The Guide to Modern-Day Breast Surgery


Our breasts seem ever-changing throughout our lives. If you really think about it, their size, shape, position and fullness can look or even feel differently from one day, month or year to the next. Depending on the clothes we wear, our hormonal changes, how many children we’ve had or haven’t had, or whether or not we’ve had breast surgery before, our boobs continue to have contrasting needs at various stages of our lives. If you have questions on the many ways to get the breast profile you’ve always wanted, we have answers.

Satisfaction Rate

A recent study published in the journal Body Image analyzed data about how women around the world felt about their breasts. Nearly 71 percent of participants said they were dissatisfied with their breast size, and less than a third, about 29 percent, responded that they were happy with their breasts.

New York plastic surgeon Daniel Maman, MD, has noticed a recent trend at his practice toward patients wanting a smaller, more natural-looking breast profile. “Many patients find them more aesthetically pleasing and they carry a far less-significant complication profile.”

The Right-Fitting Bra

Before and after a breast augmentation procedure, one of the most important things Las Vegas plastic surgeon Mary C. Herte, MD goes over with her patients is whether or not they are wearing the right bra for their breasts and body size. “If you’re not wearing the proper bra, you are not making the most of what you have and you’re not protecting your investment. Most women focus on cup size, when in fact they need to make sure they’re wearing the right band size also. I find that most women I see are wearing bands that are way too big.”

The Bra-Band Effect

According to Dr. Herte, the bra band should be tight enough so that the breasts don’t slide out from underneath it. It should also create a flatness around the rib cage that smooths out the skin in that area. “A too tight elastic on top and a flimsy bra band on bottom can cut into the back, which can cause bulging and emphasize any excess fullness on the back.”

Dr. Herte also notes that cup size is related to band size. “Proper cup fit is directly influenced by band size. As the band size changes, so should the cup. For every band size you go down, you should go up one cup. Someone who is a 34D and wants to wear a size 32 band would then need to wear a 32DD cup in order to switch to a tighter band with the same cup fit.”

Bra Fat + Side Boobs

While ill-fitting bras may contribute to bra-fat and side-boob concerns, sometimes even the best bra can’t conceal some of these issues. “The breasts are composed of both tissue and regular subcutaneous fat,” says Dr. Maman. “As weight fluctuates, the fatty component of the breasts can increase. When diet, exercise and the right-fitting bra haven’t solved the issue, I often recommend liposuction to smooth the area for good.”

“If you do have a disproportionate deposit of fat in the bra area, I also recommend liposuction,” adds Dr. Herte. “But if you want to treat the area without undergoing surgery and with less downtime, then CoolSculpting can also be very effective.

Popular Implant Materials + Techniques

“Silicone is the most popular breast implant material because it looks and feels more like natural breasts with less obvious wrinkling and rippling, which sometimes accompanies saline implants,” says Dr. Maman.

According to New York plastic surgeon William Lao, MD, at his practice, the conversation about incisions is just as important as the conversation about size and material. “Most commonly, implants are placed underneath the breast in the inframammary incision in the breast fold. I place the implants through the armpit through a transaxillary incision, which helps avoid a more noticeable scar. It’s more technically demanding, more tools are needed and the procedure takes longer.” However, in some cases, once the implants are placed and the surgery is complete the surgeon may not be able to re-enter through the same channel from the armpit to the breasts to make any adjustments. A second scar may be needed on the underside of the breasts to reach the implants again.

Eugene, OR plastic surgeon Mark Jewell, MD adds that incisions made in the armpit or around the areola also have a higher incidence of infection and capsular contracture. “The armpit is an area that women frequently show off, so excellent healing is needed if this approach is contemplated.”

App Appeal

The Aesthetic Society recently unveiled Aesthetic One, an app designed to help streamline the implant registration process with device manufacturers like Allergan, Mentor and Sientra, and give patients quick and easy access to information about their breast implants.

Correcting Asymmetries

Breast asymmetries are very common, however, evident differences in size, shape or position can affect a person’s self-confidence. “Firstly, 100 percent of women have breast asymmetry. In most cases, the asymmetry is so subtle, that women don’t even detect it themselves,” explains Dr. Maman. “In severe cases, we can do a different operation on each breast to correct the asymmetry.” The fix may involve a breast reduction or augmentation on one or both of the breasts.

A Rejuvenating Lift

With breast lifts—or mastopexy procedures—the choice to lift the breast with or without an implant will come into play. One thing that is not a choice when the nipple needs to be lifted, is the anchor scar that accompanies a breast lift. “Over time the scar will heal and flatten, but the patient will also have more lifted breasts, which is what they want,” explains Dr. Herte. “While we can’t completely avoid a breast lift scar sometimes, in the right hands, it shouldn’t be an issue.” It’s important to note that healing is individual and not only depends on the surgeon’s technique, but also on genetics.

“Every breast lift requires some type of scar, ranging from just around the areola to more extensive incisions that extend down the meridian of the breast and sometimes along the breast fold,” says Dr. Maman.” It’s impossible to lift a breast without placing scars, however it is very rare to have a woman say that she’d rather have her old breasts back than accept the new scars. Most women will heal incredibly well and the scars will become insignificant.”

Reducing Heavy Volume

Breast reduction procedures can also lift in the same way that a breast lift does, but they can also serve as pain relief. “Most women who seek a breast reduction not only have a breast size that they dislike, but they also have symptoms of shoulder, neck and back pain, and even rashes underneath the breasts,” explains Dr. Lao. “Breast reductions often use principles from breast lift procedures, and the incisions are similar to those used for a lift, but with the added goal of taking out a certain amount of breast tissue to reduce the overall weight of the breasts.”

A Natural Boost

For patients who no longer wish to have implants, or those who want to increase their breast size in a more natural way, fat grafting is a viable option. “Of my patients, 80 percent prefer using implants because they provide the most stable result, but about 20 percent of them opt for fat grafting,” says Dr. Lao.

Breast Implant Exchange

Today’s generation of implants is made to last longer and is expected to endure somewhere between 10 and 30 years. Implant manufacturer Sientra has recently unveiled a new 20-year warranty, which covers the cost of replacing the devices if needed due to common concerns like capsular contracture, BIA-ALCL and late-forming seromas; and a lifetime replacement if due to rupture.

A common misconception is that implants must be replaced, but that’s not always the case. However, an update does translate to newer devices, which has its benefits. “I like to think, if it isn’t broke, don’t fix it. But with implants, my philosophy is to replace them after 15 to 20 years and not wait until they’re broken. The technology has improved and getting more up-to-date implants contributes to longevity and safety factors.”

Depending on the age of the patient, Dr. Maman almost always guarantees that they will require at least one additional operation in their lifetime to address their implants. “We know that the spontaneous implant failure rate does increase minimally annually after 10 years,” he adds.

For patients with questions about the health and longevity of their current implants, Dr. Jewell says an analysis can be performed. “Diagnostic technology has evolved to the point that it is useful in determining implant integrity, fluid, calcification, and implant type,” he explains.

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