Many women seek breast augmentation to get more cleavage. Cleavage is a confusing concept. There are a few concepts that are often dumped into the category of “cleavage” that are not the same thing. These concepts deserve separate consideration since plastic surgeons manipulate them in different ways.

• Cleavage refers to the space between your breasts. If your breasts are close together, you have more cleavage. If your breasts are widely spaced you do not have much cleavage. This cannot be safely narrowed surgically, but your breast implant choice can affect its appearance.
• Fullness in the upper portion of the breasts is distinct from breast spacing or cleavage. This can be improved surgically…
• Breast projection refers to how far your breasts stick out from your chest. This is affected by your rib cage and your breast structure. It can be influenced surgically during a breast aug.

Cleavage

Your cleavage or breast spacing is anatomically determined and should not be changed. The attachments of the pectoral muscles along the breast bone limit how close together breast implants (under the muscle) can be spaced. Releasing these attachments can lead to synmastia (“unibreast”), which is difficult to correct. If you have widely spaced breasts, using a moderate profiled implant can help maintain more volume towards the middle compared to high profile implants. This does not mean you should not have high profile breast implants if you have wide breast spacing—breast spacing is just one of the many factors that must be balanced when selecting your implant type.

Breast fullness

If you want fullness in the upper portion of your breasts, you need an implant that is wide enough to reach up there to provide volume. You cannot generalize here… Your individual measurements and natural breast volume distribution need to be considered to determine what implants will get the job done.

Breast projection

If you want your breasts to protrude more, you want more breast projection. All breast implants increase breast projection, but some do it more than others. High profile breast implants increase projection the most. Since high profile breast implants are narrower, they may not provide as much fullness as the same volume moderate profile implant.

Relax! You do not need to figure out what type of implants you need to get the right balance of cleavage, fullness and projection. Instead, having a better understanding of what these terms mean will help you communicate your goals to your plastic surgeon so that he or she can figure out the hard parts for you. Improved communication between you and your plastic surgeon will help you get the result you want.

Improving breast symmetry with plastic surgery

Most women have breasts that are not perfectly even. One nipple is usually higher than the other. One breast is usually larger. Each breast usually has a unique shape. Most asymmetries are minor. In some cases, the asymmetry is significant enough that we recommend specific steps to improve symmetry.

Breast Size Asymmetry

We can improve size asymmetry in a couple of ways. If there is a big difference in size, we can use different sized breast implants to make up the difference. For small differences in size, saline implants can be used and the fill adjusted to even out breast size.

Nipple Asymmetry

If one areola is much larger than the other, we can improve symmetry by reducing the larger areola. This is done by making an incision around the areola and removing a ring of skin from the outside. This is the same incision as a doughnut type breast lift. This can also be used to improve mild asymmetries of nipple position.

Breast Shape Asymmetry

The amount of skin on each breast significantly affects shape. More skin generally means more sagging. Frequently, women will develop more sagging on one side after breastfeeding. A breast lift can be performed to improve shape. Even if both sides need a lift, the amount of lift can be adjusted on each side to improve symmetry.

Congenital Breast Asymmetry

Some women develop breasts that are radically different in shape during puberty. Sometimes breasts may develop a tubular or constricted shape. This can happen on one or both sides. It can be very distressing to the individual. Improvement is possible. Generally, incisions are made around the areola to release the tight, constricting bands. Next implants may be placed to increase size, improve size symmetry and improve shape.

There are as many types of breast asymmetry as there are individuals. Fortunately, our plastic surgeons are skilled at various techniques that can be used to maximize your result. We are excited to help you reach your cosmetic surgery goals. Contact us today to arrange a consultation with one of our Cincinnati based plastic surgeons.

Information about breast feeding with breast implants from your Cincinnati plastic surgeons

Our Cincinnati plastic surgeons specialize in procedures like breast augmentation, breast lifts and other cosmetic surgery procedures. As a result, we get a lot of questions about breastfeeding. Young women seeking breast augmentation and mothers-to-be with breast implants frequently question the effects of the procedure on their ability to breastfeed. In addition, many question the effect of breastfeeding on the appearance of their breasts, which may influence their decision in timing their surgery. This blog will address how breast augmentation affects ability to breastfeed, safety of breastfeeding after implants, and the cosmetic effects of breastfeeding.

Breast augmentation usually does not take away your ability to breastfeed. As long as the milk ducts are not disconnected from the nipples by an incision, all of the essential hardware is intact. Even an incision under the nipple (periareaolar) for insertion of the implants can be performed with minimal risk of affecting breastfeeding ability. The more extensive incisions used in breast lifts would increase the risk a bit. In general, the less your breast tissue is disturbed, the less you risk affecting breast feeding. If you consider placing breast implants through an incision in the breast crease and placing the implants under the muscle, chances are excellent that you will maintain your ability to breastfeed.

Safety is an important concern when you consider what nutrition you will give your new baby. Countless studies demonstrate the health benefits of breastfeeding form mothers and babies. It seems intuitive that placing implants in your body might increase silicone levels in your breast milk, making breastfeeding somehow less safe. This does not seem to be true! A study published in the journal of Plastic and Reconstructive Surgery examined silicone levels in breast milk of women with breast implants and women without breast implants. There was no statistical difference in the silicone levels of breast milk from women with or without breast implants. In fact, the same study looked at silicone levels in cow’s milk and infant formula. The levels of silicone in formula and cow’s milk were many times higher than breast milk. Does the level of silicone in milk matter? The honest answer is we do not know. Silicone is everywhere. It is an extremely common element, existing in nature. Silicone is actually needed by the body and considered an essential nutrient. The bottom line is that breastfeeding with breast implants does not appear to increase silicone levels in breast milk.

Countless women come to our practice for consultations lamenting how pregnancy and breastfeeding led to the downfall of their former perkiness. It is definitely true that pregnancy affects breast shape. The breasts enlarge, stretching skin. When your size returns to “normal,” you may find that you have less volume than before. You will almost certainly have less perkiness than before. There is some debate whether breastfeeding for any length of time results in any further deterioration of breast appearance than pregnancy alone. My feeling is that it probably does. However, if you want to get the benefits of breastfeeding and have great breasts, do not despair!

If you had breast implants in the past and have sagginess after kids, a breast lift or mastopexy will improve your shape. If you do not have implants and want to restore fullness, implants will do the trick. You may also need to consider a breast lift, in addition to breast augmentation, if your nipples are below your breast creases.

What about timing? If you are considering breast implants and want to have kids in the future, what do you do? If you want to have children in the next year or so, you may want to wait until after you are finished. There is no reason to delay augmentation if having babies is on your list years in the future.

We hope this information about breast augmentation was helpful. Our Cincinnati plastic surgeons are excited to help you with your plastic surgery procedures. Contact us to set up a consultation today.

Breast augmentation recovery tips from your Cincinnati plastic surgeons

Our Cincinnati plastic surgeons focus on maximizing your healing after breast augmentation. Healing after breast implant surgery is generally uneventful. However, it is very important to strictly follow your surgeon’s post-operative care instructions to maximize your chances of a normal recovery. Here are some tips to help. Be sure to follow your surgeon’s instructions, as they may vary from one plastic surgeon to another.

It is critical to wear a soft, supportive bra after your procedure. We recommend wearing a post-operative support bra for 6 weeks. The implants add weight to your breast. It is important to hold them in the right place so that the tissues heal to maintain the right placement. In fact, it is always best to wear a bra when you have breast implants. The more weight that the bra supports, the less your skin has to support. This equates into more longevity of your result.

Expect your breasts to look swollen and torpedo-like for the first 2-3 weeks. After a few weeks they will look much better. Two things will help swelling resolve after your breast augmentation. First, sleep on several pillows to maintain a slightly elevated position for the first couple of weeks. Second, massage your breasts several times a day.  Subtle swelling, perceived as firmness, persists even after your breasts achieve their final size. Your breasts will feel much softer 3-6 months after surgery.

Avoid exertion for the first few weeks after a breast aug. Range of motion exercises are helpful to avoid shoulder stiffness. Elevated blood pressure could cause bleeding and will make swelling worse in the first few weeks after your procedure. Based on this, light walking is encouraged, but you should wait 3 weeks to return to low impact cardio exercise. Wait 6 weeks before returning to strength training or high impact cardio.

Your breast augmentation scar will appear pink and slightly raised in the early stages of healing. Massage can help flatten and soften the scar. You can start massage 3-6 weeks after surgery, using an unscented hand lotion. We recommend doing this 3 times a day for a couple months.

We are focused on maximizing your entire breast augmentation experience. Our website and consultations are designed to educate you to make your best decision. Our surgical techniques are maximized for safety and your best result. We focus on pain control to provide maximum comfort during and after surgery. Our recovery protocols help you achieve your final result as quickly as possible. We are Cincinnati plastic surgeons who take care of women from Cincinnati, Northern Kentucky, and the world, we look forward to taking care of you.

Blog about breast implant durability from your Cincinnati plastic surgeons

In our Cincinnati plastic surgery practice, Women commonly ask about how long breast implants last. It is impossible to know how long these devices will last, but we can make estimates. Breast implants are not permanent devices—they are akin to any of your household appliances. They have a usable lifespan and then they wear out.

The way implants wear out is typically through a process called “fold failure.” This happens slowly over time. The shell of the implant is very flexible and develops wrinkles or folds as the saline or silicone gel moves inside. Imagine the shell of the breast implant resembles a piece of paper. If you fold a piece of paper in the same place time after time, it will weaken and easily tear at that place. The shell likewise weakens from bending and flexing millions of times. At some point, it may start to leak.

Silicone and saline implants seem to leak at the same rate. One is not stronger than the other is. The estimated chance of an implant rupturing is thought to be 4% the first year, and this number increases by 1% each year the implants are in place.

It makes sense that the gentler you are on your implants, the longer they will last. However, implants are quite strong. This is evident in the stomp test. This is an unofficial test not recommended by the manufacturer and definitely not to be tried at home! Check out video footage here. The point of this demonstration is to show that you can play sports, exercise, hug people, have sex, drive a car and sky dive after a breast augmentation without restriction. The chance that your normal activities will break your breast implants is very small. So what happens if they do break? First of all, it is not the end of the world! The solution is explained in our next blog, Implant Rupture. The bottom line is, satisfaction after breast augmentation is very high because you CAN do the things you want to do in addition to getting the benefits of a more feminine physique. Contact us today to set up a consultation with one of our Cincinnati plastic surgeons today.

Blog about breast enlargement with your own fat from your Cincinnati plastic surgeons

Our Cincinnati plastic surgeons perform a high volume of breast augmentation. Every once in a while a prospective augmentation patient wishes aloud that I could suck the fat out of her rear and put it into her breasts. Just imagine– get rid of the unwanted adipose that is not cooperating with your favorite jeans and reassign those fat cells to the task of increasing your cup size. Now that is a win-win situation, right? Read on…

Breast augmentation is incredibly common, with about 300,000 women having the procedure in the United States each year. The satisfaction with the procedure is very high and the vast majority of women would have breast implants placed again. In our Cincinnati, Ohio center, about half of women choose silicone and half choose saline. Although the current range of breast implants are safe, there are obvious advantages to using your own tissues, if possible.

Breast enlargement with implants may require further operations in the future because breast implants are not permanent devices and can wear out over time. Breast augmentation with your own fat avoids this problem. Also, you can usually feel breast implants to some degree. This is not bothersome to most patients, and silicone implants are very soft. However, there is an advantage to using fat because most of the breast is made of this in the first place. It feels more natural because it is natural.

Despite these advantages, caution is advised. We do not know the long term effects of large volume fat injection into the breast. It is probably safe, but studies are looking at this. Smaller volumes of fat injection are frequently used as a supplemental procedure in breast reconstruction. It is a fantastic way to fine tune the shape of a reconstructed breast.

One concern is that injected fat does not always survive. When it dies, it can harden from calcium crystals forming in the expired clumps of fat. When you are using the larger volumes of fat required for cosmetic breast enlargement, this creates two potential problems. First, you may feel these calcified areas as lumps. Second, these areas can be seen on mammograms, which may interfere with breast cancer surveillance. These issues are not generally a problem when the fat is injected in tiny amounts. Small particles of fat tend to survive well.

Beyond safety are some practical issues. It takes many hours to perform this procedure since the fat must be injected in minute quantities at a time. It can take as many as six or eight hours. This means that the procedure will cost much more than a one to two hour breast augmentation with implants. Additionally, since all of the fat may not survive transfer, multiple procedures may be necessary to get enough fat to create the right size. Thin women may not even have enough extra fat to achieve the size they want.

As you can see, this is more complex than it initially seems. This blog only scratches the surface. Fat injection for breast enlargement will likely turn out to be a great option for some patients, but not everyone. Breast implants provide safe, consistent results and help many women achieve their breast size goals. Contact us to set up a consultation in one of our Cincinnati area offices today.

Additional breast augmentation information

Click here for breast augmentation before and after pictures

New Breast Implants in 10 Years?

Breast Implant Position

Silicone vs. Saline

Learn about the cost of breast augmentation and other plastic surgery procedures

Blog about breast augmentation from Cincinnati plastic surgeons for women across the United States

Our Cincinnati plastic surgeons are committed to educating you about breast augmentation. As we discussed in the blog, Implant Strength, rupture rates for breast implants are low. However, it is important to know how to monitor for rupture so that you can keep your result looking great. Tracking this is different for silicone and saline implants.

For saline implants, a rupture is obvious soon after it occurs. The size of your breast will decrease as the salt-water leaks and is absorbed by your body (which is mostly made of salt water).

For silicone implants, it is not as obvious because the silicone gel is thick like pudding and is not absorbed. In fact, it usually remains inside the scar tissue capsule that naturally forms around the implant. You may notice a change in shape or feel or you may not notice anything different. An unnoticed rupture is called a “silent rupture.” Scientific evidence does not show any risk of illness in this situation, but you may have a higher chance of developing capsular contracture. The FDA recommends MRIs after augmentation with silicone breast implants to monitor for ruptures since they are less noticeable than with saline implants. An MRI is recommended every 2 years, starting 3 years after your augmentation.

In the event of a rupture, first understand that this is not a medical emergency. You do not need to drop everything you are doing and rush to the hospital. You will probably feel like this is a cosmetic emergency. We understand this and empathize. Call our office and one of our plastic surgeons will see you ASAP. The solution for a broken implant is generally to remove the old implant and replace it with a new implant. This can usually be done through the same incision without giving you an additional scar. We go out of our way to schedule these procedures quickly to get you looking better fast. Rupture does not happen very frequently, but it is reassuring to know that if it does occur, it is fixable.

Contact us to set up a consultation to discuss breast augmentation.

Click here to see breast augmentation before and after pictures.

Click here to learn more about silicone versus saline breast implants.

Click here to learn about the cost of breast enlargement, plus financing options.

Part 1of 3: The pros and cons of Saline Breast Implants

This is Part 1 of a three-part blog centered on the issue of deciding whether you want saline breast implants or silicone breast implants. In order to make an informed decision on this very important issue, you first must be very familiar with all of the advantages and disadvantages of saline and silicone breast implants. This part will focus on saline breast implants. Part 2 will focus on Silicone breast implants. And Part 3 will tie it all together and help you figure our which is best for you, with some important tips from me.

The advantages of saline breast implants are several. They are not listed in any particular order.

• Lower cost: Saline implants cost less than silicone breast implants by about $900-$1300 per pair (depending on your plastic surgeon). This has nothing to do with the way they are placed. It has only to do with the cost of production of the implants that the manufacturers charge to your plastic surgeon. Silicone implants simply cost more to make.

• Shorter scar: Saline implants are deflated when they are placed, so they can often be placed with a shorter incision (and shorter subsequent scar) than silicone. In most cases, the difference is less than an inch. In the case of small silicone implants, the difference may be negligible, as small silicone implants can often be placed through an incision the same size as a saline implant.

• No concern over silent rupture: Saline implants do not have silent deflations. In other words, if your saline implants deflate, you will know it right away. It may seem odd that this is an advantage, as no one really wants their breasts to shrink – especially quickly and with no warning. But, compared to the issue of silent rupture (in which the implant shell has torn but there is no way of knowing it, which may be the case with silicone breast implants), this is seen by some as an advantage compared to the alternative of simply not knowing.

• No concern over silicone leakage: Upon deflation, your saline breast implants will be releasing saline into your body. Saline is a natural fluid which is typically administered intravenously. So the release of several hundred ml of saline into your body will simply hydrate you, as the concentration of saline in saline breast implants matches that of the saline in your body fluids.

• Lower Risk of Capsular Contracture: The risk for capsular contracture with saline implants is lower than that for silicone implants. This comes about for a few reasons. The actual risk difference appears as though it will end up being about 1% per implant per year – which is important if you are in that 1%. It also is important with time, as after 10 years, the difference in risk of capsular contracture may be as high as 10%, with more occurring in those who have silicone breast implants.

Saline breast implants have two main disadvantages.

• Less favorable cosmetic outcome: Saline breast implants simply do not result in as natural a breast as silicone breast implants for most women. Just how natural (or unnatural) the saline implants look and feel has everything to do with how much breast tissue a woman has before breast augmentation: the more tissue, the more natural is the final result; the less tissue, the less natural is the final result. For practical purposes, the result is judged on two issues: how natural the implanted breast feels and how natural the implanted breast looks. The following three examples will help illustrate this important point:

• Example 1: A woman with almost no breast tissue. A woman with breasts that are so small that she does not have a crease beneath her breasts will have the most unnatural result with saline implants, compared to women with more breast tissue. Her implants will be easily felt through the skin – and this is true regardless of whether she chooses to place the implants under or over the muscle. Her implants will be clearly evident upon feeling the lateral side of the breast and the bottom of the breast, as muscle fails to provide additional cushioning in these places even if the implants are placed under the muscle. Moreover, this woman will ALSO tend to appear quite unnatural with saline breast implants. Her breasts will tend to appear round rather than breast-shaped. In other words, her implanted breasts are likely to look AND feel unnatural. From a cosmetic standpoint, this woman is absolutely best suited for silicone breast implants. (Note that some plastic surgeons would recommend a teardrop implant for these women, but teardrop implants imposed a number of other unfavorable issues.)

• Example 2: A woman with moderate to significant breast tissue. A woman with a significant amount of breast tissue – particularly firm breasts, as opposed to flaccid breasts – will look and feel the most natural with saline breast implants (as compared to women with less breast tissue or flaccid breasts). This woman will almost certainly have the same appearance regardless of whether she chooses saline or silicone. She may even have the same feel with saline as she does with silicone; but this will depend upon the amount and consistency of her breast tissue. In this woman, the difference between saline and silicone is typically minor and possibly indistinguishable. From the standpoint of cosmetic results, this woman can typically easily select saline breast implants without much (or any) cosmetic compromise. (The exception here is the woman who chooses large saline implants which have a higher rate of downward displacement (see below) than same-size silicone implants. So, I tend to steer women in this category toward silicone in order to avoid downward displacement. Under no circumstances do I advocate that these women choose a smaller size in order to be able to choose saline, as SIZE MATTERS!! My philosophy and strong recommendation is to select the very best size and work everything else around that decision.)

• Example 3: A woman with small breasts who is somewhere between Example 1 and Example 2. A woman with breast tissue somewhere in-between will end up with a result…well…somewhere in-between. She will most likely feel the implants through her skin, but her breasts will typically not appear any different than if she had had silicone implants. In other words, her breasts will clearly feel more natural with silicone than with saline, but her appearance will not likely vary. This woman is the most typical woman in my practice – and in most plastic surgery practices.

• BTW, when I talk about how the breast FEELS, I am talking about what the breast feels like to the fingers that are touching it – not how the breast is perceived by the woman with the implant when she is not touching her own breasts. In fact, whether silicone or saline, unless a woman is touching her own breasts, they will typically feel the same to her in terms of her perception of them on her chest wall.

• Increased risk of downward displacement for larger implants: The risk of downward displacement is greater in saline implants than silicone implants, particularly larger ones, such as those above 500 cc. Yet, even in this population, the issue of downward displacement is not the rule, just a greater risk. For most women, this issue is not nearly as much of an issue for smaller implants, so unless you are considering a larger implant, do not fixate on this. By the way, there is not a clear cut-off at which point the rate of downward displacement goes up. This is more of a slippery slope such that the larger you go, the greater the risk. There is almost no difference of risk of downward displacement between implants that are 30 or even 50 cc apart; but there is a difference between implants that are 300 or 500 cc apart. So, I guess what I am trying to say is that the 500 cc amount is not a clear cut-off. If anything, it is a general guideline. Also, for what its worth, I think that the cut-off defining which size implants are more likely to displace downward varies from woman to woman, depending upon how stiff or flaccid her breast tissue is. I think that a woman with firmer stiffer breasts may do well with saline implants of 600 cc, 700 cc, or even 800 cc without having the problem of downward displacement. However, a woman with flaccid, loose, floppy breasts (irrespective of droop) may suffer downward displacement with implants that are 400 cc or even 300 cc. So, again, there is really no clear line. The 500 cc mark is really just a general reference. Having said that, it is very true that IF you did select a saline implant which did result in downward displacement; it is very possible that a similarly sized silicone implant might not have.

In Part 2, I will cover the pros and cons of silicone implants. In Part 3, I will tie everything together and tell you what I tell my patients.

Breast Wishes!

Jean M. Loftus, MD

PS – Unless someone starts to complain, I might just keep on saying Breast Wishes, even though it really goes against my grain as an author…

PPS- Please do throw your comments into the pot. I’d love to hear from you.

Click here to see Breast Augmentation Before and After Images

Part 2 of 3: The pros and cons of Silicone Breast Implants

This is Part 2 of a 3-part blog centered on the issue of deciding whether you want saline breast implants or silicone breast implants. Before reading Part 2, please read Part 1 of this blog which focuses on saline breast implants. Part 2 will focus on silicone breast implants. And Part 3 will tie it all together (along with some advice from me) and help you figure our which is best for you.

The advantages of Silicone Breast Implants are…..

• Silicone implants simply look and feel more natural than saline (provided that they do not get a capsular contracture – in which case, they will probably look and feel worse). The degree of difference between silicone and saline depends to a very large extent on the amount of breast tissue you begin with and the firmness of your breast tissue (explained in Part 1). In general, the larger and firmer your breasts, the less of an advantage silicone will offer in terms of natural look and feel over saline breast implants, because saline implants can feel pretty natural in some women with generous breast tissue. Conversely, the smaller your breasts, the greater the difference there will be between saline and silicone implants. (Speaking of which, size and firmness are not related, as some women with small breasts have firm beasts, and some women with large breasts have flaccid floppy breasts – and vice versa.)
• Large silicone implants are less likely to displace downward due to gravity than the same-sized saline implants. This is because silicone weighs less than saline. As downward displacement can sometimes be difficult to fix, this is not a minor consideration in those who choose larger implants. See Part 1 of this blog for more details on this issue.

The disadvantages of silicone breast implants are …

• Silicone breast implants have a greater risk of capsular contracture than saline. The difference may be as small as 1% per implant per year, but it is a difference.
• Silicone implants cost more by about $1000 per pair.
• Silicone implants often require a longer scar – unless they are small implants, in which case, they can often be placed through a shorter incision.
• Silicone implants may rupture silently. This means that they may rupture, but you may not know it. If a silicone implant ruptures, it will either trigger a capsular contracture, or it wont. If it does not trigger a capsular contracture, you may not know that it has ruptured – this is called a silent rupture. In order to monitor women for silent ruptures with silicone breast implants, the FDA has recommended that women get MRI scans of their breasts every other year beginning after the implants have been in place for 3 years. There are a few problems with this recommendation: 1) cost and 2) false positive MRI results. The cost of and MRI scan can range from about $2000-3000, and insurance may decline coverage for such scans if related to previous implant surgery. A False Positive is a medical test which indicates you have a problem or condition when in fact you do not have it. So, a False Positive MRI scan may show a ruptured implant when in fact the implant was intact. This can create unnecessary surgery and distress. As a result of these issues, many plastic surgeons (including myself) do not recommend routine MRI scans unless the patient is having problems or unless the patient requests an MRI scan.

Aside and apart from these issues, one issue to think a bout is whether you are comfortable with the concept of silent ruptures. Many plastic surgeons feel that ruptured silicone implants do not impose any actual or potential general medical problems and that the main drawback of a ruptured implant is potential capsular contracture. Most women are in turn comfor6table with the possibility of silent ruptures. However, there are some women who are not comfortable with the concept of silent ruptures and who would be distressed over this possibility. I do not recommend that these women have silicone implants, as the purpose of implants is to make your life better – not more stressful.

Sorry for the delay in getting Part 2 posted. Hopefully it was worth the wait! Please stay tuned for Part 3 in which I will tie everything together and tell you what I tell my patients.

Breast Wishes!

Jean M. Loftus, MD

Click here to see Breast Augmentation Before and After Images