Breast Augmentation for Dummies

If you happened to find yourself sitting next to Larry on an airplane and you asked him about himself, he’d look you dead in the eye and simply respond, “I make small breasts bigger.”

Facepalm. This is a true story.

Of course, it’s not as simple as this though, right?  So how do we navigate the myriad of options when it comes to cosmetic surgery??  Are silicone implants safe? What the hell does tumescent mean?  Will I need drains?  How long before I can have sex? (pressing question, I know)

In my next few blog posts, I’d like to break down the most popular plastic surgery procedures (starting with breast augmentations)…a kind of plastic surgery for dummies, if you will.  The goal, of course, is to educate, clear up some of the common misconceptions, and ultimately try to pass on as much (practical) knowledge as I can.

So let’s dive in.  We’ll start with some simple truths:

1. Augment (verb) | to make (something) greater by adding to it; increase.
2. Ptosis (noun, and the P is silent) | lowering or drooping of an organ or a part (in this case breasts).
3. To augment ptotic breasts means to make droopy breasts bigger and therefore (in most cases) droopier.  No Bueno.  Droopy breasts typically need a breast lift (prior to or at the same time as an augmentation).

One of the simplest ways to determine whether your breasts are droopy is with the pencil test.  Place a pencil beneath each breast (as far up as it’ll go) and make sure it is perfectly horizontal.  The pencil signifies where your inframammary fold is; this is where the bottom of the breast meets the chest wall.  Now, assess whether the nipple on either breast is a) above, b) in line with, c) or below the pencil.  Know that it’s normal for the nipples to be at different levels.  Generally speaking, if the nipples are above or in line with the inframammary fold, a lift is not needed.  If the nipple is below the pencil, we should consider some type of skin excision to avoid implants weighing down the breasts and causing the nipples to point even further down.

When it comes to breast implants, there can be an overwhelming number of options to choose from.  A veritable quagmire.  Let’s deconstruct.

Implant Fill

Saline Least expensive Essentially a water balloon. Has a valve and is filled in surgery with a salt water solution. Tends to leak (in my experience, we generally see saline implants rupture within a 5-10 year period). Ripples (you can see the edges of the implant beneath the skin, especially when leaning over).

Silicone More expensive Comes prefilled (does not have a valve). Does not leak (YouTube: BMW vs Implant). (Not that you plan on getting run over by a BMW). Natural look and feel with minimal to no rippling.

Implant Covering

Smooth Thinner shell; softer and more natural feel. Movement in the breast pocket is freer, also resulting in a more natural look.

Textured Linked with Anaplastic Large Cell Lymphoma (ALCL) – basically cancer. Recalled by manufacturers.

Implant Shape

Round Duh, they’re round…like a half sphere.

Teardrop All teardrop implants are textured = no bueno.

Entry Point

Belly Button Only Saline can be put in this way. Also, it’s dumb.	Inframammary Crappy scar.
Around Areola Scar can be covered by tattooing areola pigment post-surgery.	Armpit No scar. Quickest incision healing.

Implant Placement

Above Muscle Phony, can-eat-off-your-boobs look.

Below Muscle This means partially below the muscle. Natural slope.

Implant Profile

Moderate Widest base, least projection – kind of like a pancake	Full In between moderate and extra full – like goldilocks.
Extra Full Narrowest base, most projection – like those chocolate mushroom head crackers…do you know what I’m even talking about??

OK, did you get all of that?  

Here’s the CliffsNotes version: the winning combination is smooth, round, full-profile, silicone implants, placed through the armpit (2nd choice is around areola), and below the muscle.

OK; next, we need to discuss how the hell we’re going to get a decent sized implant through a tiny incision in the armpit.  It’s also important here that we don’t contaminate the implant as we insert it.  This complicates things…   

Enter: Martha Stewart.  Did you know she’s friends with Snoop Dogg??  They had a show together and everything.  Guys, I’m so here for it.

Anyway, picture Martha decorating a cake.  She’s using a pastry bag to pipe the frosting.  In essence, this is what we use to get silicone implants through very small incisions.  The surgical equivalent is called the Keller Funnel (invented by Dr. Keller in 2009).  By using it, the surgeon’s gloves never come into contact with the implant itself.  This is called the no-touch technique.  Genius, right??  

A typical breast augmentation takes about 2.5 hours.  There will be (armpit) drains in overnight as there can be a fair amount of oozing in the first 12 hours.  It is super important that we evacuate all of this excess blood and fluid to prevent complications.

Most patients have described recovery as feeling like having an elephant on your chest.  You can return to a (desk) job in about 5 days.  You can go on long walks after about a week, and by about 3-4 weeks, you can begin to resume more strenuous physical activity (including sex; you’re welcome).  

Stuff that I never see happen: implant rupture or leakage (silicone), malpositioning, allergic reactions to implants.

Stuff that could happen but is super unlikely: hematoma (bleeding into the pocket) and capsular contracture (the formation of a really thick scar around your implants, resulting in breasts that feel like coconuts).  There are quite a few things that can be done during and after surgery to reduce the likelihood of a capsular contracture (including drains).  Dr. Schlesinger’s capsular contracture rate is less than 1% (pretty damn good).

Stuff that always happens: swelling, nausea and grogginess from anesthesia, regret and shame because you wish you’d gone bigger (we told you so), and the overwhelming desire to go shopping for new clothes.  And bathing suits.  And shoes and bags (to go with the other new stuff, obviously).

We make small breasts bigger.  And now you know how.  Piece of cake, right?