While breast augmentation trends come and go, there are universal guidelines that help surgeons achieve natural-looking results and minimize risk of complications, particularly relating to aesthetic issues such as sagging or bottoming-out, and rippling.
Leading Inland Empire plastic surgery expert Dr. Tarick Smiley, who performs over a hundred breast augmentations every year, has provided basic explanations of the current breast augmentation trends.
Although many trends and new technologies have paved way for safer, longer-lasting implants, Dr. Smiley says the ideal choice still boils down to patient compatibility, meaning that one’s underlying anatomy and aesthetic goals must be in line with her implant type, design, and size.
- Breast implants that “acknowledge” and “respect” patient lifestyle
Patients who participate in sports and fitness programs generally seek breast augmentation to achieve a more balanced figure, instead of having a “cup size” that will be the focal point of their physique. For this reason, they choose the conservative route—i.e., breast implants not bigger than 350 cubic centimeter or cc.
While cc is not directly correlated to the final breast size (due to variables such as pre-existing tissue, chest shape, and other anatomy), patients with an active lifestyle typically ask for a full B or small C cup result, or simply want to restore the lost volume in their upper breast pole following pregnancy.
- Gummy bear breast implant
This is a marketing term used to describe fifth generation silicone implants. But instead of a “runny” silicone gel, it uses solid silicone whose molecules have stronger crosslinks and so it is highly cohesive just like a gummy bear candy.
The solid silicone will keep its form when cut in half and so the risk of rupture is markedly low, with one study suggesting it is only 2.6 percent within a nine-year period.
While fat injection is a growing trend in buttock augmentation surgery, it is rarely used as a primary method to reshape and increase the breast size. Unlike the butt area, the breast can only “take” a lower volume of fat.
Nonetheless, fat injection—which involves liposuction as a way to collect unwanted fat, and purification prior to re-injection to achieve a high survival rate—can serve as an additional soft tissue coverage to prevent or minimize risk of rippling and palpability.
- Postoperative breast massage
A 2016 survey conducted among active members of the American Society of Plastic Surgeons has shown that more than half of the 1,067 respondents recommended postoperative breast massage, which basically requires pushing the implants into the outermost corners of the pocket.
The idea is to retain the thinness and softness of the scar tissue sac encapsulating the implant, which in turn prevents capsular contracture and high riding implants.
Crescent lift with implants basically involves slight elevation of the areola and a simultaneous breast augmentation. It is important to note that it only suits patients who do not require an actual breast lift.
Breast lift surgery, in the truest sense of the term, elevates the breast tissue with internal sutures. At the same time, the nipple area is repositioned higher, making sure that it lies above the submammary fold, to achieve more proportionate, perkier results.
Meanwhile, a crescent lift does not involve actual elevation of the breast tissue. Basically, it just raises the nipple area slightly with the creation of a concave shaped incision at the upper border of the areola; hence, the resulting scar precisely lies at the dark-light skin junction and is almost invisible when completely healed.
Leading Beverly Hills plastic surgeon Dr. Tarick Smiley has recently posted a series of Snapchat videos to demonstrate crescent lift with implants.
The patient shown in the videos has no “real” breast ptosis (sagging), which is medically defined as having a nipple area drooping below the submammary fold. However, she could benefit from a slight elevation of her areola and so Dr. Smiley performed a simultaneous crescent lift.
Some surgeons are hesitant to use the crescent lift due to the perceived risk of areola distortion (it may appear asymmetric, wider, or elongated after surgery). However, Dr. Smiley said in the video that poor results generally arise when excessive tension is put on the skin.
In the video, Dr. Smiley is seen closing the concave shaped incision with the use of absorbable suture. But instead of “picking up” the skin, all the stitches were made “inside” or beneath the skin layer.
Meanwhile, the skin’s edges were simply allowed to “kiss other” so the scar will remain thin and inconspicuous as it lies precisely at the areola’s border.
“Favorable or invisible scar can be achieved if there is no or very little tension on the skin. We simply respect the skin during wound closure,” he said in the Snapchat video.
One of the latest breast implant trends involves “combination procedures,” allowing surgeons to give additional volume and achieve optimal breast shape at the same time, as explained by leading Beverly Hills plastic surgery expert Dr. Tarick Smiley.
For patients with good or decent breast symmetry and shape (i.e., no sagging appearance or downward-pointing nipple), in most cases breast implants alone can provide impressive results.
However, patients with noticeable breast ptosis (sagging), suboptimal areola position, enlarged nipple area, and conspicuous asymmetry (one side larger or more pendulous than the other) will need some type of ancillary procedure to achieve optimal results from breast augmentation.
Dr. Smiley says that failure to address the aforementioned “issues” can lead to unnatural breast contour, implant displacement, imbalance, and other surgical stigmata.
The celebrity plastic surgeon has explained the most common breast implant trends and “combo methods.”
Breast lift, which basically elevates the sagging breast tissue (not just the skin), is a great complementary procedure particularly in women with ptosis in which the nipple area falls beyond the submammary fold.
Patients with mild or pseudo-ptosis in which the areola is positioned slightly lower, although still above the submammary fold, can also benefit from a modified form of breast lift. For instance, a donut lift slightly elevates the nipple by creating incisions at its border; therefore, the resulting scar blends into the background.
There is an uptick in the number of patients seeking smaller breast augmentation (i.e., B and C cup, which is often achieved with the use of 300-350 cc implants). Complementing this growing preference is the smaller nipple size, which is basically achieved with the creation of incisions around the areola’s order.
- Simultaneous fat transfer
Fat transfer as an alternative to breast implant is rarely used because of the limited results: Most patients can only expect about a cup size increase since the breast only allows a relatively small amount of grafts. Too much injection and the surgeon runs the risk of low survival rate and less than optimal results.
But as an ancillary procedure of breast implant surgery, fat transfer can be an excellent option for patients who are susceptible to implant rippling and palpability.
It is important to note that thin and athletic patients are at an increased risk of rippling in which the outline of the implant is visible beneath the skin. However, this can be minimized by fat transfer in which the goal is to add an extra layer of fat between the prosthetics and the breast tissue.
There is a growing mommy makeover trend: Today’s patients are more well versed in plastic surgery that they are demanding for more natural and more proportionate results.
Mommy makeover surgery, which is basically a marketing term, refers to multiple surgery procedures that restore or at least improve the post-pregnancy bodies of patients. Leading Beverly Hills plastic surgeon Dr. Tarick Smiley says the most common “combination surgery” involves tummy tuck and some type of breast enhancement.
Dr. Smiley, who regularly posts Snapchat videos to spread patient awareness and to share his knowledge with medical students and colleagues, has provided a list of mommy makeover trend that generally favors “subtle” and “realistic” results.
- Curvier and slender waist with tummy tuck
In the past, most patients simply wanted the removal of their apron-like skin that hangs from their abdomen. But nowadays, women are more fastidious in terms of cosmetic results—they want the “corset effect” on their waistline.
To achieve a curvier and more defined waistline, Dr. Smiley highlights the importance of suturing the pair of splayed abdominal muscle, which prior to pregnancy is lined up closely side-by-side.
But during pregnancy that causes the abdominal wall to expand, the fascia (connective tissue) holding it together becomes weak, leading to a gap that could even become palpable. This gap is also causing the barrel-shaped waist that used to have an hourglass figure.
For additional contouring effect, Dr. Smiley pulls and tightens the abdominal skin “centrally.” And if needed, he also performs liposuction of the flanks to achieve a more hourglass figure.
- Breast augmentation beyond size increase
Modern breast augmentation is focused not just on size increase, but also on the final shape and projection. The goal is to achieve the most natural results possible, which all boils down to implants settling in their most ideal position.
Due to the growing demand for natural and “realistic” breast augmentation results, it is now commonly performed together with breast lift. The idea is to achieve optimal breast shape so the “fullness” will look natural.
Dr. Smiley warns that failure to address pre-existing sagging or asymmetry can lead to surgical stigmata like “Snoopy deformity,” excessive lateral bulge, and bottomed-out appearance.
Aside from breast lift, other common ancillary procedures of implants include areola reduction and fat transfer.
- Fat transfer for a more feminine figure
Fat transfer has revolutionized the way surgeons perform body contouring surgery, particularly buttock augmentation.
The growing popularity of fat transfer is attributed to the refinements in the purification techniques, allowing surgeons to increase the survival rate to more than 70 percent. It is important to note that any amount that remains about three months after injection is expected to persist long term.
Fat transfer as a way to augment the buttock is also a powerful body contouring procedure. Because it involves liposuction (in order to harvest the “unwanted” fats), it can contour the waistline at the same time, which in turn results in a more hourglass figure.
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.