Breast Augmentation

The ideal patient for breast augmentation is small breasted to start with. A small breast implies a small “skin envelope” surrounding the breast, which results in a more firm and shapely breast following the procedure. A larger skin envelope is more difficult to lift and reshape without some degree of skin retightening (breast lift). In general, if the nipple sits at or above the fold below the breast (inframammary fold), the patient is a good candidate for breast augmentation. If skin retightening is needed, and the patient wants to be larger breasted, breast implants can be placed at the time of the breast lift (mastopexy with implants).

The type of implants used depends on the preference of the surgeon and patient. Some plastic surgeons prefer teardrop implants for small breasted or absent breasted women. Most plastic surgeons find little cosmetic advantage in using teardrop implants, even in women with extremely little breast tissue. To avoid the “round” look in thin women, they lower the round implants until the upper half of the breast has an aesthetic shape.

Round implants have several advantages. They may rotate freely under the breast without aesthetic consequences such as adverse shape or rippling of the skin. They are less expensive. Because the contents gravitate to the lower pole of the implant when a woman stands, the lower pole will naturally become more full, thus negating the need for a teardrop implant. In the submuscular position, which is most commonly used, the round implants adopt a teardrop shape which is nearly identical  to the anatomic implant. Most breast augmentations are performed using smooth round implants, usually in the submuscular position, for this reason.