Breast augmentation differs from most cosmetic operations in that a device is a key component of the procedure, and the options with breast implants are numerous. Depending on your breast shape, skin quality and chest wall dimensions, an implant is placed directly under the breast or beneath the pectoralis muscle. A breast lift or mastopexy may be done as well if sagging of breasts is present as a result of childbirth, aging or weight loss. With their recent FDA approval, silicone gel implants are now available, in addition to saline implants. Given the number of options with breast augmentation, your consultation with Dr. Smotrich will help you make the best decision to improve your physical appearance and enhance your self-esteem. For more information, view "Frequently Asked Questions".

DR. SMOTRICH'S COMMENTARY ON A BREAST AUGMENTATION PATIENT IN THE NEWS

Carrie Prejean, Miss California, became a staple of the tabloid press for comments she made during the Miss USA pageant, but it took a couple of weeks before her breast augmentation surgery came to light.  I don’t know who performed her surgery, or for that matter, what type of implant or implant size was used, but her postoperative photo on the right nicely illustrates what I try not to achieve with breast augmentation surgery.

The photo shows implants that are far too visible, in that there is too sharp a demarcation between her chest wall and the breast implant.  Her chest wall shows essentially no subcutaneous tissue (ie, fat), and that is always a potential problem in properly hiding a breast implant.  Thin patients do best with implants placed under the muscle, and even then, sometimes the muscle is thin and doesn’t provide enough soft tissue coverage.  Silicone gel implants are often used in such patients to reduce the possibility of wrinkling seen with saline implants.

Ms. Prejean’s implants also have a bit too much separation between them, and that gives the impression of someone who has had surgery.  The key to placing implants under the muscle is to free up enough muscle towards the middle of the chest so that a natural cleavage can be achieved.  Finally, it is difficult to conclude too much from one photo, but there is a suggestion of her left implant being slightly larger that her right.  Her implant size, on the other hand, does seem appropriate for her chest wall dimensions.  Most patients want to have as large an implant as possible placed without looking fake, and given a patient’s chest wall dimensions, that results in a relatively narrow range of implant sizes.