Breast augmentation for asymmetry does not only rely on using two different sized implants. Occasionally, the lopsided appearance is not just caused by size disparity between the two sides, but by the difference in the nipple position/width and/or projection of each breast.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says all women have uneven breasts, which is normal to a certain extent; however, it only becomes an “issue” when the asymmetry forces them to change the way they dress or when they hide it by padding out one side.
The success of breast augmentation for asymmetry boils down to good patient-surgeon communication. Moreover, Dr. Smiley says that the right candidate should be able to explain her goals in details.
The celebrity plastic surgeon says that some patients want the smaller breast to be as large as the other side, although others like augmentation on both breasts with the use of different sized implants to close the size gap.
While it is possible to operate on just one breast to make it bigger and more symmetric with the other side, Dr. Smiley warns that breast augmentation does not only deal with the issue of size, but also with the shape and projection of breasts.
Furthermore, the augmented and non-augmented breasts do not behave similarly and are expected to age at different pace. Hence, Dr. Smiley says that most patients will need surgery on both breasts to achieve a good level of symmetry that can persist long term.
Aside from using different sized implants, a good number of patients also require areola reduction and/or elevation to further improve symmetry between the two sides. This ancillary procedure requires incisions around the areola’s perimeter, with the resulting scar lying precisely at the dark-light skin junction for its optimal concealment.
Breast augmentation for asymmetry requires a meticulous set of procedures; hence, a surgeon performing this operation must have formal training and relevant experience that have allowed him to develop an eye for detail.
There is a lot of misconception surrounding breast implant longevity, with some patients thinking that it should be replaced every ten years. However, implant removal, with or without replacement, must only be done when there is some type of implant- or breast-related problem.
Perhaps the “10-year replacement” misconception stems from longitudinal studies suggesting that one out of five breast augmentation patients with silicone implants would need revision surgery.
However, revisions are only warranted when there are implant-related problems such as leak and malposition, or breast-related issues such as sagging appearance and capsular contracture.
Simply put, there is no point of replacing a “functioning,” stable breast implant.
Capsular contracture, according to studies, is one of the most common reasons for revision surgery. This happens when the scar capsule around the implant, which is the body’s natural response when it comes into contact with a syntethic material, becomes too copious and stiff.
Most cases of capsular contracture happen immediately after surgery or a few months afterward, which may affect one or both breasts. Many surgeons suggest that implant contamination at the time of surgery or low-grade infection during the healing stage are the most likely cause of the complication.
Nonetheless, capsular contracture may happen years after surgery, although with daily breast massage, or more aptly called implant displacement exercise, this could be prevented or at least minimized, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
The goal of breast massage is to maintain the malleability and “thinness” of the scar capsule, ultimately preventing capsular contracture, says Dr. Smiley who has performed thousands of breast augmentation surgeries (primary, revision, and reconstructive type).
While 20 percent of patients with silicone breast implants would need removal/revision surgery within a 10-year period, it is important to note that the studies involving their longevity were conducted before the introduction of the latest silicone implants.
In 2013, the fifth generation silicone implants, also referred to as gummy bear implants, were approved by the US Food and Drugs.
Gummy bear implants are notable for their durability thanks to their highly cohesive filler material that even after cutting their shell in half, no leak will occur. Hence, it is perceived that they have longer lifespan compared to saline and fourth generation silicone implants.
Revision breast augmentation typically requires techniques similar to those used in reconstructive breast surgery to achieve the most natural contour and highest level of symmetry possible, as suggested by leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
For this reason, breast augmentation reconstruction requires higher level of technical skills (and experience) on the surgeon’s part to achieve good results from the surgery, Dr. Smiley said.
The celebrity plastic surgeon has recently posted a case study on his Snapchat account involving a patient who had breast augmentation 10 years ago and was seeking revision to correct several aesthetic-related problems, which the surgeon has enumerated in the video.
- Enlarged areola
- Visible rippling along the mid cleavage
- Too much cleavage (the breasts were too far apart)
- Excessive lateral bulge
- Sagging or bottomed-out implants
Dr. Smiley first started with the areola reduction in which he used a cookie-cutter device to delineate the new areola and make it smaller. The scar from this technique goes precisely at the dark-light skin junction so it will blend nicely to the background.
To correct the sagging appearance, he made vertical incisions from the areola down to the submammary fold, and another incision pattern that goes parallel to the breast crease. (Basically, this is an anchor breast lift technique due to the shape of its final scar, which is expected to fade into the background about a year postop.)
The anchor breast lift allowed Dr. Smiley to remove some loose skin and tighten and elevate the breast tissue, leading to a perkier appearance.
To further achieve good breast shape and to correct the excessive lateral bulge, he repaired the breast pocket (by making it smaller) and so the implant will not migrate.
Meanwhile, he addressed the visible rippling by replacing the old saline implants, which have a natural deflation rate of 1 percent per year due to evaporation. And since the patient had hers for 10 years, the implants had already lost about 10 percent of their volume, and thus resulting in rippling.
Oftentimes, silicone implants are considered as good replacements if the patient wants to prevent or correct rippling and palpability since they have no deflation rate and they are filled with a cohesive medical-grade silicone gel that resembles that of the breast tissue and fat.
When plastic surgeons mention the term breast implants armpit, they refer to the incision site. This technique results in an inconspicuous fine scar that lies within the natural skin fold, making this ideal for women who want to avoid scars on their breasts.
Despite the appeal of breast implants armpit, as with any technique its success all boils down to several factors such as the patient’s underlying anatomies, cosmetic goals, and implant type. Of course, the surgeon’s skills and experience will also have a large influence on the final results.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says appropriate patient selection is the first step to reap the technique’s full benefits. In general, it favors women whose pre-existing breasts have a “decent” shape—i.e., no drooping or south-pointing nipple, and no contour deformity (e.g., tuberous breasts).
If there is sagging or contour deformity, incisions made directly on the breast skin are always warranted to achieve good results from the surgery.
Furthermore, the patient’s armpit should not be too “narrow” unless she will be having saline implants, which are propelled “empty” towards their pocket before the surgeons inflated them with saline or sterile saltwater solution. Implant manufacturers, meanwhile, always prefill the silicone implants.
Aside from the patient’s anatomy, another important factor is the chosen implants. While silicone implants can be used (despite popular misconception that only saline implants are possible with the armpit incision technique), in the ideal scenario they should not be larger than 350-400 cc lest they require longer incisions and thus defeating the purpose of having well-concealed scars.
However, the use of Keller Funnel device, which resembles a baker’s bag used to propel the silicone implants into their pockets, have made it possible to opt for a larger size range without increasing the risk of longer, more visible scars in the armpit.
Meanwhile, size is less of an issue—at least in terms of scar length and visibility—when saline implants are used. Nonetheless, it remains practical to use implants that are within the chest and breast dimension to avoid a gamut of complications such as implant malposition, rippling, unnatural breast contour, and palpability.
And lastly, the surgeon’s expertise will also determine the results from breast implants armpit, which requires high precision and eye for details, says Dr. Smiley.
Dr. Smiley says a good rule of thumb is to choose a board-certified plastic surgeon who performs breast implants armpit technique on a regular basis, and has impressive collection of before-and-after photos of his actual patients.
The use of breast implants on skinny women has certain challenges that stem from the lack of soft tissue coverage, making them susceptible to rippling, increased palpability, and less natural breast shape that is often described as too “globular.”
However, there are several ways to compensate for the lack of soft tissue coverage, as suggested by leading Orange County plastic surgery expert Dr. Tarick Smiley.
The celebrity plastic surgeon has explained all the things to avoid when breast augmentation involves patients who are naturally thin or have little soft tissue coverage.
Saline implants are filled with sterile saltwater solution once propelled and positioned into their pockets. While women with sufficient soft tissue coverage (they’re wearing B cup bras at the very least) can achieve good results from them, patients with a skinny frame may end up with visible implant edges or a breast shape that is too globular.
Meanwhile, silicone implants are suitable for women who have little soft tissue coverage or low body fat percentage because their filler material closely resembles the breast fat and tissue.
- Avoid over the muscle position (subglandular)
Placing the implants over the muscle that the only thing supporting their weight is the tissue and skin can spell disaster for thin patients. Using saline implants can further aggravate the risk of rippling and palpability.
Under the muscle position, meanwhile, favors breast implants on skinny patients because this strong anatomical layer not just gives additional coverage but also more support that prevents bottoming out or any other type of inadvertent implant displacement.
- Avoid low profile implants
Low profile implants have a wider base dimension that could occupy too much horizontal space when used by thin patients. For this reason, they may end up with unusually flatter and “bubble-shaped” breasts that give them a heavy top look.
In general, thin patients are suitable for moderate profile implants especially if they want just the right amount of lateral bulge and mid cleavage; or high profile implants if they like a fuller upper breast pole (because it offers the most forward projection and has a relatively narrow base, which is the complete opposite of low profile).
To prevent unnatural breast contour and other surgical stigmata, a good rule of thumb is to use implants whose dimension is within the chest and breast measurement.
- Avoid hugely disproportionate implants
Arguably, this is the most influential factor. When implants are too large for the underlying anatomies, they will cause overstretching of the breast tissue and skin, which of course can spell disaster.
Small-framed women who want to achieve natural-looking results are generally advised to stick to 300-400 cc breast implant size range.
The areola breast augmentation technique uses a small incision placed right at the border of the areola, i.e., dark-light skin junction, where the breast pocket is created and the implant is propelled inside, says leading Beverly Hills plastic surgeon Dr. Tarick Smiley.
On his recent Snapchat video post, Dr. Smiley has demonstrated the technique and its challenges since the patient has a small areolar complex that could make it difficult to hide the scar particularly when prefilled silicone implants are used.
All silicone implants are prefilled by their manufacturers; however, saline implants usually come “empty” and are only inflated with sterile saltwater (saline) by surgeons once positioned in their pocket. In terms of aesthetic superiority, silicone implants are the standard choice because their filler material closely resembles the glandular tissue and fat.
The patient shown in the video has a small areola but nonetheless had chosen the silicone implants, which “traditionally” requires longer incision than saline implants.
Despite the caveat of silicone implants when areola breast augmentation is used, the benefits far outweigh the potential drawbacks because the patient’s lack of soft tissue coverage could mean an increased risk of rippling and palpability when saline implants are utilized.
Because of the anatomical challenge or “dilemma” facing this particular patient, Dr. Smiley has used Keller Funnel that allowed him to use silicone implants without resorting to long incisions.
The Keller Funnel resembles an icing bag that holds the silicone implant. Its narrow tip is positioned into a small incision along the areola’s border so when it is squeezed the implant is propelled into the pocket.
With Keller Funnel, Dr. Smiley says he is able to shorten the incision even when silicone implants are used. Furthermore, the technique significantly minimizes the amount of pressure during the implantation process (compared to the standard finger push method), which in turn preserves the implants stability and reduces surgical trauma, he further explains.
And because there is very minimal trauma around the incision, the scar is further expected to heal and blend well into the background, says the celebrity plastic surgeon.
While silicone implants can already reduce the risk of rippling, palpability, and other surgical stigmata (which are real concerns because the patient has little soft tissue to begin with), Dr. Smiley positioned them beneath the chest muscle for additional coverage; hence, the patient’s breast is now softer and its contour more natural.