Breast Augmentation With Breast Implants: Will You Pass The “Pencil Test?”

I just finished watching the movie “Breast Men.” It really brought back some memories from my thirty years in plastic surgery, especially my years of training at UT Medical School at Houston, not far from the hospital where breast implants first appeared. The silicone implants were briefly removed from the market for ten years and then the FDA approved these same basic implants after studies showed no link to any medical conditions or cancer.

Breast augmentation with implants - will you pass the pencil test?

Here we are several generations of implants later and the procedure is still one of the most commonly requested. Although imperfect, breast implants have proven themselves over time to be safe, effective and life-changing. Several decades ago, surgeons like myself had two options: we could either make small breasts larger with implants or make large breasts smaller with a breast reduction.

Fast forward to 2000 and patients suddenly confronted me with a challenging request: “I like my large breasts, I just want them up where they used to be.” An implant augmentation alone would just make the saggy breast bigger and saggier. A breast reduction would reduce the sag, but also reduce the size. It was at this moment that I realized the only way to obtain the shape that my patients wanted was to perform a breast lift with implants simultaneously. This is what I have called my BAR procedure (Breast Augmentation and Reduction).

Passing the “pencil” test was only possible if I removed the heavier breast tissue that sagged. In order to achieve the goals of enhanced size and superior breast fullness, an implant was required. It’s important to note that it is not possible to take a large, natural breast and simply “lift” it to a new youthful position and shape.

Believe me, it was scary when I first performed this BAR procedure. The plastic surgery literature and my colleagues all fretted about the “dangers” of a breast lift coupled with an implant. To this very day, this procedure has not been published in any of our primary surgery journals, though some inroads have been made in peripheral outlets. My own paper describing my experience with my first 50 cases was not accepted for publication, though the results were quite positive by any measure.

Five hundred cases later, and things haven’t looked any better. It is, by far, the most powerful tool in my breast surgery arsenal and also one of the most commonly performed procedures in my practice. I have made several small modifications in the actual technique of the operation to enhance the results, and I continue to challenge myself with larger breast reductions. As with any operation, setting patient eligibility criteria is very important. In my hands, the experience I’ve gained from working with hundreds of patients has also helped to make this a very reliable and safe procedure with extremely high patient satisfaction.

What I like most about the BAR procedure is that it offers my patients complete flexibility. I have the option of adjusting the size of the breast implant and the amount of tissue I reduce to shape up the ultimate breast for all the individual variations that I see in the real world. Image, if you will, a patient who has a lot of dense low hanging breast tissue and a complete loss of breast fullness. This means breasts that are BIG and LOW. I can remake this particular breast by placing a larger implant to build the upper breast and by removing the unwanted saggy breast tissue below. The end result is simply what you had before, or even better! Mother Nature has never been able to make a breast that is big and not saggy, but with the BAR procedure, anything is possible.

If you want to know whether or not you are a candidate for a BAR procedure, the easiest way to find out is to engage my website. It’s important to remember that this procedure doesn’t have a formal name, so trying to seek out others who have experience with it may be a challenge. You will find plenty on “breast augmentation with a breast lift or mastopexy” but not much on breast reduction with breast implant.

procedure video - How To Lift Saggy Breasts - The Story Of A Breast Lift With ImplantsWatch

As an addendum, I really enjoy working with patients who have spent a lot of time on my website prior to meeting with me. When I see them in the office, they know exactly what they want and they completely understand why the BAR procedure is ideal for them. Remember, I was enlightened about the concept of the BAR procedure by my very own patients!

Robert Caridi, MD
Diplomate of the American Board of Plastic Surgery
Fellow of the American College of Surgeons (FACS)
Member of the American Society of Plastic Surgeons (ASPS)
Member of the American Society for Aesthetic Plastic Surgery
Founder of Westlake Plastic Surgery