BREAST AUGMENTATION…the most popular women’s procedure in the United States!


Breast Augmentation, Breast Enhancement, Mammoplasty Augmentation is a surgical procedure to increase the size and shape of the breast and can offer breast lifting benefits as well.  Breast lift today employs “breast implants” or “fat grafting” to achieve the desired size, shape, symmetry and restored youthfulness.

Many women are born with breasts that are too small, not their ideal size and shape and are not as sexy as they ideally would like.  Other women experience age related changes, changes due to hormones, genetics, childbirth, illness, disease, trauma or weight fluctuation.  Each woman, despite the reasons for the changes they experience, has a mental picture of their “ideal breast”…hence the reason so many women today are lining up for Breast Augmentation surgery.

Breast Augmentation…What Is Involved?  I do many, many Breast Augmentations with women choosing to use “implants.”  Many others prefer to augment the size, shape and contour of the breast using their own natural body fat. (Fat Grafting)  The procedures involves surgically placing the implant into a pocket created in the breast in front of the chest wall.  the incision is typically made in the crease underneath the breast, allowing for more precise placement and easy access should future revision or replacement be needed.

Implants come in a host of shapes and sizes allowing for “customizing” to your personal needs and goals.  Today’s implants are the safest ever and feel as natural as your own body tissue.

Implants are either saline or silicone…Saline implants are soft shells filled with saline (salt water).  The shell is inserted first and then slowly filled.  This requires an additional tiny incision which is well hidden also.  If the shell leaks (rarely happens today) the saline is absorbed by your body tissue.  Saline implants look quite natural but don’t feel as natural as silicone.  Silicone implants have a similar shell as saline implants, but are pre filled with silicone which is a natural earth substance.  Silicone is a cohesive gel with a strong bond that prevents the gel from migrating through the body if the implant should leak or rupture. Silicone implants feel more natural with less rippling than saline implants.

Leaking or Rupturing of breast implants rarely occurs with todays advanced implants, and they last longer than their older versions.

Incision Placement…you have options.    Here are your placement options:    

  1. Inframammary, this is an incision place in the crease of the breast (underneath the breast).  Most surgeons agree this is the best placement for creating breast symmetry.  Also, should revision surgery or implant replacement be needed, this has worked well….instead of having to make a new incision.
  2. Periareolar…around the nipple is chosen by many surgeons because it heals the best and is small. Most scars with this incision placement are virtually invisible.
  3. Axillary is an incision placed in the armpit.  This is your choice if you want to be virtually scar around or on the breast.
  4. Their are advantages and disadvantages to each placement and type of implant. These should be well understood when making your decision.  I take the time to educate my patients thoroughly on these important issues and help guide them through the process.

OK, my next blog will cover Breast Reduction, another procedure chosen by men and women.  Look for it soon!

I’m here to help you achieve health and well being…and to be your absolute best!

Let’s talk soon.

Steven Davison M.D.

“DAVinci…where I combine the supreme element of art and surgical science.”

Every Woman’s Ideal Breast…and common Myths About Breast Lifts


Every woman has her own idea of the “ideal breast.”  Many women are born with breasts that are too small and many women dream of larger, well proportioned, symmetrical, and not droopy or sagging…but sexy breasts. I have found this to be true among women of all ages and stages in life.

Today’s women consider their breasts to be their most feminine attributes and many women are choosing procedures that will create their ideal breast including breast rejuvenation for aging sagging, deflated breasts…or implants, fat grafting and breast lifts for restoring more youthful breasts, or breast reduction for overly large, too heavy breasts…or a combination of these to create their “ideal breast.”

In this blog I cover a few common breast myths with more information on the  procedure options, in future blogs.

When it comes to breast options, going bigger, smaller or lifting the breasts to a more youthful position requires correct understanding and knowledge of what these procedures entail.  There is a lot of misleading information that affects perception and can lead to poor choices.

MYTH #1…Breast Lifts are the only way to “lift” the breasts.   Breast Lifts work effectively for breast lifting if skin elasticity is good, there is a minimum of ptosis (sagging) and the nipple position will allow it.  However, implants are often chosen instead of a surgical lifting, for added volume and shape. Lifting with implants can be achieved if the right type of implant is used in the right patient.

MYTH #2…A Breast Lift achieves permanent perky breasts, elevated to a more youthful position.  Truth is: “nothing is forever.”  Aging cannot be stopped…but we offer many age defying options that can slow it down a bit…and rejuvenate  aging areas of the body.  A Breast Lift settles into position within a year after your surgery…this often appears as falling or drooping when in fact it’s just fullness being redistributed to the bottom of the breast.  As you age, your breast continues to age also and over time can become droopy again.  In the meantime, you can look years younger!

MYTH #3…Fat transfers ensure that your breasts are immune to future weight fluctuations and related breast changes.   FALSE!  Truth is:…the breasts are affected by weight gain/loss just as much as the rest of the body.  There is little you can do to avoid these changes if you are subject to weight fluctuation.  So if you plan to have a Breast Lift with or without implants or fat grafting injections, maintaining a healthy weight is the best way to prolong the wonderful, youthful results of your Breast Lift.

I have performed hundreds of Breast Lifts and by combining my honed surgical and artistic skills with todays advanced surgical science…my patients enjoy long lasting, outstanding, natural looking results.  Choose your surgeon wisely!

The next blog will cover Breast Implants.  Today’s implants are very natural, offer a host of sizes and shapes which means they can be “customized” to your personal needs and goals.  They are safe, effective and longer lasting.  Women love them!

Holidays and Christmas Wedding are coming soon.  If you’ve been thinking about an anti aging, age defying makeover, now is a great time to get it done…to look your absolute best…for now and for years to come.

Stay Well and Healthy!   Steven Davison M. D.

DAVinci…where I combine the supreme elements of art and surgical science.

The Trend …Gynecomastia surgery is the Ideal solution for many men!


I’ve written several articles this year about men and cosmetic procedures…because men want the information, they appreciate the education and, they love the results they get from each procedure. The trend is that men are having more cosmetic and reconstructive procedures of every type, every year. Male Gynecomastia surgery is done to reduce the size of male breasts (same as breast reduction in women) for various other reasons.  I perform many of these operations every year to help my male patients regain self esteem, get renewed confidence and a new “physique” they can show off without embarrassment.

DATA:  40% to 60% of all men are affected with enlarged women like breasts

  • Male Breast reduction is ideal for men who are self conscious about their condition
  • Gynecomastia usually begins during adolescence & continues for life if not corrected
  • It psychologically impacts men of all ages…starting in the early teen years
  • Causes of large male breasts include:  obesity, Klinefelter’s Syndrome, Gilbert’s Syndrome, normal aging, hormone fluctuations, RX medications, anabolic steroids, impaired liver function

Male Breast Reduction Surgery… Results in a chest that is flatter, firmer, more contoured. Men and boys who suffer with Gynecomastia have found this surgery to be the ideal solution to their problem.  1) Male breast reduction is typically an outpatient surgery performed under general or local anesthesia. 2) I work through one small incision to  and remove excess fat and skin and to sculpt the breast to a masculine appearance. 3) My advanced techniques/skills and experience results in inconspicuous scars. 4) As with any operation, there is some swelling, bruising and discomfort for 2 to 3 days.   Oral pain medication manages this nicely. 5) Final results are seen when all swelling has resolved…usually 2 to 3 months.

Questions Men Ask Most Often:  See my website for info: http://www.DAVinciplastic.com

How much work will I miss?   My patients report back to work in 1 to 2 days.  Choose a long weekend for your procedure.

Will Activities be Restricted?   Yes.  No sex for 1 to 2 weeks following your surgery and no heavy, strenuous exercise for about 3 weeks.    Will Male Breast Reduction surgery change my looks?  NO.  You will look like yourself…just more fit, trim and contoured!

Will Male Breast Reduction negatively affect my sexual activity?  NO…in fact…men report to me it really enhances it due to their renewed self esteem and pumped self confidence!

OK. This gives you a good overview.  Come in soon and let’s talk.

Steven Davison M.D.

“DAVinci….where I combine the supreme elements of art and surgical science.”

RESTORATIVE BREAST RECONSTRUCTION…Flap Methods


The reasons women choose to have restorative breast procedures are well stated in these quotes …

I need to feel whole again,” –  “You have given me back what cancer took away,” – “The reconstruction of my breasts made me feel restored…not reconstructed,”  –  “I want to look as good as I feel,”  –  “I want to look and feel sexy again…and want my husband to see me as sexy.” 

These are but a few of many thousands of thoughts from women who wanted to fully recover from their breast cancer…with a whole body.

Today, I review Flap Procedures (Stage II Breast Reconstruction/Restoration).  There are a variety of Flap Procedures used to restore breasts…not every type is right for every woman, but we determine this after careful and thorough evaluation of your needs and goals.  I tailor each flap procedure to achieve beautiful natural looking breasts. There are four muscle flap techniques as follows:


1) Latissimus Dorsi Flap 
uses a flap of skin and muscle from the back on the same side as the operated breast.  This is transferred forward to form a breast mound that will look and feel natural since it is your own living tissue.

2) TRAM Flap is the most common form of living tissue  breast restorative techniques used today.  It creates a natural looking, soft, warm breast.  TRAM Flap involves either free flap or pedicled flap techniques.  Pedicled flap means the tissue remains attached to its blood supply.  TRAM Flap procedures employ skin, fat and muscle removed from the lower abdomen and transferred to the chest.

3) DIEP Flap reconstruction employs excess skin and fat from the lower abdominal area, through an incision similar to that used for Tummy Tucks. This is a “perforator flap” technique that is muscle sparing…meaning no muscle function is sacrificed, but warm living tissue is used instead.

4) Gracilis Flap harvests excess skin and fat from the inner thigh to restore natural looking, soft, warm breasts.  This may be a TUT Flap (without muscle) which is referred to as a Transverse Upper Thigh Flap. When a small amount of muscle is required…a TUG Flap is employed.  Either flap can be harvested so the donor scar is discretely hidden inside the upper thigh.

This is a brief overview of the 4 Flap techniques used for restorative breast reconstructions.  Each of them has it’s own virtues… and all offer beautiful, natural looking and feeling breasts.  I have guided many women through making the right choices so as to ensure optimum results.

GOALS of RESTORATIVE BREAST PROCEDURES

Goals are critical to good outcomes.  You must have yours…here are mine: “all cosmetic surgery should be functional & all reconstructive surgery should be aesthetic & look as natural as possible.”  

ADVICE TO MY PATIENTS

Always ask me questions; ask to see pictures of my patients, gather information and consults with trusted mentors, make your decision.   There are NO wrong decisions. Choose a qualified, Board Certified surgeon with specialized training and expertise in reconstructive surgeries.

Next blog will cover Implant Breast Restoration.

Dr. Steven Davison

At DAVinci…we combine the supreme elements of art & surgical science.”


BREAST RECONSTRUCTION (Restoration)…Stage II


STAGE TWO BREAST RECONSTRUCTION

From previous blogs you know that Stage I involves placement of the Tissue Expander…often placed under the same anesthesia as your mastectomy surgery… and called Immediate Breast Reconstruction.  Delayed Reconstruction means you choose to wait a few weeks or months before starting the restoration process.

Here are the steps leading up to Stage II Reconstruction:

During the mastectomy skin and breast tissue are removed, leaving the chest tissue flat and tight.  The “expander” is inserted under the chest muscle and skin to serve as a “space saver.” The expander is slowly filled with saline solution (over many weeks) to stretch the remaining skin and muscle to allow for the future breast implant.

Expander surgery is done under the same anesthesia as the mastectomy surgery.  (Immediate Reconstruction)  Healing takes 4-6 months

NOW Stage II begins: The new Breast Implant is placed when Dr. Davison determines the space is sufficient and then the expander is removed.  This is done through the original incision.

Stages III & IV …Begin about 3 months later and Involves A new nipple and areola…with additional breast beautification.

I become your primary care physician during this entire process…generally about a year.

Stage II Breast Reconstruction involves rebuilding a new breast mound by using what is called a Flap Procedure.  There are several options for flap procedures that I will cover in my next blog.

Every year the numbers increase of women who choose breast reconstruction.  Vast experience enables me to gently guide you through the process to eliminate frustration and confusion, until you eventually see the tremendous benefits of your choices.  During the consultation you will come to understand your options and be able to choose a course of action that restores both form and self confidence.

All we do…we do sensitively, expertly and with outstanding results to improve your health and wellbeing. The results of all surgeries should be both…functional and beautiful.

Dr. Steven Davison

At DAVinci…we combine the supreme elements of art & surgical science.

TOP DOCTOR of the YEAR AWARDS…come with responsibility


Well, here’s my chance to “shine” a bit. I don’t usually hang out or post my “brag sheet”…but being recognized among the top doctors of the nation can make a guy feel proud.  In case you’re not aware…I’ve been named as a “Top Doctor” of the Year by the Washingtonian,  the Northern Virginia Magazine, and others, for Reconstructive Breast Surgeries.  Along with that award, top docs must assume great responsibility.  First let me explain the selection process.

Castle Connolly Medical Ltd. is America’s trusted source for identifying top doctors and the best in American medicine.  Their system for selection is rigorous and includes ascertaining critical information about doctors such as: exceptional training, experience and how they are regarded by their peers etc. etc. Top Doctors can have an enormous impact on healthcare for patients and their families….a “Top Doc” can mean the difference between receiving first class medical care and substandard care.  Top Docs rank among the top 10% in the Nation.

The Washingtonian and Northern Virginia Magazine also use these rigorous guidelines for selecting “Top Doctors”…or “Top” anything e.g. restaurants.  Education (not all schools are equal), experience can make a major difference in outcomes, and most important of all…life changing procedural results that patients are happy with, along with peer recognition (being recommended by other doctors)…comes only from years of growing and honing skills while keeping up with advancements.  This is the stuff Top Docs are made of.

 I love what I do, and the greatest reward is always seeing positive outcomes for my patients.  

I am honored and blessed to be able to serve the population in and around Washington, D.C. and I thank each of you for your  years of trust, confidence and support you’ve shown to me and my family.  I look forward to many more years of helping each of you, and your family and friends…and to enjoying the friendships that grow as a result.

Thank You, Stay Well and may God richly bless each of you.

Steven Davison, M.D.

At DAVinci…we combine the supreme elements of art & surgical science.

STAGE I…Breast Reconstruction


STAGE I – Mastectomy & Expander

Breast Reconstruction usually occurs as a two-stage procedure – starting with the placement of a breast tissue expander – which is replaced several months later with a breast implant. Dr. Davison will place the tissue expander under the same anesthesia as your mastectomy surgery if possible. This is called immediate reconstruction since the process is started at the time of your mastectomy.  You may choose to “delay” the start of reconstruction and wait for a few weeks or months.  This is called delayed breast reconstruction.

Here are the steps involved in mastectomy with expanders:

  1.  During the mastectomy your breast surgeon removes skin and breast tissue – leaving the chest tissue flat and tight.  An expander (balloon type expandable device) is put into place under the chest muscle and skin – to serve as a space saver – into which a breast implant is later placed.  The expander is gradually filled with saline solution – over several weeks – and slowly stretches the remaining chest skin and muscle to allow for the future breast implant.
  2.  Expander surgery is performed under general anesthesia in an operating room. Often a Biologic tissue barrier is used to create an inner Bra to cradle the expander.
  3.  The incision used to perform your mastectomy is used for the expander placement
  4.  After placement – the incision is closed
  5.  Drains are left in place – and are removed when only 30cc fluid comes up
  6.  Healing takes 4-6 months – the surgery takes several hours and is done under one anesthesia.  If delayed expander placement is done – surgery takes 1-2 hours.
  7.  Breast implant is placed when Dr. Davison determines the space is sufficient and the expander is removed.  The same incision is used to do implant placement.
  8.  A nipple and areola is created typically 3 months later – with additional beautification for both breasts.
  9.  Dr. Davison becomes your primary care physician over the next year during this entire process.
For many women…this can be a daunting process.  Over the years I’ve been able to guide my patients through it, helping them make wise decisions, and then watching them appreciate the life changing results.  My rigorous training and years of experience made this possible.  If you or someone you know is struggling with this decision…I’m here to help.
To Your Ongoing Health and Wellbeing.
Dr. Steven Davison
At DAVinci…We combine the supreme elements of art & surgical science.

Breast Reconstruction…Stage I


BREAST RECONSTRUCTION …in STAGES

Reconstructing a breast is an option chosen by hundreds of thousands of women, around the world, every year due to cancer or other trauma. The techniques we use today are more advanced allowing for less downtime, quicker healing and more natural looking outcomes. The procedure can be done in either one or two stages. I cover Stage I today.

STAGE I:  involves an “tissue expander’ that is inserted immediately following mastectomy.The expander slowly expands the tissue allowing for replacement by a breast implant a few months later.This is called immediate reconstruction since the tissue expander is placed under the same anesthesia as your mastectomy surgery.

Many women choose immediate reconstruction. Others opt to wait a few weeks or months. This is called delayed breast reconstruction.

One decision does not fit all women. Opting for breast reconstruction and the timing…is highly personal. My sensitive nature and expertise has enabled me to help many women make the wise decisions to overcome this otherwise daunting task. My patients quickly understand their options and learn how natural looking form/function and confidence can be restored.

If you or someone you know is faced with this challenge…let’s chat. During the personal consultation, I carefully listen to concerns, desires and goals before making recommendations. My experience enables me to achieve predictable and natural looking results.

IMPORTANCE of BOARD CERTIFICATION & SPECIALIZED TRAINING

Choosing a board certified surgeon, with specialized training and experience in reconstructive surgeries is critical to achieving desirable outcomes. I have the credentials, training, vast experience and many, many happy, healthy patients.

Next blog will cover Stage I…what’s involved.

Dr. Steven Davison

“At DAVinci…We combine the supreme elements of art and surgical science.”

Breast Augmentation – 4 important decisions to make!


Breast Augmentation requires four important decisions for the surgical plan. Answering the key questions clearly improves communication and helps meet patient expectation.

1 – Size of the Augmentation.

This is key to the patient’s satisfaction. It is a little like Goldilocks this one’s too big, this one’s too small and this one’s just right. Using cup size as a starting point is fine but as everyone’s perception of cup size is different, fraut with pitfalls. A better estimate is to use cc increase. As there are physical parameters such as base width of the breast and skin envelope size, a starting range should be suggested by your surgeon. Trying on sizes in a trial and error session or using state-of-the-art 3D imaging are current ways to establish size. 3D imaging now allows patients to see their own chest with and without clothes after augmentation; it is just short of amazing.

2 – Type of Implant

Silicone versus saline is the question. If you’re under 22 years of age, saline is the only option, yet any older and it’s the patient’s desire. The safety concerns stirred up in the media have had no medical science support. So now it comes down to the pros and cons. Silicone implants are softer, lighter and more natural. Saline implants are more prone to rippling unless overfilled which leads to firmness yet can be placed through smaller incisions. This advantage has been negated by the success of an implantation tool called the Keller Funnel. Type of implant is irrelevant to size unless really large implants are chosen which need a larger access incision.

 3- Placement of Margin

The location of incision is either inframammary (in the fold under the breast), periareolar or around the nipple area, transaxillary via the axilla crease or through the bellybutton.  The axilla and bellybutton offer smaller, more hidden incisions where an inflatable saline device is inserted. This benefit is not so great now that more silicone devices are used. The inframammary incision gives the surgeon the most control, yet can ride up the breast with maturity. Ideally, the periareolar incision can be almost imperceptible when it heals but a poor scar or decreased nipple sensation are potential risks. A larger silicone access incision in the axilla can be cosmetically sensitive to the women doing moderate to high intensity exercise in which the arms are raised. An experienced surgeon should consider anatomy, the size and patient desires before pitching the incision. Beware the surgeon who just uses his or her incision only.

 4 – Position of Implant

The last issue is a subglandular device which is under the breast versus the device which is partially under the muscle. The advantage of under the breast or subglandular implant is more effective in size particularly to address some mild breast ptosis. The disadvantage is the implant may show through the skin. A subglandular device is not for thin-skinned individuals or those without at least 2 cm of breast coverage in the upper pole. The partial subpectoral placement means the upper 2/3 of the implant is under the pectoralis muscle. This has the advantage  to reduce the round edge of devices being obvious. The lower third of the device is still covered by the gland alone. Muscle force and function is not affected. In conclusion, the subglandular position is ideal for a larger breasted patient who wants more fullness to correct mild ptosis. The partial subpectoral device is better for most other patients.