Just as no two faces are identical no two women’s breast and torso’s are the same either. At The Lucas Center, Plastic Surgery I do not use a cookie cutter approach to breast enhancement. I employ many algorithms to determine the best treatment plans for my patients. I am not just focused on just the breast mounds nor am I content to just place the same round implant in everyone. I analyze your breast bone (sternum), the shape and slope of the rib cage, any spine asymmetry such as scoliosis, the amount of soft tissue in the arm pits just lateral to the breast tissue, and the breast fold to collar bone length before even evaluating the breast themselves. I then measure the actual width and height of the breasts, how much thickness exists in the upper poles, the overall shape and position of the nipple areolar complexes with respect to the breast mound, how much stretch the tissues exhibit, and the volume and distribution of the volume and any skin excess. Many patients are surprised how analytical and detailed my exam is for the consultation compared to many surgeons who just eyeball the breast and decide on an implant after placing many different sizers in the OR. Normally I go to the operating room with a plan and have pre-determined the shape and size and texture of the implant prior to surgery. I avoid sizers when at all possible because the more implants are pushed through the incision the greater the likelihood of creating biofilm in the pocket (a leading cause of capsular contracture.) I also utilize a three dimensional imaging system which helps patients see themselves from a new prospective and have the ability to evaluate truly what a given implant looks like on their specific body. Much more exact than asking a patient to fill a desired cup size bra with different size implants.
My operative plan not only includes which implant to employ but the position within the breast (partially under the muscle, under just the gland or under the layer of tissue which wraps around the pectoralis muscle.) Each of these pockets have advantages and disadvantages and is not a one size fits all approach for me I use them all depending on circumstances. The shape and type of implant very much is determined by all the above mentioned measurements which involve the breast and the surrounding chest wall each type of implant has their benefits and downsides. I also determine well before hand any need for a breast lift in conjunction with implant placement.
Other adjunct procedures I often employ which can maximize the aesthetic outcomes of breast surgery beyond determining the implant size and shape or additional skin and breast lifting procedures may include the process of fat grafting. The addition of lipo-filling the breast and chest wall is analogous to photo-shopping this area of the body to uniquely sculpt your tissues such as the decollate area to enhance cleavage of in the upper pole of the breast to give the appearance of a higher positioned breast on the chest wall or even to correct contour asymmetries. This tissue refinement is invaluable to enhance the overall result for a women which cannot be achieved with an implant alone. Another fine detail which can separate an excellent result from a normal good outcome is to evaluate the arm pit / bra skin roll of tissue as it intersects with the lateral breast silhouette. Excess tissue can generally be removed or reshaped with power assisted liposuction techniques which includes removal of excess fatty tissue and equilibrate the fat volume from areas of excess to deficient regions giving an artistic aesthetic lateral profile to the breast which many surgeons ignore all together but when viewed with a discerning eye certainly creates a whole different level of excellence weather viewed with or without clothing.
My goal for my patients who seek either primary breast enhancement or “Mommy make-over” breast rejuvenation is to provide customized excellence for their outcomes. No two people are alike therefore with a thorough three dimensional examination of all associated tissues of the chest and breast we can devise a unique surgical plan incorporating all means necessary to maximize the aesthetic outcomes. I view myself as an artisan not a mass production factory for my breast services.