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Breast Augmentation – What You Really Need to Know from Dr Allan Kalus

Thursday, January 16, 2020

So you are considering having a breast augmentation – or breast enlargement.  Possibly you feel your breasts have never fully developed or maybe they have lost volume following pregnancy.  Probably, like most women, you want to go up only one or two cup sizes.  But how much is a cup size?  Should you have a saline or a silicone implant?  Should the implants be put in front of or behind the muscle? And what about this new procedure of fat transfer?  

In this blog I will give you the information you need to make an informed choice.  

First, when measuring a breast, it is important to know what is meant by “one cup size”.  Although there is some variation between manufacturers, it is generally agreed that for a woman wearing a 10 size bra, each cup size is 125 cc.  This means that an A cup is 125 cc, a B cup 250 cc, a C cup 375 cc and a D cup 500 cc.

For a woman wearing a 12 bra, each cup size is 150 cc, so a C cup would be 450 cc.

And for a woman wearing a 14 bra, each cup size is 175 cc, so a C cup would be 525 cc.

Your surgeon should have a method of measuring your current breast size.  Then it is simply a matter of arithmetic to work out what additional volume you need to achieve the size you desire.

Another way to work this out is to fill a pair of stockings with rice.  If you wear a 10 bra, why not start off with 250 cc of rice in the stocking?  Place this inside your bra, put on a t-shirt and see how it looks.  You can then add or take away rice until you achieve your desired look. Make a note of the volume and tell your surgeon.

Once you know what volume you need, it is time to choose between the various types of implants and to decide on whether or not fat transfer is the better option.  

Fat Transfer

Let’s talk about fat transfer first as it is the safest option and produces the most natural looking breasts.   For you to be suitable for a fat transfer, you will need some additional fat in an area such as your hips or thighs.  Usually about a one cup size increase can be achieved by a fat transfer. But the fat is put selectively into the cleavage and it does produce a very beautiful and natural looking breast.  In our experience, the fat often tends to grow once it has been transferred into the breast so for many women this will be the preferred option.  There is a secondary benefit of liposuction (as this is required for fat harvesting), so breast augmentation by fat transfer results in a significant rebalancing of the figure.  

Breast Implants

What then are the advantages of a breast implant?  The main advantage is that you can choose virtually any volume you desire (within reason!).  This means that women are able to go up one, two or even three cup sizes.  The problem is that the larger the breast implant, the greater the long term effects on your body.  In other words your skin will stretch and your chest wall will even become indented.  The safest way to use a breast implant is to select the smallest implant possible.  Rarely should you choose more than 300 cc.  Of course some women do choose 400, 500 and even 600 cc but these all tend to look rather like balloons on the chest and many women come to regret their choice sooner rather than later.

In fact, should you desire a larger size, then a Hybrid procedure in which you use a smaller implant as well as some of your own fat will produce a safer and more natural result.  

Silicone or Saline?

If you plan on having a breast implant then you need to be aware that the Chief Medical Officer has advised:-

“All silicone gel filled breast implants are considered high risk medical devices”. 

This is because of the risk of leakage over time with silicone migrating to other parts of the body; because of the risk of Breast Implant Associated Illness where people feel fatigued and unwell while they have their silicone breast implants; and because of the risk of Anaplastic Large Cell Lymphoma which is a serious disease of the capsule that forms around textured breast implants.  

If you plan on having a silicone gel breast implant then choose a smooth-walled implant with a small volume and follow the advice provided by the FDA in the US which is to have an MRI 3 years after your surgery and then every 2 years thereafter.  At least in this way you will detect leakage early.

In my view the better alternative is to choose a saline-filled implant.  Smooth-walled saline implants have been around for 50 years and have never been subject to a recall.  They are not associated with any of the problems linked with silicone-gel implants.  If a saline implant were to leak (which is extremely rare) then it is only saline that leaks and this is harmlessly absorbed by the body.  The implant shell can then be removed and a new implant inserted.  The only requirement when having a saline implant is that the implant should be placed under the muscle.  Because of the coverage provided by the muscle, it is difficult to notice any difference between a silicone or a saline-filled implant.  Unfortunately, most surgeons have had little or no experience in the use of saline implants so it is important to state that there is little, if any, difference in softness, rippling or any other feature provided the implant is placed under muscle.  Even if there were a slight difference, then it would be far outweighed by the greater safety of the saline implant.

Saline implants have the added benefit of tending to produce very thin capsules with much less inflammatory response than their silicone-gel counterparts. (A capsule refers to the scar tissue that forms around all implants). Placing an implant under the muscle is really a “no brainer” as not only do you get the increased coverage but also it makes mammograms much easier later on in life.

So there you have it.  The safest way to achieve breast augmentation also happens to produce the softest and most natural looking breasts.  It means having a smooth-walled saline-filled implant placed under the pectoral muscle and using a little fat to enhance the cleavage. (A Hybrid Breast Augmentation).  Or, if sufficient fat is available, have a fat transfer alone.

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