Breast Augmentation

Age 32: Breast Augmentation

This is a 32 year old mother of two, 5’4” and 130 pounds who was interested in a mommy makeover. Her breasts are somewhat “boxy” in shape with a lack of superior breast fullness. She has a different shape to her underlying ribs, with the high point the area next to her arm pit and the low area the center of her chest. On the oblique or quarter rotated photos, you can see the high-low-high nature of the projection of her breast and chest wall. She was augmented with 275cc moderate profile silicone implants placed beneath the muscle. She is seen here about a year after her procedure.

Her breasts are looking quite good. She didn’t want them too large as she is quite active and she runs a lot. Her breasts are certainly more attractive, and the breast implant was able to help with the underlying asymmetries of her chest wall.

Age 28: Breast Augmentation

This is a 28 year old 5’7” and 125 pounds interested in a breast augmentation. She is seen here after an augmentation with 275cc moderate profile submuscular implants placed from an incision at the bottom of the breast.

Learning points:

Her breasts are stationed high on her chest wall. Her breasts are small and tight. The smaller the implant the better her result. A large implant will simply not fit on her upper chest and she will certainly look “overdone” in some regards. She will also feel like her implants are under her chin!
Molding her smaller breasts over a larger implant requires some work afterwards and she did a good job to achieve the shape she has.
She has more superior fullness in the upper part of her breast than most because of her small breasts and moderate size implant. If she allows her implant to move down this would result in a “bottomed out appearance” to her breasts where her nipples move up and the bottom of the breast appears quite long. If you use a large implant there is no other place for the implant to go but down!
She is doing a great job of keeping her implants “up front” so they won’t go off to the side over time. This is more common when women work their chest muscles as this squeezes the implants off to the side.

Age 36: Breast Augmentation

This is a 36 year old mother of three who is 5’6” and 146 pounds interested in a breast augmentation. She told me that she is “conservative” and preferred smaller implants and didn’t want to look too obvious after her enhancement. In my notes, I described her breasts as “relatively small, non-projecting, no sag and nondescript”.

She is seen here after a breast augmentation with 275cc moderate profile silicone implants. She is quite happy with her results, but she says that I was right in telling her that she should have gone a bit larger. It’s often the patients that I see in my practice that insist on smaller implants that wish they had chosen a bit larger after their enhancement.

Age 38: Breast Augmentation

This is a mother of two, age 38, 5’4” and 146 pounds interested in a breast enhancement. Her breasts are smaller than is ideally suited for her body size and shape, her breasts are somewhat narrow and her breasts sag. They lack any “bling” sort to speak. She complained of fullness in her axilla on both sides.

She is seen here after a bilateral breast augmentation with 350cc high profile silicone implants placed beneath the muscle from an incision at the bottom of the breast. I also performed liposuction of the axillary fullness on both sides. She is seen here about one year out from her procedure.

Her breasts are beautiful and symmetrical. I did a release of the muscle at the bottom of the breast to allow for adequate expansion of the lower aspect of the breast to allow for a more full, rounded shape. It’s interesting that she says she felt that her breasts have fallen off to the side to some degree but in her case this isn’t true. Her breasts are very much up front. I am so insistent on my patients wearing a very supportive bra that keeps the breasts “up and in” that when they feel any movement laterally they begin to panic! I guess this is a good thing because “awareness” means that she will take good care of her breasts because she knows what could happen if she doesn’t (it’s not a terrible thing but she wants them to be as good as the first year after her procedure).

The liposuction that I performed was to contour the area of fullness she had right in front of the arm pit. This had bothered her for many years and it was effectively contoured with liposuction alone. Sometimes this is actual breast tissue that would require removal with an incision. There is some collapse of the skin in this area, but it is acceptable and well worth it (both she and I agree on this).

Age 40: Breast Augmentation

This is a 40 year old mother of two who is 5’5” and 140 pounds who was interested in a breast augmentation. I felt during the interview that she was misinformed about breast implants. For one thing, she was of the understanding that after her augmentation that she would not need to wear a bra! You can only imagine that this made my heart miss a beat or two! I wonder if this misconception doesn’t come from women who have breast contractures and who don’t have to worry about a bra because their implants are stuck to on their chest!

Anyway, she didn’t want scars and her breasts are asymmetrical (right larger and more saggy than the left), and both her breast are quite saggy and without any superior breast fullness. She clearly wanted larger breasts than most (I think her and her husband believed it would be fun to have large breasts).

We discussed the issues at hand. With a larger breast implant I would be able to “fill out” some of the loose skin and make it appear that her breasts are “lifted” to some degree BUT at the expense of larger implants that can lead to all sorts of problems down the line—particularly if she doesn’t wear a bra.

She is seen here about one year after a bilateral breast augmentation with 510cc saline implants placed beneath the muscle through a small incision at the bottom of the breast.

What you can learn from her case:

Larger implants can fill out the breast and make it appear like they have been “lifted” to some degree.
Wearing a great bra to offload the weight of the implants from the skin is essential to a nice long term result. You can see the bra that she is wearing is keeping her breasts “up and in”. She also wears a bra at night (her husband doesn’t like this).
The nipple piercing says it all in terms of her satisfaction.
With her arms up you can’t see the scar from the incision to put the implant in. If it’s a saline implant the incision is TINY so don’t even think about using any other incision (like under the arm pit or through the “belly button”).
As a general rule, the larger the implants, the greater the complication potential. If I were to pick an implant size that is starting to get large, I would say 350-375cc for the “average” breast. Ultimately, my best guess depends on what I find on examination of your breasts. Some can go larger with confidence, others can’t.
If you look critically at the shape of her breasts you can tell that they were not even before, and they aren’t even after, but they are larger and cooler.

Age 37: Breast Augmentation

This is a 37 year old mother of two, 5’1” and 105 pounds interested in a breast enhancement. She is Asian. She has very small breasts with moderate side to side asymmetries. Her right breast is situated lower than that on the left side.

She is seen here after a breast augmentation with 200cc high profile silicone implants placed through an incision about her areola and situated behind the muscle.

Asian patients can be a challenge: they almost universally have very tight skin and tissues and there is a higher incidence of darker scars after surgery. We choose an incision about the areola for the reason of scarring. An incision at the bottom of the breast would almost certainly be considerable darker in her case and may be more visible because her implants are small and so are her breasts. They is no “hang” which in most breasts would help conceal the scar at the bottom of the breast. She enjoys a nice result with an improvement in the symmetry of her breasts and with satisfactory scarring. It took a fair amount of time to mold and soften her breasts after surgery because of her taught skin, but it was well worth it.

Age 39: Breast Augmentation

This is a 39 year old mother of three, 5’5” and 115 pounds who wanted a breast enhancement. She is an excellent candidate for a breast augmentation—great skin and no sagginess to her breasts. She just lost volume after her kids.

She is seen here about 1 year after a bilateral breast augmentation with 325cc high profile silicone implants placed beneath the muscle from an incision at the bottom of her breasts. Her breasts are larger and fuller, all the while keeping her nice shape.

In one set of her frontal photographs I have put a box around the same area of her upper chest to show you how her breasts have changed after her enhancement. They are fuller at the top AND the bottom. The implant builds the breast up and down as well as to the side (lateral breast fullness).

Age 26: Breast Augmentation

This is a 26 year old patient who is 5’5” and 123 pounds. She is seen here after a bilateral breast augmentation with 300cc high profile smooth silicone implants placed under the muscle from an incision at the bottom of the breast.

She started with beautiful breasts and they are even cooler now. She wears a good bra that actually is also sexy—so it is possible to obtain a “working” bra that is also sexy.

Age 35: Breast Augmentation

This is a 35 year old woman, no kids, 5’8” and 240 pounds interested in a breast enhancement. She is Asian. She has small breasts and taught skin (like most of my Asian patients). She very much liked the larger implants. I think she liked them because she needed the larger implants to offset her fuller figure.

She is seen here after an augmentation with 850cc high profile saline implants placed beneath the muscle. These photos were taken 3 months after her procedure. Her breasts are fuller, larger and her body is more proportional. Her breasts are soft and natural in appearance.

What you can learn from her case:

Asian patients have thicker, less elastic skin that requires a lot more time to expand. In this case, all the skin that you see about her new breasts had to be expanded with the implant. This required a lot of molding on her part and she was very good at working it. This would have required only several weeks for a “non- Asian” patient.
Implant size can certainly be larger in larger figured women because it needs to be proportional.
She likes how she looks, and how she can freely shop for clothing.
Patients who need to lose weight and who have balanced their current figure with breast implants must always continue to monitor their weight with a weight scale because sometimes it’s easy to think you look skinnier when, in fact, this isn’t true (you just LOOK skinnier).
The scars in her breast crease are darker than most because she is Asian. I recommend that they apply HYDROQUINONES to the area twice a day to help reduce the excessive pigmentation that can occur with healing.

Age 30: Breast Augmentation

This is a 23 year old female, 5’5” and 143 pounds who desired a breast augmentation. As you can see from her pre-operative photos, she had small, narrow and laterally displaced breasts. She definitely liked the larger implant sizers that we tried on during her consultation. The problem I had with larger implants is that I was concerned about lateral movement of the implants over time as her breasts are naturally lateral, and the implants have to go behind her breasts. If she does not wear a very supportive bra that keeps them “up front”, there will be a good chance they will settle to the sides.

She is seen here about five months after her augmentation with 375cc high profile silicone implants placed beneath the muscle through an incision below the breast. Her result is quite nice overall. You can certainly tell that she is pleased.

Here are a few of her comments:

When I go to the gym I no longer need to wear two bras—a regular padded bra below a sports bra. Now I wear as little as possible!
I no longer need to worry about tops. I wear whatever I want.
My breasts are a great distraction from my other problem areas.
My posture is a lot better—I keep my shoulders back because I am proud.
Swimsuit problem issues are a thing of the past for sure!

From my perspective, I think it is impressive how the narrow appearance of her breasts have been corrected with the implants. I also have included photos of her moving her breasts to the middle and showing impressive cleavage. If you peek at her pre operating photos, she has an almost 7 inch gap between her breasts. Cleavage can be made my massaging and molding your breasts post operatively (move them to the middle). This expands the muscle and implant pocket which results in cleavage. You never want your surgeon to cut the muscle along the midline to make immediate room right after surgery. This is a not the way to make cleavage.

Age 30: Breast Augmentation

This is a 30 year old mother of three, 5’7” and 113 pounds interested in a breast augmentation. She desired larger implants. She has an asymmetrical chest wall, with the right chest wall projecting more than the left. Her breasts were also asymmetrical (the folds beneath her breasts are on two different levels). She was quite thin, with very little body fat.

She is seen here about seven months after a bilateral breast augmentation with smooth walled high profile silicone implants (325cc on the left and 300cc on the right). The implants were placed beneath the muscle from an incision in the breast crease.

What I immediately noticed is that she looked healthier than she did when I did my procedure. She says she gained 10 pounds. This increased her body fat layer which made her look healthier and her breasts were larger as well from increased fat. This is a good thing in her case because I was concerned about larger implants with only a thin layer of overlying tissue. She has no rippling, her breasts are sitting where they are supposed to.

She tells me that she is really pleased with her results, and that her breasts feel no natural and that she doesn’t even know that she has implants. She did note a lump on her left breast that I was easily able to feel—it is separate from her implant and feels benign. She had told me that she had a mammogram and a sonogram. Since she has no history of breast cancer in her family, it’s probably best for her to watch this over the coming year or so and see if it changes. A biopsy can always be done to make a definitive diagnosis. She is not worried about it and will continue to examine it for any changes.

Age 32: Breast Augmentation

This is a 32 year old mother of one, 5’5” and 139 pounds interested in a breast enhancement. Her breasts are small for her body, and she has two different sized breasts with underdeveloped lower breast poles on both sides. What this means to me is that she will probably require two different sized implants, and we will need to instruct her on post-operative breast molding techniques to obtain the best shape (use the implant to help shape the overlying breast tissue and muscle).

The most interesting, and instructive part of her case is not how her breasts have changed, but how her breasts have changed HER. It was obvious from the minute I stepped in the room to take her post-operative photos seven months after her procedure that she was different—she appeared different and she had a different attitude. She was augmented with smooth, round high profile silicone implants, 300cc on the left and 325cc on the right, placed beneath the muscle from an incision at the bottom of her breast.

In her own words:

“A year ago acknowledged I was not happy with my appearance and began trying to lose weight with diet and exercise. After a while I noticed that with the weight loss I also lost breast size. After doing tons of research on breast augmentation I met with Dr. Caridi and his staff at Westlake Plastic Surgery. They were awesome and made me so completely comfortable I opted to have the surgery. Now I look in the mirror and the results are fantastic. In fact I am so happy that I have turned my diet and exercise into an entire life style change. The outcome of my surgery has given me incentive to completely change the way I look at meals and work outs. I now know that you can’t diet to maintain long term weight loss, you have to change your attitude towards meals and exercise. You have to think about what you want for your figure and your health at every meal. I still eat what I want, but now I want better food and I don’t eat until I’m stuffed. Now my family is eating better and feeling better too. Thank you Dr. Caridi and everyone in your office for helping me in my decision and being so wonderful throughout this process. I am so glad I found you guys, it truly has changed my entire life.”

Age 28: Breast Augmentation

This is a 28 year old mother of two, about 128 pounds who wished for a breast enhancement. She is seen here after a breast augmentation with 275cc high profile silicone implants placed below the muscle from an incision around her areola.

I like her size. She doesn’t wish they were larger (or smaller!) They are soft, natural looking and her scars have healed very well even though these photos were taken six months after her procedure. The periareolar incision is a good one in those who have a distinct, well defined areola border and who are at higher risk for darker scars that are more visible at the bottom of the breast.

The location of the incision is closer to the nipple-areola complex but it is NOT associated with more sensory disturbances or breast feeding issues than any other incision (contrary to what most people believe). It’s impossible to get in a larger implant if you have very small areolas (you would have to beat up the implant too much to get it in such a small opening).

How a Breast Augmentation Can Change With Pregnancy

This is the case of a young woman who underwent a primary breast augmentation with 350cc moderate profile silicone implants placed beneath the muscle through an incision in the breast crease. The first row of photos below shows her pre surgery breasts.The second row of photos shows her breasts one year post surgery. The third row shows her 7 months after the birth of her first and only child. The last photo shows her post pregnancy breasts in a bra.

What can we learn from these photos?

1. The breast will change after pregnancy and breast feeding. It is believed that it is the pregnancy and not the breast feeding that causes the stretching of the breast (so choose to breast feed without the fear that this causes the breast to sag more)

2. In her case, her breast implants have stayed in the ideal position on the chest wall. The tissue that swelled during pregnancy is what has “fallen” off the face of the breast implant. This results in lowering of the nipple-areola complex to the lower part of the face of the breast, and somesagging of the breast that is best appreciated on the lateral views. The relationship of the level of the nipple-areola complex to the actual breast mound (in her case the breast implant) is critical in determining how attractive and youthful a breast appears. A breast “lift” is what canbe performed to elevate the nipple to a better position and reduce the breast “sag”.

3. The photo of this patient in her bra shows that her breasts look wonderful. The beauty of a breast implant is that it provides for fullness that is typically lost after pregnancy—particularlyfullness at the top of the breast. You would not know that her breast appears saggy with her bra on (this is not a surprise to most women). Some would argue that they want to look good in their clothes and they probably wouldn’t care if they had some sagginess of the breast whenout of a bra. This may work for some people, but most want to look their best when they are naked—that view they see every day in their mirror.

4. Some patients have asked me if they should have their implants removed before pregnancy, only to be replaced afterwards. The “logic” is that if there is less weight in their breasts, there will be less stretching and less sag. They also know they will get really big during pregnancy,and if they don’t have the added volume of an implant they won’t get so huge that it is uncomfortable. I’m not sure of the exact answer here. I think that if you wear a very supportive bra 24/7 during and after your pregnancy that you will do as well with or without an implant.

The plan for this patient is to perform a “mastopexy” or breast lift through a vertical incision that will leave a “lollipop” shaped scar. I will also perform an abdominoplasty for what has happened to her abdomen. She doesn’t plan on having more children. She also wants to change the style and size of her implants—a little bit larger and a high profile implant that is narrower and perkier in appearance.

Age: 29 Breast Augmentation

This is a 29 year old mother of two who is 5’7″ and 129 pounds interested in a breast enlargement. She has wanted a breast enhancement since she was fifteen. Anatomically, she has very narrow shoulders, a small chest and very small breasts that are asymmetrical. Her ribs slope off laterally more on the right side than that on the left.

She is seen here after an augmentation with 350cc high profile smooth silicone implants placed beneath the muscle from an incision in the breast crease. These photos were taken about 9 months after surgery.

She is pleased for sure. She has never quite felt like a “true” woman with her very small breasts. She actually is thinking about going larger. The most “fun” she has experienced with her new chest is the response from her “Ex”. What I see is a dramatic improvement for sure. There is some lateral and inferior displacement of her implants on both sides which is “normal”, but the process does not need to continue any more. For this reason a proper fitting bra that moves her implants “up and in” will be very beneficial to maintaining her beautiful results.

Her anatomy is what I am most concerned about in terms of a stable long term result. Her ribs slope laterally and her chest is very narrow and her nipples are high on her chest. There is no place for her implants to go except down and out. Going larger than she is will only make this situation even more challenging. She can always make them look as large as she wants by wearing a push up bra.

Age: 47 Breast Augmentation

This 47 year old woman is 5’6″ and 135 pounds and complained of “flat breasts” after having her kids. You can tell from her preoperative photos that she was not small, just somewhat flat. Her breasts didn’t project that much, and this is a youthful feature. Plus she didn’t mind larger breasts in general (for the fun of it!).

She is seen here after a 350cc high profile, smooth, round silicone enhancement placed in the incision at the bottom of the breast and beneath the muscle. No lift was performed as we thought that her breasts were stationed high enough on her chest and her degree of ptosis (sagging) was modest. The high profile implant provided all the projection and narrowing to make her breast appear perkier, and in the end, the patient loves her new breasts.

Age: 32 Breast Augmentation

This is a 32 year old mother of two who is 5’4″ and 130 pounds interested in a breast enhancement. Her breasts were probably a B cup, with a lack of superior fullness and a somewhat “boxy” appearance. Basically, she lacks “bling”.

She is here after a bilateral breast augmentation with 275 cc moderate profile silicone implants placed beneath the muscle from an incision at the bottom of the breast. The improvement is visible and certainly there is a better shape, a better proportion with her figure, more “bling,” and wonderful superior breast fullness and cleavage. All this was accomplished with a smaller to moderate sized implant.

Breasts don’t always have to be big to look great. Shape is critical. All patients are different in terms of their anatomy. Some patients have the perfect “situation” for a breast augmentation. Forward pointing nipples and symmetrical, non-saggy breasts with good firm tissue on a flat rib cage is ideal. In fact, the most common way to “ruin” this good situation is to go too big and to choose implants that are so large that they overwhelm your breasts, and you lose that natural shape and assume a more “balloon” shape.

Age: 35 Breast Augmentation

This is a 35 year old 5’5″ and 130 pound mother of three interested in a breast enhancement and correction of inverted nipples.

She is seen here after a bilateral breast augmentation with 325cc high profile smooth walled silicone implants placed beneath the muscle from an incision in the breast crease. I also corrected her inverted nipple condition with an incision around the nipple itself.

She is seen here a little over a year after her procedure. Her nipples are out most of the time, and she enjoys her enhancement considerably. Also, the bra she wore to the office is an example of a poor fitting one. It is larger than it needs to be and it is not working to support her breasts. She can do better and must do better because years down the line her breasts will continue to move down and to her side, a look opposing “perky” looking breasts.

Age: 41 Breast Augmentation/Weight Lifter

This is a 41 year old mother of one, who is 5’2″ and 115 pounds, interested in a breast augmentation. She is a very small weight lifter and clearly wanted larger implants.

She is seen here after a bilateral breast augmentation with 375cc high profile smooth walled silicone implants placed beneath the muscle from an incision in the breast crease. She has done well with her enhancement, and is quite pleased. She is certainly on board with wearing the correct bra. The implants have not affected her exercise regimen and her implants have not moved excessively during exercise.

Some surgeons prefer to place breast implants in the subglandular position (implants placed below the breast gland but above the muscle) rather than the submuscular position because the implant will not move as much when placed on top of the muscle. However, this often results in a very unnatural, rounded, “stuck on” appearance in these body building patients. Quite frankly, it often looks bizarre.

For this reason I have encouraged my patients to consider the submuscular position. When performed well by your surgeon, the results appear far more natural. You will look far better in your competition as well. It’s appealing (for some at least) to see a woman who has a very sculpted physique AND very soft, naturally appearing breasts. Chest exercise isn’t needed when you have submuscular implants–you already have great pectorals!

Age: 34 Breast Augmentation

This is a 34 year old mother of one, 118 lbs, 5’5″ tall, interested in a breast augmentation. She has a fair amount of rib cage, breast asymmetries, and small breasts. She does not want to be “too large,” and in her consultation, she very much enjoyed smaller to moderate sized implants.

She was augmented with smooth, round, moderate profile silicone implants 250 cc on the left and 275 cc on the right; placed beneath the muscle through an incision at the bottom of the breast. Her post operative photos are taken at one year.

She loves them and seems very content with her result. She wears a supportive bra as “instructed”. She has learned that when wearing a good bra, she sees more cleavage and superior fullness. This means her breasts have moved “up and in” as she is well aware that over time, and under the influence of gravity, there will be a tendency for them to move “down and out.”

She doesn’t wear a sleeping bra but certainly would benefit from one because of the rather significant sloping of her rib cage. Over time, her implants will tend to move laterally. I encouraged her to get into the habit of wearing a sleeping bra so that when I see her in eight years she can lay on her back and her breasts will sit “up front.”

Age: 23 Breast Augmentation

This is a 23 year old who is 5’4″ and 125 pounds interested in a breast enhancement. You can see from her pre-operative photos that she has a pleasing breast shape overall, she believes that she just needs more.

She is seen in her post-operative photos after a bilateral breast augmentation with 300cc high profile SALINE implants placed through an incision in the crease beneath the breast and placed below the muscle. She has certainly achieved more, there is greater superior breast fullness, and she enjoys a very nice shape.

Her bra is a different story; it’s not a good one. The cleavage area (see area marked by arrows below) is the best place to look to know if you are wearing a good bra. Because of gravity, all breasts want to move down and to the side over time. The role of the bra is to keep them up and in. If you wear a bra and the cleavage area is the same as when you are braless, your bra is doing nothing. If your bra makes for more cleavage, it is working to move your breasts up and in and therefore it is supporting your breasts adequately (your bra is working and not your skin to counter the weight of your breasts). Remember, it’s all about the cleavage when you are evaluating the benefits of your bra. Click here for the best bra.

On a side note, many patients believe I only prefer silicone implants. This is not true, and in her case, I couldn’t tell you what type of implant she has based on an examination. However, there are clearly instances where silicone is better than saline.

Age: 35 Breast Augmentation

This is a mother of three who is 5’3″ and 153 pounds interested in a “mommy makeover.” In addition to a breast augmentation, I also performed an abdominoplasty and liposuction.

She is seen here after about six months from a bilateral breast augmentation with 300cc smooth walled silicone implants placed beneath the muscle through an incision beneath the breast.

This is an example of a “classic” breast augmentation. She had a great pre-operative breast shape for an augmentation, she has good symmetry of her chest ribs, and nice thick skin. She complained of breast asymmetries and a loss of fullness. She wanted breasts that make her proportional. Her results are natural and beautiful.

Age: 40 Breast Augmentation

This Asian mother of one who is 5’7″ and 143 pounds desired a breast enhancement. She said her breasts have always been small and she felt this affected her self – esteem. She is seen here five months after a bilateral breast augmentation with smooth silicone implants placed beneath the muscle through an incision below the breast. I mention that she is Asian because my experience with Asian patients is that the procedure is distinctly different in terms of the degree of difficulty and the post-operative need for far greater efforts to adequately shape the breasts. The tissues in general are thicker, her muscle was much larger than most people, and the muscle is attached more extensively to the underlying ribs. This makes the pocket creation more difficult. Because of the very taught tissue they often need aggressive massage to help mold the breast and help it to drop to an optimal level.

She has a very nice result but I had to work at this quite a bit and often. I saw her very frequently so that my staff and I could mold her breasts for the first seven weeks or so after her procedure. She was not able to move them as much as we would have liked because it’s not always easy for the patient to mold their own breasts and there was no help available in her home. The concept of molding the breast is not discussed much in general. I believe that in many cases it is possible to improve on the outcome from an augmentation by molding the breast and surrounding tissues around the implant in order to obtain the best shape and to keep the implants soft (non-contracting breasts). She is very pleased with her outcome and would be the first to admit that among all the benefits from her choice to undergo a breast enhancement, the improvement is self-esteem is first and foremost.

Age: 24 Breast Augmentation

This female is 5’2″ and 118 pounds. She attended one of my Breast Seminars and decided a year later that she was ready for a breast augmentation. Upon examination, she is obviously a young woman with excellent features and wonderful skin but she had significant chest wall asymmetries. She also has curvatures of her spine. The right breast was more laterally displaced than her left and her rib cage right to left was quite asymmetrical.

She is seen here after a bilateral breast augmentation with 300cc silicone implants placed beneath the muscle from an incision beneath the breast. Her comment when these photos were taken five months after her surgery is that she wishes her breasts were not so far apart.

Given the preoperative condition of her ribs and her scoliosis, this is actually about as good as it gets. The station of her breasts (where they are situated on her ribs) is quite good and her breasts have remained up front and have not slid off to the side with time. This has been helped because she wears an excellent bra (especially at night when the implants want to move off to the side), and I have educated her about the need for continuous support “up and in.” Asymmetry of a woman’s rib cage is the rule. It is rare to have complete symmetry right to left on any human. This is an important concept for you and your physician to take into consideration so that your results are optimal and so that you have realistic expectations. This is also why it is important to try on implant sizers before your surgery as this is the time when these differences are best noted.

Age: 30 Breast Augmentation

This is a 30 year old mother of two, 5’1″ and 124 pounds interested in a breast enhancement. She is seen here after a breast augmentation with 375cc high profile silicone implants placed beneath the muscle through an incision at the bottom of the breast.

What is important in her case is that she is a competitive body builder. These patients can be quite a challenge in terms of breast enhancement because they can lose so much fat that the implants can look unnatural and they can be easily palpable. In addition, when placed under the pectoralis muscles, these implants can move quite a bit with muscle activity.

It has been my experience that these patients often do better with submuscular silicone implants rather than saline or silicone implants above the muscle. In her case, she chose a larger implant than I would typically recommend considering her body building activities and small frame.

Artistically, both she and I prefer the body builder figure with fuller, more natural appearing breasts rather than looking at round, “ball like,” “stuck on” implants under a very thin layer of skin. Read about the patient’s experience in her own words:

“Fitness and health are very important for me as a woman and a mother. Having a fit, feminine physique is enjoyable to me. Through weightlifting I build and maintain the sculpted look I desire. Together with exercise and clean eating I decided to undergo a breast augmentation surgery to create a proportional, curvy figure that I am proud of. I am very happy with my decisions to do the surgery as well as putting forth the effort into healthy living. Being muscular and womanly to me is the greatest combination.”

Age: 43 Breast Augmentation

This mother of one is 5’4″ and 104 pounds. She is seen here after a bilateral breast augmentation with 250cc smooth silicone implants placed beneath the muscle through an incision in the breast crease.

Age: 38 Breast Augmentation

This patient underwent a bilateral breast enhancement with 375cc silicone implants placed beneath the muscle through an incision in the breast crease. She is seen here two years after her enhancement. She thinks her breasts are “perfect” and that no one can tell that they are not hers. She has noticed with weight loss that she can see and feel small ripples on the lateral aspect of her breasts.

Two lessons are learned from her case; first, significant weight loss can make your implants more easily felt as there is less tissue on top of your implants to hide ripples. All implants will ripple over time weather they are saline or silicone but less so for silicone. Second, it’s imperative that a correct fitting bra is used that lifts the breasts and moves them to the middle of your chest so they don’t drop over time or move under your arms. Gravity is your enemy in terms of implant malposition over time.