Breast Augmentation: Lessons Learned From 56,000 Breasts

I’ve examined a lot of breasts – at least 56,000 – during my career as a plastic surgeon. How’d I get to that number? About 7,000 women have come to me for breast augmentation surgery. On average, I see each woman about four times – once before her surgery and three times afterward for post-op visits.

So, 7,000 women x 2 breasts x 4 visits = 56,000. That’s not a problem that would have been on your sixth-grade math homework.

Through the years, I’ve observed every variation in breast size and shape, in breast perkiness and nipple size, and in women’s thoughts about their figure and their surgical goals.

If I could sum up what I’ve discovered in one sentence, it would be this: You shouldn’t make assumptions about who gets breast augmentation – and why.

Don’t assume that . . . 

. . . many of my patients are exotic dancers. Only about 1 percent of my patients are exotic dancers. The other 99 percent include teachers, nurses, hairstylists, construction workers, doctors, ballroom dancers, stay-at-home moms, company executives, waitresses, fitness trainers, bartenders, cheerleaders, policewomen who want to know how soon they can put their bulletproof vests back on, and women in all branches of the military who email us from Iraq and Afghanistan to set up appointments for when they are back in the United States. This is not a complete list.

. . . breast implants are just for younger women. True, the large number of breast augmentation patients are in their 20s, women who come in because they want to feel more feminine and self-confident. “It’s pretty bad when your 13-year-old sister can already wear your bra,” one woman told me.

The second largest demographic is in their 30s. Many women in this age range come in because they liked the fullness of their breasts during pregnancy and want to recapture that look. Others have lost weight and with it their breast volume.

Women 40 and older – and even in their 60s – come in for breast augmentation surgery, too. They want to look as good on the outside as they feel on the inside. They tell me they’ve been taking care of everyone else for years and now they’re ready to do something for themselves. Many have been thinking about breast augmentation for years.

. . . women get breast implants to attract attention. “Do you want to be proportional, turn heads or stop traffic?” That’s what one of my colleagues asks a prospective breast augmentation patient to see what she has in mind. I’ve tried it. Most women tell me they want their figure to be more proportional, and they want to fit better in their sweaters, bikinis and tank tops. Some comment that they wouldn’t mind turning heads now and then. Not many want to stop traffic. Ironically, some of my patients are policewomen who literally stop traffic – but they would rather not do it with their breasts.

. . . women get breast implants to make men happy. Only two women out of 6,000 have ever told me that their partner wants them to get implants. Instead, women have consistently told me that their partners love them exactly the way they are, and they are having surgery to make themselves look and feel better. So, sorry guys. Women don’t get implants to please you. That might be an outcome, but it’s not the motivation.

. . . a woman’s breasts are the same on the right and left side. Breasts are sisters, not twins. Few women have identical breasts; the difference might be slight or more obvious. Nipple position, chest diameter, the amount of breast tissue, the location of the breast on the chest wall, and how high or low a breast hangs all contribute to the appearance. With all these variables, it is no surprise that no one has identical twins.

. . . women need much guidance from me. Women know what they want. During medical training, we are taught that we should know the answers, that we are the authority. But I have discovered that women know best. My job is to listen carefully and to determine if there is a match between their goals and what I can accomplish. I believe I am an expert at figuring that out.

“I love my implants, but I wish I went bigger.”

“Worth it but kinda wish I went bigger.” “Love ‘em but wish I went bigger.” Breast augmentation forums, such as RealSelf.com, are filled with comments like these.

After doing thousands of breast augmentation consultations, I’ve identified four reasons that women hold back from choosing the size they really want to be. If you can avoid these traps, you’ll likely be satisfied with your choice after surgery.

Holding back based on concerns that people will “know.”
Some women don’t want others to know they had a breast augmentation, so they choose smaller implants: “I don’t want to look fake.” “I don’t want people to notice.” “I don’t want people to judge me,” they say. They need not worry.

I assure patients that most women look natural and proportional after their breast augmentation surgery and can keep it a secret if they are so inclined. Patients tell me that their most observant friends and family members are often aware that something is different. They ask questions: “Are you just back from vacation?” “New haircut?” “New outfit?” “Are you working out now?” They can’t figure out exactly what has changed.

Choosing implant size by looking at pictures taken at 3 months after surgery or earlier, instead of looking at fully settled breasts.
When post-op photos are not labeled, you don’t know how far along a woman is in the Screen Shot 2016-01-19 at 9.12.18 AMhealing process. If you are looking at online photos taken 3 months or less after surgery, consider this: The implants have not yet settled into their final position. They are pressed up high, like your breasts would be in a push-up bra. They are not fully settled until 9 months post-op, and at that point they often will look smaller than they do at 3 months. You’ll likely be disappointed if you choose your implant size from pictures that were taken three months after surgery.

In general, your breasts look smaller when you are dressed than when you are undressed. So my before and after photo book includes pictures of women 9 months after surgery both unclothed and clothed, in a bra, tank top or blouse.

Making a decision based on cup size.
Our last blog post explained that being proportional doesn’t mean wearing a C cup bra. Click here to read “Can you make me a full C cup?”

Making a decision based on Internet forums and input from friends.
You might like the 375 cc implants you saw online, but are you comparing apples to apples? The woman whose breasts you were admiring might have started out with breasts that were larger or smaller than yours, and she might be a different height and weight, too.

If you’re starting with a full B cup and that woman started with a mid-A, you won’t end up the same size when you both get 375 cc implants. You’ll be about 1-1/2 cup sizes bigger – the extra cup you started with.

Likewise, friends who have implants might weigh in on your choice: “One of my girlfriends who has implants said that the implants I selected are too large for me. She has me second-guessing myself,” a patient told me.

My advice is that after you’ve looked at pictures of women who are similar to you and your frame, and you’ve chosen the size that seems right to you, trust yourself. Go with your gut or your heart – not your head. Remember that you’re the expert for yourself.

Bra Rules I Didn’t Know

Screen Shot 2014-11-12 at 11.12.17 PMEarlier this month, Megan Mayer wrote an article for the Huffington Post entitled “The 6 Most Basic Bra Rules You Probably Didn’t Know.” When I saw the title, I was certain I’d know all of the rules, since I’ve examined more than 6,000 women who have come to my office for cosmetic breast surgery. Turns out I scored 50 percent: #2, #4, and #5 fooled me.

Below, you’ll find Megan’s rules in orange and purple and my comments in black.

1. Bras will never be a comfortable clothing item. Their primary function is to support your breasts, so they are supposed to be firmly hugging your torso.

When my wife, Joyce, takes off her bra at night, she lets out a great big sigh. She’s always in search of a comfortable bra and never seems to find one. It makes me glad I don’t have to wear one.

Joyce is the co-author of The Dictionary of Jewish Words, where you’ll find the Yiddish word mechayah, which perfectly describes the feeling of relief she gets when she unhooks her bra at the end of the day. My mother defined mechayah as the feeling she got when she took off her girdle. It also describes how it feels to take off your stilettos.

2. Clasp those babies. To preserve your bras, be sure to CLASP them while they live in your underwear/bra drawer so they don’t get caught on other articles of clothing.

Joyce doesn’t clasp her bras; she hangs them on the doorknob of our bedroom closet for easy access, which makes sense to me. I can throw my underwear in the drawer without arranging it a certain way. This is one of the benefits of being a guy.

3. You should definitely have more than one bra. Bras are like underwear — you should have more than one pair and rotate them.

Maybe I’m an optimist, but I thought that everyone would know and abide by this rule. Megan could have eliminated it and used this one instead:

You don’t need to wear a bra. A bra will keep your breasts from sagging, but only while you are wearing it. There’s little evidence that wearing a bra delays or prevents breast droopiness or the formation of stretch marks.

4. Be aware of the gore. The center of the bra that connects the cups in front is called a gore.

It’s interesting that someone picked a word that also means bloodshed and carnage to describe this bra part. When I looked it up in the dictionary, I found out that the gore, a triangular piece of material, is used not only in making bras but also for umbrellas and sails.

5. Hand wash your bras. No dryers and no dry cleaners. Hand washing will maximize the life expectancy of your delicates.

I never thought about how you washed a bra, but if I did, I’d imagine you’d throw it into the washing machine. Happily, I can throw my underwear in the washing machine. This is another of the benefits of being a guy.

6. Your bra size is subject to change. You are most likely a different bra size at various undergarment stores. Just like clothes and shoes, bra sizes run differently.

I run into this issue every day in the office when women tell me that what cup size they want to be after surgery. The problem is that a C cup can mean one thing if it’s made by Victoria’s Secret and another if it’s made by Vanity Fair. A woman might wear a B cup in a full-coverage bra and a C cup in a demi bra, even if the same company makes both styles.

Because there is no standard cup-sizing system, I prefer to call it a C look. And to achieve a C look, a 5-foot woman with a small frame might need a B cup while a 5-foot-8-inch woman with a large frame might need a D cup.

Screen Shot 2014-11-12 at 10.19.12 PM

Can you add more saline to my implants so I don’t have to have surgery again?

By Dr. Ted

Technically, I could open your incision and add some saline to your implants, but it doesn’t make sense. Here’s why: Implants come in various sizes, like 325 ccs or 450 ccs, and they can’t be expanded an infinite amount. If implants are over-expanded, they will feel hard, like balloons that have been blown up too much. There might be room for a little bit more saline solution (salt water) – maybe two tablespoons at most ­­­– the amount of oil you would add to your pancake mix. This small amount would be barely noticeable. In fact, you could get the same look by wearing your bra one notch tighter.

In 1937, Warner’s introduced its “Alphabet Bra” with A, B, C and D cups. Before too long, these cup sizes got nicknames: egg cup, tea cup, coff ee cup and challenge cup.

In 1937, Warner’s introduced its “Alphabet Bra” with A, B, C and D cups. Before too long,
these cup sizes got nicknames: egg cup, tea cup, coffee cup and challenge cup.

Women come to me with the request to “go bigger” often after significant weight loss (about 10 percent or more of their body weight) or after pregnancy, when their breasts may have changed because of hormonal fluctuations and milk production.

In my experience, women want an increase of about one cup size or more, which would be equivalent to anywhere from 150 to 225 ccs, depending on the size of their frame. To accomplish this, they would need larger implants.

By the way, bigger implants aren’t more expensive than smaller ones. Manufacturers don’t charge by the cubic centimeter: They charge one set price for all off-the-shelf saline breast implants, whether they are 200 ccs or 600 ccs, and another set price (about $1,000 higher) for silicone gel implants.

Breast augmentation is easier the second time around, because the pocket around the implant has already been made and has already healed. During surgery, I would place a larger implant through the initial incision, which was made in the crease below the breast where the breast and the chest meet.

Post-operatively, to protect the incision, I ask patients to wear a supportive bra or a sports bra for three weeks. They report significantly less discomfort than the first time around, and women who have surgery on Friday are usually back to work on Monday if they work in an office setting.

The saline implants used during breast augmentation surgery are different from the temporary tissue expanders used during breast reconstruction surgery. These have a tube that runs from the expander to the skin near the outside of the body. Saline can be added over a period of months to gradually stretch the muscle and skin. The expander is then removed and replaced with a permanent implant.

P.S. While saline implants come empty and are filled after they are inserted, silicone gel implants come filled. There’s no way to add silicone to them.

 

I’m hoping to get pregnant in the next year. Should I wait to get breast implants?

Written by Dr. Ted

It’s no surprise that this question comes up frequently during consultation. My patients range in age from 18 to 63, but the large majority of them are in their 20s and 30s – prime childbearing years. 

The bottom line is this: If you are thinking about having a child in the next year or working on it now, I would suggest that you wait because your post-pregnancy breasts might look quite a bit different from your current pair.

Screen shot 2013-01-28 at 10.36.10 AMDuring pregnancy, your breasts will enlarge from hormonal changes and milk production. In fact, many women report that they grew at least a full cup size, sometimes more. Those women who started out smaller often tell me that they liked being bigger and fuller.

“Those early pregnancy breasts are something to behold . . . It’s a fleeting time, those early breasts, but for a couple months, before the tummy catches up, it’s as though you get a free boob job,” wrote Sasha Brown-Worsham in  “The Five Stages of Pregnancy Breasts,” which appeared online in The Stir.

Some women who start out with a D cup aren’t so enamored with their new breast size: In an online forum, one mom wrote,Before pregnancy, I was a solid 36D. I am now 36 DDD (which is equivalent to 36E), and I am only 12 weeks pregnant! I think the 4 pounds I have gained during my 1st trimester have gone straight to my boobs, and I am kind scared to see how big I will be by the end.”

After your pregnancy, your breasts might return to their original size or get smaller, bigger or droopier. There’s no way to predict the future; as Alphamom writes in “Postpartum, Posteverything Boobs,”  it depends on a lot. “Genetics. Your age. Your cup size. How long you breastfed. Number of children. Basically, it’s a total freaking wild card.”

You won’t know the outcome until six months after you have stopped breastfeeding or, if you are not breastfeeding, six months after childbirth. In order to choose breast implants that will make you proportional, you need to know your proportions – and your true starting size.

However, if parenthood is further down the road and you are anxious to enjoy new breasts now, you don’t have to wait. You just have to understand that you might need a revision after your pregnancy.

“At what age were you the happiest with your breasts?”

Ultimo Beauty, best known for its “Miracle Solutions Plunge Bra with silicone gel that can add up to two cup sizes,” recently conducted a study on women’s views on their assets. Results showed that “women are most happy with their breasts in their mid-20s, with 38 percent saying that was when they were most satisfied.”

When they crunched the numbers further, they discovered that “British women rate their boobs most highly when they hit 26.” What’s a 26-year-old look like? Think Lindsay Lohan, Megan Fox or Lady Ga Ga.

Screen shot 2013-01-21 at 10.58.39 AMWhen I think back, I remember some things about my 26th year: my job (I worked at the Jewish Exponent in Philadelphia), my apartment (a townhouse in Roxborough), my husband (that same Dr. Ted who I’m still married to!), and my dog Ginger (a Cairn terrier who looked like Toto in The Wizard of Oz,) but it’s hard to imagine my 26-year-old boobs and how they looked compared with my 24- or 28-year old boobs.

So I brought out an old photo album and searched for my 26-year-old self. I found a picture of me in a bikini on the beach at a Club Med in Guadeloupe, and I looked damn good. I guess I could vote for 26, too.

THE TEEN YEARS
Next, Ultimo found that “a wistful 28 percent of women admitted they thought theirs were best during their teenage years.”

I wouldn’t agree: My breasts didn’t amount to much in my teen years. I was envious of  the friend in my middle-school crowd who was the first to develop and wear a bra. If she were British, she would have been one of the 28 percent, I suspect, because when I saw her as an adult, it turned out she was an early starter, rather than a strong finisher.

What changed for me between ages 16 and 26? I gained a little weight, and my breasts, which are made up primarily of fatty tissue, were the beneficiaries. Unfortunately, these days when I gain some weight, it goes straight to my butt or my hips, not to my chest. Not fair.

THE 30s
Finally, Ultimo’s survey revealed, “One in seven (14 percent) claim they were at their best in their 30s.” My breasts were at their peak, so to speak, when I was in my 30s, specifically at ages 32 and 35 when I was pregnant with my son and then my daughter. Thank you, children. However, the size increase was not long-lasting. After I stopped breastfeeding, I returned to my pre-pregnancy size.

What does the future hold? It doesn’t hold up your breasts. “Generally things start heading south after women hit their late 20s,” the survey concluded.

You could consider options, like a breast lift or a good support bra that does the lifting for you – bras with names like “Ultimate Lift” or “Magic Lift.” The survey didn’t talk about what happens to breasts when they turn 65. But we know that they’ll get some good “perks” – like $2 off on a movie ticket and a discounted cup of coffee at McDonald’s. Now that’s something to look forward to.