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Bigger is Better! Or is it?

Many ladies feel that if they are going to spend their time and money on breast augmentation surgery, they want their money’s worth.  Our society/media also promotes this “pump them up” attitude. As a plastic surgeon, my job is to listen, evaluate and then recommend a course of action that is appropriate.  The goal of breast enhancement is to have natural appearing breasts that are in harmony with the rest of a ladies shape and size. That means that a tall lady with a big frame looks more proportional with a larger implant than a petite lady with a slender frame.  Bigger is not always better, especially if they look out of proportion and artificial.

There are many myths and misconceptions about breast enhancement in the general public. One is that only single twenty-somethings have it done. In fact many ladies who seek breast enhancement are mothers who have experienced a loss of breast volume after having their children. Many are seeking to restore the shape of their breasts as well as the size.  Some ladies never developed breasts and wish to have a feminine shape. Other ladies are bottom heavy and wish to balance their shape. 

An important part of the consultation is to determine what role a breast lift needs to play in the surgery.  Some ladies have a severe case of the “saggy, draggies”. Their skin is stretched out and thin. In a situation with thin skin and sagging breasts, it will be better to have a breast lift and modest enhancement, than to simply place a really large implant.   The larger the implant that is used the more the skin will stretch and the faster the breast will sag again. The general principle at work becomes “the more you give gravity to work on, the more it works.” Although time and gravity work on us all, there is no point in accelerating the process.

Many ladies have concerns about the pain after augmentation.  New techniques include the use of a “pain management pump”. This is a device that bathes the surgical site with a numbing medicine which is similar to that used by dentists.  Slender hair sized catheters are inserted next to the surgical site and automatically dispense the numbing medicine, reducing pain, the need for strong narcotics and the associated side effects of constipation, nausea and feeling disoriented.  The system can be refilled and used up to 5-7 days as needed.

After augmentation surgery, it is important not to overdo activities for the next couple of weeks.  Especially if the implant is placed behind the muscle, it takes several weeks for the muscle to get used to being stretched.  It may take up to 6 weeks for a lady to feel fully comfortable in all activities. If a lady has had a breast lift, then it is helpful to use some of the current scar fading creams.  Also it is important to avoid any sun and tanning bed exposure on the newly healed incisions, as sun damage can make scarring worse. As always it is important to stop all smoking 4-6 weeks prior to surgery to reduce the risk of complications.

Since breast implants are man-made devices, a lady needs to be comfortable with the fact that eventually she will need to have replacement of the implants.  Current implants have a ten-year warranty, which covers most of the cost of replacement. Finally, this is a decision that a lady should make carefully and without pressure from others, knowing that breast implants will not solve any personal or relationship issues, but they have the capacity to help a lady feel more balanced and attractive.

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