What is your desired breast size?

Most women tell their plastic surgeon, “I want to be a full C”.  But does anyone really know what that means?  The truth is, there is not standard measurement for cup size.  Thus cup sizes can never be predicted since a C bra at Victoria’s Secret may be a different size at another store.  The best way to convey size is by showing photos of desired breast sizes and “trying on” implants in the office with a sports bra and a t-shirt.

What is the best incision for your breast augmentation?

Incisions for breast augmentation include the armpit (transaxillary), just above the breast fold (inframammary), around the areola (periareolar), and through the belly button (transumbilical).  The “best” incision must take into consideration the following things:

Scar location – Ask yourself, where would I be LEAST happy with a scar I don’t like? (Yes, scars can be revised for improvement and some people scar well and others scar poorly).  A well healed scar on the border of the areola is often not very visible.  But  a poor scar on the areola is much more visible than a poor scar in the breast fold or armpit.

In addition, some incisions don’t accommodate silicone breast implants.  Silicone breast implants cannot be placed through the belly button.  Large silicone implants may not fit through a periareolar incision or armpit incision.

It should be noted that in darker pigmented women, scars along the areola can darken and be obvious.  In women with fair skin and light eyes, incisions anywhere tend to be very difficult to see.

Other considerations for incision placement is the type of breast surgery being performed such as a lift or capsulectomy or capsulotomy (removal of internal scar tissue around the implant).

Which breast implant should I choose?

Breast implants come smooth or textured, shaped, or round with a variety of profiles.  “Profile” refers to the amount of projection versus diameter for any given volume.  For instance, 375 cc with a smaller diameter (width) will have a larger projection from the chest wall than a 375 cc implant with a wider diameter.  While higher profile implants do offer more projection, they sacrifice this for width and cleavage.  Meaning, high profile implants may generate less cleavage than moderate profile implants.

Textured breast implants are coarse.  They have the benefit of reducing capsular contracture rate, which is the development of internal, exaggerated scar tissue around the breast implant.  Capsular contracture can develop into malposition of the breast implant, hardening of the breast, and pain.  The disadvantage of a textured breast implants is that it may show more “rippling” in small breasted women. They may also not drop as quickly as smooth implants.

Plastic surgeons will take measurements of the breasts to help guide the best “profile” choice for a given desired volume.  While measurements do help, they aren’t typically going to apply to hard fast rules.  But generally speaking, implants bigger than the breast can easily tolerate (based on tissue properties and measurements), the higher chances or problems developing down the road such as bottoming out, malposition, and rippling.

What is the best placement of the breast implant?

The advantage of placing a breast implant under the muscle is that it provides more padding to some of the implant to reduce the chance of implant visibility (in the form of rippling).  The other advantage is that studies suggest that breast implants placed under the muscle have a lower incidence of forming capsular contractures. Knowing this, then why would anyone place a breast implant OVER the muscle?

A breast implant can be placed over the muscle to eliminate animation deformities (breast implant movement) from the pectorals major muscle contracting in women who do a lot of upper body exercise.  However, with sub pectoral placement (under the muscle), it is rare to see significant implant movement with regular activities if at all.

Placing the implant OVER the muscle *may* lift the nipple a bit more in a very specific type of breast.  One way a plastic surgeon can achieve this advantage while still placing the implant below the muscle is through a “dual plane” approach.  Here, the plastic surgeon will elevate the breast off the muscle but still place the implant below the muscle.

One last thing to consider is mammography.  Breast implants placed over the muscle in a subglandular position may make it more difficult for radiologists to see 100% of the breast. Some claim that up to 10% of the breast isn’t visualized with a subglandular breast augmentation.

These are just some of the things to consider when one is interested in a breast augmentation.  Other things you want to review with your doctor are risks, benefits, and alternatives. For more information about breast augmentation, please visit this link.



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