A:  When changing breast implant size to go bigger, you want to make sure that you are getting at least a 30% to 40% increase over your prior implant size. Anything less will likely not be that visible. That means going from a 350cc implant, you need to go at least 150cc  bigger if not more. Thus the 550cc implant size sounds good to me. I have no doubt you will be visibly bigger and rounder. Whether your sagging will be improved to your liking, however, may be a different matter. Getting bigger does not always mean your breasts will be more uplifted, as defined by the nipple getting higher and more centered on the breast mound. Make sure you discuss this with your plastic surgeon beforehand to be certain you may not simultaneously benefit by some form of a nipple (areolar) lift with your breast implant exchange.

Dr. Barry Eppley

Indianapolis, Indiana

A: In looking at your breasts, your most important decision about breast augmentation is not what size implant should be used. You have a moderate degree of breast sagging, meaning the position of your nipples is at or below your lower breast fold. Contrary to the perception of many, breast implants will not have a breast lifting effect. You are in need of some type of a lift if you are going to get breast implants. With implants alone your sagging breasts will be pushed lower, a look that I doubt you will find as an improvement. All breast lifts result in some scarring, a definite cosmetic liability. Whether larger and more uplifted breasts are worth the scars as a trade-off is what you need to think about first and foremost.

Dr. Barry Eppley

Indianapolis, Indiana

A: There are is no absolutely best position for breast implants in any particular patient. There are advantages and disadvantages to both approaches. The vast majority of patients today have implants placed beneath the muscle for better pocket stability, a more natural look (upper pole shape), better tissue coverage, a lower rate of rippling and less interference with mammograms. The one downside to under the muscle is that there will be animation deformities, meaning the implants will be pushed to the side unnaturally with pectoralis mucle contraction when the arms are extended.  The one benefit to an implant being above the muscle is when there is some breast tissue sagging, it can fill out the sagging tissues better. The other under the muscle benefit is for someone who was looking for less recovery time and pain and could not avoid adjusting their fitness regimen or someone who has to have the procedure done under local anesthesia for medical and fear of anesthesia reasons.

In the end, one has to weigh these advantages and disadvantages from the perspective of their own breast anatomy and shape. As a general rule, always remember that any implant in the body always does better in the long run (i.e., less complications) when placed under a thicker soft tissue cover particularly when under well-vascularized muscle.

Dr. Barry Eppley

Indianapolis, Indiana

A: Combining breast augmentation and a tummy tuck with a hysterectomy procedure is  perfectly safe provided you are in good health and have no significant health risk factors such as smoking, diabetes, or high risk for blood clots. Tummy tucks and hysterectomies are very commonly done together as it provides unparalleled access for the Gyn doctor to do the hysterectomy and provides solutions to many body problems in one operation. Adding a breast augmentation to this combined abdominal procedure does not add significant operative time, risks, or recovery. This would be the ultimate ‘Mommy Makeover’, correcting all issues that are associated with one’s pregnancies. Your most challenging aspect in getting this done is to be able to coordinate a plastic surgeon and a gynecologist’s schedule as well as the economics of doing it in a hospital environment.

Dr. Barry Eppley

Indianapolis, Indiana

A:  Without knowing what your exact platelet disorder is or was, I can’t say with any certainty. You will need to better describe medically what your platelet problem was. There is a big difference between too many platelets, too few platelets, and platelets which just don’t work well  as it relates to undergoing.The only thing that really matters with breast augmentation, or any surgery for that matter, is whether you have adequate clotting capability. If there is any question (and it sounds like there is) you should have a bleeding time, PT, PTT (or INR) and platelet count checked before surgery. Given that you had some type of ‘platelet problem’ as a child and after your first pregnancy, you should have a coagulation work-up before any elective plastic surgery.

Dr. Barry Eppley

Indianapolis, Indiana

A: Many times modestly sagging breasts get by initially with implants alone. But when the breast tissues relax after being pushed outward, they slide off the implant creating ptosis off of the edge of the implant. If you are happy with the size of your implants and they are in good position, I see no reason why you can’t proceed forward with the lift with the implants you already have in place. Most likely, you will need a vertical breast lift to get the breast tissues up in proper position over the implants. While it is never a pleasing revelation that you will need  a second surgery to get the breast result you want, take solace in the fact that a breast lift is much easier to go through than the initial breast augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

A: Thank you for your inquiry. While you would do well with a circumferential body lift or even a frontal abdominal panniculectomy, I am not a Medicare provider so I can not be of assistance to you.

While there is the chance of some coverage by Medicare for an abdominal panniculectomy, there is no chance that they would ever cover a completely cosmetic procedure such as breast augmentation.

Dr. Barry Eppley

Indianapolis, Indiana

A: Thank you for your inquiry and sending your pictures. I can see your concern about breast size and there is no question that implants would be beneficial to get you from a B cup to a C cup. However, no amount of increase in breast size will eliminate your stretch marks. With the expansion of skin from breast implants, stretch marks may become somewhat less noticeable as they are pushed out and stretched flatter. But the concept of stretch mark elimination should be erased from your mind as an expected outcome. The one concern that I have about your breasts is what degree of sagging they may have. The pictures are taken with your arms up which artifically lifts them and may camouflage the actual amount of sagging. Breast implants do not lift sagging breasts which is a common misconception. So whether you may or may not need some form of a breast lift with your implants remains uncertain. When you have the amount of stretch marks that your breasts do, this adds to that concern. If you can send me some new pictures with your arms at your sides, that would help answer that question.

Dr. Barry Eppley

Indianapolis, Indiana

The reality of breast implant surgery, however, is far from this image. There are certainly a minority of women who do want this look. But the  vast majority of women who choose to have breast implants are much more interested in finding the right size for their body and not to have overpowering breasts that become the focal point of their appearance.

Most breast augmentation patients are average women who simply want to look good in clothes and sport attire. I have seen many women who have told me that they are embarrassed to wear a bathing and won’t go to the pool or beach with their family. While breast underdevelopment is the most common motivation for getting implants, there are numerous other reasons. These include such breast conditions as postpregnancy sagging, asymmetrical breasts, body proportioning, breast asymmetry and reconstruction after mastectomies.

Pregnancy and nursing can have an adverse effect on a woman’s breast shape and size causing sagging and, almost always, a change in the amount of breast tissue. Many women are unaware that it is completely normal to lose breast tissue after pregnancy, a phenomenon known as involution. For some women who have had multiple pregnancies, they lose all of the breast tissue they originally had. When combined with stretched out skin, the change in a woman’s breasts can be deflating for their self-image as well. These are women who simply want to return to their pre-baby size and shape.

There are many women who have breast asymmetry where one breast is larger or different in shape than the other. In some cases the breast size difference can be as much as a cup size, sometimes even more. For women so afflicted, finding a bra to fit comfortably and properly is not as easy as going to Victoria Secret’s and pulling a good fit off the rack. Often they are forced to add padding to create a more even look in their clothing.

One of the most recognized and easily understandable reasons for implants is in breast reconstruction. The physical and emotional devastation of going through any form of a lumpectomy or mastectomy procedure can be softened knowing that an immediate or even a delayed reconstruction can be done. While numerous forms of breast reconstruction exist, including flaps that form the breast mound out of your tissues, implants remain the backbone of how most breasts are recreated.

Dr. Barry Eppley

Indianapolis, Indiana

One other trend in breast augmentation is a noticeable size difference. Many plastic surgeons have commented that women are asking for bigger breasts than they were a decade ago. Historically women would usually ask to go a cup size bigger. Today it is not uncommon for a women to want two or three cups bigger, particularly the younger they are. Women state they want to get a good value for their investment and they want to make a noticeable difference in their clothed appearance.

What accounts for these trends in breast augmentation? By far I would say that it is simply more accepted than ever before. As we enter the upcoming decade of 2010 to 2020, this is the beginning of the third generation of women who have had access to breast implants for cosmetic enlargement. It is a normal part of society now and younger women’s mothers and soon grandmothers will have had the procedure.

Breast augmentation has a track history of safety as well as effectiveness. Despite the hullaboo of what transpired in the early 1990s, the procedure has been proven to cause no medical problems or makes people systemically sick.. While it is far from a perfect procedure, because after all it is an implant in the body, its complications are local in nature and often aesthetic in significance.

The social trends of today play a major role in its popularity as well. Just go through the checkout counter at the local grocery store and the magazines are full of articles about celebrities who have had or are assumed to have had some form of plastic surgery. Many of these are women actors and performers who have enhanced their top half. The influence of these magazine, TV shows and now the internet have made it seem that having breast enhancement is now the new norm.

There are more choices in breast implants today than ever before. Since 2006, both saline and silicone implants are available in not only differing sizes but projection and styles as well. With the potential for gummy bear breast implants to be available perhaps later this year, increasing implant options appeal to an even broader spectrum of women. Just like the many aisles in a drugstore, multiple options for a single product line result in more sales.

The rise in breast augmentation is a result of greater societal acceptance, safety of the devices, influence of famous people, and a wide variety of implant options. I suspect the upcoming decade will see the number of implanted women continue to rise.

Dr. Barry Eppley

Indianapolis, Indiana

A: Whether a mammogram is needed before breast augmentation has no uniform answer. Every plastic surgeon has a different perspective on this issue.  My practice is to not get a mammogram under the age of 35 unless there is a family history of breast cancer or a history of breast problems such as cysts or fibromas. While breast cancer does rarely occur in younger patients, the statistical likelihood of a young patient having it is so low that I do not feel that the extra expense and radiation exposure justifies the effort. After age 35, I follow the recommendations of the American Cancer Society in regards to a baseline mammogram and subsequent studies. Some plastic surgeons routinuely get mammograms regardless of age before breast augmentation and this is a perfectly valid approach as well. You need to discuss this issue with your plastic surgeon and reach a mutually acceptable approach to the need for this presurgical breast screening study.  

Dr. Barry Eppley

Indianapolis, Indiana

A: Depending upon what kind of work you do affects recovery time after breast augmentation. For a less active sit-down occupation, one could return to work with 5 to 7 days. For more physical or strenuous activities, it may take 10 to 14 days until one is completely comfortable with those efforts. There are no restrictions after surgery other than one’s level of comfort. I place my patients on range of motion arm exercises beginning the first night after surgery. The more and the sooner you move your pectoralis muscles, the quicker you will recover and feel better. Breast augmentation is essentially two big pulled muscles. Like rehabilitation from any muscular injury, early active range of motion is important.

While breast augmentation is exposed to all of the traditional risks of surgery (infection, bleeding), those risks are relatively small. The biggest concept to grasp about breast augmentation is that it is an implant-driven operation…meaning that most of the risks long-term are related to having an implant. One has to recognize that the implant is not going to last forever, they will eventually ‘fail’ and need to be replaced. This is not a maybe, it is a certainty. It in just a question of when it will occur. On average, many patients experience 10 to 20 years of use before replacwmwnt of one or both becomes necessary. So one needs to bear in mind that all breast augmentation patients will over their lifetime have more than just the initial placement surgery.

Dr. Barry Eppley

Indianapolis Indiana

A: Thank you for your inquiry. I will have my assistant pass along the costs for breast augmentation through our Patriot Plastic Surgery program. In general, the cost is about 20% less that that of the average cost of the procedure. Several important questions to know is whether she prefers saline vs silicone implants as that has a major influence on costs of the procedure. (up to 20% in cost differential) Also with C cup breasts, having two children and having lost her perkiness, does she have any significant ptosis? (breast sagging) If she does, implants alone will not lift a breast up or move the nipples upward. Implants add volume and will only make the way her breasts look now bigger.regards. So the potential issue of a some form of breast lift may be needed although it is impossible for me to say without at least seeing some pictures of her.

Dr. Barry Eppley

Indianapolis, Indiana

A: When it comes to the expense of breast augmentation, there are numerous misconceptions about that aspect of the surgery. The cost of getting breast implants is the same regardless of the size of the implant used. Cost differences in implants do exist, but it is based on the type of breast implant selected not its size. Saline implants will cost less than silicone gel as the cost of the devices from the manufacturer is different. Many patients do finance their breast surgery through outside companies such as Care Credit. Plastic surgeons do not finance the cost of the surgery for patients nor can patients make monthly payments until their breast implant surgery is paid off. Payment for the surgery must be all paid up front which is why patients acquire the necessary funds from a financing company and pay them back over time with interest. No health insurance covers breast augmentation or any breast implant surgery unless it is associated with reconstruction from breast cancer.

Dr. Barry Eppley

Indianapolis, Indiana

A: Breast augmentation poses multiple choices for prospective patients to consider. These options are driven by implant choice which can secondarily control the placement of the necessary incision. Saline breast implants are often placed through a small armpit incision because they are inserted deflated and then inflated once into position. Silicone gel breast implants, unless they are very small, can not be placed through the ampit because they are inserted pre-filled or fully inflated. Thus, they are usually placed through a lower breast crease or inframammary fold incision.

But the incision is not the most important part of the breast augmentation procedure, the implant is. All incisions heal really well and are rarely of any secondary cosmetic consequence. Therefore, it is important to understand fully the differences between saline and silicone gel implants. While both work well and do an equally good job at making a larger breast, there are some important minor differences in them that are relevant in the long-term. This is especially pertinent to you at your young age since you will live to see them. These include such risks as implant deflation (saline) and silent rupture.  (silicone) You will be replacing these implants at least once on your long remaining lifetime so understanding these differences is important to you.  

Dr. Barry Eppley

Indianapolis, Indiana