Breast Augmentation in Fredericksburg, VA

Breast augmentation is the most commonly performed cosmetic surgery, helping women achieve fuller, shapelier breasts to enhance their appearance. At Surgical Arts of Virginia, we offer breast augmentation and other breast surgeries to women living in Washington DC, Fredericksburg, Stafford, Richmond, Charlottesville, and the surrounding communities of Virginia.

What is Breast Augmentation?

Breast augmentation refers to breast implant placement. Breast enhancements are popular among women because the surgery allows for changes to breast shape and size via breast implants. Modern implants are of better quality and are safer than previous generation implants.

It has remained one of the most popular cosmetic surgeries for years, with the American Society of Plastic Surgeons reporting that more than 287,000 augmentations were performed throughout 2019. In 2020, despite the pandemic that kept people out of nonessential businesses, more than 193,000 augmentations were still performed.

Am I a Candidate for Breast Augmentation?

There are very few limitations placed on who would be a good candidate for this procedure or not. If you are free from diagnoses that would create increased risk during surgery, you may not be considered a good candidate. But if you are generally healthy and would like to improve the size and shape of your bust, then odds are this will be a good choice for you.

During your consultation, we will conduct a physical examination, review your medical history and listen to your aesthetic goals to ensure that you are a good fit for this procedure. If there is a different option that would better serve your needs, we will make sure to review those with you at the appointment.

Keep in mind that there are limitations to every aesthetic surgery, and if you come in with higher expectations than what can actually be achieved, you are setting yourself up for disappointment. Take a look at plenty of before and after photos and bring all of your questions to your consultation to make sure you have a clear idea of what to expect from this surgery.

What Kind of Implants Are Available?

There are several different breast implant variables: size, shape, texture and composition.

Size of the Implants: Diameter and Projection

Surgeons use their own individual criteria to select implant size, making this an important topic for discussion. Patients tend to come to the consultation with a volume in mind without understanding the parameters that are used to select an appropriate volume for a particular body size that will then equate to the final cup size the patient desires to obtain.

Dr. Palmer has been very successful in meeting patient expectations by using two key patient parameters: breast diameter and nipple to fold distance. With these measurements, the implant diameter is selected. Once the patient-specific implant diameter is selected it is matched with Mentor’s available projections (low, medium, high, or extra-high profile) such that the patient’s cup size expectation is met.

Shape of the Implants: Round or Anatomical

The idea behind anatomical implants is that they produce a more natural appearance since they use a more natural “teardrop” shape. In most cases, surgeons have found that there really isn’t a huge difference in the end result for the patient, making this decision is ultimately up to the patient.
Dr. Palmer personally tends to prefer round implants and has found great success with that particular shape. But ultimately, it will depend entirely on your aesthetic goals and the type of breast projection and shape you wish to achieve.

Texture of the Implants: Smooth or Textured

One of the primary concerns when undergoing breast augmentation is the ability of the implant to stay fastened in place while a capsule of scar tissue develops around it. In some rare cases, the implant will shift within the breast tissue, throwing your results out of balance. Textured implants were developed partly to help keep the implant stay in place.

Another benefit is that they are also less likely to develop a condition known as capsular contracture, which constricts the implant with scar tissue and can even lead to the rupture of the implant itself. While rupture isn’t always certain, this condition tends to give the breast a poor appearance, as if the skin is being stretched over the breast tissue.

In recent years, textured implants have garnered attention for their correlation to a different condition known as Breast Implant-Associated Anaplastic Large Cell Lymphoma, or BIA-ALCL. This condition is not breast cancer but cancer of the immune system. The American Society of Plastic Surgeons estimates that between 1 of 2,207 and 1 of 86,029 women with texture implants develop this condition.

Even though this means the odds of contracting the illness are as low as 0.001162%, many women understandably want to proceed with the cautious option: smooth implants Since the benefits of textured are nominal and smooth implants carry less medical risk, they are a popular option among women deciding to undergo breast augmentation.
At Surgical Arts of Virginia, we do not use any of the implants that are associated with the BIA-ALCL risk.

Composition of the Implants: Saline or Silicone Gel

Dr. Palmer uses both silicone gel and saline-filled implants. Silicone is a more natural feeling product but is more expensive. Saline is significantly cheaper but tends to be more easily felt when touching the breasts, especially in women who are thinner or begin with small breasts. In some rare cases, the thinness of saline implants can even cause rippling on the breast, which will need to be fixed surgically to achieve the look you were aiming for.

This condition can occur more often with surgeons who have a nominal amount of experience and training, but it can develop in anyone, even when a skilled and experienced surgeon performed the procedure. It is highly dependent on your body’s reaction to the implant.

View Breast Augmentation Before and After Photos

How Are Breast Implants Chosen?

Ultimately, your breast implants will be your choice, but Dr. Palmer will be happy to give you aesthetic advice based on his years of experience that will help you achieve your preferred appearance. While there are pros and cons to each, your initial consultation will be a great place to discuss any concerns, preferences or questions you have about your options. You can also look at plenty of before and after photos to get a reference for the types of results you want to achieve.

Dr. Palmer has achieved excellent results with smooth round implants and finds them to be the best option in most scenarios. This also avoids the issues that can arise with certain textured implants.

How is a Breast Augmentation Performed?

Like most surgical procedures, breast implantation can be accomplished in a variety of ways, some of which are patient-specific and some of which are surgeon specific. Breast implant position placement is an important decision for your surgeon.

Breast implants are placed either beneath the breast gland (subglandular), beneath the muscle (submuscular), or both (dual plane). Dr. Palmer has found that most patients are best served with a dual plane placement. This positions the implant beneath the pectoralis muscle superiorly and the breast gland inferiorly, hence the dual plane.

This has the advantage of providing adequate coverage by soft tissue above such that a gentle curve to the breast is obtained in the superior pole, while, at the same time, letting the implant settle into the natural inframammary fold, avoiding a “high riding” implant.

Dual plane implants also have a much lower incidence of “bottoming out” over time (implant migration towards the abdomen) than implants placed beneath the gland alone. There are other pros and cons of placement to be considered that will be discussed during consultation.

Another decision for the patient is the skin incision site. Most commonly, skin incisions are placed at the junction of the darker areola skin with the lighter colored breast skin (periareolar incision) or at the inframammary fold (inframammary incision).

Dr. Palmer prefers the periareolar skin incision because it is well camouflaged, has a low incidence of implant migration, and is almost imperceptible when healed. The inframammary incision site is also very common and is acceptable to most patients.

What type of Anesthesia is used for Breast Augmentation?

Dr. Palmer performs breast implantation surgery in our office surgical suite using conscious sedation and tumescent local anesthesia. Advantages include patient convenience, avoidance of general anesthesia risks, lower cost, easier recovery, and excellent tolerance. The patient is fully monitored throughout surgery by Dr. Palmer’s registered nurse who is qualified and experienced with these types of procedures.

This is the anesthesia most used in our office and we are proud of our 100% safety track record since its inception in 2008. No patient has ever required transfer to a hospital, although this is an option if an anesthesia complication were to be encountered.

What is Recovery Like After Breast Augmentation?

You will awaken with adhesives on your incisions and wearing a support bra. Once you have met discharge criteria, we will once again discuss postoperative instructions with you and your caregiver. You will need a driver to take you home and a caregiver with you for at least the first 24 hours. We like to see patients in follow-up on the first post-operative day for safety reasons and you will need a driver for this as well.

The first week involves significant discomfort for many, especially with manipulation of the pectoralis muscle, so you should expect to need your pain medication (hydrocodone and/or Toradol) for the first few days. You will also be asked to take an antibiotic for 5 days afterward. Wound care should be minimal, but you will need to be restrictive in your activity level to prevent increases in heart rate and blood pressure for the first week to prevent bleeding around the implants.

Much of the discomfort and swelling will have resolved by the end of the first week, but experience has shown this to be quite variable between patients despite similar procedures. Larger implants are associated with more and longer discomfort. Full activity can be resumed in four weeks.

Dr. Palmer likes to follow patients out for at least one year to allow final results to be adequately assessed. We are available 24/7 via text or phone to answer questions and address postoperative concerns.

Setting Up a Recovery Station

We always recommend that our patients do a little work ahead of time to set up a recovery station the day or night before their procedure. A lot of rest will be necessary as you begin your recovery process, so having a properly stocked station set up will do wonders for your healing process.

The first step is to locate the place where you will be spending most of your time resting. This should be a comfortable space with plenty of pillows, blankets and other comforting bed materials. Then, you should bring anything you will need during that early recovery time and set it near the station. Start with the essentials like medications, snacks and healthy liquids.

Once you have finished that step, grab plenty of entertainment material. Books, magazines, electronics, games, chargers, etc. You will be spending a lot of time in bed, so you might as well make the best of it. Once those are gathered, move to the less important stuff that you may or may not need at some point.

Are There Any Risks Involved with Breast Augmentation?

All surgery carries risks, but you can take steps to minimize the chances of experiencing complications resulting from your breast augmentation. The most important aspect is to work with a board-certified surgeon who is experienced with breast augmentation, including more complex cases, such as tuberous breast surgery and revision breast surgery. It is also important to understand and follow all postoperative instructions, especially limiting your activity in the first week.

Capsular contracture used to be a common complication that could occur any time after the procedure. Newer implant design and placement techniques have greatly decreased the incidence of capsular contracture, but if it develops it requires revisional surgery to correct.

Recently, implant placement has been associated with anaplastic large cell carcinoma. It is exceedingly rare and associated with textured implants that Dr. Palmer does not use, however, patients should be aware of it. If it were to develop it is cured by implant and implant capsule removal. We have never seen this complication in our practice.

Other possible complications such as hematoma, infection, wound breakdown, or malposition are very rare in our practice. If complications should arise, Dr. Palmer is qualified and experienced in their care. There is no additional fee for follow-up care.

When Are Breast Implants Combined with a Breast Lift?

A breast lift with an implant is known as an augmentation mammoplasty. If a patient has significant breast sagging, then a breast implant alone will not result in an aesthetic breast. Mild sagging, however, can sometimes be addressed with an implant of proper size placed in a dual plane position. After Dr. Palmer examines the breasts and discusses with the patient the result they would like to obtain, he can make a recommendation that is most likely to result in aesthetic appearing breasts for that particular individual.

View Breast Augmentation Before and After Photos

Can You Combined Breast Augmentation with Other Procedures?

Breast augmentation can be reliably and safely combined with almost every other aesthetic surgery on the market. Here are some of the most common combinations:

Liposuction / Fat Transfer

Liposuction is a minimally invasive procedure that is notorious for suctioning out unwanted fat from virtually anywhere on the body. This procedure alone can provide a drastic improvement to the contour of your body without the need for full surgery.
But you can go a step further with liposuction and combine it with fat transfer, which is the process of purifying the collected fat and injecting it into an area that you would like to see an increase in size, like your breasts or buttocks.

Tummy Tuck

A tummy tuck complements a breast augmentation well since it adds further contour at a highly noticeable area. By giving your abdomen and breasts an improvement, you can work toward that perfect hourglass figure that is so sought after.

Brazilian Butt Lift

If an hourglass figure is a goal, then a Brazilian Butt Lift is probably one of the most useful procedures to have performed. It uses fat transfer to increase the size of the buttocks and create a more robust curvature. Couple that with a bigger bust and you are more than beach ready.

Mommy Makeover

Mommy Makeover is the name given to one of the most potentially extensive surgeries on the market since it is more of a combination of as many procedures as possible at a single moment. Typically, this is aimed at women who would like to reverse the damage to their bodies caused by pregnancy and nursing, but anyone can really have this combination of procedures performed regardless of motherhood.

Arm Lift

Sometimes, the arm can be as troublesome to look at as a bust that you are not happy with. It is commonplace for unwanted fat to be stored and can be difficult for some people to properly tone. Having an arm lift performed alongside your breast augmentation can really redefine the curves of your upper body in a dramatic fashion.

Thigh and Body Lift

We’ve mentioned the contouring of your body a couple of times now, but a thigh or body lift really is one of the best ways to give your breast that extra wow factor. By getting rid of excess skin and tissue around the back, sides, abdomen and thighs, the natural flow of your body will be set up perfectly to accentuate your new bosom.

What is the Cost of Breast Augmentation?

Breast augmentation starts at $4,840 for saline and $6,490 for silicone gel implants. There are no additional facility fees because we perform the procedure in our office surgical suite. Conscious sedation anesthesia used for breast implant placement is $900. We also recommend that you purchase silicone wound adhesives (Silagen) to diminish scar visibility. Follow-up care is included in the surgical fee.

If breast implants alone will not result in an aesthetic breast and you need additional procedures concurrently to reach this goal (such as a breast lift), then this will be explained upfront and included in your personalized itemized fee breakdown.

The fee quoted at a consultation for the surgery is the total fee and there will be no additional fees after the operation is completed. You can pay for your breast enhancement with cash, personal check, money order, or credit card. If you would like to make payments, our financing options are CareCredit, United Medical Credit and Prosper Healthcare Lending.

Avoid “Budget” Practices

We hear horror stories from patients all the time about how they thought they landed the deal of a lifetime when they found a plastic surgeon who was willing to do the procedure they wanted for a fraction of the competitor’s cost. This always seems like a too-good-to-be-true moment for them, and unfortunately, it usually is.
Your cost is directly reflected by the skill and expertise of your surgeon. Other factors go into it as well, but if you have found a surgeon who has quoted you for well below the average you may be in a situation where that particular surgeon doesn’t have the skill or experience to provide you with the specific results you desire.

How Are Breast Implants Used In Tuberous Breast Surgery?

Tuberous breasts are breasts in which the lower pole (the portion below the nipple and areola) has developed poorly or abnormally. There is constricting tissue present that has prevented the expansion of the lower pole of the breast and shifted the nipple towards the midline, or center of the chest. Often, there is associated herniation (protrusion) of the nipple areola complex.

To address tuberous breasts, Dr. Palmer surgically releases the constricting tissue in the lower pole and places an implant in the dual plane position (partially below the pectoralis muscle) so that the implant acts as a tissue expander.

There is often some residual constriction where the old inframammary fold was, but this improves over time secondary to the implant stretching the skin. The herniation of the nipple often needs to be corrected at the same time. To visualize the tuberous before and after results, take a look at some of our tuberous breast patients here.


The decision to undergo breast augmentation is a big one, and the staff at Surgical Arts of Virginia and Dr. Palmer are here to help you every step of the way. To learn more about the procedure or to schedule a complimentary consultation, contact us today. We welcome patients from Fredericksburg, Charlottesville, Richmond and Stafford, VA, as well as Washington DC and the surrounding Virginia communities.

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