Breast Enhancement
Augmentation mammaplasty is a surgical procedure that enhances the size and shape of a woman’s breasts. This can be done to enlarge small breasts or help return post-partum breasts to pre-pregnancy condition. We explore several options to assure the most pleasing outcome for each patient. For instance, the implant can be saline or silicone, and can be placed under or over the chest muscle. Choice of incision sites will also be discussed before surgery. All these decisions are based on personal lifestyle and preferences as well as preoperative condition of the breasts.
The Young, Small, Perky Breast
A young woman with small, perky breasts who wants an augmentation is a relatively straightforward proposition. However, the surgeon must be careful not to put in place an implant that is too large. Some patients request a size that is simply not achievable without overwhelming the width of the chest wall and the capacity of the soft tissues to stretch and support the weight of the implant. The result in these cases is at best a significant disproportion and an obvious “done” look, and at worst, a long-term problem with implant descent (bottoming out) and even possible extrusion.
The experienced surgeon understands these issues and will recommend an implant size that will achieve the patient’s desires for improved body image and proportion without the poor results and long-term risks of an implant that is too large.
The Deflated Breast
Following pregnancy or massive weight loss, we often see a breast that is flat with the nipple pointing downward. We call this the deflated breast. The term fits, because the breast does indeed look as if someone let all the air out.
The solution is to reinflate the breast by inserting an implant. This is pretty straightforward in most cases; but in some patients, the size of the skin envelope is so large that only an extremely large implant will totally reinflate the breast. Placing an extremely large implant presents two problems. First, the resulting size is often unacceptable. Secondly, a very large implant can lead to significant long-term difficulties such as implant descent (bottoming out) and even extrusion.
So, what then do we do in that particular situation? We have two options. We can place an implant that will achieve the size increase that the patient desires and then deal with the residual tissue laxity (the nipple/areola complex sits too low on the face of the implant) by performing a breast lift or by doing nothing and letting a bra elevate the loose tissues to their proper position. Most of our patients who are in this situation prefer to place the appropriate size implant and then see what they think. Most do nothing further feeling that in public they will look great because they’re wearing a bra. Others will proceed with a mastopexy (breast lift) because they wish to also look great when they’re not wearing much in the way of support.
The Low Slung Breast
Following pregnancy, or simply as women get older, the breast naturally descends because of gravity and sits lower on the chest wall. We are not talking here of the deflated breast following pregnancy when the breast itself is flat and the nipple looks downward. With the low-slung breast, the breast is still full and the nipple still sits on the front of the breast and looks forward. But because the breast sits lower on the chest wall, the upper part of the breast (the upper pole) seems too flat or even concave.
This is the perfect situation for a breast implant. Most of these patients do not want or need an excessively large implant. A modest size implant will do nicely and the results are quite excellent.
However, the patient must realize that breast augmentation in this situation will not make the breast perkier. The breast will still be low-slung. However, it will now be much fuller and more voluptuous.
The Tuberous Breast
The tuberous breast is a developmental breast anomaly characterized by varying degrees of constriction of the breast base and resulting in a tight and high inframammary crease with enlargement, prolapse, and ptosis (sagging) of the nipple areola complex. There is a wide spectrum of anatomical changes. In the mild forms the inframammary crease is either slightly blunted or simply too high with the breast seeming to “fall off” the crease as if it were a ledge. The more advanced forms can involve significant breast distortion. Most often the milder forms can be significantly improved or even completely corrected with implants alone. The more advanced forms cannot be addressed with only breast augmentation and more complex reconstructive techniques must be used.
Breast Lift
Pregnancy, aging, weight fluctuations and the uncontrollable force of gravity can cause a woman’s breasts to lose their youthful shape and firmness over time. To regain some of that ‘perky’ appearance, a mastopexy (breast lift) is performed to lift and firm sagging breasts by removing and tightening the excess skin. Because a mastopexy slightly reduces the size of the breast, some women choose to have breast augmentation during the procedure. An augmentation can also be performed later, if so desired.
Before and After Photos
Mastopexy Examples
Perky Examples
Deflated Examples
Low Slung Examples
Tuberous Examples
