Breast Augmentation: Cost, Reviews, Photos

Getting bigger breasts and getting perkier breasts may require different procedures, especially if you have had kids.

Often after having children, breasts have excess laxity. Excess laxity is often best corrected by a breast lift, while breast augmentation is performed to increase breast size.

Getting an excessively big implant to help correct some of the excess breast laxity is usually not a wise decision as the two procedures are designed to accomplish different things.

So have a careful and throurough discussion with your plastic surgeon about your breasts and your goals and make sure to get the right procedure or set or procedures. (Remus Repta, MD, Scottsdale Plastic Surgeon)

Fuller , perky breasts with breast implants-results vary-depends on skin excess, position of nipple

It is a common dilemma and it is one of the most difficult situations, as a surgeon to explain to a patient, in my experience.  I have a lot to say about it, so sit down now, as my intent is to explain the logical, scientific and aesthetic considerations that must be addressed. The decision of – breast augmentation alone vs. breast augmentation and simultaneous breast lift (mastopexy), are dependent on some key issues which I will outline below, and which I address with all of my breast augmentation (and potential breast lift) patients:

1. I assess the breasts and ask – are the breast truly sagging, i.e., ptotic. i.e. are the nipple-areola low, below 22 cm to 25 cm by breast measurement of (SN:N) position from the manubrium, i.e., center of the clavicle?

2, I assess – is the breast skin, especially the lower pole skin ( below the nipple areola), excessively stretched and droopy.with the nipple/areola at a normal position – a condition known as pseudoptosis?

3. I assess – what size breasts does the patient want, if she has excessive skin – and – are the nipple-areola low or borderline-low? If the patient has excessive amounts of lower breast skin that hangs, yet the nipple areola is normal in position, the patient may benefit from an excision of lower pole skin along the inframammary fold, and not need to have the nipple areola moved, avoiding the circular peri-areolar scar and vertical scar of the classic breast lift (sometimes referred to as an “anchor” scar).

4. If the lower pole skin is not that relaxed/stretched, but the nipple is slightly low, then the patient may benefit from a conservative peri-areolar breast lift, raising the nipple areola “north” or “up” and then using the implant to fill the breast and assist in breast elevation by addition of upper pole breast volume. Additionally, the patient may also benefit from just a breast augmentation alone, and not even need a lift of the nipple areola.

The volume of the implant may inflate the breast enough to give it a lifted appearance and this fullness may also lift the nipple areola or give the 3-D “image” of a lifted nipple areola (despite, the fact that if you measured the position of the nipple-areola, it is in the same position or maybe even lower, than the pre-operative position!).

5. If the patient has a normal nipple areolar position, (18-22 cm from the manubrium), yet “looks” droopy because of relaxation of the breast skin and loss of breast volume, then a simple breast augmentation may provide enough volume to give the appearance of a lifted, perky breast, simply by filling the breast with volume, correcting the pseudoptosis with the sole use of a breast implant, not needing any type of breast lift and precluding excessive breast scars.

6. If the patient has excessive skin, empty breasts, low nipple areola–somewhere below a measurement from the manubrium of 26 or lower (SN:N 26 or lower), then the patient may benefit from a full breast lift (mastopexy) at the time of the breast augmentation. This would be the classic breast lift scar, which involves a circular scar around the areola, a vertical scar and a limited inframammary scar.

7. If the patient is adverse to having a mastopexy scar and the breast has limited ptosis (nipple areola lower than 22 cm but not as low as 26 cm), and some volume to the breast tissue – a breast augmentation alone can be done (no breast lift). I would highly recommend placing the implants on top of the muscle, beneath the breast tissue, to allow the implant to be in the natural position of the relaxed breast/skin brassiere. In this way, the breast will be filled, but the breast will appear full, settled, pendulous, “mature” and “heavy”, but a good bra can give the patient the lift they want when they are wearing clothing.

Many women are happy to have a full breast that is lower than the “ideal, youthful” breast. They are happy to have the breast full and do not use the word “perky”. These patients may be very satisfied with just a breast augmentation and not want or need to have a breast lift.

8. Another interesting situation, is when a patient insists that the implant be placed below the “muscle” (pectoral muscle). Many patients have read from various sources, including the internet, and/or talked with friends/family members who have had sub-pectoral breast augmentation, and they are informed of the advantages of sub-pectoral placement, but they do not understand and may not have been “educated” about “their” individual anatomy.

That is, the patient with true breast ptosis (droopy breasts, with low nipple-areolar position), will not be a good candidate, and could even be severely distorted from an attempt to place the breast implant below the muscle.

This would create a distortion of the breast, and the breast could actually droop over the sub-pectoral implant, which may appear as a bulge in the upper part of the breast, leaving the droopy bottom half of the breast empty and deflated. Most important to note, is that It takes time for a plastic surgeon to give a thorough consultation to a patient and educate them of their choices, their individual and unique anatomy and then put this into perspective, letting them know what choices are best for their anatomy.

It is not all visual- it is also mathematical, as there are normal mathematical and geometric relationships that make a breast beautiful (as well as a face beautiful). I tell patients I am not a wham bam breast surgeon, and all patients in my practice are measured before they undergo any breast surgery. The patients need to know about their anatomy and how their anatomy often defines what can be done to enhance and beautify the breasts.

All patients should take their time and find a surgeon who will spend the time with them, measure their breasts, and then explain to them the surgical options that are best for them, customized to their body and unique anatomy. I could go on even further, but I hope this gives you an idea of how complex, yet exciting and unique breast surgery is, in the hands of a careful and thoughtful plastic surgeon, and a well-informed and realistic patient.

This is an important and exciting operation that can have very powerful and positive consequences on a woman’s self esteem, so I encourage you to take your time and find a great plastic surgeon who will do the best operation for you. (Christine A. Petti, MD, Los Angeles Plastic Surgeon)

Achieving perky breasts following pregnancy, lactation and nursing

In many instances this is a complex operation and may require more than one procedure but typically requires a lift, reduction and augmentation with implants. (Otto Joseph Placik, MD, Chicago Plastic Surgeon)

Restoring fullness to the breasts after pregnancy

After pregnancy, especially when there is a large change in volume (increase and then decrease) the breast skin envelope stretches and there is a disproportionately greater envelope size as compared to the amount of tissue you have to fill that envelope.

It is essential to use measurements of the breast and assess the tissue characteristics so as to find the most ideal implant size. At that time, it can be determined whether or not a lift is required.

I find that using a dual plane 2 or 3 technque, in the vast majority of cases, a lift is not required to achieve a beatuiful result. (Mark D. Epstein, MD, Stony Brook Plastic Surgeon)

Correction of breast drooping after pregnancy

In your case it is unlikely that breast augmentation alone will correct your problem. Ideally, you need an augmnentation to restore volume and a lift to bring the soft tissue into position. This combined procedure has a 20% chance of needing a touch up surgery after the tissues have relaxed and the wounds matured. This ultimately will give you your best result. (Benjamin Schlechter, MD, Reading Plastic Surgeon)

Achieving fuller, perkier breasts after pregnancy

The question I always ask patients who ask if they need a lift or an augmentation or both is : When you have your bra on, are you happy with the size / volume of your breasts?”

If the patient IS happy with the present volume, then they aren’t looking for an augmentation and by lifting the breast, repositioning the nipple/areolar in a perkier position and tucking all the present breast tissue inside a smaller envelope of skin, this will result in a lifted, better shaped breast, with a high degree of satisfaction. It also eliminates the cost of implants and potential future surgeries for problems with the implants. If however, the volume is not adequate AND the breasts are sagging then a lift with an augmentation will be required to correct the problem. (Jeffrey M. Darrow, MD, Boston Plastic Surgeon)

The best way to restore the full, perky lift you had during pregnancy is by combining breast augmentation with a simultaneous breast lift.

In my experience, breast augmentation with implants are a great way to enlarge your bust line, but should not be thought of as a way to change the position of the nipples or shape of the breasts. To restore the volume lost following preganancy often requires a breast lift in addition to augmentation. To guide your decision process, you should consult an experienced cosmetic breast surgeon and carefully review your goals and expectations befiore deciding on surgery. Oh, and it’s never a bad idea to get a second opinion before proceeding with surgery. (Michael H. Rosenberg, MD, White Plains Plastic Surgeon)

Implants alone vs. Implants and Lift: THAT is the question.

Examination of your breasts (or digital photos if you’re at a distance) will allow any board-certified plastic surgeon to tell you if implants alone can restore your deflated beasts to a fuller, perkier look. Basically, if your nipples point forward (not down), and are above the position of your inframammary crease (put a pencil beneath your breasts in the crease and look in a mirror), implants alone can often give your breasts a youthful improvement.

The degree of deflation can require implants of sufficient volume to “fill” the skin brassiere, which could make you larger than you wish. Thus, smaller implants may not adequately fill the loose breast skin, and a full or partial lift would be needed to tighten and lift the breasts.

More incisions, more scars, more cost, BUT better cosmetic result. If your nipples point down, or are positioned below the crease, a lift (skin tightening) will be required, and implants can give more volume to the uplifted (and reduced areola size, if desired) breasts after pregnancy. (Richard H. Tholen, MD, FACS, Minneapolis Plastic Surgeon)