This surgical procedure is performed in our state-of-the-art outpatient facility under general anesthesia and will take approximately one and a half hours to perform. In the holding area prior to surgery, the patient's "before" pictures are taken and then the breasts marked. After speaking with the anesthetist/anesthesiologist, the patient is brought to the operating room. After asleep, local nerve blocks combined with a medication that shrinks blood vessels and capillaries to reduce any bleeding are instilled. Next, the incisions are made and the "pockets" created – generally under the pectoralis muscle – and the implants are placed.

Saline implants are inserted into the "pocket" while empty and then filled after in position. An antibiotic solution is generally added to the saline which some studies suggest reduces the incidence of capsular contracture (firmness and hardening of the healing tissue around the implant). Cohesive silicone gel implants are prefilled and require a slightly larger incision to be placed. The operating room table back is elevated to place the patient in a sitting position to check implant position and symmetry. Minor adjustments are made to the implant "pocket" as necessary to obtain the best possible results and symmetry. After the table back is lowered, a long acting anesthetic is placed into the "pockets" which greatly reduces postoperative discomfort. The incisions are closed with sutures predominantly below the surface of the skin to avoid cross-hatching suture marks and optimize the chances for the finest scars. Steri-strips are applied as well as being placed in a post surgical bra.

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