I received an email from a woman yesterday looking to use a very large implant on a very small frame.  She inquired if there would be problems in doing this.  In a word, “Yes.”  There will be problems to using a very large implant in a patient like herself.    Let me go into this further. 

 Appropriate implant selection is one of the most important decisions that a woman will make when choosing breast implants.  There are long term ramifications to using an implant that is larger than the soft tissues can handle.  An implant has weight and over time will thin the breast tissues and cause descent of the breast on the chest wall.   Furthermore, it is possible that breast tissues can thin enough to cause significant problems with rippling or even implant extrusion.   Large implants are very heavy and cause significant stretching and thinning and put patients at greater risk for these problems.  The fact that heavy breasts fall sooner may be obvious to women who were well developed in their teens who later in life have breasts that are much lower following pregnancy or breast feeding.  However, young women who are seeking breast augmentation usually don’t have issues with breast positioning and are unlikely to recognize this potential problem.    

During your consultation with me,  I analyze your breast using a technique outlined by Dr. Tebbetts.  The approach is called the “High Five Process” and is designed to systematically assess five critical aspects of breast augmentation planning to come up with an “ideal” procedure for an individual patient.  I use the process because I believe that there is probably an “ideal” implant volume for a given patient that can be derived from her soft tissues.  Implants that are signficantly larger than this “ideal” will be at greater risk for complications.  Furthermore, I believe that if an “ideal” procedure is used  that there will be a reduction in the rate of reoperations following breast augmentation.

Here is an example of a patient that underwent a breast augmentation in my practice using the “High Five Process.”  She is a 27 y/o that presented wanting a saline breast augmentation.  She was internally motivated and wanted a proportional augmentation that would not have an increased risk of breast thinning and descent with time.  On examination she has some mild asymmetries and modest soft tissue coverage.  Here is the preoperative photograph:

During our consultation I used the “High Five Process” to derive an implant volume based on her soft tissue characteristics.  The implant volume was 425 cc’s.  Due to the thinness of her soft tissues at the upper pole of her breasts the implant was positioned into the dual plane.  Here is the postoperative result at 4 months:

The operation achieved her goal of a proportional breast augmentation using an implant that was individualized and idealized for her soft tissue needs.  This implant should reduce her risk of tissue thinning and other complications in comparison to a larger implant.

Our websites, www.beauty-surgeon.com and www.drmckane.com have additional information and before and after photographs of breast augmentation for review.  I invite you to schedule a consultation with me if you would like to learn more about breast augmentation or the “High Five Process.”  Please feel free to contact our office at (713) 661-5255 if you have any questions.

-Brice W. McKane, M.D.

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