Are you considering enhancing your breast shape, size, or symmetry? Breast augmentation can address a range of aesthetic and reconstructive goals, such as:

• Restoring volume after pregnancy or weight loss

• Balancing asymmetrical breasts

• Enhancing confidence in your appearance

• Help clothes fit better

• Reconstructing the breast after mastectomy or trauma

Breast augmentation is one of the most popular cosmetic surgeries, providing patients with options tailored to their unique goals. According to 2022 statistics from the American Society of Plastic Surgeons (ASPS) there were nearly 300,000 breast augmentation procedures performed that year, representing a close second to liposuction as the most popular aesthetic operations. 

Of note, the current line of breast implants represent the fifth generation of cohesive gel form-stable devices; the breast implant was first introduced to the market by Cronin and Gerow with the Dow Corning Corporation in 1964. 

What does the procedure entail?

A breast augmentation involves the placement of implants or fat transfer to achieve the desired breast size, contour, and symmetry. The procedure is customized for each patient, incorporating choices like implant type, size, shape, and placement. Common goals include:

• Enhancing projection and volume

• Restoring balance to your silhouette

• Augmenting cleavage and providing a modest ‘lifting’ effect to the breast

• Improving breast shape after changes from pregnancy, aging, or weight fluctuations

Who is an ideal Candidate?

Candidates for breast augmentation are typically individuals who:

• Are in good health with no conditions that impair healing

• Have realistic expectations about the results

• Are bothered by the appearance of small, uneven, or deflated breasts

What evidence supports the

Evidence from clinical studies demonstrates high patient satisfaction and improvements in quality of life following breast augmentation. While aesthetic motivations are most common, breast augmentation can also play a key role in reconstructive procedures (discussed elsewhere, see separate post).

3. Contraindications

• <18 years of age

• Collagen vascular disease/wound healing issues

• Psychological factors

• Significant breast disease 

4. Workup/History

• Medical: current mammogram by age 35 prior to operating 

• Personal or family history of breast disease 

• Pregnancy history: breast feeding status, size of breasts before/during/after pregnancy, future pregnancies?

5. Physical Examination

• How does the skin look?

  • Stretch marks (striae)

  • Tone

  • Elasticity

• Are there any asymmetries?

  • Often, I tell patients that breasts are ‘sisters not twins.’ Patients frequently acknowledge these asymmetries, and it is important to point out preoperatively so that we have firm mutual footing to discuss how the results shape up after the operation. 

  • Chest wall discrepancies, curvature of the spine, variations in the inframammary fold can all affect the appearance and symmetry of the breasts

• Ptosis (sagging) of the breast (Figure 1)

  • 3 grades (based on position of the nipple relative to the inframammary fold – 

    • Grade I – nipple at the IMF

    • Grade II – nipple within 2 cm of IMF

    • Grade III – nipple at the lowest breast contour, well below the IMF

  • Sometimes, you may need a concurrent breast lift with the augmentation to achieve optimal results. We will go over this in detail at the consultation, if applicable. 

• Measurements – these are key! (Figure 2)

  • BMI (height to weight ratio), body frame – helps contextualize the implant size based on body type characteristics

  • Sternal notch to nipple distance

  • Nipple to IMF distance on stretch

  • Base Diameter – arguably the most important one! This is the width of each breast (like a ‘shoe size’) that determines appropriate implant sizing. 

  • Upper pole pinch test – how much breast tissue is present to cover the upper pole?

    • Determines where the implant can be placed: under the breast (subglandular), under the fascia of the pectoralis major muscle (subfascial) or under the pectoralis major muscle itself (submuscular). Each has certain advantages and drawbacks, which will be discussed at the consultation as it pertains to your operation. 

• Choosing an implant

  • Typically, silicone implants are sized and chosen based on the evaluation above

  • We have an extensive discussion regarding goals and expectations. I like to have patients ‘try on’ implants in specialized bras to simulate the augmentation. 

  • Patients frequently ask or request specific cup size changes; while I cannot guarantee a particular cup size (often these are commercial terms that vary from brand to brand for bra sizing), 125-150cc correlates roughly with one cup size change. 

  • Implants are smooth (no texture)

  • Dimension/shape: 

    • Round versus anatomic (tear-drop)

    • Degree of upper pole projection/fullness – Low, moderate, moderate-plus, high profile. Corresponds to amount of projection for a given base width.

• Choosing the incision

  • Inframammary – most common. Allows for accurate placement of the implant in the pocket, with incision concealed under the breast.

  • Transaxillary – appropriate in certain candidates. Allows for placement under the muscle through a small axillary (armpit) incision.

  • Periareolar – less common, but utilized at times if performing a breast lift at the same time. 

• Fat grafting

  • This is an option for appropriately selected patients, who have minimal sagging (ptosis) of their breasts and would like a modest increase in breast volume

  • Fat is typically harvested from the abdomen, flanks and thighs via liposuction and is then be injected into the breasts

  • The amount of fat that lasts long-term in the breast can vary, but typically averages to about 60% over time

  • We will discuss this option more thoroughly at the consultation, should you be a candidate.

3. The Procedure

Preoperative Planning:
I will work closely with you to determine the best surgical plan, including implant type (silicone or saline), placement (above or below the muscle), and incision site (inframammary, periareolar, or transaxillary).

Surgical Steps:

To summarize concepts mostly outlined above:

• Anesthesia: Performed under general anesthesia for comfort.

• Incision: Discreet incisions tailored to your anatomy and goals.

• Implant Placement: Implants are inserted into a pocket created either above or below the pectoralis major muscle based on preoperative evaluation.

• Closure: The incisions are meticulously closed to minimize scarring.

Most procedures are completed in about 2-2.5 hours, with patients going home the same day.

4. Recovery and Results

Early Postoperative Phase:

• Dressings and a supportive bra will be applied immediately after surgery.

• Moderate swelling and discomfort are common and can be managed with prescribed medications.

  • Prescribed medications can include oxycodone and gabapentin. 

• Frequent walking is encouraged, including on the day of surgery

• Post-operative day 3 – dressings removed and a surgical bra is fitted. Ok to resume light daily activities, return to a desk job, and drive if off the narcotic pain medications. 

• Avoid heavy lifting and strenuous activity for 2-3 weeks.

Later Postoperative Phase:

• We will see you again in the office at the 2 week mark and may recommend massage at this time to help the implants settle in the appropriate position. 

• Swelling gradually subsides, and the breasts settle into their final position over 3-6 months.

• Scars will fade over 12-18 months and can be treated with silicone sheeting or laser therapy for optimal healing. We will often start a scar care regimen at 2 weeks, which includes silicone sheeting. 

5. Risks and Considerations

While breast augmentation is generally safe, potential risks include:

• Capsular contracture (scar tissue around the implant)

• Implant rupture or leakage

• Bleeding

• Infection

• Changes in nipple or breast sensation

• Decreased breastfeeding potential, depending on location of implant placement

• Need for revision surgery over time

• Anaplastic Large Cell Lymphoma (ALCL) – a rare, but serious complication of breast implant surgery; most commonly associated with textured implants, which are not used widely anymore. 

• Squamous cell carcinoma (SCC)

• Need for ongoing surveillance: MRI or ultrasound at 5-6 years after surgery, then every 2-3 years thereafter

6. Choosing the Right Surgeon

• Look for a qualified surgeon, with credentials in the field of plastic and reconstructive surgery prior to proceeding. 

Conclusion

Breast augmentation enhances both form and confidence, with results that can transform lives for years. From initial consultation to long-term follow-up, we’re here to support you every step of the way.

"Ready to explore your options? Schedule a consultation with Dr. Raj Iyengar to create your customized treatment plan today."