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Patient Details
This is a 36 year old mother of two is 5’6″ and 135 pounds interested in a breast enhancement. She has a history of scoliosis (curvature of the spine) that has been treated with orthopedic rods in her back.
She has small, laterally displaced breasts. She has differences in her chest area because of the curvatures of her spine and ribs. She has a large gap between her breasts. She is an exercise buff as you can tell from the photos.
She is seen here after a bilateral breast augmentation with silicone implants beneath the muscle from an incision at the bottom of her breasts. I used 355cc implants on the left and 375cc implants on the right. I adjusted the implant size based on what I observed when we were trying on the implant sizers during her consultations.
She is very happy with her result. She told me that she wished she would have gone larger. I generally like what I see, and I can understand why she is happy. If I could improve on the results, in my opinion I would go larger with her implants, I would have her work regularly with “cleavage molding” and I would have her wear a better bra that keeps her breasts medially than she had on her recent visit. The reason for the larger implants is not for size as it is for “fit”. They would fill out more of the gap in the middle of her chest. This is a challenging area in her case because of her anatomy.
Learning points:
- The gap between her breast is a challenge in her case. The only way to get more fullness from the implant would be to move her existing implants towards the midline and/or choose a larger implant that would help fill out this area.
- It has been my experience that the patients who think they should have chosen a larger implant are those I had to encourage to go larger from the beginning. Some people worry too much about going “too large” because of the weird stuff they see from other people. I assure my patients that based on our technique of choosing the right size, we really tend to get it right. This is totally different than those who have the surgeon decide the size without actually trying on implant sizers. The best way to see what you will look like after your augmentation is to try on various sizers and look in the mirror. This is an almost foolproof system of getting it right. It takes time and patience-maybe this is why so many other surgeons don’t choose implant size in this way.
- Cleavage is not something that can be made in all cases. Patients with widely separated breasts will not be as likely to get cleavage as opposed to a patient with closer breasts.
- In almost all patients, the central part of the chest is flat and the sides are sloped. Implants that are situated in the central area are less likely to move off to the side as opposed to implants sitting on the side (the sloped area). The best way to keep implants from moving under the arms is to wear a bra that keeps them up front and center.
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