Breast Enchancement surgery: Augmentation is not the only aim


Quite often, the terms "breast augmentation" and "breast enhancement" are used interchangeably, but the reality is these are very different terms that imply very different goals.

Breast augmentation, or making the breast larger in size, may be the primary aesthetic goal that one is interested in achieving, but having larger breasts are only one aspect of the total aesthetic hierarchy. As a result, the term breast enhancement surgery is often a more appropriate term, as size is only one aspect of achieving total breast beauty.

In fact, a larger size alone in many cases may be undesirable to many patients, and instead, patients often desire a fuller contour that is consonant with their total body habitus (ie their height, their weight, and the general contour of their torso).

In order to provide the highest aesthetic standard possible when undergoing breast enhancement surgery, there are four critical factors that need to be considered by both patient and surgeon in order to achieve ultimate success.

Size, Fullness, and Contour. As stated previously, size may be an important consideration for many patients, but often it is not simply a matter of larger breasts which is the issue or how many cc’s (how large) the implant actually is. The issue instead, it is more about the shape, contour, and fullness in the appropriate regions of the breast. In general, many patients desire some fullness that is not excessive in the upper portion of the breast, while having more fullness in the lower poles of the breast, in order to achieve a gentle, teardrop convexity of the breast that is not overly prominent.

Nipple position and shape.  In addition to a more aesthetic contouring fullness of the breast tissue, patients are also looking for repositioning of the breast tissue, especially in the area of the nipple and areola, which tend to descend as a result of age and multiple childbirths in many patients. Although breast augmentation alone correct this condition in many patients, sometimes mastopexy (ie a breast lift) must also be performed.  If the patient also desires correction of the size of their areolas (perhaps they are large and irregular/aymmetric) this can also be corrected at the time of the mastopexy procedure.

Torso Considerations. Often, the size of the breast implant that can be used is not simply a matter of patient desire, but rather a function of the patient’s general body habitus, especially the size of their torso. For instance, if the patient tends to be long, lanky, and angular with a thin torso, then generally speaking, a larger implant may be very difficult to use. The size of many implants is limited by the size of the base of the implant, which in a person with a thin torso may not be very big. This does not mean that a spectacular aesthetic result cannot be achieved, or that breast enhancement surgery should not be performed. Nothing could be further from the truth. But there is a limit to the size of the implant that can be used, which brings us to reiterating the point that it is not the actual size of the implant that is most important, but the general shape and contour that it provides which is vital to getting the highest aesthetic result possible.

Feel. Although we have repeatedly mentioned size as an important aesthetic consideration, the fact is the actual feel of a breast once it is enhanced is a critically important aspect of the final aesthetic outcome for most patients. Generally speaking, when a patient has the opportunity to compare silicone implants versus saline implants, it becomes clear that silicone mimics the natural feel of the breast while saline oftentimes falls short. Saline implants do offer the advantage of being able to be placed through much smaller incisions, or through incisions that are not on the breast (eg the belly button, or TUBA) approach, the trade-off is not enough for some patients who want, as part of their aesthetic goals, both a natural looking and natural feeling breast.

Of course, there are other considerations which are important, but much of this relies on the aesthetic judgment of your surgeon and your own personal preferences. Make sure you have a discussion with your surgeon about your specific goals.

A board-certified plastic surgeon will be able to discuss these at length, and make recommendations based on your goals as well as inform you about the specific risks and benefits of the procedure in the short-term and in the long-term.

Practicing in Chicago, specifically in the suburb of Glenview, I see many patients who come to me for a second opinion regarding their breast surgery, and often my most important job is to inform and educate them about the short and long-term view they should keep in mind as they consider breast enhancement surgery.

In many ways, this aspect of what I do is more vital and more important to establish a level of trust and rapport with the patient than the surgery itself.

Article by
Chicago Plastic Surgeon