The “right” breast implants on a bony chest can help improve its appearance. Patients with this “anatomical feature” also typically have wide cleavage gap and little soft tissue coverage, which must be improved as well.
Dr. Tarick Smiley, one of the leading Orange County plastic surgery experts, has recently shown on his Snapchat the effects of “meticulously selected” breast implants that have had improved the bony chest appearance and visible dents of a female patient.
Dr. Smiley used a pair of slightly wider breast implants to “conceal the visible dents” along the sternum and to improve the wide gap between the breasts. Nonetheless, the implants’ base matched the horizontal measurement of the chest otherwise the patient would face a higher risk of scalloping, rippling, and malposition.
To further ensure natural-results—i.e., proportionate to the patient’s body and with no surgical stigmata—the celebrity plastic surgeon used small silicone implants (i.e., 400 cc).
The use of smaller silicone implants particularly suit the patient because of her limited breast tissue coverage and low body fat percentage. These implants were filled with a medical-grade silicone gel designed to simulate the cohesiveness of natural soft tissue.
Saline implants, meanwhile, would not suit the patient because of her little soft tissue coverage that could predispose her to higher risk of rippling and increased palpability. These implants have outer silicone shell filled with salt-water solution; hence, they may lead to firmer results and too globular breast contour when used by thin and small-breasted women.
To further ensure soft and natural contour, Dr. Smiley positioned the implant beneath the patient’s pec muscle, which provided more coverage than the over-the-muscle implant placement.
Even without fat grafting, the right implant design and volume was enough to conceal the patient’s bony indentations of her cleavage.
In general, Dr. Smiley says he reserves fat grafting for patients with “very poor upper-inner breast pole” that an implant-alone approach may not be enough to deliver satisfying results.
Fat grafting that is a part of composite breast augmentation, he says, also suits patients with certain types of deformity.
The use of two different sized breast implants is reserved for patients with at least a “half cup” difference. The goal is to make both sides appear the same in size, shape, and projection, as suggested by leading Los Angeles plastic surgeon Dr. Tarick Smiley.
Recently, the celebrity plastic surgeon performed breast augmentation in a patient whose right breast was noticeably smaller than the other side, thus she entailed the use of two different sized breast implants to help improve the asymmetry.
During surgery, Dr. Smiley placed a 495 cc implant in the right breast, and 470 in the left. Both implants were filled with medical-grade silicone noted for its cohesiveness comparable to soft tissue.
The implants were placed via peri-areolar incision technique, also referred to as “through the nipple.” The incision was precisely made at the dark-light skin junction so it could blend well into the background.
Furthermore, the peri-areolar technique was particularly suitable for the said patient because of the stark color contrast between her areola and its surrounding skin, making it easier to hide the scar.
Aside from a more symmetric look, the patient was also concerned about having natural-looking appearance and “feel,” which silicone implants are known to provide. Saline-filled implants, meanwhile, are more likely to appear globular in shape and are firmer particularly when used in patients with very little soft tissue coverage.
To further ensure natural-looking results and soft feel, Dr. Smiley placed the implants beneath the pec muscle, which provided additional soft tissue coverage. This implant placement is also linked to lower risk of wrinkling, scalloping, and palpability, which are common cosmetic issues among thin or small-breasted patients.
Sometimes, the disparity is not limited to size. For instance, one of the breasts may be more saggy or flatter than the other, or the nipples are of different diameter or position. Hence, Dr. Smiley says that breast augmentation surgery requires a highly customized approach to address specific cosmetic issues and to achieve high patient satisfaction.
Occasionally, breast lift and areolar reduction are performed simultaneously with breast augmentation to further improve symmetry between the two sides, says Dr. Smiley.
Breast implant profile refers to how much it projects off the chest wall. In the past, the only available design was the moderate profile implant, which is now considered the normal or standard projection.
But nowadays, patients have other options that include low, moderate Plus, high, and extra high profile implants.
High profile implants stick out more, giving an illusion of a bigger breast. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says that women with a narrow chest are often a good candidate for such design because it occupies just the right amount of space.
Dr. Smiley has recently posted high profile breast implants before and after photos on his Snapchat account to demonstrate its effects on a patient who specifically asked for additional fullness in her upper breast pole.
Prior to surgery, Dr. Smiley performed breast and chest exam to determine the ideal implant profile, size, and shape based on the patient’s underlying anatomies. Of course, the surgeon also interviewed her to identify the aesthetic goals and to explain to her the surgical approach and implant design that could help meet her objectives.
During physical exam, Dr. Smiley used a pair of calipers to measure the breast width and identify any pre-existing asymmetry between the two breasts.
The celebrity plastic surgeon noted the patient’s highly symmetric breasts that had nice overall projections and ample soft tissue coverage, making it easier to achieve natural and balanced results from breast augmentation surgery.
“It is quite unusual to have highly symmetric breasts. For the vast majority of patients, one of the pre-existing breasts is bigger or wider than the other side,” he said in a Snapchat video.
Based on physical exam and consultation, Dr. Smiley decided to use 375 cc silicone high profile implants; these were the perfect choice as the relatively thin patient was more concerned about the upper pole fullness than the actual augmentation.
It should be noted that 375 cc implants would provide just a moderate amount of augmentation, leading to a more proportionate, natural result.
During surgery, Dr. Smiley positioned the silicone implants beneath the pec muscle, which provided additional soft tissue coverage, resulting in a softer feel and a more natural breast contour. This implant placement also reduced the risk of traction rippling and palpability.
Breast implant consultation varies from patient to patient, although it usually lasts between 30 minutes and two hours. Others require more than one preoperative visit before they are completely comfortable going under the knife and have all their questions/concerns answered.
Dr. Tarick Smiley, a renowned Los Angeles plastic surgeon who performs cosmetic and reconstructive breast surgeries, gives his tips on how to make the most of your preoperative consultation.
After doing your own research by watching and reading contents from reputable sources, Dr. Smiley says the next step is to jot down the questions that will help you assess your surgeon’s qualifications, the most ideal breast implant size and design, and all the ramifications that come with the surgery.
You should bring this list of questions during your preoperative consultation so you would not overlook issues that are important to you, says Dr. Smiley.
Aside from the list of questions, Dr. Smiley says you should also bring the following during your consultation:
- A list of your complete medical history. This should include your previous surgeries, medical conditions, and drug allergies.
- You may bring along your spouse, friend, or family member. They may ask questions on your behalf that you may have overlooked.
- A list of medications you take. Remember that this should include not just prescription drugs but also over-the-counter medications, herbal supplements, and vitamins and minerals.
- Bring your “wish pics.” While these could help you explain your cosmetic goals more clearly, remember that the final results will still largely depend on your underlying anatomy.
- You may bring different types of clothing. Todays’ surgeons typically offer breast implant sizers that are worn inside an unpadded bra, allowing their patients to visualize the most likely results of their surgery.
Take note that you should not feel rushed during your consultation. In fact, you may meet with your surgeon as many times as you want should you still have lingering concerns.
Trends in breast augmentation are greatly influenced by media, social and cultural-based beauty standards, and prevalent lifestyle. Nonetheless, all efforts are made to create results that will satisfy the patients on a long-term basis.
While some trends in breast augmentation come and go, there remain some well-entrenched guidelines that aim to promote patient safety. For instance, board-certified plastic surgeons only use FDA-approved breast implants whose manufacturers are mandated to participate in longitudinal studies to further determine the safety and long-term effects of their medical products.
Liposuction collects fats from multiple donor sites. Then, these are purified and injected into the breasts to prevent implant wrinkling and palpability and other surgical stigmata.
Leading Los Angeles plastic surgeon Dr. Tarick Smiley says that a growing number of breast augmentation patients today are choosing a more conservative implant size, leading to a more natural proportion.
The conservative implant size range is also becoming popular as more women these days follow a healthy, active lifestyle. In the past, it was not uncommon for patients to ask for significant augmentation (i.e., bigger than D cup) even though the size would not match their physique.
Some patients are more concerned about the breast shape than the size, making them an ideal candidate for conservative-sized implants. A survey published in Evolution and Human Behaviour has suggested that while men’s preference in breast size greatly varies, almost everyone agrees that no matter what the size is, the aesthetically pleasing ones are always “perky.”
Hence, many breast augmentations today are performed concurrently with mastopexy (i.e., breast lift). The idea is to correct the droopy appearance and the insufficient “cup size” in one surgery.
And since there is a strong inclination to natural-looking results, many surgeons nowadays complement breast augmentation with fat grafting or injection. The idea is to create additional soft tissue padding to further conceal the implant edges, resulting in softer feel and more teardrop breast contour.
Nonetheless, fat grafting is rarely used as a primary method in breast augmentation, although many surgeons believe that it is a powerful supplemental tool in order to make the results more natural.
A simultaneous fat grafting is often warranted if the patients have very poor cleavage and little soft tissue coverage. Some women with pre-existing deformities (due to previous surgeries or congenital defects) can also benefit from this supplementary procedure.
Breast revision for capsular contracture requires meticulous procedures to prevent the complication from recurring. The core guideline is to eliminate the bacteria, which are believed to cause the body to react and release a thick biofilm or scar capsule that causes hardness and asymmetry of the breast.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently demonstrated breast revision for capsular contracture on his Snapchat. The surgery involved a patient with silicone implants she had for eight years; these were implanted by a different doctor.
Dr. Smiley irrigates the implant pocket with strong antibiotic solutions to kill microorganism known to cause low-grade bacteria, which is linked to increased risk of capsular contracture.
The patient’s left breast appeared constricted and “high-riding” due to the thick fibrous scar tissue, while the right side had no such problem. Dr. Smiley said that about 98 percent of capsular contracture affects only one side due to unknown reasons.
Every time an implant—e.g., breast implant and pacemaker—is placed, the body makes a layer of tissue called capsule. Dr. Smiley said this is an auspicious natural process that prevents implant malposition.
He said that the only time that the capsule is considered capsular contracture is when it becomes too copious and “problematic,” leading to hardness of the breast, asymmetry and unnatural contour (narrow and constricted base), and a varying degree of pain and discomfort with arm motion.
The celebrity plastic surgeon cited medical literature suggesting that the risk of capsular contracture in primary breast augmentation is around 5 percent, and may reach as high as 33 percent in revision surgery.
Dr. Smiley said that irrigating the breast pocket with strong antibiotic solution reduces the capsular contracture rate by “killing the microorganism.” According to several studies, low-grade bacteria may cause the copious production of fibrous tissue, but not enough to cause an infection.
To further reduce the capsular contracture rate in primary and revision breast augmentation surgery, Dr. Smiley emphasized the importance of using brand new implants and removing the entire scar capsule, instead of just incising or eliminating some parts.
In addition, Dr. Smiley said that placing the implants beneath the muscle than above this layer (with only the breast tissue enveloping the prostheses) further minimizes the risk of capsular contracture. The theory is that the reduced contact between the implant surface and the tissue known to harbor staph bacteria, and the constant massage provided by the pec muscle preclude the formation of copious scar tissue.