Breast Augmentation Gallery

An Indian dancer and mother of 2 in her late 40s who is bothered by the small size of her breasts – she describes herself as a 34A cup and would like to fit her dresses better.  She is shown before and again, 6 months after bilateral breast augmentation. She is 5’ 5 ½” and 132 lbs and has Sientra smooth round high profile 385 cohesive gel implants placed through an inframammary incision with a partial sub-pectoral placement.

A 15 ½ year follow-up on a patient in her early 50s who had saline breast implants with us when she was in her later 30s and comes in now for a check.  She is petite at 5’ 4 ½” and 120 lbs and wanted to be fuller but still natural in appearance.  She has smooth round saline implants 300-325 filled to 325 ml and placed through an inframammary incision ( at the breast fold) in a partial sub-pectoral ( below the muscle) space.

She continues to have an excellent and natural appearance many years later.  The implants are not wider than her breast, so she doesn’t have an unnatural “implant” look.  One advantage of saline implants is that they do not require ultrasound or MRI screening to check for a leak.  If they leak, they will have an obvious change in size.  A testament to the importance of proper implant sizing and placement.  The preop view is our original polaroids scanned into her chart, as this was just before digital cameras.  If she had silicone Gel implants the FDA would recommend ultrasound in asymptomatic patients starting at 5-6 years.

An 18-year-old student with hypoplasia ( underdevelopment of the breasts) who is interested in looking more proportional, but still natural.  She is a 32 A cup.  She is shown before and again, 4 weeks after bilateral partial sub pectoral  (below the muscle) placement of smooth round silicone gel implants, placed through an inframammary ( at the breast fold) incision

Discussion: She has a narrow chest, with the measurement around the chest and under her breasts 27/5” which would place her in a 31” band-size bra. She is 5’6” and 111 lbs. Her left breast is slightly smaller and sits a little higher on her chest.  Her nipple to breast fold on stretch is 7 cm and her breast width is 10.87 cm.  After careful sizing in the office, she elected to use a Sientra 240 cc high-profile silicone gel implant on each side. These are 10,5 cm at the base, to fit her breast.  The base of the implant is not greater than the base width of her breasts, so it won’t give her an overly round “implant” look. With an IMF-N on the stretch of 7 cm, she could accommodate an implant up to 11 cm without appearing overly full in the upper breast. The FDA in their labeling recommendations restricts the use of silicone breast implants to women 22 years of age or older.  Silicone implants under the age of 22 are perfectly legal and appropriate for patients who have bully informed consent, and understand that use of silicone implants under the age of 22 is considered “off-label” by the FDA  Off-label use is something that a doctor does frequently when a medication or device is prescribed for another reason than the primary FDA-approved recommendation. An example is Botox being approved for cosmetic use for the frown muscles between the brows, but being used “off-label” to treat crow’s feet lines and forehead lines. Patients are allowed to make their own informed medical decisions, and we as doctors are allowed to provide medical advice based on training and experience in our patient’s best interests.

At 4 weeks she already has a natural appearance, which should continue to soften and improve over the next several months as the tissues gently stretch to accommodate the implants.

A 19-year follow-up on a patient with saline breast implants. Our patient is an RN in her early 60s who had saline breast augmentation with us 19 years ago.  She has done great, is still pleased with her result and size, and wants to know when she needs to have her implants replaced.  She has heard and seen various statements on the internet and I thought discussing her case would help other patients who are wondering. Our only old photos were polaroids which had been scanned into her electronic medical record so I apologize about the quality of the “before” photos, but they will serve the purpose.

Her breasts remain soft bilaterally ( Bakers class I).  Her records were reviewed and she has Mentor smooth round saline moderate profile implants 300-325 cc filled to 325 cc.  They were placed in a partial subpectoral ( under the muscle) position through an inframammary incision (at the breastfold)

Because she has saline implants she needs to do nothing until she develops a spontaneous deflation – with saline implants this will be obvious because the breast will decrease in size.

If she had silicone gel implants, the current FDA recommendation in asymptomatic patients is to start screening with ultrasound starting 5-6 years after initial surgery and then repeat every 2-3 years.

An implant that has not failed does not need to be replaced until it does as long as it is serving its purpose.

Our patient case also illustrates the benefit of careful sizing of implants to match the breast diameter and therefore decrease the risk of excessive stretching of the breast tissue.  Nearly 20 years after her surgery, she continues to do well and remains pleased with her breast augmentation.

A woman in her mid-20s who describes herself as an A cup and wishes to be fuller but still natural in appearance.  Her case is complicated by having pectus excavatum, a depression of the mid-chest ribcage.

She is shown before and again, 5 months after bilateral partial sub-pectoral breast augmentation with 225 cc round smooth high profile silicone gel implants.

Discussion:  her right breast is smaller than her left and her pectus excavatum is more prominent on her right.  Her inframammary fold to the nipple on the stretch is 5.5 cm and the base width of her breasts is 10.6 cm.  If the implant base is smaller than the width of the breast then patients generally do not get an “implant” look.

The Sientra 225 high-profile silicone implant is 10.2 cm in width.  Textured implants tend to be more stable and shift less, but there is a slight risk associated with the texture of Breast implant-associated ALCL so she elected for smooth surface implants.  Her existing inframammary fold was reinforced at the time of surgery by anchoring it to the rib periosteum with long-lasting but dissolvable sutured to decrease the risk of  “bottoming out” as the fold can give way under the pressure of the implant early after surgery.  By 5 months the “pucker” from this suture has relaxed and her fold is stable.  An excellent result in a case that is challenging because of the small size of her breasts and the pectus excavatum.

A mother of 4 in her late 30s who has also lost 30 lbs and feels that her breasts look deflated.  She describes herself as a 36 B and wishes to be fuller but still natural in appearance.

She is shown before and again, nearly 4 months after bilateral partial subpectoral placement of Sientra 440 cohesive round smooth high profile silicone gel implants through an inframammary incision

Discussion: Her case is challenging to give her the fullness that she wants but still have a natural appearance. The base width of her existing breast is 14 cm which means that she can accommodate a silicone gel implant 14 cm or slightly wider without having an “implant look”.  But her IMF ( inframammary fold) to nipple distance on stretch is only 8 cm which typically accommodates a 12 cm base width implant.  After sizing in the office she liked 425 and 450 cc implants.  The Sientra 10621-440 HP is 12.8 at the base.  Although this is slightly wider than the ideal 12.0 base that “fits” more easily, I reinforced her folds at the time of surgery with long-lasting absorbable sutures to help the inframammary fold ligaments remain intact while the lower pole of the breast stretched slightly to accommodate the new implant.  We were able to avoid “bottoming out” and/or a “double bubble” that can happen when a fold is released and lowered.  She has a natural, proportional look that balances with her body and appears natural.

An early, 6 week, follow-up on a woman in her mid 20’s after breast augmentation.  She was a 30-32 A-B cup and wanted to be more proportional.  She did not mind having some superior pole convexity ( fullness in the upper breast) but did not want an overly round, “Implant” look

She is shown before and again, 6 weeks after bilateral partial subpectoral placement of smooth round Sientra high profile cohesive silicone implants 225 ml placed through an inframammary incision.

Discussion: While this may not seem to be a very large implant, it is the largest that I feel we can use for this patient and still maintain a relatively natural result. She is petite at 5’3” and 117 lbs and her optimal bra band size is just 31”   Her breast base width is 10.35 cm on her right and 11.4 cm on her left.  Her IMF –N ) Inframammary fold to the nipple) distance on the stretch is 5.5 cm on her right and 7 cm on her left

The Sientra 225 high projection implant is 10.2 cm in width.  This fist is within her existing base width of 10.35 cm so it won’t look overly round once her tissues have settled.

To avoid excessive fullness above the nipple level, we might select a 9.5 cm base width implant to have the nipple centered.  Because she does not mind some superior breast fullness we can use a slightly wider implant ( 10.2) anticipating that the lower portion of the breast will stretch with time to accommodate the new implant.  Her existing Inframammary fold ligament was reinforced at the time of surgery by anchoring it to the deep tissues with long-lasting dissolving sutures- this decreases the risk of the existing fold “giving out” and the breast bottoming out.

An Asian mother of 2 in her later 40s who wished to have fuller breasts but still have a natural look.  She is petite at 5 ‘ 3 ½ “ and 110 lbs and is shown before and again, nearly 2 years after partial subpectoral breast augmentation with Sientra  smooth round high profile cohesive silicone gel implants of 255 ml

Discussion: The base width of her breast before surgery is 10.6 cm and her Inframammary fold to nipple distance on stretch is 7.5 cm.

The 255 Sientra HP implant is 10.8 cm at the base

The 280 Sientra HP implants are 11.1 cm at the base

She liked both implants when sizing in the office but did not want a round “implant” look

The 255 implant therefore is only slightly larger than the existing base width and she decided to go with this one to ensure a more natural look.

The IMF- Nipple distance on a stretch of 7.5 cm will typically accommodate an implant base of 11.5 cm without excessive upper pole fullness so this implant also fits here.

She loves her fuller but still natural look.  Her inframammary breast fold incisions have healed well and are not visible unless the breast is lifted.

An 8-year follow-up on a mother of 2 in her early 40s who was bothered by a deflated appearance of her breasts after pregnancy.  She wished to be fuller but still natural in appearance.  She is in for an implant check and questions about how she should follow her implants.  She continues to be thrilled with her result which is fuller but still natural.  She is 5’$’ and 117 lbs and has 275 cc smooth round silicone gel implants placed in a partial subpectoral pocket through an inframammary incision.

Discussion:

Breast implants are not meant to last your lifetime.  If you are like many of my patients, it has been a few years since your breast augmentation and you are wondering “What should a thoughtful patient be doing now?

There has been a little confusion because the FDA shook things up a little bit with new recommendations that they released in 2022.

These recommendations are for patients who do not have any symptoms and are doing well after their breast augmentation.  If a breast augmentation patient is having symptoms, they should call their plastic surgeon and make an appointment to be examined.

If a patient has had saline-filled implants, such as the traditional saline filler implant or the newer multi-lumen Ideal Structured saline implant, then they do not require any special screening for rupture.  The breast will get visibly smaller as a saline implant leaks and you will be able to tell if you have a full or partial deflation by looking in the mirror.  The saline is harmlessly absorbed like an IV.  They will typically not need an implant study such as an MRI or an ultrasound. ( photos of saline and ideal structured saline implants)

90% of breast implants used in the US for breast augmentation now are smooth, round silicone gel filler implants.  Rupture rates with breast augmentation vary depending on the implant study but around 10% of silicone breast implants have failed by 10 years.

I mentioned that the FDA changed things in 2022.  BEFORE 2022 the recommendation from the FDA in breast augmentation patients with no symptoms was to get a non-contrast  MRI every 2-3 years.  And a non-contrast  MRI is still thought to be the gold standard for detecting breast implant rupture.  However patients weren’t generally getting routine screening done— it was expensive, insurance companies often didn’t cover the cost in patients with no symptoms, and many patients don’t like being in an MRI scanner.

In 2022 the FDA changed to recommend MRI or ultrasound starting 5 -6 years after the initial surgery.  Why 5-6 years? Waiting 5-6 years was recommended because the chance of having a rupture in less than that time was very low and they didn’t feel that it made sense to screen before then.

Studies have been done showing that diagnostic ultrasound is very good at screening asymptomatic patients, as well as being more widely available and lower cost.

So the current FDA recommendation is ultrasound or MRI starting 5-6 years after breast implant placement and then repeating this every 2-3 years to monitor for asymptomatic silent rupture. Our patient is due for her next mammogram in a few months and will schedule a screening ultrasound to be done at the same time.

A 16-year follow-up on a patient with silicone breast implants in a nurse who first presented in her early 30s with a desire to have fuller breasts,  She described herself as a 32 A cup.  She had a bilateral partial sub-pectoral breast augmentation with a 350 cc smooth round silicone gel implant on each side.  Her postoperative course was uneventful and she had a child and breastfed after her surgery.  She continues to do well 16 years later.  She comes in today for a breast check.  Her breasts remain soft, and she continues to get routine mammograms for breast health.  She now wears a 32 C cup,  Her breasts remain soft and have settled slightly with time, pregnancy, and breastfeeding but continue to have an excellent appearance.

Her reason for coming in is to check her breast implants.  In patients with no symptoms a silicone breast implant rupture is often “silent”, ie, there are no visible or palpable signs. A saline implant is easier to follow because it will deflate when there is a leak and the breast will become visibly smaller.  An implant failure with a saline implant is not “silent”

Breast implants are not meant to last your lifetime.

Like our patient shown here, 90% of breast implants used in the US for breast augmentation now are smooth, round silicone gel filler implants.  Rupture rates with breast augmentation vary depending on the implant study but around 10% of silicone breast implants have failed by 10 years.

There has been a little confusion because the FDA shook things up a little bit with new recommendations that they released in 2022.

BEFORE 2022 the recommendation from the FDA in breast augmentation patients with no symptoms was to get a non-contrast  MRI every 2-3 years.  And a non-contrast  MRI is still thought to be the gold standard for detecting breast implant rupture.  But patients weren’t generally getting routine screening MRIs— it was expensive, insurance companies often didn’t cover the cost in patients with no symptoms, and many patients don’t like being in an MRI scanner.

So in 2022, the FDA changed to recommend MRI or ultrasound starting 5 -6 years after the initial surgery.  Why 5-6 years? Waiting 5-6 years was recommended because the chance of having a rupture in less than that time was very low and they didn’t feel that it made sense to screen before then.

Studies have been done showing that diagnostic ultrasound is very good at screening asymptomatic patients, as well as being more widely available and lower cost.

So the current FDA recommendation in breast augmentation patients without symptoms is ultrasound or MRI starting 5-6 years after breast implant placement and then repeating this every 2-3 years to monitor for asymptomatic silent rupture.  So she is going to get a screening ultrasound.

The link to the FDA’s section on breast implants is below

https://www.fda.gov/medical-devices/implants-and-prosthetics/breast-implants