..Before & After Cosmetic: Breast
Dr. Sheftall’s Aesthetic Sense and Philosophy Regarding Breast Augmentation
| This introduction is perhaps the most important part of this presentation. It is where I outline the aesthetic principles which guide me in creating the most beautiful breasts I can for each patient. What do I use as my model? – the naturally-beautiful un-augmented breast, of course! It only takes a few minutes of perusing the internet to discover that most breast augmentation patients look worse after surgery, not better. Did you catch that? Its true. A woman’s shape is distorted so much by almost all surgeons that they actually end up looking worse. If you don’t believe me, take a few minutes to look at a healthy sampling of before and after results on websites from all over the world. Most breasts look fake after augmentation. It is my goal to do the opposite. I want to create breasts that are so natural in appearance and feel that only the patient will know she has had a breast augmentation. Toward this end, I must make augmentations that resemble natural, unaugmented breasts. This means that they must not have bulging, convex upper poles in profile. Instead, they must have straight or concave upper poles. They must be soft like real breasts. Finally, there should be no tell tale signs that the woman has had breast augmentation surgery. This means that there should be no scars on the breasts. |
Breast Augmentation five years previously |
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| Below and on the various pages of this website, you will see many examples of my aesthetic sense and philosophy in action. The patient below received a breast augmentation from me five years previously. |
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Here she is preparing to put her bra back on after her consultation. Look at the upper pole after five years! In the time between when I performed her surgery and when this picture was taken, she had her fifth child yet she is still a raving beauty. Look at that figure! I wish I could show you her face! The patients below are shown with corresponding amounts of time elapsed since surgery and number of deliveries. |
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Four months post-op, no children |
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 Pictured below is the same patient 3 1/2 years later. Look at the 3/4 profile views of her right and left breasts. They both have maintained the beautiful, slightly concave upper pole that I pride myself on. |
One Month post-op, three children |
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Four months post-op, no children |
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Ten days post-op, no children
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All five patients presented here had their implants placed through their axillae and therefore have no scars on their breasts. One of the most important points I would like you to take away from this short presentation is that it is very important that you are ‘’on the same page’’ as your doctor. If you want something other than what he believes is most beautiful for you, you must communicate that to him or her before surgery. Clearly, by looking around the internet, it is obvious that either very few doctors have my aesthetic sense or very few know how to make natural looking breasts. Ultimately, it doesn’t really matter what the problem is. If you want breasts like these, you must find someone who prefers the natural look AND knows how to create them without leaving scars on your breasts..
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how do i do it? |
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| Here is an example in progress of making a natural looking breast augmentation. I am frequently asked to present at conferences on the subject of breast augmentation. In every instance, many, many surgeons tell me they have never seen anyone who can make the breasts look so natural and ask me how I make them look so much like real breasts. Observe the patient below. She is pictured at one week post-op. Notice that her upper pole in profile is already straight like natural breasts. It is not convex like 99.9% of breast augmentations. Notice in the reclined photo that the breasts flop to the side slightly like real breasts. Please be aware that the lower poles in profile will become convex during the first month. This young woman was small-breasted pre-operatively and has never had children. As such, it takes a couple of weeks for the breast skin to stretch enough to accommodate the implants comfortably and form a beautiful convex lower pole. As this occurs the upper pole will become slightly concave , resulting in the incredibly sexy shape we all love. |
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only five days post-op |
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Here is another patient inside of one week. This woman is pictured at only five days post-op yet already you can see the slightly concave upper pole and slight convexity of her lower pole. Please note that there is a lot of bruising still present in this mother of one. The implants have been placed in the ideal position and that is why this looks so good already. She is also devoid of pain at this point. The dents in her skin are from the wrap that I just removed. I sometimes watch video logs of other doctors’ patients on YouTube. When I hear of patients experiencing discomfort for more than a few days after surgery or talk of ‘’waiting for the implants to drop’’, I know there’s going to be trouble ahead. There is no need for the implants to drop if they have been placed in the correct position during the operation. |
the natural look |
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| Here is another example of a patient during her first week post-op in the reclined position showing her breasts flopping to the side slightly like naturally-beautiful, un-augmented breasts. Unfortunately, I cannot show you pictures of these last three patients at later dates as they returned to their home countries. The first five patients in this presentation are shown at varying later dates. Four are local women who were kind enough to come in and let me get some pictures and/or video at various points in their post-op recovery. Here are two of those women demonstrating another critical element; softness. |
Softness
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No Scars on the breast
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Can you tell which is a wrinkle and which is my healed incision? I can’t and I did the surgery! |
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looking natural with…
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Its OK to have some upper pole fullness when wearing a bra or bikini top… |
or without clothing. |
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| But you DON’T want the upper poles to bulge when going without a bra! | |
no scars on the breasts! |
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| I never put scars on the Breast. NEVER! The scar in your underarm becomes virtually invisible after a few months. Not so for infra-mammary and peri-areolar scars. Also, the peri-areolar approach has a higher infection rate because you are cutting through ‘’dirtier’’ skin and some milk ducts where there is greater bacterial colonization. It also has a higher rate of injury to the nerve supplying sensation from the nipple. Incidentally, the trans-umbilical route is no good because it requires that the surgeon use saline implants which are inferior to silicone implants. | |
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| These three patients help me demonstrate that when we take the stitches out at one week, the scar is very angry looking. At one month, a little better, and at one year, virtually indistinguishable from a wrinkle line… Who wants their husband to see the infra-mammary scar and be reminded that you had a breast augmentation every time you lay on your back.. The same problem exists with the peri-areolar approach. Surgeons use these inferior approaches because they find it easier than doing it through the arm where they get generally poorer results . | |
The only exception to this rule.. |
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The only time I use the infra-mammary or peri-areolar approach is when a previous doctor used it and I am being asked by the patient to remove a capsular contracture or just to make her breasts look prettier. In such a case where there is already a scar there, it would make no sense to give her a new scar under her arm. The woman pictured above had a severe capsular contracture. Her breasts were misshapen and very hard. I removed the capsule and redid the pocket correctly. Look at her now! At one week post-op, she looks wonderful and they are s
Please see the video located elsewhere on this site.
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uper-soft. It is virtually impossible to tell she has had a breast augmentation by appearance or touch (except for the scar…)
staying in contact |
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This concludes my presentation covering my aesthetic sense and philosophy regarding breast augmentation surgery. If your questions are not answered adequately here, please feel free to write me at  |
Augmentation Mammaplasty (Breast Augmentation)
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| This breast augmentation was performed the day this young woman arrived from Australia. Notice the concave upper pole of her right breast and the slightly upward-pointing nipples, giving a beautiful and youthful look. Please also notice how the increase in fullness to her bust line makes her waist appear smaller, enhancing her curves.. Shown at post-op day 10. 375 cc’s Mentor silicone gel |
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| This gorgeous woman’s face could launch a thousand ships but she lost breast volume after nursing her babies and her figure became too linear. She did not need a breast lift so I performed a transaxillary augmentation alone. You cannot tell she’s had a breast augmentation which is the result both she and I desired. Please note the lovely cleavage and smooth transition from the nape of her neck to her breasts. 26 years old, 5’ 5’’, 110 lbs, 225 cc’s, Mentor silicone gel |
how pregnancy might affect your augmentation |
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| Have you ever wanted to know how pregnancy might affect your breast augmentation? You might be wondering: 1. Can I nurse my baby after the augmentation?, 2. Will my breasts sag after I deliver?, and 3. Will they still look good? All three of these questions are answered by my beautiful patient from the previous slide. She came in to the clinic recently after six years of us not seeing each other! As you will recall, she was 26 (pink bra) and had had two babies when I performed her first augmentation. Now she is 32 (black bra) and has had another baby. Please note her fullness and beautiful cleavage after one additional baby which she nursed. The only difference is that she is even more adorable and beautiful than before!! |
timing your breast augmentation |
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| This young woman came in when she was 19 and asked for an augmentation. I asked her to wait a few years to make sure her breasts had stopped developing on their own. It was not easy. She was very beautiful in every way but was self-conscious about her small breasts. I wanted to go ahead but she was so young and undeveloped in some ways that I thought it would be prudent to wait. Two years later, she was back and the pre-op picture I had taken had not changed. She had grown about three inches, however.. I performed a transaxillary augmentation and a nipple reduction. I admire her patience as much as I love the shape I gave her. This is a local girl so I was able to get a picture four months post-op. 5’8’’, 114 lbs, 225 cc Mentor silicone gel. |
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Almost any plastic surgeon prefers to perform breast augmentations on women who have been pregnant at least once. This is because the parous woman’s skin envelope has been stretched during the pregnancy and many times more if she chose to nurse her baby. The young, fit, nulliparous woman with very small breasts presents a special problem since her skin envelope has trouble accommodating an implant. These patients tend to look their best a month or two after surgery (please see the previous slide) when the skin overlying the implants has had time (with massage) to stretch into its new volume particularly at the lower poles (below her nipple/areola complexes). This young woman, pictured at day seven, is still quite swollen and looks a little tight but you can tell she will have cute, ‘’melon-like’’ breasts when the swelling recedes and the skin has had time to relax into a natural shape. Despite the V-shape of her infra-mammary folds, I was able to create nice semi-circular infra-mammary folds which are evident in the post-op pictures. If she returns for a later follow-up as in the previous slide, I will post pictures. 5’6’’. 105 lbs no pregnancies.
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| An oft-overlooked benefit of breast augmentation is the way it improves one’s body profile. And the ladies report to me that they are thrilled to be able to go without a bra when they feel like it. This beautiful Vietnamese girl is 5’5’’ and weighs 104 lbs. She received 275 cc Mentor silicone gel implants placed through her axillae. |
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| Again, please note the improvement in body profile resulting from augmentation. This young woman did not want big breasts; just a return to her pre-baby figure. She didn’t like the way her abdomen was anterior to her breasts in the pre-op photo, giving her a manly appearance. She doesn’t look that way at all now and looks more like she belongs on a college campus than what she is; a mother of three. She flew all the way from America to have this done and then returned on a flight to the east coast on post-op day three, the day this picture was taken. The world is indeed getting smaller. The scratches on her left breast are a reaction to the tape and will fade. 5’4’’, 115 lbs, 250 cc Mentor silicone gel implants. |
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| This beauty felt her bust line was too flat given her height (5’8’’, 120 lbs, one delivery) and lovely square shoulders. As a child, she had suffered from a deep abscess of her left breast (see the scar at her areolar border) and this made her left breast smaller than her right one. At operation I encountered a lot of scar tissue there, making dissection difficult but eventually, I was able to free up everything. I inserted 300 and 325 cc Mentor silicone gel implants which gave a lovely curve to her bust line. She is shown at six days post-op and I already love the way she looks with or without her sport top. Stitches out tomorrow! |
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| At only five days post-op, this woman’s shape is excellent even though there is still some swelling. (Please note the bruising and creases in her skin from the wraps I just removed. ) As the excess water is absorbed and excreted, her upper poles will become slightly more concave and her lower poles slightly more convex, revealing that super sexy, natural shape we all love. There is no need for the implants to ‘’drop’’ if they are placed in the correct position during surgery. I love being able to give back to young mothers the youthful figure (and then some) they may have lost during their pregnancies . Look at that sexy projection! | |
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| Like most ladies, this lovely Khmer woman did not like the appearance of a padded brassiere, preferring the natural look of unpadded silk. After her surgery, she can comfortably wear a sheer blouse, with or without a bra. The new curve to her bust line has enhanced her beautiful figure by creating a more pronounced curve from her right breast to her waist. The after picture was taken at seven days post-op. |
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| Her tummy doesn’t look it but this woman has had three children! These pictures were taken on post-op day 6 (as you can see, the sutures are still in). I felt that I had matched her bust line and hips quite well but she still thinks her breasts are too small. Please see the video located elsewhere on this site. 5’7” 115 lbs 300 cc Mentor silicone gel. |
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| The progression from pre-op to one month post. Please note how, as swelling subsides, shape improves. I rarely get to see the final shape because travelers return home. This is a local woman. |
Below is another patient I completed recently. Her more full look creates an hour glass shape with and without clothing. Look at that beautiful concave upper pole!  
Above is pictured a beautiful woman of Chinese descent who received a breast augmentation. She flew in from Indonesia and we did the procedure the next day. She left on the 4th post op day.. This woman has 2 sons (one of which is 16 years old if you can believe it) and runs two businesses. She is a club singer also.. She is so talented!
The below lady is 50 years old. She is a lovely woman and so sexy. She doesn’t realize how good she looks now; so modest… She described her breasts pre-operatively as ”two tablets on an ironing board.” (see Testimonials) Now she has a beautiful C cup.. Look how pretty her cleavage looks in the below picture. This is without the help of a bra. There is no gap between her breasts! I took this ”Facebook-legal” picture so the nipples are not showing…
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![047.mp4_snapshot_07.23_[2014.12.26_17.56.23]](http://drsheftall.com/wp-content/uploads/2016/05/047.mp4_snapshot_07.23_2014.12.26_17.56.23.jpg)
Augmentation by Fat Transfer
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Could this be the future of breast augmentation? By fat transfer, not implant? This close friend was willing to let me try this even after I told her I had never done it before. So I studied carefully the pioneering work of Dr. Daniel Del Vecchio of Boston. This outstanding surgeon has performed many of these procedures successfully. Our patient is shown at 60 and 90 days with the associated amount of fat injected in the first and second operations listed. As I believe that free fat cells are nourished by oxygen diffusion exclusively (initially anyway), I felt the benefits of immediate injection outweighed the benefits of preparing the cells. Since more time outside the body would both increase cell loss and decrease the viability of surviving cells, I simply moved from the donor site at the abdomen and thighs to the recipient site at the breast each time I filled a syringe, taking only the time necessary to remove free tumescent liquid and blood, and most importantly, changing to a smaller cannula as Dr. Del Vecchio recommends. (This makes sense because you want to increase the surface area of the fat relative to the volume if you are surviving on diffusion of oxygen molecules alone). One of the keys, I believe, is to spread out the fat as much as possible and to put as much in contact with the pectoralis muscle as possible; even injecting some intra-muscularly since this region is rich in oxygen. I overfilled her a little at 60 days (you can still see it at 90 days) as we expect minor retrenchment. She put up with a lot given my lack of experience with this operation and given that we still do not know how long it will last. She endured two surgeries (albeit free) and even agreed to gain a few kgs to enrich my donor sites. She is pleased with the result as am I.Update: Here she is 6 years after the original procedure. She has gained 3 kilos (=6.6 lbs) so this complicates the result in that I am not sure how much of her improvement is due to me and how much is due to her weight gain. Still surprisingly, she has lost very little from the original enhancement (from an A cup to a large B). It lasted very nicely. I still think it is because I used a very small cannula (Dr. Del Vecchio’s suggestion) and because I thought to inject all around the pectoralis major muscle and, importantly, minimised the time the fat cells spent outside the body. Dr. Daniel Del Vecchio is in Boston. Dr. Louis Bucky also does this type of breast enhancement, frequently combining it with mastopexy (breast lift). He is in Philadelphia. If you want it done in Asia, I will do it for you. |
Mastopexy (Breast Lift)
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Reduction Mammaplasty (Breast Reduction)
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| When this young woman saw my result as she woke from surgery and started crying (out of happiness), all those sleepless nights during residency became worth it and then some. She is only 24 and has had no children but had suffered with ptosis after significant weight loss from several years before. I had done surgery on her mom 2 days earlier and the stress building up for her “turn” was a lot to bear. The far left pre-op view demonstrates why I couldn’t perform a breast augmentation on this patient. Her right and left nipples are much too far below her infra-mammary folds so a lifting procedure was necessary. Can you see how her nipple/areola complex is medial on her R. breast mound in the second from left pre op view? Postoperatively, it is lateral and of course superior in an ideal position. The third from left photo was taken less than 24 hours after her surgery; hence, the bandages. The final, rightmost photo was taken on post op day 2, 39 hours after surgery. Please note the fullness in her cleavage area in this photo, even without the “help” of a brassiere. I love being able to give my lift and reduction patients a youthful, natural fullness even when not wearing a bra and of course they love it too… Please note that in the post-op photo at far right, no breast skin is in contact with her abdominal skin. This is the way breast lifts and reductions should look after surgery. If there remains sagging after these procedures, you have not been treated adequately. Mother and daughter left for a trip through Thailand on post op day 7 before heading back to Canada, both of them a little sore and a lot beautiful. I love doing breast and body procedures and will probably focus on them exclusively when I come back to the States although I tried that here and the women kept talking me into doing their faces too. I love my patients so much, its hard to say “no” to them. |
Breast reduction and liposuction of the abdomen; a winning combination |
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| Please compare the relative projections of breasts versus abdomen in the two profile views above and of course the breast shapes themselves. The post op breast silhouette has a beautiful shape compared with the pre op view. Please note that the breasts are not bottomed out in any way yet the nipples point up ever so slightly, giving them a very youthful appearance in this sixty year old. This patient also received liposuction of her abdomen as you can see. She is also featured in the section ‘’Body’’, subsection ‘’Liposuction’’. |
Nipple/Areola Reduction
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| As is frequently the case, I performed this nipple reduction (in height and girth) at the same time as the breast augmentation. Small nipples give a more youthful appearance. They do not affect breast feeding since the ducts are not damaged. Do you see how the post op areola is more round than the pre op one? This is another sign of youth since in younger nulliparous women, there has been no differential tension on the breast skin (from sagging). It is the result of a perfectly performed breast augmentation where the tension on the skin is exactly the same in all directions, something we call ‘’point symmetry’’ in physics… Please notice also how the new nipple is in the exact center of the areola. We also do a lot of areola reduction procedures but this patient did not need it. |
