Your Questions
Your Questions
Q: Dr. Eppley, I am 47yrs old and I have had four children and over the years I have tried to lose the belly fat and the fat in my thighs. Question can you use the belly fat to enlarge my breast and not saline or silicone implants. I am a 36B and would just like to stay that way just want them to look fuller and firm.
A: While the appeal of breast augmentation with fat is undeniable, it has significant limitations compared to the use of traditional saline or silicone implants. It is different in the following ways:
1) It will cost 2x to 3x more
2) It will only increase the size of the breasts a 1/2 cup in most cases
3) It requires an adequate amount of donor fat
4) How well the fat takes is unpredictable, 100% almost never occurs
5) It may require more than one fat grafting session/surgery
6) Breast lumps and irregularities may occur
7) If you need a breast lift also, this must be done first and wait three months before doing the fat grafting
8) It requires one month before and one month after surgery of using the Brava breast suction device 8 to 12 hours per day
In short, breast augmentation with your own fat is not a comparable operation to doing it with synthetic implants. As we know it today, it is more expensive, less effective and not as efficient. It is best done on patients that have the proper motivation, expectations and breast and body anatomy. This will likely change in the future but for now it is only a good option for a very select few breast augmentation patients.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 66 years old. I have had breast implants for approximately 30 years and would like to have them removed. I have Medicare / Anthem insurance, but I don’t know if they will cover this. I would like to know how much this procedure would cost if I paid for it (without insurance).
A: Congratulations on the longevity of your breast implants. Although at the time they were placed you probably thought they would last a lifetime, few patients ever do and one could predict a 10 to 20 year lifespan until the devices fail and have to be replaced. Thus you have done well. You did not state why you wanted your breast implants replaced. Is there a particular problem with them or is this just an aesthetic issue? Replacing them with new silicone implants will have total costs in the range of $5800. Issues to be considered are new size and style of the silicone gel breast implants and whether they should stay in their existing anatomic location (above or below the muscle) or be changed.
Your assumption is correct about insurance coverage. Breast implants are only a covered medical procedure if they are being done as part of a breast reconstruction after cancer or part of a revision of a prior breast reconstruction procedure.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have decided I am done having children and am considering a breast lift with implants. Two children and nursing have taken quite a toll of my breasts. They are just two sacks of hanging skin now. What type of implant or lift I need? I don’t want to look completely fake, but a more perky and fuller breasts would be a big improvement. Is this even achievable after having nursed two kids? How soon before surgery do I need to stop breastfeeding?
A: The ‘two sacks of skin’ breast look is very common after multiple pregnancies, particularly in women who have small to moderately-sized breasts beforehand. When the breast tissue involutes (shrinks) after pregnancy, the stretched out skin collapses and falls over the inframammary crease. (lower breast fold) In each of these cases of breast sagging (with little to no breast volume), a combined breast implant and lift is needed. Usually either a vertical (lollipop) or combined vertical and horizontal (anchor) breast lift is needed and the resultant scar trade-off is unavoidable. A breast implant, regardless of size, adds volume but in and of itself will not lift the sagging nipple back up to a satisfactory position. You will need to stop breastfeeding three months before undergoing breast lift and implant surgery to give the engorged breasts time to fully ‘deflate’.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I just want breast augmentation with implants and don’t want a lift. But based on my pictures do you think I need an uplift. My sternal notch to nipple distance measures 24 cms on each side. I had one plastic suregry consultation and was told I need a lift with breast implant. I would prefer them filled out and was hoping the use of an implant would lift them up. I have lost weight and breastfed so I have lost the fullness they once had.
A: Your pictures show an undeniable need for a combined breast lift and augmentation surgery. Implants only provide some degree of a lift if the nipples are initially at or above the lower breast crease. (inframammary fold) If not, the nipples will only be driven lower as the breast volume get bigger. Having a breast lift is really about accepting the scars as a trade-off for the improvement in breast shape. This is easier for some than others but is the defining decision about whether to do anything at all. There is another option, often called the ‘minimal’ or ‘crescent breast lift. It is not really a breast lift at all but does lift the nipple a bit by removing a small crescent of skin at the upper nipple skin edge. For those women that have a minor amount of sagging, nipple lifts with implant placement must just be enough to get them an acceptable result.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am wanting a breast lift and augmentation. I am 24 years old and my left breast is a cup size larger than my right. After having a baby a year ago and breast feeding for 6 months, the all around shape and liveliness has headed south. I want to get some information about a lift. I am interested I’m how much of a difference just a lift would make, is it better to do both augmentation and lift, and what is the likeliness of breast feeding if I were to have children in the future and would it bring the breast back down. Thank you
A: Breast asymmetry is always one of the most challenging of all breast reshaping surgeries to do. In interpreting your question, it sounds like you are just interested in doing something with the original larger left breast. That may be a reasonable approach if a lift can approximate the position or shape of the opposite right breast. In many cases of breast asymmetry, before or after pregnancies, it usually takes treating both breasts to get the best result. Whether this is done with implants, lifts or combinations depends on the size and shape of the initial breasts and their degree of asymmetry. Regardless of what is done, future pregnancies and breast feeding will negatively impact the surgical results that are obtained.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I was wanting to find out information about breast augmentation surgery. I used to be a DD and then I have lost weight and gained weight off and on and my breasts have gotten smaller and they sag very bad. I would like to find out how much you charge and if you do any type of financing. Could you please let me know because I really need to figure out how I can get this done because I have such a complex about my body now. It is very bad and I want to try to get this done if at all possible. Thank you.
A: The first thing that I can tell you is that breast implants alone are not the complete solution to your breast concerns. Knowing how big your breasts were at one point (DD cup) and then having lost weight, you undoubtably have a lot of breast sagging. You have described your breasts as so yourself. Contrary to common perception, implants will not lift up sagging breast tissue. This will require some form of a breast lift if implants are done to get a satisfying result. Sending me a few pictures of your breasts will show what type of breast lift you will need with your implants and what the cost of that procedure would be.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am looking to get breast augmentation and mastoplexy. What do you charge usually? And what type of lifts do you preform?
A: In trying to determine cost of a combined breast implant-lift procedure, there are several variables in that combination that affect cost. One is what type of implant (saline vs silicone) and the other is what type of lift is needed. These two issues significantly affect cost due to a material issue (implant) and the time it takes to perform the procedure. (lift) Thus there are a wide range of price differences (thousands of dollars difference) when these two issues are factored into the cost equation. I would really need to know what type of implant you want and would need to see pictures of your breasts to determine the degree of sagging you have and the type of lift that is needed to improve its shape. There are four basic types of breast lifts which differ based on how much lift they create and how much scar results from doing it. So it is not a question of what type of lift I perform (you have to be able to perform them all) but what type of breast lift you need.
But for the sake of information, I will have my assistant pass along the costs of a combined silicone breast implant and vertical (lollipop) breast lift which is the most common need/request that most women have.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 46 years of age and a runner in great health–I use to love my breasts, but now not so much. Looking at either breast lift or augmentation and brazilian butt lift. I have always had a flat butt, especially flat since I run…and sit all day–have great legs want the rest of my body to match. Seeking cost of both surgeriess (I realize average is best you can estimate, not having seen me), all scenarios. Would like to save an pay up front if possible, will not finance. PS – I do have that baby belly fat still in there, so I’m sure it can be used to help my buttocks out! 🙂 Thank you!
A: One of your problems will be easy to solve and that is the breasts. Breast implants will provide an immediate and permanent solution to a larger breast mound, of a size of your choosing. Whether you would really need a breast lift I am not sure but as long as your nipple is above the lower breast fold you would not. I will assume that since you are a runner that you have breast deflation not breast sagging. The more difficult problem to solve is that of your buttocks for three specific reasons, none of them surgical per se. First, would a runner in great shape really have enough fat to harvest for an effective brazilian butt lift…in most cases usually not. Second, even if enough fat were transplanted the odds are high that being a runner will result in the fat being absorbed quickly…burning it off. Those who have less fat do so for a reason. Thirdly, like breast implants real buttock implants are the definitive permanent answer but in a runner the recovery might be longer than you want.
Expect silicone breast implants to be around $ 5,700, a brazilian butt lift to be around $ 4,500 since yours is small and buttock implants to be around $ 5,900.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have saggy breasts and I was hoping to avoid a lift so I would’t have scarring. Is it possible with a bigger implant not placed under the muscle that this can be achieved? I did try on 600cc with a bra and a shirt over and decided I wanted bigger. I was thinking of 800cc. I know I’m not the Dr. and this is something you would know more about. So with some of these things I’ve mentioned. Could you tell me if this can be a possibility. Thank you so much for your time.
A: One of the great dilemmas in breast enhancement surgery is that of the sagging breast. It is a common misconception that an implant is going to lift a saggy breast. While that is true for the very smallest amount of breast sag, it will simply not work for what most women perceive as breast sagging. If an implant can not lift a breast, a bigger implant will not do so either. As a matter of fact, the bigger an implant is in breast sagging, the worse the result may appear afterwards if a lift is not done at the same time.
So in what cases will an implant help lift a breast? Check where the position of the nipple is. If the nipple is at or just below the lower breast fold, some form of a lift is going to be needed. The other way is to do the pencil test. If a pencil placed underneath the breast stays, then a breast lift will be needed as too much sag is present.
In reality, implants help re-expand a deflated breast but it will not really lift a sagging one.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I’m 25 and have one child, I would like to have breast implants but I’m afraid the cost and recovery time is too long. Can you give me any advice and info on the payment plans and the recovery times. Thank you.
A: Cost and recovery are always the biggest issues when any women is considering getting breast implants. So every potential patient has to contend with these issues so let me discuss the facts on both of them. The recovery from breast augmentation is really a physical therapy one since the implant is placed under the muscle. (in reality, partially under the pectoralis muscle) So how does one recovery from a muscular injury…use it! I place all patients on arm range of motion exercises the night of surgery and no physical restrictions thereafter. The more you use your arms (within reason) the quicker you will recover. With there be discomfort after surgery…absolutely, but most patients do not find it severe enough to be very limiting for very long. I would have to know what type of work you do to better answer how many days you would need to return to it. From a cost standpoint, the issues are the type of implant where does one get financing to do it. Saline breast implants are the most economical and we have all of our patients use Care Credit for financing. They are a national company that we have found to be the best to work with and has the greatest option of repayment plans.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had saline breast implants placed under the muscle 11 years ago. While I know they have not ruptured, they seem to be less full and firm that they used to be. Is it possible that they are slowly leaking saline but without a rupture. Do saline implants get weaker over time and more likely to rupture? Are they more fragile now and more prone to rupture? Should I stop doing strenuous physical activities?
A: Your breast implant experience and questions are common. Many augmented breasts, although not all, over time will feel softer and less full years later. This is not the result of something going on inside the implants but rather what has happened on the outside. The pressure of breast implants over time will cause the loss of some breast tissue between the implant and the skin. This is known as pressure atrophy. With the loss of some breast tissue, the breasts will feel softer and less firm. With saline implants, the breasts may really feel loose and ripply as there is no longer as much tissue between the implant and the skin to act as a cushioning buffer…and this then reveals the more rippled surface of a saline implant.
The second part of your question is actually true. The shell or bag of a breast implant does get weaker over time, no different than any other manmade device. The constant stretching of the bag does over time create flaws or weak spots in the silastic shell which will eventually lead to a spot of rupture. While this is inevitable, there is no reason to stop doing any type of physical activity that you enjoy. This is not different than one stopping driving so their car tires will never wear out.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am curious to the cost of Botox in specific areas on my face. My biggest issue is my eyes as I am only 31 and am very attractive and often to I don’t look my age but I’m feeling as though I’m beginning to these days :-(. Also, am interested in the cost of breast augmentation. Thank you
A: Thank you for your inquiry. When it comes to Botox, the cost is completely related to the number of units delivered. Such units are usually very consistent for the area treated and so the cost can be well estimated. For between the eyes (glabella), which is the most popular area on the face for Botox injections that will take 20 units with a cost of around $300. For the crow’s feet area (beside the eyes) the number of units usually needed is 16 with a cost of around $225. When the two are done together, the total units can be reduced to 30 with a cost of around $425. For breast augmentation the cost is completely related to the type of implant used. Total surgical costs for saline breast implants is around $4700 while that of silicone implants is around $5800.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I would like information on breast augmentation. I have breastfed 2 of my children and my breast sag considerably. I compare them to a much older woman. It is very difficult to buy bras that fit well without adding any padding and I am not happy with the way I look shirtless. I would like some info emailed to me so i can think about my options.
A: Based on your own description of ‘ my breast sag considerably’, it sounds like you would need some type of a breast lift if implants were placed. Breast implants have no capability of lifting up a breast and moving the nipple to the center of the breast mound if the starting position of the nipple is below the lower breast fold. Therefore you have to think about the trade-off of scars for fuller and uplifted breasts. You will also have to consider whether you would want saline vs silicone breast implants. I would be happy to look at any pictures that you want to send to me to give you a more exact recommendation. But for now I will assume that you need full breast lifts with implants. I will ask my assistant to send you some cost information for such a procedure for your further education on the matter. If you have any other questions, please let me know.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting breast implants. I am trying to find out pricing on getting implants and to see about payment. Most offices require full payment, however, I have heard of a few that will do payment plans. I didn’t know if this office was one of them?
A: When it comes to elective cosmetic surgery, including breast augmentation, you will find virtually no plastic surgery practices that take payment plans. A plastic surgery practice is not a bank or a credit agency that has any ability to finance and ensure that payments are received over time on a non-returnable service like surgery once it is provided. Full payment is required in advance of the actual surgery date. However, every plastic surgery practice recognizes that many patients can’t pay the full fee up front and work with independent loan agencies that do provide financing. One of the most common cosmetic surgery financing companies is Care Credit. You can go online with the amount you need to finance and apply and qualify. You can choose from a wide variety of terms up to 36 to 48 months. Many patients opt for the interest-free financing which extends out to 6 or 12 months. Our office has worked with many lending institutions over time but have found none that are as easy to work for our patients as Care Credit.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, Help! I have got the saggest breasts ever. I am only 20 years old and am small at just 5’ 1” and 105 lbs. I have never been pregnant. Despite not having children, I have very sagging breasts and am not sure the best way to get them lifted. Should I have implants or just have a lift? I am not sure I care either way although I might prefer implants because of the scar issue. How do I go about making the right decision? Thank you.
A: Your question is a common one and often illustrates comfusion about whether a breast implant can create a lifting effect. The asnwer to that question is yes and no. By filling and pushing out the breast skin envelope, the breasts can appear in some patients to be actually lifted. But the key question to this type of ‘scarless breast lifting’ is the location of the nipple before surgery. As long as it is above the level of the lower breast fold, an implant alone will create a lifting effect. But if the nipple is at or below the breast fold, no real lift will happen and the added volume may create the opposite effect of just pushng the existing breast tissue and nipple even further down. Your descriptor of ‘very sagging breasts’ suggests that you do have a low nipple location and a real surgucal breast lift will be needed. Whether that may include an implant for the creation of more volume is an option but the implant alone will not create the desired breast lifting effect.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am getting breast augmentation next week and I can’t decide between two breast implant sizers. I am 5’ 6” and weigh 135 lbs. I am currently an A cup but lost much of my original volume due to children so they are flat with some loose skin. I am torn between 450cc or 500cc silicone gummy bear breast implants. They are going under the muscle so I am wondering if more volume is needed because they will be covered by more tissue. I don't want to look too big in my clothes but do want to have a wow factor without my clothes 🙂 Also, I hoping to achieve close to a full size D cup and I know if 450cc or 500cc will get me closer that. What do you think?
A: The difference of 50cc between breast implant sizes in the 500cc range is very small as that constitutes less than a 10% volume difference when you do the mathematical ratio. That is barely if at all visible. But in the debate between these two sizes, you have stated several important factors that make it clear to me as to which is best for you…the desire for a full D cup, wanting a wow factor and the very fact that you are asking this question. These suggest that you are afraid of not being big enough. In addition you have a lot of loose skin on your breasts of which it always take more volume to fill them out. Therefore, between those two sizes I would opt for the slightly larger one and choose the 500cc implants.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I am wondering if I should be at my ideal weight before having breast augmentation?
A: In regards to getting breast implants and your ideal body weight, I think that answer depends on how much weight loss you are anticipating and what your breasts look like now. If you plan to lose a lot of weight (greater than 20 to 25 lbs) and you have some significant breast sagging, then you may be wise to wait until you achieve that weight loss. You do not want to put in implants that will later develop additional breast sagging as the weight loss may cause the breast tissue to slide off of the underlying implant support or ledge, maing the sagging look worse. Also additional weight loss may tip the balance between a marginal breast lift candidate with their implants versus someone who definitely needs a lift with their implants. If the breasts have little to no sagging and the desired weight loss is fairly minimal, then you could proceed with breast implants at any time.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, After breast feeding, my breasts are less than perfect. My confidence has drastically decreased. I'm in incredible shape but my breasts are just mush. What kind of breast procedure do I need, augmentation or a lift?
A: For many women, the decision between needing an implant or a lift is very straightforward. Breast sagging after childbirth may be improved by implants if there is not too much loose skin and the nipples do not hang below the lower breast fold. If there is significant breast sagging then a combined implant and lift will be needed. It would be very rare to get a breast lift alone unless you already have substantial breast tissue volume. Having breasts described as ‘mush’ indicates a significant loss of breast tissue so some amount of volume through the use of implants is needed. With enough added volume, the loose skin may be adequately filled out and the nipple will sit in a good position. But if there is too much loose skin and the nipple sits even a little bit too low beforehand, the implants will not lift the nipple upward enough and some form of a breast lift will be needed.
Dr. Barry Eppley
Indianapolis,Indiana
Q: Dr. Eppley, I had a combined breast lift with implants nearly 5 days ago. My recovery is going well I think, however, the appearance of my breasts concerns me. I've attached two photos (front & side view). My concern is that my breasts are oblong with a definite, large “indentation” above the nipple. In the photos, you see the implant sitting high, then a big indentation above what, I think, is my own breast tissue below. This seems abnormal to me. My breast shape looks kind of like an eggplant. Is this a cause for concern?
A: When undergoing a combined breast implant and lift for severe breast sagging, the early appearance can be disturbing. This is because the implants often ride early and in conjunction with swelling can push the breast tissue forward and down. This creates the exact appearance that you are seeing. It is important to remember that it is early and many changes will take place. One of those is that the implants will drop. This can be helped by wearing a breast band to encourage the implants to move south into the bottom that has been created for them. Putting gentle sustained pressure on the upper pole of the breasts will help the bottom tissues to expand and allow the implants to drop. It will take 6 to 8 weeks before you have a clear idea as to how much dropping they are going to do. They will definitely drop, it is just a matter of how much. Once that happens the breast tissue in front of them will move up into a better position on the implants.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am interested in getting breast implants but don’t know if making the breast bigger will also lift may nipples up. They have a little sag but not bad. I have read about a nipple lift but am not sure what it does or how it works.
A: A nipple lift, also known as a superior crescent mastopexy (SCM), is the simple removal of a half moon-shaped piece of skin above the nipple. This allows the nipple to move up higher based on the amount of skin removed. This leaves a very fine line scar that is usually imperceptible along the upper areolar-skin margin. A nipple lift is almost always an adjunctive procedure when placing breast implants if the patient has some mild breast sagging. An extra 1/2 to 1 inch of upward nipple repositioning can be helpful. But a nipple lift is not a replacement for a formal breast lift in cases of more significant breast sagging. In breast augmentation a nipple lift is usually done for one of two reasons. First, in women with very small amounts of breast sagging, a breast implant alone may not provide enough of a lift and the nipple lift is insurance that a more centrally positioned nipple on the breast mound may occur. Secondly, in women who really need a more formal breast lift with their implants (such as a vertical breast lift) but are very apprehensive about the scars, they may initially try a nipple lift and see how much improvement they get. One can always proceed with a fuller breast lift later if enough improvement is not obtained. A nipple lift is not the same and should never be thought of as a form of a breast lift although many call it such. It is nothing more than raising up the level of the nipple on the breast mound, it does not change the shape of the breast mound.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 5’9” weigh 146 pounds and am a 36D. I had breast implants that were placed three years ago and were 500cc moderate silicone gel implants. Although I like the size, they look flat to me. My breasts are very wide and require a push up bra, otherwise they look flat in my shirt. They have given me reasonable cleavage but they are just so flat. What is the best way to improve their shape? What type of new implant do I need?
A: Moderate projection/profile implants have the lowest projection and widest base of any of the breast implants. Because they are so wide, I actually never use in my breast augmentation patients. Changing breast implants to a more narrow base with higher projection seems logical. It would also be important to go up in volume somewhat so you get more outer and upward push of the breast mound. Therefore I would change to a high projection implant with a volume of 600ccs. This will provide more upper pole fullness and may even narrow your existing width somewhat. With your body frame, a 600cc implant would not be much bigger than your existing breasts…just more towards the shape you want.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to do something about my breast shape but am confused as to what to do. I have a little sag to them after two pregnancies and would love for them to be a little fuller and up higher. So I think that is why I need a breast lift but I really don’t want any scars on my breasts if I don’t have to. On the other hand, I am not opposed to breast implants if it will lift up the breasts and avoid any obvious scars on them. I have attached some pictures of my breasts for you to see. What is your recommendation?
A: Your breast dilemma is a common one in that you are what I call a ‘tweener’. You have some sagging so breast implants will add volume but the breast position will likely stay low. A larger than desired breast implant may be needed to get the lifting effect you are after. A breast lift alone will changhe the position of the nipple and the breast mound but often the breasts may look smaller afterwards despite the better shape. A lift with an implant will allow you to have a smaller implant and slightly higher positioned breasts but that comes with the trade-off of scars.
Either way you have to accept some disadvantages with either approach and different plastic surgeons will have different preferences for either approach. You must think it through and decide which of the trade-offs is the better choice for you.
In ‘tweener’ patients like you, I wil often choose the middle of the road choice…breast implants with a superior or crescent nipple lift. This provides a slight upward nipple repositoning with minimal scars (no scars on the breast mound) while relying on the implant to add volume and provide a bit of an upward push.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I had a recent consultation with another plastic surgeon and that surgeon believes I only need augmentation, no lift necessary. I am somewhat asymmetrical so I need about 50cc more on the right side. I want silicone implants placed under the muscle. I am a paramedic so I have recovery time concerns, but think I will have no problem recovering since I am very fit. The size I had looked at were around 420cc/480cc, but think I might go just a little bit smaller. I am basically a B-cup on the right and a C-cup on the left, but lost size and volume after breast-feeding three children. Fortunately, my nipples are in a good position still and I am not too droopy, just lost my size and fullness. I am 34 years old and weight 145 lbs, but I am an extremely fit size 6. Thanks.
A: The key factor in determining the need for a breast lift is where the nipples are positioned. If they are above the lower breast fold still, then an implant alone will suffice and no lift will be needed. With asymmetrical breast sizes before surgery, placing different implant volumes is common. But be aware that this may improve the asymmetry but it is unlikely they will be perfectly matched after surgery since they are other tissue factors that affect breast size other than just breast tissue volume. (e.g., skin envelope) Most breasts are asymmetric for multiple reasons and a breast implant only addresses one of them.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 28 year-old woman who doesn’t like the shape of her breasts. They are very saggy and not even. One is smaller and hangs lower than the other. In addition, my areolas are huge and way out of proportion to the size of my breasts. I am young and these breasts like old lady breasts. I have attached pictures for you to see. What type of breast reshaping procedure do I need and will there be scars?
A: Thank you for sending your pictures and expressing your interest in breast reshaping/rejuvenation. Breasts like yours pose real challenges in getting uplifted fuller symmetric breasts while minimzing scars. There are two fundamental approaches that can be done. The first would be a periaroelar mastopexy (breast lift) with implants. This approach would make the breasts larger and would have have scars limited to around the smaller areolas. Its downside is that only a minimal lift and an improvement in symmetry would be achieved, so you would have larger breasts that still hang. The second approach would be vertical breast lifts combined with implants. This would be infinitely more effective an uplifting your breasts, improving their symmetry, making the areolas smaller, and providing improved fullness. The one downside is that there would be scars around the smaller areola and then vertically down to the lower breast fold. (and perhaps some scar along the breast fold crease as well)
As you can see, neither approach is perfect and one has to accept either low hanging breasts with minimal scar or uplifted fuller breasts with more scar.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am a 34 year old woman who has had two children. I am done having children and now want to address the damage done to my breasts by pregnancy and breast feeding. I have lost all of my breast volume and they sag. I want breast implants but I don’t want a breast lift. I don’t want the scars from the lift. I would be ok with small hidden scars but nothing that goes beyond the border of the nipple and the skin. I have attached some pictures of my breasts. Can you tell me if what I am asking is reasonable?
A: Unfortunately, there is a significant difference between what you need for a good breast result and what you want. You are not alone in this position as many women need a breast lift but don’t want the scars. You have too much sagging to get a good result using breast implants alone. In fact, implants without a lift is going to make your breasts look worse not better. They will create a mound above the current level of your hanging breast tissue and will merely end up placing your nipple on the bottom half of the implants. This will create a breast appearance that you will likely not find better. It will just be trading into a different type of breast deformity.
If you are not ready to accept scars as of yet, you can always have breast implants first and let the result prove to you whether that look may be acceptable.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I want to change the look of my breasts. I don’t mind having small breasts but I just don’t like the sag. Do you think a breast lift alone will give me a good result? What are the benefits of implants with a lift? Is the combination better than a lift alone?
A: Your breast sagging and your questions about how to improve them are fairly classic. Your dilemma is not new and it can be hard to figure out what exactly to do. So let me break down into the structural problems. In sagging breasts, there are three elements to them that bother women. First is the lack of upper pole fullness. While a lift may make some immediate improvement, it will not be sustained. This is what implants are used for to create some permanent upper pole fullness. The next issue is the low nipple position that is either pointing forward but low on the breast mound or is pointing downward to the floor. This is what a lift does best, reposition the nipple back up higher and in a more centric position on the breast mound. Lastly, is the bottoming out of the lower breast tissue that hands over the lower breast fold. This also is what a lift helps with by removing skin and tightening the tissues on the lower pole.
This being said, I find in many cases that a breast lift alone can be disappointing particularly in the thin-skinned small breasted patient. It really requires an implant to create sustained upper pole fullness and some upward movement of the breast
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, can breast implants be injured during sex? While having sex with my husband he leaned on my breast and it caused some immediate pain. For the past few days now, I have had lingering pain although it has gotten better. That breast also feels a little harder now. Could I have a breast implant rupture? I had silicone implants placed three years ago.
A: Your question is actually a common one and let me provide an overall explanation. The shell or bag of a breast implant is made of a very flexible but strong silicone elastomer material. It is designed knowing full well that it will regularly be exposed to a compressive crushing force…known as mammograms. Any woman that has ever had a mammogram can testify to the fact that their breast is really squashed between two paddles to do a mammogram. Millions of breast implants are exposed to lots of mammograms every year in the U.S. and around the world and there is no evidence that they induce rupture unless the implant shell has already been weakened. So it is highly unlikely that rupture of breast implants can occur as a result of sexual activity. It takes a high energy force to rupture a breast implant such as might occur from an automobile accident or other traumatic injury. What you are likely feeling is a mild bruise around the implant capsule which should go away in a few weeks. If in doubt, an MRI or a high definition ultrasound will be needed to answer the breast implant rupture question conclusively.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am 19 years old. My father made me take diet pills when I was younger and my breast went from a D cup to maybe a B now. I’m finally losing weight and my dream is to get my breasts big again. I don’t have the finances to pay for it through. What can I do?
A: Breast augmentation is an elective procedure that has numerous fixed expenses to perform. It is going to cost money to have this surgery and the fees vary based on whether one chooses saline or silicone gel breast implants. You will have to set a financial goal to reach based on the cost of the procedure and await the day when it will be financially achieveable for you.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dear Dr. Eppley, my breasts are slightly droopy and I want them to be more perky. I thought I needed a lift but one doctor that I consulted with said that I needed more volume in my breast instead of a lift. He said this could be done with an implant or fat injections. The length between my nipple to sternal notch is 22.5 cm. Should I have breast lift or breast augmentation? If augmentation is best, which treatment is better an implant or fat injections?
A: The key to knowing whether a lift or the addition of volume can make the breast look better depends on the position of the nipples. If it sits above the lower breast fold, then volume is the answer. While I do not know exactly what your breasts look like, knowing that the distance from your nipples to the sternal notch is only 22 cms tells me that your nipples are definitely above the inframamammary folds. That is essentially a completely normal or ideal nipple position. (the normal range is 18 to 22 cms depending in the length of one’s torso)
Since more breast volume is the answer, the question of whether it can be done with an implant or fat injections becomes very relevant. The use of fat injections for augmentation of a variety of body areas has become very popular in plastic surgery recently. While it is widely accepted for volume augmentation of the face and buttocks, its use in the breast is currently controversial. This is because there already exists an augmentation method that works well and is very reliable, an implant. For overall breast augmentation, an implant works better, is a one-step procedure, and will cost less. If there is just one area of the breast that needs filled in, then fat injections becomes the preferred treatment.
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I am going to get breast implants and need some help in selecting size. I am currently a 34B with one breast about a quarter of cup larger than the other. They are perky but just not full. I am uncertain on whether to get saline or silicone implants and am looking for the most natural result possible.
A: When it comes to getting a natural breast augmentation result, it does not matter whether a saline or silicone implant is used. That has nothing to do with making a difference between looking augmented or not. Rather it is a function of implant size and implant location (above or below the muscle) as well as what your breast tissues look like now. As a general rule, it is almost always better to go below the muscle so that there is a natural slope in the upper pole of the breast. If you keep the implant base width at the same size or less than that of your natural breast base width, you will almost always look fairly natural. The size of breast implants is directly related to their base diameter. The larger the base diameter, the larger the implant. A simple tape measurement of your breast base diameter would help considerably in making a good implant size selection for you.
Dr. Barry Eppley
Indianapolis, Indiana