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Dr. Barry Eppley

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Posts Tagged ‘breast implants’

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

Case Study – Breast Lifts with Implants

Wednesday, March 16th, 2016


Background: Severe sagging of the breasts occurs for a variety of reasons but the most common is weight loss. Weight loss creates the unaesthetic combination of excessive stretched out breast skin and loss of breast volume. Occurring together this allows many breast mounds to fall over the inframammary fold carrying the nipple with it. The empty sack of breast skin creates a very deflated breast appearance. While its look may be masked when compressed upward in a bra, its lack of support is very apparent without it.

Breast Sagging classification Dr Barry Eppley IndianapolisSevere sagging or Grade III breast ptosis always requires a full breast lift to get the breast mound and nipple back up on the chest wall. A full breast lift is an anchor pattern procedure with the result scars appearing like its description. It is identical to the breast lift component used in a breast reduction procedure. An implant is always needed for some degree of volume restoration and to create support to hold the breast lift up.

The combination of a breast lift with an implant, the so called implant mastopexy, is always a difficult procedure to perform and get consistently pleasing results. This is because the two aesthetic breast procedures fight against each other. The breast lift tightens and make the enveloping breast skin smaller. While the role of the breast implants is to push out and expand the overlying breast tissues. These two opposing forces can make it challenging to get the right combination of implant size and degree of breast lift. When one factors in the issue of secondary tissue relaxation after any lift, the naturally ‘stretchy’ nature of the breast tissues in the weight loss patient, the normal risks and complications that come from breast implants and that every woman has two breasts that ideally should match, it should be no surprise that the revision rate on this type of aesthetic breast procedure is significant.

Case Study: This 47 year-old female was bothered by the very saggy appearance of her breasts. While once having much larger breasts significant personally-induced weight loss caused her breasts to deflate and severely sag. She passed the ‘pencil test’ with flying colors. (placing a pencil under her breasts and it stays in place) She had a full Grade III ptosis with the right breast hanging lower than the left.

weight loss BAM LIft results front view Dr Barry Eppley IndianapolisUnder general anesthesia and using preoperative markings made in the standing position, a full breast lift was performed. The bottom part of the lift was left open through which anatomic shaped silicone breast imlpants of 450cc size were placed in the partial submuscular plane.

weight loss BAM Lift results oblique view Dr Barry Eppley Indianapolisweight loss BAM Lift result side view Dr Barry Eppley IndianapolisHer three months postoperative results show dramatic improvement in her breast shape and size. While her breast mounds appear to be in good position at this point after surgery, I would not judge the final result until six to nine months when full tissue relaxation has occurred. I would anticipate some residual drop of the breast mounds to occur over the implants with further tissue settling.

While early combination breast lifts and implant result may be very acceptable, the poor quality of the breast skin/tissues will inevitably make for some secondary tissue sag off of the implants. Whether that will be enough to bother the patient is a personal decision. But it is wise in combination breast lifts with implant surgeries to anticipate the potential need for a revisional surgery.


1) Severe sagging of the breast always has the nipple located below the inframammary fold and is associated with significant breast tissue loss.

2) Full anchor style breast lifts are needed with Grade III ptosis and an implant to restore volume to the elevated breast mound.

3) The revision rate for combined full breast lifts with implants in Grade III ptosis is as high as 50% or more due to secondary tissue relaxation of the overlying breast mound.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Nipple Lifts with Breast Implants

Tuesday, February 9th, 2016


Background: Sagging or ptosis of the breasts is seen in s wide variety of forms, all of which can influence breast augnentation results. Severe or Grade III and IV breast ptosis is an easy breast lift decision to make as there is no other choice. Grade I breast ptosis is also an easy decision as breast implants alone will have a lifting effect on its own.

The intemediate or Grade II breast ptosis is challenging decision. A breast lift will provide the needed upward change of nipple position but will create undesired scars in so doing. Implants will avoid visible breast scars but may make the appearance of the breast worse with a lot of upper pole fullness but a nipple-areolar complex that is oriented more to the lower pole of the breast.

Case Study: This 34 year-old female presented for breast implants. She knew she had a bit of breast sagging but did not want any scars that went beyond the margin of the areolas

Breast Implants with Nipple Lift results front view Dr Barry Eppley IndianapolisUnder general anesthesia she had 400cc smooth silicone breast implants placed through small inframammary incisions using a funnel technique. At the same time nipple lifts were performed by removing a superior crescent skin at the superior aspect of the areolas of 1 cm in height at the central aspect.

Breast Implants with Nipple Lift results oblique view Dr Barry Eppley IndianapolisSmall to moderate degrees of sagging pose issues for optimal breast augmentation results. Many patients understandably think that implants will have a breast lifting effect which is only true if the nipples are right at or above the inframammary fold level. Often in more minor amounts of sagging the patient may not even recognize that they are ‘droopy’ since they may have been that way for a long time.

Breast Implants with Nipple Lift result side view Dr Barry Eppley IndianapolisThe nipple lift, formally called a superior crescent mastopexy, is not a true breast lift. It is really a nipple edge relocation procedure. While it may not centralize the nipple during the placement of breast implants, it can prevent it from having a worse and lower mound position after its enlargement.


1) Ptosis or sagging of the breasts is not usually fixed by breast implants alone.

2) Borderline breast lift patients can be treated by a superior crescent mastpexy (nipple lift) with their breast augmentation.

3) Nipple lifts offer an alternative option to the scars of a more formal breast lift albeit with a much less lifting effect.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Breast Implants and Tattoos

Sunday, December 13th, 2015


Background: Placing implants to increase breast size is the most common surgical method of breast enhancement. The most common non-surgical method of breast enhancement are tattoos. When it comes to breast tattoos, there is an endless variety of patterns, sizes and colors. From words to images to some incredible artistic patterns, breast tattoos are as individual as the patient themselves. While most breast tattoos are fairly small, some of very large and can even cover the entire breast mound.

As breast implants enlarge the breast mound some enlargement of the existing tattoos is likely to occur. The closer it is to the center of the breast mound the more the tattoo will increase in size. But rarely does it ever distort the tattoo that it is not longer appealing.

Case Study: This 35 year female came in for breast augmentation. Across her sternum on the lower half was large inverted moth tattoo. The lower body of the moth;’s wings were on the inner lower portion of the small breast mound.

Moth Breast Augmentation results front viewMoth Breast Augmentation result oblique viewUnder general anesthesia 450cc high profile smooth round silicone gel breast implants were placed through inframammary incisions. The implants enlarged the breast mounds to the desired size and gave the back wings of the moth tattoo a ‘lift’ as well,

There are no contraindications to getting breast implants with any form of a tattoo on the breast mounds. The tattoo may change slightly with a modest increase in its size as would be expected.


  1. Some women that present for breast augmentation have a multitude of tattoo sizes and patterns in their breast mounds.
  2. The incisions to insert breast implants rarely disturb breast mound tattoos.

3) Some tattoos may increase in size some what as the breast mounds get larger due to the placement of breast implants.

Dr. Barry Eppley

Indianapolis, Indiana

Aesthetic Insights – Wide Spacing of Breast Implants

Sunday, November 29th, 2015


For women undergoing breast augmentation surgery, the location as well as the size of the breast implants is of critical importance. While women can participate in the selection of the size of their breast implants, they have little say in where they are positioned on the chest wall. Ideally the plastic surgeon centers the implant with the nipple-areolar complex  positioned over or close to the center of the newly projected breast mound.

But many women’s native breast mounds are not usually symmetric and the position of the nipple-areolar complexes may be positioned fairly far to the side. Such widely spaced breasts mound and lateralized nipples pose an aesthetic compromise that is important to diagnose and discuss before surgery.

Wide Spaced Breast Augmentation result front view Dr Barry Eppley IndianapolisWhile many women want to have their breast implants create cleavage, or be as medialized as much as possible, the limits as to what can be achieved is their natural breast mound location. Widely spaced breasts simply pose limits as to how close breast implants can be placed to the sternum. A good rule of thumb is that no more than two-thirds of the implant’s base width can be placed medial to the areolar edge. By making this measurement it can be seen before surgery how close the breast implants can be placed to the sternum. (or how much of a sternal gap will persist afterwards)

It is often said that breast implants don’t make cleavage…that is what bras do. While there are certainly examples of where breast implants can be placed very close up to the sternum, this is primarily a function of the woman’s natural breast mound position as well as the size of the breast implants used. For many women undergoing breast augmentation, their desired close spacing of the breast implants is often not a reality.

Dr. Barry Eppley

Indianapolis, Indiana

The Effects of Breast Implants on Native Breast Tissue

Saturday, November 28th, 2015


Breast Augmentation in Asians Dr Barry Eppley IndianapolisBreast augmentation using breast implants is the tried and proven method to increase breast size. It does so by an outward displacement of the overlying breast tissue (parenchyma) and skin due to the push of the implant. Plastic surgeons have recognized for years that the push/pressure of the implant causes a reduction or loss in the amount of breast tissue that existed before surgery. This is easily observed in any breast implant replacement surgery where the removal of the old implant shows a near concave appearance of the breast in many women as the patient is in the horizontal position on the operating room table. While a well recognized phenomenon, such breast implant effects have not been quantitatively evaluated.

In the November/December 2015 issue of the Aesthetic Surgery Journal, an article appeared entitled ‘Evaluation of the Effects of Silicone Implants on the Breast Parenchyma’. In this clinical study the authors used volumetric magnetic resonance imaging at six and twelve months after the subglandular placement of silicone braesy implants. A total of thirty-four (34) women were studied with twenty-four (24) of them receiving the breast implants compared to a control of ten women. They found that at one year after surgery there was a 22% reduction in the amount of natural breast tissue that was initially present.

This is one of the few studies that provides quantitative evidence of the loss of breast tissue with implant placement. The parenchymal atrophy is a direct effect of mechanical compression. One theory is that such compression impinges on the tissue’s blood supply but it is equally likely that it is a direct effect on the cells themselves with pressure-induced apoptosis of the fat cells. But regardless of the mechanism the effect is real and is of considerable consequence when a patient considers implant removal (one does not return to their preoperative breast size and shape) or implant exchange. (this is why more implant volume may be needed later just to maintain the same breast size)

Large Breast Augmentation result oblique view Dr Barry Eppley IndianapolisThere are lots of problems with this clinical study including the location of the implant in the subglandular position and the use of textured polyurethane implants…two breast augmentation variables that are not done in the U.S.. Whether smooth saline or silicone implants placed in the partial submuscular position would create an exactly similar effect can only be speculated. There is also the highly variable impact of the size or volume of breast implants on how much breast tissue one has go start with and the tightness of the overlying breast skin. Large volume breast implants placed in breast mounds with lower amounts of breast tissue would be expected to cause considerable breast parenchymal loss over many years of implantation.

The main pertinent point of such a study like this to women considering breast augmentation is that it should be considered an aesthetically irreversible procedure. While breast implants can always be easily removed, one’s breasts will never return to their original size and shape. Fortunately only a minority of women ever progress to the point in their lifetime that they want their breast implants removed.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Ten Year Old Silicone Breast Implants

Tuesday, November 24th, 2015


Background: While the effects of breast implants can last a lifetime, the implants themselves may need to be replaced due to mechanical failure. This is a well known reality of breast implants and the younger of age one has them placed the near 100% probability they will need to be replaced over one’s lifetime.

But other reasons breast implants may be replaced can be either a physical or psychological one. The breast tissue around an implant may decrease with aging or the overlying skin can become more stretched and a sag develop. A women may also perceive a different breast size ‘need’ at a different time or place in life as her body or social circumstances have changed.

Case Study: This 42 year Asian female who weight 130 lbs wanted larger breasts using 375cc silicone gel breast implants. While she had a little bit of breast sagging, it was not enough to warrant any form of a breast lift. Through an inframammary incisions, the silicone breast implants were placed in a partial submuscular plane. (dual plane positioning)

10 Year Silicone Breast Augmentation result front view Dr Barry Eppley Indianapolis10 Year Silicone Breast Augmentation result oblique view Dr Barry Eppley IndianapolisShe was not seen again after her six week checkup appointment until ten years later. While her breast tissues had relaxed a little over the years, there was not substantial change in their shape that could be perceived. In essence, her breast augmentation result appeared to be very stable with no change in implant position or loss of breast parenchyma. (breast tissue)

10 Year Silicone Breast Augmentation result side view Dr Barry Eppley IndianapolisWhat brought her back ten years later is that she had lost ten lbs and now felt her breast implants were too big. She now desired smaller implants and breasts that were positioned higher up on her chest. This os going to require a concomitant vertical breast lift with her new smaller breast implants.

While breast implants do not change themselves, the body and the mind’s perception of them can. Pregnancy and weight loss, for example, can result in loss of overall breast size  and also result in tissue sag off the implants. Also as women age their perception of breast size may change and there may be a perceived need to go bigger or smaller depending on a variety of personal factors.


  1. The long-term effects of silicone breast implants is well studied as plastic surgeons have seen many such patients often as long as three or four decades after implantation surgery.
  2. While breast implants themselves are usually dimensionally stable, it is the breast tissue around them that can change based on a variety of individual patient issues.
  3. Besides the breast tissue changing on top of implants, patients may also change their  attitudes and objectives with them.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Breast Implants with Periareolar Lift

Wednesday, July 29th, 2015

Background: Loss of breast volume is very common amongst women usually caused by pregnancies or weight loss. As the breast deflates sagging of the breast mound often occurs. As long as the nipple remains positioned at or above the inframammary fold (lower breast crease) augmentation with breast implants will adequately fill up and out the deflated breast creating a more pleasing breast size and shape.
But with increased degrees of breast sagging (nipple at or below the inframammary fold), an inplant alone will not be satisfactory solution. While it will expand the breast volume the nipple will likely be driven downward not upward creating a breast look that few would desire or accept as an improved breast shape outcome.
The need for a breast lift at the time of breast augmentation is very common. While no woman wants a breast lift and the skin scars that result they may have little choice. The options for true breast lifting are three fold. The most common and effective are the vertical breast lift (lollipop lift) and the combined vertical and horizontal breast lift. (anchor lift) But the breast lift that creates the least scar and also has the least lifting benefit is that of the periareolar or donut pattern breast lift.
Case Study: This 42 year-old female presented for breast augmentation. She had lost some weight, and between that and having had children, had a bit of a breast sag. Her nipples were exactly at the level of the inframammary fold. The dilemma was whether just getting breast implants would create a nipple positioning problem on the enlarged mound or whether she should just have a breast lift at the time of her implants. She was adamantly opposed to any type of breast skin scar on the mound itself.
MM Bam results front viewUnder general anesthesia she had silicone gel breast implants (475cc) placed in a dual plane position through a small inframammary incision. At the same time she had an eccentric ring of skin removed from around her areolas. (donut breast lift)
MM Bam results oblique viewMM BAM result side viewAt three months after surgery, her breasts show an acceptable breast mound enlargement and nipples that were in good orientation on the breast mound. There was no appreciable sag of the breasts although her breast mounds remained in the same overall position as that before surgery. Her areolar diameters were increased.
Of all the types of breast lifts, the donut lift is the ‘weakest’ of the group. It really has a very limited breast lifting effect and this could be seen if it was ever just done on its own. It does provide a bit of a lift when combined with implants although the implants really do the heavy lifting in the final result. But the donut lift does have a role to play in the woman who is questionable if she really needs a lift or not. It may be just enough in some women to allow them to get by without having to get scars on the skin portion of the breast mound. It is hard to say whether the increase in areolar diameter seen is due to the natural stretch of it from the underlying implant expansion or from the combined tension of the periareolar skin reduction.
1) Minimal to modest amounts of breast sagging can be improved with a perirareolar or donut style breast lift procedure.
2) A periareolar breast lift works best when combined with breast implants.
3) A periareolar breast lift almost always enlarges the diameter of the areola, particularly when used in combination with breast implants.
Dr. Barry Eppley
Indianapolis, Indiana

Case Study – Small Natural Breast Augmentation

Sunday, July 5th, 2015


breast involutionBackground: Many may perceive that breast augmentation is about getting bigger breasts  but for many women is merely about getting back to what they once had. Usually due to pregnancies and breast feeding, a woman’s actual breast volume will almost always become less through a normal biologic phenomenon known as involution. This may not be so evident after one pregnancy but becomes more manifest with two or more pregnancies.

Besides fat injections, saline or silicone gel breast implants are the only surgical method to restore lost breast volume. What size implant a women desires is a personal choice and many women will end up picking an implant size that is bigger than they were before having children. If one is going to have surgery and incur costs and recovery one might as well be better than how one was originally made.

But this is is not true for all postpartum women undergoing breast augmentation. Some women may only want to get back what they had lost. An implant can do that well provided that the soft tissue envelope of the breast is not overly stretched and sagging. If some sagging exists more breast volume than desired may be needed to fill it out adequately.

Case Study: This 28 year-old female presented for breast augmentation. She has her last and final child six months ago. She opted for a silicone implant to get the most natural feel given her nearly complete lack of any breast tissue.

small breast augmentation result front viewsmall breast augmentation result oblique viewUnder general anesthesia, she had 270cc silicone gel breast implants placed in a dual plane position from inframammary incisions. They were of moderate profile with a base width of 11.5cms. While she had a bit of breast skin sag beforehand her nipples remained largely above the lower breast creases.

small breast augmentation result side viewBreast augmentation can be modest and can be done to just fill out the deflated breast envelope. This can also create a bit of a ‘breast lift’ with the volume expansion. This is not a true breast lift per se as it is just lifting up the nipple through restoration of previous breast volume.


1) Breast augmentation for many women is only about restoring lost breast volume, not necessarily being bigger than they originally were.

2) Small breasts that have lost volume from pregnancies only need a small breast implant, often below 300cc.

3) As long as there is no ptosis (sagging) and the nipple is above the inframammary fold a small breast implant will adequately restore breast volume.

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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