The top heavy look is one of the most recognizable breast implant effects. Hence, patients who want the natural look always take into account their body frame, particularly their upper body dimension, waist-to-hip ratio, and height when selecting their implant size.
In general, the breast implant size range between 300 and 450 cc provides “smaller” augmentation that suits petite women. Also, going the conservative route favors patients with little soft tissue coverage who are prone to rippling, globular shape, and increased palpability particularly when overlarge implants are used.
Conservative-sized implants also suit athletic patients who typically have low body fat percentage that makes them prone to rippling if overlarge saline implants are used.
Due to the inherent strength of modern breast implants, most patients seeking revision surgery nowadays are not concerned with rupture or leak but want an implant exchange to upsize or downsize, as suggested by a recent survey.
Hence, the breast implant size and its “specific” results on each woman is one of the most important topics during consultation. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the patient’s candidness—describing her “bust goals” in precise detail—plays a critical role in the success of breast augmentation.
Of course, it is the surgeon’s responsibility to offer his patients all modalities that will improve their discussion. For instance, some doctors offer sizers that are put inside an unpadded bra to give women an idea on how a specific implant size will look on them.
Some doctors also offer three-dimensional imaging to further improve the discussion regarding the implant size and profile, or how much it projects from the chest wall.
Meanwhile, some studies and surveys have attempted to shed light on the ideal breast size in which individual preferences greatly varied. However, most respondents favored medium-sized breasts, namely, C and D cup.
One study has even suggested that medium-sized breasts that are firm and with a 45:55 ratio, which means most of the volume is in the lower pole, with the nipple serving as the delineating mark, as the most preferred breast appearance.
It is important to note that some patients seek breast implants to enhance their shape or correct the deflated-looking upper breast pole without resulting in significant augmentation.
Breast lift and implants is a “combination” surgery to reshape the pendulous breasts and provide additional volume especially in the upper breast pole, which tends to deflate with aging or following weight loss and pregnancy.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted breast lift and implants before and after photos on Snapchat to illustrate its “contouring and volumizing effects.”
During breast lift with implants, Dr. Smiley always completes one breast before proceeding to the other side. The idea is to create a template for the other breast, leading to more symmetric results.
Prior to surgery, the patient shown in the photos had significantly drooping breasts whose areolar complex, which is the ring of pigmented skin around the nipple, settled below the level of the breast crease and were hugely disproportionate.
With the severity of her breast ptosis, or sagging, Dr. Smiley performed the anchor breast lift, which involved a donut-shaped incision around the areola that extended down the midline to the breast crease. Another incision shaped like a crescent was also created along the base.
The anchor breast lift is also referred to as inverted T lift due to the shape of the incision or scar pattern.
The donut-shaped incision around the areola allowed Dr. Smiley to drastically reduce its size. To achieve good symmetry between the two sides, he used a cookie-cutter device to delineate the new smaller areolar complex.
When making the areolar incision, Dr. Smiley says “it is important not to go too deep in order to preserve the blood supply,” and ultimately “minimize the risk of healing problems and delayed recovery.”
Before and after photos of breast lift with implants
During breast lift, Dr. Smiley elevated the tissue of the lower breast pole with the use of internal sutures, and repositioned the areolar complex higher, ensuring that it would lie approximately at the center of the breast mound. Meanwhile, studies have suggested that the ideal nipple position should be above the breast crease, and there must be a 18-21 cm distance between the nipple and the sternal notch, which is the small dip at the base of the throat.
Afterwards, he positioned the implants beneath the pec muscle, instead of placing them above this anatomical layer. This technique, referred to as submuscular implant placement, reduces palpability and risk of rippling and bottoming out due to the additional padding from the muscle.
Conservative breast implants typically refer to a size that is not bigger than 350 cubic centimeters, leading to 1 or 2 cup size increase after surgery. It is important to note that aside from the implant volume, the patient’s starting anatomy will also have a large effect on the final results.
For instance, the soft tissue coverage, chest and breast shape and dimension, nipple position, and skin elasticity will all have their effects on the surgery.
To shed light on the issue, leading Beverly Hills plastic surgeon Dr. Tarick Smiley shares the before-and-after photos of two patients who opted for conservative breast implants.
Patient no. 1
Patient no. 1 received 340 cc silicone breast implants, which have cohesive silicone gel to compensate for her lack of tissue coverage and thus minimize the risk of rippling and palpability, problems that commonly plague women with inadequate soft tissue prior to breast augmentation surgery.
To further give her “smoother,” more natural results, Dr. Smiley positioned the silicone implants beneath the thick pec muscle, which provides additional coverage. However, the bottom aspect of the implant is only covered and supported by the tissue and fascia, leading to a “teardrop effect” that is the quintessence of a natural breast contour.
Because the patient said she disliked the idea of “direct” scars on the breast, she requested for trans-axillary breast augmentation, a technique that involves a small incision that is positioned within the deepest fold of the armpit for optimal scar concealment.
Dr. Smiley recommended the trans-axillary technique to the patient because her “starting anatomy” was perfect for this method: Her breasts had a good level of symmetry and they were not saggy prior to surgery.
Patient no. 2
Patient no. 2 received breast lift with conservative breast implants; hence, the size of the “after” photo was not too different from the “before” pic.
The patient opted for conservative breast implants because she already have adequate breast tissue, which Dr. Smiley re-arranged to correct the sagging appearance.
The patient requested for implants not for additional volume, but for the enhancement of her breast shape and upper pole fullness.
Because of her significantly droopy breasts, she received the standard breast lift technique in which the incisions go around the areola, down the midline, and across the base of the breast. This is also referred to as anchor breast lift due to the shape of the scar, which is expected to fade into the background after 6-18 months.
Breast implants and cleavage appearance have become synonymous issues in breast augmentation. However, it is important to note that the “starting” anatomy of the patient—the natural distance between the breasts and the nipple position—will have a large impact on the final result.
In general, after surgery patients will have a cleavage quite similar to its natural or pre-operative state. Nonetheless, there are certain steps that can improve the distance between the breasts without causing unnatural appearance and other complications.
Leading Los Angeles plastic surgery expert Dr. Tarick Smiley says good results starts with correct implant size and meticulous pocket dissection.
Excessive lateral dissection of the implant pocket can lead to malposition, resulting in the appearance of breasts that are abnormally far apart. To prevent this from happening, Dr. Smiley emphasizes the importance of surgical precision to prevent implant displacement.
Despite meticulous pocket dissection, some patients remain susceptible to implant malposition due to their loose skin or weak fascia and ligaments. This might be true for some women aged 55 years and above who may benefit from the use of biological mesh called acellular dermal matrix.
ADM works as a “sling” that will support the implant’s weight, thus preventing the prosthesis from migrating too low (sagging) or too laterally (excessive lateral bulge). And because this is derived from cadaveric skin whose cellular components are removed, except the basement membrane or “foundation,” the risk of rejection and viral contamination is nearly absent.
To further promote better cleavage, meticulous implant selection will also play a critical role. In general, the implant’s horizontal width and projection must reflect the patient’s natural breast and chest measurement.
However, patients with adequate breast tissue could tolerate an implant whose width slightly goes beyond the chest/breast horizontal dimension in an attempt to narrow the gap between the breasts. It is important to note that this will not work on women with little soft tissue coverage because of the increased risk of wrinkling (along the implant’s edges) and palpability.
Despite the use of correct implant dimension and meticulous pocket dissection, some patients may still opt for fat injection to further improve their cleavage appearance.
Fat injection is basically a reversed liposuction in which the “unwanted” fats are collected from two or more areas, purified usually with the use of centrifuge, and then re-injected into the area that needs additional soft tissue coverage or augmentation.
Upper pole fullness after breast augmentation can be achieved with precise physical examination of the breasts. The idea is to identify the “challenges” and anatomical variables that must be overcome to achieve the best shape and projection possible.
Of course, the patient must be able to describe in details her cosmetic goals and expectations. Hence, patient-doctor communication plays a crucial role in the satisfaction rate, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
Dr. Smiley has recently posted a series of Snapchat videos showing one patient whose primary goal was to achieve increased upper pole fullness after breast augmentation.
While the patient’s pre-operative breasts had adequate soft tissue, they were remarkably pendulous that her areola sagged a few centimeters from its breast fold (or submammary crease). Further aggravating the sagging appearance was the deflated or “empty” upper breast pole.
Due to the extent of her breast sag, Dr. Smiley performed the standard breast lift technique in which an incision goes around the areola’s perimeter, down the midline, and then across the breast fold. The resulting scar from this method resembles an anchor, and so it is also aptly named as anchor lift.
before and after photos
Despite the growing popularity of modified breast lift techniques, the patient remained suited for the standard incision pattern because her areola required more than 5 cm of elevation, something that cannot be achieved with shorter incisions.
The anchor lift has allowed Dr. Smiley to remove some tissue and skin at the bottom of the breasts before lifting and reshaping the remaining tissue with the use of internal sutures. But as a stand-alone procedure, breast lift cannot give ample fullness on the upper poles of the breast—this is where implants become helpful.
Because the patient was more concerned about the final breast shape and fullness of the upper pole, a smaller or conservative-sized implant would suit her.
While showing the patient’s before and after photos, Dr. Smiley said “there is no significant change in her breast volume even with the use of implants, although the upper pole has received significant improvement in terms of looking full and youthful.”
Breast implant strength is one of the most pressing concerns of women who consider undergoing breast augmentation surgery. To shed light on the issue, leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of Snapchat videos in order to demonstrate how durable this artificial prosthesis can be.
In the first trial, Dr. Smiley asked a 125 lbs. woman to step on two breast implants, putting all her weight on them (one was saline-filled, while the other was silicone-filled). No leak or rupture occurred after the experiment.
In another trial to assess breast implant strength, Dr. Smiley asked one of his assistants to throw saline and silicone implants out the window four stories high. When picked up and closely observed, again, no rupture was seen.
To further demonstrate how strong [FDA-approved] breast implants can be, Dr. Smiley conducted another trial in which he literally ran his car over saline implant, then silicone implant. Both prostheses remained intact; the only sign that showed they were subjected to extreme load was the tire mark.
The weight of this large sedan is not enough to cause implant rupture.
To further take it to the next level, he asked one driver of an SUV to pullover and run over saline implant, which instantly burst. Simply put, it would take about 4,200 lbs. of force or weight before the breast implants rupture or “explode.”
Dr. Smiley posted these trials on Snapchat to bust common myths about breast implants.
* The changes in air pressure during flight will not cause the implants to instantaneously explode.
* Weight lifting, strength training, rigorous aerobic exercises, and the likes will not affect implant durability.
* Modern breast implants have impressive durability that in the event of replacement, leak only accounts for a very small percentage. More common reasons for breast revision or replacement include capsular contracture, implant displacement (e.g., sagging), wrinkling, and wanting to downsize/upsize.
In an attempt to preserve the results of breast augmentation or at least minimize the revision rate, the celebrity plastic surgeon said he makes all the efforts to prevent capsular contracture, a condition in which the scar capsule around the implant becomes copious due to the over-production of collagen (scar tissue).
The body is believed to produce excessive scar tissue around the implant when the latter comes into contact with microbes and other “irritants.” Hence, Dr. Smiley said he utilizes all techniques to reduce risk of implant contamination at the time of surgery.