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Michael G. Leadbetter, M.D., F.A.C.S.

Breast augmentation is a very popular procedure worldwide and has been for several decades. There are many reasons why breast augmentation may be sought by patients to improve their body image. The patient may have had a lack of development of the breast through puberty, or an asymmetric development of the breast through puberty. The most common reason for breast enhancement is loss of volume after pregnancy and breast-feeding (postpartum atrophy of the breast). Regardless of the reason for the patient seeking breast augmentation, the affects on the patient can be the same including body image difficulties, difficulty with clothing or bathing suits, and significant psychosocial stresses affecting their intimate interpersonal relationships.

The lay population tends to discuss breast augmentation in a very cavalier manner visualizing the starlet or the topless dancer. In reality, this population makes up a very small percentage of women seeking breast augmentation. Most women seeking breast augmentation just wish to feel better about themselves, more confident, and be able to replace what has been lost or never developed due to genetic or physiologic changes.

We as plastic surgeons understand that breast augmentation needs to be approached in a much more artistic manner than one might think, and proper breast enhancement needs to be put into prospective for the patient so they don't create long-term injury or irreversible changes for themselves. We are often faced with the young woman who is an A cup and comes in wishing to be a D or DD cup. It is important at this point to put breast augmentation in perspective for the patient and approach the augmentation of her breast in a customized approach. There are two important measurements of the chest when considering breast augmentation. (1) The base diameter, the widest inner point of the breast to the widest outer point. (2) The vertical height from the crease of the breast to where the natural breast tissue stops superiorly. It is important to understand that these measurements should be carried to surgery when determining the appropriate size implant to be placed. Using sterile sizers during the operation to adequately size the breast, and then placing the appropriate implant becomes very important for good, long-term results. Today, the majority of plastic surgeons are using salt-water implants in the submuscular position for better aesthetic long-term results and because of that, custom fitting is very important. Over-augmentation of a patient's chest can create significant changes that may be irreversible for the future including long-term injury to the pectoral muscle, migration of the implant either laterally or inferiorly, or loss of nipple sensation.

The approach to the breast augmentation must be different depending on the age of the patient. The patient who is young, has never had any children, and is just wishing to enhance her body image must keep in mind that she is not doing this at the most ideal time of her life. She may experience pregnancy in the future, which is going to change her breast shape in relationship to her breast implant, and may necessitate further surgery including exchange of implants, or uplift procedures.

The patient who is having breast augmentation performed for replacement of volume loss after pregnancy is approached differently. This patient has lost significant breast volume, but has also had significant change in her breast skin. Thus, the proper sizing of the breast becomes important to replace the volume loss, and determining the proper relationship of the breast to her breast implant becomes very important, sometimes necessitating uplift and reshaping procedures.

Every woman's breast is different. Breast augmentation should be looked at as an artistic procedure with this in mind, and should be customized to fit every patient's individual needs. Ideally, we would like the patient to look the same at one year, as they do at 10 years postaugmentation. Unfortunately, we cannot change the aging process and we cannot overcome gravity, but we can do our best to not accentuate these problems by over-augmenting the female breast.

Further information can be obtained through The American Society of Plastic Surgeons at; or The American Society of Aesthetic Plastic Surgeons at

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