See the fat cells releasing their fat:

Below are two ladies who are both thrilled, are both at a similar stage after surgery, both with high-profile implants, and who yet have different looks.

The first patient is more what I consider the mom/breast-fed/deflated-breast type of patient.  These women typically want to restore what they had pre-pregnancy (or maybe just a tad more!).  But typically they want to look fairly natural.  Notice how the implant restores volume to the breast, adding projection, and providing a “pseudo-lift” (see how much more skin can be seen below the lower border of the areola–sometimes these women come in thinking they want a breast lift).  The contour of the upper pole of the breast is fairly straight.

The second is more what I consider the slightly younger/no-kids/wants-to-be-pretty-busty type of patient.  The breast is not really deflated, and the whole skin envelope is tighter.  Typically these women don’t mind looking a little “fake” and want to increase a number of cup sizes.  Notice how the lower pole does not change too much and most of the volume goes into the upper pole.  (In fairness, this will settle some over time).  The upper pole has a rounded contour.

Now, usually the first type of woman does not want to look like the second, and the second type hates to go through with it and not get the look they want if they look like the first!

So when people ask me “How I do it”, I answer that it is up to the patient!  As long as it is within the realm of reason, I try not to impose my biases into the equation.  The main goal is to provide a person with what she wants.

For more about breast shape and breast implants, see my previous blog post.

This type of product works by relaxing the muscles into which it is injected.  For cosmetic use, I want to relax muscles that cause that wrinkles when activated.  For example, the muscles that cause “frown lines” between the eyebrows are generally a good target for this.  Sometimes patients tell me that they are perceived as tired or angry when they are not.  Generally we target muscles in the upper half of the face (some of these are considered “off-label” use, much like using an antibiotic approved for pneumonia to treat sinusitis).  Usually lines in the lower half of the face are better treated by dermal fillers.

You can see some examples at the Botox website.  Or the animations on my website may be helpful.

I should say that there is some misinformation about botulinim toxins…while they are a “toxin”, so is aspirin (in the wrong dose) and so is alcohol.  Used appropriately, botulinum toxins have a tremendous safety record.  My staff and I are happy to discuss this more.

It will be interesting to see how Reloxin fits in the market.  There WILL be differences from Botox, and so one may be more attractive than the other for certain situations or for different reasons.  Stay tuned!

1) Someone who comes in for an implant, but is droopy enough that I need to have a long talk about the possibility of a lift.  Or,

2) Someone who comes in for a lift, but may get the result they want via an implant without a lift.

There are two other possibilities as well:  absolutely needs a lift (with or without implant), and thinks they need a lift, but really just has a deflated upper pole, and who will do fine with an implant alone.

For example, the following lady has a concave upper pole, which is corrected after implants:

In this case, the upper pole (the portion of the breast above the nipple–if it were Earth, the Northern Hemisphere) is now fuller, and even convex.  This is to some degree modified by implant selection, which gets into personal preference.  And the nipple/areolas start a little bit in the lower pole of the breast, and so they end up in the lower pole of the breast.

Here is a similar case where the breast implant makes the upper pole relatively straight:

But I digress.  

The single biggest determinant of whether or not someone needs a lift is the position of the nipple relative to the inframammary fold.  (The fold, or the IMF, is the crease where the breast and the chest meet.)

So one thing you cannot always see on a picture is where the fold is!  So unless you examine the patient, it is somewhat hard to know what the situation was based on a picture.  Since the implant will sit at or above the fold, if the main portion of the breast tissue is below the fold, then an implant alone will not look right.

This lady has marked upper pole volume loss, and looks like she might need a lift, but she obviously did fine with “only” an implant.  While the breast are a little low on her frame, this is essentially where the breasts were just put, nd this is hard to modify.

On the other hand, this lady has enough tissue below the fold that we opted for a lift (also known as a mastopexy), in addition to an implant:

This results in a scar around the areola, down the front of the breast, and in the fold. 

So, for a final example, here is someone in whom I discussed the possibility of a lift, but who did fine without one.  You can see how the implant has filled out the lower pole–look at the near breast and the amount of skin you can see below the areola before and then after.

So I think we’ve covered a bit about the shape of the upper pole and the position of the nipple relative to the inframammary fold.  Other factors are volume of native breast tissue, skin quality, and implant volume.  And another idea you can get a flavor of from the above pictures (which is another topic!) is that the shape of the breasts before surgery influences the shape after surgery.

For more information on Breast Augmentation or Breast Lift, click on the links to my website.

And let me know if you have questions!

Almost always I can.

This is an example of a lady who had old malpositioned breast implants, and a lot of soft tissue ptosis (medical for droop). She also has large areolas. She also had had a recent breast biopsy (which was benign).

I exchanged the implants for silicone breast implants (which I medialized), did a lift, reduced the areolas, and was able to incorporate the biopsy scar. This is at six weeks.

For more information on breast lift (mastopexy), see my website.

I removed the old implants, put new silicone breast implants (high profile 475 cc) under the muscle (submuscular placement), fixed the upper pole capsule, and did a small wedge resection of the lower pole.

This is about three months out.

For more about breast augmentation, see my website.

The silicone breast implants are 800 cc (I need to review the size that the saline were, but I think somewhere in the 400’s).  While this is again larger then some people would want, this base diameter fits her chest, and does not look excessive.  In any event, she loves it!  

This is postop 6 months.

And I think saline and silicone mostly look the same (as long as the saline is not filled beyond the manufacturer’s fill range), but the big difference is in how they feel.  For more about silicone implants, see my previous post on Silicone Breast Implants or my main website piece about breast augmentation.

Here is another example–this is 700 cc at 4 months.  This is a silicone breast implant, although I think saline breast implants look the same.  (see Silicone Breast Implants for more about implants).

You can see how the implants have fallen into place a little more compared with the example in the last post.  And again, I have no desire to make anyone larger than they wish–but if someone is going to go through breast enhancement, I certainly hope to get them to the size they want.

The final breast volume will be a sum of the native breast tissue plus the implant.  And while everyone can look on the internet and see a result they like, knowing the volume of the implant is only half of the story.

The reason why is because I try to match the width of the implant to the width of the breast.  And there are a variety of breast widths.  So just because a person’s friend got so many cc’s, and looks great, that may not apply to that person, because comparing her to her friend may be like comparing apples to oranges if they have different widths (and different amounts of starting tissue).

And so narrower breasts will require less volume than wider breasts to get a similar look in different women.

For a given width, then, we try to determine if a woman wants low, medium, or high profile implants (they may have slightly different names).  At a given width, the three different profiles have different projections but the same diameter.  So the lowest profile is flatter, and the highest profile is more round.  This is true in both saline implants and silicone implants.

Here is an example of a woman who got 800cc high profile silicone implants–the largest volume made.

While this may be larger than another individual may desire, it is certainly not overdone.  For her frame they fit very nicely.  But in another woman they might be too big.  A woman with a narrower breast might get a similar look with a much smaller implant.

And this is only at 3 months…they ought to settle a little bit more over time, causing the upper pole to be less convex while the lower pole expands a little bit.

This individual is 3 months out from a tummy tuck and a breast augmentation (also known as a Mommy Makeover, which sometimes includes liposuction and can fall under the larger umbrella of body contouring).  She obviously had lower abdominal existing scars.  These are now hidden under her underwear.  

The scar that DOES cause concern is a large horizontal scar above the belly button.  This is because it may interrupt the blood supply to the skin after a tummy tuck.

The classic one we see is from an open cholecystectomy.  (This is less common with the wide introduction of laparoscopy.)  Vertical scars may limit the result but are usually OK for healing.