Breast Augmentation Surgery – So Many Choices!

Breast augmentation is one of the most common surgical procedures in the United States and the world.  In the US alone, hundreds of thousands of augmentations are performed each year!  It has one of the highest satisfaction rates of any plastic surgery procedure.  There are many choices that have to be made before surgery to provide you with the optimal result.  Choosing the right surgeon as your guide throughout this process is the first and most critical choice.  Characteristics to look for are experience, board certification in plastic surgery, and how well you connect with your surgeon.  It is also important to ask “why” he or she makes certain recommendations. Nobody wants a “one size fits all” surgeon who doesn’t individualize the procedure, and performs the same technique on everyone.  If your surgeon says “I always put the implant under the muscle” or “I always put it over the muscle” – they may not be assessing your unique breast anatomy.

What size is right for me?

Choosing an implant size is generally the choice that creates the most patient anxiety.  Ideally, choosing a cup size gives your surgeon a rough estimate of what your goals are.  Remember, cup sizes are not based on a national standard of a “perfect” A, B, C or D cup.  Each bra company will have different sizes for the same breast, not to mention that virtually all women (and men) have some asymmetry in the sizes of their breasts.  A “C cup” from Victoria’s Secret will be different than a “C cup” from Nordstrom’s.  Bringing in pictures of a breast size you want to achieve, sizing in the office and a discussion with your surgeon all come into play.  Do you desire a subtle increase in size and fullness to better fit into clothes and restore lost volume after childbearing, weight changes or aging?  Is your goal to go significantly larger to attain a goal look?  In many cases, the surgeons at West End Plastic Surgery use temporary “sizers” while you’re under anesthesia to test out various sizes of implants before putting in the final, permanent, perfect pair.

When should I have the procedure performed?

While there is no “right” time to perform a breast augmentation, there are several “wrong times”. Ideally patients should be over 18 years old (except in certain cases such as breast deformity), it should not be done for several months after breast feeding is complete (due to the unpredictable results of trying to hit a moving target) and it should be avoided during times of major weight fluctuation for the same reason.

Should I go under or over the muscle? (or even subfascial or dual plane)

There are pros and cons to various levels of placement of the implant.  This depends on your breast anatomy, how much time you have to recover, your lifestyle/job, your desired size, whether you need a lift, etc.  In order to get the best result, this needs to be individualized to each patient.  Do you need a little more lifting than a under the muscle implant can provide?  Do you actively move your pectoralis (chest) muscle when you’re working out, is your inframammary fold (breast fold) too high, etc., what type of implant are you using, do you have enough tissue to avoid a step off, etc.  You are an individual and in order to get the best result, your surgery has to be individualized.

Do I need a lift?

After weight loss, childbearing or simply just aging, a breast augmentation by itself may not lift the breast enough to achieve a desirable shape.  Augmenting a breast without a lift in certain patients can lead to a “snoopy deformity” or “rock in a sock” breast – probably not the look anyone is looking for.  In mild cases, placing the implant above the muscle can lead to a small increase in lifting; potentially slightly increasing the size of the implant may help as well.  If you have more significant drooping, a periareolar (an incision around the areola), a lollipop (areolar and an up and down incision) or a full anchor type lift (areolar, up and down and under the breast incision) may help you achieve the elevation and shaping that your breast needs.  These incisions are on the lower portions of the breast and can be hidden easily in bras, bikinis, or a low cut dress.

Silicone or Saline?

Years ago, the choice was easy – you could only get saline.  The implants are cheap, can be put in through smaller incisions (because they’re filled on the table), and certain incisions like the belly button could be used to place the implants.  With the reintroduction of silicone implants for cosmetic surgery, the implant choices and quality grew by leaps and bounds.  Now the vast majority of implants placed are silicone.  They have a more natural feel, less chance of rippling (or waves seen through the skin), better lift and upper breast fullness.  The implants also come in different amounts of cohesivity which can better hold their shape (gummy bear implants).  This means that even if you were to cut an implant in half, the gel stays bonded to itself and doesn’t go anywhere it’s not meant to.  The implants now come in increased fill levels, which gives you better cleavage and less chance of rippling, especially when placed above the muscle.

What incision should I choose?

Questions you might be asking yourself:

  1. Around the nipple, under the breast, through the armpit or a belly button incision?
  2. Which is best for me?

Each incision has various pros and cons.  Under the breast incisions are the most commonly used (and for good reason).  They are small, not easily seen in most patients; they are hidden by clothing and can be used to precisely position an implant and used for any potential future surgeries.  A periareolar (around the nipple)  incision from 3-9 o’clock, can be good in patients with larger areola, but has a higher risk of disrupting the nerves to the nipple (causing numbness) or interrupting the milk ducts, potentially complicating future issues with breast feeding.  A belly button incision is rarely used because it can only be used for saline implants; proper placement of the implant is much less predictable.  Armpit incisions can be good in some patients, however the visualization is less, future surgery can be tough through this incision and the positioning can be trickier.

Here are the results of a Breast Augmentation Surgery:

Front Before 1

Front After 1

Side Before 1

Side After 1

Side Before 2

Side After 2

Front Before 2

Front After 2

Make sure to watch the following video to see the actual steps of Breast Augmentation!

Breast Augmentation Surgery - Dr. Praful Ramineni | West End Plastic Surgery

If you are interested in Breast Augmentation, please call us at (202) 785-4187 or Contact the office. I look forward to hearing from you!


Posted in: Breast Augmentation, Breast Lift

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