A woman in her early 20’s who described herself as a 34 A cup and wanted to be a full C cup if possible but still natural in appearance. She is 5’4” and 135 lbs. and is shown before and again, 6 weeks after bilateral partial subpectoral breast augmentation with the Sientra Opus 5 th generation cohesive gel round smooth moderate plus 325 cc implant placed through an inframammary incision (at the breast fold).
Discussion: Her breast width is 12.5 cm and the fold to nipple distance is just 5.5 cm but increases to 8 cm on manual stretch. The Sientra 325 moderate plus implant is 11.8 cm at the base. This fits within her measured base width so the breasts will not look overly round after augmentation. The nipple to fold distance on stretch of 8 cm would theoretically allow an implant base of up to 12 cm without being overly full on top. She is still at some risk of “bottoming out” if the inframammary fold ligament were to detach from the extra pressure of the implant so I reinforced the fold at the time of surgery with slowly dissolving but strong anchoring sutures. This allows us to use the largest possible implant that will fit her measurements without appearing unnatural. On close observation you may notice nipple piercings before surgery. I ask patients to remove these at the time of surgery and never replace them because I think it can increase the risk of capsular contracture. The nipple ducts, like the mouth and vagina have bacteria and a piercing in these areas may allow bacteria to enter the blood stream, travel to the implant and lead to bacterial contamination of the implant with biofilm and a subsequent capsular contracture. Piercings in other areas without bacteria such as the umbilicus, do not seem to have the same issue.
A mother of 1 in her early 30’s who is bothered by a deflated appearance of her breasts after pregnancy and breast feeding. She describes herself as a 36 B and would like to be a full C. She is 5’4” and 158 lbs and is shown before and again, 6 weeks after bilateral subglandular placement of Ideal Structured Saline implants 370 filled to “100%” fill of 410 cc.
Discussion: Our patient wanted a natural but fuller appearance and wanted to restore some volume to her upper breasts. Her breast width is 13.97 on her right and 14.3 on her her left. Her nipple to breast fold distance on stretch is 9 cm. The diameter of the Ideal Implant she selected and filled to 410 is 11.7 I usually add 3 mm to the base width of the Ideal because is it designed to sit on a curved surface. So 12 cm is less than her breast width, so it will not “look like an implant”. Her nipple to breast fold on stretch is 9cm. Any more and she may be a candidate for a lift. If her implants were placed below the muscle the implant would move separately from the breast and the breast which is slightly lax would have a tendency to drop off of the implant- this is sometimes called the “waterfall effect”. In a case like hers where the breast is lax, a subglandular placement allows the implant to move with the breast and settle with the breast, giving a more natural look. The tradeoff for a subglandular placement is a slightly higher risk of capsular contracture.
The 370 implant has an empty implant volume of 56 cc. The inner lumen is always filled to 214 cc. The outer lumen is filled to 145 cc, giving her a total implant volume of 410 cc. This gives a higher profile, which helps to add some volume back to her deflated upper breast.
A 39 year old woman who described herself as a 34B but wished to be a full C to D but still relatively natural in appearance. She was concerned about capsular contracture because of a friend who has breast augmentation elsewhere and wished to do everything to avoid this. She wanted to have some superior pole fullness as long as it would look relatively natural. After discussing the different implant choices she elected for an Ideal Structured Saline implant because she did not want to have to worry about a silent rupture. She is 5’5” and 137 lbs and elected for a 455 cc implant placed through an inframammary fold incision and below the pectoralis muscle.
She is shown before and again, 10 months after her surgery.
Details: We used the 405 cc Ideal Structured saline implant with the empty implant volume of 60 c. The inner lumen was filled to 235 cc and the outer lumen was filled to the maximum recommended volume of 160 cc to give a total volume of 455cc. ( “100% fill “) Because of the relatively large size of the implant that she selected, I reinforced her inframammary folds by anchoring her inframammary fold ligament to the rib periosteum at the time of surgery with a strong dissolvable suture to decrease the risk of “bottoming out”. This can be an issue with a larger implant when additional force is placed on the fold, causing it to “give way” and allow the implant to drop excessively. She is thrilled with her very full but still natural appearance, and her inframammary folds have been stable.
A more than 17 year follow-up on a woman who is now in her 40’s but had a breast augmentation with us at the age of 24 with saline implants. She had per-areolar incisions with partial sub-pectoral placement of 300-325 filled to 305 on her left and 325 on her right. She continues to do well and just stopped in for an implant check in our office. Her case illustrates 3 important concepts of breast augmentation.
First, pick the right size but don’t use an overly large implant. She is 5’2” and 117 lbs and has not had issues with too much stretching of her tissues because we did use too large of an implant for her tissues. 17 years later she still looks good.
Second: Don’t keep the nipple piercing in after surgery ( or a tongue or vaginal piercing) because they may increase the risk of capsular contracture by allowing bacteria that lives in the nipple ducts/ mouth or vagina to get into the blood stream and travel to the implant, leading to biofilm and a capsular contracture. Her breasts remain soft after 17 years.
Third: One huge benefit of saline implants is not having to worry about a silent rupture- the implant will go flat when it eventually leaks. So it is nice to be able to tell her that her implants are fine without getting an MRI or an ultrasound as would be need at this point to check on the integrity of a silicone gel implant.
A mother of 2 in her late 30’s who has 2 children and breast fed. She describes herself as a 34 B cup but would like to be a C cup. She is 5’2” and 127 lbs and is shown before and again, 6 weeks after bilateral partial subpectoral placement of Ideal Structured saline implants.
She had the 270 cc implant with the inner lumen filled to 165 cc, the outer lumen filled to 70 cc to give, along with the empty implant volume of 35 cc a total volume of 270 cc. This is considered the “ High” volume. The outer volume could also have been filled to a total of 200 cc to give the “100%” fill of 305 cc for this particular implant. She is thrilled with her fuller but still natural appearance.
A long term follow-up on a woman now in her later 30’s. This helps answer the question of “what will happen to my breast if I get pregnant after breast augmentation” She was initially seen in her late 20’s and described herself as a 32 AA cup and wanted to be a B or C cup if possible, but still natural in appearance. She is petite at 5 feet tall and 101 lbs. She elected for a smooth round silicone gel implant placed in a partial subpectoral position through an inframammary incision. A 250 cc high profile implant was used. This was the largest implant that I felt would still fit her tissues without looking overly round. She is shown just before and again, 10 months after surgery She has since had a child, and is shown again, 7 1/2 years after surgery. Although the breast typically gets larger with pregnancy and then smaller after, she has not developed significant drooping or stretching of her tissues and has maintained an excellent result. This is partly because she does not have as much native breast tissue to change with pregnancy, and partly because she did not have an implant that was too large for her tissues and could therefore lead to more problems with stretch.
An RN in her later 30’s who wished to have fuller breasts. She comes from another state and found us after seeing one of our patients and being impressed by the natural appearance of her results. She wanted to have a natural but fuller appearance. She found that her breasts looked deflated after losing weight with diet and exercise.
She is 5’6” and 119 lbs. She is shown before and again, 6 weeks after sub-glandular placement of Ideal Structured Saline implants size 370 cc through an inframammary incision.
Discussion: The empty Ideal implant volume is 56 cc. The Back/inner lumen is filled to 214 cc. The front/outer lumen is filled to 100 cc. This gives a total volume of 370 cc. This is listed as “high” fill on the sizing chart. The outer lumen is also designed to be filled to 145 cc which would give a total volume of 415 and is listed as “100%” fill. This greater fill volume is similar to a high profile implant and gives a slightly firmer feel. She did not want to be fuller than the 370 upon sizing in the office and prioritized the softer feel of the implant at 370.
A sub-glandular placement was chosen in her case. With a caliper pinch of 3.2 cm her breast tissues are thick enough to hide the implant ( 2 cm or less is usually considered “thin”). Her nipples are just slightly above the breast fold and she would be prone to a “waterfall effect” with a placement of the implants below the muscle. With a sub-pectoral placement the breast can fall off of the implant. With the sub-glandular placement the implant drops with the breast and avoids the “waterfall”. So when a patient has a nipple just at or above the fold but does not yet require a mastopexy, a sub-glandular placement can be a good tradeoff when the breast tissues are thick enough to hide the implant.
A mother in her early 40’s who would like to have fuller breasts. She is 5’4” and 116 lbs and is shown before and again, 6 weeks after a bilateral partial subpectoral breast augmentation with 275 moderate profile round smooth silicone gel implants placed through an inframammary incision.
A mother of 3 in her late 30’s who wanted fuller breasts. She describes herself as a 34 A cup and wanted to be fuller but still natural in appearance. She petite at 5’3” and 114 lbs and with a measured circumference around her chest of 29 ½ inches, is closer to a 32 Band size bra. ( 3 inches is typically added to this measurement to get the proper band size)
After reviewing the implant options she decided upon the Ideal Structured Saline implant. She was happy to not need to worry about a silent rupture, and even happier to be able to purchase an enhanced warranty from an outside insurance company that she will be able to renew annually for life. The base-width of each breast is 11.85 cm and the nipple to IMF on stretch distance is 8.5 cm. She was sized in the office and liked 325/350 but felt that 375 was simply to full in her clothing. Our decision was for the Ideal 335-375 cc implant that has a base-width of 11.4 cm, filled to a total volume of 350 cc. The implant has an empty volume of 52 cc, and the back/inner chamber is filled to 188 cc. The front/outer chamber was filled to 110 cc to give a total implant volume of 350 cc. Her implants were placed below the pectoralis muscle and through an inframammary incision. She is shown before and again, 4 ½ months after surgery. She is thrilled with her fuller but still natural look.