Breast augmentation
Implant types
We use implants that have an outer shell of silicone rubber and are filled with silicone gel. Implants are either round or teardrop shaped and have a smooth or textured surface. A round implant adapts to the shape of the breast and usually adopts a teardrop shape when standing. A teardrop or anatomically shaped implant mimics, and helps determine breast shape.
Early implants had a smooth surface but now almost all of the implants we use have a textured surface to reduce the risk of capsular contracture. (See complications).
Implants are filled with Silicone gel which is available in two main formulations. The standard gel is an oily gel which creates the softest implant available or a firmer gel known as a "cohesive" gel. This gel is available in round and shaped implants. Silicone gel has a consistency and viscosity that is most like normal breast tissue of the materials available.
An alternative to silicone gel is Saline which is salt water. Saline filled implants are available but do not perform as well as silicone implants, having a less natural feel and an increased complication rate.
Shaped or round
The introduction of the firmer "cohesive" gel allowed a shaped implant to be developed which has led to a major improvement in the results that we can achieve. In appropriate individuals a shaped implant filled with a cohesive silicone gel allows the implant to dictate the shape of the future breast keeping the main breast volume low on the chest wall rather than leaving a too rounded breast. In general this means that the shaped implant is most suited for patients who have very little breast development where we need to create new breast shape with a natural teardrop appearance. The disadvantage is that this implant is a little firmer than the soft implant and is not so well suited for the patient who is looking for a restoration of breast volume later in life where volume has been lost following pregnancy, age, or weight loss. For these patients a rounded soft implant is often more appropriate.
Recommended implants
At the present time I recommend implants from Allergan's Natrelle collection.
The Natrelle Inspira implants are round implants that have a wide range of sizes varying in volume, diameter, and projection. They are filled with a soft gel known as a "responsive" gel or a "cohesive gel" known as a "soft-touch" gel.
The Natrelle 410 anatomical implant is tear drop or anatomically shaped. To maintain its shape it is filled with "soft-touch" cohesive gel. The shaped implant has an even wider range of sizes with variation in volume, width, height, and projection. With careful measurement and assessment we can select the correct implant from the matrix of sizes available to achieve the desired result.
Although I consider these to be the standard implants that I use and recommend, other implants can of course be used if you have a particular request.
Sizing
There are many factors that will determine the size of implant that we should use for your proposed breast augmentation. We are constrained by the size of the space that we can create to accept the implant and by the aesthetic proportions of your future breasts. If too large an implant is used the breast will look very rounded and is less attractive to many. Also the larger the implant that is used the greater its weight and therefore the more stretching of the breast will occur in the future. Within these limitations the final decision is of course yours.
Choosing the correct size and type
of implant for breast augmentation
In deciding which implant to use we are looking at enhancing the shape and form of your breast to create an aesthetically pleasing breast which I believe is more critical to a successful outcome than mere volume. Everyone has an ideal shape and volume for their breasts in their mind and I trust that with careful sizing and assessment we will achieve this for you within the limits of feasibility. Choosing the correct size and shape of implant is critical to achieving the result that you are looking for from your breast augmentation.
We need to determine the dimensions and volume of the implant to be used. The volume of the breast implant added to your own breast tissue will determine your eventual cup size. As people have varied amounts of breast tissue and different shaped chests it is not possible to select a particular cup size of implant from the range available. Implant selection is primarily done by measurement to determine the dimensions of an implant that will give you the desired result. We then check that the volume of the selected implant is correct for you with the use of trial implants.
Buying a bra of your desired cup size
The first stage in sizing is for you to buy a bra of the size you would like to be. This should be a full cup sports bra which you will also need following surgery. The band size, which is your chest circumference in the infra-mammary fold, will not change with an augmentation. It is useful to be measured formally so that you are wearing the correct band size and then select your desired cup size. It is not unreasonable to buy bras of more than one cup size, to try them on at home, and potentially return those that you find do not 'fit' your requirements!
With the bra that you have selected pad it out at home to check that the profile of your upper body that this creates is correct for you. You should also try on various items of clothing from your wardrobe to ensure that your selected cup size is creating the desired effect for you.
Your sizing appointment
Once you have selected your desired cup size we should see you back in clinic for your sizing appointment. This is also an opportunity for you to ask any further questions that you might have about the procedure, its implications and its aftercare.
We will start by measuring the dimensions of your breast. If we are using a round implant this will indicate the maximum size of implant that realistically we would be able to insert under your breast. If we are using a teardrop shaped implant we will then assess the dimensions of your proposed augmented breast which will indicate the size of implant to be used.
With the teardrop shaped implant our base measurement is the width of the proposed breast that we want to create. We then select the height of the implant based on your stature, and your chest wall contour. We then select the projection of the implant based on the amount of breast tissue that you have and the cup size you would like at the end of the day. The implant is then selected from the matrix of implant sizes aided by a computer program.
This will give us a small range of implants that would be suitable for you. We then check that the volume of implant that we have selected is appropriate for you by using trial implants or sizes inside your sports bra. With trial implants in place it is your opportunity to decide whether the proposed increase in size is too much or too little for you.
We will then be able to select the proposed implant, make a final decision as to whether this implant should be placed underneath the breast only or underneath the muscle as well and proceed to the next stage, which is surgery.
By sizing your breast in this way I find that we select the correct implant in the vast majority of patients. Occasionally, however, the space that we can create underneath your breast is smaller than the implant selected. Under these circumstances it is better to use the next size smaller to avoid a round and bulbous breast. I will have discussed this with you pre-operatively and if you are very keen to use the selected implant, and accept that the breast may be more rounded than ideal, we will of course do this for you.
