A woman with very low body fat presents a challenge in breast augmentation, as the implant edges must be hidden to avoid an artificial appearance. In this case, a dual-plane pocket was used, with muscle covering the top of the implant. Professional body builders may opt for an over-muscle implant, and we would use the stiffest available silicone gel implants to minimize the appearance of rippling

Proper choice of implant size and careful pocket control can 'inflate' the breast and create a lifted effect from augmentation. Not all breasts can be corrected with implants alone. 'Waterfall', 'Snoopy Dog', 'Orange-in-sock', and 'double-bubble' are among the deformities that can arise in less than ideal results.

Careful scar placement and choice of implant, along with release of constricted tissues resulted in this excellent correction for mild tuberous breast

Single-stage breast augmentation for tuberous breasts requires selective release of the constricted breast tissue across the lower-pole of the breast

11 years after breast augmentation, this young woman continued to maintain good cosmesis despite very large breast augmentation. Wearing a well-fitted bra may contribute to avoidance of ptosis and bottoming out of breast implants.

Correct choice of implant size, shape and position can overcome significant cosmetic problems, and spare the need for breast lift surgery

Asian skin is prone to conspicuous dark scars, and the chest is a particularly troublesome area. If an inframammary scar will not hide easily under the shadow of the enlarged breast, we recommend the implant be inserted through an armpit (axillary) location. This is usually a saline implant, although silicone gel implants can also be inserted through this location.

If a patient has at least modest (2 cm pinch) subcutaneous fat, we can do an augmentation over muscle with the anatomic (breast -shaped, style 410) gel implants which produces an excellent cosmetic result. We have found the some patientsdevelop problems with the implant shifting in position/rotating, so consideration of a smooth round implant is important in someone seeking a submammary augmentation.

The axillary approach can provide beautiful results with scars that are hidden in the arm-pit. Implants used are round, smooth, and can be either silicone gel or saline.

Nipple reduction is a common procedure in our practice. The cosmesis and sensation are generally excellent, but breast feeding would be compromised by this procedure.

We rarely perform the nipple incision for breast augmentation. In this patient a successful result was obtained, but the incision damages milk ducts, sensory nerves and exposes the implant to duct bacteria (and increased risk of capsular contracture).

Our recommendation of breast implant procedure is influenced by how quickly a patient must return to physical activity. This fitness instructor wanted to return to work quickly, and so a textured implant (whcih must adhere to the surrounding tissues) was not a good choice. We chose a smooth round implant, and by placing under muscle through an axillary incision, a return to exercise at two weeks was safe.

If breast shape is good, but deflation is main problem, a large breast implant can dramatically improve cosmesis

Exaggerated upper pole fullness can creat an unnatural appearance. Although some of our patients want that 'porn-star' look, patients seeking a more natural appearance will be offered the anatomic (style 410) implant to create a natural look

Implants placed through an axillary (armpit) incision will initially sit too high on the chest. Beginning about 10 days after surgery, we encourage massage exercises to push them into a better position. Massage is not helpful for implants put in through an infra-mammary incision unless malposition of the implant is a problem.

Procedures can be combined to achieve beautiful cosmetic results

If breast shape is generally good and there is little skin laxity, a small implant can create a fresher 'perkier' look with a substantial increase in size. In this case, a 150 cc implant was effective.

Tuberous breast deformity describes a collection of different problems that can compromise breast cosmesis. We offer techniques specific to each type of problem.

Textured, anatomic implants are our best option for improving droopy breasts without creating scars around the areola typical of a breast lift. The textured implant adheres to the chest wall skeleton and doesn't weigh down on the breast skin, and the increased volume in the lower pole of the implant pushes the breast forward and upwards. A large volume implant is necessary to get this effect. Note also that there is substantial filling of the upper pole of the breast. Patients often ask for round implants in an effort to correct for an empty upper pole, but the upper pole of the breast is well-filled by a 'tear-drop' shaped implant.

We prefer a one-stage appraoach to correctign tuberous breast deformity, but all patients are advised of the possibility of a second prcedure to complete the transformation.

We do not use endoscope in our transaxillary implant surgery. We rely on patient to wear garments and do massage to position implant ideally. Use of endoscope can result in over-dissection, with deformity resulting from dettachment of the muscle from the chest wall.

Even with the anatomic implants (style 410), upper pole fullness is present.

This patient would have obtained a greast result with incision under the breast as well, but in skin types where scars are unpredictable, an axillary augmentation is a good choice.

Many patients come to their consultation with a particular size of implant in mind, often based on a friend who had the surgery. Predicting the post-op appearance after breast implant surgery is difficult, as appearance depends on soft-tissue and chest-wall characteristics that are not factored into algorhythms that have been used to make these predictions. This patient achieved a substantial augmentation with 250 cc implants, inpart because she was small with a narrow chest-wall.

When breast implants are place under muscle or partially under muscle (dual plane), the implants have no contact with breast tissue. Breast augmentation is not a contraindication to piercing.

Many of our patients present seeking modest augmentations using small implants. Recovery is quicker, and risk of complications are less, but if the implant is too small then the cosmetic results won't warrant the effort. Some patients will meet with us several times before a size is chosen.

This is a result 10 days following surgery, and the implant has not yet descended to fill the lower pole of the breast. In breast lift surgery, the soft tissues are lacking in elasticity so some over-correction is necessaray to allow for the effects of gravity and time on the implant. A final result at 9 months was beautiful for this patient.

Saline implants are more prone to deflation and can feel more 'fake' (ripples, harder) than silicone gel implants, but for the patient who wants to minimize silicone in her body, saline implants are a good option.

Combining an abdominoplasty with breast augmentation may seem like a lot of surgery at once, but our experience has been excellent with all patients going home same-day.

Breast augmentation with large implants can correct for laxity following weight-loss or pregnancy, but a large implant is necessary to fill in the skin excess. Typically, an implant must be chosen to match the breast size at peak of previous size.

Breat implants can be place over muscle, under muscle, under fascia, or partially under muscle (dual plane). Among the advantagse of dual plane augmentation is that the top of the implant is hidden by muscle, and the bottom part of the implant is able to push the breast forward correcting for sagging or ptosis.

Placing a breast implant helps to correct for excess skin in the upper abdomen, and so only a lower abdominoplasty was necessary in this case to achieve a beautiful result.

Often patients request augmentation that will decrease the gap between their breasts. We can try to improve this problem by using wider implants, but ultimately the implant is centered on the breast and we creat a perfect left and perfect right breast. Whether they look good together is difficult to influence by breast implants alone.