Your Questions
Your Questions
Q: Dr. Eppley, I’m currently looking for a surgeon to do my transgender breast augmentation, I’ve done my research for a few years and now. Looking for a surgeon, a little about my profile: I’m a transgender girl with a small rib cage and an overall very small frame and build. I’ve been on hormones for about two years now and believe I’ve achieved all I can naturally. I definitely know that I want to do cohesive gel ( “gummy bear”) implants, if you offer them (I think I read that you do). And would love to hear back from you!
I also would like to ask about removing ribs 11 12 and maybe 10, I know you’ve recently removed them from two women before and I’ve read your feedback on RealSelf.com about the procedure. I’d love to hear back from you on what you recommend! Much appreciated!
A: All silicone breast implants today are of the highly cohesive gel variety known as the urban term, gummy bear breast implants. All three existing breast implant manufacturers use the same silicone gel today. What implant size, shape and profile remain to be determined. (volume in ccs, round versus tear drop shaped and medium vs. high profiles) Such selections are based on what your breast augmentation goals are.
The role of lower rib removal is for narrowing of the anatomic waist. This is for patients who are unable to achieve a more hourglass shape or any inward indentation at the level of the waistline at the umbilical level. This is often a particular body contouring issue in male to female transgender patients whose ribcages are phenotypcally wider with greater outward rib flare.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I came in about a week ago to discuss breast augmentation. I am confused about breast implant profiles. I’m about five one and 100lbs. Right away I knew I wanted silicone due to them having a softer feel and I also was leaning towards moderate Plus due to the pictures that I have liked. They seem to look more natural well as natural as you can get with implants. Though right away you said high profile I’m sure it’s due to my small frame. My question is this afterwards will the high profile give me that two very round balls on my chest? Or will they hang a lil and have some side boob like real ones do? I just don’t want to look like I have balls on my chest though with my small frame will the high profile give me the boob look I’m looking for the noticeable though somewhat natural look. That the moderate Plus would give if I was a little wider? Could you help explain a little more the difference and looks please. I’m very interested I just want to be 100% with my decision. I understand with my small frame my options are limited. I believe I decided with 400cc round high profile silicone.. Thank you.
A: Your primary question about breast augmentation is in understanding the difference between high profile and moderate plus profile implants. To some degree, the size of 400cc in your body size is never going to look ‘natural’. Larger breast implants placed in smaller tight chested skin can not really avoid having a rounder/fuller look. That is more a function of the patient’s anatomy that it is being placed in and much less to do with the implant’s profile. There is also the very relevant issue of what happens with time (e.g., 6 months after surgery) as the tissues relax and settle after being so dramatically expanded in such a short time. Meaning implanted breasts that look high and round will always settle into a more natural shape over time. But the key issue is time and one has to be patient.
To better understand breast implant profiles, a high profile implant is less wide than the moderate plus. (even though they have similar 400cc volumes) This type of implant profile is often used in smaller women who are getting ‘bigger’ implants so the implant does end up too wide or too far to the side of the chest. (in the way of the swing of the arms) The tradeoff for that choice may be that they will slightly more round in the upper part of the breast. A moderate plus profile implant is more wide and slightly less high. It will have slightly less upper pole fullness but at the expense of more implant to the side. At the end of the day one has to choose which aesthetic tradeoff they prefer….a slightly rounder looking breast (high profile) or one that is a bit too far too the side. (moderate plus)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have an Inquiry regarding breast augmentation, I am wondering if my wife would be a candidate or should even consider a consultation. She had ovarian cancer in 2005 and then in 2014 was diagnosed with Stage 4 head and throat cancer. She is currently in remission. She has always wanted breast augmentation surgery but I wonder now if it would be too late.
A: Just because one has cancer, or even a lifespan that looks limited, does not preclude one from undergoing breast augmentation surgery. I did a lady some time ago who a stage 4 liver cancer. She had always waned to have breast implants and finally fulfilled her wish. She lived for two years after the procedure. It is all about making patients happy. Some people in having a cancer diagnosis may take that trip around the world or climb up Machu Picchu…others may want to have breast implants. There is no medical reason to not do so if her cancer doctors approve and she is not on any active chemotherapy or immunosuppression drugs. Breast augmentation surgery would be comparatively ‘easy’ to go through compared to any of her other cancer surgeries.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, What is the cost of start to finish with Breast Augmentation. I am concerned that I may need a breast lift as well but I see you have a before and after photo on your website when you click on the breast tab and below its says large breast implants there is a female on the left that is very comparable to my breast structure and looks like she just had implants and looks amazing. That’s what I am looking for. I am 27 years old with one child now with extra skin. Thanks
A: The critical question is whether you need a breast lift with your implants or not. That, of course, would impact the results as well as the cost of the surgery.if you could send some pictures of your breasts I could make that determination. The other issue that can tip the balance for or against the need for a breast lift is the final size of the breasts one desires. In some cases, large breast implants can overcome mild to moderate amounts of breast sagging with the considerable volumetric expansion. But that depends on the position of the nipple to the inframammary fold. Large volumetric expansion (large breast implants) works to create a breast lift IF the nipple is at the level of the inframammary fold or higher.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’ve been considering a breast augmentation but I have a few questions. I’m 21, and I’ve read that you cannot do silicone breast implants until you are 22. I’ve also read that it’s illegal to get silicone done under 22, but I’m not wanting to do saline. I’m curious if it’s possible to do silicone or not at my age. If it’s not how does that work. thank you for your time!
A: Let me provide clarification about age and the insertion of silicone breast implants. Because the long and extensive clinical trials for the silicone breast implants used today consisted largely of women between the ages of 22 and 65 years of age, the FDA listed that age range as the recommended ages of silicone breast augmentation. While that is the FDA guidelines for the use of silicone breast implants, it is completely up to the plastic surgeon to use them as he/she sees medically appropriate. Thus it is perfectly legal and medically appropriate to use silicone breast implants at any age below 22 years old. This is up to the decision and informed discussion between the plastic surgeon and the patient.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am currently an A cup and would like to set up a consultation to review my eligibility for breast augmentation. I would like to consider a full B cup. Some information about me – 32 year old female, kidney transplant recipient five years ago and on dialysis for seven years prior to the transplant.I have wanted to have breast augmentation for many years and after a lot of research I have not been able to find anyone locally who has previously done this type of plastic surgery on a kidney transplant recipient. Please let me know your thoughts, I see that you do have previous experience in this specialized procedure.
A: I have done various types of cosmetic surgery in kidney transplant patients from breast augmentation, breast reconstruction, tummy tucks and facelifts. I have not seen any complications from any of these procedures despite the patients having a kidney transplant and being on immunosuppression. I think as long as your transplant doctors so not see a contraindication you should have an uncomplicated postoperative course.
In theory the elective placement of a synthetic device, like in breast augmentation, in a patient on immunosuppression seems one that would be fraught with peril but that has not been my experience.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am just finishing nursing our fourth baby and am looking into getting breast augmentation done. How long do I need to wait after finishing nursing? Also, we are military stationed overseas so would be flying in. How soon is the follow-up appointment? About how many nights should we plan to stay in a nearby hotel? Thank you!
A: The first question after having nursed four babies is whether you just need implants alone? Do you have any sagging and is the nipple above the lower breast crease/fold. if sagging is present, as defined by the nipple being at or below the lower breast fold, then a lift will be needed with the implants. As a general rule it is good to wait three moths after nursing to have the breasts shrink back down to reveal the amount of true sagging, if any, and to have a good appreciation of the desired implant size needed for the desired breast size result.
Since the real time to judge the results of breast augmentation is that of months and no sutures are placed that would need to be removed. One could leave for home fairly quickly after the breast augmentation procedure when one feels comfortable traveling.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I met with you for a breast augmentation consultation last week. Before I schedule my surgery, I have a few more questions about specific brands of implants. I believe you recommended Sientra, but I’ve been looking into Mentor implants. Specifically, the Mentor MemoryGel Siltex round implants. I’ m interested in the textured surface versus the smooth because the (perhaps dubious) Internet research done suggests textured surfaces lead to a lower rate of capsular contracture. And, Mentor appeals to me because of the enhanced warranty available for purchase. If my logic and/or research are wrong, please do correct me. If I did choose to go with Mentor, would there be a price difference from the original quote I received?
A: Thank you for the additional questions about breast augmentation and specifically about breast implants. Let me preface my comments with the understanding that it does not make any difference to me what brand of breast implants a patient uses. From my perspective, the three major breast implant manufacturers offer comparable devices for surgical implantation. The manufacturers, of course, see it differently and often promote and advertise relatively miniscule purported advantages to their devices.
When it comes to smooth and textured breast implants, it is important to understand what their advantages as well as their disadvantages are …as you will pay more to use them. (they are more expensive because it takes an extra step in their manufacture to add the textured surface onto the implant) Textured breast implants have only been shown to reduce the risk of capsular contracture when the implants are placed above the muscle. There has never been shown any differences in capsular contracture rates when they are placed below the muscle. The greatest reduction in capsular contracture, what was once a common breast augmentation problem, was the change in implant location from above to below the muscle. The type or surface of the implant is irrelevant when placed in the submuscular position. In my breast augmentation experience, which spans over 20 years and over 800 breast augmentations, I had yet to see a capsular contracture from a primary breast augmentation. In that time I have only performed a single above the muscle breast augmentation. All the surgeries have been done using smooth breast implant devices. This is a testament to the value and importance of the submuscular (technically the partial submuscuar or dual plane location.
It is also important to be aware that textured breast implants, besides costing more, require a slightly bigger incision to place and have a slightly higher risk of infection as any textured surfaced implant does. (the rough surface offers greater opportunity for bacterial adhesion than a smooth surface does) Due to their thicker shells they will feel more firm and will move less freely (due to tissue adhesion) than smooth breast implants.
Today, all breast implant manufacturers offer the identical warranty…lifelong implant replacement and a 10 year for surgery warranty of new implants plus $3500 towards the cost of surgery to replace them. (technically Sientra offers $3600 towards the surgery cost on the first ten years and also has a capaulat contarcture warranty so one could argue their warranty is better than Mentor and Allergan)
Again, it does not matter to me what breast implant manufacturer, style or size any patient desires. I will surgically place whatever they want. The only thing I do care about is that patients make an educated choice and that they understand the advantages and disadvantages of those choices.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, after breast augmentation why do women usually have high placement of their implants even when insertion of the implant is inframammary? Also, why do the implants drop? Why doesn’t the surgeon just place them where they belong? Is it due to the type of implant used? (e.g. size, textured vs smooth?) Maybe you can offer some clarity?
A: Your breast augmentation question is an excellent one and the phenomenon of ‘high riding’ breast implants early after surgery is common. In fact, the plastic surgeon does place the implant in the desired position during surgery. But it is important to remember that the implant places some degree of stretch on the overlying skin which is greatest in the new lower pole of the breast mound. (nipple down to lower breast fold) In getting larger breasts much of that effect (at least 50%) comes from increasing the size of the lower pole of the breast. Tissues in this area are much tighter than that above the nipple and often new skin is recruited form the abdomen to accomodate the effects of the immediate and often dramatic volume expansion. (lowering of the breast fold)
This lower pole expansion will create a rebound effect as it needs time to relax after surgery. Since the upper pole of the breast has much softer tissues, the breast implants will often naturally ride up for a while from this rebound effect. Thus the early high riding implant. Once the lower pole skin relaxes the implants can drop down into the original pocket for which it was created. (implant settling)
How significant this rebound effect is and how high and how long breast implants may be high riding is influenced by many factors. The quality and amount of breast skin, size of the implants, and whether they are smooth or textured all influence this postoperative healing process.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have been wanting breast implants for a long time and have been researching a lot of doctors and implants. I would like to speak about the augmentation with you. I have has one consult last year and I really liked the doctor but he only did saline implants and I think I am leaning more towards silicone implants but would like to discuss both with a doctor that does both.
A: Saline and silicone filled implants are both FDA-approved options for breast augmentation. They do share certain similarities, they both create equally effective enlargements of the breasts and are equally safe. Looking at augmented breasts from the outside, it would be impossible to tell what type of breast implants was used. But beyond their external appearance, they do have several very distinct differences. Saline implants are associated eventually with palpable and visible ripples on the bottom and sides of the breasts which does not occur with silicone implants. Most women will say that silicone implants feel more natural as a gel-filled implant feels better than a bag of water. A dramatic difference between the two is in how hey will eventually fail. (they will not last a lifetime and will eventually need to be replaced) Saline implants fail by a dramatic loss of fullness like like that of a flat tire. Silicone implants never lose volume because the gel does not act like a liquid (like a gummy bear candy) and just stays in place and with same volume even if the bag sustains a tear or a hole. For this reason alone, silicone breast implants last longer than saline implants.
The concise version of this story is that there is one and only one reason to ever get saline breast implants….cost. They are the most economic form of breast augmentation because a pair of saline implants costs less to buy than a pair of silicone implants from the manufacturer.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in a tummy tuck with breast augmentation at the same time. Do you include contouring with tummy tuck? Will I still have all the feelings in my breasts after augmentation. I want to go up one to two sizes. What would the cost of these surgeries.
A: Thank you for your inquiry and sending your pictures. You are a good candidate for breast augmentation and most patients will not lose nipple or skin feeling in their breasts after the surgery in the long-term. However, at your current weight and with the amount of intrtaperitoneal abdominal fat that you have you are not an ideal candidate for a tummy tuck based on what I am seeing these pictures. With this amount of abdominal fat, it will be limited as to how much skin and fat can be removed and most certainly your stomach will not be flat and will remain round. (less so but round nonetheless) You would get a better tummy tuck result if you lost some weight first.
There are numerous variables that affect the cost of breast augmentation and tummy tuck surgery. (type of implant, type of tummy tuck, how much liposuction is needed) So I will make some assumptions when I ask my assistant to send along the general costs of both procedures to you on Monday.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, What is the average age for breast augmentation? I am 50 years old. Do you have many patients in that age range?
A: Over the years I have performed breast augmentation on women from ages 17 to 76. Today a women having breast augmentation.reshaping at age 50 is very common while twenty years ago it was much more uncommon. While the mean age for women having breast augmentation is in the age range of 35 to 40, age 50 is not very far from the mean age for breast augmentation patients today. Certainly age has very little with anything to do with the ability to have successful breast augmentation surgery.
The only real fundamental difference between younger and ‘older’ breast augmentation patients is age and pregnancy related changes in their breasts. Older women usually have more sagging and therefore often have to have some form of a lift for optimal breast reshaping results. Younger women, without having had children yet, usually do not have this lifting need. But I have certainly see an equal number of women age 50 and older who have merely lost volume without sagging and implants have an immediate and often remarkable breast rejuvenative effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like to get a tummy tuck, breast lift and aug, as well as some liposuction. I have a vacation in April that I would like to look like a million dollars for!! What is the best time to have this surgery?
A: Your description of plastic surgery to help reverse the effects of pregnancy is a classic one for the well known Mommy Makeover procedure. In reality this is a combination of procedures that focus on the breasts and abdomen/waistline area. Although technically it could be any body contouring procedure that helps to reverse the changes induced by pregnancy.
Given your April vacation target date (and this is later December) and the magnitude of recovery really needed for a full recovery from major body contouring surgery, such as a Mommy Makeover, you need a minimum of eight weeks between surgery and the day you leave for vacation. Ten to twelve weeks for Mommy Makeover recovery is even better. This way you will have complete freedom any residual issues that can linger after surgery during the second month thereafter and be only be thinking about what you are doing on vacation and not what you can’t or don’t feel like doing.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, what can I do to make sure my breasts won’t be too far apart after getting breast implants? I know that breast augmentation doesn’t change where your natural breasts sit and that it only enlarges them. But I simply don’t want my new breasts to be too far apart. What can I tell my surgeon to make sure that my breasts are full and close together?
A: You are both asking a reasonable question abut a common breast augmentation concern and also answering it at the same time. You have correctly surmised that all breast implants do is make your natural breasts fuller. That may or may not necessarily make them somewhat closer together depending upon the size of the implants. But there is no guarantee that they will and there is not anything your surgeon can do to change the natural wide spacing between your breasts. You will need to accept that this is a limitation of breast augmentation surgery and is a function of your anatomy and not your surgeon’s technique or ability. At the least, every plastic surgeon recognizes and understands this implant spacing concern…and usually goes to great lengths to point it out and that your after surgery result is still going to have a sternal gap between the augmented breasts.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, what can I do to make sure my breasts won’t be too far apart after getting breast implants? I know that breast augmentation doesn’t change where your natural breasts sit and that it only enlarges them. But I simply don’t want my new breasts to be too far apart. What can I tell my surgeon to make sure that my breasts are full and close together?
A: You are both asking a reasonable question abut a common breast augmentation concern and also answering it at the same time. You have correctly surmised that all breast implants do is make your natural breasts fuller. That may or may not necessarily make them somewhat closer together depending upon the size of the implants. But there is no guarantee that they will and there is not anything your surgeon can do to change the natural wide spacing between your breasts. You will need to accept that this is a limitation of breast augmentation surgery and is a function of your anatomy and not your surgeon’s technique or ability. At the least, every plastic surgeon recognizes and understands this implant spacing concern…and usually goes to great lengths to point it out and that your after surgery result is still going to have a sternal gap between the augmented breasts.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m breast feeding now. How long should I wait after I stop before I come in for a breast augmentation consultation? How soon can I have breast augmentation after breast feeding?
A:You should wait for breast augmentation surgery until your breasts have returned to their natural size after breastfeeding. By so doing you can gauge properly the implant size you need and the type of breast lift if necessary. But one can come in even while breastfeeding to get an initial evaluation and some general information about the combined breast lift and breast augmentation procedure. That will answer most of your questions and help you prepare for the surgery when your breasts are ready. Then you just have to stop in for a quick implant sizing appointment right before the anticipated surgery date. While there is no hurry to get the ball rolling so to speak, you certainly can if you desire.
It is also important to note that many women who have breast augmentation after breast feeding may note that they have some milk production after the surgery. This is due to the pressure of the implants on the milk glands that can cause additional discharge from the swelling of surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a question about my breast augmentation procedure that I forgot to ask about during my consultation. My left breast is slightly bigger than my right breast and I was wanting to know if this would affect the overall look of my breasts after getting implants? It is only a slight difference in size, and is only noticeable from a side view. I am just afraid that it will affect the look of my breast post surgery.
A: Breast asymmetry is very common amongst many women undergoing breast augmentation and is a very important aesthetic issue to identify before surgery. As a general statement, all implants do is to take the breasts you have and make them bigger. They are nothing more than a mound enlarging device. Thus whatever breast shapes one has when they are small will become bigger. This means that for some women a small breast asymmetry may become more noticeable afterwards. (i.e., the breast asymmetry becomes bigger) In other cases, enlarging the mounds may make the slight breast asymmetry go away completely. The difference in what may make breast asymmetry more or less noticeable after augmentation is whether the asymmetry is due to mound size differences or whether it is due to a difference in the horizontal position of the nipples. Slight mound size differences will usually go away even with equally sized implants on both sides. (the key is the term ‘slight’ mound size differences) Conversely, horizontal nipple level differences will usually get worse with implant enlargement as the mounds enlarge. For this reason if I see such differences I point that out to patients during their consultation and usually recommend a small nipple lift at the time of breast augmentation to even out the horizontal nipple levels to avoid the so-called ‘cock-eyed’ breast look when nipples are at different levels on the breast mounds.
I don’t specifically remember any significant asymmetries in your breast mounds that would justify either a nipple lift on one side or the use of different implant volumes. But since you have noticed a slight asymmetry in your breasts and it is of concern to you, I would lastly mention an old breast augmentation adage…‘breasts are not twins but sisters’. This means that if they are slightly different before breast augmentation surgery, they will continue to be different after surgery. One should not expect perfect symmetry from surgery when the breasts are exactly perfectly similar before surgery.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was interested in having breast implants done via TUBA. Do you perform those? Is What is the cost of this surgery? My daughter is getting married in June and I really want to have this done before that. I have attached 2 photos. One is with my normal bra and the other is what I would like my breasts to look like (I used several bras to accomplish this). I look forward to hearing from you.
A:Trying to place breast implants via the umbilical approach (TUBA) is a very poor way to do the operation. It is fraught with problems such as the inability to use silicone implants, difficulty in getting into the proper submuscular plane and persistent problems of after surgery upper abdominal pain. If you are looking for a scarless method of breast augmentation, the transaxillary approach is far more successful with less potential complications. Using saline implants through the armpit would also be the most economical approach to breast augmentation. It is hard to know exactly the size (volume) of implants you would need just based on how the change in the upper pole of your breasts. (as shown in your pictures) A volumetric sizing method is the best way to pick the proper size for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have thought about liposuction a long time on my abdominal area which has always had a roll, even as a child. I would like to consult on liposuction and perhaps breast augmentation. I am going on vacation by the middle of June and did not know if it is even possible to schedule with you prior to that time.
A: It is very common to perform breast augmentation with any number of other body contouring efforts. Coming breast implants with a little bit of liposuction would not extend that recovery to any significant degree. Given that you are going on vacation in the middle of June, I would recommend that you have this surgery at least six weeks in advance of that event so you can be fully recovered, have few if any twinges of discomfort/soreness and be able to be completely in the the benefits phase of the surgery with little body ‘memory’ of the actual surgery. Thus it would be ideal for you to have this surgery no later than the end of the month. We strive to service our patients in an expeditious manner so I can see that happening on our end. I will have my nurse contact you tomorrow to find a convenient consultation time as soon as possible.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in gummy bear breast augmentation. I’m a mother of three and have breastfed each baby for about a year. (currently breastfeeding my six month old). Once I’m done, I’d like to have breast augmentation with gummy bear implants. After breastfeeding, I have been left with very small breasts (embarrassing!). Can you possibly just shoot me a ballpark figure so I know what I’m able/not able to do? I’ll be probably a small B and will want a natural looking D. Thanks in advance!
A: Pregnancy and breastfeeding always cause some degree of breast involution or loss of one’s breast tissue. The breast skin is stretched out and then there is less volume inside to support the skin. This often, but not always, leads to some degree of breast sagging. How significant that is depends on what size breasts one had before the pregnancies. The bigger breasts one had to start with the greater the sagging will be afterwards.
When it comes to gummy bear breast augmentation using highly cohesive silicone implants, knowing whether any breast sagging has to be dealt with is critical in determining whether a breast lift is needed with the implants and that impact on cost. But for general numbers expect the total cost for gummy bear breast augmentation to be $5,500 and the addition of a lift can increase the to total costs to around $8,000.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast augmentation and need help in breast implant sizing. I am very small in size I am not looking for something huge. I am 4’11 and weigh 100 pounds. I am a 32C Cup. What cup size would you recommend?
A: When it comes to breast implant sizing there is no question that you are small in frame but what constitutes an adequate size that is not too big depends on numerous factors…not the least of which is your perception of ‘huge’ or what looks right. Obviously you do have some breast volume given that you wear a C cup bra. Having some breast volume also plays a role in how an implant will look in size compared to someone who is flat chested. Given someone with more loose breast skin compared to tighter skin in a woman with little to no breast volume also makes a difference in how the size of the implant affects the overlying look of the breast. I would really need to see some pictures of your breasts currently and some pictures of what you think is a good size or even too big on someone else before I can really offer any meaningful input. The most assured way to choose the right breast implant size is to use volumetric sizers which is done in the office. In my experience, this is the most reliable method to give women the breast size they want with implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast augmentation surgery but needs some basic recovery questions answered. What is the average time you recommend returning to work? I already have dates that I’m taking off for this year for vacation and other things, so I don’t want to have to take too much time off work. Also, I have an 18 month old, and she is a big girl for her age right now! She is a momma’s girl and is always wanting me to hold her and carry her, so my other concern was being able to lift her and carry her. What are your lifting requirements after surgery?
A: Returning to work after breast augmentation is highly variable based on what one does, how physical their job is and their own discomfort tolerance. On average, it can be anywhere from 3 to 5 days. I place patients on arm range of motion exercises the night of surgery and the more you move the quicker you will recover. I have no lifting restrictions after surgery and you can lift anything you want without fear of hurting the result. Your body will tell you what you can and cannot do.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in having breast implants. I am currently a 34B and am interested in a full C or a small D cup. Also, I was previously 190 lbs and am now 135 lbs. I have a flabby area above my belly button which I would love to have tightened. I work out regularly, yet it just doesn’t seem to help. This area would be optional though, as my primary interest would be having breast implants. I saw the general fees for each procedure, and was curious if combining procedures offer any cost reduction.
A: In answering your breast implants and tummy tightening questions:
1) When it comes to size of breast implants, I do not use the concept of cup size. While women understandably have that as a breast reference, implants come in volume (ccs) not cup size. And regardless of cups size or ccs, in the end all you really care about it how the breast looks…the number attached to it in that regard is not important as long as it looks the way you want. In choosing breast implant size in volume for any patient, I use a Volumetric Implant Sizing System. You can try on the various volumes and see how they look and then choose. I find this to be incredibly accurate which less to a very rare problem of patient dissatisfaction withe the outcome of their breast augmentation procedure.
2) Having lost 55 lbs, this raises the question of whether you have any loose breast skin or sagging. This is an important preoperative consideration since breast implants do not create a ‘breast lift’ effect and can make make a saggy breast look worse even though it is bigger. Seeing some pictures of your breast would help answer that question.
3) Your weight loss is also the source of the flabby area around your belly button. Since the belly button is the only fixed point on the stomach, weight loss causes the skin around it to sag resulting in flabbiness and sometimes an actual upper belly button overhang. The only method to truly tighten loose abdominal skin is some form of a tummy tuck.
4) Your assumption is correct in that there is some cost savings when procedures are combined.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast augmentation surgery and am having trouble deciding between saline vs silicone implants. I know there are numerous differences between them but one specific question I have is about capsular contracture. Does silicone implants lead to a higher rate of capsular contracture problems than saline implants?
A: One of the risks of breast augmentation surgery is capsular contracture. Capsular contracture is the result of excessive scar tissue forming around the implant. Then like a shrink wrap, it tightens around the implant causing it to feel more firm and can also distort the shape and position of the implant.
Historically silicone gel implants were associated with a higher rate of capsular contracture problems. This occurred because the implant allowed for some of the gel material to get through and out into the breast tissue (gel bleed) leading to the soft tissue reaction known as capsular contracture. In addition there was a moderately high rate of silicone implant rupture which exposed a lot of the gel material to the breast tissues. By comparison, today’s newer silicone gel implants do not have any significant gel bleed and a much lower rate of implant rupture. (less than 1% in the first five years for one manufacturer) Thus, silicone gel breast implants of 2014 are much improved designs over those used in 1989 with a much lower rate of capsular contracture.
The other issue that has led to a dramatic drop in capsular contracture problems over the past two decades has been the change in implant position. Today the vast majority of breast implants are placed in a partial submuscular (dual plane) position. Decades ago it was far more common for implants to be placed above the muscle (subglandular) position. Submuscular breast implants have a known lower risk of capsular contracture rate.
While the risk of capsular contracture always exist with any type of breast implant, it is a very low risk today with the use of either silicone gel or saline implants placed in either a total submuscular or dual plane pocket position.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had breast implants done about one year ago. I had textured silicone gel shaped breast implants placed under the muscle. They were 335cc in size. My breasts were A cup size before surgery. I would like to know if corrective surgery with bigger implants will create more cleavage. have quite a small frame and chest. I would not mind getting bigger implants but only if they looked natural and the breasts did not move any further out to the sides than they are now.
A: One of the basic principles of breast augmentation surgery is that the breast implants merely take the breast features that one currently has and makes them bigger. Therefore, if one’s breasts are fairly widely spaced, getting implants will not create cleavage. It is clear based on your pictures that your breast mounds, small as they were, were more to the sides of your chest wall. That can clearly be seen by how far your nipples are to the side before and after breast implant surgery. With the placement of implants under the muscle, it is hard to create any semblence of cleavage unless one has breast mounds that are naturally close together. That being said, the question is whether bigger implants will give you cleavage. If you place large enough breast implants, you will likely end up with more cleavage but they will not likely look very natural and will be oversizes for your frame. You are better off just accepting the good breast augmentation result you now have even if it doesn’t create the cleavage you want. That is where bras can compensate for what implants can’t do.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m undergoing a breast augmentation in less than a week and I like the look of your case study, breast augmentation in Asian women. I am exactly her size except a smaller breast base diameter (10.5). For reference, what profile is the implant you used? I would appreciate any info you could give me. Choosing between 260 high profile, 280 high profile, or 320 full profile (leaning toward 280).
A: Many patients get hung up when considering their breast augmentation of an implant’s profile which actually has little to no influence on the final breast shape, contrary to popular perception. The only real relevance to an implant’s profile is how it influences the base diameter with the goal of using an implant whose base diameter is no larger than one’s natural breast base width. This is the real role of high projection/profiled implants, keeping the desired volume in a very narrow chest to within the breast dimensions. Almost assuredly with a breast base diameter of only 10.5 cms, any implant volume over 225cc will need a high profile implant to accomplish that important aesthetic goal.
Not to confuse you further, as the implant manufactures do a good job of that in this regard anyway, there is no correlation between any of three manufacturer’s (Allergan, Mentor and Sientra) implants in regards to volume and their profile types.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am getting breast implants in the near future. I am currently a 32A and am looking at 400cc silicone breast implants. (high profile) My hope is that they will make a full C or a small D cup. I am 24 years old and am 5’ 3” and 115 lbs. I tried the 400cc sizers in the office and they looked a little big to me. But I was told that they may look a little smaller since they are going under the muscle and that it was always a good idea to go a little bigger than you think anyway. I’m not sure if I should go with 400 cc or go smaller to be safe. On the one hand I don’t want to be too big but I’d hate to wish I would’ve gone bigger afterwards.
A: There is no question that the biggest issue in getting breast implants, for the patient, is what size in volume to get. The reality is that there is no magical and assured method that can guarantee any patient that they will get end up with the exact breast size that they want. No matter how it is done there is some ‘guessing’ involved and there is always the unknown variable of how any patient interprets what a C or D cup looks like in their mind. With that being said, there are certain presurgical measurements that can be done to help hedge the bet so to speak.
The Volume Sizing System is very good at providing a good estimate of the final size and this should be a good guide. If you think it is just a little big then drop down 25cc to 50cc. From this volume, the patient’s breast base width can help guide the projection that the implant should have, keeping it within the dimensions of one’s natural breast base width. High projection silicone implants should only be used if one wants a very round or full look, If not then consider either a lower projection or even a shaped (teardrop) implant.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast augmentation. After having two children I have lost all of my breast tissue, I am completely flat, the proverbial straight as a board chest look. I desperately need breast implants. What size and style of breast implant would you suggest?
A: Based on a review of your pictures, you are an ideal candidate for breast augmentation. Let me detail what makes one an ‘ideal candidate’ . An ideal candidate for any plastic surgery procedure is the one that is most likely to get the best result based on their natural anatomy and the anticipated changes from the surgery.
The best breast augmentation results come from small breasts that have no sagging and with the nipples centered on the diminuitive breast mound. Thus when the mound gets expanded by an underlying implant the resultant shape assumes completely the shape of the implant with firm skin and a perfectly positioned nipple-areolar complex. Your pictures demonstrate that you have an ideal presurgical breast mound by this description.
When choosing a breast implant, the first thing to decide is between saline or silicone-filled. With your lack of any breast tissue, silicone would be a better choice to avoid the rippling of saline implants which would be revealed without a thick layer of breast tissue to disguise it. Implant size is a matter of personal choice but the volume of the implant should generally not exceeded your natural breast base width. The final implant decision is whether the implant should have a round or teardrop shape. That is a personal choice of whether you want an augmented breast look that is round (full upper pole) or a more natural or sloped breast shape. (lower pole fuller than the upper breast pole)
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting breast implants. I have been wanting bigger breasts since I was 16 years old, I am 26 years old. I am currently a very small B cup and want to be a full D cup using gummy bear breast implants. I am 5’ 4” and weigh 135 lbs. I have attached a picture. Based on my picture and height and weight, what size implant should I get?
A: From the one picture you have sent, there is no question you would be a good candidate for breast implants. Having no sagging of the breasts with good tight overlying skin and centrally positioned nipples is the definition of an ideal breast augmentation candidate. Since implants largely just take what you have and make it bigger, the better-shaped breast (small as it is ) will always create the best looking breast augmentation result. Since you are young and do not have any sagging you should be able to have your breast implants placed beneath the muscle which is the best option for a young person for the long-term.
When it comes to choosing breast implant size,m it is not as simple as looking at a picture and knowing your height and weight. What counts is what volume will create the look of a full D cup on you. That, of course, is also open to your interpretation of what that is exactly. This is why I prefer the use of volume sizers for the patient to try on and see how it looks. It is also important to know what your natural breast base width is. With that being said, an experienced estimate would be 400c to 450ccs breast implant size for you, probably of a high profile style.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had breast augmentation three months ago. Can I lift weights if my breast implants are under the muscle? I am almost three months after surgery. I have 450cc silicone implants put in under the muscle on both sides. Do I have my final result now? I want to know if I can go ahead and lift weights. I don’t want to work so much on my chest but to start doing biceps and triceps to tone my arms with light weights and more reps. Can I do that now?
A: At three months after your breast augmentation surgery, it is fair to say that you are looking at the final result. Even though the implants are under the muscle (partially), there is no reason you can not resume any form of chest or arm workouts. I usually let my patients resume any activity that involves pectoral muscle activity as soon as possible after surgery so they recover faster. Three months from surgery is more than an adeaquate amount of recovery time.
Dr. Barry Eppley
Indianapolis, Indiana