Plastic Surgery
Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Case Study – Breast Augmentation in Pseudoptosis


Background: Since breast augmentation is about increasing breast size it is no surprise that so much thought goes into choosing implant size before surgery. This is the one single issue that patients focus on and are often indecisive about before the surgery. No patient wants to be too big or too small knowing that in the vast selection of breast implant sizes there is the right one for them.

Numerous methods of breast implant sizing have been used and each has their own merits. The one I prefer is the volumetric method using different overlay sizers so the patient can see how different implant volumes affect their breast size. While not a perfect method it has worked as wells anything I have ever used and I have yet to have a patient sho felt their implants were too big with this sizing method.

Between breast base diameter and volumetric sizers, these parameters will work well for most patients. The other breast variable that must be considered is the overlying skin envelope. The volumetric sizers assume the breast skin is tight but when it is loose or has a deflated appearance it is going to take more implant volume to achieve what the volumetric sizers show.

Case Study: This 30 year-old female presented for breast augmentation surgery having lost much of her breast volume from having children. Her nipples were above the inframammary fold but there was some loose skin hanging over it. (pseudoptosis) Volumetric sizers showed she like 350cc implant size.

Under general anesthesia and through inframammary incisions, 425cc moderate plus profile silicone breast implants were placed in a dual plane location.

It is important to remember that the amount of loose skin on the breast will take more volume to expand outward than one may think and should be considered in the implant size selection process. The loose skin has lost elasticity and often has stretch marks. It will take more implant volume to fill it than if the overlying skin were tighter and there was less of it.


1) The amount of loose breast skin does influence how much implant volume is needed to fill it.

2) While there is no exact formula to calculate how much extra implant volume is needed to fill the ‘extra space’, it is best to add 50 to75cc onto the original breast implant sizing estimate.

3) It is best to overfill and not underfill the breast with loose skin when it comes to implant size.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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