Breasts Resized

Want a little more va-va-voom in the breast department?

Bigger isn't always better, but can be! Below are some questions and answers to help you navigate the world of breast augmentations, as well as non-implant ways to increase breast size. We look at what a plastic surgeon sees when they look at breasts, how to decide where the implant goes, what type of implant to get, most importantly how to size it, and possible complications to look out for afterwards. 

Of course, if you want to come in for a consultation, we can help answer questions specifically for your breasts.

Some people are happy with their breasts. Others used to be happy, but things aren't what they started out as, and yet others never had what they wanted. At Pulsar Health, we can help you feel more confident and comfortable naked by making breasts more beautiful!

This section focuses on breast resizing - going bigger. Other Pulsar Health website sections cover breast resizing going smaller, breast reshaping, male breast gynecomastia, gender affirmation tops surgery and breast reconstruction after breast cancer. Feel free to roam among them or just come in for a consultation to have your questions answered!

Q: How do Plastic Surgeons look at breasts?

A: If you were to step into the mind of a plastic surgeon, this is what you would be seeing when looking at breasts:

1. The breast footprint - where it sits on the chest wall, its horizontal width and vertical height. This is usually stable over time.
2. The breast volume - the actual breast tissue which can be firm, cystic, or soft, and can change with breast-feeding or weight fluctuations. This is what makes breasts "too big" or "too small".
3. The "skin envelope" that holds the breast volume to the footprint. This can be nice and elastic in a perky breast, or have gotten lax over time, or just been too loose or too tight from the get-go.

Breasts are sisters, not twins. One side of your body tends to be taller whilst the other side is wider, and that holds true for breasts as well. Most people don't look that closely, so no worries if you weren't even aware of that!

Q: Why does it matter if breast implants go above the muscle or below it?

A: Breast augmentation (increasing the size of the breasts) is one of the most popular cosmetic surgeries. Most breast augmentations are done using breast implants A breast implant can be placed "below the muscle" - called subpectoral - or "above the muscle" underneath the breast tissue (mammary gland) - called subglandular. This makes a big difference to the final look, as well as affecting the recovery and the risk of some complications.

Subpectoral placement allows the top of the implant to not jut out so much from the chest wall. In essence, the pectoralis muscles ("pecs" in gym terminology!) act to fill in or soften the shelf-like ledge at the top of the implant that you can get if you put in a good size implant in a slender person with small breasts. Most subpectoral implants are subpectoral for the top and middle of the implant, but under the breast tissue (mammary gland) for the lower part. The lower end is disguised better by the fuller breast tissue at the bottom of the breast. 

Subpectoral placement is associated with a lower rate of "capsular contracture" which is one of the more common complications of breast implants. However, if the pectoralis muscles (chest muscles) are tightened, it can look unnatural as the muscle shifts in front of the implant, which can happen when on top during sexual intercourse or in some gym activities. 

Subglandular implants are directly under the breast gland adding to the breast volume. They don't need muscle dissection so are less painful and easier to recover from. Subglandular breast augmentations can be done awake at Pulsar Health, avoiding a general anesthetic, making the recovery that much easier.

For the die-hard geeks out there, "dual plane implant placement" refers to a subpectoral implant but some of the lower portion of the subglandular area is also released to improve cosmesis. 

Q: What kind of implants are used for breast augmentations?

A: Breast implants all have a silicone outer shell but vary in their core, which can be silicone gel or saline. There are different brands of breast implants which come with different warranties (sounds like tire shopping, doesn't it?), but one brand we like at Pulsar Health is Mentor, which is an international brand with a great safety profile. In the United States, 90% of breast augmentations are done using silicone gel implants and the rest with saline, but anyone younger than 22 years of age still legally must get saline rather than silicone breast implants. There are a lot of nuances to breast implants, such as if they are smooth or textured, round or shaped, the thickness of the gel, etc... At Pulsar Health, we can guide you through the selection process.

Q: What size implant should you go for?

A: When you are being helped in selecting your breast implant, the sizing is very important. One of the most common reasons for revision breast surgery in general is changing the size of the implant, so consider this carefully before your surgery. The pectoralis muscle does press down on the implant to some extent, so if going subpectoral, you may want to get a slightly bigger size. We have a sizing system at Pulsar Health, so when you come in for your preoperative visit, please wear a snug-fitting nude or white top so that we can have a look at the different options to help you find the one you are most comfortable with for overall fullness given your personal height, build, and aesthetic goals. Other things to bear in mind are that the base of the implant should not be wider than your natural breast footprint unless you want the breasts to protrude out to the sides. 

Q: What if the breasts are different sizes / shapes?

A: As breasts are sisters, not twins, you may benefit from different size breast implants on each side to help make the result more symmetrical. Besides the actual size that you're looking at, consider if you are happy with your "skin envelope" - a little skin looseness and down-turn of the nipple can be corrected just with placement of the implant, but if there is more sagging, you may need to have the breasts lifted - known as a mastopexy - in order for the augmentation to look pretty. This is called an augmentation mastopexy. The mastopexy can vary from just a little adjustment of the nipple areolar complex (NAC) or simple skin tightening, to rearranging breast tissue. Please see the Breast Reshaping section of the Pulsar Health website for more details on mastopexies.

Q: Where are the scars for breast augmentations?

A: Scars for breast augmentations can be placed in the fold under the breast - the inframammary fold (IMF) - where the breast meets the chest wall. A larger implant can sometimes cause a rise in the height of this line, putting the scar onto the lower part of the breast. The scar can alternatively be placed around the nipple areolar complex (NAC) which is where the darker skin of the nipple area meets the lighter skin of the rest of the breast. We rarely place the scar in the armpit, as it is harder to control the placement of the implant in that approach, and it is generally restricted to saline implants. It takes about 3 months for the scar to "mature" from a red line to a fine skin-colored line. Over time, the breast implants will also "drop" into their correct shape, as they usually look too high straight after the surgery.

Q: What complications can I get from breast implants?

A: Before getting breast implants, you should be aware of possible complications. Many people think that breast implants need to be replaced every 10 years, but that isn't the case. There is a breast implant "rupture" rate of:

• 1% to 18% at 10 years after first time cosmetic breast augmentation
• 3% to 15% at 10 years after revision cosmetic breast augmentation (not first time or primary)
• 1% to 35% at 10 years after first time breast reconstruction such as for breast cancer
• 0% to 20% at 10 years after revision breast reconstruction

Rupture refers to a crack in the silicone gel/shell, and can be picked up by MRI imaging which is recommended every 3 years for those with silicone gel breast implants. Usually, any rupture is contained by the fibrous capsule that surrounds the breast implant, which the body naturally makes around anything "foreign" placed inside. Saline breast implant rupture is more obvious as they just deflate when there is a break in the wall of the implant. So, from the data above, about 8/10 breast implants are intact and NOT needing replacement for rupture at 10 years. Warranties can help cover the cost of replacing a ruptured implant.

Contracture of the capsule around the implant is another recognized complication of breast implants. A capsular contracture is noticed when the breast implant feels firmer and rides higher than it should. It can be associated with a "subclinical" infection, so we take great care to minimize touching the breast implants as we do the surgery, and to keep everything as clean as possible. Reported rates of capsular contracture vary widely from 3% to 20%, but about three quarters of cases happen in the first two years after placement of the implant, and later time points are thought to be due to rupture of the implant. Sometimes medications such as Zafirlukast (leukotriene receptor antagonist) or fat grafting can reverse it, but if advanced, usually you need to have surgery to deal with it ("breast explant" - see the section on Breast resizing: Going smaller) and it may reoccur. 

Other reasons people may have their implant removed is breast implant associated illness (BII), which appears to happen to approximately 1.5% of breast implant clients, or the rare breast implant associated anaplastic large cell lymphoma (BIA-ALCL) which is reported as 1.8/1000 textured implants and extremely rare if ever in smooth implants. At Pulsar Health, we only use smooth implants unless there is a specific reason to use textured, such as recurrent capsular contracture. Both BII and BIA-ALCL are related to immune dysfunction. BIA-ALCL is seen as swelling and redness in the breast usually many years later. BII symptoms are much more vague - musculoskeletal aches, fuzzy thinking, headaches, sleep disturbances, gut symptoms - which may or may not get better by removal of the breast implants (breast explant). BII has not been found to be related to any particular type of implant from silicone to saline. 

The most common reason to have repeat breast surgery is not for complications, but rather for aesthetic considerations - size of the implant or aging of the breasts with sagging. Sometimes scar tissue can be very thick and require interventions, or infection can occur. Other complications like bleeding or exposure of the implant are much more uncommon. Doing a mastopexy at the same time as the augmentation does increase risks, including possibly affecting the blood supply or sensation to the nipple areolar complex (NAC). For more information on mastopexies, please review our sister website section on breast reshaping.

Q: How do I increase the size of my breasts without implants?

A: Breast size can be increased by using fat grafting or other fillers such as Platelet Rich Plasma (PRP) bio-fillers. These have less structural support than implants but are a great "natural" alternative for increasing the size of the breast a small amount. They usually need to be repeated at least twice. PRP bio-fillers require your blood, and at Pulsar Health we photoactivate the PRP to make it more potent before thickening using a bio-incubator. It functions like a filler, especially for the cleavage. This is a short-term fill, but it does gradually improve the skin quality and fullness in the area over repeated treatments. It is done conveniently as a med-spa treatment is less than an hour. Fat grafting is more "permanent" but requires a liposuction procedure to obtain the fat just before placing it in the breasts. About half the injected fat "takes" or lasts long-term. Repeated treatments can add quite a bit of volume to the breasts, similar to Brazilian buttock lifts (BBL) from fat grafting. Please see the Pulsar Health website section on Buttock Enhancement or Breast Reconstruction for more information on fat grafting, and of course you are welcome to visit us for a consultation. Fat grafting using liposuction is done awake, and PRP bio-fillers is just a med spa visit. Selective breast augmentations using breast implants can also be done awake if subglandular. Doing awake procedures is usually easier to recover from and less expensive.