Breast enlargement is the most popular cosmetic surgery procedure in the UK. The increasing popularity and accessibility of cosmetic surgery has seen a significantly increased demand. Yet, few patients truly understand the risks, limitations and long-term effects. Although the past few years have seen much media hype associated with the good effects of breast augmentation, most information is less than satisfactory. An even more disturbing fact is that, due to lack of proper training, few surgeons really understand the factors and variables paramount in achieving a good, long-term result. Everyone knows that a breast augmentation involves adding an implant onto pre-existing breast tissue, but relatively few patients and surgeons grasp the relationship of patient desire, expectations and the physical aspects of volume enlargement.
If you're a patient, this is what this post will help you to understand so you can arm yourself with the correct knowledge before seeing a surgeon. A cosmetic surgeon has to look into the future to visualize the desired final result after the healing process is complete, taking into account the physical characteristics unique to each individual. Even more importantly, a cosmetic surgeon has to delve into the patient’s mind to ascertain what the patient dreams of, wants, desires and expects. Understanding this is fundamental to a successful cosmetic surgery operation.
Most patients try to describe their desired result in vaguely defined concepts and unquantifiable terms. In my experience, many female patients are even unaware of what a breast cup size means and how cup sizes are measured. Without the basic understanding, achieving patient expectations may be impossible. Hence, educating the patient to make her understand her own desires and relating them to the limitations imposed by her own body and tissues is the most significant contributor towards patient satisfaction. For many surgeons and patients, proper implant selection is an art, not a science. No single method has been proven to predict the size or shape will provide long-term satisfaction. With detailed patient education, discussion, counselling and respect for implant soft tissue dynamics, the rate of dissatisfied patients can be reduced significantly. The goal of augmentation is to improve the size and the shape of breasts. And while this creates a more positive self-image, the only predictable change is larger breasts. Positive psychological effects are common but are not necessarily predictable. At the beginning of each consultation, patients are asked about two elements of what they seek.
. First, why do they want their breasts enlarged
. Second, what do they want to achieve?
Understanding the answer to the first gives a clearer picture of the motivation behind why they are seeking surgery and makes it easy to root out misconceived expectations and to filter out an obsessive element of the patients desire. The answer to the second question helps the surgeon to define and quantify the patient’s desire in physical and measurable terms.
Patients seeking breast augmentation fall into three broad categories:
All practicing surgeons have come across patients who have complained that their desired cup size has not been achieved. This has been despite the insertion of the desired volume and good, aesthetic results. The discrepancy between a cup size and the volume arises because a cup size is not a scientific measurement and means different things to different people. In this regard, patient education is crucial, as almost all patients will indicate the desired cup size they want. However, if at this stage one asks the patient what she means, almost always it's the case that she does not specifically know the size of a particular cup. Cup size is extremely variable and inconsistent from one brand of bra to another, and it should be pointed out and explained that a cup size is only a general guideline and can’t be ordered or delivered.
Bra size is not a measurement of a particular volume. Rather, it takes into account the volume as well as the dimensions of the breast. The same volume placed in two women will create a different tissue stretch during healing and settling. three implants’ sizes stacked This means that the same volume can achieve different dimensions in different bodies and, hence, the importance of a patient's tissue characteristics as well as difference of the cup size. We always point out to the patients that they will be measured as different cup sizes by different shops. As well, if they pick up the same size bras from different manufacturers, these will be different in terms of proper fitting. Hence, the most crucial piece of information that a surgeon must pass to the patient before the surgery — precise cup size cannot be guaranteed. It is, however, not as despairing as it sounds. With proper measurements and accurate assessment of tissue characteristics, it is almost always possible to choose an implant volume in that will match the patient’s desire. That we do not guarantee this to the patient does not mean we do not endeavor to achieve it and find the right breast implant size in cubic centimeters.
Once the surgeon has quantified the patient’s desire, defining the implants volume is the most important decision. This is the single most important determinant of failure or success of the operation. The answer to the question — how much breast is enough? — depends on breast size in proportion to body size; the characteristic of each woman’s breast skin; and breast tissues. The variables affecting the final breast size are numerous, but the most important are:
This is, of course, ultimately the most important factor. The skill is to reconcile the patient’s desire with the appropriate volume, taking into account this may involve a patient’s desire to modify and create realistic expectations, which will lead to patient satisfaction. For example, a patient may desire a D cup. However, a surgeon may assess that the volume needed to achieve the patient’s desire, in adding to the pre-existing volume, may cause tissue damage. In such cases, a detailed explanation is necessary to change the patient’s desire, or to explain the consequences, in terms of changes in the future and what other corrective surgery may need to be performed if the patient were to fulfil her desires and go ahead with what is seen to be a larger implant.
A breast cannot be seen in isolation as if hanging in the air. It has to be seen always in relation to the body. Hence, assessing the patient’s build in height and weight, and assessing the shoulder and hips provides a basic measurement.
The base width of the breast is the most important dimension. NAC IMCA second important measurement is the distance between the nipple (NAC) and the inframammary crease (IMC) as shown in the image. Others are the distances between both anterior axillary lines and the distance of the nipples from the sternal notch.
The most important element to measure is the thickness of the breast tissue. This will determine whether there is adequate cover for an implant. However, most surgeons make the mistake of taking absolute thickness as the important measurement. Thickness of the tissue should always be judged against the intended volume of the implant. In other words, the bigger the volume, the more the desired thickness.
Thickness of tissue is not enough to provide adequate cover if the quality of these tissues is not good. By quality, I mean the adherence between the skin and breast tissue to act as a single unit and envelope. If the skin comes away from underlying tissue, the thickness needed to provide cover to the implant will have to increase significantly. Every woman’s breast skin can stretch and enlarge by only a certain amount without sustaining damage, such as excessive stretching and thinning.
It is crucial to understand that any implant adds volume into the breast. This is extremely important in groups two and three, as their breast tissue and ligaments have already been damaged. The stronger the breast ligaments, the more volume they can hold.
It is important to remember, as well as to remind the patient, that the final volume achieved is the total of pre-existing breast volume plus the volume of the implant inserted.
No surgical option is without trade-offs. The question is how to pick the option that maximizes the benefits and minimizes the trade-offs. Perfection or change to a different breast is never an option. Improvement in the existing breast is the only realistic alternative. No plastic surgeon can totally predict what a patient’s tissues will do over time, but every surgeon and patient should consider these issues when making implant choices. No implant will produce the same result in two patients as already explained.
This actually depends on your desired result. What's considered a large breast implant size for one body type, might be considered average or even small-sized for women of a different body type. We again have to look at things in terms of "volume". It is crucial to understand that a range of volumes, instead of a specific volume, will result in a specific cup. For example: In patients with a height range of 5’2-5’7 (about 158-173cm) A weight range of 8.5-9.5 stones (about 52-58kg) Chest measurements, generally are 29-32 cm. To achieve a C cup in such patients, a volume range of 265-330g is generally needed. The precise volume depends on the pre-existing breast volume, the thickness of tissue, expected tissue stretch and the strength of the holding ligaments. Similarly, the distance between the NAC and the IMC influences the cup size (more information on NAC and IMC can be provided during your consultation).
In the frame range mentioned, a distance of 9-11cm will achieve the basic dimensions of a C cup requirement. This means that, if the distance between NAC and IMC is less, it will need to be increased in addition to an adequate volume. On the other hand, if this distance is more, then the patient should be informed that the cup size dimensions are already bigger than the desired cup — in this example, C. It will be a rare situation when she doesn’t already know this. In such cases, the loss of volume has resulted in the loss of cup size, but the dimensions are still intact. Hence, a smaller volume, compared with the dimensions needed to reduce the cup size. This relationship between dimensions and volume is crucial to understanding cup sizes as generally spoken by patients.
This section might get a bit sciencey! As described, the second important measurement is NAC-IMC distance. In an aesthetically appealing breast, the wider the breast, the longer this distance. Determining optimal inframammary fold position at the end of breast augmentation is a major factor that affects the aesthetic result and achieves a certain cup size. We take the following general guideline to achieve proper cup size and use the right size implants:
. NAC to IMC 7cm or less provides an A cup
. B is 8-9cm;
. C is 9-11cm;
. D is 10.5-12cm
. DD is 12-13cm and so on
The chosen volume is then inserted with the incision placed according to the measurement given, taking into account any stretch that may have taken place; hence the volume and the measurement help the desired cup size. This is a simple and effective method. As mentioned, the concept behind this is by performing breast enlargement using this method, the whole figure is enhanced. The importance of explaining this to the patient is she understands the breast sits on the body and the breast implants operation is being performed to enhance the whole body. Each individual has her own special needs and desires, and once the volume has been determined, the shape, feel and projection of the implants should be explained. Lastly, the issue of the cup size and the impossibility of guaranteeing a precise cup size should be emphasized. The main aim of cosmetic surgery is to make a patient happy; this aim should never be ignored for any surgical procedure.
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