Are you confused and bewildered by media reports about breast augmentation? – or by friends who had vastly different experiences? If you need help making the right choices about breast augmentation, read on. The difference between average and excellent results can often be measured in fractions of an inch, so be sure to choose a plastic surgeon who is certified by the American Board of Plastic Surgery and who specializes in cosmetic surgery. A breast augmentation is an easy operation to perform (many are done by non-plastic surgeons) but is very demanding to perform with consistent artistry and beauty. The most difficult choice a woman faces is whether the implants are placed under the chest (pectoralis) muscle or on top of it. Many surgeons don’t offer a choice, and do all their breast augmentations one way or the other. It is my belief that the best surgeons will offer a thorough education during the consultation, so that each woman can select the option that’s best for her.

In short, breast implants placed on top of the muscle usually result in only minor discomfort and have a very rapid recovery. Those whose priority is the avoidance of pain or who only have time to take a day or two off will often select this option. Also, in women whose priority is dramatic cleavage, placing the implants on top of the muscle may better deliver the desired result.

There are compromises, however, and each woman must carefully weigh this decision since implants placed on top of the muscle may have a higher likelihood of becoming firm from the body’s production of scar tissue around the implant. This risk may be minimized by selecting a breast implant with a rough textured surface, but again, there are tradeoffs. Texturizing requires a thicker implant, which may feel slightly less realistic than a smooth implant and there also appears to be a higher likelihood of visible ripples on the breast surface with textured implants in very small-breasted women.

If one is willing to accept the higher likelihood of firm scar formation (contracture), advantages of the smooth surfaced implant include a softer feel due to the thinner implant shell, a more natural movement of the breast since the implant slides around more freely, less swelling early after surgery (the breasts appear to take shape more quickly) and some data suggesting a lower likelihood of implant deflation.

More of my patients choose the option of placing the implants under the muscle. The recovery varies but tends to be a little longer since some of the muscle fibers must be cut to properly shape the breasts. We can control this with muscle relaxers and pain medication and, although every individual is unique, most of our patients are really comfortable and resume many activities in a day or two and return to sedentary jobs within 3 or 4 days. Advantages of breast augmentation under the muscle are numerous and include a lower likelihood of visible surface ripples, less chance of the breast drooping with time (more a problem with very large implants), an apparent lower likelihood of developing breast firmness due to scar formation around the implant and greater breast visibility with mammograms, which may be an important issue if there is a strong family history of breast cancer. The tradeoffs of breast augmentation under the muscle include unnatural movement of the breast when the muscle is forcibly contracted and sometimes a slightly wider space between the breasts resulting in less cleavage in some women.

The final variable involves the use of anatomically contoured implants which can be placed above or below the pectoralis muscle. Rather than a round shape, these implants are sloped so that the upper portion of the breast is not so full. Anatomically shaped implants are not very popular today as they can shift position and generally don’t feel as soft and natural as smooth surfaced implants which are always round in shape. Round implants can be filled conservatively and also give a very naturally sloped shape. Nonetheless, anatomically shaped implants are useful in women with certain starting breast shapes to create a specific look. For a woman who wants a very round looking breast, we may use the high profile implant which offers more aggressive enlargement and is more spherical in shape.

There is no single perfect option in breast augmentation for everyone. Often, two very similar women will select entirely different options due to their completely different goals. With proper education, most patients will choose the right option for them. Breast size is selected based on careful measurement to achieve proper and realistic breast dimensions as well as the patient’s specific desires. Patients are encouraged to bring in pictures of models they find aesthetically appealing.

I often place implants in the patient’s bra during the consultation to confirm that we are in agreement regarding the appropriate size selected. We also have extensive catalogues of before and after photos to demonstrate the many options and possibilities.

Psychologically there are few procedures in cosmetic surgery which can so dramatically and positively affect a woman’s self-image as breast augmentation. Clothes fit better, proportion is normalized, and social confidence often soars. The careful selection of the proper breast augmentation can be a time consuming but rewarding process, and ensures the best possible results.

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2020 09 09
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