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Breast augmentation surgery is truly more than selecting an implant and having the plastic surgeon insert it into the selected pocket, either behind the muscle (submuscular) or in front of it (submammary). That would just be a technical exercise which should be within the scope of all plastic surgeons. Some surgeons, notably non-plastic surgeons “performing” this procedure, can’t even reach this basic level on a consistent basis.

In order to have the opportunity to obtain the best possible breast enlargement results based on a woman’s unique anatomy and individual characteristics, more than technical skills are needed.

What can separate the average result from a truly nice, dramatic and maybe even dazzling one is also the presence of a substantial innate “artistic” component. This is a comprehensive understanding and appreciation of aesthetic issues. Many have this ability, others not so much. Of course, the plastic surgeon then needs to be able to effect the desired changes by making the appropriate decisions and manipulations as relates to the multitude of variables he/she is faced with.

Experience can also serve to help realize these types of results.

What are some of these issues that a plastic surgeon is faced with in breast augmentation surgery?

A few of these include:

a) what size and proportionality/disproportionality does the patient REALLY want? (Many women really can’t precisely verbalize what they want. Others don’t really even know. Seriously!)
a) initial breast size including amount of breast tissue present
b) implant size (duh!)
c) implant configuration – base to height ratio: low, moderate, high and ultra-high profile
d) tissue characteristics such as skin tightness or laxity; presence of thin skin
e) asymmetries of breast size, shape, nipple position, laxity and vertical height on the chest wall
f) space between the two breasts
g) width of the chest wall
h) rib and sternum abnormalities and asymmetries
h) consideration of relationships of breast size to other key anatomical structures as regards harmony or disproportion

And so on …

As you may be able to better appreciate now, breast augmentation surgery is more than just picking out implants based on the number of cc’s (360cc or 550cc, etc.) and then having them “put” in.

The following patient of mine demonstrates recognizing and addressing these above issues, aiming to help her obtain the best possible result despite significant asymmetries, etc. Her situation is the rule as most patients have differences between the two sides and other “issues” as compared to being extremely ideal.

She was a 34A and wanted to be a 34C/D but not too large. As you may notice in her photos (left column – photos A, C and E), there are truly a lot of asymmetries and other relevant issues. For example, her right breast preoperatively is higher and larger than the left with a larger though lower nipple-areola complex. The shape is different from the left and there is a slight drooping effect with decreased skin elasticity. Meanwhile, the skin envelope is very tight on the left which means that it won’t stretch the same way the right side does when an implant is placed.  Her breasts are fairly low on her torso and are VERY far apart. Really separated!

A) before breast augmentation

A) before breast augmentation

B) after breast augmentation

B) after breast augmentation

C) before surgery - side view

C) before surgery – side view

D) after surgery - side view

D) after surgery – side view

E) before surgery  - oblique view

E) before surgery – oblique view

F) after surgery - oblique view

F) after surgery – oblique view

Now the results, based on appropriate adjustments, implant size, configuration, etc. (right column – photos B, D and F).

She is extremely happy with her results which were even better than she had expected.

For information on breast augmentation surgery or on any other plastic surgery procedure that I perform or to schedule your complimentary cosmetic consultation, please call my office at 480-451-3000.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona

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