Board certified Salt Lake City Plastic Surgeon, Dr. Yates, has helped many women with uneven breasts to achieve the results they desire and feel more confident. Some women also desire uneven areola correction, or correction of the size of the areolas, which may also be done at this time. This summer, get evened out before slipping into your bikini and feel more confident than ever. If you are interested in learning more about correcting breast asymmetry, contact our office to schedule a consultation with Dr. Yates today!

Article contributed by NKP medical

• Review lots of breast augmentation before and after photos.  Pay attention to the breast implant volume (cc’s) more than the cup size.  Bra sizes are not standardized.   Find a patient with a similar body type and breast size to get an idea of how that implant would look on you.
• Schedule more than one consultation with experienced plastic surgeons.  Get a couple of opinions regarding your ideal breast implant size.
• Know what you want.  Do you desire to be proportionate to the rest of your body?   Tastefully obvious?  Overdone?  Make sure your plastic surgeon has a good idea of your goals, so that he/she can guide you appropriately.
• Try on breast implants.  This can be done at the time of the consultation and at home.  Most plastic surgeons will have “sizer” breast implants for you to try on at the time of the consultation.   At home, a bag or nylons filled with a known volume of rice can be worn throughout the day.  There are also commercial home breast implant sizing kits available.
• Do 3D breast imaging.  This is an incredible new tool for breast implant sizing.  There are only a couple of 3D breast imaging centers in the Salt Lake City, Utah area.  I am proud to say that we are one.  This allows you to see the results and really helps with communication and sizing.   A new website has a 3D imaging online demonstration of the Vectra technology that we use, this is another helpful resource.

“Natural breast augmentation” is a procedure where fat is harvested from the patient and transferred into the breast.  I have been asked for years “why can’t you just put the fat in my butt into my breasts?”.  The procedure undoubtedly works.  It is not yet undoubtedly safe and reliable.  I have previously written about the controversy and risks of natural breast augmentation.

There are not many board certified plastic surgeons who offer this procedure.  Many, like myself, routinely use fat grafting for other indications but have concerns with putting the large volume required for augmentation into the breast.  Most plastic surgeons who offer natural breast augmentations admit that it hasn’t been perfected and the long and short term risks are poorly understood.  It is investigational at this point.

Whenever there is a new billboard, TV or radio advertisement about a “new” procedure many patients ask my opinion.  The billboard I am referring to is an advertisement for a medical spa in Layton.  I clearly have biases regarding who should be performing these types of procedures.  Here are some facts that patients considering going to this medical spa for natural breast augmentation need to know to help them make an informed decision.  I will include only facts without editorial.

• The physician at this medical spa is a D.O in aerospace medicine
• Certified by the American Board of Preventative Medicine
• He has no formal plastic surgery training
• Not board certified by the American Board of Plastic Surgery

Plastic surgery is a big deal.  Plastic surgeons have extensive training for a reason.

“If you want fullness, you have to have an implant”, many patients have heard.

I would disagree.  A well performed breast lift.  One that does not rely on the skin to hold the breast shape.  Can have excellent upper breast fullness without an implant.  In fact, the fullness achievable with a patients own breast tissue is ideal.  It is soft and natural!

My approach is common sense.  If a patient is happy with their breast size with an unpadded bra, a lift is unnecessary.  If they would like to be larger, breast implants are the answer.

One of the “hot” new topics in plastic surgery is fat grafting for breast augmentation.  This is a seldom performed procedure and the vast majority of plastic surgeons still consider this a “taboo” procedure.   For a few plastics surgeons (and many non-plastic surgeons), this has become a routine part of their practice.

I spent a good portion of this year’s meeting trying to separate the hype of this procedure from reality — Here are a few of the important points that I can share with a patient considering this type of procedure:

• It is very controversial!
• Whether fat grafting impairs the ability to detect breast cancer by radiographic studies such as mammogram is not entirely known.
• Whether fat grafting for breast augmentation will increase a woman’s risk of breast cancer in the future is unknown.
• The best method of fat harvesting and transfer is not entirely known or standardized.
• A period of breast expansion with the BRAVA system is necessary before grafting (3 weeks to 3 months).
• The procedure definitely works and a fairly significant increase in breast size is achievable.
• Often multiple grafting procedures are necessary to achieve significant change.
• The “feel” of the fat grafted breast is soft and natural (when things go well).
• It is more possible to “shape” the breast with fat grafting than is possible with an implant alone.
• Very few plastic surgeons currently offer this procedure.

I currently do not offer fat grafting for breast augmentation, mostly for reasons stated above.  Stay tuned.  When these procedures are proven safe and techniques are better understood, I certainly will.

For now I will continue to do breast augmentation with implants.  This is a reliable,  well understood procedure with a good track record of safety.

Of course, patients interested in breast augmentation would for the most part prefer a natural breast augmentation.  Does this mean the results look “natural” or that the augmentation uses natural tissue without implants?

Natural breast augmentation can mean:

1. Breast augmentation with structural fat grafting
2. Breast enhancement pills or creams (worthless in this plastic surgeons opinion)
3. Breast enlargement with a suction device (Brava device)
4. A natural appearing result with breast implants.

Of these, fat grafting is currently what most people are referring to when they use the term “natural breast augmentation”.

The idea is simple.  Fat and associated stem cells are harvested from other areas of the body and injected into the breast for augmentation.  Undoubtedly this works, but only to a small degree.   This is controversial and currently very few plastic surgeons offer this type of natural breast augmentation.

There are major problems with this procedure that need to be fully worked out before someone like myself would feel comfortable doing the procedure on a patient.

The most compelling issue is the diagnosis and treatment of breast cancer.   When the fat is injected there is always some of the tissue that does not survive the transfer.  This can lead to “fat necrosis” which could be confused with breast cancer on mammography.  This may lead to “too few” or “too many” biopsies of concerning areas.

Areas of fat necrosis could feel firm, defeating the goal of “natural breast augmentation”

The procedure, at best, results in a modest breast size increase.  In my experience, most patients who desire breast augmentation are looking for a more significant change than “natural breast augmentation” can afford.

Fat grafting is fickle and requires significant knowledge and experience to get it right.

I can not recommend “natural breast augmentation” at this time.  If you choose “natural breast augmentation”, please choose a board certified plastic surgeon who is comfortable with the procedure.  (There are very few).

For the first 6 weeks to 3 months (depending on the surgeon) the bra should be comfortable, without underwire, and clasp in the front.  We use a simple post surgical sport bra.    After the first 6 weeks, patients are excited to wear new, prettier bras.

I recommend wearing a bra nearly all the time, including at night.  This is to prevent the implant from “bottoming out” or falling to the sides.  This is unlikely in most patients, although some patients have less internal support for the implant (weaker scar tissue).  These patients are at higher risk for implant displacement.  It is impossible to tell which category you fall into until there is a problem, so I recommend support for everyone.

Many bras do not fit comfortably after breast augmentation.  Breasts with breast implants are generally a little different shape than natural breasts.  Augmented breasts are generally a little rounder, narrower to the sides at their base, and have more spacing than natural breasts of similar size.

Underwire bras are controversial.  I prefer patients do not wear underwire for the first 6 weeks.  After that, I prefer that patients do not wear underwire for extended periods of time.  The issue with underwire with breast implants is that the underwire could displace the implants if worn too early or often.  The underwire is often improperly shaped to support the augmented breast and is uncomfortable.

One bra,  Le Mystere No. 9, is marketed as the  first bra specifically designed for women with breast implants.  The cup is more rounded, the underwire is narrower to fit the implant ideally and the spacing between the cups is designed a little wider.  This bra manufacturer is in partnership with Mentor, one of the leading implant manufacturers.  The reviews are good.  Cost is around $75.

Most readers of this blog post are post augmentation patients looking for help finding a bra after breast augmentation.  If you are happy with your outcome, I am happy for you.  If you have any concerns, feel free to email me your concerns.  I am always happy to help.

The cliff note version of the story, for those inclined to short cuts, is basically this:

1) A number of “cosmetic surgeons” are doing large procedures such as breast augmentation in their office operating rooms under local anesthesia and sedation.

2) The training of these “cosmetic surgeons” involves a weekend course

3) The “cosmetic surgeons” state that the procedures are safer because it is done under local anesthesia

4) Some patients are allowed to choose their breast implant size on the table while sedated

5) “awake breast augmentation” is a vague term and the level of sedation may be quite deep.  The article implies that anything other than general anesthesia would be considered “awake”

6) Many (if not all) of these “cosmetic surgeons” are doing these procedures in non-accredited operating rooms.

I find myself particularly well suited to comment on this article as I do all of my breast augmentation operations without general anesthesia in an accredited office operating room.  My general feeling of the article is that they did a reasonable job in helping distinguish the board certified plastic surgeon from the “cosmetic surgeon” in experience and level of training.

The first example in the article is a patient who had breast augmentation under general anesthesia followed by exchange for a larger implant years later under light sedation.  She was able to choose her implant size on the table.  Sounds incredible?

An implant exchange requires little if any sedation and is a painless procedure.  The pocket is already developed.  Many plastic surgeons, including myself, would do the procedure with just local anesthesia if a patient so desired.  Allowing a patient to pick their breast size while sedated is nonsense.  “Here take this …. try to keep your eyes open and head up …. now how large should your breasts be again?”   Some decisions are best left to proper planning.

I have never heard of the “National Society of Cosmetic Surgeons” discussed in the middle of the first page.  This is just one of many “societies” and “boards” fabricated to try to validate someone with inadequate training.  It sounds like this societies members have in common $7,000 and a free weekend.

Safety – There is nothing safe about having breast augmentation performed by someone with inadequate training, no matter the type of anesthesia used.  That being said, I personally prefer sedation for breast augmentation.  I feel it is easier on the patient.  Patients generally wake with less pain and nausea.  Many well qualified plastic surgeons prefer general anesthesia for their own reasons.   What is important is choosing a board certified plastic surgeon and they can discuss what they feel most comfortable with.

I have seen patients for breast augmentation revision who originally had a “painless” breast enhancment who reported to me that the experience was otherwise.

Much of the pain after breast augmentation is due to the stretch of the tissues around and above the breast implants.  Larger implants and placement of the implants beneath the pectoral muscles can increase this pain.

Its not all doom and gloom, however.  There are some excellent “tricks” to help reduce the pain significantly.

• Gentle tissue handling without tearing
• Creation of the implant pocket with minimal cautery (burning)
• The use of local anesthetics at the end of the procedure (pain pump vs long-lasting anesthetics)
• Avoiding hematoma (bleeding in the implant pocket)
• Use of conservative breast implant sizes
• Placement of the implants above the muscle

I would not recommend placing the implants above the muscle for most patients.  There are too many advantages (shape and feel) with placement beneath the muscle.

Generally, using these tricks the pain is minimal to moderate, lasting a couple of days to weeks.  The average patient takes pain medications for 3 days after surgery.  I certainly have patients who report they take no narcotic pain medications at all.  Unfortunately, the converse is also true and I have patients who still need pain medications for 2 weeks after surgery.

Here is my advice to the patient concerned about breast augmentation pain:

1. Choose a board certified plastic surgeon.  (You just want to do this once)
2. Go into it expecting pain (I have found that these patients generally do better)
3. Do seek out a plastic surgeon who is experienced in breast augmentation
4. Do find a surgeon who places an emphasis on limiting your pain and down-time as much as possible

The truth is that breast feeding can be affected by breast implants, although unlikely. The inframammary (crease) incision does not involve division of any milk ducts or glandular tissue and these risks can be minimized with this incision choice. The incision around the nipple involves the division of some of the milk glands and is more likely to be a problem. That said, with either incision breast feeding is very likely to be successful with breast implants.

Studies have looked at the risks to the baby with breast feeding with breast implants. This has been aggressively studied and no risks have been identified. I can safely say that it is safe to breast feed with breast implants.

I have found that some women with breast implants choose not to breast feed. I suspect this percentage is higher than that of the general public. My assumption is that there is fear that breast feeding will “ruin” the results. It is true that pregnancy can cause droop of the breasts. This can occur whether on not the patient has had an augmentation. However, there was an interesting study about 3 years ago that determined that pregnancy affected the breasts similarly with or without breast feeding. My experience would suggest otherwise, but an interesting study nonetheless.