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Breast Augmentation

Breast Augmentation

Breast Augmentation at Genesis Plastic Surgery

Genesis Plastic Surgery has a private but full-sized hospital operating room that is certified by the Joint Commission, the same accrediting broadly used by hospitals. This allows us to do the majority of procedures in our office facility but with the utmost safety.

With a team that works together, our safety record is outstanding and yet allows the privacy that a large facility cannot offer. In addition, our facility has had a much lower infection rate than procedures done at larger facilities. Safety is our utmost goal, yet we are able to offer the convenience, privacy, safety, and familiarity of a team dedicated to aesthetic plastic surgery.

Other breast augmentation and enlargement options we offer include mini lifts, breast fat grafting (natural breast enlargement), and revision of prior breast implant surgery. We also offer a breast augmentation with lift (augmentation mastopexy) and a breast lift without implants.

Why Iowa Plastic Surgery for breast enlargement?

Some patients wish to improve the way they look in clothes or a swimsuit. Others wish to regain the figure they had before children. Most patients feel that their breast implants have improved how they feel about themselves.

Genesis Plastic Surgery has extensive experience with a large number of breast augmentations, including the different incisions, different sites of implants, and correction of breast droop. We will help you pick the optimal shape, style, or implant rather than just volume alone. We offer all the options and tailor them to your body frame and desires. We hope our experience can help you to obtain the best possible result and appearance!


  • “I came in unsure of the whole process and the staff was extremely knowledgeable and professional in helping me make a decision as well as during surgery and post-op. Great experience. Love my results!”
    – A.F.
    Individual results may vary

  • “Excellent service and care throughout my entire experience. I couldn’t be happier with my results!”
    – S.M.
    Individual results may vary

  • “Dr. Benjamin Van Raalte and his team have been fantastic, very supportive, and patient. I wish I did this years ago. Very happy.”
    – E.B.
    Individual results may vary

  • “I was extremely insecure with my body and was also afraid of things not going right with surgery; however, the staff was very professional, explained everything in full detail and ultimately, I was extremely satisfied with the outcome.”
    – C.A.
    Individual results may vary

  • “Great experience, great results! Highly recommend!”
    – P.N.
    Individual results may vary

  • “Recommend this office, they are very professional. Treated me like family. Nurses were amazing, talked me through whole procedure so I wasn’t scared. Definitely coming back to do more work.”
    – J.H.
    Individual results may vary

  • “Very pleased with results.”
    – K.G.
    Individual results may vary


At our consultation, we not only listen, but it is the careful measuring and planning that we do that helps you to achieve your goal with a low re-operation or revision rate. We measure, use sizers, and use computer imaging to help you choose.

During your consultation, we will show you before and after pictures of patients that have had breast augmentation surgery. In addition, we provide 3D imaging with Crisalix, a program that can show computer-generated pictures of your potential outcome.

We also have a sizing kit that we will utilize to help you pick out your preferred size. Many patients prefer large breast implants, but the ideal option is the one that fits the patient’s frame. Although perfect results can never be guaranteed, we will use our expertise to get your best result.

Crisalix for Patients from Crisalix on Vimeo.


Genesis Plastic Surgery has extensive experience with different options for breast implant placement, including submuscular (preferred), sub-glandular, or subfascial placement. We have used different incisions for placement, and our preferred incisions are transaxillary for smaller or saline implants, and inframammary for larger, or gel implants. The inframammary incision is also best for those with a degree of droop.

The transaxillary incision is placed in the armpit. Axillary incisions are best for the smaller round gel or saline implants. Cohesive gel-shaped implants are best placed in an incision under the breast fold or inframammary incision. We place the majority of implants under the muscle, but a few may be placed below the breast tissue fascia.

We offer both general anesthesia and intravenous (IV) anesthesia. Intravenous anesthesia is the medication given by an IV that makes you forget, feel intoxicated, and tolerate the procedure. Numbing medications are then administered. General anesthesia is when you are put completely to sleep. Currently, about 80% of our patients choose IV sedation.

The same implant can look different in different people, and one size implant will not guarantee the same cup size for different patients of different body build or type. Differences include not only the size of the patient, including height and weight but also the width of the rib cage or even the appearance of the rib cage itself.

Differences in volume may change the width more than the projection. A different style implant such as a high-profile breast implant may give more projection. In some cases, small breast implants can provide a dramatic difference, making larger implants unnecessary.

Lastly, the appearance of the existing breast tissue will affect the outcome. Breast enlargement is not the placement of a new breast on the outside – it uses the existing breast tissue and places an implant below. We recommend cohesive gel implants, as they have the best chance of molding or shaping the existing breast tissue.

Iowa Plastic Surgery uses the best breast implant to fit your desire, your body type, and your chest width. It is often the width and style of the implant that is more important than the size or volume of the implant for your best result.


Saline implants have a silicone shell. They are called saline implants because they are inflated with saline solution. Should they deflate, saline is physiologic with blood and would be absorbed by the body, and the implant will go flat or deflate. The different types of saline implants include round, anatomic (also known as a teardrop or shaped implant), and expandable (postoperatively adjustable) implants. Saline implants can be placed through smaller incisions but do have higher wrinkling and rippling rates than gel implants.

Gel implants, or silicone implants, are composed of silicone gel. They have a silicone shell, and they are filled with silicone gel. The majority of implants used around the world today are silicone breast implants. Many women feel that gel implants have a softer and more natural feel. They do not deflate but can rupture. They do have less rippling than saline implants and are better for thinner women. They also are best for older patients, as in that age group, they look the most natural.

The cohesive gel, or Gummy Bear Implant, has the least rippling and wrinkling and holds the shape of the breast. Over time, the cohesive gel seems also to have less displacement. Our cohesive gel expertise has been noted by the manufacturers of cohesive gel implants. We have become one of the most experienced users of these in the upper Midwest.

These implants have a natural feel and look. The cohesive gel implants have lower reported complications and mold the shape of the breast. These implants also can correct mild degrees of droop.


Round implants are available in both saline and gel. A round implant when upright becomes more teardrop shaped.

The anatomic, or teardrop-shaped implants, not only look the most natural but seem to correct mild to moderate droop better. With a push-up bra, they become rounder.

Expandable saline implants allow fluid to be injected at a later date if the patient needs or desires to become larger. They are useful when the patient wants to be larger than the tighter skin envelope might allow. Fluid is injected at several postoperative visits to stretch out the skin to a more acceptable size. They are also helpful in cases where either both breasts are poorly developed or misshaped.

Breast implants can be low, moderate, or high projection. The surface of the implants can be smooth or textured. All shaped implants are textured breast implants since the textured surface is necessary to avoid turning.

We will help you choose the best implant for you depending on your anatomy, your concerns, and your desires and choices. We use measurements, implant sizers, computer simulation, as well as Dr. Van Raalte’s extensive experience to determine your best fit.


An implant can be inserted under the crease in the breast, around the nipple, or through the armpit. The nipple incision has higher reported rates of infection and capsular contracture. The inframammary incision (underneath the fold of the breast) is best for the placement of shaped implants or correcting mild droop, and the axillary incision (armpit incision) is used for either saline or smaller implants.

Covering the upper portion of the implant with the pectoralis muscle (submuscular placement) is probably better for mammograms and fewer capsules and is the recommended approach. There are some instances where going sub-glandular may give a better appearance.

Types of Breast Implant Placement Locations

Our most common breast implant placement is submuscular. Prior to the cohesive gel implants, 99% of our saline and regular gels were submuscular. The exceptions were an occasional bodybuilder and those with pectus (chest wall) abnormalities. With the cohesive gel (“gummy bear”), we now do 85% submuscular and 15% subfascial, with those with moderate droop being most of the 15%.

Subfascial is not the same as sub-glandular. Although both are above the muscle, the subfascial is a thin layer below with advantages over the sub-glandular of fewer capsules. I only do subfascial with the cohesive gel-shaped implants, as the others have more problems.

Also, even in submuscular, the lower half is subfascial anyway. In the biplanar, just the upper third is submuscular.

Advantages of Submuscular breast implants

  • Good taper in the upper pole
  • Best mammograms
  • Possibly lower contracture
  • Upper pole is covered by muscle

Disadvantages of Submuscular breast implants

  • More pain the first day
  • Muscle creasing in tight clothes when flexing
  • Mild loss of strength
  • If moderate droop can get the breast hanging over the implant, the “snoopy dog” deformity

Advantages of Subfascial breast implants

  • Corrects moderate droop better possibly avoiding the scars of a breast lift
  • May allow a larger implant to be placed for either patient desire or to correct moderate breast droop (ptosis)
  • Less pain
  • No muscle injury
  • No muscle flexing over the implant. No muscle creasing. No loss of strength

Disadvantages of Subfascial breast implants

  • Slightly higher hematoma rate, bleeding
  • Probably increased capsule rate
  • Increased implant visibility in the upper pole, including less taper, and possibly more wrinkling and rippling
  • No 10-year US Data. Overseas reports rates are low, though
  • Increased lateral displacement
  • Possible increase in mammogram interference with capsules


The risks related to surgery include hematomas, infections, scarring, nipple numbness, and asymmetry among others.

A hematoma is postoperative bleeding that occurs in the breast pocket. It occurs in 1% of operations and is generally not life-threatening but may result in a return to the operating room. Avoid aspirin, ibuprofen, or other medications that increase the risk of bleeding for 10 days prior to surgery.

Infections occur in about 1% of operations. Bacteria live on our skin, and despite the use of antibiotics and sterile preparation, bacteria are not entirely eliminated. Infections unfortunately can occur and then do result in the loss of the implant. The implant then is replaced three months later. The occurrence of infection in patients who are nonsmokers has been less than 1%.

Scars occur with any operation and take time to fade, but only about 1% of patients will form thicker scars.

Asymmetry, or unequal size or shape, occurs in 2% to 4% of patients. If the skin is tighter on one side, it is going to push the implant differently. One side of the chest may be wider, or the breast may be shaped differently. Sometimes this asymmetry can be corrected by use of the cohesive gel implants. The use of a band or bra afterward will help to stretch the skin. Lastly, 2% of the people may require repeat repositioning of an implant.


At your personal consultation, we will work with you to determine which implant size and shape will best suit your needs based on your physical dimensions and your size desired.
Breast augmentation is an outpatient surgery and typically takes 1 to 2 hours.
Based on the type of work you do, most patients find they can return to work in as little as a few days for a desk-type job.
You must wait three weeks before beginning any vigorous exercise. You will have a 20-pound weight restriction for the first three weeks.
You will be released to go home about 1 hour after surgery. Your chest will be taped, and you will have a wrap on. You should keep this on until your first postoperative appointment, and we will unwrap you. Breast pain in the first week of breast augmentation recovery is not unusual. Pain medication, including narcotic pills, is written for you. We also use other medications to make your experience more pleasant. Most of the discomfort is in the first 24 to 48 hours.
Our surgical package includes implants, surgeons, facilities, and anesthesia. We offer both intravenous sedation and general anesthesia. Our surgeon’s fee may vary due to the specific type of implants, which do have different prices. Be aware that many surgeons will quote a breast augmentation cost based on the surgeon’s fee alone and not include the facility or anesthesia prices. Our price for breast enlargement or implants will depend on the type of implants and anesthesia.

Schedule Your Consultation

To find out more about breast augmentation, contact Genesis Plastic Surgery for a consultation.

Breast augmentation week 1 instructions


Capsular contracture or firmness is due to excess scar tissue that has formed around the implant. The body forms scar tissue around any operation. Unfortunately, in the case of an implant, that may make it feel too hard.

Patients who form too little scar tissue may see rippling or wrinkling of the skin over the implant, usually in the lower portion not covered by muscle. The cohesive gel implants have the lowest rate of wrinkling.

Deflation or Rupture
Saline implants are reported to deflate at 1% per year or higher. Routine activities will not cause deflation. It can happen in the first year or 10 years later or may never happen. There is no “life expectancy of the implant.”

Gel implants do not deflate, but they can rupture. The gel thickens and is enclosed by scar tissue that forms around the implant. Rupture rates are 0.5% for the newest cohesive gel implants. There are no known health problems with rupture. The implant might interfere with the quality of mammograms. Techniques that can be done to correct this include placing the implants under the muscle or obtaining additional views on mammograms. If you have a strong family history of breast cancer, this should be discussed with your physician.

Rippling or Wrinkling
The lower portion of the breasts may not have enough tissue to cover the implant. The patient may see rippling or wrinkling. This is more common in thin patients. The cohesive gel has the lowest rate of wrinkling or rippling.

There has been an association of rare cancer, ALCL (anaplastic large cell lymphoma), that has been reported in approximately 60 cases in the 10 million women worldwide who have had implants.

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