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Archive for the ‘breast implants’ Category

Case Study – The Perfect Breast Augmentation

Tuesday, August 30th, 2016


Background: With almost a million breast implants placed per year in the U.S. for aesthetic breast augmentation, the results achieved are highly variable even though the implants have the same basic shape. This is due a basic breast augmentation concept….all breast implants do is take what you have and make it look bigger.

Breast implants do not have the capability to fix natural breast asymmetries, sagging breasts, where the breast mound sits on the chest wall or change the position/shape of the nipple-areolar complex. Implants are simple mound enlargers that have no other magical properties to do more. For this reason it is critical that the patient be aware of what breast implants will or will not do before surgery so their postoperative expectations are realistic.

While most women will achieve satisfying results from their breast implant surgery, few women ever achieve a perfect result by either patient or surgeon assessment. This is for the simple reason that few breasts are ever perfect initially and that the placement of paired synthetic implants into the body can create different responses in healing.

Case Study: This 20 year-old female presented for breast augmentation desiring a full round breast look result. She opted for high profile silicone implants.

Perfect Breast Augmentation results front view Dr Barry Eppley IndianapolisUnder general anesthesia she had 350cc high profile silicone implants placed trough 3.5 cm long inframammary incisions in the partial submuscular dual plane position. (it required her nipple piercings to be removed right before surgery)

Perfect Breast Augmentation results oblique view Dr Barry Eppley IndianapolisPerfect Breast Augmentation result side view Dr Barry Eppley IndianapolisHer breast augmentation result is as good one as one can get. This is judged by the symmetry of the breasts and their rounded shape which she desired. While good placement and surgical technique was needed, it was aided by the good symmetric shape of her breasts before surgery.


1) The best breast augmentation results occur in those women who have the best breast tissue/shape before surgery.

2) A high profile silicone breast implant produces a fuller looking breast mound with good upper pole fullness.

3) Symmetry is an important element of a good breast augmentation result.

Dr. Barry Eppley

Indianapolis, Indiana

The Ideal Implant Update

Sunday, August 7th, 2016


Ideal Implant internal structure Dr Barry Eppley IndianapolisThe Ideal implant is the first truly new idea in breast implants that has come along in decades. Its innovative internal baffle and dual chamber design allows a saline-filled implant to act more like a silicone breast implant. It has a fairly natural feel and does not develop rippling but also offers the piece of mind of being saline-filled device for those so concerned about silicone. It also will undergo complete deflation if there should be a disruption in the shell due to its two internal chambers.

The FDA has recently changed the Ideal Implant name from saline-filled to that of a ‘Structured Breast Implant’. This name change helps make for a clear distinction between that of the traditional saline breast implant. Now there are officially three types of breast implants; saline, structured and silicone gel.

The Ideal Implant or structured breast implant does not come in every size that is available with the more traditional saline and silicone implants…as of yet. But it does come in a fairly wide variety of sizes from 210cc to 635cc. A new 675cc size will be available shortly. Since one can slightly overfill the implant the range of implant sizes is virtually identical to that of silicone breast implants.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Breast Implants and Cleavage

Wednesday, July 6th, 2016


cleavageBackground:  Cleavage is defined as the area between the breasts. It usually confers that the inner or medial part of the breast mound encroaches upon the flat sternum which lies between the breasts. While the term defines a certain breast appearance it usually refers to a look that is seen in clothing such as a low cut shirt or blouse, lingerie or swimwear. For Western cultures cleavage is usually viewed as an important element of femininity and sexual attractiveness.

Patients have many expectations from breast augmentation surgery and having cleavage afterwards is often one of them. Having much fuller inner breast mounds that are more prominent and rounder with the breasts fully exposed is often their goal. This is somewhat ironic in that how cleavage is usually perceived is in clothes with a low neckline. Thus surgically enhancing a fully exposed breast that has a cleavage appearance  is a bit unnatural and is asking the breast implant to do what clothing usually creates. This is particularly true in today’s modern positioning of the implant in the submuscular location.

But what defines whether cleavage is the result of placing breast implants or not is the patient’s chest anatomy and the size and positioning of the implant. Breast mound and nipple spacing between both sides is a major factor. Many women simply have very widely spaced breasts and no matter what size breast implant is placed, augmented inner breast fullness is not going to occur.

Case Study: This 42 year-old female presented for breast augmentation. She had small breast with good skin. Her nipples were located on the breast mound at the mid-clavicular level.

Breast Implants and Cleavage result front view Dr Barry Eppley IndianapolisBreast Implants and Cleavage results oblique view Dr Barry Eppley IndianapolisUnder general anesthesia she had smooth round silicone breast implants placed of 375cc through inframammary incisions. Her results show the creation of unsupported fullness in the inner poles of her breasts.

Whether cleavage will result from breast augmentation depends on the spacing of the breast mound and nipples, the location of implant placement (subfascial vs submuscular), the size and projection of the breast implant and the amount of tissue quality that makes up the breast mounds. For most women undergoing breast enhancement prominent cleavage will not be the result. But when several of the natural breast characteristics are just right, some women will indeed develop an inner breast appearance that can appear without clothes to what it may be in clothes.


1) Breast implants rarely create cleavage for most breast augmentation patients.

2) The spacing of the breasts and the width of the sternal gap are the main natural limitations to breast augmentation cleavage.

3) When the distance from the sternum to the nipples is 12 cms or less, and the breast implants are of adequate size, postoperative cleavage can occur.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Teardrop Breast Implants

Wednesday, July 6th, 2016


Background: Breast implants have obvious effects on increasing the size of the breasts. While volume of the breast obtained per implant size will vary amongst patients, it is obvious that the larger the implant is the larger the breast becomes.

But when it comes to breast implant shape, the effect on the outer breast is not so straightforward or always completely predictable. In round implants they come in different projections (e.g., medium, medium plus and  high) which makes alterations in the height vs width measurements within the same implant volume. Such changes in implant dimensions, however, are not as significant as that between implant shell shapes.

Teardrop Breast Implants Dr Barry Eppley Indianapolis copySilicone implant shells come in two shapes, round and anatomic. (aka tear drop) The anatomic implant. also called the shaped breast implant, has a defined difference in its upper and lower pole configuration. By making the bottom part of the implant fuller (2/3s of the implant’s volume) it will have the same shape regardless of whether the patient is standing or laying down. Because of having this shape, it is important that the implant does not move around or rotate after surgery. Thus the implant shell has a textured layering on its outer aspect making it thicker than a smooth silicone implant. This means the implant will feel more firm and will not move regardless of the patient’s position.

Case Study: This 35 year-old female wanted a breast augmentation result that was very natural looking. Her definition of that breast look was that it was not too round on the top part of the breast.

Teardrop Breast Implants result results oblique view Dr Barry Eppley IndianapolisUnder general anesthesia she had shaped breast implants placed of 350cc silicone through inframamammary incisions.

Tear drop Breast Implants result side view Dr Barry Eppley IndianapolisHer six week after surgery results show a very natural looking result of modest size with good implant symmetry. This satisfactorily achieved her breast enhancement goals.

Shaped or teardrop breast implants have a role to play in breast augmentation surgery. They give women an option that has a more powerful effect on the final breast result that does implant projection.


1) The design of a breast implant shell has both an initial and long-term impact on the external shape of the breast.

2) Anatomic breast implants allow for less initial upper pole fullness and a quicker attainment of a natural breast shape.

3) Anatomic breast implants are best inserted through an inframammary approach to ensure optimal implant orientation which is critical in these type of breast devices.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Large Breast Implants with Vertical Lift

Friday, June 24th, 2016


Background: Breast sagging can be treated by either the use of a lift or an implant. A lift works by removing sagging skin and physically moving the nipple upward. Any lifting effect of an implant comes from tissue expansion with an outward and upward push. In many cases of breast sagging both a lift and implants are used because an implant can not really push the nipple up very much.

Many women understandably try to avoid the need for a breast lift by using a large breast implant. While this would seem to be an effective approach, the reality is that unless the nipple is at or above the level of the inframammary fold a large implant will push the nipple further down. Thus it becomes important to get the nipple moved upward by some form of a breast lift even if it is not a complete one.

Case Study: This 44 year-old female had lost some weight and had breast implants placed years ago. She was never completely happy with their small size and how they did not lift up her breasts. Since she has lost weight her breast sagging had become worse.

Large Breast Implants with Lift result front viewLarge Breast Implants with Lift result oblique viewUnder general anesthesia, vertical breast lifts were performed as well as breast implant exchange. Her existing 450cc saline implants were replaced with 900cc saline implants (700cc base size filled to 900ccs) Given her large and taller body size, this size of breast implant did not look too big.

Large Breast Implants with Lift result side viewEven with a larger breast implant size, a sagging breast may still not be sufficiently lifted. Only a formal lift through tissue excision and nipple-areolar relocation can  a breast be lifted. With larger breast implant sizes the type of breast lift can be affected. With larger breast implant sizes, the need for skin to accommodate that volume may eliminate the possibility of any horizontal skin excision. This leaves the vertical or the lollipop breast lift as the only breast lift of choice.


1) Many women want to lift their sagging breasts by implants alone but this rarely is successful.

2) Even with the use of larger breast implants some actual lifting of the breast is usually needed.

3) The size of the breast implant chosen affects the type of breast lift that can be used. (vertical vs anchor pattern)

Dr. Barry Eppley

Indianapolis, Indiana

Natural Breast Augmentation

Friday, June 17th, 2016


One basic preoperative concept of breast augmentation has taken on a contemporary approach of tissue-based planning. Such an approach strives to achieve a ‘natural breast augmentation’ result by not overwhelming the breast tissues with implants that are more than the tissue can accommodate. By having good tissue support for the implant there is a  lower risk of bottoming out, implant malpositions and reoperation rates. To some degree this fundamentally means that smaller breast implant sizes are used.

Based on a study of natural breast beauty the ICE principle has been described. This is an acronym that stands for Implant dimensions, Capacity of the breast and Excess tissue required. This is a simplified approach for calculating the inframammary fold incision placement and to create a 45:55 ratio between the upper and lower poles of the breast. The key element in this approach is the location of the new inframammary fold.

In the June 2016 issue of the journal Plastic and Reconstructive Surgery, a paper was published entitled ‘Design for Natural Breast Augmentation: The ICE Principle’. The paper described a study of 50 women who had primary breast augmentation using the ICE principle. The study looked at both round and anatomical silicone breast implants using the implant meridian relative to the nipple-areolar complex. For an anatomic implant it is 50:50 compared to a round implant of 45:55. The mean upper pole:lower pole ratio changed form 52:48 before surgery to 45:55 after surgery. Mean nipple angulation improved from 11 degrees to 19 degrees upward. The accuracy of the inframammary incision location was 99%.

Asian Female Breast Augmentation result oblique view Dr Barry Eppley IndianapolisThe ICE principle takes into account that in the vast majority of breast augmentations the inframammary fold must be lowered. Much of the work of a breast implant occurs in the lower pole of the breast which must be expanded. If not the upper pole will develop excessive fullness and the position of the implant will cause the breasts to look too high and unnatural. Expansion of the lower breast pole requires extra skin which comes from the abdomen. Knowing where to place the incision in the new inframammary fold location is key. This is not only to avoid a visible incision below the new fold but also to allow a greater amount of the implant to sit below horizontal level of the nipple-areolar complex. Knowing the diameter of the implant allows these measurements to determine the location of the new inframammary fold.

Natural Breast Augmentation Indianapolis Dr Barry EppleyA natural breast augmentation for most women means a breast that has an upper pole that is less full than the lower. Achieving this look does not always require a smaller breast implant to achieve it. The amount of available breast tissue, the natural width of the breast and the elasticity of the tissues may mean a larger breast implant by volume can still allow for a bigger breast augmentation result to still look natural.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Hispanic Breast Augmentation

Wednesday, June 8th, 2016


Background: Breast augmentation is a common body contouring procedure. Of the many pictures of breast augmentation results on the internet, the vast majority are of Caucasian type. The main difference with Hispanic or Latin women is their increased propensity to develop dark pigmentation at incision/scar sites. While they almost never develop hypertrophic or keloid scars, the color of the scar may still make it noticeable.

Case Study: This 21 year-old hispanic female never had any breast tissue develop. Her chest was completely flat with a small diameter areola.

Hispanic Breast Augmentation results front view Dr Barry Eppley IndianapolisUnder general anesthesia she underwent the placement of 300cc smooth high profile silicone breast implants through a high axillary incision. (3 cms length) Her implants were placed using a funnel insertion technique.

Hispanic Breast Augmentation results obique view Dr Barry Epley IndianapolisHispanic Breast Augmentation result side view Dr Barry Eppley IndianapolisHer result at six weeks after surgery showed a scarless breast augmentation with tight skin over the implants. With six to none months more time her very round breast augmentation result will soften and they will become more natural and softer.

Young Hispanic breast augmentation patients may want to avoid even the smallest scar at the inframammary fold area. The transaxillary incision offers a scarless approach that is appealing to women of increased pigments. Being placed in the hair bearing skin of the axilla, it heals very well and rarely develops any significant hyperpigmentation.


1) Breast augmentation can make a dramatic change in one’s self image for young women who have no breast tissue. (flat chest)

2) The young juvenile appearing female chest with tight skin will create more of a rounder appearing breast implant result.

3) Hispanic breast augmentation women may prefer a ‘scarless’ method using high axillary skin incisions.

Dr. Barry Eppley

Indianapolis, Indiana

The Ideal Implant for Breast Augmentation

Friday, May 6th, 2016


Historically the choice for women considering breast augmentation were either saline or silicone devices. These very contrasting breast implants choices have very well known advantages and disadvantages. Saline breast implants offer the most economical approach to the procedure with aesthetic device issues such as rippling, an unnatural feel in some patients and the risk of an eventual dramatic and inconvenient failure event. Silicone breast implants offer an improved and more natural feel and no risk of a dramatic deflation event albeit at a higher surgical cost.

Ideal Implant Dr Barry Eppley IndianapolisAlong has come the Ideal implant which marries characteristics of both saline and silicone breast implants. The advantages of the Ideal breast implant over either traditional saline or silicone implants are numerous. They offer the benefits of both types of implants without any of their downsides. The Ideal implant has an external feel that is similar to that of silicone implants (no rippling) but without the use of any silicone filler material. For those women that may harbor some persistent concerns about silicone gel, this provides peace of mind. It will also not suffer a complete implant deflation which lets the patient know their implant has a problem (partial deflation) but yet will not go completely flat.

Ideal Implant structure Dr Barry Eppley IndianapolisIdeal Implant internal structure Dr Barry Eppley IndianapolisHow does the Ideal implant achieve these improved physical characteristics over the traditional saline breast implant? It is in its proprietary and clever internal design. The implants has an internal structure which has an inner shell around the inner chamber which contains the inner saline filler and an outer shell around an outer chamber which holds the outer saline filler. Between these two shells are several baffle shells. This specialized type of inner structure controls the movement of saline inside the implant.

Bernoulli's PrincipleEven in a saline breast implant which has been filled to the point of stretching out the silicone containment bag (shell) and appears full, fluid does move around in waves inside it. But why does a traditional saline implant have ripples and feel so soft and extremely pliable? Using  the well known Bernoulli’s Principle, the pressure in a moving fluid decreases as its speed increases, and increases as speed decreases. Thus the saline in a traditional implant moves very rapidly and therefore exerts a low pressure on the outer shell. The innovation of the Ideal breast implant is that its internal structure chambers and baffles slow the movement of the saline down and, as a result, increases the pressure on the outer shell which dramatically reduces wrinkling and makes it feel more firm. (like a silicone breast implant)

Ideal Implant shape Dr Barry Eppley IndianapolisSuch fluid dynamics also affect the shape of the implant. The Ideal implant maintains a higher profile with lower edges and better upper pole fullness than that of a silicone implant. It does not develop the so called ‘ash tray’ effect that almost all silicone implants do that occurs when the implant is laying on a flat surface.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Vertical Breast Lifts with Implants

Saturday, April 30th, 2016


Background: Sagging of the breasts is a common result from pregnancies and weight loss. The loss of breast volume withdraws the support of the overlying breast skin leading to collapse of the breast mound. The breast mound then falls over the fixed inframammary fold creating a sagging breast appearance.

Breast Sagging classification Dr Barry Eppley IndianapolisThe classification of breast sagging is well known and is based on the location of the nipple relative to the inframammary fold. The relevance of this classification is in how it directs how the sagging breast is best treated and what type of breast lift is used to get the nipple back up above the inframammary fold.

In Grade II breast ptosis where the nipple sits just below the fold, the best correction is that of a vertical breast lift. Known as the lollipop lift because of its scar pattern, It moves the nipple vertically upward leaving a vertical scar between the nipple’s new position and its former location. In some cases, surgeons may try and make the periareolar or donut lift      work to avoid the vertical scar but the lifting effect will not be the same.

Case Study: This 35 year-old female had two children and lost much of her original breast volume. She wanted her breasts lifted and large breast implants placed at the same time.

Vertical Breast Lift and Implants result front view Dr Barry Eppley IndianapolisUnder general anesthesia, a vertical breast lift was performed raising the nipples 7 cms in the process. Silicone breast implants of 650cc high profile were after the lift was completed. The push of the large breast implants had its own lifting effect as well.

Vertical Breast Lift and Implants result oblique view Dr Barry Eppley IndianapolisVertical Breast Lift and Implants result side view Dr Barry Eppley IndianapolisHer one year result shows a major change in breast shape and size. Her vertical breast lit scars were remarkably imperceptible. The areolas were wider and the nipples ‘flatter’ as often happens after breast lift with a large implant push behind it.

The vertical breast lift is a very effective tool in the management of the sagging breast. While many women fear the resultant scars, in the right patient even large implants placed at the same time do not cause excessive widening or prolonged redness of the scars.


1) Vertical breast lifts and implants is a common combination breast enhancement procedure when ptosis occurs after pregnancy.

2) Vertical breast lifts are useful when the degree of breast sagging is modest with the nipple at or just below the inframammary fold.

3) The size of the breast implant placed partially controls how much breast lifting effect can be achieved.

Dr. Barry Eppley

Indianapolis, Indiana

Large Breast Implants

Tuesday, April 26th, 2016


While there many important issues to consider in breast augmentation, the size of the implant is one that women spent the greatest amount of time pondering before surgery. There are a variety of implant sizing methods and they all have their merits, but the reality is that breast implant sizing is not an exact science. No patient can really know for sure how they like the implant size selection until they swelling goes down and they have ‘worn’ it for awhile.

Women for breast augmentation usually want an implant size that looks natural, fits their body frame and does not stand out as their most notable feature. What that implant size may be is open to interpretation and highly subjective. But there are women who do want to have large breast implants and their goal clearly is not to be subtle in the result and a natural look is not their goal.

Breast implants come in a wide range of sizes from 150cc to 800cc. Because silicone implants are prefilled, their maximize size is 800cc volume. Saline implants, however, are alway overfilled and their volume can well exceed 1000ccs if desired. Considering these options in breast implant sizes, a large breast augmentation is going to be in the range of 600cc to 800ccs. For some women the volume may be much more.

For a variety of reasons, many plastic surgeons are opposed to larger breast implants. Such opposition is based on two basic and understandable reasons. Large breast implants are associated with a higher rate of complications such as loss of tissue support (bottoming out), implant asymmetries and deflations. (saline implants) The fundamental teaching in plastic surgery is to not place implants that exceed the ability of the tissues to support them long-term. The second reason for objection is the long-term consequences of the stretched out breast tissue. Large implants do deform the breast tissue irreversibly and their removal or reduction in size in the future will necessitate major breast lift surgery and its associated scars.

But breast implant size is a very personal decision and as long as the patient has been educated as to its potential consequences, large breast implants are a patient’s choice. The most common women who seeks large breast implants in my experience is the one who already has breast implants. They may have had them for years and now desire a much larger size. They may have had children or lost weight and their overall breast size has gotten smaller and a lot more volume is needed to fill out the loose skin. In these cases it can take a lot of implant volume to adequately expand the stretched out breast skin. In many ways these women are much more ‘qualified’ for large breast implants because they have a better frame of reference.

Some first time breast augmentation patients do seek large breast implants but they are far less common. Big for them might be up to 500ccs or so in small frames and 600cc to 700ccs in larger framed women. This is big for them given where they started but are not that big compared to women who are changing their existing breast implants.

The concept of large breast implants is open to interpretation but would be anatomically one where the implant width exceeds that of the the natural breast base width. While this may contribute to better cleavage it equally means that the side of the implant will protrude out beyond that of the chest wall.

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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