Breast Implants

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.

breast implants and cleavage


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.

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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.


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

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.”

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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.


breast implant strength

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.

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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.


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.


  • Fat injection


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.

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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.


crescent lift with implants

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.

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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.


breast implant trends

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


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.


  • Areola reduction


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.

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