How to avoid the “I wish I went bigger” after breast augmentation

According to national data, the most common reason for reoperation after breast augmentation is not implant rupture, infection, or scarring….it is size change! It is all too common for women to undergo breast augmentation yet still feel like they want to be bigger. As a board certified plastic surgeon specializes in cosmetic breast surgery, this makes me crazy because it is preventable.

Have a Discussion with Your Surgeon

So, how do you avoid becoming one of those “I wish I went bigger” with my breast impants? It is all about proper selection of the implant size. This means an in-depth discussion with your surgeon about your expectations. You should bring a photograph to demonstrate what you want to look like. This is important because I have had several women who have come to me saying things like “I want to be natural looking” or “I just want to be fuller, but I don’t want people to notice”. This all sounds reasonable until they whip out a picture of Pamela Anderson to show me what they want! Clearly in this case there is a disconnect between what they want and what they say. Do you want to be BIG, do you want to be just a little fuller? These are things you should be clear about before you even arrive for your first consultation.

Next, your plastic surgeon should give you implants to try on. You should see how you look and feel with the new look. Sometimes, your surgeon will even let you take the implants home for a few days so that you can “test drive” your new breasts. Trying on the implants is a million times better than any expensive imaging program that your surgeon may use.

Also important is to understand how the implant will look after it is “inside”. Breast implants tend to look slightly smaller after they are inserted during surgery. I notice that the implants look about 10% smaller. This means that if you like the way a 350 cc implant looks when you try it on, it may appear more like a 325 cc implant after surgery. In this case, you should consider having a 375 cc implant placed.

Discussion Between You and Your Surgeon

So, as you can see, a good discussion between you and your surgeon about implant size should prevent you from being unhappy with your size. Breast Augmentations are a major component of my practice, and I pay particular attention to sizing the implant so that my patients are happy afterwards. During our first visit, we discuss the surgery, the risks, and implant size. There is a lot to think about so I do not make anybody commit to the implant size. If there is any doubt about size, my patients will return again specifically to discuss implant size and not be distracted by all the other details about surgery that we go over. I also allow my patients to return as many times as they want to try on implants before surgery.

To date, I have had no woman return for reoperation purely because she thinks she is “too small” after her breast augmentation.

Avoid Bottoming Out

If a breast implant “bottoms out”, it drops below the normal breast fold. This causes the nipple to turn upward and appear near the top of the breast mound instead of over the center. Also, as the breast implant drops lower, the upper pole of the breast becomes flatter.

The cause of this is usually over aggressive dissection of the breast fold. If the surgeon disrupts the support structures of the normal breast fold, the fold weakens and cannot support the weight of the breast implant. Large and heavy breast implants may make this problem more likely.

Repair of this problem involves reconstructing the breast fold. This can be done with carefully placed internal sutures. Recently, surgeons are now using acellular dermis – either human or pig dermis – to help strengthen these internal sutures and to help support the breast implant in the normal position and prevent it from sliding lower. Keep in mind that these materials provide great results and are recommended, but it can add about $2,000 to the cost of your surgery.

“Bottoming Out” is unfortunately common with breast implants and while we have very good and effective ways of repairing it, it is best not to suffer from this at all. Like everything, the key is prevention. Your surgeon must respect the fold. The breast fold is a normal anatomic structure and care must be taken to not damage it during a breast augmentation. I should mention that it is standard to have to slightly lower the fold to accommodate breast implants, but this needs to be done carefully. Also, very large implants in very thin women should be avoided because of this possible complication.

Contact Our Office

To learn more about breast augmentation with Dr. Schulman, including his Rapid-Recovery Breast Augmentation using the Keller Funnel, contact us by calling 212-289-1851.

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