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Breast Augmentation

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Dr. Stephens is considered one of the best breast augmentation plastic surgeons in the Northwest and one of the nation’s premier plastic surgeons in breast implant procedures and techniques. His vast experience with thousands of happy breast augmentation patients and reputation is well-known throughout the community. Medical professionals and celebrities, as well as their friends and family members, praise his beautiful results and often seek out his care. He is well-known for his desire to understand and discuss his patients’ wishes and aspirations as well as his intimate, intuitive understanding of how breast implants and breast tissue work together to shape the breast. His artistic sensibility and understanding of how breast size relates to the proportion of a woman’s silhouette as well as her self-image and emotional well-being is an important consideration during your consultation.

Model by a pool

Why Have Breast Augmentation? Why Do Women Want Breast Augmentation?

There is a general misunderstanding of why women want breast implants to begin with: there may be loss of breast volume and shape after breastfeeding the kids; the woman with no breast tissue may wish for breasts that are more proportionate and natural for her body; a woman may have lost a lot of weight and with it, lost all of her breasts; she may want to look less masculine; there may be asymmetry; or she may well want larger breasts that fit her self-image. The point is that a lot of women here in the Puget Sound as well as all over the country and world have breast implants for a variety of deeply personal reasons, and there are a lot of women in the Northwest with breast implants.

Diagram: Implant Placement


There are three incision locations:

  • Transaxillary (“Hidden Incision”): Dr. Stephens is one of the leaders of a team of plastic surgeons who originally developed the transaxillary endoscopic approach to implant placement, which he later described as “The TEAM™” approach to breast augmentation: (T)rans-(A)xillary (E)ndoscopic-assisted (A)ugmentation (M)ammoplasty. Through an incision hidden within the armpit, the endoscope is placed, which allows for precise dissection and creation of a breast pocket for the implant. He is one of the few surgeons in the country who can place both round and certain shaped breast implants all while hiding the scar completely off of the breast and chest wall. Dr. Stephens has performed thousands of these procedures through the years with great results.
  • Inframammary: The incision is made in the crease where the breast meets the chest wall.
  • Periareolar: The incision is made along the lower half of the areola where it meets the breast skin.

The Keller Funnel®: This is used to reduce the risk of infection and capsular contracture. Dr. Stephens was one of the first surgeons in the northwest to use this ingenious device to place breast implants.

Breast Implant Types: Saline, Silicone; Now Gummy and IDEAL; Choosing the Right Implant for You:

Breast Implants: Saline, Silicone

Historically, there are two basic types of breast implants: saline and silicone, each of which has an outer shell made of silicone but different inner substances.


These implants are filled with a silicone gel. They are said to provide a softer, more natural feel than saline implants with less rippling.


These consist of a silicone shell filled with a sterile saline solution. Since the improvement of silicone gel implants, we see fewer saline implants being used.

Cohesive Implants

All current FDA-approved manufacturers in the U.S. carry several types of cohesive silicone gel implants, including the proverbial “gummy” implant. Dr. Stephens prefers the softer version of the Sientra® cohesive implant due to the superior ability of the gel to stick to itself and stay within the breast implant if the shell is broken. This and the superior shape of these implants and stronger materials will provide for better implant durability than traditional gel or saline implants.

Implant Manufacturers

Three companies manufacture FDA-approved breast implants: Allergan™, Sientra®, and MENTOR®. Dr. Stephens uses mostly Sientra® cohesive implants, and has been a long-term user of the Allergan™ Implants.

logo: Sientra®


Sientra® manufactures silicone implants in both round and teardrop shapes as well as smooth and textured options. They currently have the best warranty for failure and capsular contracture in the industry and only sell to ACGME board-certified plastic surgeons. Their silicone gel effectively maintains its attachment to the breast shell in case of a rupture while being one of the softest and strongest cohesive implants in the industry.

logo: Allergan


These consist of a silicone shell filled with a sterile saline solution. Since the improvement of silicone gel implants, we see fewer saline implants being used.

Sientra® Implants

Until recently, women have been limited to only a few options for breast implants in the United States by only two manufacturers. However, Sientra® is a new kind of breast implant company that caters exclusively to board-certified plastic surgeons. Sientra® offers diversified choices for silicone breast implants featuring several profile options for a customized look.

Sientra® provides a form stable, or “gummy bear”, style implant. This is a cohesive silicone gel implant where you don’t have to worry about silicone leakage occurring. This implant is offered exclusively to board-certified plastic surgeons. The unique design of Sientra® includes strong integration between the inner gel and the outer shell. This can help prevent deformities in the upper pole of the implant and makes them softer and more resistant to ruptures.

The Sientra® brand has been developed with over 33 years of advanced product testing and research and are FDA approved. Sientra implants are Made in the USA, have the lowest rupture rates and the strongest safety profile on the market. They are available for women who wish to undergo breast augmentation and/or breast reconstruction.

Sientra® offers a diversified list of different breast implant shapes and sizes, with either smooth or textured surfaces to suit most patient needs. Dr. Stephens can help you decide which implant will best suit your individual needs. Round implants typically provide more volume in the upper breast area. Anatomically shaped breast implants are designed to match the anatomy of your chest wall and natural tear-drop positioning of a natural breast.

Sientra OPUS Platinum20 Warranty

More Complete Coverage. More Peace of Mind.

Sientra®’s Limited Warranty

Sientra® is committed to patient safety and cutting-edge innovation. This philosophy began long before they developed their Sientra® breast implants. Remaining faithful to that commitment with exacting production standards allows them to provide patients with one of the best warranties in the industry.

Learn more about Sientra® Breast Implants cohesive gel in this video

Sientra® silicone breast implants use a cohesive gel matrix which will not bleed out in the event of a rupture or implant shell failure.

Your Sientra® Limited Warranty and Product Replacement Program includes:

Platinum 20

  • It is the most comprehensive warranty, longest length of coverage with the highest financial assistance available amongst all implant brands.
  • Safety is our number one priority.
  • Rupture is a 20 year warranty with up to $5000 in financial assistance.
  • Capsular Contracture is covered for 20 years (and $2000 in financial assistance if it happens within the first two years).
Diagram: Dual Plane vs Subglandular insertion

Implant Placement

Dr. Stephens uses the “dual-plane procedure” when placing breast implants in most cases. This consists of placing the implants below the muscle in the upper two-thirds of the breast pocket and below the breast tissue in the lower-third of the pocket. This is the most important determinant of providing an excellent long-term result and provides the most natural shape for the breast. A dual-plane will maintain the long-term shape and minimize thinning out of the breast tissue over the upper part of the breast implant seen in pre-pectoral implant placement. There are several important benefits to placing breast implants below the muscle, including a significantly lower capsular contracture rate as well as better mammograms and less rippling.

Subglandular Placement: Breast implants can be placed over the muscles of the chest in the space created between the pectoral muscle and the breast gland. The tradeoffs are a much higher risk of capsular contracture and more visible implant rippling on the upper edge of the implant which can get worse as the breast tissue thins out over time. The breast implant is also more palpable than below the pectoral muscle and there can be a distinctive shelf at the top of the breast with less of a teardrop shape. This and the “sub-fascial” implant, located between the pectoral fascia and the pectoral muscle can especially be a problem in women with thin breasts. The sub-glandular breast implant has less tissue support than below the pectoral muscle so it is at more risk of implant/breast drooping over time.

Model of a woman's body

Implant Size

Your current breast size and body shape will have a significant influence on the size and type of implant used for your procedure; you don’t want a breast that is too big or too small. Dr. Stephens’ innate artistic sensibility as well as using dimensional analysis to determine breast base width and shape starts the process of deciding on the size and the type of the implant. In your consultation, we use the concept of dimensional breast analysis, which describes your breast size and shape as well as the relationship of your breast with your chest and body type. We review the concept of the “breast footprint,” or the base width diameter, of the breast and how this relates to the ideal width of your implant to provide the desired and proportionate result. We review how the different profiles of the breast implants affect the augmented breast size and shape.

The VECTRA® XT 3D System

Through the process of measurements, implant trial sizes, and the VECTRA® 3D imaging system, you will leave your consultation with confidence about your implant choice. The VECTRA® system uses six high-resolution cameras to create three-dimensional images of you, and the state-of-the-art software program displays what your potential results may look like using implants of different sizes. Dr. Stephens wants you to have a good idea of your ultimate implant size and shape to achieve a natural and attractive appearance in line with your ultimate goals and harmony with the rest of your frame.

Your Breast Procedure; Our Ambulatory Surgical Suite (ASC)

Dr. Stephens performs all of his procedures, including breast augmentation procedures, with his experienced and talented team in our beautiful, state-of-the-art, state-licensed AAAASF-certified ambulatory surgical suite (ASC) located in our office for your privacy, safety, and convenience! Our board-certified anesthesiologist is an ACGME board-certified physician and is uniquely experienced and an expert at outpatient cosmetic surgical procedures. Our anesthesiologist utilizes gentle and fast-acting light general anesthetic with the latest and safest medications and techniques, ensuring that you will not feel anything during your procedure and that you will have a fast, comfortable, and uneventful recovery before leaving our office. In addition, during your procedure, our anesthesiologist will give specific medications designed to reduce pain following your surgery. You will also be cared for by one of our skilled, thoughtful, and attentive recovery nurses after the procedure.

Our team is serious about our business and is committed to providing a safe, pleasant, and comfortable experience. Most of our patients do not require much medication following their procedures.

Your Recovery After Your Breast Augmentation Procedure; Minimizing Pain and Ensuring a Quick Recovery

Our office is committed to providing a pleasant, comfortable, and fast recovery. We have designed a specific, comprehensive recovery program to help you get back to your activities as soon as possible. It is less than honest and a bit disingenuous to say that you will have a “24-hour recovery” with early unlimited activity; this would be dangerous! We have a “fast recovery program” to get you back to your activities as soon as reasonably possible, and you should be able to return to most quiet activities in 24 to 48 hours, return to work within one week, and do non-chest-bearing and non-impact exercises in two to four weeks.

A comfortable and fast recovery begins with a good and careful surgical technique. Dr. Stephens is particularly careful in performing a gentle and precise procedure with minimal retraction force and gentle dissection. Utilizing a Keller Funnel® allows him to place the silicone in the breast “pocket” with minimal force. The implants are placed using a “dual plane” dissection, which requires the pectoral muscle to adapt to the implant over time, so this is different than the recovery with the implant placed above muscle; however, this technique provides for a much superior long-term result with reduced long-term complications.

Your recovery: An avid athlete and exerciser himself, Dr. Stephens has developed a “breast implant recovery protocol” that utilizes gentle stretching and early range of motion exercises and other therapeutic activities to facilitate a fast and comfortable recovery. This reduces the need for powerful pain medications while substituting effective therapies, muscle relaxant medications, anti-inflammatory medications, and tailored pain medications. Neither drains nor pain pumps are necessary, nor are heavy bandages; only a simple bra and “breast strap” should be worn lightly and comfortably. During your recovery, we will guide you from day one, with specific short- and long-term instructions to educate you on the optimal recovery and long-term care of your implants. You are always free to visit or contact our office following your breast implant procedure regardless of the date of your official one-year follow-up visit if you ever have any questions or need to be examined.

upper torso of female model with a voluptuous chest in black lingerie


While the most common scar from breast augmentation procedures by most surgeons in the U.S. is in the inframammary fold, the scar may be left around the lower half of the areola or in the armpit (axilla) from the TEAM ® Procedure. This hides the scar in the recess of the axilla so it is not seen on the chest at all! Scars are minimized by how we hide them in these areas and also by using the Keller Funnel® that allows us to utilize a shorter scar. Regardless, any scarring can be easily hidden with undergarments and should fade over time with proper scar care and sun protection in the healing phase. We recommend Biocorneum®, an FDA-approved, silicone-based scar treatment (other scar treatments have not been studied nor FDA approved for effectiveness) to reduce the size and thickness of your scars. In darker skin types, we will recommend a scar lightening medication as well.

Patient Testimonials

Five stars

“I wish I could give this more than five stars! I met with several surgeons in the area before deciding on Dr. Stephens for my breast augmentation and let me tell you, I am so happy I did. I have always felt self conscious about my breast size and thanks to Dr. Stephens, I have a new-found confidence. The results are beautiful and exceeded all my expectations. I had a lot of anxiety about surgery and the entire staff, Dr. Stephens and Dr. Brandford made me feel right at home.”

I would definitely recommend Dr. Stephens to my family and friends. There is a reason he is the best of the best!

“Dr. Stephens and his team were AMAZING! They truly care for your needs and the outcome was perfect! I couldn’t have gotten a better surgeon for my breast augmentation! They were very detailed, always made sure that I knew and understood everything I was going to go through.”

“Dr. Stephens and his staff have been amazing throughout the process of my breast augmentation. It is obvious how good the dr is at what he does during the consultation. He doesn’t just give you what you want, but instead informs you of what will look best. As someone who works in the medical field, I often have high expectations and can sometimes be overly critical. I have nothing to criticize. The entire experience has been perfect. My breast look better than I even expected.”

“From start to finish, Dr. David Stephens and his staff have been amazing. Karina at the front desk is always so inviting and on top of it. Nurse Rosemary is very explanatory and caring. Lori the office manager is organized and easy to talk to. I cannot express how grateful I am with my breast augmentation results, and how amazing Dr. Stephens’ work is! Thank you to all the staff for making this such a positive experience.”

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Frequently Asked Questions

Frequently Asked Questions

Voted The BEST

Consecutively voted in the top 5 “Best Favorite Plastic Surgeon” in Evening Magazine’s Best of Western Washington and “Best Cosmetic Surgeon” in 425 Magazine.

Dr. David Stephens, Plastic Surgery | Medical Aesthetics

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Our Location

Within easy access from all points in the Northwest, Bellevue makes the ideal location for all your cosmetic needs. Free parking included.

10687 NE 2nd Street
Bellevue, WA 98004

Phone: (425) 455-0444

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