6 Important Tips for Women Considering Breast Augmentation
Article by Dan Mills, MD
Orange County Plastic Surgeon
1. How do I calculate what implant size I need in order to get from the cup size I am to the cup size I want to be?
The lingerie industry does not have standardized cup sizes, so it’s important not to be too dependent on cup letter when choosing an implant size. Victoria’s Secret, for marketing purposes, has generally a full cup size difference (larger) than other popular manufacturers. We also refer to ranges in a cup size, such as a small C or a large C cup. A B-C cup is around a total of 450 ccs. If you have 150 ccs of your own tissue, you will want to consider a 300 cc implant. If you are looking for a C-D cup, you will want a total of 600ccs (own tissue plus implant size) so you would be considering an implant about 450ccs. In my years of practice I’ve determined that an increase of 150-200ccs equals approximately one cup size.
One way to choose an implant size is to try on a “sizer” (an implant that you can insert into your bra to try on) and see how it looks in your clothes. Your board certified plastic surgeon or patient coordinator will help you choose an implant size for surgery that reflects the look that is achieved with the sizer that you like the best. You will need to be careful with this, however-If you are using a high profile sizer, it can be appear to be larger volume than a lower profile sizer.
2. How do I choose the best implant size?
In my practice in Orange County, CA, I personally feel that the most attractive and reasonable choice is a middle C. This gives you the option to “dress” your breasts up and down based on the situation-they can be downplayed with conservative clothing and still look great in a sexier outfit when it is appropriate.
The right choice is not a simple formula. The best size for YOU will depend on your lifestyle, what you normally wear, where ou live, and other cultural factors along with your height and weight. “Normal” or “best” are very relative terms. The average look in Southern CA is very different from the average look in the Mid-West. Some cultures will tolerate a C-D cup size as normal-another, such as Asian culture, may consider anything larger than a B to small C cup size as very large and distracting.
Your own physique will also dictate what will look proportional. If you are built like a ballerina, tall and slim, large implants will seem out of place. What you wear, and the level of activity that you have throughout the day will affect what makes sense in your real life. If you spend most of your time in business attire with a blazer, an increase in your breast size will not be very noticeable.
Your personality plays into this choice also. If you tend to be gregarious and outgoing, larger implants may suit you more than if you are shy and don’t want to call attention to yourself.
Take an outfit that you wear in your career, sports, casual life and in special occasions to your consultation so that you can try out your potential new look in your own clothes. You can also take an outfit you’d love to look great in if you had the breast size you desire.
Surveys have found that nationally 70% of patients would go larger in size than they had the choice to do over again. You might want to keep this in mind if you’re having a hard time choosing between two sizes.
3. Implant type and positioning of the implant
Each Board Certified Plastic Surgeon (double check that the certification is by The American Board of Plastic Surgery) will have their own preference when suggesting the type of implant, incision site and placement of the implant. There are advantages and disadvantages to each, and it’s important that you take the time to review the information that you receive from each board certified surgeon that you interview to determine which surgical philosophy makes the most sense to you.
My preference is to use a smooth wall implant through an armpit incision (Transaxillary Subpectoral Augmentation Mammoplasty or TASPA). I use both saline and silicone implants based on patient preference. I stress that this is my own personal preference.
Some patients are just not comfortable with the idea of having a silicone implant because of the question of safety if they break. Saline implants are a good option for those that are worried so that they have peace of mind. Saline implants are a bit harder to the touch. For patients with very little of their own breast tissue you may also be able to feel more rippling with the saline at the edge of the implant. If you have a moderate amount of your own breast tissue you will be less likely to have this problem. Silicone implants are softer to the touch and move more naturally, so most people feel they are the better aesthetic choice.
The reason to use a textured implant when placed on top of the muscle is to decrease the occurrence of capsular contracture. If you choose to have your implant below the muscle there is no difference in capsular contracture rate between smooth wall and textured.
When implants are placed under the muscle, it acts as your own internal “bra” and the weight of the implant will not cause sagging with your own breast tissue. I don’t suggest putting implants on top of the muscle if you have drooping as it makes them droop more.
If you choose a shaped implant it will need to be a textured implant so that it stays in place and won’t rotate or turn upside down.
There are essentially three different incision sites. Periareolar, or around the nipple areolar area, has a nice scar, but technically has a higher capsular contracture rate. Inframammary, or under the breast in the crease where the underwire of your bra would sit, is a bit more conspicuous scar. My preference, the Transaxillary, or armpit, incision leaves the best scar. Surgeons who have made this approach their specialty and perform it frequently usually perform this approach. It requires a special set of skills and significant practice.
4. Breast implant safety
FDA studies show that breast augmentation is a safe and effective procedure. Your compliance with postoperative instruction plays an important part in achieving a great result and safe experience. Follow the instructions of your surgeon carefully!
5. How long they last
It’s not possible to say exactly how long implants will last. Like anything man-made, they will wear out. Saline implants generally last about ten years, but they don’t have to be replaced until they break. When they break it will become quickly apparent, as your breast will go flat. The saline that is in the implant will simply be absorbed and expelled by your body.
In my view it is prudent to replace silicone implants prophylactically at 10-15 years as you could have a silent leak. Yearly mammograms will be helpful to determine if you need to replace your implants earlier. MRIs can also help, but are more costly. Many women can feel a change in their breasts when doing self-exams if their implants break. I also encourage my patients to return to see me on an annual basis so that I can do a physical exam to detect a break early on.
Most ruptures are caused from a fold failure due to capsular contracture, so following your board certified surgeon’s instructions carefully is very important. Most of the time if I see an implant break it is due to a capsular contracture. If there is no capsular contracture they usually last more than 10 years.
6. How do I choose a good Plastic Surgeon?
First and foremost, make sure you choose a Board Certified Plastic Surgeon. Ask about his training, experience and affiliations with organizations such as The American Society for Aesthetic Plastic Surgery and The American Society of Plastic Surgeons. Ask if your surgeon has privileges at local hospitals. If he does not, beware. Ask what his personal statistics are for capsular contracture rate and revision rate, and also how often he has a complication with hematoma or infection. Ask how he compares to the national average. He should know that rate. You will want to choose a surgeon that can tell you what the advantages and disadvantages are to the surgical options and will communicate well with you regarding what will best suit your needs. Ask what the office policy is for surgery fees if you have a complication or need revisional surgery. When you meet with your potential surgeon ask to see his before and after photos and if he has previous patients that would be willing to talk to you about their experience.