Breast Augmentation
Breast Augmentation
This is a breast augmentation patient who is two years out from her procedure. She was enhanced with 275cc silicone implants placed beneath the muscle through an incision in the crease beneath the breast. The arrow shows the scar beneath the breast. This is quite typical of an inframammary scar. They heal and hide well if placed accurately at the time of the procedure. The inframammary incision is the most favored one by surgeons as it provides the most control of the procedure and when it comes time to replace or adjust your implants there is no better incision. You need to think in the future when you consider other incisions.
It’s important to remember that the incision for silicone implants is larger than saline. This is because the silicone implants are pre filled and are not adjustable where the saline implants are just silicone shells that are filled with salt water and are adjustable to some degree. If you are choosing saline implants there is no incision to consider other than the inframammary because the incision length is the size of your fingertip and it heals so well and offers patients the benefits of the best incision to make the best breast and then to “service” it afterwards! Why in the world would you want an incision in your belly button or your armpit if you are considering saline implants? You really need to give this some thought.
Age: 40 Breast Augmentation
This Asian mother of one who is 5’7″ and 143 pounds desired a breast enhancement. She says her breasts have always been small and she felt this affected her self – esteem (a confidence and satisfaction in oneself). 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: 35 Breast Augmentation
This is a mother of three who is 5’3″ and 153 pounds who presented for 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: 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. On examination, she is obviously and young women 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. 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: 37 Breast Augmentation
This patient, who is 5’7″ and 114 pounds was interested in a breast enhancement. She is seen here after a bilateral breast augmentation with 325cc smooth silicone implants placed beneath the muscle through an incision at the bottom of the breast.
She has a pleasing outcome. Her left breast sits higher than her right because that is what it did before her surgery. Although it is said by some surgeons that breast asymmetries are accentuated after a breast augmentation I have found this to be uncommon. It’s interesting to note that this patient would prefer to raise the right implant rather than lower the left. This is not uncommon because woman enjoy fullness in the upper pole of the breast. In her case she said that she felt that if all implants lower down with time she would prefer them to start as high as possible!
In the patient’s own words: “My confidence is higher than it has ever been, knowing that no one can ever make fun of me for being flat-chested again.”
Age: 31 Breast Augmentation
This is a patient who is 5’11″ and 120 pounds and interested in a breast enhancement. She made it very clear that she wants small implants. She is seen here after a bilateral breast augmentation with 200cc smooth silicone implants placed beneath the muscle from an incision below the breast.
She is an ideal candidate in many ways. She is choosing a moderate size which means I have to worry less about the implants stretching her tissues. She has symmetrical breasts and relatively flat ribs below. She measures a 32D which seems large compared to what she appears but when women are professionally sized they are almost always found to be wearing the incorrect size.
She is very pleased with her results and has enjoys the size she chose. She did say, however, that she has had to learn how to sleep on her side because she no longer feels comfortable sleeping on her stomach. She also has modified her exercise routine a bit because some upper body regimens put “too much strain on my breasts”. Both these issues should improve with time as she is only four months out from her procedure.
Age 34: Breast Augmentation
This is a 34 year old woman who is 5’6” and 115 pounds. She is a mother of one. She came to my office for a breast enhancement and told my nurses that she “didn’t want a lift”. She was seen by another plastic surgeon who recommended 350cc plus sized implants.
She is seen here after a breast augmentation with 275cc smooth silicone implants placed beneath the muscle. She is seen here about one year after her procedure. She told me when I was taking her pictures that “ I think I should get the lift now but I look good in a bathing suit”.
Her results are quite good, and honestly I think she looks beautiful without the bathing suit as well. It may not be “perfect” but it is quite good and the idea of “perfect” is very subjective. I don’t necessarily believe that your breasts have to be perfect to be perfectly fine. The one whose opinion matters most is yours. I will help you with some perspective and tell you what I think. This is, in fact, what most women want from me—they have heard about me and they have seen my work on my website and they trust my opinion regarding the need for a lift and the size of the implants and all the other factors that come into play when considering breast enhancement.
We determined that she looked like a “stripper” when the implant size was 350cc and over. From a certain perspective this probably isn’t the worst appearance in the world, but I think for “everyday looks” it’s probably best to choose a size that avoids this look. I tell my patients that if you are old enough, and married with kids, and YOU CAN LOOK LIKE A STRIPPER, this probably isn’t a bad thing!
This issue of a “lift” is a source of anxiety for many woman. Again, to need a lift is all subjective and based on your goals and the expertise and artistic eye of your surgeon. Your personality must be taken into consideration, and it’s important that your surgeon explore all the issues with a lift (put it all out there for discussion and discovery) because the fear of this lift is overblown and misunderstood for sure.
How do I know if I need a lift? Most women know if they need a lift because if they ask the question things aren’t what they want them to be. I look at the forest and then the trees when I make this evaluation. If your breasts look attractive and cool than a lift may not be in order. The level of your nipple relative to the fold at the bottom of the crease is the technical way we determine ptosis or sagging of the breast. Is the nipple above, at or below the breast crease? Is it pointing at your feet? The “ideal” relationship of the nipple to your breast mound occurs when the nipple is well above the breast fold (remember when you were a teenager!)
The other big issue that’s hardly discussed is the “breast station”. This is my definition, and this is the apparent horizontal location of your breasts on your ribs (a line you would draw across your chest that would mark where you think your breasts are located). Breasts that are actually “low” are those that sit lower on your ribs. My patients tell me where they would prefer them to be by placing their hands beneath the breasts and pulling them upwards.
Timing can also be an important consideration. Maybe you plan on more kids. Maybe you just aren’t there mentally quite yet. Maybe you have an aversion to a lift for reasons that aren’t valid. Maybe your impression of the scars makes you uncomfortable—will your significant other be “turned off” by the scars?
All good questions indeed and here is a brief synopsis of what I see from my perch (and I see lots of this stuff as it is one of the most common breast procedures that I perform). The scar issue is completely overblown for sure. There are very few complaints about the scars and if there are any they are always minor. Shape of the breast is as important if not more important than size. All the size in the world can’t make up for a beautiful shape. If the issue is your concern about your significant other, rest assured that men see the “big picture” and don’t see details. Given a long enough time (two years or so) and these scars usually heal quite good. Photographs taken for my website will always make the scars look darker and more noticeable because of the lighting. They always look better in real time. Do you want a Ferrari with a scratch or an old worn out car?
Keeping good posture with your shoulders held back will always provide for breast lift. You can always choose a lift as a secondary procedure if you prefer. Only a really good surgeon can provide you with the best advice about the need for a lift. Not everyone who I think needs a lift actually needs a lift. One alternative breast surgery is in fact NO SURGERY AT ALL! It’s certainly wonderful to have options!
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