Joseph Grzeskiewicz

Breast augmentation remains one of the most popular cosmetic procedures perfomed with over 300, 000 of them done in the US each year.  One of the most significant advances has been improvement in both the materials and the design of the implants themselves. With current technology there is lower risk of capsule contracture, rupture, and rippling and other surface irregularities, and this all translates to a lower likelihood of returning to the OR for problems.  There are also improvements in the design of the implants such that we now have shaped form-stable implants as well as round implants, and we have more than one company making them with slight variations between them.  The fact that there are now three implant manufactures in the US has helped create competition and disruptive change, and this advances the science and technology of the implants.  Furthermore, each company offers very robust "warranty" programs for their implants, and this makes the operation less of a financial risk too.  Little has changed in the landscape of saline implants, in fact, I would say they are sort of fading out; at least they are in my practice.  The silicone gel filled implants have improved dramatically, though.  In addition to the implants themselves, I would also say that our understanding of the anatomy of the breast and the techniques of breast augmentation have evolved and become more refined.  Even advances like the Keller funnel have improved the way we do the operation.  We have more ways to deal with differnet types of bodies and situations and more ways to deal with complications like capsule contracture too.  All in all, I think that if you look at the details of breast augmentation instead of just considering it as a "commodity" - merely putting in an implant to make the breasts bigger - you will find that the operation has improved dramatically over what it was, even 10 years ago.

For me, age itself is not a factor, rather the health of each patient as well as her needs and goals are much more important considerations.  Some of my 40 - 60 year old patients are actually better candidates for surgery than ones in their 20's!  One thing I do find related to age, however, is that goals often change, and the surgeon must be very attentive to each patient's individual goals and stage in life so that he or she can advise the patient appropriately.  One of my favorite patients was a 64 year old lady, who came in with  her very dashing and dapper husband, to ask about breast augmentation so that she would feel better in her competitive ballroom dancing gowns.  She had a very reasonable augmentation with 250 cc implants and looked and felt fabulous after her surgery.  Life is what each of us makes of it, at any age.  What is it that they say?  "50 is the new 30!"

Your breast tissues can still respond to the same factors that any other normal breast tissue will respond to after breast augmentation surgery.  Thus, hormonal changes, such as with pregnancy, breastfeeding or hormone treatments, or  weight gain can all cause some increase in the size of your breasts.  Some of these changes may be temporary, while some of them may be permanent.  This is one of the reasons why I advise my paients that while it is uncommon for ladies to have reoperation on their breasts in the future for this reason, it is not unheard of, and no breast augmentation should be thought of as an absolutely permanent thing that can't change over time or that won't ever need to be altered or corrected for some reason in the future.

Typically breast implants tend to settle a bit after surgery, and the slight overcorrected fullness at the upper pole that is often seen tends to decrease as tissues loosen up and soften. Thus, it is very unusual for the implants to migrate upwards and create more fullness over time.  That is, unless there is some capsule contracture, in which case what we typically see is firmness or hardness of the involved breast(s), increased roundness of the breast shape, and increased fullness in the upper part of the breast.  However, this is not the desired kind of fullness usually.  If you feel as though your breasts aren't full enough after augmentation, you may need to revisit the issue with your surgeon and consider larger implants, higher profile implants, or a lifing procedure to increase the tone of the breasts.

Each breast augmentation is different, thus each case is individualized.  In cases with asymmetry, as long as it is relatively mild and can be camouglaged by volume or dimension of the implant, the asymmetry can ususally be corrected with augmentation alone using differing implants between the two breasts.  The limitation in doing this however, is that the formula is not always one of simple volume adjustment.  That is to say, just because one breast may have 50 cc more volume than the other, doesn't mean the correction can be accomplished easily by just using a 50 cc larger implant.  Because implants have not only volume to consider, but also three dimensions - width, length, and height (with round implants width and "length" are really the same), you will often see differences in these variables even if the volume adjustment corrects the difference in volume.  For example, even though the volume in a bra is now equal when a 350 cc implant is on the right and a 400 cc implant is on the left, the left breast may now project outward more and appear fuller or it may be wider than the right, and this creates its own asymmetry.  Thus, the correction of asymmetry with implants alone requires a keen artistic eye and good analytic judgment on the part of the surgeon.  In addition, this does nothing to correct any asymmetry in the position of the nipples.  In order to do that, one must usually add some type of lifting procedure too, at least to the lower breast/nipple.  Usually in cases of mild nipple asymmetry it either improves sufficiently with augmentation alone, or the patient and I decide to accept the mild asymmetry as a reasonable trade-off for a less complicated procedure.  Not every asymmetry NEEDS to be conrrected; you are really the boss when it comes to that.