Breast Augmentation Gallery

A medical professional in her early 30’s who is bothered by the small size of her breasts. She describes herself as a 34 A cup and would like to be fuller but still natural in appearance. She is 5’9” and 157 lbs and is shown before and again, 6 weeks after bilateral partial subpectoral breast augmentation with 350 cc Sientra Opus 600 series round smooth cohesive high strength silicone gel implants placed through an inframammary incision.
Discussion: She likes fullness in the upper breast and does not mind a slight implant look if needed. Her nipple to Inframammary fold distance is just 8 cm on her left ( the smaller of her two breasts) with a base width of 12.2 cm. The Sientra 350 High Profile implant is 12 cm at the base, which will just be accommodated by the n-IMF on stretch of 8 cm and bhte base width at 12 cm is must slightly less than the existing base of her breast so it should not have an “implant look” that can happen with the implant is wider than the breast. A larger implant would be difficult to do without worrying about her Inframmamary fold giving way and causing “bottoming out” or a “double bubble”. To decrease this risk I have reinforced her fold at the time of surgery with Long lasting but dissolvable sutures.

A mother of 3 in her early 50’s who is bothered by a deflated appearance of her breasts after pregnancy. She was a 34 B cup before pregnancy and wanted to be a full C with some fullness of the upper breast if possible but still natural in appearance. She is 5’ 6/12” and 132 lbs. She is shown before and again, nearly 8 months after bilateral partial subpectoral ( below the muscle) placement of Sientra 440 cc textured round High profile cohesive implants placed through an inframammary incision.

Discussion: The base width of her breast is 12.6 cm and the inframammary fold to nipple distance is 7.5 but increases to 10 cm on stretch. More than 9 cm on stretch is sometimes an indication for a breast lift, but her sternal notch to nipple distance is 18.5 cm on the right and 19.5 cm on her left ( “normal” is 21cm) So she is a risk for increased stretching of the lower pole skin of the breast which would allow the implant to drop and give the appearance of “bottoming out”.
A microtextured implant is less likely to drop and shift and “bottom out” balancing the potential slight increased risk of BIA-ALCL with textured implants which is much lower with the Mentor and Sientra “microtextured” implants vs the higher risk of bottoming out in a patient who is prone to this.

This Sientra implant is 12.8 cm at the base- This matches the current width of her breast which is 12.6 cm . I we went much wider than her breast width it could begin to give an overly round or “implant look” which she did not want.

A long term followup on a mother of 2 in her early 50’s who presented in her mid 30’s with deflated breasts after pregnancy. She is 5’ 4” and 116 lbs.

She elected for a smooth round saline implant placed through a vertical mastopexy position in a subglandular space. When the breasts are a little droopy the subglandular placement allows the implants to settle with the breasts and avoid a “waterfall “ effect of the implants falling off of a mound which can happen with a subpectoral placement. We were conservative with the size of the implants which have prevented excessive stretching and still fit her frame. Her breasts have changed remarkably little in the 15 years since her surgery.
She asked about whether she should change her implants now that they are 15 years old- the answer is no- she is doing great, and it will be easy to tell if and when her implants eventually leak because the saline implants will visibly deflate. But even though 8% of saline implants may have leaked by 10 years, the rest have not and she will hopefully get many more years out of her implants.
followup on a mother of 2 in her early 50’s who presented in her mid 30’s with deflated breasts after pregnancy. She is 5’ 4” and 116 lbs.

She elected for a smooth round saline implant placed through a vertical mastopexy position in a subglandular space. When the breasts are a little droopy the subglandular placement allows the implants to settle with the breasts and avoid a “waterfall “ effect of the implants falling off of a mound which can happen with a subpectoral placement. We were conservative with the size of the implants which have prevented excessive stretching and still fit her frame. Her breasts have changed remarkably little in the 15 years since her surgery.
She asked about whether she should change her implants now that they are 15 years old- the answer is no- she is doing great, and it will be easy to tell if and when her implants eventually leak because the saline implants will visibly deflate. But even though 8% of saline implants may have leaked by 10 years, the rest have not and she will hopefully get many more years out of her implants.

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 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.

Update: Our patient is now seen 1 ½ years after surgery. With the subglandular placement, the implants have settled with the breasts and avoided a “waterfall” deformity which can be more common with the subpectoral approach in a patient with early ptosis.

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.