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Posts Tagged ‘large breast implants’

Case Study: Large Breast Implants in Smaller Women

Sunday, July 19th, 2015

 

Background: The size of breast implants selected for any woman’s breast augmentation is usually a hybrid between the patient’s desire and the surgeon’s recommendations. Many women are heavily focused on a natural look and fear looking like they have had their breasts ‘done’. They talk about being proportionate and having a new breast size that fits their body. Conversely some women, usually a smaller number, are more interested in a sizeable change in their breast size and prefer to have a more obviously augmented look.

Large Breast Implants Dr Barry Eppley IndianapolisWhile it is somewhat true that just about any breast implant size can be placed in many women, this does not mean that it should. The long-term consequences of large breasts are based on the tissue support that can keep them held into place. If inadequate tissue support exists the inevitable sequelae is that the implants may bottom out…a difficult problem to easily correct and one that is best avoided.

It is not an exact science to determine what proper tissue support is. Feeling of the breast tissues helps determine how thick or thin it is and the amount of subcutaneous or breast tissue present. But there is no real way to determine the strength or integrity of the all important inframammary fold…the ligament that secures the bottom of the breast fold to the chest wall. It is this anatomic structure that plays a major long-term role in keeping breast implants in their desired position.

Case Study: This 28 year-old female wanted breast implants and did not fear having a breast size that was noticeably different. (large for her body frame) She was 5’ 2” and weighed 102 lbs. Her breast base width was 11.5 cms. She opted for saline implants placed through a transaxillary (armpit) incisional access.

Large Breast Augmentation in Petite Female result front view Dr Barry Eppley IndianapolisLarge Breast Augmentation in Petite Female result oblique view Dr Barry Eppley IndianapolisUnder general anesthesia, she had 350cc high profile saline implants (base width 11.5 cms) placed through high 2.5 cm long axillary skin incisions. The implants were placed in a dual plane position (partial submuscular) and overfilled to 400ccs on each side. her existing inframammary fold were lower by 1 cm on each side to accomodate the new breast volume without being too high.

When seen at one year after surgery, her breast implants were in a stable position. They were ‘large’ for her very thin body but the new inframammary fold positions were stable and no implant bottoming out was seen. Despite disrupting the inframammary fold (as is almost always necessary for most breast augmentations) the implant size did not cause loss of anatomic support.

Like every breast augmentation, one of the keys to good long-term implant position is not to make an implant pocket that is too large. An implant pocket that is just the size of the implant, properly positioned, is all that is needed. This is of particular importance in thin women who get larger sized breast implants.

Highlights:

1) Occasionally small women do request ‘large’ breast implants based on their small body frames.

2) As long as the breast implant base width does not significantly exceed the natural breast base diameter, the breast tissues should be able to support them.

3) Small incisional approaches that do not disrupt the inframammary fold helps provides long-term support to larger breast implants in women with minimal tissue support.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: The Pseudolifting Effect of Breast Implants

Tuesday, August 13th, 2013

 

Background: There is a common perception that an implant can lift up a sagging breast. The reality is that nothing could be further from the truth. In most cases of sagging breasts (breast ptosis) an implant will actually making the breast shape worse. It will fill out the upper pole of the breast while having no positive shape effect on the downturned breast tissue which contains the nipple. This is why a lift with an implant is almost always needed for reshaping and lifting of the sagging breast.

There are a few instances of apparent breast sagging, however, in which an implant can have a breast lifting effect. If the breast mound is small and the sagging is largely restricted to the nipple, implant enlargement can create the perception of an uplifted breast. By making the breast base diameter bigger in both a vertical and horizontal dimension, the location of the nipple on the mound is changed as the mound is expanded.

Such positive benefits of an implant alone on a sagging breast almost always occurs when the initial breast size is small. Large breasts create a big sleeve of overhanging breast tissue as it has shrunken due to pregnancy or weight loss. This type breast already has a small base diameter and the droop is more nipple-related than mound-related. With careful assessment one can see that the low hanging nipple position does not fall below the level of the inframammary fold. (lower breast crease)

Case Study: This 40 year-old Hispanic female wanted breast enlargement after having had two children. She never had large breasts even though she had a wide chest. She wanted silicone implants and wanted at least a D cup breast size afterwards.

Under general anesthesia she had 550cc high profile gummy bear silicone implants placed through lower breast fold incisions. Using a no-touch funnel device technique, the implants were inserted through 3.5 cm long incisions in a dual-plane submuscular position. At least half of her mound expansion was on the lower pole with the creation of a new lower breast fold.

With implant augmentation in the smaller droopy breast, the entire lower pole of the breast is expanded lower. This makes a new inframammary fold location well below the location of the presurgical smaller breast mound. This is how the breast becomes ‘lifted’. The nipple position actually stays relatively the same, it is the breast mound around that changes. With a larger and lower breast mound the nipple ends up acquiring a central position. This could really be called a pseudolifting effect.

The expansion in the breast mound also creates an important issue for the actual placement of the breast implants. Since the breast mound will lower the existing inframammary fold, it is important to make that consideration into the incision location. The inframammary fold incision will need to be made at 2 cms. lower than the existing breast fold. If this is not done the incision will end up above the fold and on the actual lower pole of the breast is a more visible location.

Case Highlights:

1) It is a common belief that breast implants can lift a sagging breast which is rarely true.

2) Very small breasts that have a little droop due to involution, however, can be effectively ‘lifted’ with breast augmentation alone.

3) Larger breast implants achieve their lift by enlarging the lower pole of the breast making the nipple appear higher on the new breast mound.

Dr. Barry Eppley

Indianapolis, Indiana

Large Implants in Breast Augmentation

Tuesday, July 21st, 2009

The choice of implant size is a major consideration for every breast augmentation patient, for that is the reason they are having the procedure. I would wager that women spend more time on this aspect of breast augmentation than any other, including their selection of a plastic surgeon. As a result, one of the keys to a happy breast augmentation patient is that they have the size that they desire.

There are numerous methods that plastic surgeon use to select breast implant size. For most plastic surgeons, they really do listen to the patients and there are a variety of well established methods that work. None of them are perfect and all involve some level of subjective estimation and some eye for size proportion to body type.

One of the breast implant sizing paradigm shifts that has evolved over the past decade is the concept of putting no larger an implant than the breast tissues can support. For long-term fear of bottoming out and the fact that breasts do change in shape over time for many women, the objective is to avoid a regrettable decision and lower the risks of secondary complications. While there are no long-term complications of how breast implants fare based on size, it would be reasonable to assume that very large breast implants (per the patient’s chest size) will have more secondary problems (e.g., need for revisions and thinning of breast tissues.

While I find in my Indianapolis plastic surgery practice that most women have very size appropriate goals (at least by my view), there are clearly some women that prefer a final result of a much larger breast. In these cases, the plastic surgeon is caught between saying they aren’t comfortable doing it or accommodating the patient. While one could argue that as long as the patient has been apprised of the potential long-term implications of their choice, then the burden of whatever happens is their responsibility. That is usually well and good…until the patient returns with a complication.

So what is the best implant size choice for most women…..or how big should one ‘safely’ go? While different answers will come from every plastic surgeon, I think a good rule is to not put a breast implant in whose base width is greater than that of the natural breast. If the implant starts to violate the axillary space or get in the way of the swing of the arm, that is too big of an implant. Beyond this functional basis, recovery from an implant that is too far to the side (should downsizing ever be done and the pocket needs to be closed down) is always difficult and unpredictable. In essence, this problem is not easily recoverable.

The base width of the breast consideration is one of the primary reasons for having different projections or profiles on the implants. If the size a patient wants is a little too wide, then a narrower width implant with more forward projection can be used to achieve the same volume or size.

In the end, breast augmentation satisfaction is ultimately a combination of the final size and shape that is achieved. Larger breast implants may be acceptable if their widths do not exceed the natural base width of the breast.

Dr. Barry Eppley

Indianapolis, Indiana 

Extreme Breast Augmentation

Friday, February 13th, 2009

In most cases of breast augmentation, women usually desire predictable and reasonable increases in their breast size. (implant sizes of 300cc to 500ccs) Occasionally, maybe once or twice a year in my practice, someone will want really large breasts. A size that is disproportionate to their body frame but still able to be achieved with standard off-the-shelf implants sizes. (standard implant sizes go to 800cc for prefilled silicone and 800cc for saline which can be filled to roughly 1000ccs)

But the recent world record for breast implant size reached an astronomical increase of KKK. As recently reported a Houston Texas woman had her tenth breast augmentation surgery (performed in Brazil) to reach the gigantic size of 3,500cc per breast! Besides questioning the sanity of any patient who would even want to go half that size, it is not a very proud moment for plastic surgeons. While I am all for helping patients achieve what they want, not everything that some patients want is actually good for them…….and we as plastic surgeons should not be afraid to say so. Yes it is true that patients will go ‘down the street’ and find someone else to do it….there is a time to let them do so.

While such an extreme breast implant patient makes worldside news, the occasional patient who wants to be really big, by more normal standards, is more commonplace. When women make a choice for a large breast implant, they need to understand the long-term consequences. And there will be some. Most pertinently, there will be a day when the patient will not want to be so big. Downsizing breast implants will always make the breast sag…and many women will want a lift which results in breast scars. It is easy to go big, the skin will stretch and be nice and tight, but going down is another matter. The breasts will be deformed and will require some degree of skin tightening. Large breast implants over time will weaken the soft tissue support of the skin and many such patients will develop bottoming out of the implant over time as this support is lost.

In short, large to extreme sized breast implants are unnatural and the breast tissues are not designed to support such weight and size over time. When downsizing of a large breast implant is wanted, the loose size and large underlying breast implant pocket must be managed in a more reconstructive breast approach. This results in scars and may require multiple surgeries to get an acceptable shape and result. For these reasons, I advise patients to think very carefully about making breast implant size choices that exceed what their breast tissues are designed to handle. What size that is will vary greatly based on the patient’s breast and chest wall anatomy. There is no absolute upper implant size that applies to everyone.

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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