Your Questions
Your Questions
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 would love to discuss getting breast implants, keloid removal, and possibly upper lip injections. My questions are: 1. Would all three of those procedures be able to be done during the same surgery andin the same anesthetic if I so chose to do all three? 2. The keloids are on my right ear are from botched piercings/healing. This a substantial keoid on my earlobe, a more minor one on the upper ear cartilage. 3. In your experience, what products are the most natural looking, safest, and have the most longevity in the human body for breasts and same question for lips. Again, I appreciate all insight and hope to soon be one of your patients.
A: In answer to your breast augmentation, ear keloid removal and lip augmentation questions, I can provide the following answers. It would most efficient and prudent to combine all three procedures during the same surgery. Ear keloids are common and their removal often involves the concurrent use of steroid injections to prevent their known high rate of recurrence. For earlobe keloid removal the use of a postoperative compression earlobe device is recommended. The most assured and effective method of breast augmentation is the use of breast implants. Silicone breast implants offer the most natural feel and longevity over saline breast implants. For lip augmentation one should take advantage of the operative location and anesthetic to do fat injections for the lip augmentation. While no method of lip injections is assured, the use of fat at least offers the potential, is natural and is best done in an operating room location.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting breast implants. I am a 29 year old female who has not had any children yet (would like to eventually), but has always wanted larger breasts. I am more than ready (financially and otherwise) to pursue surgery now, but am wondering if you recommend waiting until after pregnancy to have breast implants. Dies it matter having breast implants before or after pregnancy?
A: Your question about the timing of breast implants is a very good one for which there is no right or wrong answer. Unless one has a pregnancy planned in the near future, the placement of breast implants could be done at anytime. Unlike a tummy tuck, for example, pregnancy does not usually have a dramatic effect on the results of breast implants. Breast implants is also a self-image surgery so the timing of having that type of surgery is controlled by many personal factors, not a physical one per se. if you are psychologically and financially ready now, with no pressing plans for pregnancy in the foreseeable future, then placement of breast implants now is probably as good as anytime you may have for the rest of your life.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting breast implants. I am in the process of losing weight (40 pounds to date) so would also like to consult with you regarding how much more weight loss would be ideal before having the breast augmentation surgery. Thanks!
A: In the face of future weight loss the standard answer would be to wait until one’s weight loss is maximized before getting breast implants. Like all standard answers, however, the specific response for any patient must be further qualified. If one has no existing breast ptosis or sagging and not much residual breast tissue (volume) then further weight loss will have no impact on current breast implant size selection or whether ones needs a breast lift or would affect what type of breast lift one might need. However if one already has some breast sagging and /or some significant breast volume, further weight loss will affect both. And, as a result, any breast implant/enhancement decisions made now may be adversely affected when further weight loss occurs.
The final variable is this decision is the amount of weight loss one believes they can achieve before getting breast implants. As you have stated you seek a 40lb weight which would be considered substantial in how it could potentially affect your breasts. If it was a 10 or 15lb weight loss that amount would be considered to have a negligible influence on the current state of your breast shape and position on the chest wall.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting breast implants. However I’m terrified of losing sensation in my boobs and not be able to breast feed. What are the chances I will lose sensation? Also I’m worried my implants won’t look symmetrical, what are the chances this will occur. Because of these concerns that’s why I’m trying to find a doctor that I know cares about my results and does the best job that they possibly can!
A: Breast implants are placed in a partial submuscular position which means there is no chance of any interference with the ability to breastfeed. Loss of nipple sensation, while a risk of breast augmentation surgery, is very uncommon in my experience and only patient in the past twenty years has reported it to me. The biggest reason for revision in breast augmentation surgery in my experience is implant asymmetry. That risk is about 5% to 7% and is highly influenced by how much breast asymmetry one has initially and whether there is any existing breast ptosis. (sagging)
An important consideration in having breast implant surgery is that there are risks like any surgery and one should have a full understanding of them before undergoing the procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 32 years old with a full 34C cup breast size.. I went for a plastic surger consult last week and I figured I would need a breast lift because my breasts were very saggy. I also wanted a breast lift with implants as I want perky very round (ok to look fake) looking breasts. I wouldn’t mind being bigger even a DD cup. My plastic surgeron said he won’t do a lift and breast implants at the same time. I was shocked that he would not do them at the same time as this ultimately means more money, recovery and longer to finally get the breasts that I want. Why won’t he do them together? And do you think just a lift will give me the perky round look I want?
A: It is important to understand the combination of breast lift and breast implants is a ‘ying and yang’ type or procedure where want (how much) is done in one will usually adversely affect the other. If I needs a big breast lift (lifts and tightens the breast skin) it will be impossible to put in very big implants at the same time. Conversely if one wants big breast implants the amount of lift obtained will be small and you will likely end up with some residual sagging.
When one needs a lot of breast lifting and also wants larger breast implants, it is best that the procedures are staged. That way you can get the maximal breast lift and then secondarily (3 months later) you can put in implants of the size needed to obtained the amount of fullness that you want. Trying to both at the asme time dramatically increases the your risks of complications and has a very high incidence of the need for revisional surgery. If you are going to get two surgeries anyway it is far better to have the second surgery on your terms…not managing complications from the first procedure.
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 looking to get breast implants. I am 5’ 9” inches tall and weigh 165 lbs. I am currently a B cup and would like to go to a C. My husband wants me to get DDs. I am not completely opposed to that. I just want to make sure they will be proportional to my body. How do you go about making sure that the breast implant size is not too big and looks disproportionate to the rest of your body?
A: As for choosing breast implant size, I use volumetric sizers in the office to help me the best choice for you. We do not choose breast implants by cup sizes since they do not come that way. Rather they come in ccs (250cc, 350cc etc) and the goal is to see what breast look you prefer and feel is proportionate. Whatever cup size that ends up being afterwards is unknown and largely irrelevant since that is just a number. What you ultimately care about is how your breasts look whatever the numbers turn out to be. (volume or cup size) The look of the augmented breasts are far more important than any numbers.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in temporal and jaw angle implants. But when I get really old would it look like this if I have implants in my face? See the attached picture of breast implants where one is able to see all the edges of the implants. This is a scary picture.
A: It is important to separate what can happen with facial implants vs that of breast implants with aging. The show of breast implants can become more obvious when one loses weight or has very little subcutaneous fat cover from aging. Breast implants are ultimately only covered by the thickness of the breast tissue and if they are partially under the muscle. (which the lady’s implants in the pictures are not) Facial implants are placed next to the bone with a soft tissue cover that is not as influenced by fat loss. (more muscle cover) Thus, facial implants will never get as skeletonized or develop implant edge show as breast implants can. Facial implants are bone implants while breast implants are soft tissue implants. That is a fundamental anatomic difference. Because facial implants add support to the overlying soft tissues they often are a positive additive feature rather than a detraction from aging.
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 first contacted you in March and have taken awhile to get a consultation scheduled. I am now down to Breastfeeding once a day, so even though my breasts don’t look exactly like they will once I’m completely done, I thought maybe I would still be able to get a good idea about what I need/want. As you’ll see in the pics, my right one is bigger. It is by far my dominant breast where Breastfeeding is concerned. I didn’t realize just HOW bad they look until I took these pictures!! Talk about being even more depressed. Lol. Anyway, I’ve been looking at doctors who offer the Rapid Recovery Breast Augmentation as I have a 1, 3 and 5 year old. I see now from the pictures that I may need a lift as well as implants. I’m very interested in the teardrop shaped moderate profile textured gummy bear implants. Ones with a warranty is preferred. Also, will I be screened prior to the surgery to make sure there are no cancerous lumps or anything? Any info you can give would be great!
A: In looking at your pictures, if you go large enough with the implants I am not sure that you absolutely needs a lift. But you has a lot of skin and it will take substantial volume to fill it out. If you go with a ‘small’ breast implant size, then some type of lift/skin reduction will be needed.
In regards to our breast asymmetry, while two different size breast implants can be used, you are going to have to accept that there will always be some asymmetry between your breasts. Implants alone will not completely solve most breast asymmetry issues.
Rapid Recovery Breast Augmentation uses a combination of early arm range of motion with intraoperative muscle injections to return the patient back to their normal life as soon as possible after surgery.
All breast implants have warranties that come from the manufacturer. These include lifelong implant replacement for device failure and a ten year from surgery contribution towards surgical cost ($3600) plus free implant replacement.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast lift surgery. I have severe ptosis of my breasts. I had weight loss surgery in 2012 and my breasts turned into nothing but skin! I am let with extremely saggy breast.s I assume I need a reduction and then implants because my breast tissue is non existent at this point. I just know that I need new breasts. I want to know what my approximate cost would be to have the type of augmentation I need done. A breast lift with free nipple grafting may be the route to take. I just want nicer breasts. I don’t expect the nice set I once had but anything would be better than what I currently have! How can I achieve my goal?
I weigh 230lb, am 34 years old, and am a non smoker. I can be 180 to 200lbs in 30-45 days which is my target goal. I am ready to take the next step. I just need to know what procedure would work best to fix my horrible breast. Can I have decent looking breast with surgery? I want full breasts that aren’t saggy.
A: Many patients that have undergone extreme weight loss after bariatric surgery are left with saggy breasts and little internal breast tissue. While there are a number of types of breast lifts, these patients always require a combination of breast implants with a full breast lift, also known as the classic anchor pattern lift/scar pattern. The issue in very extreme cases of breast sagging like yours is whether the implants and the lift should be done together or whether it should be staged. (breast lift first followed by implants later) To avoid complications and the risk of loss of the nipple, you are one of the rare cases of breast sagging in which I would probably stage it. Besides risking loss of the nipple as a single combined procedure, you are at a very high risk (probably 100%) of needing a revision surgery anyway. It is just too hard to get teh amount of lift you need, put in implants for volume and have them be very symmetric all in one surgery.
Dr. Eppley
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 am wanting to know if I can have a breast lift with implants in place. I had breast augmentation before I had children at 26 years old. Seven years later after two children my breasts have gotten so heavy and saggy. I saw one plastic surgeon who said he could just do a breast lift using my current implants. My concern is having a lift then having to go back in in a few years to have saline implants replaced when they eventually deflate. Would love to get good result with breasts that are lifted with more upper pole fullness using my current implants.
A: As long as the implants are in good position, one can always have a breast lift on top of them. No one can predict how long your current saline implants will function before they fail. It could be next month or ten years from now. To get the best value from your current implants, I would recommend having the breast lift and leaving the implants alone. They are not that old and you should get more than a few years of use out of them. You can always replace them with silicone implants when they fail as such a replacement surgery is very easy with next to no real recovery.
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 seeking information for breast augmentation and possible breast lifts. Here are my questions. I am a 45 year-old female who is 5’ 7” and weighs 125 lbs.
1) In order to achieve my desired look, will augmentation suffice OR would a lift also be necessary?
2. Would silicone be preferred over saline breast implants for the most realistic feel? (Prefer the round look over teardrop)
3. For inframammary incisions, what is the likelihood of decreased sensitivity in the breast? Is an armpit incision ever the best choice?
4. Is a caregiver necessary? I am from out of town, I would prefer to travel alone.
5. How soon after surgery can I return to work? How many days would I need to remain in the area?
6. How far out is surgery currently being booked?
Much thanks.
A: Thank you for sending your pictures. In answer to your breast lifts/breast augmentation questions:
1) You would need a vertical breast lift, the raising of the arms in the pictures proves that need.
2) Silicone implants do have more of a natural feel to them.
3) Very low risk of any nipple feeling loss with the inframammary approach. Since you need a breast lift, that would exclude the benefit of an armpit incision.
4) No caregiver needed.
5) Returning to work would depend on what type of work you do. Five to seven days for a sit down job, ten to fourteen days for a very physical labor job.
6) Surgery is booked based on your schedule. You are the one making the big effort so we accommodate your schedule.
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 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 have breast implants but I want to be bigger. I think I may have maybe 300ccs ?? But I want to go bigger like 500 cc’s. My only concern is that I am really thin and weight about 110lbs. However, I think they should go that big . I have had 3 kids nursed and had weighed more. I have a really small frame I don’t want them too big but I want a DD . Right now they don’t look big at all. I think it’s because of weight loss and having children.
A: One of the advantages of having existing breast implants is that you have a reference about size. (volume) As a general rule in breast implant exchange for larger breasts you should always go at least 100 to 125cc bigger to see a cup size difference in most patients. Obviously that number changes based on the body frame of the woman. (smaller frames may be 100ccs, larger frames may be 150 to 200ccs) Based on your description, the size change of 200ccs sounds about right in your case. If 300ccs is not big at all and a DD cup is your goal, then at least 200ccs would be appropriate in my experience for your breast implant exchange.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had saline breast implants done 19 years ago. About 3 years ago I noticed my implants felt wrinkly and softer and had a more unnatural feel to them. I can even see dents in my breasts in the mirror. This as about the same time that I had lost some significant weight. My old plastic surgeon said he could fill them up with more saline. He said he can do an ultrasound to see if they can be refilled. Is this common?
A: The first thing to realize about breast implants is that they are not lifelong devices. Many breast augmentation patients have either never been told this or they did not hear it prior to their initial breast implant surgery. Most saline breast implants will last an average of 10 to 20 years, a few will spontaneously deflate in just a few years while a few others may last more than two decades. But none will last as long as over a long patient’s lifetime. At 17 years after their initial placement, your breast implants have served you well but they are coming to the end of the functional use. What you are feeling is not deflation but the rippling and folding of the implants as they have gotten older and you have had some natural breast tissue atrophy which makes the implant profiles more obvious. It is time to start thinking about their replacement whether it is with new saline implants or silicone implants who do not have some of the same aging concerns that saline implants do.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 42 years old and have had 600cc implants for over a decade. While the number makes them seem big, and they are not small, I am 5’9” and weight 140 lbs. I now would like to go up to 1000ccs or even 1250ccs. What do you think?
A: When one considers very large breast implants (at least based on the volume measurement), the most important long-term issue is whether the breast tissue will hold up and support them. If not, the implants will eventually drop (bottom out) and this will become a really difficult problem to correct. For most women going to that size initially would be impossible given the amount of breast skin that they have. But in someone with existing implants there has already been some significant expansion. So the concern then becomes where releasing the existing capsule to enable a larger size to be placed will exceed the surrounding soft tissue support. The other issue is that such a larger implant size will have a larger base width to it so one shoudl expect that the sides of the implant will go past the outer chest wall area and closer into the swing of the arms. (which many women do not like) The last consideration is that these will have to be saline implants as the largest prefilled silicone breast implant size only goes to 800cc. The largest saline implant size is 960cc but that can be overfilled up to 1100ccs if desired.
All of that being said, it is not a question of whether it can be technically done but whether it should be done. Having breast implants in place, you are in a good position to make an educated decision about what new size breast implants you want.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, if I get silicone breast implants will I be able to breastfeed? If I get pregnant after breast augmentation should I first check and see if the implants are ruptured before breastfeeding? If the implants are ruptured can I breastfeed or do I need to get the implants out immediately or can I let my son self wean??
A: You taken taken the classic ‘can I breastfeed with implants’ question to every conceivable scenario. Most breast implants today are placed under the pectoralis muscle well below the glandular breast tissue. As a result there is no interference with milk production or breast feeding. If you have no symptoms suspicious of an implant rupture (pain, change in breast shape) I see no reason to get an ultrasound, mammogram or MRI before breastfeeding, In addition, the implants are contained within a surrounding scar capsule so even if there was an implant rupture there should be no silicone in the milk ducts. However, in the event that you have a rupture and are breast feeding, I would suggest that you do not breast-feed until you have had the rupture evaluated by a board-certified plastic surgeon.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a breast augmentation three weeks ago. I am no longer worried about any particular problems at this point as they look great. What I wonder is if the heat from a hot tub can weaken the implants in any way or cause them to prematurely break down and leach out the silicone material.? Could it weaken them in any way? I have read that it is ok to swim after they are healed but can’t find anything about what happens if they are immersed in temperatures above body level like 104 or 105 degrees. How heat resistant are these materials?
A: The answer to your question comes from the Periodic Table of Elements. Breast implants are composed primarily of silicon-based materials. Silicon is a metalloid element (#14, atomic weight 28) that is very stable and non-reactive. (it is actually less reactive than carbon) When combined with oxygen, a wide variety of polymers are created which are used to create elastomers (rubber-like materials) which make up breast implant shells and the internal gel. They are very resistant to degradation including a high heat resistance and are structurally stable from temperatures ranging from -55 degrees to 300 degrees F. Thus a hot tub poses or even a sauna that reaches air temperatures of 150 degrees F or higher poses no risk of causing any implant-related issues. This is not to mention that they are also protected by your body tissues which would suffer a burn injury far sooner than your breast implants ever would.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have breast asymmetry and am interested in breast augmentation/lift surgery. I am 18 years old and have had two children. My breasts are significantly different by at least two cup sizes and have been so for six years. I have Tricare insurance. I am wondering if my being 18 years old is ok for breast surgery because I have already had two children so my body is done growing. I’ve spoken with my family doctor about wanting to have this done because its already done a lot of physiological damage to me.
A: Significant breast asymmetry is always a challenge in any form of cosmetic or reconstructive breast surgery. Having had two children and being two cup sizes different almost certainly speaks to the potential of needing some form of a breast lift on at least one the breasts (usually the larger one) and perhaps implants for both. Until I can see some pictures of your breasts I can not be any more helpful in recommending a specific plastic surgery treatment plan as there is great variability in many cases of breast asymmetry.
What is known now, however, is that insurance is not going to cover this type of breast surgery. Unless it is a case of reconstruction after breast cancer, breast reshaping surgery will be considered as a cosmetic procedure by any insurance provider today. The fact that you may have developed this through no fault of your own and it has a significant negative impact on your self-esteem is something that I have learned carries little weight with insurance companies.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in breast augmentation and possibly breast lift. I live in Minnesota but my best friend lives in Indianapolis and she suggested you. I am wondering is I were to come to Indiana for the surgery if I could have a consultation with surgery the following day. Also, being from out of town, how often would I need to be rechecked?
A: There would be no problem with scheduling surgery and just having a consultation the day before. That is a common occurrence in my practice as we see patients from all over the world every week. To make that happen effectively there are certain breast augmentation questions that should be answered in advance. They include the following:
1) Are you interested in saline or silicone breast implants?
2) Are you interested in round or shaped (anatomic) implants if you prefer silicone?
3) Do you have an incisional preference for placing the implants of lower breast fold (inframammary) or axillary (armpit)?
4) What size result do you want? (pictures are helpful here of breast augmentation results you like)
5) What is your height, weight and current bra size?
6) Do you have any breast sagging? (this is a very important as if so a breast lift may be needed with the implants)
If you have the ‘perfect’ breast for augmentation (no sagging, nipples locate well above the lower breast fold) then presurgical photos may not be necessary. But if your breasts may be less than perfect or have known sagging, please send me some pictures of them so I can know in advance as to what you exactly need.
As for follow-ups, I like to do phone, Skype or Facetime conversations to accomplish that for my far away patients. Between pictures and e-mail communications, all the follow-up that is ever needed can be done at a distance. From these we can make the determination if you ever need to come back and be seen by me in person.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am having trouble deciding whether I need a breast lift alone or should have implants with it. I am 35 years old, had 2 kids and am a fairly full 34C. I do struggle to keep them in a C bra however. While I am happy with the size of my breasts I am not so with their shape. I just want back my fbreasts back up where they used to be and were nice and perky. I know I need a lift but am uncertain about whether an implant is necessary? I have several plastic surgery consutations and have been given different opinions, one says I definitely need it the other I cn have it or not. Neither doctor seems to be able to explain why in terms that I can understand and, quite frankly, they both seemed a little uncertain themselves.
A: The breast issue that you have is a common one, once full breasts have fallen even though they have not necessarily gotten smaller. This has happened because of two breast tissue changes, there is now more skin and less internal breast tissue. That combination makes the change from a perky to a saggy breast. While you are happy with your breast size now know that they appear the same size because of the extra skin. When they are lifted, the breasts may appear smaller because a lot of extra skin has been removed. While breast lifts do not remove volume, this is why some women will have the perception that their breasts are a little smaller after a lift. There is also the longer term issue in that most breast lifts will lose the initial upper breast fullness that exists right after surgery as they settle with tissue relaxation. The role that a small breast implant may play for you then is in maintaining upper pole fullness and avoiding the fear that you may look a little smaller after a lift alone.
Dr. Barry Eppley
Indianapolis, Indiana