Why do you think you need breast enlargement?
Patient often wants breast enlargement if they have small breasts from early adulthood, or they have lost volume and size of the breasts due to pregnancy, weight loss or any breast surgery. Some patients have normal shape and size of the breast but they are looking for further enhancement. Some complains of asymmetrical breasts size and shape. In all of these patients breast enlargement will help.
What is your present cup size and what size are you expecting?
This will help me understand your expectations and plan accordingly. Many people are not aware of cup sizes. Read this to understand it.
- Measure your band size.Place a tape around your body just underneath your breasts and take measurement in inches. Make sure the tape measure is horizontal and fairly snug. Bra band sizes are usually an even number. If this measurement is an odd number, then you should try out bras in both the size below your measurement and the size above. If you measured 31 inches, your band size could be 30 or 32.
- Determine your Breast cup size.Your cup size is not an absolute measure — it is measured in proportion to your band size. Bend over so that your chest is parallel to the ground. Measure around your chest with the tape over the most prominent part of the breasts. Now to calculate your cup size you will subtract your band measurement from the cup measurement you just took. The difference between the two numbers determines your cup size:
- Less than 1 inch = AA
- 1 inch = A
- 2 inches = B
- 3 inches = C
- 4 inches = D
- 5 inches = DD
- 6 inches = DDD (E in UK sizing)
- 7 inches = DDDD/F (F in UK sizing)
- 8 inches = G/H (FF in UK sizing)
- 9 inches = I/J (G in UK sizing)
- 10 inches = J (GG in UK sizing)
What is your weight fluctuation?
Weight can fluctuate if you were pregnant or gaining/ losing weight or have any medical illnesses. This will help me understand the elasticity of the skin and amount of sagging. If there is sagging of breasts then we will have to decide whether or not breast implant alone will help lift the breasts.
What is your medical history?
In terms of past surgeries, pregnancies, medical illnesses, allergies, ongoing medications etc I will than grade you according to ASA (American Society of Anesthesiologists) physical status classification system. This will help me assess your fitness for surgery. The levels are as follows; ASA type
- Healthy person.
- Mild systemic disease.
- Severe systemic disease.
- Severe systemic disease that is a constant threat to life.
- A moribund person who is not expected to survive without the operation.
What you like or don’t like about the shape of the breasts that you desire?
Some patients show me photos that help me to understand what patients are thinking. However, I warn them not to expect similar results as people vary a lot in anatomy. Some patients like more fullness in the upper part of breasts others don’t. This helps me to understand the positioning of implant and profile of implant that I will use (eg moderate or high profile).
I will then explain to you A to Z about the procedure.
What are the methods of breast enhancement?
- Silicone Implant: This is by far the gold standard of breast enhancement. The new generation of implants are more cohesive (No risk of leak), stronger (minimal risk of rupture) and very natural in feel. FDA approved Implants are Mentor & Natrelle. Eurosilicone is also a registered implant that comes with Premium patient Warranty.
- Saline filled Implants: These are less commonly used implant for cosmetic purpose. It has the disadvantages of unnatural feel and leakage. They are used for breast reconstruction with tissue expansion is required.
- Fat grafting: This is a fairly new method of breast enhancement. The advantages are the fat is taken from patients own body & it feels very natural. However the disadvantages are it is unpredictable (it may require few sessions to get adequate volume enlargement), it has risks of lump formation that may be bothersome to patients and there is a limitation to the size of the breasts. It is very useful for correction of asymmetry, tuberous breast deformities and corrective surgery after breast implant.
- Injectable Gels: The only safe gel based product is Macrolane (Hyaluronic acid). But it has many limitations it is injected into the breast tissue, can cause lumpiness, very expensive, it is not permanent and large volume injection can cause risks of infection etc.
Where do I insert the implant?
1) Dual plane Retromuscular: This is my preference in most patients. It means upper two third of implant is covered by muscle and lower one third is under the breast tissue.
- It gives good fullness to the upper part of breasts and shape is very natural.
- It is away from the breast and behind the muscle so the breast tissue is not directly affected.
- Less risk of sensory loss and lactation problems.
- Mammography in future is easier.
- Less risk of capsular contracture.
- It is more painful and requires strong analgesics.
- If the breast is saggy than an additional procedure of breast lift may be required.
- In bending forward position the breast may feel separate from the implant.
- Not suitable in patients with tuberous breast deformity, heavy weight lifters and other congenital problems.
- It can cause snoopy dog deformity in long run ie the breast sags below the implant.
2) Subglandular (Subfascial)- this is my second preference. In this procedure the implant is under the glands and above the muscle. In most cases I am able to put under pectoral fascia that gives an additional protective layer above the implant.
- Less painful, quicker recovery.
- Natural feel if the implant is of reasonable in size.
- It fills up the breasts in people who have mild sagging.
3) Submuscular Breast implant- This is very rarely used because the muscle is high up on the chest and is fixed structure whereas breast is at the lower level of muscle and is a mobile structure. Inserting behind the muscle will cause upper pole fullness and Nipple tends to point downwards, like a “Snoopy Dog”.
What Incisions are used for Breast Implant insertion?
- Submammary incisions are by far the most common approach as it gives direct access and better control to the pocket formation and Implant insertion.
- Periareolar incisions are rarely used as most patients have very small areola and it is difficult to insert a silicone gel filled implant. It can be used in patient who requires an additional breast lift.
- Axillary incision – I use sometimes for very young patients.