructive correction.

Today the choice in implants, is not simply silicone or saline, but various shapes and types such as tear drop or gummy bear implants. All are FDA approved and can provide natural enhancement. Though augmentation using one’s own fat has gained popularity in some countries, there are ongoing studies to establish its medical safety.


When the subject is breast enhancement, size is usually the reigning topic. However, shape matters just as much, if not more than size. Appropriate fullness is part of the shape, therefore the goal of augmentation should take both size and shape into account. It is important to understand that not every size and shape can be accomplished for every breast. Your breasts and chest wall predetermine what will look best. There are limits to size, and crossing the line can result in distortion and an unnatural appearance. Correcting these unintended consequences is difficult.

No pair of breasts are identical. Familiarize yourself with your own asymmetries. During consultation we will study your torso and breast width size that will dictate size ranges. We will also discuss the implant type, implant placement and choice of scar location.

Keep in mind, a breast augmentation addresses loss of tissue and firmness, changing the size and shape of the breasts. If your breasts sag (ptosis), a breast lift may be needed to restore the position of the breasts. The determining factor is where your nipples fall in comparison to your breast fold. During your physical exam we will ascertain the degree of ptosis and whether you are a candidate for breast augmentation alone, or breast augmentation with a breast lift.

Hirmand Technique


My philosophy regarding breast augmentation is—“to enhance shape and size in an invisible manner such that even without clothes, it is not apparent that a breast augmentation was performed.”

The consultation is very important to understand each individual’s motivation and goals and how they see this impacting their life in the short and long term. Based upon our visit and a comprehensive physical exam, the size, shape, type of implant and incision site are reviewed.

The most frequent complaint I hear from those seeking a breast revision is, “The doctor really didn’t listen to me and made my breasts larger than I wanted.” Because of this, I am very attentive to sizing and employ the following steps:

  • Quantitative analysis is performed taking into account key breast measurements to determine which implant size ranges will work for an optimal outcome
  • An extensive in-office sizing session is available as an option prior to the procedure
  • During the surgery, intra-operative sizing is performed in a sitting position, using sizers that exactly match the implant not only in volume but also in shape

Though there are exceptions, I prefer to place the implant beneath the muscle for a more natural appearance, lower rate of capsule hardening and clearer mammography. A precise pocket dissection, correct placement of implant at the appropriate level, inconspicuous scars using meticulous scar closure and specific techniques to avoid capsular contracture, all combine to facilitate immediate recovery and provide a long lasting, beautiful and natural result.

Surgical notes

Anesthesia: General
Length of surgery: 2 ½ to 3 hours
Outpatient/inpatient: outpatient
Adjunct procedures: mastopexy or breast lift
Recovery: less than a week