Breast Augmentation Q&A on RealSelf Mountain View

Q: How Long is Breast Implants Recovery Time?

I am a phys ed teacher and would like to get breast implants. I want a very natural look and do not want anyone to know. I am afraid that if I take additional vacation time either before or after winter or spring break, everyone will notice. Is it possible to be back to work after only a week of recovery?

A: Breast Implants, Breast Augmentation Recovery Time

Breast augmentation recovery with return to normal activity including driving takes about four days or less for 95% of my patients and three days or less for 85%. I recommend that patients keep their heart rate under 100 for two weeks. This keeps their blood pressure down and lessens the chance that they could have bleeding into the pocket after surgery. This seems to work since the incidence of bleeding or hematoma has been about 1/10th of one percent in the last 23 years. Sixty-five percent of patients have no bruising at all and another thirty percent have minimal or slight bruising.

Normal activity is defined as the ability to lift normal weight objects, raise your hands above your head sufficiently to wash your hair, and to drive. If you are a physical education teacher requiring aerobic activity you could certainly return to work, but I would advise against running around so much that your heart rate exceeds the rate of 100. You could have a period of brisk walking or similar activity, but followed by a rest so you stay at or under the 100 limit. This does not mean you would have a problem if you exceeded the limit, but as an arbitrary guideline, it seems to work. Patients with office-type jobs usually go back to work in three or four days, as soon as they feel comfortable. For example, with surgery on Friday, patients would go back to work on Monday or Tuesday. Patients who have to use their arms a lot, like restaurant servers, usually take five to eight days off, sometimes longer.

After surgery, my patients are advised to lift their arms overhead five times an hour. We start them in the recovery room. This helps hasten recovery by stretching out the pectoralis muscle. They don’t wear any special bras or have drains. Specific details of recovery can be found on my website. You should consult your own plastic surgeon for specific guidelines on when to return to work and return to any specific activity.

Web reference: http://enhanced-you.com/cosmetic-surgeon-services/breast-procedures-mountain-view/breast-augmentation-recovery/

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Q: How Much Do Breast Implants Cost?

I would like to get breast implants but before i do i would like to know about breast augmentation prices. How much do breast implants cost?

A: How Much Does Breast Augmentation Cost?

How Much Does Breast Augmentation Cost

Let us assume you want your procedure done by a very experienced plastic surgeon, one who has done thousands of procedures and has over 20 years of experience.

You also want your anesthesia to be provided by a board-certified MD anesthesiologist in a fully accredited outpatient surgical facility.

As you will read in the very comprehensive posts on this subject, the experience of the doctor, their track record in providing excellent results with a low rate of re-operation, and the geographic area in which they practice dictate the price range of breast augmentation.

For every area there is a “sweet spot” where excellent plastic surgeons can provide you with a quality breast augmentation at a total cost that is fair to you and allows them to earn a reasonable fee and cover their fixed overhead costs, the costs of the implants, and anesthesia and facility services. While overhead costs have gone steadily up, surgical fees have not.

My practice falls in this range with saline augmentations around 6400 and gel around 7400. This includes all pre- and post-operative visits, anesthesia and facility fees, implants and, in addition, CosmetAssure insurance.

CosmetAssure, endorsed by the American Society of Plastic Surgeons, is a first-dollar indemnity policy that covers the cost of complications for 17 different cosmetic procedures, including breast augmentation. The coverage is up to 6,000/day for as long as 45 days, for any complication that occurs in the first 30 days after a procedure. While such complications are very rare, it gives peace of mind, to know that the insurance is there.

We are all aware of the difficult economy and try to provide our patients with the services they want at prices that are affordable. Financing is available.

As you may have read in these posts, there is a national range from around 4800 to 18,000 for breast augmentation. While this range takes into account geographic variations based on the costs of providing the service, in any given area such as the Bay Area, there is no reason to overpay to have your procedure done by a very skilled and competent plastic surgeon.

On the other had, it is unwise to seek out the lowest cost procedure because that may make it impossible for you to get the services of a board-certified plastic surgeon. As you know, any MD can practice surgery, including a GP, an internist, or an Ob-Gyn. They are not trained to do this, and I and other plastic surgeons all too often see their patients for revisions or problems. They get away with this because they practice in office settings without peer review. They do not have hospital privileges to perform these procedures and would not be able to get them because they do not have the residency training that a hospital requires. It is possible that the facility or office is not certified to perform these procedures under IV sedation or general anesthesia, a violation of State law. This is another issue that you should check up on when you have your consultation or investigate the background of a potential surgeon.

These doctors cannot compare in training and skill with a plastic surgeon, certified by the American Board of Plastic Surgery. Many of our area plastic surgeons with a special concentration in cosmetic surgery are also members, as I am, of the American Society for Aesthetic Plastic Surgery, an educational society whose purpose is to maintain and increase skills and knowledge of aesthetic surgery.

A board-certified plastic surgeon will have undergone 3-5 years of general surgery training or more, followed by 2-3 years of residency training in all facets of plastic and reconstructive surgery, including cosmetic surgery. Many have post-residency fellowship training as well.

So when you make your decision to choose a surgeon, make sure your surgeon is certified by the American Board of Plastic Surgery. This is your assurance that your doctor is qualified to perform your surgery.

Web reference: http://enhanced-you.com/meet-mountain-view-plastic-surgeon-dr-lowen/

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Q: Care Credit – Breast Implant Financing Options

i talked to a plastic surgeon about financing my breast augmentation surgery. She said that Care Credit charged her exhorbitant fees so she wouldn’t take it. Since getting credit is really hard now days, are doctors more welcoming of Care Credit even if it costs them more? Will doctors make me pay more to use Care Credit?

A: Care Credit-Breast Implant Financing Options

Care Credit is a great financing program and has helped dozens of my patients have surgery that would otherwise been unable to afford it if they had to pay the full cost up front. The interest rate is currently about 14.9%, not cheap, but fairly standard for consumer finance compared to credit cards. You have to have a reasonably high credit score to qualify, but if you do you can finance the procedure over 2-5 years with monthly payments.

Web reference: http://enhanced-you.com/contact-mountain-view-cosmetic-surgeon/cosmetic-surgery-financing/

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Q: How Long Do Breast Implants Last?

I have had breast implants for 14 years and I am now developing a large rash under my left breast, and it hurts and I feel alot of air pockets. One doctor told me to replace them every 10 years and another told me you never have to replace them

A: How Long Do Breast Implants Last?

Breast implants can last a lifetime, but unfortunately there is no way to predict how long any particular one will last. We know from experience that current silicone gel implants are much more durable than ones placed twenty years ago.

When saline implants leak, you will usually know fairly soon that there is a leak because the breast will start to get smaller. Over a five-year study period in my practice, the deflation rate for saline implants was 0.4% per implant or 0.8% per patient/per year. This is in general accordance with the literature. To achieve these rates, it is known that saline implants should not be underinflated. For example, a 300 cc saline implant should not be filled to less than 300 cc. If it is, the deflation rate greatly increases. In practice, I usually fill saline implants about 10% above the nominal size. This keeps the shell from folding, decreasing the risk of shell-fold failure. It also makes a saline implant smoother and not so likely to feel ripply through thin skin.

The leakage rate for gel implants seems lower, with the Mentor core study showing a 0.5% rupture rate at 3 years. For re-augmentation patients, the rate was 7.7%. It was noted that the main reason for re-operation was capsular contracture. The core study found a capsular contracture rate of 18.9% over a 3- year period. Capsular contracture prevention is obviously a very worthy goal, but the exact cause of contracture is not known. Current theories point more and more to the colonization of the implant surface by bacteria that are found in breast tissue or on the skin. These bacteria protect themselves by forming a biological shield known as a biofilm. This film prevents the immune system’s white cells from fighting the bacteria. These bacteria are also resistant to commonly used antibiotics.

The use of an antibiotic and betadine solution to irrigate the pocket during surgery helps greatly to reduce the incidence of capsular contracture. The use after surgery of antibiotics effective against the particular organisms implicated in capsular contracture has also been advocated. A “no-touch” technique during implant placement means that the surgeon uses new powder-free gloves and touches nothing but the implant during insertion. This decreases the risk of getting bacteria on the implants. The use of the new Keller funnel allows placement of silicone-gel implants through a smaller incision without trauma to the implant as well as maintaining a “no-touch” technique.

Finally, a meticulous dissection with monopolar forceps cautery under direct visualization as introduced by Dr. John Tebbets of Dallas, and used in my practice for years, allows pocket dissection without any bleeding. Case studies have shown that having little or no blood in the pocket also correlates with a reduced contracture rate. I and others using similar techniques have noted capsular contracture rates for both saline and gel implants between 1-1.5% over a three to five year period.

The FDA ensures that women having breast augmentation are informed that implants are “not lifetime devices” and that re-operation with or without implant replacement “will be likely” during your lifetime. There is, however, no recommendation based on any studies that implants should be changed at any particular time interval, such as 10 or 15 years. If a woman is having no problems with her implants, then there is no reason to re-operate simply to change them.

To monitor your gel implants, an MRI is recommended periodically, since it can be difficult to know if a gel implant has ruptured by physical observation or examination. The treatment for a deflated saline implant or a “silent rupture” of a gel implant is to replace the implant. The replacement operation does not have the same recovery period as the initial placement, since the pocket is already formed. However, if years have passed since the initial operation and skin has stretched, or if a larger implant is desired, additional surgery on the skin envelope or breast pocket may be needed.

Web reference: http://enhanced-you.com/cosmetic-surgeon-services/breast-procedures-mountain-view/breast-augmentation-choices/

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Q: Breast Implant Sizes

I’m worried that if I get breast implants they will give me a top heavy look (my friend calls it the stripper look!), so, I’m trying to figure out what size breast implants should I get. Is there a rule of thumb or tips for choosing breast augmentation sizes? What are my options in breast implant size?

A: Choosing the Right Size for Breast Implants

There definitely is a rule of thumb for choosing the right size implants. Choose the size that makes you feel how you imagined you would feel if your breasts were always the size you wanted. Sounds simple, simplistic?

Let’s see what the process is for deciding what implant suits you. This is going to be a decision with long-lasting consequences and you want to avoid a re-operation just because you have found out after surgery that the size as not right for you. In the Mentor core study, at 3 years nearly 15% of re-operations were done for change of size or style). We want to avoid this.

First recognize that every woman is different in how she sees herself, and what is too small for one woman may be too large for another. When a woman first starts trying on gel implant sizers in the appropriately sized bra, she may be quite startled and even anxious about the difference. This is common. After a few minutes, the idea that this can actually be how you will look without artificial padding seems to overcome this initial reaction.

Your surgeon is trying to be sensitive to your feelings about what will work for you. Women commonly indicate that they want something natural, that they don’t want anyone to know they have had surgery, that they want to be conservative because of concerns over how they will be perceived by family, friends or at work. But again, this is not everyone. Some women are not “conservative”. They know what they want and if it is a larger look, they know that is what they will have. After all, this operation is for your happiness and satisfaction only.

The sizing always begins by taking measurements of your breast base width and evaluating your soft tissue envelope. These measurements set the reasonable limits for implant width. This can be done by direct measurement as I and most plastic surgeons do, or with a computer-imaging device. I have found that the 3-D tactile and visual information that women get from using the actual implants in the form of gel implants sizers is very important. This virtually ensures that the choice will not be too large or too small.

During the sizing process, what you tell us, as you feel more at ease, helps refine the eventual decision. Your preferences can be reviewed repeatedly by you alone or with feedback from a friend, relative, spouse or significant other. There is no rush.

For example, let us say your breast width is 12 cm. We know what size implants, both medium and high-profile will fit in that diameter (we rarely use low-profile implants). A computer-imaging device would show the same information.

We know from what you have told us so far which direction you are leaning, more conservative, less conservative. We encourage you to bring to the consultation several different items of clothing so you can see how you look in the clothes you usually wear.

Based on all this initial input, one implant size would be chosen to begin with. Sometimes the patient says it is the perfect size. But we know that sometimes when we give you the opportunity to try one “a little larger” that you may not see much difference and say that this one is “perfect” too. This process gives you the chance to try out how an implant looks and feels with no pressure whatsoever. A little bigger, a little smaller, until you know very well what implant size is just “too big” and which is “too small”.

Most women will narrow the size down to 1-2 sizes fairly quickly. They then have the opportunity to go home, think about it and look at the cell phone pictures that they may have taken to review or show someone close to them. If a woman has a moderate amount of breast tissue, we always tell her that there can be perhaps 10% loss of volume after a year, from the effect of the implant on overlying breast tissue. There seems to be a small degree of thinning of the overlying breast/skin envelope. Since 10% of an implant in the 250-400 cc range is about the same as the difference between two sizes, this information sometimes makes a woman feel a little bit more comfortable in choosing the larger of their two choices, slightly bigger rather than slightly smaller.

Two groups of women who seem to have the most difficulty in choosing the “right” size are the women who are very afraid of being too large and those who want to be quite large. The former tend to want implants in the 180 to 250 cc range. These are the smaller implants and are often chosen by slim or athletic women who definitely want to look natural and not be seen as having had breast augmentation. They are usually happy with the results, but in my experience are more likely after the surgery and living for some time with the implants, to feel that they should have gone bigger, or request re-augmentation with larger implants.

Women who are comfortable with the larger sizes, 400-500, are usually very comfortable with their choices. However I have noted that women in this group are also more likely after surgery to wish they had had a larger implant. It is important to realize that trying to place an implant that is wider than the internal breast base diameter is more likely to lead to stretching of the skin, numbness and eventual re-operation. Therefore, it is not recommended. Sometimes women who request a “D” cup find that they could have gone even larger. Since we never want to make someone larger than they wanted (a great source of unhappiness), we have to spend more time and more than one sizing session before coming up with the final decision.

If an implant that fits the base diameter is smaller than preferred, then the patient can see if she likes the look of the high-profile implant. A high-profile implants allows more volume in the same diameter than a moderate-profile implant. For example, instead of a 350 cc implant, the same width might accommodate an implant that is 450 or more. The difference is that the high-profile implant will not come out so far at the sides and will project forward more. Then, it is important to decide if the patient even likes the look of the high-profile implants. This is an individual taste, which is easily determined by trying on the different implant styles. We offer every patient the chance to see what she thinks of the moderate and high-profile implants. Some women immediately know that they do not like the look of high-profile implants, while some women find they prefer them.

In summary, whether the sizing is done by computer or by use of sizing implants, if a woman has the chance to both see and feel the implants, and feel that she is in control of the process, the outcome will be good. If there is uncertainty, particularly a lot of uncertainty, then it is time to step back and use the information gained in this sizing process to re-evaluate what one really wants. Sometimes, after sizing the patient becomes very energized and enthusiastic, and sometimes she needs to stop and think for some time. In the end, by giving yourself time to adjust to the potential new image, you are likely to be happy and not to have regrets about your size choice. The doctor and staff can help, but should be non-judgmental and supportive, and not try to influence you or try to make your decision for you.

Web reference: http://enhanced-you.com/cosmetic-surgeon-services/breast-procedures-mountain-view/breast-augmentation/

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Q: Best Breast Implants

i dont know whether to go big or medium, saline breast implants or silicone breast implants, under or over muscle. help!

A: What are the best breast implants for me?

Do not be daunted by the multitude of choices in breast implants, because they allow women with their own individual needs and desires to find the “best” implant, size, placement and incision for them.

Because this is a large subject, I have devoted several pages of my website to answering these questions, but let us give an example of how women typically proceed from initial questions, through their consultation, to surgery.

Let us say you are 40 years old, 5’4”, 120 lbs., have had 2 children, were a 34 C before pregnancy and are now a 34 B with somewhat loose skin. You are not sure how big you want to be, but you don’t want to be “too big”. You are different, then, from a woman who is 23 years old, 5’4, 120 lbs., who has had no children, is a 34 A/B, wants to be “fuller”, possibly a large C. You have studied saline and silicone gel implants and heard that gel feels more “natural”, but you have never actually felt one. You have read that to check for “silent rupture” or leakage of a gel implant, the FDA has recommended that you have an initial MRI three years after the implant was placed, and although you know this is a bit of an inconvenience and expense you would be willing to do it if you really wanted gel implants.

When you come in for your consultation, you will feel and discuss the differences between saline and gel implants. In thinner women, the saline implants will feel more “wrinkly” at the bottom and sides compared to gel implants. Your plastic surgeon will evaluate your soft tissue thickness and degree of looseness and let you know if this will affect the feel of gel or saline implants in your particular situation.

Placement below the muscle is done about 99% of the time in my practice because it offers camouflage of the implant by the muscle thickness in the visible upper inner part of the breast. But for women with more than an inch of thickness in the upper breast, above the muscle placement could also be done and still be covered adequately. Since there are other considerations involved with placement, such as ease of mammograms, and risk of capsular contracture, the final decision would be made based on your anatomy, preferences and evaluation of trade-offs.

For choosing the right size, it starts with you, your desires, your imagination, your particular psychology. What is right for you is your individual choice. I assist by discussing what you want; reflecting back to you whether what you want is compatible with the anatomy of your breast from the point of view of width of the breast, tightness or looseness of the breast and skin. You have the opportunity to try on the exact size implants in sizing bras, and after this most women will have chosen the exact size they will eventually have placed. There is a detailed discussion of “How Do I Choose the Right Size Implants” under my answer to this question on RealSelf, and on my website.

Don’t worry. You have taken the first step by asking these questions. With the assistance of your plastic surgeon you will arrive at the answers that are best for you.

Web reference: http://enhanced-you.com/cosmetic-surgeon-services/breast-procedures-mountain-view/breast-augmentation/

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Q: Mentor vs. Natrelle Breast Implants

The only brand of breast implants I’ve heard of are Mentor. Are these the best kind of breast implants to get and do lots of surgeons recommend them?

A: Mentor vs. Natrelle Breast Implants. Should I prefer one over the other?

Both of these companies produce well-tested, highly respected products with long track records in the United States. As competitors they like to emphasize different statistics with regard to their longevity, failure rates and degree to which gel can microscopically migrate across the shell. From a practical standpoint I have never been able to find a difference between them that matters, so I use both. It is helpful to have both as options because the sizes differ slightly. For example, if using Allergan Natrelle gel implants in moderate profile, the size increments are 234 cc, 265 cc, 284 cc, 304 cc. Mentor’s comparable implants are sized 225, 250, 275 and 304 cc’s. There are similar differences for saline implants.

In my opinion, both implant manufacturers produce implants that are perfectly acceptable for their intended use.

Web reference: http://enhanced-you.com/cosmetic-surgeon-services/breast-procedures-mountain-view/breast-augmentation-choices/saline-vs-silicone/

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Q: Breast Implants Pregnancy

what can i expect should i go with breast implants and then get pregnant? does the pregnancy cause the breast swelling to become abnormally painful? do stretch marks appear more often?

A: How do breasts with implants change with pregnancy?

Your breasts will change with pregnancy, that is a given. They will enlarge, but the degree of enlargement is going to be different for every woman. Changes will come with that enlargement. At the very least, the skin will become looser, and frequently the breasts will be smaller after pregnancy. Because the skin will stretch, stretch marks may form, and this is also common.

When breast implants are placed before pregnancy, they do sometimes cause stretch marks, but not that often. The occurrence of stretch marks after breast augmentation is unpredictable, but much less common than after pregnancy, so one could say that having implants is not going to result in more stretch marks after pregnancy than if the implants had not been present.

What you may note after pregnancy is that the implants do not sit as high and fill out the breast/skin envelope as before. Some women will then choose to have a second augmentation or lift/augmentation combination, because as they say, the breasts are less “perky”. Using a larger implant will fill up the skin envelope, or if the skin is too loose, a skin-reducing lift can restore the original higher position of the implant. If tightness without change in volume is desire, only a lift can be done.

Web reference: http://enhanced-you.com/cosmetic-surgeon-services/breast-procedures-mountain-view/breast-lift/

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Q: Breast Implant Scars

I want larger breasts but I’m afraid that the scars will be obvious when I wear a swimsuit. Where and how big would the scars be if I got breast implants?

A: Breast Implant Scars, Location and Size

Scars should never be obvious when you wear a swimsuit, and only if done in the underarm would they even be barely visible. Scars are kept to a minimum length in my practice, just sufficient to make the pocket. For saline implants this can be as short as 2.5 -3.5 cm. or 1.0-1.5 inches. Incisions are repaired very securely with slowly absorbing sutures so there is no worry about the incision coming open in the healing process, and there are no sutures to remove.

In the past, a gel implant required a larger incision than a saline implant. The saline implant comes deflated and can be placed through a 2.5-3.5 cm incision. However, a gel implant comes fully filled from the manufacturer, so one must imagine the full size of the new breast fitting through the incision. The larger the implant, the larger is the required incision. In fact in the past, implants in the 400 cc or larger range required incisions of 4.5-5.25 cm or larger. The reason the incision had to be longer is because one cannot force an implant through an incision that is too small. In the first place, the implant will simply not go through the incision, and secondly, the manipulation required to gradually introduce the implant could traumatize the implant shell, possibly leading to early implant failure. The usual procedure is to make an incision of adequate length, and then if there is any significant resistance at the time of insertion, to stop, remove the implant and slightly lengthen the incision.

For patients requesting gel implants, I always now give them the option of using a Keller Funnel, to get the smallest possible incision. This innovation in breast augmentation surgery allows placement of gel implants through incisions that are often as small as the incision required for saline implants. This depends on the implant size, but since most women have implants of 400 cc or smaller, most women can have their implants placed through an incision length of 3.5-3.75 cm, the same as saline implants. You can read more about the Keller Funnel at their website.

The result is a shorter scar and minimal handling or trauma to the implant regardless of incision location. The incision location is an individualized decision made in consultation with the patient based on her anatomy, location preference and consideration of trade-offs and advantages with each incisional approach. Since I offer a choice of all incision locations, patients make their own choice after consideration of the pros and cons associated with each.

Web reference: http://enhanced-you.com/cosmetic-surgeon-services/breast-procedures-mountain-view/breast-augmentation-choices/#location

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Q: Flat Chested Woman Going To a C Cup With Silicone Gel Implants. What Size/cc’s Should I Go With?

I have been to 2 different doctors, and I believe my breast base measures around 13cm’s if I heard correctly. Both mentioned the moderate profile implants. I would love to be a nice “C” size. I was told by one doctor to go with around 390cc’s, and another told me 339cc’s. That doesn’t seem like a big differece, but I want to make sure I get the look that I want. I am not even an A cup now, I am completely flat with some loose skin. HELP!!! I am having my surgery soon and need some help!

A: Getting the right size for a C cup with base width 13.0

Moderate profile gel implants up to about 397 (Allergan) will fit a base width of 13.0 cm. 397 cc usually gives a nice, full C cup for a 34 A woman. 339 (Allergan) or 350 (Mentor) is also usually a C cup but more smaller or more conservative.

Since many women say that they wish they would have gone a little larger, and since an implant that does not exceed your base width does not increase your risk of problems, the final choice would be completely subjective and based on your own preferences.

In our office, we would have a patient try on a 34 A bra, for example, and all the implants up to her base width to see which ones she likes. If all were too small, we would try the high profile implants because up to 500 cc still fits in a 13 cm breast width. Then the patient would decide if she liked the high profile or moderate profile implants and make her own decision. If she did not like the high profile, then the largest suitable size would be 397 or less for this example.

Web reference: http://enhanced-you.com/cosmetic-surgeon-services/breast-procedures-mountain-view/natrelle-pre-consultation-sizing-kit/

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Q: Donut Lift with Augmentation or Just Augmentation?

I am 5’5 and 110 pounds. I am a B cup and have grade one ptosis post pregnancy. My ps recommended a donut lift with augmentation (325cc). I am quite concerned with scars and so is my husband, so much that he would only wants me to get an augmentation. I want nice looking breasts but I don’t really know which way to go…Please help!

5'5 and 110 pounds. I am a B cup and have grade one ptosis post pregnancy.

A: Donut Lift vs Augmentation without Lift

A donut or periareolar mastopexy is only indicated if the nipple/areola needs elevation. Best results are achieved when the lift is accompanied by an implant and the elevation is under 4 cm.

Some guidelines are helpful in achieving a good shape when doing a periareolar lift with implants.

The periareolar lift is accompanied by an augmentation in which the volume of the implant is significantly greater than the existing breast volume. For example, the breast is an A and the implant size is sufficient to increase the size to a B+, C or larger. The shape of the breast will then be primarily due to the implant. As the purse-string suture tightens the skin down around the platform of the implant, a round breast shape is preserved without flattening of the breast.

If the ratio of breast tissue to implant is too great, e.g., a B/C or more with an implant that is sufficient to go up perhaps one cup size, there will be a lot of loose skin and breast tissue contributing to the shape. In this case the purse-string lift will flatten the front of the breast, an outcome that is not cosmetically desirable.

If optimal breast shaping is needed when there is significant sagging of breast tissue below the inframammary fold, then a vertical or inverted-T incision is required. This can be combined with an implant to achieve both optimal size and shape.

Your photographs show a nipple/areola that is already at a satisfactory height, and you have a relatively large breast volume in relation to an appropriate implant. Therefore the operation for you is entirely dependent on your goals for breast appearance and willingness to accept trade-offs of scarring or persistent glandular ptosis.

If a patient with similar anatomy desires no periareolar scar and is willing to accept the droopiness of the gland, then augmentation alone could be chosen. Remember that using an implant alone, will not do more than increase the size of the breast, and would have to be quite large to put enough tension on the skin/breast envelope to elevate it off the chest wall. Long-term this would tend to stretch out the breast with recurrent droopiness, and might be larger than the patient really wants for optimal breast size.

For a patient who wants to avoid a scar on the front of the breast and whose priority is optimal breast size, and whose areola is at or above the inframammary fold, augmentation alone achieves that goal. The trade-off is persistence of some descent of the breast below the fold. This is a mature look, but natural.

If after living with this, the patient wants more elevation and projection of the breast, a lift can be done. Since the augmentation will have filled out the breast/skin envelope, it will be possible with greater predictability at that time, to then choose the appropriate mastopexy technique, which may be periareolar, vertical or inverted T.

Web reference: http://enhanced-you.com/cosmetic-surgeon-services/breast-procedures-mountain-view/breast-lift/

Q: 180 CC Too Small For A To B Cup Increase?

I am 5’4″ and 115 lbs. Currently 32 A. I would like to achive full B. 180 cc will be filled to 200cc and it will go under my muscle. I am not sure it will give a full B figure.

A: How much volume needed to go from 32A to 32B

Generally one cup size is 200 cc for smaller band sizes, e.g., 32 and 34. For bra sizes of 36 and up larger volumes are needed.

In my practice we try to give the patient exactly what she wants, rather than aiming for cup size.

As you know, the cup can vary with the bra size. Many women are intermediate, sometimes using a 32, and sometimes a 34. The actual volume of a 34B is about the same as a 32 C. So cup size is an imprecise measure of what size implant to use.

We use gel sizers and let the patient judge when she looks exactly the way she wants to look. That is the size that is most likely to correlate with long-term satisfaction. It could be somewhere in the range of 180 to 240, but the final decision would be up to the patient.

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Q: Are 350 cc Implants Too Large For Over The Muscle Placement For Me?

Iv’e just had a consultation with my surgeon and im very confused!!! Im 37 have a small frame at the top with 31inch across breast at nipple and 28 inch rib cage, i have had two children so lost volume of the breast at the top, im a 32aa not saggy and do not need a lift but excess skin to fill. I want to be a perky, large c cup and have been given the choice of 290cc low profile overs, i was handed 350 cc to feel and i asked if i could have them, my surgeon said yes! are these to big for what i want?

 

A: Get 350 and put them under the muscle

Actually, you need to choose your implant size in a more precise manner than just being handed a certain size.

To accomplish this In our practice, we use the appropriate sized bra, and then the patient tries on each size implant, using a gel implant sizer, until she feels she has exactly the right size for her, not too large, not too small. Too many times have I seen unhappy patients whose implants are not the “right” size, because the doctor made the choice for them.

The usual implant is the moderate profile in my practice. They look feminine and have nice projection and shape. Low profile implants are so flat and wide for the volume, they don’t do the job that women want. They are certainly not perky. High profile implants are reserved for women who want more volume but whose breasts are not wide enough for moderate profile, or who just like the look of high profile

Putting the implants partially under the muscle is the only way to provide some soft-tissue coverage in the upper breast for a woman who does not have at least 2.5 cm of pinch thickness in the upper breast. If you don’t, and it sounds like you don’t, then you have increased risk of issues like implant visibility and visible wrinkling to deal with, if not right away, then down the line when the skin stretches, not to mention the increases risk of capsular contracture when above the muscle.

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Q: Will Making a New Inframammory Crease Cause a Double Bubble?

I just had my consult today regarding breast augmentation. My doctor said that he would have to create a new inframmamory crease about a 1/4 of an inch lower my existing crease. His reasoning is because my breast are somewhat droopy and he doesn’t want the implant to sit above my breast. Will this method cause my breast to look natural? I’m afraid of the “double bubble affect” and looking like I have deformed breasts. Please help! My surgery is 10 days!

A: Getting a lift from lowering the inframammary fold

The only way I have reliably found to correct a drooping breast is to do a lift.

If the drooping is mild, what we call Grade I, with the nipple at or above the fold, the augmentation alone will usually give a satisfactory lift and projection to the breast and nipple/areola without a formal lift.

If the nipple is below the fold and the breasts are droopy, then it requires elevating the nipple/areola surgically, i.e., a lift with whatever technique is appropriate.

Lowering the fold is done when there is truly a lack of skin between the nipple and fold on stretch. For example, for a 350 cc implant you need about 9 cm of stretched skin and you might only have six. Then, of course, you must lower the fold to recruit some upper abdominal skin to cover the implant. The new fold must be well secured to prevent bottoming out.

Frankly, lowering the fold 1/4 inch is so minimal that I would hardly consider it lowering the fold. It often goes down that much in an augmentation anyway just from skin stretch. If there is that much droopiness that your plastic surgeon is concerned that the implant will be too high in relation to the breast mound and nipple, then you should really be asking if a lift is necessary in addition.

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Q: Crescent Lift with Bigger Implants, is this the best way to go?

After viewing Dr.Ray’s before and after pictures from 90210, he gets fabulous results with just a crescent lift and bigger implants if you have sagging breasts. Is this the best way to go, so you don’t have to get all those scars?

A: Crescent lifts are poor trade-off for the scar

Placing a scar above the areola has always seemed to me to be the most unattractive and least desireable scar on the breast.

The degree of lift needed to really justify placing a scar on the breast requires a scar that is at least the full circumference of the areola.

Using only a superior crescent incision often leads to stretching of the scar and its visibility in a very unnatural location.

A completely periareolar scar can at least be controlled quite well with a purse-string suture. A superior crescentic skin incision scar cannot be controlled at all.

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Q: I Am Very Self Conscience About the Size of my Areolas, What Are My Options?

I am interested in a breast aug, but am worried about what my areolas with look like after. I am 23 years old 5’3, with no plans on having children anytime soon. I am about a full B cup, with my right breast slightly lower and pointing downward. I would like to know what my options. I am looking for a much rounded appearance, with a possible areola reduction. I attached a picture below as well. Thanks so much, Adrianna

A: Reduce the size of the areola with purse string suture

Your goals are to have a rounded appearance with the areola higher and smaller after breast augmentation.

The procedure most likely to achieve this is to relocate the areola slightly higher with a peri-areolar lift, place the appropriate size implant and control the size of the areola with a purse-string suture.

While it is not possible to control the areola size precisely after breast augmentation since it will always be larger due to skin stretch, this technique is the one currently available that I think is most likely to achieve your goals.

The asymmetry of areola level will be corrected at the same time because the final position of the areola is determined by equalizing the level during the surgical planning.

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