At New York plastic surgeon William Lao, MD‘s state-of-the-art Manhattan practice, the surgeon combines his years of expertise, skill and surgical techniques he’s perfected on both sides of the globe to patients looking for natural-looking, meticulously executed results. One of the top body-perfecting procedures is breast surgery and the doctor says his patients are left with such minimal scarring, you’d never know they’ve had an augmentation until they tell you so.

“The typical patient population I often see are women in their early 20s who are naturally born with small breasts which has kind of inhibited their confidence. They want to look better in clothes and add more volume to their chests,” explains Dr. Lao. “The other population are moms in their 30s and 40s who have given birth, breastfed, and are now ready to do something about their breasts which have kind of deflated after breastfeeding.”

During a consultation, Dr. Lao will work with patients to choose the right implant and the best approach for surgery. For many patients who are seeking a volume boost, the approach that shows the least amount of scarring involves placing the implant via the underarm area. Here, he explains how this technique is done and who it is best for.

What is the best way to choose an implant?

“Patients will come in with certain celebrity photos and say, ‘I want to look like this.’ However, a C-cup may look one way on a larger body type and another way on a smaller frame. While we have a rough idea in plastic surgery how many cc’s will equate to cup sizes, it’s our job to help you choose the best sized implant to compliment your body frame. Typically, you don’t want to pick an implant that’s larger than the base diameter of your breast. If you do choose one that’s larger than your breast, you can look a little more fake and risk the bordering of the implant appearing more prominent.”

What is the difference between a low-profile and a high-profile implant?

“A low-profile implant is wider, and a high-profile implant means its base is narrower. If you want more cleavage, you should pick a low-profile implant. If you want more projection and less upper pole fullness, then choose a high-profile implant, however, your cleavage will be further apart.”

How long should I expect my implants to last?

“Breast implants are man-made materials. The newest generation are meant to last longer, but they’re not meant to last forever. There’s always a chance that in the future, like in 20 years, if there’s any rupture or damage to the implant, they will need to be exchanged. There is also a myth that you must have implants replaced every 10 years, but that’s not the case. There’s no need to change implants when there are no problems. It’s like the adage says, if it isn’t broken, don’t fix it.”

Which implants do you like best?

“In my opinion I think the Mentor implants feel the softest and most natural, so that’s what I recommend to my patients.”

How do you place an implant via the underarm?

“It’s called a transaxillary breast augmentation and it’s done using an endoscope which allows me to see better internally. It’s a very clean surgery with minimal blood loss or pain. Most doctors will create an incision underneath the breast fold or around the nipple, and while those are easier approaches, they also leave a highly visible scar. This is a more difficult method for placing the implant and does take a bit longer; you need to have the right instruments and make sure your dissection plane is well done. However, unlike here in the U.S., this type of incision is the most preferred in Asia. That is because Asian people, like many black and Hispanic people, tend to scar worse than Caucasian patients.”

What is recovery like?

“It’s the same as any other type of breast enhancement recovery. While transaxillary breast augmentation is a more meticulous approach, the outcome is much more beneficial for the patient because you don’t have to worry about the issue of very visible scarring at all, except under your armpit which is so hidden no one will ever see it.”