Breast Augmentation Surgeon
Dr. Joshua Greenwald
Joshua A. Greenwald, MD, FACS, is a breast augmentation surgeon who provides breast augmentation with silicone and saline breast implants for women throughout the metropolitan New York region, including White Plains, Westchester and the surrounding areas. With his impressive skills and vast experience, he has helped numerous women increase the size of naturally small breasts, correct a difference in breast sizes (i.e., asymmetrical breasts) and restore volume to breasts that have lost their shape due to pregnancy or weight loss.
Dr. Greenwald offers silicone and saline breast implants at his state-of-the-art surgical facilities in Westchester County. By tailoring each surgery to match the body type and aesthetic goals of the patient, Dr. Greenwald provides his patients with curvaceous bustlines that more closely match their ideal self-image.
Determining Your Implant Type, Size and Placement
During your initial consultation, Dr. Greenwald will answer all your questions and develop a treatment plan geared toward your specific body characteristics and aesthetic ideals. Dr. Greenwald believes that by fully informing patients of all the benefits and risks of surgery, he helps ensure a satisfactory outcome. Therefore, he will spend considerable time helping you decide which implant type (silicone or saline) is right for you, whether you would benefit from breast lift with breast implants and what implant size will best meet your individual needs.
Dr. Greenwald maintains a vast library of before and after photos of past breast implants patients, which he will review with you. You will most likely be able to find a photograph that matches your preoperative anatomy and to view postoperative photos of the same patient following breast implant surgery. Dr. Greenwald also makes use of implant sizers that can be placed inside the bra to help you decide the size of breasts you would like after surgery. He will then take photographs and use imaging software to produce a computer-altered “after” photo for you to review.
In addition to the implant type and size, Dr. Greenwald will help you determine which incision location is best. For some patients, he recommends a periareolar (around the nipple) incision, while for others an inframammary incision (in the crease under the breast) is deemed more appropriate. Another option is the transaxillary (in the armpit) incision. Dr. Greenwald will discuss each incision option with you in great detail prior to making his recommendation.
A decision must also be made regarding where to place the implant in relation to the chest muscles. When placing an implant, Dr. Greenwald creates a pocket in which the implant will rest. This pocket can be created behind the breast tissue but in front of the muscles, a position known as subglandular placement. It can also be placed partially or entirely behind the chest muscles, placement options known as partial submuscular or complete submuscular, respectively. Dr. Greenwald typically recommends a submuscular placement. However, as with the size and incision, the decision regarding implant placement is best made in consultation with Dr. Greenwald.
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Frequently Asked Questions Regarding Breast Augmentation Surgery
The following are answers to questions frequently asked by Dr. Greenwald’s breast augmentation patients:
How should I prepare for my breast augmentation surgery?
Once you have decided on the breast implant type, size, incision and placement, your surgery will be scheduled. You will be provided with a set of specific instructions to follow prior to surgery as well as prescriptions for medications you will need following the procedure. In addition, before the procedure can be performed, you will need to have blood tests conducted. Depending on your age, you may also need to have an electrocardiogram (EKG) and a recent mammogram.
What can I expect on the day of surgery?
Dr. Greenwald performs breast augmentation procedures at his Westchester County surgical facilities. After arriving one hour prior to surgery and checking in with the nursing staff, you will be interviewed by your anesthesiologist. Dr. Greenwald will then review the surgery with you one more time and answer any final questions you might have.
The surgery is performed on an outpatient basis under twilight anesthesia. Your surgery will take about 60 to 90 minutes, and you will be discharged following your recovery from the anesthesia. You will require another person to accompany you to the surgery and remain with you for 24 hours following the procedure.
How will my incisions be dressed?
Following surgery, you will be sent home with steristrips (adhesive strips used to close small wounds) beneath gauze dressing. The steristrips will remain in place until you return for your first follow-up visit with Dr. Greenwald, typically five to seven days after surgery. Most patients will not receive surgical drains; the exception is for some patients undergoing revision breast augmentation procedures.
How much pain will I experience following breast augmentation surgery?
Pain levels vary greatly from patient to patient, with some relying only on Tylenol for pain relief and others utilizing the prescription medication provided by Dr. Greenwald.
How soon can I resume my normal activities following breast augmentation surgery?
You will be able to resume normal activities gradually. Most patients may shower one day following surgery, removing the gauze bandage but keeping their steristrips in place. You can drive once you are no longer taking pain medication and are comfortable with a seatbelt across your chest. Strenuous activities, such as heavy lifting or working out at the gym, should be avoided for three weeks. Although you may feel up to the task, there is a risk of hematomas (blood clots) following strenuous activities during this time period.
What are the risks of breast augmentation surgery?
Dr. Greenwald strongly believes in fully educating each patient about the benefits and risks of breast augmentation surgery. Therefore, he provides detailed information to each of his breast implants patient prior to surgery. Some risks of breast augmentation surgery include infection, bleeding, asymmetry, capsular contracture and loss of nipple sensitivity.
What is capsular contracture?
After your breast augmentation procedure, your body will form a lining called a “capsule” around the implant. In some cases, the capsule can become hard—a condition known as capsular contracture. Although the exact cause of capsular contracture is not known, it may be the result of inflammation due to bleeding or of low-grade bacterial infection.
The risks of capsular contracture may be reduced by careful control of bleeding, employing a “no touch” technique when handling breast implants and irrigating the breast pocket and implant with antibiotic solution. In addition, placing the implant in the submuscular position also reduces the chances of capsular contracture.
How is capsular contracture treated?
Capsular contracture can vary in severity. In minor cases, the breast may be firm but appear natural. In more severe cases, it may appear distorted and cause pain to the patient. In these cases, the patient may be given medication. In the most severe cases, a secondary surgery may be required to remove the capsule and place the implant in a new breast pocket.
Will I experience a loss of nipple sensitivity?
Many women are concerned about the loss of nipple sensitivity following breast augmentation surgery. Studies have found that the incidence of sensory loss following the surgery is 10 percent. The risk of sensory loss is higher in secondary breast augmentation procedures, in which existing capsules must be manipulated.
Will my scars be visible?
In order to ensure the least visible scars possible, Dr. Greenwald places the incisions in inconspicuous locations—under the arms, around the nipples or along the creases beneath the breast. Saline implants require slightly shorter incisions than do silicone implants (2.5 to 3 cm versus 3.5 to 4 cm, respectively) because saline implants can be inserted prior to being filled with fluid. When closing incisions, Dr. Greenwald uses absorbable sutures in multiple layers so that the resulting scar is a fine line.
All scars require up to a year to fully mature; therefore, it is best to allow one year before drawing a conclusion about your scar. However, the vast majority of patients feel that the small, well-hidden scars that result from breast implants surgery with Dr. Greenwald are a good trade-off for a stunning new breast appearance.
How will pregnancy affect my breast augmentation?
It is difficult to predict how your breasts will appear if you have a child following breast augmentation surgery. Most patients seem to return to their pre-pregnancy breast appearance following pregnancy, delivery and breastfeeding. However, various factors may affect your post-pregnancy look, including how long you breastfeed, how enlarged your breasts become during pregnancy, and how much weight you gain during pregnancy.
Can I breastfeed following breast augmentation?
The ability of most women to breastfeed should not be affected by breast augmentation surgery. Women who undergo breast implants surgery utilizing a periareolar incision may experience some reduction in their ability to breastfeed due to damage to nerves and ducts. Women who receive an inframammary or transaxillary incision will likely have no difficulty breastfeeding.
Some women are concerned about breastfeeding in the presence of silicone breast implants. However, the American Academy of Pediatrics has concluded, “The Committee on Drugs does not feel that the evidence currently justifies classifying silicone implants as a contraindication to breastfeeding.”
How will breast augmentation affect my mammograms?
Women should undergo regular mammograms regardless of whether or not they have received breast augmentation surgery. Be sure to inform the radiologist performing the exam that you have implants. In general, breast implants placed in the submuscular position (behind the muscle) allow better imaging than those placed in the subglandular position (in front of the muscle). In addition, the presence of capsular contracture can also limit the quality of mammograms.
To overcome these limitations, mammograms of all women with breast implants include extra pictures known as breast displacement views, or Elkund displacement views. In addition, MRI, ultrasound and digital mammography can be used to improve the effectiveness of breast cancer diagnosis in women with breast implants.
Despite making mammograms slightly more complicated, patients with breast implants are diagnosed at a similar breast cancer stage and have a similar prognosis as compared to women without breast implants.
What if I am not satisfied with the outcome of my breast augmentation surgery?
Dr. Greenwald is dedicated to providing each patient with the breast appearance that matches her aesthetic goals. The majority of Dr. Greenwald’s breast implants patients is extremely pleased with their new bust profile and experience a renewed enjoyment of life. However, if you are not satisfied with the outcome of your procedure, Dr. Greenwald is committed to working with you to achieve the desired results. Dr. Greenwald strongly believes that the best route to a satisfactory surgical outcome is to ensure that the patient is fully informed and has realistic expectations prior to surgery.
