Breast augmentation is now the most common cosmetic surgery performed in the world! According to the American Society of Plastic Surgeons, approximately 300,000 of these are performed per year in the U.S. alone. It is estimated that nearly 3 million American women have breast implants. Since the “implant crisis” of the early ’90s, studies have been completed which show that there is in fact no association between breast implants and autoimmune or other diseases. With this reassurance, the popularity of breast augmentation has been steadily increased in popularity.

Why do women get breast implants?

Surprisingly, it is usually not to attract men or primarily for the appearance e of the exposed breast. Most women want breast implants to create a better body proportion and look good in their outfits. A lot of my patients answer that question by saying they just want to look normal. Relatively few outfits “off the rack” will properly fit a woman with very minimal breast tissue. An equal number want implants to restore the breast volume and shape they lost following pregnancy. Interestingly, husbands and boyfriends sometimes put up resistance because they completely misunderstand and assume their mate wants to be more attractive to other men. For many women, this is not even an issue. As a rule, breast implants are chosen for proportional and relatively natural-looking in the vast majority of my patients.

Can a woman choose any size or shape she wants?

Every woman has her own unique starting point. Occasionally someone comes in with goals that simply are not possible with their tissues. I spend a lot of time with my patients teaching them about their own anatomy and their own range of possible results. The compliance or (elasticity) or each woman’s skin and the size of her rib cage establish the limits in the size of implants she can accommodate. When you try to exceed those limits the result is often a tight, unnaturally round breast which I think is a poor trade-off for greater size. On the other hand, if the tissues are loose, deterioration in shape and sagging can occur with overly aggressive augmentation. We have a really effective system of sizing in which I precisely measure each patient’s ideal breast diameter and match it up what a range of appropriate implants, using reference charts. The most commonly used implant comes in 16 sizes. Usually two or three different sizes are available to most women to offer a range of possibilities that will look right on their body. We then help our parients try on each of her choices with pre-filled sizing implants in an unpadded bra and she can choose the size she likes best. This step is done by one of four members of my staff, and all of them have breast augmentations which I have performed. This is usually a lot of fun for the patient. She can try the sizers with different outfits. Patients often bring their husband or boyfriend for their “vote!” Once the size is selected we try to show results that are realistic for that individual using hundreds of “before and after” pictures of my patients .

Why are there so many different breast implants?

In an attempt to create the ideal breast, a number of different implants have been developed. Anatomically shaped or “teardrop” implants were devised to try to create a more naturally shaped breast, but many plastic surgeons don’t consider this successful. Anatomically shaped implants have a rough textured surface which keeps them from shifting position by adhering to the adjacent tissues, but the texturizing process requires a thicker implant, which can feel stiffer and move less naturally. Many plastic surgeons have abandoned anatomically shaped implants completely. I have found that a naturally shaped and softer feeling breast can usually be created using smooth-surfaced implants which are thinner and more pliable. Smooth implants are round in shape but different breast contours can be created by adjusting the fill volumeof saline implants or choosing from 3 different “profiles” using silicone gel. Each individual has their own starting shape which defines and limits their choice. We will spend time during your consultation listeninmg to your hopes but before you leave we will work to be sure your expectations are realistic in term of what is possible with your starting anatomy.

Silicone gel implants are generally softer and more natural feeling that saline implants. This is especially important in women with minimal breast tissue. Round silicone implants appear to shift in shape more like real breast tissue too. In my practice over 90 of our patients choose silicone gel implants over saline. Sometimes women with saline implants will have subtle rippling, which can be felt through the skin and occasionally is even visible. Silicone gel implants will often prevent or minimize this rippling.

Do you use the same method of breast augmentation on all of your patients?

Absolutely not. There are number of choices and it is very important to consider each individual’s unique starting anatomy, their specific goals and their history. Implants can be placed below or on top of the pectoral muscle. Every patient has her choice. Occasionally better shape can be obtained with implants placed on top of the muscle. Most patients select placement under the muscle, however, because the mammogram us usually more accurate and the additional layer of tissue covering the implants decreases the likelihood of seeing of feeling implant ripples. I also believe that with submuscular implants the upper pole contour is better, especially in thin women with very little breast tissue. I still use some anatomically shaped implants for certain breast shapes but more commonly prefer low, medium or high profile round implants to offer a wider variety of options. High profile implants may be a good choice for someone with a narrow chest who wants larger breasts. I also still use surface textured implants occasionally is I’m performing corrective surgery for capsular contracture, which is unnatural hardening of a previously augmented breast by the patient’s own excessive formation of scar tissue. It’s important to be able to vary your technique and to have a good understanding of each of the available implants, especially when performing corrective surgery.

Do you see many patients for secondary or corrective breast augmentations?

Yes I do, and it has become an area of special interest to me. We have so few laws regulating our specialty that any physician can legally perform these procedures with no formal training in plastic surgery. Gynecologists are now doing them in the Dallas area. Insufficient training can result in a lot of avoidable problems. One way to be more confident about your choice is to confirm that your doctor is a plastic surgeon who is certified by the American Board of Plastic Surgery. Nonetheless, even with proper training, if a breast augmentation is rushed or performed without meticulous attention to detail there are many potential problems with final shape or symmetry. Many of the corrective surgeries I have performed appear to be very dramatic, but technically, only involve refining or finishing up underdone operations and placing correctly sized implants. Others are more technically challenging and involve reshaping the breast tissues using a variety of breast lift procedures in addition to corrective augmentation. I especially love these challenges because they are artistically interesting and no two are the same.

What is The Mommy Makeover and how does it complement breast augmentation?

It’s pretty common to see patients with multiple areas they’d like improved. A lot of the breast changes we see following pregnancy are accompanied by unwanted changes in the abdomen, hips, and thighs. It’s very common in my practice to perform abdominoplasty (or tummy tuck) at the same time as breast enhancement. Even before pregnancy, fat accumulation in those same areas can often be improved by sculpting away the bulges with liposuction. Total body contouring or “Mommy Makeover” are terms we use to describe the process of analyzing the relationship between different areas and developing a plan to improve overall proportion which enhances the entire body. Interestingly, I even combine breast surgery with facial cosmetic surgery, especially enhancement of the nose, eye and lips. After 12 years in practice, one of the things that keeps it fun and challenging is this variety. Every individual is different and requires a unique approach. That’s the art of plastic surgery.