Breast Augmentation

With A Warm, Caring Staff And Stunningly Natural Results, Our Approach To Breast Augmentations Is Anything But Plastic.

Breast augmentation is a very personal decision. So it’s not surprising our patients come to us with a variety of results they want. Some of the goals we hear most often are:

  • “I’d like to fill my bra.”
  • “I want to feel more feminine.”
  • “I’d love my breasts to look like they did before I had my kids.”
  • “I’d like better proportion so that my breasts match my hips.”

Whatever your personal reasons, we’re here to help you achieve the results you want.

Whether you wish to increase the size of your breasts or improve their shape, we’re happy to discuss all of the options with you. Whatever you hope to achieve, breast augmentation is an enormously satisfying procedure that among other things can increase your self-confidence and help your clothing to fit better.

Once you decide you want to enhance your breasts, the question becomes which surgeon to choose. Here’s few reasons you should consider CARE Plastic Surgery.

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Dr. Brian Coan performs a large number of breast augmentation surgeries every year. He is a double board-certified Plastic and Reconstructive surgeon who has the experience and artistic skills required for both medically sound and aesthetically pleasing results. He is a leading national expert on shaped, form-stable (“gummy bear”) implants. He’s as passionate about creating beautiful and natural reconstructions after mastectomies as he is about performing exceptional cosmetic enhancements.

Our team is committed to patient education. Before recommending anything, we’ll make absolutely sure you understand all of the advantages and disadvantages of each option available. By empowering you with information, we instill your decisions with the confidence that only comes from knowledge and understanding. In all cases, Dr. Coan customizes every breast augmentation to your personal needs with the goal of providing the look you want with minimal post-operative discomfort and downtime.

“I went in a little worried about an interest I had for at least 15 years. Once I met Dr. Coan and his staff, I realized the time was now right. I was interested in breast augmentation. CARE made me feel more than a patient. I felt as if I was talking to friends/family. I could not be happier with my outcome. Dr. Coan and I talked several times, as he wanted to make sure he had a clear understanding of the results I was hoping for. I would HIGHLY recommend him to anyone! I’m so excited for the upcoming summer. For once in my life, I am ready for bathing suit season!! I’m one happy lady … and can’t speak highly enough for the CARE staff!! They are all just amazing people!” –LP 

What Are the Choices You Must Make for Your Breast Augmentation?

In the past, surgeons often made all of the choices for their patients. This lead to a high revision rate and many women wishing they had been able to choose either larger or smaller implants. At CARE, we believe the best choices are those made together – Dr. Coan guiding his patients. Most women are aware that they can choose the size of their implants, as well as the type of implant (silicone or saline). But there are other decisions that must be made as well, including the:

  • Shape of the implant
  • Profile of the implant (the amount that the breast projects outward from the chest in profile)
  • Texture of the implant

Besides these implant decisions, you also get to choose the placement of the incisions and whether the implants will be placed over or under the chest muscle. Of course, Dr. Coan will guide you through the entire process and help you make the decisions that are best for you.

Breast Augmentation Videos


Care Plastic Surgery is the only office in Durham offering 3D imaging technology by Crisalix. Discover how you can look after a cosmetic procedure or plastic surgery. 

The following sections will help you learn more about each of these important choices:

Size Matters – What if Your Breasts Are Really Small?

When you think about the size you wish your breasts to be, consider your proportions, your starting point, and whether or not you have ever had larger breasts such as after pregnancy and with breast-feeding. If you have narrow shoulders and/or your natural breasts are narrow, large breasts will look different on you than on someone with wider shoulders and wider natural breasts. Think of it this way: 125 pounds looks very different on a short person than a tall person. Similarly, the same sized implants will look different on two women due to the variations in their body proportions and the size of their respective individual frames.

If you have very small breasts, and wish to increase your size significantly, there may not be sufficient skin to cover large implants while maintaining an aesthetically pleasing shape. Alternatively, if you have lost breast volume, the skin may have stretched and need to be tightened in order to provide a pleasing result.

During your consultation, Dr. Coan will take a number of body measurements and will offer his expertise and advice on the best implant size for you. The final decision, of course, is yours.

Which Type of Implant Is Right for You?

Silicone implants, shaped, form-stable or anatomic silicone (often called “gummy bear”) implants, and saline implants are all available in this country.

  • Silicone implants are the gold standard implant around the world. The round shell is filled prior to insertion and comes in a variety of projections and textures. They are less prone to rippling than saline, and ruptures are not detectable without imaging. For this reason, women with silicone implants are recommended by the FDA to undergo an MRI every few years to check for ruptures. Dr. Coan can discuss the timing with you during your consultation.

Watch Video On Silicone Implants

  • Shaped, form-stable, or anatomic implants are a special kind of silicone implant that represent the latest innovation in implant technology. Commonly referred to as “gummy-bear” implants, they are a different kind of silicone implant that is called “highly cohesive” or “form-stable” because the silicone maintains its shape within the shell of the implant.. They are available in both round and teardrops shapes, and are particularly beneficial for patients who not only want to increase their breast volume but also wish to improve the shape of their breasts. We offer several types, including the Natrelle 410 Shaped Implant and Mentor Memory Shape. Dr. Coan is a leading national expert on form-stable implants and can make recommendations as to whether these particular implants will help you achieve your personal goals.
  • Saline implants were most popular during the 90s, and we believe the downsides of saline implants make them less advantageous for most of our patients. The shell can be inserted through a small incision, occasionally remote from the breast (such as in the belly button or armpit). The implant is filled with saline after insertion. They come round and shaped, but do not tend to maintain their shape despite their thicker and stiffer shell. They have a less natural feel, and are more prone to visible ripples. If a saline implant ruptures or leaks, it is easy to detect within a couple of weeks, as the implant deflates and your body absorbs the water inside. They have a slightly higher leak rate and revision rate as well as a higher propensity to form scar tissue over time that can distort the shape of your breast.

Watch Video On Saline Implants

How Do You Decide on the Shape and Profile of Your Implants?

Do you seek more fullness in the top of your breasts where they are? Would you like that fullness even higher on your chest? In general, higher profile round implants provide more visible cleavage, by adding more fullness to the top portion of the breast. Teardrop-shaped implants (sometimes called “anatomic” implants) create more fullness in the bottom portion of the breast.

Profile refers to how far your breast implants project outward from the chest when you are viewed from the side. High-profile and Ultra-High-profile implants project the most.

Our team is expert at helping you decide not only the right volume, but also the perfect shape to achieve your goals. We’ll assist you in arriving at the very best decision based on your desires and your own starting point.

When Are Anatomic-Shaped Implants Preferable?

If your breasts seem poorly defined and lack the normal anatomic boundaries, you might benefit from a shaped rather than round implant. A shaped implant does more than simply enlarge an already well-shaped breast. Shaped, form-stable, or anatomic (“gummy bear”) silicone implants are frequently a good choice for women who wish to improve the shape of their breasts. Due to the slightly more cohesive or sticky silicone gel within their shells, they hold their shape better than any other type of implant (even if they are cut in half!).

The most common and beneficial situations that arise where shaped implants may make your breasts look more natural and youthful are women with:

  • Mild glandular ptosis (common after breast feeding)
  • Tubular breasts – a specific shape that requires release of the internal bands

Why Do Implants Come in Different Textures?

Implants also come with outer shells that are smooth or textured. Of course, textured implants do not feel textured after your surgery. Your breasts will still feel smooth and normal to the touch.

Textured shells, however, can adhere more easily to the breast tissue. In some situations, they are also less prone to capsular contracture, a condition in which a scar tissue forms around the implant making it feel hard.

On the other hand, implants with smooth outer shells are less prone to rippling. If your natural breasts are small, a smooth implant might be preferable since less natural breast tissue could cause an implant to ripple.

How Is Breast Augmentation Performed?

Breast augmentation is generally performed using deep IV sedation anesthesia. You are monitored thoroughly at the highest level of safety, and a local anesthetic is applied to the breast region and chest after you are fully sedated. You will not be awake and you will not have any recollection of the surgery. We have found this method allows for a more rapid and comfortable recovery. Most patients are able to dress themselves immediately and then shower just two to three hours after surgery.

Dr. Coan will follow the surgical plan you have chosen together. After the incisions are made, a pocket is created behind your breast tissue. The implants are then inserted either above or under the chest muscle. If the implants are saline, the shell is inserted and then filled with salt water. If the implants are silicone, they are inserted fully inflated. The incisions are then sutured beneath the skin. The sutures are completely absorbable so that no stitches need to be removed later.

Most breast augmentations take about an hour. After some time in recovery, you can leave the same day with assistance getting home.

What Are the Incision Options for Breast Augmentation?

Most breast enhancement surgeries are done using one of three incisions:

  • Inframammary incisions are under the crease of the breast. This incision choice is preferred for the majority of patients. It delivers the best cosmetic appearance and is less likely to result in post-operative problems that could lead to secondary surgery.
  • Periareolar incisions go part way or all the way around the areola (the darkened skin around the nipples). When the scar fades, it is well hidden in the transition between the areola and breast skin. This incision choice is best for the patient who requires areola reduction or nipple repositioning (a limited breast lift) at the same time as augmentation. This is common in mothers or women who have lost volume due to weight loss.
  • Transaxillary incisions are in the armpit. This incision choice creates limitations for the surgeon and have a higher long-term complication rate, so it is not used as frequently as the other two options.

Dr. Coan will review these incision choices with you during your consultation and examination, and he will guide you in making your decision.

Should Your Implant Be Placed Above or Below the Chest Muscle?

When the implants are placed above the muscle, it is called subglandular. When the implants are placed under the muscle, it is called submuscular or subpectoral.

In general, capsular contracture rates are lowest with submuscular placement, and recovery time is the same as with subglandular placement. Long-term appearance is best maintained when the implant is under the muscle, and there is less visibility if ripples develop in the implant. Placement directly under the breast is chosen only if there is a significant need for breast reshaping.

What Can You Expect During Recovery from Breast Augmentation?

In most cases, you can return to work and non-strenuous activities within two to three days after your surgery. You must wear a support bra and sleep on your back for a few weeks.

You will feel sore for several days, but most patients use only Motrin or other over–the-counter pain medicine by the third day. Most patients have no bruising, while some patients occasionally experience minor bruising for a short time. Swelling may take several weeks to fully resolve. The scars will gradually become smoother and lighter in color during the months following your surgery.

Within a little more than a month, you will be able to resume vigorous exercise, sleeping on your stomach or sides, and lifting heavy objects.

Breast implants do not limit your ability to get routine mammograms as indicated by your age. They have not been shown to contribute to an increased risk of breast cancer, nor have they been shown to delay the diagnosis of breast cancer. We recommend that you continue to have mammograms at the frequency suggested by your primary care physician.

What Are Capsular Contracture and Other Complications of Breast Augmentation?

While complications after breast augmentation are uncommon , it is important to be educated about the possibilities that may occur at some point in your lifetime. Capsular contracture, leaking, rupture, or rippling of the implant can occur, necessitating a breast implant revision procedure. Dr. Coan will discuss the factors with you that can lead to these conditions. He will also discuss the techniques he utilizes to minimize these possibilities.

Capsular contracture occurs when the normal scar tissue that forms around the implant (the capsule) becomes thickened or tightens. This can distort the shape of the breast and make it feel hard.

Rupture and leaking are easily detected if the implants are saline-filled, but they cannot be detected without an MRI if the implants are silicone. For this reason, women should have an MRI every few years to make sure a rupture has not occurred. Most women consider this to be a minor obligation that is well worth the benefit of having silicone breast implants.

Call CARE today at 919-484-4884 to make an appointment for your consultation. We are happy to answer any questions you have about breast augmentation.