A Boston professional woman in her mid 20’s who wished to be able to wear a bathing suit or dress and look like her padded bra but without needing the padding. She wanted to have a natural , proportional appearance after surgery. She did not want an “implant” look. She was a 32 A cup before surgery and at 5’6” and 122 lbs was relatively thin. Her chest is narrow. Based on her current breast width and tissue characteristics she selected a 300 cc smooth round moderate profile plus silicone gel implant. She is shown before and again, 6 weeks after surgery. The implant is placed below the pectoral muscle, through an infra mammary (at the breast fold)
incision. As is typical with most women, she has a difference of the positioning and size of her breasts before surgery which is still seen after surgery. A breast implant merely increases the volume of the existing breast. She is thrilled with her natural appearance after breast augmentation, and now feels comfortable in her clothes and bathing suit.
Update: Our patient is now seen 7 years later, how in her early 30’s and after 2 pregnancies. Her breast augmentation has held up well despite the changes from having children. . Her weight is back to 125 lbs. The breasts remain soft and proportional to her frame.
A mother of 3 in her late 40’s who would like to have fuller breasts. She describes herself as a 34 B cup. She is 5’ 7” and 132 lbs. She was carefully sized in the office with her breast dimensions and wished the largest implant that would still appear natural. She is shown before and again, 3 months after bilateral partial subpectoral breast augmentation with a 5th generation cohesive silicone gel round high profile Sientra Opus implant placed through an inframammary incision.
An Asian woman in her early 20’s who wished to have fuller breasts. She described herself as a 32-34 A cup and wanted to be a C cup is possible but still natural in appearance.
She is shown before and again 1 year after breast augmentation with 5 th generation smooth round cohesive silicone gel implants placed below the pectoralis muscle through an infra mammary ( at the breast fold) incision. Implants used were Sientra Opus 255 ml moderate profile cohesive silicone gel implants. She is petite at 5’3” and 116 lbs. This was the largest implant that would fit the dimensions of her breast and still maintain a natural appearance, without an overly round “implant” look. Her inframammary fold was reinforced at the time of her surgery by anchoring it to the rib periosteum with long lasting but dissolving sutures to prevent “bottoming out” and dropping of the breast fold.
A woman in her late 20’s who had been thinking about breast augmentation since she was 18. She feels that she is tall at 5’8” and 147 lbs. and has full hips and wanted to have fuller breasts that were more proportional to her frame, but still natural in appearance. She is a 34 B cup bra before surgery and a full C after. She is shown before and again, 8 weeks after bilateral partial subpectoral breast augmentation with the placement of Sientra, 5 th generation silicone cohesive gel round smooth high profile implants placed in a partial subpectoral position through an inframammary incision. Her Inframammary fold was reinforced at the time of surgery by anchoring it to the rib periosteum with long lasting absorbable sutures.
Discussion: After careful sizing and measurements in the office she has a base width of 12.2cm on her left and 12.4cm on her right. Her nipple to Inframammary fold distance on stretch (to simulation the weight of the implant) is 8 cm on her right and 8.5 cm on her left. She liked a volume of 385 cc in her Bra. The Sientra 385 HSC implant has a base width of 12.3 cm and a projection of 4.9 cm. So the base width is just under the diameter on her left and just over on her right. In my experience it is possible to go just slightly wider than the base of the breast as shown here without giving an overly round “implant” look. The ideal IMF-Nipple distance for a 12 cm base implant is typically suggested as 8 cm so the base width of the implant is perhaps 2 mm wider than ideal given this distance on her right. To decrease the risk of the fold “’giving way” and “bottoming out” it was reinforced at the time of surgery.
At 8 weeks she already has a natural appearance which should appear even more natural over the next few months as the breasts gently stretch to accommodate the new implants. In the side views we will notice that early on she has mild fullness of the right breast upper pole which is expected now that we know the IMF to fold distance on stretch before surgery of 8 cm, and no upper pole fullness on the left which had the IMF to fold distance on stretch of 8.5 cm.
A mother of 4 in her early 50’s who is bothered by a deflated appearance of her breasts after pregnancy. She is 5’ ½” and 112 lbs and is shown before and again, 6 weeks after subglandular placement of Sientra Opus smooth round high profile 280 cc cohesive silicone gel implants placed through an inframammary incision.
Discussion: She has early breast ptosis but because of her petite size the implants were enough to fill up the breasts and correct the drooping appearance. She is on the borderline of requiring a breast lift and the implants were placed in a subglandular space so that they will drop with the breasts and avoid a “waterfall” appearance that would be likely to happen in her case with a subpectoral placement which would have the breasts “falling off” of the breast implant. 6 weeks is still early and we can expect the breasts to drop and settle more over the next few months.
A woman in her early 30’s who is petite at 5’5 and 112 lbs. She has a very narrow breast width at 10.6 cm and a nipple to inframammary fold distance on stretch of 7.2 cm. She wanted to be fuller but still natural in appearance. She also has a mild pectus excavatum (depression of the chest bone) and an accessory nipple on her right. She is shown before and again, just 6 weeks after bilateral partial subpectoral placement of smooth round high profile Sientra Opus implant through inframammary incisions. The base width of this implant is 10.5 cm. A slightly larger implant was tried at the time of surgery and appeared unnatural. The breasts will typically continue to settle and appear even more natural over the next 3-4 months.
A mother of 2 in her mid 30’s who is bothered by a deflated appearance of her breasts after pregnancy. She described herself as a 34 A cup and wanted to be a B or C cup if possible, but still natural in appearance. She is 5’ 3 ½ inches in height and 119 lbs. She is shown before and again, 6 weeks after bilateral partial subpectoral placement of 270 cc Ideal Structured Saline implant filled to 270 cc and placed through an inframammary incision.
Discussion: She liked the idea of not having to worry about a silent rupture and chose the ideal structured saline implants. Her chest diameter at the IM fold is 29 inches which would place her in a 32 inch bra. (3 inches is added to this distance to get the bra band size). Her nipple to inframammary fold distance on stretch is 7.2 cm on her right and 8 cm on her lift. Her breast diameter is 11.3 cm. The dimensions of the Ideal 270-305 implant at 270 is 10.7 cm with a projection of 4.3 cm. Because the implant is shaped to fit on a curved surface such as the chest wall I would typically add 3 mm to the width to be equivalent with a “standard” implant. So 11 cm base equivalent is smaller than her existing base width so her breast does not have an overly round “implant” look and the nipple to fold distance of 11.2 accommodates an implant base of 11-11.1 without giving too much superior pole convexity or unnatural fullness of the upper breast. Tattoos have been blurred for her privacy.
A mother of 2 in her early 40’s who is bothered by a deflated appearance of her breasts after pregnancy. She described herself as a 34 A cup before surgery and wished to be a full B-C cup but still natural in appearance. She has breast ptosis, with her nipples being lower than her breast fold. She is shown before and again, 18 months after an augmentation mastopexy. She had Mentor high profile 325 cc silicone gel micro-textured implants placed in a dual plane position through an inframammary incision and combined with a periareolar round block mastopexy using a Gortex suture to prevent spreading of the areola.
Discussion: when the breasts are “loose” after pregnancy, a smooth implant is more likely to shift to the side. Although aggressive textures such as the Allergan texture have a higher association with Breast Implant associated anaplastic large cell lymphoma (BIA-ALCL) it is much less common in the less aggressively textured implants such as the Mentor and Sientra devices, and many surgeons feel that texture still has a place in decreasing the risk of implant shifting in carefully selected cases such as this. At 18 months, her implants have remained soft and stable and have not shifted laterally or inferiorly. She has maintained volume in her upper breasts.
A woman in her early 20’s who described herself as a 34 A cup and wanted to be a full C but still natural in appearance. She is 5’4” and 135 lbs. She is shown before and again, 5 months after bilateral partial subpectoral placement of 325 cc Sientra smooth round 5th generation cohesive silicone gel implants with a moderate plus profile, placed through an inframammary incision. I have recommended that she remove and not replace her nipple piercings to decrease her risk of capsular contracture. Nipple ducts have bacteria, and a piercing in this area may allow bacteria to enter the bloodstream and travel to the implant. I also recommend against oral or vaginal piercings after surgery for the same reason.
Update: Our patient is now seen 6 months after surgery. The breasts have settled and appear even more natural in appearance.
A mother of one in her early 30’s who is bothered by a deflated appearance of her breasts after breast feeding. She describes herself as a 36 B but wanted to be a full C. She is 5’4” and 158 lbs and is shown before and again, 4 ½ months after bilateral subglandular breast augmentation with Ideal Structured Saline implants filled to 410 cc.
Discussion: She has pseudoptosis with her nipples being located just at to above her breast fold. Caliper pinch of her breasts shows a thickness of 4.5 cm. A subglandular placement was chosen because she has enough breast tissue thickness to hide the implant and a subpectoral placement puts her more at risk for a “waterfall effect” with her somewhat loose breast falling off of the breast mound. With a subglandular placement, the implant drops with the breast, avoiding the potential for a waterfall effect. She has the Ideal 370-410 cc implant. The empty implant volume is 56 cc and the inner lumen is filled to 214 cc. The outer lumen is filled to 145 cc to give a total implant volume of 410 cc. This higher fill volume is similar in profile to a high profile silicone implant and gives a little more fill to the upper breast. She is pleased with the soft feel of the Ideal Implants which are nearly as soft to the touch as silicone implants. She is also happy to not have to worry about silent rupture.