Introduction

Endoscopic breast augmentation plastic surgery is a popular choice for many women in New York City seeking to enhance their physical appearance. Selecting the right hospital for this procedure is crucial, as it directly impacts the safety, effectiveness, and overall outcome of the surgery. In this article, we will provide an in - depth introduction to the top public Class - Three Grade - A hospitals in New York City for endoscopic breast augmentation plastic surgery, including relevant background information, the capabilities of hospitals and surgeons, and potential concerns during the surgery.

The Rising Trend of Plastic Surgery

Elective plastic surgery has become increasingly popular in recent years. According to data released in November 2023 from the global intelligence platform Statista, in 1997, there were 900,000 cosmetic surgical procedures in the U.S., and by 2022, this number had grown to more than 1.87 million. The increase can be attributed to a greater number of options for safe, less invasive surgeries and an increasing cultural emphasis on self - care and confidence.

Importance of Choosing the Right Hospital

Endoscopic breast augmentation is a significant surgical procedure. A top - notch public Class - Three Grade - A hospital has advanced medical equipment, a professional medical team, and strict safety management systems. These factors are essential for ensuring the success of the surgery, reducing the risk of complications, and providing high - quality post - operative care.

Leading Plastic Surgeons in New York

2024 Newsweek Ranking

Newsweek partnered with Statista for the fourth annual ranking of America's best plastic surgeons in 2024. In the breast augmentation category, several surgeons from New York City made the list:

• David Hidalgo, MD, FACS
• Adam R. Kolker, MD, FACS
• Alan Matarasso, MD, FACS

These rankings are based on a comprehensive scoring model. Thousands of medical experts with knowledge of plastic surgery were invited to an online survey in March and April 2024. Over 8,400 votes were collected and analyzed for each procedure. The scoring model includes in - state and out - of - state recommendations (45% of the overall score), quality score (15% of the total score), and certification score (5% towards the total score for those with American Board of Plastic Surgery (ABPS) accreditation).

2023 Newsweek Ranking

In the 2023 rankings, David Hidalgo, MD, FACS and Adam R. Kolker, MD, FACS from New York also made the list for breast augmentation. The 2023 ranking also followed a similar methodology, with over 2,000 medical experts invited to an online survey from March to April 2023, and over 8,400 votes collected and analyzed for each procedure.

Background of Endoscopic Breast Augmentation

Brief History of Implant Design

The first breast implant used for augmentation was developed by a plastic surgeon Cronin in the 1960s in Texas. He used a silicone rubber filled with silicone material in a patient volunteer. Since then, subsequent implant designs have focused on decreasing the rate of rupture and capsular contracture. The current silicone implant available in the market is the 5th - generation form - stable implant utilizing highly - cohesive gel properties, and textured implants are claimed to be associated with lower capsular contracture.

Implant Crisis

There have been several implant - related issues over the years. In 1992, the Food and Drug Administration (FDA) prohibited the use of silicone gel implants until 2006 due to concerns about their association with auto - immune disease and poor durability with high rates of rupture. In 2011, the silicone implants made by the French company PIP were withdrawn due to the use of industrial (not medical) grade silicone, resulting in high rupture rates. In 2015, implants from a Brazilian company manufacturing Silimed implants were withdrawn due to concerns of contaminants. In December 2018, Allergan decided against renewing the CE mark, leading to the withdrawal of its textured implants due to a higher incidence of breast implant - associated anaplastic large cell lymphoma (BIA - ALCL).

Pre - operative Considerations

Patient Expectations

During the pre - operative consultation, it is crucial to establish patient expectations. Some patients may desire a modest augmentation, while others may wish for a substantial and possibly unrealistic augmentation. Surgeons need to communicate that implant - based surgery is a process of care, and further surgeries may be needed in the future to address complications or maintain the aesthetic form.

Clinical Examination

The clinical examination should focus on the patient's body habitus to ensure that the augmentation is proportional. The medial fold (subcutaneous and breast tissue) thickness should be assessed to determine the plane of implant insertion, with a preference for subpectoral implants if the overlying tissues are too thin to support the implant. The sternal notch to nipple distance, breast width, breast height, and breast projection also need to be assessed to plan the choice of size and shape of the implant.

Key Principles in Implant Augmentation

Indication

It is important to determine if the patient's goals are realistic for their body habitus, chest wall shape, and tissue quality. Some experts suggest limiting the augmentation volume below 350 ml due to concerns about surrounding tissue pressure leading to a higher risk of long - term problems. The expected breast shape after augmentation helps in choosing between round and anatomical implants.

Incision Choice

There are several incision options:

• Infra - mammary incision: This is the most common incision used worldwide. It offers good access to both subglandular and sub - pectoral pockets with minimal violation of the breast parenchyma. However, care must be taken to ensure that the scar remains hidden in the infra - mammary fold after implant insertion.
• Peri - areolar incision: This is the preferred choice if mastopexy is planned concurrently, for example, in tuberous breasts. However, it is a challenging incision for small areolae and areolae with indistinct margins, and there are concerns about the risk of bacterial contamination and altered nipple sensations.
• Trans - axillary incision: It offers the advantage of avoiding scars on the breast. This approach involves placing an expandable implant through a small incision followed by inflation. It is ideally suited for smaller non - ptotic breasts, but its remote access makes it challenging to place larger implants.
• Trans - umbilical incision: This is a newer approach that offers remote access and avoids a scar on the breast. A subcutaneous tunnel is created above the plane of the rectus fascia to access both the subglandular and subpectoral pockets for the placement of tissue expanders. However, both trans - umbilical and trans - axillary approaches do not allow secondary procedures to be performed easily in the future.

Choice of Pocket Plane

The choice of pocket plane includes subglandular, subfascial, or subpectoral. An implant placed in the subglandular plane has less morbidity compared to the submuscular approach that involves dissection of the pectoralis muscle. However, it carries a risk of implant visibility and palpability, especially in thin patients. The subglandular placement is suitable for patients with good medial fold thickness. The dual - plane approach, where the implant lies partially behind the pectoral muscle and partially behind the breast, is preferable in some cases as it provides good muscular cover of the upper pole of the implant with adequate lower pole expansion.

Implant Choice

When choosing an implant, the following factors are considered:

• Saline or silicone gel implant fill: The FDA restricted the use of silicone implants for breast augmentation in the USA from 1992 to 2006, so saline implants were the only type used prior to 2006. The benefits of saline implants include a smaller incision for surgery and easier detection of implant deflation. There is no convincing data demonstrating that either saline or silicone implants are associated with less capsular contracture.
• Round or anatomical implant shape: Both anatomical and round implants can produce good aesthetic results depending on patient preference.
• Smooth or textured surface implant shell: Texturizing of the implant shell reduces capsular contracture. However, there are concerns that textured implants are associated with BIA - ALCL.
• Fixed volume or adjustable implants: Fixed volume implants are usually preferred for aesthetic procedures, but adjustable implants can be an option in difficult cases such as tuberous breasts and in breast reconstruction.

Operative Procedure and Complications

Operative Procedure

The breast footprint should be marked in an upright position pre - operatively. Implant augmentation is performed under general anesthesia with a single dose of antibiotics given at induction to prevent infection. During the surgery, it is important not to over - dissect the pocket medially to avoid symmastia or implant palpability, and meticulous haemostasis should be ensured. Various measures are taken to reduce the risk of infection, such as changing gloves prior to implant handling, washing instruments and the implant pocket with antiseptic/antibiotic solution, avoiding implant contact with the skin, minimizing theatre personnel traffic, and using a nipple shield.

Complications

There are several potential complications associated with endoscopic breast augmentation:

• Bleeding/haematoma: Re - operation and washout are recommended in case of a significant bleed.
• Infection: The ideal infection rate is less than 1%.
• Capsular contracture: The rate of adverse capsular contracture requiring operation is 10% at 10 years.
• Implant palpability/visibility/wrinkling: This is more often seen with smooth implants and implants in the subglandular position.
• Implant rotation: This is seen with anatomical implants.
• Implant loss: If the implant gets infected, antibiotics are rarely effective, and removal of the implant is usually required.
• Leakage of silicone: In case of implant rupture, the silicone gel may remain within the capsule (intracapsular rupture) or spread outside (extracapsular rupture), which may require further treatment.
• BIA - ALCL: This is a rare type of T - cell non - Hodgkin lymphoma related to breast implants. As of April 2020, there have been 800 confirmed cases worldwide with 33 deaths attributed to ALCL. The most common presentation is a large spontaneous seroma around the implant. Triple assessment including clinical examination, breast ultrasound and/or MRI, and aspiration of the fluid and/or biopsy of the mass is required for diagnosis.
• Breast implant - associated illness (BII): BII is a term used for women with breast implants who describe a variety of symptoms such as fatigue, chest pain, hair loss, etc. There are two predominant theories to explain these symptoms: psychological and immunological. Management of these patients requires compassionate consultation, a detailed discussion of symptoms, and appropriate clinical examination and imaging to rule out implant - related complications.

Fat Transfer for Breast Augmentation

Procedure and Suitability

Fat transfer, also known as lipofilling, is increasingly used for breast augmentation. It is suitable for patients who desire a moderate increase in breast volume or who want to recover the fullness they had before weight loss or pregnancy. The ideal patient is a young woman with a slim upper body, moderately small breasts, and sufficient regional adiposity of the lower body to allow one or even two lipomodelling sessions. The key advantage is the autologous nature of the augmentation, which reduces the need for further surgeries related to implant complications.

Potential Concerns

There are some potential concerns with fat transfer. It may interfere with breast assessment due to fat necrosis/calcifications, although mammogram and/or ultrasound is usually diagnostic. In some situations, a biopsy may be needed to confirm the diagnosis. There has also been some concern about the safety of lipofilling in terms of the risk of breast cancer, but there is no evidence to support this in clinical studies. Complications include donor - site issues such as extensive bruising, swelling, pain, paraesthesia, infection, lumpiness, or very rarely, skin necrosis, and recipient - site issues such as inadequate fat take, fat necrosis, oil cysts, infection, and swelling/bruising.

Top Plastic Surgery Services in New York City Hospitals

Mount Sinai

Mount Sinai's plastic surgeons have extensive experience in performing breast augmentation. They use the latest technologies, such as advanced 3D imaging technology, to help patients visualize how their larger breasts will look. Before scheduling the surgery, the surgeon will consult with the patient, listen to their desires for enhancing breast size, and help them decide on the size and shape that will look best for their body. They offer several options for breast augmentation, including two types of implants (silicone and saline) and a non - implant option (NaturalFill, a fat - transfer technique).

NewYork - Presbyterian

NewYork - Presbyterian plastic surgeons are passionate about helping patients feel their best. They provide a full range of cosmetic breast surgery options, including breast reduction surgery, breast lift surgery (mastopexy), breast augmentation with implants, and DIEP flap surgery. Starting with the initial consultation, their plastic and reconstructive surgeons work with patients to understand their goals and discuss the best options for their needs.

Conclusion

Endoscopic breast augmentation plastic surgery in New York City offers women the opportunity to enhance their physical appearance. However, it is essential to choose a top - notch public Class - Three Grade - A hospital and an experienced surgeon. The pre - operative consultation, proper assessment of patient expectations and body conditions, careful choice of implants and surgical techniques, and awareness of potential complications are all crucial aspects of the process. Patients should also be well - informed about the long - term implications of the surgery, including possible changes to the breasts over time and the need for follow - up care.

If you are considering endoscopic breast augmentation plastic surgery, we encourage you to further research the hospitals and surgeons mentioned in this article. Consult with multiple medical professionals, ask questions about the procedure, risks, and expected outcomes, and make an informed decision that is right for you. You can also share this article with others who may be interested in learning more about breast augmentation in New York City.