For many years one of the most popular pages on our website has been Breast Augmentation 10 Things You should Know. Patients often remark to me that this list has helped them gain an understanding of the operation and that it includes material that is not found on most plastic surgery websites.
I realized that it is time to release a new list of things to know about this popular surgery. The list comes from my experience of having performed several thousand breast augmentations surgeries. It is fair to say that I have a distinct bias toward naturalism in my work as a plastic surgeon, but no matter what your taste I think these questions will help you prepare for your consultation.
1. Naturalism is important is breast enhancement surgery
The goal should be to create a breast that looks and moves naturally, both in clothes and out of clothes. In my opinion very large implants don’t look natural and tend to accumulate problems over time. If your surgeon adheres to artistic principles and uses good technique your implants will very likely last 20 years or more before they need to be replaced.
2. Round implants don’t look round if they are positioned properly
For the vast majority of my patients, I make use of so-called “round” silicone gel implants under the pectoral muscle. Since the muscle drapes across the upper portion of the implant, it causes the implant to take on a teardrop shape, with greater fullness in the lower portion of the breast. There is much to be said for the simplicity of round, smooth-surface implants since even if they rotate, the shape of the breast remains the same.
3. Ask about the warranty associated with your Implants
There are several manufacturers of breast implants, and each has a different warranty. Issues to look at include the length of the warranty, specific conditions in which the warranty applies, whether there is an additional cost to obtain a longer warranty, and whether the opposite implant is covered if one needs to be replaced.
4. Incisions in the fold under the breast have advantages, especially if more sophisticated techniques are used
A great deal of attention is placed by some patients on the location of the incision for breast implants, but this has less impact than the technical skill and judgment of your surgeon in determining the quality of your result. The simple truth is that most incisions for breast implants tend to mature over time and become quite inconspicuous, no matter what their location. If more sophisticated techniques are required as part of your surgery, the inframammary approach provides the best visualization. Techniques such as repositioning of the lower portion of the pec muscles, resetting of the lower pole of the breast, and release of the lower part of the breast can be accomplished most accurately through an inframammary approach.
5. If your breasts have lost tone due to pregnancy or weight loss a repositioning of the pectoral muscle can be very helpful.
If your breasts have been emptied of their structure due to pregnancy or weight loss, a simple augmentation under the pec muscle may result in a breast that tends to have a double contour, one formed by the implant, and the other formed by the original breast structure. Some surgeons refer to this as a “double bubble.”
One strategy to avoid this is to place the implant on top of the pec muscle and under the breast, but this can have its own disadvantages.
A very good approach that I have used for years in breasts like this involves a repositioning of the pec muscle so that it covers a little less of the undersurface of the breast. This allows the implant to nicely fill out the lower portion of the breast but retains the advantage of having the upper portion of the implant covered by the muscle.
6. There are several good ways to help you visualize your result from the surgery
In my practice at The Whole Beauty® Institute, we help our patients in 3 different ways to understand how their breasts will look after surgery.
3D computer visualization has evolved significantly in the last few years to where it is reasonably accurate in its approximation of the results that will occur from breast implant surgery. It is now possible for our patients to “try on” different implant shapes and sizes with the help of the computer program.
We also make use of custom breast sizers that our patients wear inside a gentle stretch bra. These sizers are not simply breast implants, which often tend to overstate the results of surgery. Instead, our sizers follow the natural contours of the breast and give a better sense of how you will look with implants.
We also have an extensive collection of before-and–after pictures that are arranged in a way that enables us to find patients who have a similar body shape and breast size to your current condition. This will allow you to see how implants have worked in patients who are similar to you.
7. Breast augmentation is about much more that the selection of a particular implant.
A beautiful result from breast augmentation surgery comes from a combination of factors. The size and shape of the breast implant is only one of those factors. There are many other issues that I consider when I examine a patient for breast surgery. These include the fundamental dimensions of the breast, the structure of the breast, the history of the breast, and the relation of the breast to the other contours of the body. Every plastic surgeon with a large experience in breast surgery also draws upon a base of experience that allows him or her to predict how a particular implant will behave in your particular body form.
8. For some patients, the results of breast enhancement surgery can be complemented by other forms of body contour surgery.
A beautiful breast is beautiful in its own right, but its beauty is enhanced if the contours of nearby regions of the body are also at their most refined. This often comes about when a person optimizes her patterns of nutrition and exercise, but sometimes there are resistant areas in the abdomen and other body zones. If this is the case liposuction, or other forms of abdominal contour surgery can create a beautiful frame of reference for surgically-enhanced breasts.
9. Surface texturing of breast implants has advantages and disadvantages
Some breast implants are manufactured in a way that the outer surface of the implant has a rough texture, almost like sandpaper. Different implant manufacturers have different ways of achieving this effect.
The original purpose of surface-textured implants was to reduce the frequency of capsular contracture, the hardening that occurs if excess scar tissue forms around an implant. More recently with the advent of shaped implants (form-stable, gummy bear), the texturing helps to keep the implant in the proper position. When these implants have smooth surfaces they tend to slip out of position.
We must also consider the disadvantages of textured implants. First of all, they are more prone to rippling, and some surgeons are concern that this might lead to long-term weakness in the implant shell. There is also a very rare condition known as ALCL, which may be more common in patients with textured implants.
10. Breast augmentation surgery is optimized when the patient and surgeon have similar tastes.
There are different surgeons for different patients. There are some plastic surgeons that routinely place extremely large implants in their patients. I am sure these patients initially are quite happy with their results because that is what they are looking for. I’m personally not too keen on these results because they call out to the world that the breasts have been “done.” I also think that these very large implants are almost a guarantee that the patient will under another or perhaps several surgeries down the road.
For my part, I have a naturalistic bias in every surgery that I do, whether it is the face, breast, or body. My goal is to attract patients with a similar naturalistic bias.
This does not mean that I only put in small breast implants. Instead, I carefully consider each patient’s preferences, breast architecture, and body form and present her with a range of choices that will allow for a result that is similar to a natural breast.