Age: 52 Breast Augmentation
In the patient’s own words:I am extremely pleased with the results of my recent breast augmentation. On a personal level, I simply like the way that I look, as does my husband. Prior to surgery, I was uncomfortable with my small size and tended to shy away from attention. Now I exhibit better posture and address others directly. On a professional level, I find new confidence and am projecting a stronger professional image. I generally wear business type attire so my increased size is not readily noticeable. Whatever the reason, I am thrilled with the result. My husband says my posture is better, my sex life is certainly better, my professional life seems to have improved, and I thought I was just getting breast implants.
This mother of two is 5’6″ and 118 pounds. She was interested in a breast enhancement. On physical examination, she was tall and thin with minimal body fat. She has breast and chest wall asymmetries. She has scoliosis (curvature of the spine). She has small breasts with little to no superior fullness. Her breasts were shaped differently. She preferred moderate sized implants that we tried on in the office. We felt that by using two different sized implants we could adjust (in part) for her underlying breast and chest wall asymmetries.
She is seen here five months after a bilateral breast augmentation with silicone submuscular implants 300cc on the left and 325cc on the right. She enjoys a very nice result with excellent fullness, shape, and symmetry improvement. The size works well with her broader shoulders. You can clearly see that her nipples pointed in a downward direction before her augmentation and they are straight forward afterwards. She says the sensation to her nipples has actually increased after the procedure (hard to explain but this certainly is favorable to her). I show her in her bra because it is a very good one that fits well and supports her breasts from moving either down or out to the side. She was fitted professionally and wears her bra as recommended. She couldn’t be happier with her results.
Age: 31 Breast Augmentation
This 5’1″ and 105 pound Asian female desired a breast augmentation. She was enhanced with 340cc saline implants placed under the muscle through an incision around her areola.
Asian patients have a tougher healing process. We chose a periareolar incision because it will usually be less noticeable than a poor scar below the breast. If a patient has an areola that is too small, it may not be possible to place an implant, particularly a silicone variety that is pre filled and needs a larger incision.
Age: 32 Breast Augmentation
This mother of three complained of deflated breasts after her pregnancies. She is 5’9″ and 133 pounds. On pre-operative evaluation I noted that she has small deflated breasts with collapse of the nipple-areola complex. The ribs beneath her breasts are actually concave (there is a depression beneath her breasts that make them appear even smaller). She has a relatively wide rib cage and her shoulders are broad (and beautiful!).
She is seen here after a bilateral breast augmentation with 450cc smooth silicone implants placed below the muscle from an incision in the breast crease. It was surprising that we had to use such a large implant but when we tried on the implant sizers in the office beforehand it was evident that she required a larger volume to work with her dimensions and to fill out the volume lost because of her depressed ribs beneath her breasts.
In the before and after photo comparisons we can clearly observe larger and fuller breasts. She has excellent cleavage and superior fullness. Look at the tan skin on the upper part of her breasts-this is what is exposed to the world the vast majority of the time. This is the area that benefits most from the superior fullness created with breast implants. Women absolutely love superior fullness. They don’t prefer however if this area has a crease or “step off” often associated with using too large of an implant or overinflating a saline implant or in some cases, using a high profile implant. With her hands held up you can see these early scars in the crease beneath the breast. When choosing pre filled silicone implants, the larger the size the larger the incision.
Age: 39 Breast Augmentation
This is a 39 year old mother of two who is 5’2” tall and 131 pounds. She was interested in a breast enhancement. She knew that she didn’t want a “breast lift” because she didn’t want the scars. Her pre-operative evaluation revealed significant breast and chest wall asymmetries. The left breast was larger and had a palpable central area of dense breast tissue that was quite different from the opposite breast. The left breast nipple-areola complex was also pointing much lower than the right side. Given the fact that she wouldn’t consider a breast lift my surgical options changed significantly.
She is seen here at five months post operative from a bilateral breast augmentation with saline implants (375cc on the right and 310cc on the left) as well as a breast tissue reduction of about 25 grams on the larger left breast. It was a difficult and challenging surgery because of her anatomy. She was seen in the office after surgery frequently in order to instruct her on the proper massage techniques on her breasts to mold them into good shape. There is a vast improvement on what she had before she saw me and she is very pleased with her result, but she isn’t perfect. Her right breast is firmer than her left side. You can see that the top of the right breast is more rounded than that on the left. There has been a tremendous “lift” associated with the breast implant alone on the left side. She enjoys the improved symmetry and superior breast fullness.
This case illustrates what can be achieved when my options are limited. She developed a contracture on the right side probably because this implant is subglandular (her muscle was very small and I was not able to put the implant below this small muscle). Subglandular implants contract more than submuscular. I also had to manipulate her fibrotic breast tissue in order to allow it open up around her implants. I believe this tissue manipulation increases the potential for contracture especially with subglandular implants. The bottom line in her case is that I was able to make the patient happy even though the results are imperfect. I am also pleased with how I was able to change the shape of her breasts with implants, tissue manipulation/reduction and post operative breast molding. Interestingly, she understands the “value” of a mild beast contracture because this actually helps stabilize the position of her implants. I told her that she can always come back in the future and I can perform and open capsulotomy (cutting into the scar around the breast to make the breast softer through her original incision). There is no guarantee this will work but in my experience it has often been very rewarding. We also discussed before any surgery that she can always elect for a breast lift afterwards if she feels this is needed to meet her goals.
Age: 46 Breast Augmentation
This patient, who is 5’6″ tall and 108 pounds, complained that her breasts “became flat after having kids.” She used to have small but perky breasts and now they are flat and deflated. She is seen here five years after a saline breast augmentation with 350cc smooth walled implants placed through an incision around the lower half of the areola and beneath the muscle.
One can clearly see an obvious improvement. The deflation is certainly gone and the shape is much better (she actually has a shape!). This implant size is larger than would be ideal in her case because she is so small, but she clearly has done well over the years. There is no visible rippling of the implant and the implants are sitting where they need to be and have not displaced downwards or off to the side. She admits to wearing a very supportive bra as recommended. The scar around the areola has healed relatively well. The larger the implant relative to the size of your breast, the more likely you will experience complications such as rippling and implant displacement. Despite all the precautionary information that I provide my patients it just seems that some patients do better with their augmentations than others (this is probably related to their better tissue elasticity). Sometimes it’s just better to be lucky.
In the patients own words: “I am extremely pleased with the results. I was very uncomfortable when I was undressed, particularly in front of my partner. I love how I look with any outfit I’m wearing…I definitely have more confidence, I even took my bikini top off on the Barcelona beach!”
Age: 24 Breast Augmentation
This patient is 5’4″ and 114 pounds. She came to me from out-of-state desiring a breast augmentation. Upon analysis of her breasts, I noted that she had a long upper chest relative to the position of her breasts. Her breasts were asymmetrical with high nipple-areola complexes on both sides. She has scoliosis of her spine (curvature) and rib asymmetries as well. She has significant sloping of her ribs on both sides (her breasts don’t sit on a flat surface, her ribs drop off at nipple level so that her breasts sit on a hill rolling down to the underarm area).
She clearly wanted larger implants than I felt was in her best interest. My concern is that because of her long upper chest, relatively lax tissues and lateral sloping of her chest that there would be a high probability that over time her implants would move down and laterally because of gravity. A smaller implant would be less likely to experience this problem. Because she insisted on a larger size, I modified the plan a bit. I chose a textured (not smooth but rough surface) implant that I hope would “stick” a bit and be less likely to stretch the pocket and result in implant displacement.
She is seen here at four months after a bilateral augmentation with 390cc textured saline implants placed through an incision at the bottom of the breast. Her breasts are sitting perfectly on her chest wall and are soft, although they don’t move much. She is extremely pleased with her result as she enjoys the size and the shape (particularly the superior fullness). She says that she is much more confident when she doesn’t have her clothes on and that she really looks much better in a bathing suit now. As always, an excellent supportive bra is critical to her success.
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