Looking at Your Breasts -- The Way a Plastic Surgeon Does

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“All of my patients discuss these decisions with me prior to their breast augmentation surgery”:

1- saline or silicon
2- size of implants
3- smooth or textured
4- round or oval
5- under or over the muscle
6- location of the incision site
7- with or without a breast lift

After a breast augmentation consult you will have to make seven decisions regarding the type of implant and surgical approach. The consult itself can be an emotional event full of new information which may be hard to process. It is essential that you and the physician be ‘on the same page’. It will help you a lot if you can see your breasts as the doctor sees them. Before making the seven decisions, a good plastic surgeon should take into account various attributes of the breast, such as the breast tissues, symmetry, ptosis (degree of sagginess), and the base of the breast. Here are some definitions of the breast terms that I will be discussing with you in your consultation and pre-operative appointments. This knowledge will guide you in your decisions:

-breast tissues
The breasts may appear either ‘full’ or ’empty’. A ‘full’ breast gives a surgeon great flexibility in planning. An ’empty’ breast has a possible impact on the choice of implant as well as placement above or below the muscle.

-inframammary fold
This is the horizontal line where the base of the bottom of the breasts meets your chest wall. To get a better idea of the line of the inframammary fold, tuck two pencils horizontally under the folds of your breast. The line that the two pencils make is your inframammary fold. If one or two nipples sag below the line of the inframammary fold you should seriously consider a breast lift in conjunction with your breast enlargement. The decision to have a breast lift will affect the incision location.

The first thing I do when I evaluate a breast is point out to the patient how their breasts are different. The differences may be subtle or obvious, but they are always there. Significant asymmetry will affect the choice of incision location such that the nipples can be adjusted to be more symmetrical with each other.

-ptosis (or ‘sagging’)
The amount of ptosis or sagging that you have will determine if you should consider a breast lift and this will directly affect the choice of incision location. To determine how much ptosis you have, stand straight facing a mirror with shoulders even and place an index finger horizontally in front of each nipple. Most women will have at least a half finger breath difference in position. Do the same by placing the fingers in the fold underneath the breast and see if there is a difference. Most women have at least half a finger breath difference in position. Ptosis is easily identified once one nipple is more than one finger breath lower than the other one.

-the breast base
Next, put your hands in your waist and turn 3/4 to the mirror and notice how far the fold extends into the side of the chest wall. A good ‘marker’ is the angle in the armpit between the arm and the chest. Is the base of the breast in front of this angle or behind it? The base is important as it may influence the surgical approach and the size of the implant. A small base can not accommodate a large implant.

Having a basic understanding of the above concepts should help you follow the logic of your plastic surgeon’s proposed surgical plan. Of course, there are other lifestyle factors which may also play into your decisions. For example, if you are a runner, a very large implant would not be the best decision for you. However, knowle