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Dr. Barry Eppley

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Double Board-Certified Plastic
Surgeon Dr. Barry Eppley

Posts Tagged ‘large breast implants’

Case Study: The Pseudolifting Effect of Breast Implants

Tuesday, August 13th, 2013


Background: There is a common perception that an implant can lift up a sagging breast. The reality is that nothing could be further from the truth. In most cases of sagging breasts (breast ptosis) an implant will actually making the breast shape worse. It will fill out the upper pole of the breast while having no positive shape effect on the downturned breast tissue which contains the nipple. This is why a lift with an implant is almost always needed for reshaping and lifting of the sagging breast.

There are a few instances of apparent breast sagging, however, in which an implant can have a breast lifting effect. If the breast mound is small and the sagging is largely restricted to the nipple, implant enlargement can create the perception of an uplifted breast. By making the breast base diameter bigger in both a vertical and horizontal dimension, the location of the nipple on the mound is changed as the mound is expanded.

Such positive benefits of an implant alone on a sagging breast almost always occurs when the initial breast size is small. Large breasts create a big sleeve of overhanging breast tissue as it has shrunken due to pregnancy or weight loss. This type breast already has a small base diameter and the droop is more nipple-related than mound-related. With careful assessment one can see that the low hanging nipple position does not fall below the level of the inframammary fold. (lower breast crease)

Case Study: This 40 year-old Hispanic female wanted breast enlargement after having had two children. She never had large breasts even though she had a wide chest. She wanted silicone implants and wanted at least a D cup breast size afterwards.

Under general anesthesia she had 550cc high profile gummy bear silicone implants placed through lower breast fold incisions. Using a no-touch funnel device technique, the implants were inserted through 3.5 cm long incisions in a dual-plane submuscular position. At least half of her mound expansion was on the lower pole with the creation of a new lower breast fold.

With implant augmentation in the smaller droopy breast, the entire lower pole of the breast is expanded lower. This makes a new inframammary fold location well below the location of the presurgical smaller breast mound. This is how the breast becomes ‘lifted’. The nipple position actually stays relatively the same, it is the breast mound around that changes. With a larger and lower breast mound the nipple ends up acquiring a central position. This could really be called a pseudolifting effect.

The expansion in the breast mound also creates an important issue for the actual placement of the breast implants. Since the breast mound will lower the existing inframammary fold, it is important to make that consideration into the incision location. The inframammary fold incision will need to be made at 2 cms. lower than the existing breast fold. If this is not done the incision will end up above the fold and on the actual lower pole of the breast is a more visible location.

Case Highlights:

1) It is a common belief that breast implants can lift a sagging breast which is rarely true.

2) Very small breasts that have a little droop due to involution, however, can be effectively ‘lifted’ with breast augmentation alone.

3) Larger breast implants achieve their lift by enlarging the lower pole of the breast making the nipple appear higher on the new breast mound.

Dr. Barry Eppley

Indianapolis, Indiana

Large Implants in Breast Augmentation

Tuesday, July 21st, 2009

The choice of implant size is a major consideration for every breast augmentation patient, for that is the reason they are having the procedure. I would wager that women spend more time on this aspect of breast augmentation than any other, including their selection of a plastic surgeon. As a result, one of the keys to a happy breast augmentation patient is that they have the size that they desire.

There are numerous methods that plastic surgeon use to select breast implant size. For most plastic surgeons, they really do listen to the patients and there are a variety of well established methods that work. None of them are perfect and all involve some level of subjective estimation and some eye for size proportion to body type.

One of the breast implant sizing paradigm shifts that has evolved over the past decade is the concept of putting no larger an implant than the breast tissues can support. For long-term fear of bottoming out and the fact that breasts do change in shape over time for many women, the objective is to avoid a regrettable decision and lower the risks of secondary complications. While there are no long-term complications of how breast implants fare based on size, it would be reasonable to assume that very large breast implants (per the patient’s chest size) will have more secondary problems (e.g., need for revisions and thinning of breast tissues.

While I find in my Indianapolis plastic surgery practice that most women have very size appropriate goals (at least by my view), there are clearly some women that prefer a final result of a much larger breast. In these cases, the plastic surgeon is caught between saying they aren’t comfortable doing it or accommodating the patient. While one could argue that as long as the patient has been apprised of the potential long-term implications of their choice, then the burden of whatever happens is their responsibility. That is usually well and good…until the patient returns with a complication.

So what is the best implant size choice for most women…..or how big should one ‘safely’ go? While different answers will come from every plastic surgeon, I think a good rule is to not put a breast implant in whose base width is greater than that of the natural breast. If the implant starts to violate the axillary space or get in the way of the swing of the arm, that is too big of an implant. Beyond this functional basis, recovery from an implant that is too far to the side (should downsizing ever be done and the pocket needs to be closed down) is always difficult and unpredictable. In essence, this problem is not easily recoverable.

The base width of the breast consideration is one of the primary reasons for having different projections or profiles on the implants. If the size a patient wants is a little too wide, then a narrower width implant with more forward projection can be used to achieve the same volume or size.

In the end, breast augmentation satisfaction is ultimately a combination of the final size and shape that is achieved. Larger breast implants may be acceptable if their widths do not exceed the natural base width of the breast.

Dr. Barry Eppley

Indianapolis, Indiana 

Extreme Breast Augmentation

Friday, February 13th, 2009

In most cases of breast augmentation, women usually desire predictable and reasonable increases in their breast size. (implant sizes of 300cc to 500ccs) Occasionally, maybe once or twice a year in my practice, someone will want really large breasts. A size that is disproportionate to their body frame but still able to be achieved with standard off-the-shelf implants sizes. (standard implant sizes go to 800cc for prefilled silicone and 800cc for saline which can be filled to roughly 1000ccs)

But the recent world record for breast implant size reached an astronomical increase of KKK. As recently reported a Houston Texas woman had her tenth breast augmentation surgery (performed in Brazil) to reach the gigantic size of 3,500cc per breast! Besides questioning the sanity of any patient who would even want to go half that size, it is not a very proud moment for plastic surgeons. While I am all for helping patients achieve what they want, not everything that some patients want is actually good for them…….and we as plastic surgeons should not be afraid to say so. Yes it is true that patients will go ‘down the street’ and find someone else to do it….there is a time to let them do so.

While such an extreme breast implant patient makes worldside news, the occasional patient who wants to be really big, by more normal standards, is more commonplace. When women make a choice for a large breast implant, they need to understand the long-term consequences. And there will be some. Most pertinently, there will be a day when the patient will not want to be so big. Downsizing breast implants will always make the breast sag…and many women will want a lift which results in breast scars. It is easy to go big, the skin will stretch and be nice and tight, but going down is another matter. The breasts will be deformed and will require some degree of skin tightening. Large breast implants over time will weaken the soft tissue support of the skin and many such patients will develop bottoming out of the implant over time as this support is lost.

In short, large to extreme sized breast implants are unnatural and the breast tissues are not designed to support such weight and size over time. When downsizing of a large breast implant is wanted, the loose size and large underlying breast implant pocket must be managed in a more reconstructive breast approach. This results in scars and may require multiple surgeries to get an acceptable shape and result. For these reasons, I advise patients to think very carefully about making breast implant size choices that exceed what their breast tissues are designed to handle. What size that is will vary greatly based on the patient’s breast and chest wall anatomy. There is no absolute upper implant size that applies to everyone.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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