Before and After Photos
Breast Augmentation
There are two general groups of patients that come to my office for augmentation consultation – One is the young, nulliparous woman with small breasts that desires enhancement to "balance" her body shape. The second is the woman in her 30s or 40s who may have had small or moderate sized breasts in her "youth", but then after the birth of children and oftentimes breastfeeding, she develops post-partum involutional atrophy or the loss of breast volume, usually associated with some element of sagging – either pseudoptosis or loss of upper pole fullness (UPF) or Grade I ptosis (nipple above the fold, but some of the gland below the fold).
Regardless of the reason for wanting larger breasts, I tell all patients during a breast augmentation consult two concepts:
- The general shape of one’s breasts will be comparable to what her present breast shape is, merely an enlargement of that shape. What does this mean? As an example, if someone has widely positioned nipple areola complex (NAC), the breasts will still appear to be widely spaced. If there are asymmetries (especially of the NAC position) these will persist after surgery, unless something is done to correct the asymmetries. Sometimes asymmetries can be exaggerated after augmentation.
- The effects of aging, gravity, loss of elasticity, weight fluctuations, pregnancy and other hormonal changes will have an effect on the breasts. What does this mean? The younger one is when she has breast augmentation, the more changes her natural breast will undergo during her lifetime. Hopefully, her breast implants will not change (although the risks of rupture and capsular contracture are possible) but the breast tissue overlying the implants will change over time, which can result in less than aesthetic breasts as one ages. Classically, this change is breast tissue sagging off the mound of the implants causing a "double bubble" or "Snoopy nose" deformity. Usually, this can be revised if one desires. Ultimately, these two concepts underscore one of my mantras – "Realistic Expectations are the Key to Satisfaction!
I have not put "hundreds" of photos into this gallery. Instead, I have selected a few in order to demonstrate that different body types and different breast shapes look "differently" when enhanced with breast implants. Organizing the selections, I started with what appeared to be the patient with "average" looking breasts pre-op, then proceeded to include thin patients, patients with prominent pectoral muscles, patients with thicker chest walls, patients with issues of the inframammary fold (IMF) and NAC positions, and I complete the gallery with breast asymmetries and deformities.
With each patient, I have included her "story", her goals, my exam, a summary of the procedure and my comments and critique.
Note: Most patients in the photos below opted for the IMF incision. This is a direct approach and results in a well hidden scar. Furthermore, if a revision is ever necessary, this is often the preferred incision of most surgeons. Pocket selection is usually dependent on implant selection. Note also that all but one of the patients have saline implants; this is because most photos selected were from before the FDA approved silicone gel implants; previously they were restricted for primary breast augmentation patients. Now that gel implants are FDA approved, my "usual" recommendation for the "typical" breast augmentation patient is either smooth, saline implants placed subpectorally (SP) as most of these are, or textured, silicone implants placed in the submammary (SM) position. In addition, other implant factors include "profile": low, moderate, high. For the same volume implant, a low profile implant will have a wider base diameter and less projection and the high profile implant will have a narrower base diameter and more projection. Expanding on this concept, a saline implant that is inflated over its nominal amount will change to a narrower base with greater projection and will "feel" stiffer.
Upon evaluation of a patient’s goals and anatomy, and based upon my experience with both silicone gel and saline implants, specific recommendations are offered and final selection is, of course, the patient’s preference. For example, a narrower chest with significant breast volume loss will most likely need an implant that has a narrow base but more projection, and silicone versus saline and pocket placement are dependent on the amount of overlying breast volume and chest wall tissue.
For each patient listed below you will see that not everything "looks" as it "seems".