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| Browse questions and answers on topics that are hot right now. |
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| Breast Enlargement: Too Many Choices? |
| By Paul G. Pin, MD Dallas, TX |
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Every woman having breast augmentation wants to make sure she has the best possible operation and achieves the best possible results. Though the basic idea of breast enlargement is simple, there are many factors to consider, and a simple idea can become quite confusing. Obviously, one wants to be bigger, but by how much? Alteration in shape is another goal, but what shape?
When discussing breast augmentation with a patient, I try to limit confusion by helping each woman define their goals. There is no one perfect breast for everyone, as every woman has preferences regarding size and shape. Therefore, each operation needs to be tailored to meet an individual patient’s needs.
There are five basic variables I then discuss with each woman as part of her preoperative planning:
- Implant Size;
- Implant Shape;
- Implant Surface;
- Implant Position (relative to the pectoralis major muscle); and
- Incisions.
Implant Size
The issue of implant size is inherently tricky, as women naturally think about breast size in terms of cup size, while breast implants themselves come in discrete volumes measured in cubic centimeters. In other words, implant volumes do not directly relate to bra cup size. For instance, an obvious problem is that a 300cc implant might result in a C cup size in a small woman, but only a B size cup in a large woman.
To circumvent this issue, we go over pictures of augmented women, and I ask the patient to identify those most closely to her ideal, as well as those that are unappealing. By knowing their body size and their goals, I can use my experience to select the appropriate implant size.
Implant Shape
As with size, most women have a preference when it comes to breast shape. However, while some want a gentle slope to the upper part of their breasts, others want upper breast fullness. To help accommodate these preferences, breast implants come in “tear drop” shapes for a more flat upper breast and a round shape for a more prominent upper breast. Generally speaking, tear drop shaped implants tend to look more natural, more quickly, in patients with very little breast tissue. Round implants tend to be favored by women who have had children and have preferentially lost volume in the upper portion of their breasts.
A final shape consideration is cleavage. Tear drop implants tend to be narrower than a round implant of the same volume. When patients tell me cleavage is important, they will usually be happier with a round implant.
Implant Surface
Breast implant surfaces can be textured (rough) or smooth. Textured implants are designed to ensure breast softness after augmentation. Among saline implants, a textured implant is about 5% to 10% more likely to remain soft when compared to a smooth surfaced implant. Additionally, textured implants do not need to be massaged or moved to maintain their softness.
Texturing, unfortunately, comes at a cost. Texturing causes the implant to adhere to one’s tissues (breast or muscle) and is more likely to result in rippling of the overlying skin. A textured implant is usually easier to feel than a smooth implant.
To confuse matters further, all tear drop implants are textured to help maintain their orientation. Thus, implant shape and surface are somewhat interrelated.
Implant Position (relative to the pectoralis major muscle)
Saline implants have proven to be safe and reliable. However, due to the lack of viscosity (thickness of the water), saline implants can cause rippling of the overlying skin in thin patients. To reduce or eliminate rippling, saline implants are frequently placed beneath the pectoralis major muscle. The main consequence of this is that the surgical procedure is more involved, requires general anesthesia, and results in more significant early postoperative pain. However, in most patients, the long-term results are better with subpectoral placement of the implants.
Incisions
Implants are generally placed through an incision in one of three places: 1) inframammary (the fold under the breast); 2) periareolar (beneath the nipple); or, 3) through the axilla (or armpit). Implant placement through the axilla obviously leaves no scarring on the breast. The problem with this incision is it is the most difficult to ensure proper placement of the implant. Periareolar (beneath the nipple) incisions easily result in an excellent scar; however, frequently patients are intimidated by this incision being so close to their nipple.
The most common incision used in breast augmentation is an incision in the fold underneath the breast. While this incision is on the breast, it is extremely difficult for anyone to see once the breast is augmented because the breast basically covers the incision.
There is a fourth way to do breast augmentation, which involves an incision near the navel or belly button. Generally speaking, this type of procedure typifies gimmickry in plastic surgery. While it is possible to do a breast augmentation through this incision, in general, it has significant limitations, and the complications which can predictably ensue, meaning implant dislocation, are much more difficult to treat following this procedure. A scientific problem with this operation is that the implant cannot be placed beneath the pectoralis major muscle. For this reason, this is not a procedure I do as it simply does not efficiently accomplish the goal of breast augmentation.
After explaining each of the choices to a patient, most patients generally have one clear preference and this is the approach that is selected for them.
As you can see, there are many choices to make regarding breast augmentation. I strongly encourage patients to take the time to define their goals and make choices which seem most right for them. To me, patients who are the happiest with their breast augmentation are those who felt they helped select their final results.
Breast augmentation is real surgery and involves risks such as bleeding, infection and scarring. Results will vary and your expectations and risks should be discussed with a board certified plastic surgeon.
Paul G. Pin is a plastic surgeon board-certified by the American Board of Plastic Surgery who practices in Dallas, Texas.
Getting Started
If you are considering a cosmetic medical procedure, consult a board-certified plastic surgeon about the process, risks, recovery time and costs. For confidential, personalized information at no cost or obligation, use the Find A Specialist tool to find a board-certified plastic surgeon near you. It’s your first step to looking and feeling better today!
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