Breast Augmentation is one of the most commonly requested cosmetic surgery procedures. It’s also the most commonly misunderstood. This month’s blog addresses 4 of the misconceptions voiced by my patients along with some clarifications about cup sizes, implant types, recovery, and longevity.
Myth: I can just order my desired cup size.
It’s important to understand that cup size is not an objective measurement. In fact, there is variability even across bra manufacturers. A cup size discussion is useful during the consultation because it will give me a good idea of what you are looking for. In other words, it is not an exact science, nor is it definitive, but it is helpful. Implants are measured in cc’s, or cubic centimeters. For the sake of perspective, 100 cc’s equal 3.3 ounces. As a general rule 200 cc’s will equal a cup size and an additional 150 cc’s will add another, so 350 cc’s would be approximately 2 cup sizes. But a cup is just one measurement. You are not actually “ordering” a breast. Your “best” breast is a combination of your desires and your anatomy. Think about a tall woman with a wide chest wall compared with a woman who is petite and thin with a narrow chest wall. The same implant would necessarily look very different in terms of size, shape and projection. The first girl would need a wider implant to fill out her chest, along with increased projection if the proportion is to be aesthetic.
During your consultation I will measure your chest wall, and that will determine how wide the implant should be. Next I’ll see how much natural tissue you have. If there is substantial tissue, we might want a lower profile implant. Conversely, with little tissue, a higher projection dimension would be recommended. It’s a combination of size, shape and profile. Most patients want an increase in size, a prettier looking shape and a more aesthetic proportion. It is my role to educate the patient on what they are asking for. I have to balance what the right choice is long term. An example might be someone who wants a DD look but doesn’t have the support tissue to accommodate it. The breast has a good chance of being not only large, but droopy, which I know is not what she had in mind. I will listen closely to what you want, tell you what plastic surgery can accomplish, and explain the trade-offs involved.
Myth: The gummy bear implant is always the best choice.
The real answer here is the best implant is the implant that is right for the patient. There have been multiple generations of implants since their initial introduction to the market. We are presently at the 5th generation. Over the years the “feel” versus the safety of the implant has always been the issue. The term “gummy bear” refers to the cohesiveness of the gel. The 2nd generation gels were softer–not nearly as cohesive, so consequently if they did leak, the gel would ooze out. Today’s implant is much firmer but less likely to leak out into the tissue. By the way, the whole silicone controversy was resolved with no evidence of any connection between breast implants and autoimmune disease. Today all three manufacturers in the United States offer FDA approved silicone breast implants.
Implants can be silicone or saline; smooth or textured; round or anatomically shaped. Most women choose a smooth, round, silicone gel implant. Textured implants are designed for the anatomic, teardrop shape option to prevent displacement. There is also the option for a round textured when indicated. The reality is the anatomic shapes were not what we initially thought. When you put a round implant in a breast, it assumes a natural shape when behind the muscle. We have found through preliminary studies that neither the patient nor the doctor can ultimately tell if a patient has a teardrop or round shaped implant. However, if an anatomic implant becomes displaced—which is not common, but can happen—you can definitely tell. In my experience, the smooth, round, silicone implant has the least complications without sacrificing the appearance of the breast.
To summarize, the term “gummy bear” refers to the cohesiveness of the gel inside the implant. This means that both round and anatomic implants can house the gummy bear type gel. There are many different factors to consider when having implants placed. For this reason, I spend significant time determining the right individual implant for each patient.
Myth: Recovery from breast augmentation is rough.
Length of recovery and amount of discomfort is dependent upon the individual, implant size, tissue compliance, and the surgeon’s skill. How compliant the patient’s breast tissue is and how the muscle reacts when it is released is a function of the patient’s anatomy. The size of implant influences recovery. A bigger implant will necessarily stretch out the tissues and the nerves in the tissues more than a small implant, causing a bit more discomfort. Having said that, the surgeon’s technique can really make a difference in recovery. My entire approach is calculated. I select the implant prior to surgery based upon anatomic measurements and patient goals. I use very strategic approach to creating a pocket to house the implant with minimal trauma to the surrounding tissue. I want to keep the pocket as clean and precise as humanly possible. My patients tell me there is more pressure than pain in recovery, as the tissues gradually stretch. But we make prescription pain medication available if necessary. In my experience, if a breast augmentation is done on a Thursday, the patient can return to office work by the following Monday. Apart from lifting restrictions, and certain workouts, normal activities can be resumed within a week. Bottom line: recovery doesn’t have to be rough if you choose the right surgeon.
Myth: My breast implant result will last forever.
There are certain procedures in plastic surgery where the result is fairly maintained over a patient’s lifetime. Procedures like a tummy-tuck or rhinoplasty would fit into this category. Procedures like breast augmentation and facelift are more subject to influence by gravity over time. This means that a subset of women who undergo breast augmentation will possibly need a breast lift later in life. These patients experience a loss of tissue elasticity and may even see drooping of their nipple complex. The lift allows the nipple to be repositioned and the tissue to be tightened. Incidentally, the larger the implant, the more likely the tissues will be influenced by the aging process. Manufacturers also recommend implants be replaced with new implants approximately every 10 years. Aside from the march of time, weight changes, pregnancy, and nursing can also influence another surgery in the future. Keep in mind, implants are not lifetime devices.