Breast Enlargement, AKA Breast Augmentation

Before & After

Breast augmentation is one of the most common procedures performed in Orange County and other areas for a good reason. When performed by a competent plastic surgeon the results are dramatic with little scarring, and little down time. Many women want their breasts enlarged because they know it would make them feel more self-confident, more attractive, and will make them fit into clothes better. Often, they have thought about it for a long time. Others seek augmentation because their breasts have begun to sag, either due to age or childbirth. These women wish to regain that youthful "perkiness" and cleavage they once had. Some wish to return back to the shape they were in their early twenties. Others, when given the option, want a more dramatic enhancement. The effect of augmentation in the saggy breast is impressive as it raises the nipple, fills out the sagginess, creates significant breast projection, as well as cleavage.

For those who are interested, here is a little history on breast augmentation. In 1895, Czerny transplanted a benign fat tumor from a woman's back to fill a breast defect created by removal of a breast cyst. Other accounts of fat transplantation for breast augmentation have been documented. All these early attempts led to disappointing results.

In the 1950s, many materials were injected into the breasts for augmentation purposes. This uniformly caused severe local reactions that left the breasts hard, painful, and distorted. As an aside, a common question is, "can we put the fat that was liposuctioned from other areas of my body into my breasts." The answer is no. First of all, fat transplantation does not come close to providing the necessary volume. Second, fat transplantation my cause scar tissue with micro-calcifications. This is not dangerous but it impossible to determine on mammogram whether these micro-calcifications are from the fat transplantation or from cancer. Therefore, is it not performed.

The modern age of breast augmentation began in 1962 when plastic surgeons for the first time started placing silicone gel implants under the breast tissue. This was a significant advance but it still caused an unacceptably high incidence of breast hardening, otherwise known as capsular contraction.

In the 1980s, it was found that by placing the implant under the pectoralis major muscle, capsular contraction could be greatly reduced. Today, this is where the great majority of breast implants are placed.

In 1992, the FDA banned the use of silicone gel implants. This left saline implants (a.k.a. salt water implants) as the only option for implant material. What we have found is that saline implants, when placed under the muscle, have even a lower rate of hardening than silicone implants. Silicone implants, however, have a more realistic feel. Since the ban, several major studies have shown rather conclusively that silicone implants are safe and soon will return as an option for breast augmentation. It should be pointed out that the shells of the current implants are still silicone. Silicone implants currently are available to certain patients. These patients include those who dislike their saline implants and those undergoing concurrent breast lift. Currently, silicone implants are available if you enroll in a research study. Also, to qualify you must meet one of four criteria. 1) You already have silicone. 2) You also are having a breast lift. 3) You have a significant congenital or traumatic deformity to one or both breasts. 4) You already have saline implants that require revision.

It appears that within a year or two that silicone breast implants will available for anyone interested in breast augmentation.

Incision for Breast Augmentation

There are three incisions that most plastic surgeons use for breast augmentation. Dr. Cruise has considerable experience with all three incisions but, for the majority of his patients he has found that the periarolar incision provides the best results. This incision allows for the most accurate implant placement, because it is located exactly where the implant needs to go. In addition, the scar is the least visible of the three incisions because the areola scars much more favorably than normal skin. This is especially true when the incision is made right at the margin of the areola.

The three incisions are:

1. Within the fold at the bottom of the breast.

2. Exactly at the margin of the areola where the lighter skin meets the darker skin.

3. Within the axilla (armpit).

All 3 incisions can provide excellent results. The incision along the margin of the areola allows for very accurate implant placement. The scar becomes almost imperceptible within 2 months in most women. The incision within the fold at the bottom of the breast can provide excellent results but in some women scar widening can occur with this incision. Also this incisions tends to remain redder for a longer period of time than the Peri-areolar incision. The axillary incision also can provide a great result but implant placement is more difficult because the implant is being placed from a remote location. This topic is discussed more in "Dr. Cruise's Philosophy."

A fourth option for the incision is through the naval. Some plastic surgeons use this incision but the results when compared to the standard incisions are not as predictable. This is because it is impossible to visualize the pocket where the implant will be placed. For this reason Dr. Cruise, and most plastic surgeons, no longer perform breast augmentation via this approach. This is not to say that this incision cannot produce good results. It is just that the results are less predictable and Dr. Cruise only performs procedures with predictable results.

Breast Enlargement and Mammogram

Breast implants require more X-rays during mammography in order to see around the implant. For this reason, mammograms on women with implants often cost more. If you have a strong family history of breast cancer and/or significant fibrocystic disease you should be sure to discuss this during your consultation. It should be pointed out that breast augmentation does not increase the likelihood for breast cancer; also breast feeding is possible after augmentation.

Dr. Cruise's philosophy regarding Breast Enlargement

The beauty of breast augmentation is not only the dramatic results that it creates but also its predictability. Patient satisfaction in our hands, at least, is very high. The key to having successful breast augmentation for a woman is to find a plastic surgeon who will take the time to find out exactly what look the woman is seeking. The number one reason why breast augmentation patients have to be revised is because the wrong size implant was used. Therefore, when you leave your consultation, it is imperative that you are comfortable that the plastic surgeon and the patient coordinator took the time to find out what size you want.

Often, the patient does not know what is best for her until she sees it on herself by bra sizing. In my experience, I have found that it is critical to determine both the size AND the shape desired. When a woman consults with me, I sit with her and go over example pictures as well as before and afters of previous patients. Then, we have her try on sizer bras that demonstrate the various volumes possible. Armed with all this information we are able to give the patient the breasts she is looking for.

What always amazes me is how women easily adopt their new breasts. Within a month or two after the procedure they no longer consider their breasts as implants. They become part of their body in both a physical and emotional sense. They are aware they had their breasts augmented but they do not look at them as foreign. They look at their breasts as if this is how they are supposed to look. Often, they are shocked to see their Before pictures. This brings me great satisfaction.

Whenever a plastic surgery procedure is considered, you must always look at the pros and cons. What I like the most about breast enlargement is that, if well thought out, the results are quite predictable and patient satisfaction is uniformly very high. Furthermore, the recovery is quick. Often patients are back to work within 4-7 days as long as they are not performing strenuous upper body activity.

A word of caution. If you are considering breast augmentation, make sure you do it for the right reasons. Do it for yourself. Do it because it will make you feel more self-confident, sexy, and heighten your self-esteem. Don’t do it because you think your boyfriend or your husband will like it. Although, this may be true you must do it for yourself. It is a great procedure if done for the right reasons. It is very satisfying for me as a surgeon and as someone who wants to improve the quality of life of my patients. I can see the enhanced confidence within each one of them. It is true, they walk with more confidence and a certain flair that they did not have before. There is no doubt in my mind that this enhanced perception of themselves improves their outlook and even their overall quality of life.

Regarding the placement of the incision, I have found that for the most part, the incision at the inferior margin of the areola provides the most uniformly favorable scar. This scar becomes almost undetectable after 3 months and continues to improve with time. This incision allows me to have the best access possible to make sure the implants are in the correct location.

The vast majority of my breast augmentations are done beneath the muscle with a saline implant. Silicone, however, is becoming very popular. The size and shape of the implant are determined by the patient's preference. It is very helpful when the patient brings in a picture of a model who has breasts that she would like. Obviously, I cannot guarantee that her breasts will look exactly like the model's, but it does give me a good idea of what she would like to achieve. The key is to pick a model of similar height and weight so that the analysis is most precise.

When there is a significant amount of breast sag or there is a lot of natural breast tissue it is often beneficial to place the implant above the muscle. The reason for this is that breast tissue is naturally located above the muscle. Therefore, breast enhancement should also be done above the muscle when there is enough of natural tissue to hide the implant. It also helps prevent double bubble effect because the implant and the natural breast tissue are not separated by the muscle and therefore can become one.

"Double Bubble" This occurs when the implant is not allowed to merge with the natural breast tissue. The muscle often prevents this merger. This is not a problem when there is very little breast tissue because sagging does not occur in these patients.

Finally, one must be realistic about the results. While breast augmentation is safe, reliable, and gives dramatic results, it must be pointed out that all breasts are asymmetrical. While breast augmentation will help correct a great majority of the asymmetry some may persist.

Frequently Asked Questions

• What is the minimum age to have breast augmentation?
  
• What does it mean under or above the muscle?
  
• Which is better? Above the muscle or below?
  
• What are the major differences between under the muscle vs over the muscle?
  
• Is it possible for the implant to be completely under the muscle?
  
• What is capsular contracture?
  
• What is the likelihood that I will get capsular contracture?
  
• How can I prevent capsular contracture?
  
• What are textured implants?
  
• Who should get textured implants?
  
• What are the most common complications of breast augmentation?
  
• Is it likely that I will need more surgeries on my implanted breast in the future?
  
• How will my breasts look if I decide to have the implants removed?
  
• What size implant is best for me?
  
• Which incision is best?
  
• What shape implant is best for me?
  
• Will breast augmentation affect my ability to breast feed?
  
• How will my implanted breasts look over time? Will they sag?
  
• How will my implanted breasts look after pregnancy or breast feeding?
  
• What are my options if I am dissatisfied with my breast augmentation?
  
• When deciding on a plastic surgeon, what is important to know?
  
• How long is recovery after breast augmentation?
  
• Will breast implants cause stretch marks?
  
• When can I wear an under wire bra again after breast enlargement?
  
• Will I lose sensation in my nipples?
  

What is the minimum age to have breast augmentation?

Eighteen is the minimum age that I recommend for breast augmentation. This is my policy and the policy of the American Society of Plastic Surgeons. The reasons are: 1) Teens and their parents may not fully realize the risks associated with implants. 2) A teen's body often has not yet fully developed.
3) A teen may not be psychologically ready to handle the outcome or potential complications. Click the link for more information from the American Society of Plastic Surgery.

What does it mean under or above the muscle?

Deep to the breast tissue is the pectoralis major muscle. Breast implants can be placed either on top of this muscle or underneath it. See pictures below.

Which is better? Above the muscle or below?

The answer is not completely straight forward and depends on the amount of the amount of natural breast tissue and amount of breast sag, if any, that the patient has. Outlined below are four possibilities:

1. Patient with little breast tissue and no sag.

In these patients, implant placement above the muscle would likely create an "implant look". The superior part of the breast would be unnaturally round. In addition, because there is little natural breast tissue to cover the implant rippling would be more likely. For these reasons, implant placement below the muscle is usually the best choice.

2. Patients with moderate amount of breast tissue and no breast sag.

These patients have a choice. If they desire a large implant than below the muscle is probably best. If they go with a moderate implant or smaller then implant placement above or below the muscle are both acceptable. One caveat, in athletes or bodybuilders who need full use of their pectoralis major muscle, placement above the muscle may be a better choice as the muscle is not altered.

3. Patients with small amount of breast tissue and breast sag.

In these patients, it is usually best to put the implant under the muscle and perform a breast lift. If silicone implants are use than above muscle placement is also acceptable as silicone has a more natural appearance and is less likely to show rippling.

4. Patients with moderate or large amount of breast tissue and also breast sag.

These patients are best served when the implant is placed above the muscle in conjunction with a breast lift. This is so that the natural breast tissue and the implant are allowed to integrate into one. This provides a more natural appearance and lessens the chance of "double bubble."

What are the major differences between under the muscle vs over the muscle?

Advantages of placement under the muscle.

1. Lower risk of rippling. Once again, if you have large implants the inferior and lateral portion of the implant is not under the muscle and, therefore, is more likely to have rippling regardless of placement. If you have a moderate amount of natural tissue then rippling is unlikely regardless of placement.

2. Lower risk of capsular contracture. It is thought that the constant flexing of the muscle acts like a massage to the capsule and, therefore, keeps it softer.

3. There is less of an "implant look" at the superior aspect of the breast when the patient has little natural breast tissue. The muscle softens the upper pole of the implant. This causes the implant to have more of a sloped look and less of a rounded, implant look. When a patient is a B cup or larger this becomes less relevant.

4. Mammograms are slightly more accurate. Because the breast tissue is separated from the implant by the muscle the breast tissue is easier to see on mammography.

Advantages of above the muscle.

1. In women with well developed pectoralis major muscles such as body builders, it is possible that the muscle will move the implant with shoulder movement. This can be very annoying. In body builders I recommend silicone implants over the muscle.

2. Allows for more natural appearance in patients who have a significant amount of natural breast tissue. This is because the implant and the breast tissue are not separated and are allowed to become one.

3. Allows for a more natural appearance in patients with breast sag. In these patients the placement of the implant below the muscle will separate the breast tissue from the implant and may create a "double bubble" appearance. This is caused because the implant is held up higher on the chest wall by the muscle and the natural breast tissue sags lowers creating an unnatural separation.

3. Less painful. Since the muscle is not stretched there is less of postoperative pain.

Is it possible for the implant to be completely under the muscle?

The short answer is "No." Over the years I have developed a technique where I place the lateral aspect of the implant under the Serratus Anterior muscle. This effectively covers the part of the implant that is most likely to show rippling via the conventional "under the muscle" technique.By placing it under both the pectoralis major and serratus anterior almost all of the implant is covered by muscle.

Of note, a small percentage of women have a poorly developed serratus anterior muscle making total muscle coverage impossible. In this situation the implant is still covered by the pectoralis major muscle. With large implants, the inferior part of the implant remains uncovered.

What is capsular contracture?

When any foreign body is placed under tissue the human body defends itself by walling it off. This involves forming a capsule around the foreign body. The same is true for breast implants. All women form capsules around breast implants. The problem is, some people form very thick and hard capsules. In rare cases, this can distort the implant and even make it painful. It can occur months or even years after the implants have been placed.

Capsular contracture can occur on one or both sides.

What is the likely hood that I will get a capsular contracture?

The chance of getting a capsular contracture that causes distortion is less than 4%. Saline implants are less likely to cause capsular contracture than silicone. Similarly, placement under the muscle is less likely to cause it than placement over the muscle. Finally, textured implants are less likely to harden than smooth implants. Theoretically, the best scenario to prevent capsular contracture is textured, saline implants placed under the muscle.

How can I prevent capsular contracture?

The most effective way to prevent capsular contracture is to perform daily massage of the implant. Massage is known to soften scar tissue. If you feel your breasts begin to become firm I recommend taking vitamin E daily. In addition, I recommend taking Accolate twice a day for six months. Accolate is an asthma medication that blocks the production of leukotrienes which are known to contribute to inflammation and scar formation.

What are textured implants?

In the 1970's capsular contracture was a much bigger problem than it is today. It was found that by adding texture to the shell of the implant the capsule that formed around the implant was much thinner and softer. It was found that the texture caused tissue ingrowth which broke up the collagen that formed around the shell. Textured implants still have a slightly lower rate of capsular contracture today but the advantage is not as significant because the smooth shells have been improved dramatically.

Who should get textured implants?

There are two types of women who can benefit from textured implants.

1. Women who have developed capsular contracture with smooth or silicone implants and need to do everything they can to prevent it from recurring. They should have their previous implants removed, the capsule removed and textured saline implants placed under the muscle. This is the best chance of preventing recurrence of capsular contracture.

2. Women who desire anatomic implants a.k.a. tear drop implants. If anatomic implants turn within their pockets they will not be positioned correctly because they are not round. When round implants turn it does not matter because round implants are in proper orientation no matter how they rotate. This is not true for anatomic implants. When they turn they are no longer oriented properly. This can be a big problem. Textured implants are less likely to rotate.

What are the most common complications of breast augmentation?

The most common complication of breast augmentation is patient dissatisfaction with breast size. More commonly, the implants are too small and the patient exchanges them for larger ones. Therefore, it is important that you feel comfortable during your consultation that your plastic surgeon and patient coordinator have meticulously gone over this with you. This requires bra sizing either with trial implants or, my favorite, bra sizers. This is important and can not be over emphasized.

The second most common complication of saline breast implants is wrinkling. This is especially true with big saline implants over the muscle. Even under the muscle the lateral aspect of the implant is close to the skin and prone to wrinkling. I feel that if you plan to get a large implant it should be placed under both the serratus anterior and pectoralis major muscle. This, however, is not a common practice.

Silicone implants are much less likely to ripple.

Other complications include:

3. Loss of nipple sensation <10%.

This tends to improve over several months.

4. Asymmetry 7%.

Once again bigger implants are more likely to be asymmetric because it is necessary to lower the infra-mammary fold. This make the procedure more complicated and increases the chance that both folds will not be lowered the same amount.

5. Intense nipple sensation 5%.

This tends to go away in several months. It is not uncommon for the nipples to be constantly erect.

6. Capsular contracture 4%.

This has a whole FAQ devoted to it. If it happens it can be a bad problem that may not go away unless the implant is removed or re-operated on.

7. Infection 2%.

Is it likely that I will need more surgeries on my implanted breast in the future?

You must understand that a breast implant is not designed to last a life time. It is likely at some point you will have your implants changed. This may be because you wish to change size or you need a lift. Remember, the number one reason for re-operation is dissatisfaction with implant size. It is critical that you feel that your plastic surgeon and patient coordinator know what you want. Other reasons include deflation or implant shifting. Many women in my office have had their implants for over 20 years and have not had a problem. If there is no problem, I tell them there is no reason to exchange them.

How will my breasts look if I decide to have the implants removed?

This depends on how big of an implant you have and the quality of your skin. If you have good quality skin, i.e. no stretch marks, and your implant is less than 400 cc's it is likely that your skin will recoil well and return close to where you were before the implants. If you are over 40 years of age or have stretch marks it is unlikely that your skin has the ability to recoil. This may result in loose skin or dimpling.

What size implant is best for me?

There are several ways to determine implant size. One way is for the surgeon to place different sizers during the operation. The other way is to do bra sizing during your consultation. I believe that it is critical to determine implant size prior to going into the operation. I do not believe in having the surgeon put trial sizers on during the operation because on the surgery table the breasts do not look like they normally do. Furthermore, this technique does not take into account how the breasts adapt over time. Finally, this method relies on the surgeon deciding on what is best for the patient. In my opinion, it is important to try on trial bras during your consultation, form fit it and then look at yourself in the mirror. Not all plastic surgeons do this, therefore, you can improvise by filling zip-lock bags with appropriate amount of e.g. rise and place them in your bra to get an idea. As you can imagine, this is not as accurate.

It is very helpful to bring in a picture of someone with a similar body type to you who has breasts that you would like. This helps immensely to demonstrate size, shape, and implant position. Do not be embarrassed! Remember, dissatisfaction with implant size is the number one reason why implanted women have to exchange their implants.

There is a number of factors influencing the size you will choose. And it should be always you who chooses the implant size. You might take into consideration opinions of your spouses, friends, etc. but you will be the one who carries them ultimately. This is why it is very important that you feel comfortable with the size you choose. Our patient coordinator will help you figure the size and match it with your body size, look for proportion and symmetry.

Which incision is best?

The three common incisions are 1) Infra-mammary (in the breast fold)
2) Peri-areolar (under the nipple where the dark skin meets the lighter skin)
3) Trans-axillary (armpit)

Each incision has its pros and cons.

All 3 incisions can provide excellent results. The incision along the margin of the areola allows for very accurate implant placement. The scar becomes almost imperceptible within 2 months in most women. The incision within the fold at the bottom can provide excellent results but the scar can be more noticeable than the other two incisions depending on how well you heal. This approach may be necessary if you decide on large silicone implants that can not be inserted via the other two incision sites. The axillary incision can also provide a great result but the tradeoff is that implant positioning is not as easily adjusted from this distant site. This topic is discussed more in "Dr. Cruise's Philosophy."

A fourth option for the incision is through the naval. Some plastic surgeons use this incision but the results when compared to the standard incisions are not as predictable. This is because it is impossible to visualize the pocket where the implant will be placed. For this reason Dr. Cruise, and most plastic surgeons, no longer perform breast augmentation via this approach. This is not to say that this incision cannot produce good results. It is just that the results are less predictable and Dr. Cruise only performs procedures with predictable results.

What shape implant is best for me?

Most plastic surgeons use round, saline implants. Round has become the favorite because there is no way for it to become mal positioned because of rotation. If tear drop shaped implants rotate they may need to be surgically repositioned. The fact is, when you are standing round implants assume a tear drop shape anyway because gravity naturally causes the saline to descend. This makes the implant bigger at the bottom of the breast and smaller near the top.

Will breast augmentation affect my ability to breast feed?

It is unlikely that breast augmentation will affect your ability to breast feed. With the peri-areolar incision there is a small chance ( <5% ) that the ducts could be injured during implantation. The likelihood that both breasts would be affected is less than 1%. Therefore, if breast feeding is critical than an infra-mammary or trans axillary incision may be best for you.

Current studies do not implicate any problems associated with silicone implants and breast feeding. Having said that, I have seen inflammatory reactions within lymph nodes from extremely small amounts of silicone bleeding out of the implants and collecting in the lymph nodes. So far, this has not been identified as a problem. Read more information than you could possibly want on this topic at:www.lalecheleague.org/cbi/bibimplant.html

How will my implanted breasts look over time? Will they sag?

Breast implants are much more resistant to sag than your own breast tissue. If you have little nature breast tissue you will probably never have to worry about sag. If you have a significant amount of breast tissue then this tissue will sag with age just like it would if the implant were not there. If the sag becomes severe you may notice a separation of the implant which stays in place from the nature breast tissue. This is called a "Double Bubble."

Double bubble can corrected by a breast lift.

How will my implanted breasts look after pregnancy or breast feeding?

This is variable. If you are young and have good quality skin, i.e. no stretch marks, it is likely that your breast will return to your pre-pregnancy state. If you have poor quality skin and/or your natural breast tissue enlarges greatly during pregnancy or breast feeding than some changes will likely result. This usually results in one nipple being slightly lower than the other and/or some degree of sag.

It should be mentioned that these changes would have occurred without the implant. If anything, the immobile volume provided by the implant provides some degree of protection against sag.

What are my options if I am dissatisfied with my breast augmentation?

There are many different scenarios that fall within this category. At the very least, you should discuss this with your plastic surgeon prior to augmentation.

When deciding on a plastic surgeon, what is important to know?

1) Word of month. If you know someone with a good result and a overall good experience than this plastic surgeon should be seriously considered.

2) It is important to know how many breast augmentations does the plastic surgeon perform in a month. My recommendation is that the surgeon should do at least 4 a month. This shows that he or she has the recent experience necessary. This can be verified by asking the patient coordinator to show you the surgeon's schedule for the last month.

3) How comfortable do you feel with the plastic surgeon and the office in general. This can not be emphasized enough.You must be able to place a great deal of trust in their hands. Does the surgeon answer your questions? Does the patient coordinator genuinely help you through the process?

4) How comfortable are you with implant sizing. Remember the number one reason for re operation after breast augmentation is for change of implant size. While dissatisfaction with implant size can not be eliminated it can be markedly reduced. This requires proper interviewing by the surgeon and proper bra sizing by the patient coordinator. You should be able to leave your consultation with confidence that the time was taken to determine what size is best for you. If you do not feel this than you should look elsewhere.

5) Ask to see before and after pictures performed by the surgeon and not by some other surgeon. This makes sense. The surgeon should be able to provide examples of his or her work.

6) Is he or she board certified? Be careful to make sure he or she is board certified by the American Board of Plastic Surgery and not some other board.

7) Make sure the plastic surgeon uses a board certified anesthesiologist to administer anesthesia. Remember, the most important thing is safety.

How long is recovery after breast augmentation?

There is less discomfort if the implant is placed above the muscle. If the implant is placed under the muscle then you can expect the most discomfort for the first 48-72 hours. After this time period, the muscle adapts and the discomfort level drops off quickly. Bigger implants take slightly longer. You will not be able to actively move your shoulders for the first 3 weeks. If you have a sedentary job it is possible to return to work after 5 days as long as you do not move your arms too much. In general, you should expect to take a week off work.

If your job requires significant lifting than you will need to take at least 3 weeks off work.

Will breast implants cause stretch marks?

Usually they do not. If, however, you go with large implants and have poor quality skin then it is possible that you will. Stretch marks are small scars within the dermis caused when the dermis is no longer capable of stretching. Massaging with Vitamin E twice a day may help to reduce the chances of developing stretch marks.

When can I wear an under wire bra again after breast enlargement?

Most plastic surgeons require that you wait at least 6-8 weeks after breast augmentation to begin wearing an under wire bra. This is because the strong support provided by the wire can alter the positioning and/or prevent the "dropping" of the implant into proper position. The reality is you probably will not need an under wire bra because the implants provide more than enough upward support on their own. You will notice that comfortable under wire bras are much harder to buy with implants because the implants are less moldable than your nature breast tissue.

Will I lose sensation in my nipples?

There is a small chance, i.e. < 3%, that you will lose sensation in your nipples. This is more likely with large silicone placed through a peri-areolar incision, The reason for this is that silicone implants are pre-filled. Saline implants, on the other hand, are placed in the pocket first and then inflated. This allows saline implants to be placed through a smaller incision with less trauma. If you are worried about nipple sensitivity and want to have silicone implants 450 cc's or larger than the infra-mammary incision may be best for you. Another consideration is the size of your areola. If you have very small areola it is harder to place silicone implants through the peri-areolar incision.

Often after breast augmentation, women experience hyper-sensitivity. The nipples may become erect which can be uncomfortable. This goes away within a month or two.

Benefits of Breast Augmentation

There are many benefits to breast enlargement. These range from the way clothes fit you to how you feel about yourself. In general, there are two categories of women who benefit most from breast augmentation. The first is naturally small and has always wanted to have larger breasts. Typically, she is very secure with herself. She just knows she would feel more self confident with larger breasts.

The above example shows a common problem after childbirth; saggy breasts with loss of upper breast fullness and loss of cleavage. This is caused by several factors including skin stretching and breast tissue descent. A third significant cause is loss of breast tissue known as breast tissue atrophy.

Breast augmentation can correct only minor amounts of breast sag. However, if there is too much sag then a breast lift is required. This can be done with or without an implant. This depends on how much breast tissue is left and what the patient wants. If the sag is minimal then a breast augmentation alone can provide the necessary breast lift. By increasing the breast volume with an implant the nipple/areola complex will elevate slightly. This is demonstrated very well in the profile Before and After above.

Outlined below is a summary of legitimate reasons to desire breast augmentation.

• If you are self-conscious about your small breasts size.
• If you feel that larger breasts would make you feel more attractive and improve your self-confidence.
• If you have a hard time finding clothes that fit because of discrepancy between your breasts and your buttocks.
• If you have saggy breasts due to age or childbirth.
• If you desire more cleavage.
• If you recently lost weight leaving you with smaller, sagging breasts.
• If there is a significant difference between one breast and the other.
• If you feel unable to wear sexy clothes because of your small breast size.
• If you feel disproportionate because your hips are much larger than your breasts.

The benefits above must be weighed against the downsides of getting breast enlargement. These include cost, downtime from work, need to buy new clothes, possible need for revision surgery.

When Is a Breast Lift Necessary?

This is one of the most commonly asked questions. The answer is not simple. There are many variables but we will try to make it as clear as possible.

In general, if the nipple is above the Infra-Mammary Fold (the fold below the breast tissue) then a breast lift is not usually necessary. If the nipple is more than 1 centimeter (about one-half inch) below the Infra-Mammary Fold (IMF) then a breast lift is most likely required.

What about the nipple that at the level of the IMF? With this situation, the need for a breast lift depends on two things:

How big will the implant be. It stands to reason that a bigger implant will create more of a lift.

What bothers you more; low nipples or scars around the areola. The scars are not very noticeable but they are still scars.

Remember, if you elect not to have a breast lift, you can always have it done later on.

Possible complications

The most common complications of breast augmentation are:

• Wrong choice of implant size. Sometimes it is too big but more commonly too small. This can be markedly reduced by a proper preoperative evaluation as well as experience. This is always discussed with Dr. Cruise during preoperative evaluation. During your consultation you will try on specially designed bras filled of various volumes that imitate what the implants will look and feel like. This helps tremendously to determine what size is best for you.

• Asymmetry and/or implant malposition.

• Capsular contracture. This is where thick scar tissue forms over the implant making the breast feel hard.

• Nipple sensory changes. This is common right after surgery but usually goes away. Often, the nipple is hypersensitive for the first 6 weeks after the procedure and may be quite erect. This will go away with time.

• Infection. Because an implant is a foreign body, infection is always a consideration. To avoid this, Dr. Cruise uses antibiotics during and after the operation as well as meticulously sterile technique. If it does occur it is possible that the implant may need to be removed.

• Implant rupture. If this happens the saline leaks harmlessly into the body tissues. The implant company, will pay for a new implant but usually not the cost of the operating room.

• Implant rippling. This is markedly reduced when the implant is placed under the muscle. It occurs more commonly along the lateral margin where complete sub-muscular coverage is not always possible. See FAQ for more information as this is explained in great detail.

Are you a good candidate?

To determine whether or not you are a good candidate just look above and see if any of the scenarios apply to you. Most women who consult with Dr. Cruise for breast augmentation have known for quite a while that they want their breasts enhanced. Often, they know of friends or family that have had it done. The most important consideration is to do it for the right reasons! Do it for yourself! Don't do it for a boyfriend or a husband or anyone else. Do it because you feel that you would be more self-confident, your body would be more proportional, and you would just feel better about yourself.

Prior to surgery

• Medications. Certain medications thin blood and should not be taken within 2 weeks of surgery. The most notable is aspirin and aspirin containing products. Vitamin E and many herbal products also thin the blood and should be discontinued 2 weeks before surgery.

• Sleep. It is important to get a good night's rest prior to the procedure. If you think this may be a problem, please, do not hesitate to ask Dr. Cruise for something to help you sleep.

• Smoking. You must not smoke within 2 weeks before and after surgery. Smoking has a profound effect on reducing wound healing capabilities. It significantly increases the likelihood of infection, wound healing problems, and scar formation. It also affects your airway, which makes anesthesia much more difficult.

• Eating. Do not eat within 8 hours of surgery and do not drink within 6 hours of surgery. It is OK to take medications with a sip of water. Please discuss all medications with Dr. Cruise and the anesthesiologist.

• Arrival. It is important to arrive on time so everything goes as planned. By law, you must have someone else drive you home.

• State of mind. Remember, this should be a happy and exciting time. A certain amount of nervousness is normal but you should not be overly concerned. Our specialists are professional, well trained and experienced. If you like, Dr. Cruise will prescribe something to keep you calm the night before and the morning of surgery. Remember take all medications with only a sip of water, otherwise surgery may be cancelled.

Consultation

• General Health

• Past Surgical History

• Medications

• Allergies to Medications

• Smoking, Drinking and Drug Use

• Size

• Shape

• Round

• High Profile

This implant is best for women who want a dramatic augmentation but do not want too much lateral fullness. It is especially useful if she has a narrow chest. As the name suggests, this implant gives more projection than the round implant without adding as much width.

• Anatomic

This implant is best for tall, thin women who want more vertical height than width to their breasts. It is taller than it is wide. It is the least common of the three because it has the potential to rotate and be positioned sideways.

• Silicone Implant

• High Projection Silicone Implant

• Height, Weight and Bra Size

• Observation

• Palpation for masses

• Measurements

• Distance from sternal notch to nipple.

This distance determines sagginess of the nipple. Normal distances are less than 21-22 cm. Over 22 cm usually means there is some component of sag. Minor sag can be corrected with augmentation but usually needs some type of breast lift in conjunction. See the section on Breast Lift for more information.