Breast Augmentation Gallery

A 10-year follow-up on a patient with silicone breast implants.  She first presented as a mother of 1 in her middle 30’s. She was bothered by breast asymmetry as well as the deflated appearance of her breasts after breastfeeding.  She liked the size of her breasts when she was breastfeeding.  She had a bilateral partial subpectoral breast augmentation with a 300 cc smooth round high-profile silicone gel implant on her right and a 275 cc smooth round high-profile silicone gel implant on her left.  Her postoperative course was uneventful and she continues to do well 10 years later.  She comes in today for a breast check.  Her breasts remain soft, and she continues to get routine mammograms for breast health.

Her case illustrates a few important points.  The first is proper implant selection-fitting the implant to the patient and balancing the desire for an increase in size with long-term considerations such as stretching of the breasts with larger implants.

She is petite at 5’2” and 104 lbs.  Her preop nipple to breast fold on stretch is 7 cm on her right and 7.5 cm on her left.  The implants selected are appropriate to the size of her body and breasts: they give her a nice increase in size but are not larger than the base width of the breasts or too wide to accommodate the nipple to IMF distance on the stretch.  So they appear natural.

It is difficult to balance breast asymmetry – the smaller breast has a smaller envelope of skin and will look “bulgier” if the implant is too full the implant is first chosen based on the “tighter” smaller breast and sized down for the larger breast

Because her implants are not too large for her frame, she continues to have a natural appearance years later

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

A mother of 4 in her mid-30s who is bothered by the deflated appearance of her breasts after pregnancies.  She is shown before and again, 6 weeks after bilateral partial subpectoral breast augmentation with smooth round silicone implants placed through an inframammary incision.

Discussion: Our patient is 5’5” and 132 lbs  During our sizing appointment she liked the 375 and 400 and felt that 425 was starting to look too full.  After discussions, she elected the Sientra 415 smooth strength cohesive moderate plus profile round silicone gel implants.

She had some asymmetry before surgery with her left breast fold being 5 mm higher than her right.  Her measured breast base width is 13.1 cm on her right and 13 cm on her left, and her nipple to breast fold on stretch is 10.5 cm on each side.  This implant has a base width of 12.95 cm and fits easily in the footprint of her breast, so she will not have an “implant” look.

She loves her result and like many women says she “could have gone bigger” but we know that on the sizing appointment, a larger implant would start to look unnatural for her frame, as well as having a higher risk of stretching and displacement.

A medical professional in her early 30’s who wished to have fuller breasts.  She is shown   before and again, 4 ½ months after bilateral partial sub-pectoral breast augmentation with the placement of Ideal Structured Saline implants placed through an inframammary incision

Discussion:  She wished to have a natural appearance after surgery.  At the sizing appointment, she liked a 375 cc but felt that a 425 was too full for her frame.  Both implants would fit her measured breast dimensions without giving an “implant” look. We settled on an Ideal implant of 330-375 filled to 375.  Because she is a medical professional, we tested her preoperatively for MRSA, which was negative.

Ideal implants are, we hope temporarily, off the market at this time.  The company did not survive Covid-19  and went bankrupt in the spring of 2023.  I hope that they are purchased and returned to the market because they fill an important niche for patients who wish to have a saline implant that feels more like silicone.

A woman in her early to mid-30s who describes herself as a B cup and wishes to be a full C cup.  She is 5’5” and 134 lbs and is shown before and again, 18 months after bilateral partial sub pectoral ( below the muscle) placement of Sientra high strength gel, smooth round high profile silicone gel implants 330 size.  They were placed through an incision at the inframammary fold.

Discussion: The base width of her right breast is 12.3 cm and her left breast is 12 cm.  The nipple to inframammary fold distance on the stretch is 9 cm on the right and 8.5 cm on the left.

The 330 HP implant is 11.7 cm at the base.  When two breasts are different in size, which is common, we usually limit our size based on the smaller of the two breasts if we wish to maintain a natural appearance.  When the implant is bigger than the base width it can start to give an “implant “  look.  Also, the nipple-to-breast fold distance on stretch guides us in choosing an implant that is centered under the nipple.  Typically, 7 cm on the stretch will accommodate an 11 cm base implant, 8 cm, a 12 cm base, and 9 cm a 13 cm base implant without looking overly “bulgy” (superior pole convexity) in the upper half of the breast.  In this case, the implant gives her the volume that she liked during sizing in the office, but still gives her a natural appearance.

A woman in her later 30s with a deflated appearance of her breasts after weight loss.  She is 5’ 4 14” and 112 lbs and is shown before and again,  4 ½  after the bilateral partial subpectoral placement of Sientra round smooth moderate profile cohesive silicone gel 355 breast implants. They were placed through an inframammary incision.

Discussion:

The base width of her existing breast are 11.9 cm on her right, and 11.8cm on her left.  Her IMF-N ( infra-mammary fold to the nipple) distance on the stretch is 9 cm.  This represents the approximate expected distance with the weight of an implant in the breast.

She was sized in the office and liked a volume of 350 but felt that 375 and 400 looked out of proportion to her petite frame.  A Sientra 355 moderate plus projection cohesive round smooth high strength silicone gel implant is 12.1 cm at the base.  Although this is 3 mm wider than her existing breast base it is s silicone gel implant and we can go slightly larger than the base without appearing unnaturally round once the breasts have had a few months to settle.  More importantly, with an IMF-N on the stretch of 9 cm, a 12 cm base implant allows the breast implant to be centered under the nipple so that the upper ½ of the breast is optimally filled but not overfilled and bulging.

A 4  ½ months her breasts are full but not overly so and maintain a natural appearance.

Tattoos have been blurred for the patient’s privacy.  The photos are otherwise untouched.

Details: A woman in her early 30s who has been thinking about breast augmentation for years, and describes herself as an “A” cup.  She is thin at  5’8” and 131 lbs and has some mild breast asymmetry.  She is shown before and again, 6 weeks after bilateral partial subpectoral breast augmentation with Sientra smooth round High profile High strength silicone gel implants placed through an inframammary incision.  Her Inframammary fold was reinforced at the time of her surgery with long-lasting absorbable sutures.

Discussion: Her IMF distance on the stretch is 7.5 cm which suggests that the largest implant that we can use that will still look natural and not put excessive stress on her Infra mammary fold is the Sientra HP 300 ml implant with a base of 11.4 cm.  Her existing breast base is 12.45 cm so this fits within that measurement and will therefore not give her an “implant” look, which she doesn’t want.  She is thrilled with her full but still natural appearance after surgery.

A mother of 2 in her later 40s is bothered by the deflated appearance of her breast after children. She describes herself as a 34 B cup and would like to be fuller.  She is shown before and again, 4 months after bilateral sub glandular Sientra smooth round 350 ml High profile cohesive silicone gel implant placed through an inframammary incision.

Discussion:  Although a partial sub-pectoral placement of the implant is more common in my practice when a patient has some drooping and an increased stretch of the lower pole of the breast, a sub-glandular placement allows the implant to settle with the breast and gives a more natural appearance in this instance.  If the implant is placed under the muscle and the breast “drops off” the mound we call that a waterfall effect and it does not look as natural.

A woman in her later 30s with a deflated appearance of her breasts after weight loss.  She is 5’ 4 14” and 112 lbs and is shown before and again, 6 weeks after the bilateral partial subpectoral placement of Sientra round smooth moderate profile cohesive silicone gel 355 breast implants. They were placed through an inframammary incision.

An Asian mother of 2 in her later 40’s who described herself as a 32 A cup and wanted to have a fuller but still natural look.  She has some asymmetry with her right breast being higher and slightly more lateral on her chest wall  She does not want an “implant” look.  She is shown before and again, 4 ½ months after bilateral partial sub-pectoral placement of round smooth highly cohesive silicone gel Sientra 255 High profile implants through an inframammary incision.

Discussion: The Sientra 255 HP implant is 10.8 cm at the base.  The measured base width of her breasts was each 10.6 cm and the IMF to nipple distance on the stretch was 7.5 cm.  A larger implant would have been significantly wider than her breast and would have been more likely to give her an overly round “implant” look, which she wanted to avoid.  She is thrilled with her fuller but still natural appearance.

A mother of 3 in her early 60’s who is bothered by a deflated appearance of her breasts after children.  She is 5’ 4” and 116 lbs and is shown before and again, 6 weeks after subglandular placement of Sientra 415  cc high profile  smooth round high strength cohesive silicone gel implants.

Discussion: Although I would more typically recommend a subpectoral placement of the implants ( below the muscle) which may have a lower risk of capsular contracture,  She has some early ptosis or drooping of the breasts.  A subpectoral placement in her case would place her at a higher risk of a “waterfall deformity” with the breasts falling off of the implant mound.  With a subglandular placement, the implants settle with the breasts and gives a more natural appearance.