Robert Vitolo, MD, FACS

The areola is basically just pigmented skin.  Most women have areola that are portioned to the beast size,  When an implant is inserted there is an increase in volume of the breast , and consequently the skin and the areola stretch.  They result is usually in proportion the the new breast.

If your areolae are abnormally large, they probably will  become larger.  The can be made smaller by reducng the size of the areola. surgicaly.

Placing the implants thru an incision in the areola will leave a visible scar and may damage the sensory nerves the the areola.  I prefer the TUBA technique ( trans umbilical insertion).  With this procedure the implants are placed thru a small incision in the belly button which is almost invisble.  

The implant is inserted thru tunnels that are made in the fat layers of the abdomen and never are actually in the abdomen,  The procedure usually takes 20 minutes or so, and most patients can return to work in a day or two because there is almost no damage to the body with this technique.

Partial or complete deflation will allow the skin to shrink back towards its pre implant state ( how ever it usually never gets that tight) It may then not be necessary to do a lift if the deflation was done over a long period of time.  The need for a lift depends on how much extra skin you are left with.  For a small implant its probably worth a try.

After the External Ultrasonic Liposculpture (EUAL) that I perform on my patients a prelininary result is seen 2 days after surgery when the garment is changed.  That , however is only the beginning of healing , skin contraction and swelling reduction.  The use of ultrasound stimulates skin contraction and the body begins to absorb the excess fluid that remains in the remaning fat.

I frequently use a diuretic for a short time after liposuction to mobilize and remove the excess fluid.  After 7 to 10 days , the patients can see an improvement in their shape and are excited about what is to come.  Using  the EUAL technique, final resolution of minimal remaining swelling and skin tightening usually takes 3 to 4 months in the average patient

My average liposuction patient, after a central body liposuction (abdomen, flanks, inner and outer thighs with buttock sculpting )  can usually return to work on the 3 rd day after surgery.  The patient would wear a garment for a total of 2 weeks after liposuction.

The technique that I use , that makes this possible, is External Ultrasonic Liposculpture (EUAL). In this technique,after fluid injection ((tumescence) ultrasound is applied to the areas that we are targeting thru the skin using a gel medium.  The ultrasonic energy is transmitted thru the skin , causing no damage, and creates heat. 

The fat cells are softened and semi liquified by the heat thus making it easier to sculpt the fat cells, allowing us to use finer cannulas and thus creating minimal trauma to the body.  The fat actually comes out looking like slush and there is minimal bleeding.  Less trauma to the body and minimal bleeding translates to a rapid recovery.

The ultrasound also helps the skin to tighten after surgery and prevents post op eccymoses. Most patients take pain meds only the first night and then they realize that they dont need them.

Dr Vitolo

Using the Scar Less (TUBA) procedure, most of my patients can return back to work in 1-2 days .  Some patients return to work the next day, even with sub muscular placement.  With sub muscular placement I advise patients to avoid upper body exercise for one week.

With the Scar Less (TUBA) technique there is no scar on the breast or anywhere near it.  A 1/2 incision is made in the belly button , and since the belly button is everyones one natural scar, this incision heals as a scar on a scar and is inperceptable.  Most of my patients OBGYNs dont even know the patients have breast implants!

This technique does not cut any tissue and causes almost no bleeding, so the breast tissue is minimally damaged, and consequently, minimal pain. And that translates to a rapid return to work and activity.

Hopes this helps.  Dr Vitolo

Cavitation machines have been around for over 20 years, starting with the Lyposonic  machine.  This was supposed to be sciences answer to perfect liposuction.  These machines have been living in the corner of plastic surgeons operating rooms for the last 18 years,collecting dust.
Imagine a pencil with a tip that heats up and burns fat to dissolve it, then the melted fat is suctioned out. This takes forever and perforations and skin burns were common.  Even the newer similar machines are not as effective as the " real liposuction".  Hope this helps.  

From your photos, it appears that your right breast implant is under the muscle , but your left seems like its under the breast tissue.  You don really have a "double bubble" yet, but the right will probably progress to that.
You dont get a double bubble when the implants are in the sub glandular position because both the breast and the implant slowly age and droop together.  Not so with submuscular placement.  This can be fixed by an experienced plastic surgeon.  Hope this helps.

The selection of  the profile of the implant is , perhaps, the most important decision in breast augmentation.  Size is simpler.. bring a picture, try on sizers and pick something you would like to look like.  Type.. you have 2 options , saline or silicone .. do your research independent of your surgeon, and come to a conclusion as to what you are comfortable in having in your body for the next 10 to ??? years.  Most plastic surgeons favor one over the other and may lead you the type they like.

The complex decision is PROFILE.. There is type ( HP, MP, M+ (etc), width, and projection, and these are different for each size and profile!  What all these parameters will translate into is "what the implant will look like in your body"and is very complex, as your question shows.  The end result of those parameters depends on the experience of your plastic surgeon who has , hopefully performed thousands of augmentation using all profile and sizes of implants.  The right answer is in his experience and you should allow him to do what you are paying him for, giving you a great result.  Hope this helps. Dr Vitolo

From your photos, it is difficult asses your pectus excavatum because you have round perky breast, that in themselves, camouflage the depression of the pectus.  That is what implants will do to a greater extent.  The idea being, that by bring the edge of the implants closer to the center of the sternum, the pectus depression looks like more cleavage.  From looking at your photos it also looks like you have "flared"  rib cage under your breasts.  Placing implants to enlarge the breast may make this look less prominent.  Hope this answers your question.  Dr Vitolo.

Does this area swell with your menstrual cycle or becomes tender?  If it does, it may be axillary breast tissue mixed with some fat.
If that is not the case, then it is probably weigth loss resistant fat.
In either case, it can be corrected with liposuction and the results are usualy very good.
In my technique I make a1/4 inch incision under your armpit and after injection of a saline solution I use ultrasound transmitted thru the skin, which softens and melts the fat.  I then can use very thin cannulas to remove the softened fat with liposuction.  The use of ultrasound helps the remaining skin to tighten.  Hope this helps.

Dr Vitolo