General Information about Breast Augmentation
Cosmetic surgery has existed, in one form or another, for over a thousand years. Traditional breast augmentation surgery has undergone many changes, and both the implants and the surgical techniques are much improved, even when compared to five years ago. My hope is to allow you to make informed decisions by presenting options in a factual, informative, objective, and somewhat irreverent format.
Typical stereotypes of cosmetic surgical patients are a somewhat vacuous young woman who somehow wants a "sexier" body or a narcissistic "aging" beauty that wants a face lift to regain her youth. Plastic surgeons are often portrayed as conceited, suave, sometimes narcissistic, and/or vaguely foreign men with an attitude of "Don't worry, I am an artist, and I will make you beautiful." Although most stereotypes contain at least a small kernel of truth, cosmetic facial and body rejuvenation is a very personal issue, and should be treated as such. Patients desiring facial and body rejuvenation are incredibly diverse, each with unique wants, needs, and expectations.
Just as each patient is different, doctors differ in their personalities, skills, interests, and approaches to their female (and male) cosmetic patients. You should make every effort to find a physician who is not only skillful, but with whom you are compatible, both philosophically and personally.
Cosmetic and reconstructive surgery is equal parts psychiatry, judgment, technique, and surgical skill. The challenge for every surgeon is always to try to do the right thing for the right patient. Especially in cosmetic surgery, the patients' goals are paramount, and the surgeon should try to meet these goals while keeping his/her patient safe.
The vast majority of cosmetic surgeons are excellent and honorable. Still, it is not uncommon for cosmetic patients to undergo too much treatment (and expense) than is required to achieve their initially stated goals. "Smart shopping" (on several different levels) is essential. Dissatisfaction usually stems from unrealistic or incorrect expectations. Most patients are very happy following whatever procedure they choose to undergo, assuming that their expectations are very realistic.
Many of my patients (both cosmetic and reconstructive) are initially surprised, and sometimes uncomfortable, with what they incorrectly assume to be my passivity regarding their problems and desires. What most come to understand is that my only goal is that their concerns are addressed and acted upon openly, completely, honestly, effectively, and safely. Only then should rejuvenation of any kind be considered.
As a cosmetic surgeon, the majority of my patients are women. Because I sincerely enjoy caring for women (and men), my work is almost always enjoyable. As one pundit wrote, "If you truly love what you do, you will never have to work a day in your life." My abiding, fervent hope is that I can enhance the lives of my patients with the results of my care.
Before Considering Breast Augmentation Surgery, You Must Accept the Following Facts
- Your breasts are sisters, not twins. Even after surgery, they will not be twins.
- Cleavage is a result of your bra, not implants. With or without implants, no woman has cleavage without a bra, dress, or other clothing to push the breasts inward.
- People, and partners, sometimes change. Choose the size you would like.
- The larger your implants, the more breasts will sag over time. "The bigger they are, the harder they fall." The larger the implant, the more difficult many activities will be.
- Choose the implant size that you will want on Tuesday morning, after you awaken, when you are exercising, not the size that you want for Saturday night or parties.
- Of those women who are not completely happy within the first year after breast augmentation surgery, at least 90% complain that the implants are not "big enough."
- Of those women who are not completely happy 5-10 years after breast augmentation surgery, many consider their implants "too big."
- In Germany and the rest of Europe, the average implant size chosen by women is ~ 200-225 cc. In France, the perfect breast size is considered to be that of a champagne glass; 200-250 cc (before any implantation). In California and Texas, the average implant size chosen is ~ 425 cc. Topless dancers often select at least 425-450 cc, because they make more money with larger breasts. In the Midwest, non-entertainers are usually counseled to select 375 cc or less, although this is an individual choice.
- Statistically, 1 out of every 8 women will have breast cancer at some time during their lives.
- Your anatomy, your skin thickness, and the amount of breast sagging (ptosis) will determine, in large part, the size of implant that your body will accept.
- If you are an athlete, a runner, a weight lifter, are very active, or exercise regularly, strongly consider implants smaller than ~ 375 cc. If you go larger, you may regret it.
- Complications after surgery may increase significantly when implants larger than 375 cc are used. There are some exceptions to this, but not many.
- Breast implants will never feel or look completely natural, no matter what the implant size, material, or surgical procedure.
- Almost all women will have some amount of visible "rippling" after implant placement.
- After breast augmentation, about 50% of women will need another breast surgery within 10 years, even if everything about the original implant surgery was perfect.
- All breast implants have a capsule around the implant within one year of surgery. This is normal. We hope that the capsule forms without contracting. Some capsules require re-operation for contracture.
- Whatever breast, nipple, or areola abnormalities are present before breast augmentation surgery will almost certainly be present after surgery. The surgery does not usually fix these abnormalities. Some asymmetries can be improved; some cannot.
- All implants very, very slowly "leak" over the years. Saline implants leak salt water, silicone implants leak silicone. Sometimes, this causes deflation.
- All implants (including saline) have a silicone "shell."
- There has never been any accepted scientific evidence that silicone implants caused any form of systemic disease. Despite this, Dow-Corning went bankrupt, and the FDA requires saline implants for "primary" implantation.
- Without any other reconstructive surgery, your nipple/areola area may enlarge some after implant surgery. The larger the implant, the more the potential enlargement.
- Mild to moderate breast sagging can sometimes be corrected with beast augmentation surgery. Marked sagging cannot. (More on this later)
Why Breast Implants?
Many women (and men) have protruding ears, crooked teeth, a very large nose, or some other visible body part that is smaller, or bigger, or different than the societal norm (or the patient's desired appearance). It is now commonplace for these "abnormalities" to be corrected with cosmetic surgery. In fact, most people in 21st century North America are very accepting of most cosmetic surgery.
We should be just as supportive and accepting of women who would like fuller or larger breasts to feel more "normal," or to enhance their self-image. A woman should be able to have breast augmentation surgery without judgmental attitudes or recrimination. Most negative attitudes regarding breast augmentation surgery have one of two causes:
- First, an appealing female chest, of any size or shape, is often considered sexually attractive, which is discomforting (for whatever reason) to some people. But then, beautiful teeth, good health, a pleasing shape, smooth skin, or a friendly smile can also be considered sexually attractive. Sexual attraction is a very normal, natural part of all of our lives.
- Second, the FDA frightened the public in 1992 about the risks of implant surgery after a widely publicized legal action against Dow Corning for its silicone implants. To this day, there is no accepted scientific evidence that silicone (gel, solid, or liquid) caused any of the diseases or systemic problems for which it was blamed.
In the 1970s and 1980s, breast implant surgery was the most common cosmetic surgery in the United States. After the "silicone scare" of the 1990s, it is once again one of the most common cosmetic surgeries. Currently, over 100,000 such surgeries per year are now performed in America. At least 1.5 million women in this country have breast implants.
Other Options for Breast Enlargement
Non-surgical options for breast enlargement are limited. The Brava company (www.brava.com) has a suction device which may provide lasting enlargement of 100-125cc for some women, but it requires at least 10 weeks of wear for at least 8 hours per day, an incredible commitment of time, attention, and money. There is a procedure called BAMBI, which is the injection of your own fat into the breasts to enlarge them. However, this procedure can be risky and usually requires at least two procedures, and can enhance the volume by about 150 cc per breast, per procedure. Only a few surgeons in America offer this. None of the pills (herbal or pseudo-hormonal) on the market will cause any significant enlargement without significant risk to the rest of the body, and are a waste of money and time. Creams are even less effective, which is to say that they are worthless. Some women will loose significant amounts of breast tissue when they diet and/or loose weight, particularly when they are at or below their "ideal" weight. Many women are simply too thin, and may gain at least a cup size (and often, more shape) by simply gaining 10-20 pounds. Although this is often viewed as an unacceptable alternative in our society, it is safe, inexpensive, and can be very effective.
The illusion of larger breasts can be very effectively achieved in many ways, particularly with the enhancement bras, water bras, and very lifelike inserts now available. Obviously, these cannot be used in some situations, or during some activities.
Cleavage without Surgery: Non-Surgical Breast Enhancement
- Apply bronzer or darker toner to cleavage area to highlight depth
- Surgical tape under breasts for lift (1.5-2.0 inch wide tape)
- "Wonder Bra" or "Water Bra" (in lingerie aisle, they are very realistic)
- Water, silicone or foam inserts which are shaped to fit inside bra (very realistic)
- Strapless, formed "half cups" with adhesive along lower edge of breast.
- Pushups and/or isometric exercises to firm and tone pectoral muscles (chest)
- Stand up straight: Posture can do wonders
- For revealing garments: Spray or tape skin adhesive along edges of fabric to avoid lift of fabric
- Pills for breast enlargement are now sold. There is no proof that they do anything but take your money.
- Since a "Sex and the City" episode, "artificial nipples" are now sold. They enhance the appearance of nipples below clothing.
What Facts Should I Know Before Considering Implant Surgery?
- What will the operation do for me, and what choices do I have?
- Complications and risks involved
- How, when, where, and by whom it can be done
- Frequently asked questions
What will Breast Augmentation do for me? What choices do I have?
Breast implants make your breasts larger and fuller; they do not give you new breasts. A silicone bag filled with salt water is placed next to your breast, in one of three positions, through one of four types of incisions.
Your surgeon will guide you in making the following choices:
- Size of implant
- Site of incision
- Type of implant
- Hospital, surgical center, or office surgery
- General, IV sedation, or local anesthesia
- Placement and position of the implant
Many different combinations of choices can achieve a satisfactory result. Most surgeons will have preferred methods and techniques that incorporate only a few actual choices. When a surgeon is asked to accommodate one of our choices with which he/she is not comfortable, it is usually best to either accept his/her usual preferences, or simply search for a surgeon who is able to comfortably honor your choices.
Size of Implant
Your final size will be the amount of breast tissue that you already have, added to the size of the implant, measured in cubic centimeters, or "cc's." All women's breasts are different and individual, but, in general, your current cup size will correspond to the following (very approximate) volumes:
- AA: 0-50 cc
- A: 50-125 cc
- B: 125-250 cc
- C: 250-400 cc
- D: 400-550 cc
Therefore, if you are currently an A cup, and wish to become a C cup, the implant volume should be roughly 250-300 cc, giving you a total of (50-125 cc) + (250-300 cc) = 275-425 cc. This is very rough, and just an example, but you get the idea.
You and your surgeon should decide together what you would like your final size to be. Many surgeons strongly encourage you to estimate what size you would like to be by using the "Sandwich Baggy Technique." This can even be done before your initial consultation. It will sound strange as you read it, but it is very, very helpful, both for you and the surgeon.
- Purchase an inexpensive bra with the cup size that you would like your breasts to fill. The bra should have straps, and not be padded, sheer, or stretchy.
- Some patients take some socks into the store; fill the bra with the socks, to see which bra size gives you the appearance that you want.
- When you get home with the bra size which you have selected, fill a sandwich baggy or sheer anklet (tied at the top) with very small birdseed (mixed or finch food), rice, or other measurable substance until you have the size that gives you the appearance that you desire. The baggy should close tightly, and is placed in the bra. Check your appearance with and without your top.
- Once you have determined what sandwich baggy or sheer anklet volume gives you your desired look, measure the seeds, rice, or other substance in the baggy by pouring it into a kitchen graduate marked in cc or milliliters. Most women begin with 200-300 cc. There will be almost no detectable difference within a range of 10% (more or less), but you can determine as well as anyone the volume of the implant which might be best for you. Record the volume in cc or milliliters. With this information, your surgeon can better estimate which implant size to give you.
- You may benefit from actually wearing the baggies in your bra, with your chosen volume, for a period of time, while doing different things, to really get a feel for what it will be like to actually perform daily activities with the implant size which you have chosen. For instance, if you exercise, jog, ski, play tennis, or play golf, you may get at least a rough idea of what it would be like to do these things with significantly larger breasts. This may cause you to opt for somewhat smaller breasts than you initially thought you might want. "Saturday night" breasts may not be what you want for weekday afternoons. This is a serious consideration.
- 400 cc saline imlants weigh almost a pound each, and you will be carrying them on your chest, for the rest of your life. The weight difference between 325 cc and 425 cc (almost 8 oz.) is not insignificant, particularly for small women.
Please consider the following, true for all patients:
- The most common patient error is selecting an implant that is too small.
- The smaller the implant, the fewer the complications and problems.
- Implants over 350-375 cc tend to cause significantly more long-term complications.
- The exact shape of the breasts, areola, and nipples cannot be chosen with any certainty. Implants control the size and volume, not necessarily the shape. They do not mitigate the sagging, drooping, size or shape of the areola or nipples, or the symmetry in position or shape (only size). In some cases, mild to moderate drooping is improved after implantation.
- The larger the implant, the more the size of the areola may increase.
- The bigger they are, the harder and faster they fall.
- Do you want "Saturday night" breasts, or those that are comfortable during the rest of the week?
- Choose the size that you like, not the size which a partner or significant other likes.
- With very large breasts, you will get a lot of attention (and stares), like it or not. If you are at all self-conscious, you must anticipate this.
Which Surgeons Perform Breast Implantation?
Cosmetic surgeons or plastic surgeons typically perform breast implant surgery. Some plastic surgeons are cosmetic surgeons, but not all. Many cosmetic surgeons are not originally trained as plastic surgeons, and come from many surgical backgrounds, including otorhinolaryngology, general surgery, ophthalmology, and obstetrics and gynecology.
Breast Cancer Detection and Implants
Statistically, 1 of 8 women in North America will have breast cancer at some time during her lifetime. There has never been any evidence to suggest that women with implants have any higher rates of breast cancer. In fact, since the 1970s, the incidence of breast cancer has been slightly lower in women with implants, perhaps because they have more frequent breast examinations. Women with a strong family history of breast cancer should avoid breast augmentation.
For the purposes of breast augmentation surgery, we suggest that any woman 30 years of age or older have a mammogram within one year of implant surgery. Those under 30 should have written proof of a breast examination by their family practitioner, internist, obstetrician/gynecologist, or family doctor within 6 months of the time of surgery.
Although mammography interpretation is somewhat more difficult with breast implants, this is very dependent upon the experience and skill of the radiologist, and the breast anatomy and size of the individual patient.
We continue to believe that breast self examination may be very valuable, and certainly cannot hurt, assuming that the woman continues to have mammograms and regular examinations by her doctor. Breast lumps and abnormalities in women with implants are treated the same as they are for those women without breast implants.
Learn More About Breast Enlargement:
- Risks and Possible Complications of Breast Augmentation
- Breast Augmentation Surgery & Recovery
- Costs of Breast Augmentation
- Frequently Asked Questions about Breast Augmentation
- Links to Additional Information about Breast Augmentation
- Things to Consider Before Cosmetic Surgery