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Breast Augmentation Information Resource for Southern California including Orange County, Los Angeles, Newport Beach, San Diego, and Beverly Hills.

 

Breast Enlargement

 

 

Consultation for Breast Augmentation

 

Outlined below is what to expect from your breast augmentation consultation. Read carefully, as there are many suggestions that will save you time, clear up questions, and help you convey to a plastic surgeon what it is that you want to accomplish.

 

Health History

 

All cosmetic surgery consultations begin with a thorough health history. This is especially true if general anesthesia is being used, but also applies to local anesthesia. Breast augmentations are usually done under general anesthesia. Rarely, if the implant is placed above the muscle, local anesthesia can be utilized. Prior to meeting with Dr. Cruise you will be given a health history questionnaire to fill out in the waiting area. There are questions about five areas of your health. Be sure to answer questions in detail so that your surgery and anesthesia can be optimized.

 

• General Health

 

It is important to discuss general health problems before your surgery so that it is as safe as possible. Be sure to mention any chronic illness. Of particular concern are high blood pressure, diabetes, heart problems, liver and kidney disease, stroke, cancer, bleeding problems, and wound healing problems.

 

Dr. Cruise will make sure your health is optimized as much as possible to ensure your safety during surgery and recovery. This may mean referring you to your private physician. If you know you have a health problem, you can often save time by bringing a letter from your private physician to your cosmetic consultation stating what the health problem is, how it is being treated, and whether or not you are able to tolerate general anesthesia safely.

 

If you are seeing any specialist (cardiologist, kidney doctor, psychiatrist, etc. ) be sure to bring a letter from them stating that you are able to tolerate surgery.

 

• Past Surgical History

 

You will be asked to describe previous surgeries and to identify any problems you may have had with anesthesia. Of particular concern are previous cosmetic surgeries, especially if you do not like the result and are interested in revision. With breast augmentation, it is especially important to mention all breast surgeries including breast biopsies.

 

• Medications

 

Be sure to list all your medications including aspirin and over-the-counter medications and supplements. These may increase bleeding and affect your surgery. It is extremely important to stop taking aspirin and aspirin-containing products at least 10 days before surgery. Tylenol is a good alternative.

 

• Allergies to Medications

 

Information about medications that have caused you to have allergic reactions is very important. Be sure to include this information so that these medications can be avoided. Of particular importance is a description of the reaction you had, especially if it was breathing difficulty.  Nausea is not an allergic reaction, but it is important to mention it at this time as well.

 

• Smoking, Drinking and Drug Use

 

These three will certainly affect your surgery and must be mentioned so that your surgery and surgical results can be optimized. With large procedures such as a face lift, neck lift, tummy tuck, and breast lift, smoking must be stopped at least 2 to 3 weeks before and after surgery to prevent disastrous result such as non-healing wounds, increased scarring, and/or infection.

 

With smaller procedures such as eyelid surgery, nose surgery, breast augmentation, and liposuction, smoking will certainly affect the overall result, but effects may be less noticeable. In these surgeries, therefore, smoking cessation is strongly advised but is not mandatory.

 

Specific Breast Issues

 

During your consultation, you must be very accurate about breast problems. Of particular concern is a history of breast masses and/or breast cancer. If you are over the age of 40, Dr. Cruise will require that you have a mammogram, verified by bringing the results with you to your consultation. If you or a family member have a history of breast cancer, then a mammogram may be required at age 35 or even 30.

 

It should be noted that breast augmentation has no effect on breast cancer. The only potential problem is that mammograms are harder to read when there is an implant. This problem is minimized by taking special mammogram views called Eckland views. Eckland views show the breast tissue in multiple planes that help to "see around" the implant. It works very well, but there still is a small (less than 10 percent) amount of breast tissue that remains unseen. Mammograms work better when the implant is placed under the muscle, allowing better visualization.

 

What do you want changed?

 

It is important to understand the goals of breast augmentation and to make sure Dr. Cruise understands what you want, including whether you want results to be subtle or dramatic. A subtle augmentation varies from one geographical region to the other. For example, breast augmentations are somewhat larger in warmer climates. It helps Dr. Cruise if you bring a picture to your consultation of someone with the type of breasts that you want to have. Be sure to choose someone with a body type similar to yours. The following are some things to consider.

 

Size

Implants sizes are measured in cubic centimeters or (cc). One ounce is about 30 cc, therefore, a 12-ounce can of Coke is close to 360 cc.

 

The chart below will give you an idea of what a woman close to her ideal body weight can expect from augmentation based on the size of the implant. The categories are Subtle and Dramatic. These terms are subjective, but the chart gives you some general guidelines.

 

Height	Size of Implant
	Subtle	Dramatic
5'0" -5'3"	<240cc	>350cc
5'3"-5'6"	<280cc	>400cc
5'6"-5'9"	<320cc	>450cc
5'9"-6'0"	<360cc	>500cc

 

Thinner women must subtract volume. Likewise, heavier women must add volume to the above guidelines.

 

It should be noted that these volumes are based on youthful skin. If you have saggy breasts or have been pregnant, larger volumes may be necessary. You should read the section on Breast Lift as well.

 

Shape

The shape of the breast that you wish to achieve is dependent on your physique. The most common shape of breast implants, either saline or silicone, is round. The second, not as commonly used, is anatomic.

 

• Round
  This implant is by far the most common. As the name suggests, the implant is round. Therefore, it can never be improperly placed. This implant is ideal for any woman.
  
• Anatomic
  This implant is taller than it is wide and is best for tall, thin women who want more vertical height than width to their breasts. It is not as commonly used as a round implant because of its potential to rotate and be positioned sideways.
  

 

Profile of an implant

There are three types of implant profiles: low, moderate, and high. Each is used according to the patient's physique and desired look.

 

• Low Profile - is used on patients who either have wider chests or are looking for a very natural look. This implant has the widest base and the least projection.

• Moderate Profile - this is the most commonly used implant; it fits almost all patients. If a patient chooses an implant that is appropriate for her body type, a moderate implant is used.

• High Profile - this implant is used on patients with relatively narrow chests who desire large breasts and would like to avoid the lateral fullness. This implant has the most narrow base and the most projection.

Saline vs. Silicone Implants

Saline implants are currently the most common. A saline implant has a silicone shell but it is filled with salt water. In the event of rupture, the fluid gets absorbed by the body and is totally harmless. A ruptured implant should be exchanged within 2 to 4 weeks to avoid closure of the capsule.

 

Silicone Implants have a more gel-like consistency. They are less likely to show rippling and irregularities. They are recommended in patients with little natural breast tissue. Silicone Implants may have a higher rate of capsular contracture (getting firm) than saline.

 

Physical Exam

 

• Height, Weight and Bra Size
  Typically, your exam will begin with your height, weight, and bra size. You should be as accurate as possible. If you have been pregnant or have had a significant weight change, be sure to let Dr. Cruise know.
  
  Tell him what size you would like to be. For example, "I am a 34 A and would like to be a 34 full C." While cup sizes are highly variable depending on manufacturer, this still gives Dr. Cruise an idea of what you are looking for.
  
  Once again, a picture of someone with breasts that you like is helpful. Be sure that this person's body type is similar to yours. Point out what you like about the picture; i.e., "I like her size, I like her cleavage, I like her fullness up high, or I like her natural appearance."
  

• Observation
  

  The second part of the exam involves evaluating the breasts for size, shape, and symmetry. It should be pointed out that all breasts are asymmetrical. Some are extremely asymmetrical while others have only minimal differences. These asymmetries will persist postoperatively.
  

  Common causes of asymmetry include size differences, sagginess, nipple location, areola size and shape, scoliosis, and chest wall asymmetries.

  
  

Palpation for masses

 

Typically, your plastic surgeon will perform a quick breast exam. Monthly self exams are extremely important and are the best way to find cancers that are at an early, easily treatable stage.

 

Measurements

 

Dr. Cruise will take measurements to objectively determine what implant size would best meet your goal.

 

Here are the most important measurements:

 

• Distance from sternal notch to nipple.

  This distance determines sagginess of the nipple. Normal distances are less than 21 to 22 cm. Over 22 cm usually means there is some component of sag. Minor sag can be corrected with augmentation, but usually needs some type of breast lift in conjunction. See the section on Breast Lift for more information.
  

• Distance from nipple to inframammary fold (IMF)

  This distance determines if there is a bottoming-out of the breast. It increases as the breast tissue falls downward. Typical lengths are less than 8 cm in the ideal breast, but may be more in large breasts and still be acceptable.
  

• Relationship of nipple to IMF

  This is perhaps the most important measurement. It determines whether the nipple is on top of the breast or has fallen. The ideal breast has a conical shape with the nipple on the top. The nipple should be at least 1 cm above the IMF. When the nipple falls below the IMF, it should be lifted. Nipples that are at the same level as the IMF may, or may not, be corrected by augmentation alone. This must be determined by your plastic surgeon.
  

• Width of breast

  This measurement is important in determining the maximum size of an implant that will fit on the chest wall. This measurement can be anywhere from 11 cm to over 16 cm. If someone has a thin chest but desires a large augmentation, she may need to use a high profile implant.
  

• Gap between breasts

  This is the distance between the breasts. Most people relate it to cleavage, but cleavage also is dependent on breast size. Typical separation is about 3 cm. This distance can be made smaller by elevating the pectoralis major muscle along its medial border. Point this out to your plastic surgeon if this is important to you.
  

• Areola size

  The areola is the colored area around the nipple. It often enlarges after pregnancy as well as changes shape. Ideal areola size is subjective. Areola reduction is often done at the same time as breast lifting, but not routinely with breast augmentation. Reduction results in a scar that goes all the way around the margin of the areola.
  

• Typical Incisions:

  • Peri-areolar - under the nipple
  • Inframammary - in the breast fold
  • Transaxillary - in the arm pit
  • Umbilicus (Navel)

 

Breast Augmentation Information Resource for Orange County, Newport Beach, Los Angeles, San Diego, Beverly Hills, and  Southern California