Breast Augmentation

Breast Augmentation with Implants

Real Patient Story

 

Left: 33-year-old mother after having one child. She lacked upper pole fullness and was asymmetric. Right: 6 weeks following breast augmentation with Dr. Duncan. She has tasteful cleavage and improvement of asymmetry.

To view all of my before and after photos, click here to visit my Breast Augmentation gallery.

My goal with breast augmentation is a natural yet beautiful appearance. I look for enhancement rather than distortion in my preferred outcome. I specialize in a natural, conservative style. This means I don’t use overly projecting implants that look too big for your frame or “stuck on.”

Many women are self-conscious about their disproportionately small breasts. There are many reasons for small breasts:

• Genetics and a thin stature generally cannot change without some surgical help.
• Many women get smaller and droopier breasts after breastfeeding their children.
• Weight loss can also result in a desire for the restoration of a fuller and perkier appearance.

Who's a good candidate for a breast aug?

Good candidates for breast augmentation:

• Are looking for classic and tasteful results.
• Are healthy and have realistic expectations.

Poor candidates:

• Are looking at implants as a replacement for a breast lift.

Understanding Implants

Silicone versus Saline?

Saline or silicone gel? Many people still view saline as “safer” than gel implants, despite FDA approval of several brands of gel implants for use in breast augmentation.
The lifetime of a saline implant is generally quite a bit shorter (7-10 years) than a cohesive ‘gummy-bear’ gel implants (20-25 years barring trauma).

Gel implants tend to migrate down and out into the armpit less than saline implants. Saline implants tend to deflate suddenly, causing an urgent need for repair. Cohesive gel implants do not suddenly lose volume. A significant injury would be needed to cause the gel to leak out of the shell. Since gels last longer, hold a better shape and need less frequent replacement, I tend to use cohesive gel implants for my patients.

Smooth or textured? 

 

 

 

 

Textured or smooth implants? Textured implants were popular for a while as they were supposed to reduce the incidence of capsular contracture. However, my experience has been that contracture is actually more common with these implants. They feel a bit more firm than smooth implants, and they don’t tend to shift naturally as smooth gel implants do. They are good for patients with recurrent migration. Otherwise, most of my patients prefer the smooth cohesive gel implants for a top long-term result.

What about Profile?

Question: “I went to another doctor who only uses high profile implants. Why won’t you put in implants with a high profile?”

Answer: See the photo below. She went to a doctor who only uses high profile implants. Her outcome was not satisfactory. Because the high profile implants have a very narrow base and a lot of projection, using them is like stuffing a grapefruit into a breast. The look is very unnatural as there is an upper hump and no lower pole fullness.

My 8 Rules of Breast Augmentation

1. The ideal proportion of a breast is 40% of the volume above the nipple; 60% below the nipple.
2. The nipples should point forward, not up nor down.
3. The lower breast has a pretty round curve and a well defined infra-mammary crease.
4. The upper pole of the breast should be full, without a defined ridge or “hump.”
5. Fill out the entire breast without a flat spot on top nor a big gap between the breasts.
6. The décolleté should have a gentle swell, not a flat spot, then a bump.
7. The key to a good outcome is using the broadest implant that fits each individual’s frame. I use smooth, round, moderate implants for most of my patients. As you can see, this does not result in a flat silhouette. The higher profile implants tend to have a base that is too narrow to give the desired contour.
8. Never go too large. Big implants make people look overweight, matronly, or trashy. I recommend thinking about this as a lifetime choice; classy and tasteful will last much longer than a dramatic overstatement!

This patient’s before (left) and after (right) results show all of my criteria for a good breast augmentation outcome (rules number 1 through 8, above).

To view all of my before and after photos, click here to visit my gallery.

Brief Overview of the Procedure

Surgery
After making an incision under the breast, Dr. Duncan carefully opens the pocket underneath your pectoral muscle. She then inserts a ‘sizer’ implant and lifts the back of the table to see if that size gives the desired aesthetic result. If not, she’ll try on another sizer. Once it passes her standards, she replaces the sizer with the implant that will stay with you, and closes the incision.

What to Expect

Goals

Most plastic surgeons can make breasts larger; our goal is to make them look prettier. Implants can fill out and lift mild sagging, but moderate to severe drooping as assessed by Dr. Duncan may require an additional lift procedure. This surgery is not intended to lift the breasts and no patient starts out with perfectly even breasts, no patient will have breasts that match exactly afterwards.

Dr. Duncan

A board-certified plastic surgeon, Dr. Duncan has been operating for over 30 years here in Fort Collins, CO.

Her breast procedures are some of the most sought-after as many of our patients are more comfortable with a female surgeon, especially one with her breast expertise. Her signature look is sought after by patients’ who want a natural and tasteful appearance. as opposed to oversized implants.

Prior to Surgery

• Prior to surgery all patients must get a COVID-19 test the week prior and remit results to us. A positive result will necessitate rescheduling.
• Please stop all hormones (including oral birth control) 3 weeks prior along with any NSAIDs (Advil, Aleve, etc).
• Make sure you have a caregiver lined up that can pick you up following surgery and stay with you for at least 24 hours post-op (Lyft/Uber are not acceptable rides home but we do use BrightStar Home Care!).

Surgery

• Upon arrival to our office one of Dr. Duncan’s assistants will get you started with vitals, IV and other pre-op necessities in an exam room.
• Dr. Duncan will run through everything one more time, mark you and our anesthesiologist will also chat with you regarding any anesthesia concerns.
• We’ll head to the OR, you’ll take a lovely nap and wake up with a new chest!

Post-Operatively

• Please refrain all hormone use (including oral birth control) 3 weeks post-op along with any NSAIDS (Advil, Aleve, etc).
• Make sure you have a caregiver lined up that can pick you up following surgery and stay with you for at least 24 hours post-op.
• We will safety pin your sleeves to your sides to remind you to restrict your arm motion — think about being a baby T-Rex. This means no picking up kiddos, dogs, or doing housework!

Recovery

• Post-operative success is dependent on a team effort; we can control what happens in the office but you are in charge in the world at large!
• Full arm extension overhead will not be advised until 4 months post-op. Pulling on incisions will increase scarring, weaken the closure and increased inflammation in the pocket can cause capsular contracture.
• Patients can get into the ocean at 3 months, but we recommend avoiding hot tubs and saunas for a year in order to avoid burns and micro-infections.
• No contact sports/intense workouts for 4 months post-op.

Common Complications

Capsular contracture (capsule thickening resulting in hardening and tightening of the pocket), spitting sutures, implant migration and asymmetry are all common post-op concerns following augmentation.

Though more rare, implant rupture is a possibility following trauma or other implant impingement.

Warranty

Mentor (our implant manufacturer) offers warranties on your implants following surgery. There are options; learn more at MentorDirect.com! To register your implants, visit MentorDirect.com/Warranty