Breast Augmentation Basics
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What is a breast augmentation?
In this post, we discuss breast augmentation with saline or silicone implants. – the most popular type of augmentation. Implants allow a predictable breast enhancement in all body types. Breast augmentation is often performed to replace volume lost from weight loss, breastfeeding, or age or to increase the size of the breast for aesthetic reasons. It is most appropriate for patients with breasts that don’t sag (normal ptosis). In patients with breasts that sag, the need for a lift is determined by your current nipple position and the quality of your tissue.
A breast augmentation can also be performed using fat harvested from other parts of the body using liposuction – Brazilian breast augmentation. The results from a fat augmentation are less predictable, however, and work best for slightly overweight patients looking for a modest augmentation.
If using your own fat to augment your breasts sounds intriguing, check out: Breast Augmentation With Fat.
Where are the implants placed during a breast augmentation?
The implants can be placed over (sub-muscular) or under (sub-glandular) the pectoralis muscle. Advantages to sub-muscular implants include a lower risk of capsular contracture, lower chance of rippling, better coverage in thin women, and perhaps a more natural upper pole contour. Implants placed under the muscle can, however, be influenced by the contraction of the pectoralis muscle – especially in very athletic women.
Implants placed over the muscle, in contrast, are more visible. This results in larger-looking augmentation and a sharper transition between the natural breast and the edges of the implant resulting in a more done look. Additionally, in thin women, the folding of the implant in the sub-glandular pocket can manifest as rippling of the skin.
What kind of incisions can I expect?
There are a variety of implant types, shapes, and styles, and the implants are most often inserted through one of two different small incisions. These include 1) an incision around the lower half of the nipple-areola (peri-areolar), or 2) an incision in the breast crease between the breast and the chest wall (infra-mammary incision). The choice of incision is based on multiple factors including surgeon preference, patient preference, patient anatomy, and/or type of implant.
What is the recovery like after a breast augmentation?
After surgery, the breasts swell from the trauma of surgery and the tissues become edematous. This combined with the tightness of the skin and the squeeze of the pectorals muscle on the implant can give the implants a high and flat appearance as the round implants are squeezed like a pancake against the chest.
As the swelling subsides and the tissues begin to stretch from the weight of implants, the breasts begin to settle. Over the next few months, the implants settle and the soft tissue and pectoralis muscle relax. The shape changes from high and tight to lower and fuller as the implants round out and more of the implant is in position to provide lower pole projection.
This “drop and fluff” often occurs over the first few months after surgery as the edema finally escapes and the soft tissues relax. This process is often asymmetric as the breasts relax and settle at their own rates. It will take 3 to 6 months to see a final result – although for some patients this process occurs faster.
Get more details on the management of swelling and scars in blog post: Post-Operative Care After Plastic Surgery.
What surgery is right for me?
A detailed examination will help delineate the best surgical treatment. The goal of breast augmentation is to create an aesthetic breast with the size, shape, and projection that is desired by the patient. The decision on the type of surgery and the size, shape, and position of the implants is based on the patient’s anatomy, the type and size of the implant, and the patient’s preferences.
During your consultation, measurements of the breasts are used as a starting point to recommend surgery and in-office sizing, and digital three-dimensional computer simulations are used to help guide your implant choices.
4 Surgeries With Quick Recoveries
One in five people seek out professional plastic surgery, particularly as they approach middle-age. Modern plastic surgical techniques, attention to detail, and meticulous follow-up allow the surgeons of DeLuca Plastic Surgery to offer patients a quick recovery from surgeries such as liposuction, breast augmentation, mini facelift, and rhinoplasty. A quick recovery with minimal bruising and swelling allows patients to get back to work and play faster.
Picture it. You wake up, head to the operating room, and are pampered by the operating room staff as you drift off to sleep. Only a few hours later you are back at home in your own bed watching Netflix. Minimal discomfort. Excited by the changes that have occurred. Yes. This is the new reality. There are a host of amazing options today. With advanced tools and technologies, a plastic surgeon can help shape the new you without breaking the budget. Consider these four fabulous surgeries to jumpstart the season…
Rhinoplasty
Need a nose adjustment? Rhinoplasty surgery—getting your nose reshaped—could be just what the doctor ordered. Rhinoplasty surgery is tailored to your individual needs – from total nose reshaping to a small hump removal. Post-operative recovery involves soreness and some mild bruising, however, in a week, you can be back in your office, tending to business as usual. And the clincher? A whopping 80-90% of your bruising and swelling with disappear within the first week! Total healing takes longer but, those are changes often only noticed by you (or you close friends). Remarkably, a great majority of patients have relatively mild pain. Exercise can be resumed after 2 weeks.
(more…)
Correcting Tuberous Breasts with Surgery
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What Are Tuberous Breasts
Tuberous breasts is a condition where the breasts form into a tube-like shape because of constriction at the base of the breasts during development. The breasts also tend to develop farther apart and unevenly than a normal chest. The breasts are often characterized by enlarged areolas and sagging. Although this condition may prevent a woman from breast-feeding, it doesn’t lead to any other pregnancy or fertility related issues.
Women with tuberous breasts may range from type one, which is the mildest to type five, which is the most severe. With type one, only the lower inside of the breast is constricted. In the most severe cases, the entire breast is constricted and can be physically deforming.
Impact of Tuberous Breasts
While having this condition isn’t necessarily a physical concern for health related reasons, it can be psychologically troubling to women who suffer from this condition. Many women tend to be self-conscious about their breasts, and shy away from intimacy, or are embarrassed to get undressed in front of their partner.
There are also other issues to consider for someone with tuberous & tubular breasts. Many women tend to have trouble finding bras or other undergarments that fit properly. Some women have to specially order their bras in order to support their breasts correctly.
Surgical Correction
The correction of tubular breast deformity is to augmentation with a lift surgery. For women who are self-conscious or frustrated about the shape of their breasts, a surgeon can correct the size and fill out the shape. The doctor can also thin the area around the nipple in cases where the areola is large or puffy.
Although the surgery is challenging, the surgeons of Deluca Plastic Surgery have a track record of being able to achieve beautiful results for their patients. It’s important to discuss the surgery and your expectations with your doctor before heading into the operating room, if you are considering this type of surgery. In many cases, surgery can correct this condition restoring the breasts completely.
Recovery
Initial recovery after tuberous breast surgery is about 2 weeks. During this period the implant position is managed and the skin is allowed to begin healing. Patients of Dr. David Tauber at DeLuca Plastic Surgery can often return to work or social engagements in 2-3 weeks. Physical activity and exercise are started at 4 weeks and patients are back to full activity without restrictions at 8 weeks.
Get more details on the management of swelling and scars in blog post: Post-Operative Care After Plastic Surgery.
Everything You Should Know About Breast Implants, Pregnancy and Breastfeeding
Breast Augmentation surgery appeals to many women who would like to change the size or shape of their breasts. However, women often worry about the procedure’s effect on breastfeeding and future pregnancies. It’s important to understand the risks and benefits while avoiding common myths.
Will Pregnancy Affect Implants
(more…)Do I Really Need A Breast Lift?
The decision to do a breast augmentation without lift versus a breast augmentation with a breast lift, however, is less based on patient preference and more dictated the saginess, the nipple position, and the ratio between the breast volume and the amount of excess skin that is present.
How Ptotic Are My Breasts?
The gold-standard method of assessing the need for a breast lift is the “pencil test.” Standing in front of a mirror, lift the breast and lay a pencil in the fold under the breast and allow the breast to settle over the pencil. Look at the position of the nipple in relation to the pencil.
The lower the nipples and breast are below the pencil and the more excess skin you have, the greater the chance you will need a breast lift and the more of a breast lift you will need. If your nipple and a majority of your breast are at or above the pencil (Normal), you will likely get a great result from a breast augmentation alone. Larger implants can shift this equation slightly for patients that have borderline ptosis (Grade 1).
(more…)Breast Q&A: To Breast Lift or Not to Breast Lift, With or Without Implants?
Perhaps the two most frequently asked questions I receive from women interested in breast enhancement surgery are:
- “Do I need a breast lift with or without implants?”
- “Can I get an ideal result with just breast implants?”
As with most operations, it’s always best to get things right the first time around. And when it comes to breasts, getting it right doesn’t typically mean looking great for only a few short years before the effects of gravity and time undue all the good work that was done.
So when I advise my mastopexy (breast lift) patients on what their options are for achieving the best and most youthful looking breast possible, I always make sure that they have a crystal clear understanding of what their surgery options are and how each option will look and feel over time (re: 1 year, 5 years, 10 years etc.) rather than just what they can expect to look like during the immediate post-operative period.
9 times out of 10, the best path forward is clear and the patient is in full agreement that the procedure’s pros outweigh any cons that may inherently be involved (e.g. a slightly longer incision in return for a stronger, more longer lasting lift).
Of course, not every breast fits perfectly into one of the the breast types described below, but most do, so hopefully readers will find the following example photos and procedure recommendations helpful and/or informative , especially if they are considering their options for a breast lift with or without implants/augmentation.
Breast Q&A: What’s the Best Way to Correct Grade 1 Breast Ptosis (Sagging)? Implant, Lift or Both?
Question – What is the best way to correct breast ptosis, high or moderate profile implants, a breast lift or both?
Breast sagging after pregnancy
I am 36 years old, breastfed 2 kids, and have lost volume in my breasts. I have some sagging but my nipple is still over the fold. I weigh 130 pounds and am very fit and toned.
I am 5″4″ and my breast size is a 34B. Before my kids I was a 34C cup. When I was breastfeeding I was a 34D cup. I would like to be a D cup and wonder what type of procedure would be best to correct my ptosis?
Answer – Since you have a small amount of glandular ptosis (pseudoptosis), you not only want to fill-OUT, but lift-UP a little as well. Therefore, my approach would be a dual plane breast augmentation, which would fill out the inferior/lower pole nicely, give you muscle coverage across the upper two thirds of the breast and a nice, slightly lifted appearance.
More specifically, given your body measurements and photo (which shows pseudoptosis with mild Grade 1 ptosis), I suspect that 450cc moderate plus profile implants are needed to give you both the breast size (D cup) and breast lift you desire.
How To Classify/Grade Breast Ptosis
Simply put, grade 1, 2 or 3 glandular ptosis, which refers to how far the areola is sagging below the inframammary fold beneath the breast, the lower attachment point of the breast to the chest wall.
- Grade 1: Mild Ptosis – The nipple is at the level of the inframammary fold, but most of the breast tissue is below the nipple.
- Grade 2: Moderate Ptosis – The nipple is located below the inframammary fold and below the majority of the bottom breast tissue.
- Grade 3: Advanced Ptosis – The nipple is far below the inframammary fold and points towards the floor.
- Pseudoptosis – The nipple lies above or at the level of the inframammary fold while the majority of the breast has descended below the level of the fold. This is not true ptosis, or sagging.
The degrees/stages of breast ptosis (drooping/sagging)
Breast Q&A: Will High Profile Breast Implants or Moderate Plus Give Me Natural Looking Breasts?
Question – Will High Profile breast implants give me natural looking breasts vs Moderate or Moderate Plus?
I am 5’4″ 125lbs, 31″ ribcage, 34C (wanting at least a DD) and my breast measures 13cm wide. I told my PS I wanted large, very nice looking (not high and ball-looking) breasts. He told me he will use a smooth, round, High Profile, 500cc silicone implant and it will look “very nice” with a “nice downward slope”. Everywhere on the internet says that high profiles don’t give a really nice natural look, and that moderate profiles do. Will high profile breast implants give me large, full, and natural-looking breasts with nice cleavage?
Answer – Although I use Moderate Plus or Moderate Profile prosthesis in the vast majority of cases, given your base width dimension of 13.0cm and your wanting a 500cc implant, a High Profile implant would be appropriate.
In answer to your question, it is not so much the size of the prosthesis that results in a ‘natural’ or ‘unnatural’ look but rather the surgical technique used in relationship to the pre-operative breast appearance.
If, on examination, your nipple to inframammary fold distance is 5.0cm – 6.0cm (meaning that the fold does not need to be lowered excessively), then a high profile implant can be placed in a position that provides adequate inferior/lower pole projection and avoids creating an overly round upper half of the breast (i.e. the “high, ball-looking” and ‘unnatural’ look you don’t like).
That said, there are many women who like the look of round, projecting breasts with upper pole fullness (high cleavage) – neither look is ‘right’ or ‘wrong’ so to speak, they’re just different. Every plastic surgeon has a certain aesthetic style they prefer (re: some aim for the most natural looking shape and size possible while other find the ‘high and round’ look more attractive), but at the end of the day, if the patient is clear about the way they want their breast to look after surgery, it’s my job as their surgeon to achieve it (within reason of course).
Breast implant profiles: high vs moderate plus vs low
Before diving into a few specific recommendations given the measurements you provided, here are my general thoughts on each of the 3 Mentor breast implant profile types:
Breast Q&A: Undecided – Lift vs Implants for Deflated Breasts
Question – Undecided, Lift or Implants. Surgery in 3 Weeks, Opinions Please
Hello. I have my breast surgery scheduled in June, however, am still undecided which route I should take. Would 500cc saline implants be sufficent to give me some volume, or will I end up with large, saggy breasts? If I decided to go just for a lift, my boobs will be tiny and scared. Hence, I’d rather go for implants even if I will have to get a lift 10 years down the road. I don’t want both surgeries, so it will be either tiny or big. What to do? I’m 40, 1 child. Thank you.
– via RealSelf.com
With deflated breasts, a lift + implant is needed for best result
Answer – For the best result possible, a vertical breast lift + submuscular, moderately sized implant is needed
In response to your question and based on your photos, this is not really a one or the other type of situation. You really need to have both a lift and an augmentation. If you do them separately you will probably not be satisfied with the eventual outcome. You have significant loss of volume, and if you were to only proceed with skin tightening all that would be accomplished is a higher position of the nipple areola complex. There would be no superior fill and an even smaller appearing breast mound.
Breast Q&A: Is a Perfect Breast Augmentation Result Possible in My Case?
Question – I think my “goal” photo = a perfect breast augmentation. Is it possible for my breasts to look similar after implants? Am I being realistic about what’s possible for me?
My plastic surgeon wants me to bring in pictures of what I want to look like after breast augmentation so he can be sure that he understands what “look” I like best. We’ve discussed this at my consultation; however I did not bring any pictures with me. My surgery is on the 5/26/2011. At my pre-op appointment, we will go into the specifics of the look/result I am hoping for. The first two pictures are “before photos” of my breasts and the third is what I believe is a perfect breast augmentation. The measurement from my collar bone to my nipple is 21 cm on both breasts. Am I being realistic? Thank you!
Patient provided two 'before' photos of her own breasts and one 'goal' photo
of what she feels are 'perfectly augmented breasts'.
Answer – For a similar result to the “perfect breast augmentation” look you like, a lift is needed.
I agree with my colleagues that it is difficult to compare apples to oranges since every breast has its own unique characteristics, but since the photo you chose as an example of your ideal postoperative outcome is mine, I will give you my thoughts on the situation. (n.b. here’s a link to the ‘perfect breast augmentation’ case you cited as an ideal result).
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