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Background: Much of a preoperative breast augmentation discussion focuses on implant size. To determine what implant volume would create the desired increase in breast size, a variety of methods have been advocated from the rice test, volumetric sizers and 3D imaging. All have their merits and to those who use each one they are staunch advocates of them.

But another important preoperative measurement is that of the natural breast base width, both from side to side as well as from top to bottom. One of the very significant effects of breast implants is the expansion of the breast’s base width by that of the implant’s base width. This consideration is often just as important in determining desired implant volume, particularly in the patient with a more constricted base width.

Case Study:  This 39 year-old female wanted to enlarge her breasts to fix her smaller and slightly droopy breasts. She was not hesitant to go bigger given her larger chest width and body frame. Her breast were small and had a short vertical distance from the nipple to the inframammary fold.

Under general anesthesia and through 3.5 cm long inframamammary incisions, 550cc moderate plus profile smooth silicone breast implants were placed in the dual plane position lower the inframammary fold level. Insertion of the implants was done using a no touch funnel device.

Her 6 week after surgery results show the volumetric effects of significant expansion of the breast mounds. The larger the implants the greater their base width. With a larger base width to center the implant behind the nipple, the inframammary fold must be lowered. As a result the impact on the shorter lower pole of the breast become more significant. This lower pole volumetric effect helps drive up the nipple position creating a lifting effect.

Case Highlights:

1) Lack of significant breast development on a larger frame with aging can create small breasts that have a little sag.

2) Larger breast implants expand the lower pole of the more constricted breast mounds creating a mild lifting effect

3) In the smaller more constricted breast mound knowledge of the desired increase in breast base width is also a factor in determine ideal implant volume.

Dr. Barry Eppley

Indianapolis, Indiana

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