What is a healthy breast augmentation? This is a term that has been making the rounds recently, so I thought we could discuss what I consider to be a healthy breast augmentation. As we discussed in previous entries, the most important initial decision when considering elective surgery is to choose an experienced, reputable surgeon who is knowledgeable. You should have a good rapport with your surgeon, to ensure that your needs and wants are addressed to your satisfaction. Once you’ve found your surgeon, then some choices must be made regarding your breast enhancement procedure.
These are the technical details. While our current climate and level of information readily available to most patients is a great resource, you need to trust your selected surgeon to guide you appropriately through these choices. This means that your next most important job is to communicate your desired outcome to your surgeon, whose role is then to decide how best to meet those desires, and whether those desires are realistic or attainable.
Many patients will bring in online photos and examples to a consultation, along with recommendations from friends/family members who have had the procedure. While these examples can be helpful in communicating one’s likes and dislikes, it is impossible for a surgeon to reliably replicate someone else’s results onto another person’s figure. Each patient is unique and will have a distinct result.
Implant Size & Selection
While incision choices and implant placement, such as above or below the muscle, complete or partial muscle coverage, and other details are important, I think that the thing most patients get hung up on is implant size, so let’s concentrate on that. When choosing an implant, your surgeon should guide you through the selection process. Most surgeons will carefully measure your chest and breasts, and base implant selection on these dimensions. While there is a bit of artistry in this, there is also a lot of architecture. Just like the foundation of a house, a woman’s breast also has a foundation, or footprint. It is very important, with a few exceptions, to respect the extent of this native footprint to avoid breast distortion and poor support over time. If the breast implant selected pushes beyond this anatomic footprint, then the supporting structures of the breast are weakened or even eliminated, and over time, the implant will descend in an unnatural and often problematic way to cause long term dissatisfaction and poor breast shape. These secondary problems can be very challenging, if not impossible, to correct.
This concept may seem obvious, but unfortunately many patients seek implants that are larger than their frame can support. Though some get away with these extreme choices, many do not. The photos that you see online are usually depicting the patients who got away with it – not the patients who experienced problems and complications. Patients will often tell me that they were told by friends or online groups to choose an implant at least one size bigger than what is recommended by their surgeon, as many women often wish they went larger once healing is complete. While it may be true that a larger result is desired, it does not mean that such a decision is a wise one. I find that choosing implants that are larger than the breast footprint can tolerate is inevitably a poor choice causing long term soft tissue failure and lack of support. Therefore, I dissuade my patients from making this error. In fact, when I present implant options to my patients, I will only present implants that I know will fit safely. If the size is not enough to please the patient, then I explain my reasons, or suggest that they seek surgery elsewhere with a surgeon who feels otherwise. After 20 years of doing breast surgery, sadly I have often seen the results of overly large implant placement. While repair or improvement is usually possible, it would have been far preferable for the initial operating surgeon to have insisted on a more appropriate size, or to have just said no.
I like to select implants by matching the base width of the implant to the base width of the breast, and then selecting the forward projection of the implant based on the patient’s desires for size, their overall figure and proportions, and the laxity or tension within the breast envelope itself. Though lax breasts can tolerate larger implants, the lax breast may descend quickly with a heavy implant. Such patients might consider a smaller implant and add a breast lift to their procedure to firm and tighten the soft tissue and breast envelope. Tight breasts can also only tolerate so much stretch without developing issues like stretch marks, spread and visible scars, poor shape and late distortion and descent.
As you can see, there is a science as well as an art to selecting breast implants. The goal is to meet the patient’s needs and desires, but also to avoid an overly ambitious operation with excessively large implants which will ultimately lead to soft tissue disruption and the need for secondary or multiple revision surgeries!
I hope this discussion was helpful for you, and that you keep these suggestions in mind when considering surgery. Again, trust your surgeon to help you to select the best possible choice, and be aware that there are of course limits to what can be done safely and effectively to get healthy, beautiful and long-lasting results!