Breast Augmentation
This patient requested a breast enhancement. She wanted “more and a big, better shape.” She is a mother of two and is 5’4″ and 155 pounds. She is a patient on whom we performed a “mommy makeover.” This included a large liposuction on the first stage and an abdominoplasty and breast augmentation on the second about six months later. She was augmented with 500cc silicone implants placed through an incision below the breast with the implant under the muscle.
She is seen here three years later. Her breasts are certainly larger and still very shapely. Interestingly enough, when I asked her what about her breasts could be better she basically told me she wanted them “larger, firmer, and lifted.” This was interesting to say the least. Fortunately, I convinced her that she is a very lucky woman and that I didn’t recommend any additional “improvements” as this would result in scars and the potential for complications. We both smiled and went on with life.
Age 28 Breast Augmentation
This is a 28 year old female who is 5’7” and 200 pounds who came to the office with a wish for better breasts. She wanted to lose weight and be healthy. Her preoperative photos illustrate a classic case of “tubular breast condition.” This is not a deformity per se, just a situation that leads to breasts that appear narrow, with enlarged areola and usually with extension of the breast tissue into the areola (herniation of the breast tissue into the areola). The breast tissue is usually quite firm and localized to a small area beneath the nipple-areola complex and the “lower pole” or bottom of the breast is constricted (short) compared to the “normal.”
There is no doubt that “funny looking breasts” are not a desirable attribute. Many women come to my office with “different” breasts, and they would initially have me believe that it isn’t a big deal, but in short order, it becomes quite apparent to me that it is a big deal (as you would reasonably expect).
She is fuller figured with narrow breasts that sag, she has no cleavage, and her breasts are small for her larger frame. The main goal is fuller breasts that fit her figure and breasts that are shaped better. There are many alternatives to achieve this goal and if you visited with seven plastic surgeons you will probably come away with four different recommendations. There is no correct and incorrect way to treat this condition but an experienced surgeon will always give you better advice.
She is young. She has good skin. If I am able to add an implant to give her fullness and proportion, to “splay” the constricted breast tissue surgically and massage her aggressively afterwards to make the tissue conform, and mold around the implant, she would notice a nice improvement without a lot of scars. At the very least, it will set the stage for additional procedures that can be performed once a “stable foundation” of the breast is established. I saw no need for an immediate lifting procedure because I knew I could mold her into a very satisfactory shape without a lift.
She was enhanced with 450cc silicone implants placed above the muscle with treatment of the constricted breast tissue so that it “opens up” and is less narrow. Sometimes this can result in a “snoopy” breast where you have a round mound with a smaller one on top of it. This has been avoided by postoperative massage to essentially mold the breast tissue on top of the implant. I chose the subglandular position of her implants because she has thick tissue and good skin and the ability to shape the breast in her case will be easier with the implant in this position. However, this puts her at higher risk for breast contracture.
She has lost twenty pounds since her procedure and seems like a totally different young lady (in a very good way).
Age: 25 Breast Augmentation
This patient, 5’3″ and 110 pounds is the mother of one child. She was interested in a breast enhancement. She says that her breasts became huge with her pregnancy and then deflated to almost nothing. She is relatively thin with asymmetries in her breasts and her underlying ribs and chest wall. She has thin skin and stretch marks. She required a much larger implant than normal in order to make her look like she has some volume.
She is seen here at five months after her enhancement with smooth silicone implants, 350cc on the right and 325cc on the left (to compensate for her chest wall differences). You can see that she has some differences in the appearance of her breasts but this is consistent with her preoperative asymmetries. It’s imperative that she wear an excellent bra because her thin stretched skin and larger implants are no match for the weight of her implants.
Age: 30 Breast Augmentation
This woman, who is 5’3″ and 100 pounds was interested in a breast enhancement because she “simply doesn’t have any.” She is seen here after a 275cc silicone enhancement with implants placed beneath the muscle through an incision below the breast.
She is very pleased with her results and wishes she had gone larger. She says that she loves trying on clothing now, enjoys the ability to wear strapless dresses, and that her self esteem and confidence have been improved tremendously. She simply feels more like a woman. She is very aware of the need for a perfect fitting bra for long term shape maintenance.
This is an impressive result by any measure. The beauty and magnificence of her breasts are not realized in the photos as much as they are in person. An important educational point to consider is that these implants are about as large a size as she can handle (she is tiny). Larger implants will only work against a patient in the short and long term by thinning and stretching of the tissue and moving lower and more laterally. All these negative consequences compromise your result potentially leading to dissatisfaction and revisional procedures. Rule number one is choosing a breast implant that FITS your breast.
Age: 32 Breast Augmentation
This mother of two was considering a “motherhood makeover.” With regards to her breasts, she had small C cup breasts with associated breast ptosis (sagging). She was adverse to the scars of a mastopexy augmentation procedure which, in my opinion, would have made her breasts fuller, higher, and tighter. She is seen here about five months after a breast augmentation with 300cc silicone high profile smooth implants placed beneath the muscle from an incision in the breast crease.
I also performed a full body liposuction at the same time which makes her abdomen and chest look smaller relative to her breasts. Her breasts are certainly larger and more lifted in appearance. There is some looser tissue at the bottom of her breasts as we expected because the augmentation alone can only provide for a modest amount of lift. She likes the larger size of her breasts, which is even more so when you consider the liposuction of her body made her much smaller. I chose to use high profile implants because it will provide for more lift, more superior fullness and it will narrow the appearance of her breasts (oftentimes post pregnancy breasts that are larger are also wider and more matronly in appearance and narrowing the breasts creates a more youthful breast).
You can see her body photos under the liposuction category. A reduction mastopexy procedure can always be performed as a secondary procedure if she so desires, but she has been extremely happy with the improvement obtained with an implant alone, particularly with the fullness in the upper part of her breasts. It takes a lot of experience for your surgeon to predict what your breasts will look like with an implant alone without a lift. If the tissue quality is poor and the skin is very lax, a lifting procedure may be needed for the best result. If your goal is higher and tighter breasts, a reduction augmentation procedure is often needed (look under the mastopexy category).
Age: 45 Breast Augmentation
This is a 45 year old woman who is 5’7″ and 120 pounds. She was from out-of-town and was interested in a breast augmentation. Upon examination, she is quite thin with very flat, involuted (collapsed) breasts. Her breasts and underlying chest wall are asymmetrical. She is seen here after a bilateral breast augmentation with 350cc silicone smooth walled implants placed in the crease beneath the breast. Theses photos were taken at seven weeks after her procedure.
There is an immediate improvement that is obvious: she finally has breasts; they are fuller, more proportional, and without the “sad” appearance. She has gone from having no assets to having wonderful assets. She is very pleased. They are soft, symmetrical, and she is enjoying shopping for clothes that she never would have considered before.
Her bra size history is such: She says she was a 36A before she had her surgery. She came to my office after her surgery wearing a 34C and after I sent her to Petticoat Fair to get professionally fit, she returned the same afternoon with a 32DD! The vast majority of women do not wear the correct bra-this is a fact. I can tell you that the main problem is that they choose a band width that is far too large. The smaller the band width the larger the cup size. Also, it should be known that nowadays the new C is a DD. This has to do with the bra manufacturers and their measuring system. A proper fitting bra is discussed at length in my Breast Augmentation Article.
I see many patients from out-of-town as well, and from all over the country for that matter. This takes more coordination for obvious reasons. Patients will send me photographs and we will talk with them to determine if the procedure they are interested in is appropriate, and whether I think we can perform it without compromising their care or results considering the distance issues. Some procedures are more easily performed on out-of-town patients than others.
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