Breast/Enlargement (Augmentation Mammoplasty)

Background

The procedure known as augmentation mammoplasty is the operation that is done to enhance a woman’s bustline using implanted prostheses. This operation remains one of the most popular procedures that women seek, despite controversy surrounding silicone gel breast implants in the early 1990’s. Whether for enhancement of very small breasts, enlargement in the setting of significant existing breast tissue, or to fill out a "deflated" appearing breast following pregnancy and nursing, placement of breast implants affords a wonderful psychological and physical boost to women who are unhappy with this part of their figure. The vast majority of women who undergo breast enlargement are very pleased with their results and report years later that they would unequivocally undergo the procedure again. In fact, it is not infrequent for the daughters of previously augmented patients to seek out the procedure themselves.

Having said that, it remains that with breast enlargement, as with any elective cosmetic procedure, it is very important for women considering this procedure to be given informed consent. This means that anyone considering having permanent implantation of a medical device is made aware not only of the risks of the operation itself, but also of the lifelong risks of having implants. These will be enumerated below.

It is our opinion that it is also important for patients to understand how the operation is performed, what the recovery is like, what the costs of the procedure are, and what the typical appearance of implanted breasts are in the hands of Dr. Creasman. For this reason, we have developed this section of our website and an extensive photo library of patient results, all performed by Dr. Creasman. While it is impossible to show every variety, size, and shape of breast that exists, we have tried to show average results in various scenarios. Though these results do not in any way guarantee that you will obtain the same exact result, they serve to demonstrate a level of competence and expertise by the doctor, and provide a visual basis for estimating the size of implant which would provide the patient with the desired result.

Surgical Principles

The Incision

The most basic principle upon which the operation is based is the creation of a space, or POCKET, into which the implant is inserted, thereby enlarging and reshaping the breast contour. Technically, breast enlargement is not a simple operation because a relatively large pocket must be made through a very small incision in order to achieve an attractive result with the most inconspicuous scar. Incisions that are utilized for this operation include:

• Inframammary - in the crease between the breast and the chest wall
• Axillary - in the armpit
• Periareolar - at the junction of the dark and light colored skin of the areola

Dr. Creasman performs the procedure using any of these approaches

The Implant

Significant advances and alterations have been made in the prosthesis itself since the original introduction of the silicone gel breast implant in 1962. The two main types of implants are the silicone gel prosthesis and the saline-filled prosthesis. Both envelopes are made of a solid type of silicone (Silastic), but the material inside each differs. In 1991, the FDA restricted the use of silicone gel breast implants to certain patients and until late 2006, access to this prosthesis was been restricted to Plastic Surgeons participating in FDA sanctioned Clinical Studies. Since 1991, Dr. Creasman has been an investigating surgeon in several of these studies. There are currently no other types of implants that are available such as soybean oil or other types of fillers. An implant known as the “cohesive gel” implant, which is a more dense silicone gel material, is currently in clinical investigations but is not yet available for general use. Though there has been considerable controversy over the last decade and a half about the safety of silicone gel breast implants, there has been no compelling scientific evidence to date that would validate any claims that silicone gel implants lead to any systemic illness. In late 2006, the Food and Drug Administration placed silicone gel implants back on the market for primary (first time) breast augmentation, with some restrictions.

Silicone gel implants have different characteristics than saline, some more favorable, some less. It remains clear that a more natural FEEL is achievable with a silicone gel device versus a saline device. In most patients however, a very natural result can be achieved with use of the proper technique and size of saline implant. Saline implants are the same specific gravity as silicone, i.e. they weigh the same per cc, but the saline is not viscous like silicone and this can lead to a greater tendency for the breasts to thin out over time and also for the wrinkles in the bag to be more apparent either by feel or even visually. The saline implants have historically been more inclined to incite a scar reaction around the implant (capsular contracture). While it is obvious when saline implants leak, with silicone implants often a leakage is not obvious and there may be no symptoms whatsoever (also known as “silent rupture”). For this reason, patients requesting silicone gel implants are advised by the FDA to obtain periodic MRI (magnetic resonance imaging) of their implants to ensure their integrity. Currently, silicone gel implants are more expensive than saline implants. You can read more about silicone gel breast implants by clicking on the following link: www.breastimplantstoday.com

There are two types of surface textures available, smooth and textured. This texturing was developed to mimic the appearance of a polyurethane foam implant, now off of the market, which had a very good record for resisting capsular contracture, or hardening of the breasts due to scar. Textured saline implants were not shown in a recent study comparing the two, to have a better track record than smooth surfaced implants. Dr. Creasman dislikes the textured saline implant because of many problems he has heard from patients in whom they were used, including a high incidence of visible wrinkling, and a very unnatural feel, compared to smooth implants. There was a push by one of the implant manufacturers several years ago to market an "anatomical" implant, which has a teardrop shape and is textured. Though this has an intuitive appeal on a theoretical basis, in practice these implants do not look any different once implanted, and carry the risk of feeling very unnatural, since they adhere to the surrounding tissue. This effect is not as great with textured silicone gel implants as it is with textured saline implants

Dr. Creasman uses smooth, round, saline or silicone gel implants for most breast augmentations. These come in various widths and also three basic styles of projection (the amount they stick out from the chest wall). They are referred to as low profile, moderate profile, and high profile implants. Most patients use moderate profile implants. In very petite patients with narrow breasts who desire maximum augmentation, a high profile implant provides a means of enhancing volume without over enlarging the width of the breast. In women who have a significant amount of breast tissue and have wider breasts, but who only want a small degree of enhancement, the low profile implant provides a means of enhancing the entire width of the breasts without over doing the augmentation from a volume standpoint. The figure below shows three implants of the same base width, but with the three different profiles (and of course, different volumes).

High profile implants tend to look rounder, particularly in the upper pole of the breast when looking at the profile of the breast, and they are heavier. Low profile implants require that a patient have enough breast tissue to hide wrinkling, as they tend to show rippling to a greater extent with their sharper radius, or side edge.

Silicone gel breast implants are available in low, high, and moderate profile versions as well.

The following points address concerns frequently expressed by patients about implants:

1. There is absolutely no evidence that the breast implant predisposes the patient toward or in any way causes breast cancer.
2. Evaluation of breast tissue by clinical examination and mammograms is somewhat more difficult with an implant in place, but is still very satisfactory, with special techniques.
3. The breast implants do not deteriorate or decompose in the body and the silastic bag does not migrate away from the local area of implantation. There is NO REASON to routinely replace an implant after a certain period of time (e.g. 10 years), though patients commonly believe this.
4. Assuming normal tissue and a properly performed operation, a breast that has been augmented will not sag any faster than a natural breast of the same size.
5. There is no interference with the function of the breast or the chest (pectoral) muscle, and permanent interference with feeling or sensibility of the nipple is unusual.
6. Breast implants do not “lift” the breasts (we can’t fill them with Helium!). They may fill out a loose envelope of skin which can create the perception of lifting, but true lifting does not occur with implantation of a fluid-filled mass. If anything, breast implants add weight to the breasts, and women who have them must be more mindful of wearing a bra to keep them from sagging over time.
7. Once healing is complete, the patient loses a subjective awareness of the implant, and incorporates it as part of her body image quite rapidly.
8. The improvement produced by the implants is noticeable immediately, and there is very little swelling and bruising produced by them. However, the final appearance of the breast does not occur for several months because of the need for the tissues of the chest muscle and breast to accommodate to the size of the underlying prosthesis. In the interim, the breasts appear unnaturally high on the chest, and the skin feels tight. This is temporary and improves strikingly over the first three months. The most important thing to remember is that this is a normal and natural phenomenon, and is unavoidable.
9. It should be appreciated that changes continue to occur in the breast due to the presence of the implant for many months. Many patients report a perceived shrinkage of the breasts at a year following operation. This is most likely due to the compressive effect of the mass of the implant on the breast tissue. This can be seen on mammograms, and is akin to a sponge being squeezed. There may also be a purely psychological tendency to adjust one’s personal definitions of size after having undergone the procedure. There is a natural tendency to "want more of a good thing". Though there are obvious examples of "too much of a good thing" in the media, suffice it to say that one invites problems with over enlargement (e.g. wrinkling). This will be explored in greater depth during the consultation.

The Level of Placement

In addition to several types of incisions and implants, there are also two basic techniques of breast enlargement, involving differences in the location of the pocket. In one the pocket is made beneath the breast tissue, but on top of the pectoralis muscle (figure 3, left). In the other, more common, method, the implant is placed beneath the pectoralis muscle, between the pectoralis and the ribs (figure 3, left). The advantages of placing the implant above the muscle are that it is less painful for the first few days and the appearance of the implants matures faster (because skin stretches faster than muscle). Contraction of muscle, more noticeable in body-builders, has no effect on the appearance of the breast. This technique is utilized in women with sagging breasts as the breast position relative to the underlying muscle has changed and a deformity known as a double mound is created if the implant is placed under the muscle, at the higher level.

The advantages of placing the implant under the muscle are numerous. First, it provides a more natural appearing breast with a better transition from the upper chest to the breast mound. This avoids "upper pole convexity" or roundness of the upper breast, which does not occur in nature. Second, the rates of scarring around the implant (covered later) are significantly lower when the implant is placed beneath the muscle. Third, the risk of visible ripples or folds in the implant envelope (a more common problem with saline than with silicone implants) is diminished because of the greater amount of the patient’s own tissue overlying the prosthesis. Fourth, the ability to obtain an adequate mammogram is enhanced with placement under the muscle, as the mammogram technician is better able to separate the breast from the implant when the muscle is interposed.

With the exception of patients who are body builders and those with sagging breasts, Dr. Creasman recommends the subpectoral technique to his patients. One technical consideration deserves mention. It is very important during the operation to release pectoral muscle attachments near the breastbone (sternum) and underlying the lower part of the breast, to open this part of the pocket adequately such that the effect of having CLEAVAGE is provided. This is, in Dr. Creasman’s opinion, a critical step in the procedure. When these muscle attachments are not released from the ribs and breastbone, the implants tend to settle to the sides and a wide spacing between the implants occurs, which is undesirable and unnatural. This tends to be more of a problem with the axillary approach.

The Consultation

The consultation is usually thirty to forty-five minutes in length and involves a process of information transfer between the doctor and the patient. For the doctor’s purposes, he needs to obtain a pertinent medical history, family history, medication history, allergy history, and he needs to determine the general goals and expectations of the patient. One issue is the role of sagging, if appropriate. An examination must be done to determine the patient’s basic chest and breast anatomy, the presence of any breast abnormalities, the amount of size increase desired, and whether or not correction of sagging is needed. Most of the consultation is an educational experience.

One of the most essential factors in achieving the goals of both the patient and the doctor is the individualization in planning and carrying out the surgery. The following represent aspects of this of which all patients should be aware:

1. Achieving ideal enlargement and consistency (softness) is more difficult in breasts that are extremely small and in which there has not been stretching of the skin from pregnancy or hormonal stimulation; however, in a high percentage of patients, this goal is still achievable.
2. A moderate amount of stretching of the breast skin and a slight amount of sagging as a result of pregnancy can be desirable since this permits greater enlargement without sacrificing softness.
3. Sizing breast implants is an important issue both for the patient and the doctor. Brassiere cup size is a nebulous parameter of measurement, which is too imprecise for the purposes of performing a surgical procedure. Any woman knows that depending on the manufacturer, style, and preferred fit, bra sizes widely vary for a given size breast. For this reason, and the fact that breast implants are not manufactured in cup sizes, we utilize a sizing method which is predicated on the patient’s own anatomical measurements. A range of implant sizes is suggested to each patient, and a subjective approximation of the resultant cup size is given. But the most useful advice is for each patient to follow her own anatomy, rather than trying to strive for some arbitrary ideal, which may or may not be achievable or appropriate.
4. If significant sagging of the breast has occurred (called ptosis), which is determined primarily by the position of the nipple relative to the inframammary fold, then simple enlargement of the breast with an implant will not suffice. In this case, the breast must be recontoured as well as enlarged, and this requires a different operation, which is known as a mastopexy. If this is a factor pertinent to your situation, this operation will be discussed in detail with you.
5. In women who have been nursing, a period of time must pass after the complete weaning of the baby from the breast. Dr. Creasman will not perform breast augmentation for AT LEAST THREE MONTHS after the last signs of milk flow. This is to avoid incising into milk producing breast tissue, which can lead to complications of a galactocoele (milk cyst), and/or infection.
6. Some asymmetry (difference in size and shape) of the breasts in the same individual is very common; so common, in fact, as to be considered the rule rather than the exception. Every attempt is made to improve or correct this asymmetry at the time of surgery, but perfection cannot be achieved. (See section on Breast Asymmetry)

Before Your Procedure

Following the initial consultation, Dr. Creasman prefers that patients give appropriate time for reflection and counsel from those closest to them before proceeding with scheduling the operation. Scheduling surgery involves payment of a non-refundable deposit, as there are costs involved with preparing for your operation, and for holding the time. A PERIOD OF AT LEAST TWO WEEKS OFF ANY MEDICATIONS CONTAINING ASPIRIN, IBUPROFEN, VITAMIN E, OR OTHER MEDICATIONS THAT COULD ADVERSELY AFFECT THE BLOOD CLOTTING MECHANISM, IS REQUIRED TO PREVENT ANY BLEEDING COMPLICATIONS. At the time surgery is scheduled, a pre-operative visit is also scheduled two weeks prior to the date of the operation, and takes approximately 30 – 45 minutes. In women aged 35 and older, a baseline mammogram needs to be obtained prior to surgery and the report faxed to Dr. Creasman. At the preoperative visit, a consent to operation is signed. The size of the implants to be used is finalized. Photographs are taken. A directed physical exam is carried out. All questions relating to the surgery are answered in detail. We will advise you which bra to purchase for your recovery. Here is a preoperative checklist to follow prior to surgery:

1. Please pick up liquid Ivory hand soap and cleanse the skin of your chest and underarms with it for the three days prior to your operation.
2. Report any signs or symptoms of infection, such as fever, inflamed body parts, burning with urination, cough, diarrhea, or flu symptoms.
3. You should avoid shaving your armpits for two days prior to surgery. You should not wear deodorant the day of your surgery.
4. Wear a non-pullover blouse to your operation. We suggest a zipper front sweatshirt. Wear slip on shoes with smooth soles for ease of ambulation. Wear cotton panties and clean white socks. Do not wear makeup.
5. Please remove any artificial nail material from both of your index fingers. We monitor your oxygen levels through your nail beds, and artificial nail products interfere with this.
6. Do not wear jewelry or bring other valuables to the office on the day of your surgery. Pierced body parts, including navels, nipples, and tongues, need to be free of jewelry for your safety.
7. Take any prescribed medications as directed.
8. DO NOT EAT OR DRINK ANYTHING FOR SIX HOURS PRIOR TO YOUR ARRIVAL.
9. Avoid smoking for six hours prior to surgery.
10. Avoid alcohol for 48 hours prior to surgery. It can lead to dehydration and can interfere with clearance of your anesthetic medications.
11. Stock up on Coca Cola Classic. It is useful to reduce any nausea you might feel after your anesthetic.
12. Bring your bra with you to surgery.

The surgical fee is due in full at the preoperative visit. Arrangements should be made for transportation for the day of surgery and for the first post-operative visit (usually two or three days after surgery). Usually three to four working days off are required for recovery. You should arrange to have someone with you for at least the first 24 hours after surgery.

The Operation

The operation usually requires one hour of operating time and one hour of anesthetic recovery. You will have a general anesthetic. A Board-Certified Anesthesiologist provides the general anesthetic, which will give you the greatest degree of comfort during the operation. In fact, with general anesthesia one is completely unaware of the experience and feels absolutely no pain whatsoever. Dr. Creasman administers nerve blocks during the procedure which numbs your chest with a long lasting local anesthetic, to provide you with pain relief post-operatively. At the conclusion of the procedure you will be placed into your bra.

The Recovery Period

Because of the use of sedative medications, it is absolutely essential that a responsible adult escort be available to transport the patient to and from the operation, and be available for the first 24 hours. During that time, the caretaker person will assist the patient in getting up to the bathroom, taking medications, andpreparing meals. Most patients rest for the first 12 hours after surgery, but you may be up and around.
Dr. Creasman will generally call in the evening, between 8 - 9 pm, to check up on you. You need to anticipate some discomfort until the serum level of the narcotic pain medication reaches a therapeutic threshold. This usually takes a double dose of the pain pills for the first two to three doses, after which a single dose is sufficient to maintain control of the pain. You will also be prescribed a non-steroidal anti-inflammatory medication that is to be taken in addition to the narcotics. Do not take any other medications unless this is cleared through our office, to avoid medication-related complications. You do not need to discontinue your birth control pills. We provide a prescription for suppositories to help fight any nausea you might have from the anesthetic. Take them only if necessary.

Activity should be restricted to no lifting, pushing, pulling or driving for 48 hours. It is not advisable to drive a motor vehicle until one is completely off narcotic pain medication and there is no restriction of upper extremity mobility, such as may be required in an avoidance maneuver with a car. The bra is left in place until the first post-op visit, and the breasts must be kept dry. A small amount of oozing at the incision sites is to be expected. The breasts should not be manipulated in any way. One should be up and walking on the evening following surgery, and a light solid diet begun to the point of tolerance.

Certain events should be reported to the office immediately. A temperature over 99.5 degrees, chills or sweats, a markedly different degree of swelling between sides, and/or increasing rather than decreasing pain.

At this point in the recovery, it is normal and expected for breast implants to ride up higher on the chest than they will ultimately rest. The skin and muscle are still tight, there is swelling from the surgery, and this all needs time to resolve. Typically, this period of settling takes 3 – 6 months, but varies from patient to patient. Here are shown images of a typical patient pre-operatively, at 2 days, and at three months.

Patients are seen 2 - 3 days after the operation and their bandages removed and the healing assessed. Patients are then allowed to shower and to wash their hair. Tapes on the incisions can then be gotten wet, but the incisions should not be submerged, as in a tub or pool. Most patients can resume a reasonably normal activity pattern and non-exertional type job situations within 5-7 days after surgery.

Implant massage exercises are begun at the first post-operative visit and are done with greater frequency early on to displace the implant around the generous pocket, in an attempt to prevent the body from closing down the pocket and compressing the implant. It is painful at first, but quite rapidly this becomes very tolerable, and it is essential to establish this large pocket early in order to obtain soft breasts.

Dr. Creasman’s protocol is begun at 2-3 days after operation and is as follows:

1. Use your right hand to move your left breast implant, and your left hand to move your right implant.
2. Cup your breast on the bottom and lift straight up toward your collar bone. At first this should be done gently, but increase the force with which you displace the implant until you can move it all the way up nearly to the collar bone. Hold the position for ten seconds in the UP position.
3. Next, cup the breast on the lateral, or outside, aspect and move it inward toward the breastbone. Hold it there for ten seconds.
4. Now do the same with the opposite hand and opposite breast.
5. Steps 2-4 constitute a single REPETITION. Do 10 of these repetitions to complete a SET.
6. Do a SET of massage exercises every TWO hours while awake, for the first 2 weeks after they are started. After two weeks, we recommend you 2 sets a day for life.

Click any of the 4 images below to see a video demonstration of the recommended implant exercises:

Risks of Breast Augmentation

Surgery of any kind, no matter how seemingly trivial, no matter how expertly performed, involves some degree of risk, and this operation is no different in that respect. Having prostheses implanted involves the acceptance of some liability that was not present prior to their implantation. Some women cannot handle any further responsibilities in their lives. The addition of breast implants may just be too complicated for you. If this is the case, you should not have this operation.

What are the surgical risks?

1. Bleeding (hematoma formation) - abnormal bleeding into the space around the implant can occur after surgery with the rate being about 1% of patients. If bleeding occurs in any significant amount, a return to the operating room is necessary to remove the blood and control the bleeding, since to not do so would produce an abnormal shape of the breast and increase the chance of postoperative hardening.
2. Infection - because the ducts of the breast contain bacteria normally and are moved around in the process of making the pocket, all patients are given a dose of intravenous antibiotics just prior to the operation to reduce the risk of infection. The implant space and the prostheses are bathed in a potent antibiotic solution as well. The protocol has kept the risk of infection to approximately 1% or less.
3. Loss of nipple sensation - most patients have some partial loss of feeling of the lower part of the breast for several months following the surgery; this is due primarily to the stretching effect of the implant on the nerves in this area. It is also not uncommon for patients to develop irritability or hypersensitivity of the nipple and areola within several weeks following the surgery; this represents regrowth of the nerves that are cut where the incision is made and usually lasts only several weeks. It is unusual for any permanent loss of sensation to occur after the surgery, but it can occur in 5-10% of patients .
4. Malposition of implants - particularly in patients with native asymmetries, adjustments to the position of the inframammary folds can be done to attempt to correct the asymmetry. This is rarely perfect, and sometimes requires revision if it is possible to improve it further.

What are the long-term liabilities of breast implants?

1. Capsular contracture (hardening of the breasts by the presence of scar compressing the implant) - part of the normal healing in every patient who has breast augmentation surgery is the formation of a thin membrane of scar by the body’s immune system, which is termed a capsule. This is a normal aspect of healing, and always occurs because the implant is a foreign object. What is variable is the tendency of some capsules to contract or squeeze down around the implant (like “shrink wrap”). If this occurs, the breast will feel firm and can become distorted, usually by becoming more spherical and sitting higher on the chest. It can happen on one side only. It tends to occur, when it does, earlier rather than later. It can occur to varying degrees, with the ultimately severe form actually causing breast pain. The rates of occurrence with submuscular placement of a saline implant are approximately 5 -10% of cases. The treatment is surgical removal of the scar (capsulectomy) and replacement of the implant. The problem can re-occur, as t here is no definitive cure. The tendency to develop this problem is not something that can be predicted by any available test. Massaging the implants to maintain the large size of the created pocket is the only thing a patient can do which possibly reduces the incidence of this problem, and has been very successful in Dr. Creasman’s practice.
2. Interference with mammography - placing an opaque object next to the breast interferes to a variable extent with the ability to mammogram the breast for breast cancer screening purposes. By placing the implant behind the muscle, the ability to displace the implant away while pulling the breast forward into the mammography machine is increased. This technique, known as the Eklund technique has improved the ability to see most of the breast such that the presence of implants does not represent a statistically significant risk to patients of missing an early breast cancer.
3. Deflation - as strong as they may be, Silastic bags can and do occasionally leak their contents, which in the case of saline-filled implants is IV grade saline (the same salt water that makes up approximately 70% of our bodies). The incidence ranges between 1.5 - 2% per year if the implant is properly “over-filled”. The usual cause of saline implant deflation is scar tissue ingrowth at the fill valve site. This is unpredictable and cannot be completely prevented, but “over-filling” places more pressure on the valve and reduces the statistical likelihood of deflation. With silicone gel implants, there is no valve, but the shell or bag can split and release the gel contents. This is an event that occurs in about 0.7% of implants per year. Since in most patients leakage of silicone is not accompanied by any symptoms, the FDA recommends periodic MRI surveillance of silicone gel implants. The current recommendation is that an MRI be obtained at 3 years after implantation, and then every two years thereafter. Unfortunately, physical examination is not reliable in detecting silent implant ruptures. Implant manufacturers provide warranty coverage for this complication, and usually pay for some of the costs of the surgical room and anesthesia for a period of ten years as well. Additional warranty coverage may be purchased from the manufacturer for a nominal fee. Though a medically harmless complication, treatment of implant leakage involves going back to the operating room and re-entering the pocket through the same incision (if on the breast) and replacing the implant. Many experienced surgeons feel that deflation is inevitable with a saline device, but there is no reason for implants to be routinely replaced if they remain intact. In the event of a deflation, you should seek treatment promptly as the collapsed implant pocket will shrink rapidly, and if a new implant is not replaced within a week or so, this may require additional surgery to correct.
4. Interference with breast-feeding - extremely rare, it is possible to divide the ducts that empty the breast gland and thus interfere with lactation when the procedure is performed via the periareolar approach. Additionally, the breasts may be too uncomfortable when engorged, and so lactation may be hindered in this way.
5. Visible rippling - in very thin patients with very little native breast tissue, the saline implant in particular can reveal itself with visible folds and creases. The larger the implant, the greater the likelihood of this complication. This is a much more common problem with textured implants than with smooth implants. It is also more of a problem when the implants are placed above the muscle. The implants are actually overfilled at the time of placement to distend the envelope such that this complication is mitigated, but over time as the skin thins out from the weight of the implant, this can become worse. The treatment is replacement with a silicone implant, and even this sometimes does not completely eliminate the issue.

Conclusions

The female breast is an important symbol of femininity and sexuality to both women and men. Having fuller breasts often enhances clothing choices. It is therefore very natural and normal that most women would desire to maintain or achieve an attractive or pleasing breast contour. What is most attractive in practically every body feature though, is proportion.

That some women are more generously endowed with natural breast tissue than others is also an undeniable, if unfortunate, fact. Women suffer a great deal of emotional frustration and anxiety because of the small size of their breasts, because of breast asymmetry, because of sagging breasts, or because of a disproportion between the size of their breasts and other body structures. It is fortunate that in recent years our society has become more enlightened and open-minded about the desirability and reasonableness of correcting dissatisfaction with breast size and contour.

Many women approach this process with feelings of guilt about excessive vanity or self-indulgence. These are normal feelings and they pass after surgery as one begins to appreciate the overall value of the results. It usually takes several months to incorporate the new look as part of one’s body image. While a breast augmentation cannot solve all of life’s problems, it can increase immeasurably one’s self-image and self-confidence, and make a significant and long-lasting contribution to a person’s overall functioning and happiness. Having heard testimonials from women now in their late sixties and seventies who were the pioneers in breast augmentation thirty or so years ago, the vast majority state they would unequivocally do it again.

Information Regarding Your Post Operative Bra

List of (Wire Free) Bra Styles that would work well after Breast Augmentation Surgery:

*Following bras below can be purchased at Target or Mervyns and online @ www.championcatalog.com

• Champion Action Shape Sports Bra Style #CH072SB
• Champion Sports Shape Sports Bra Style # CH009SB

*Following bras below can be purchased online @ www.barenecessities.com or retail stores.

• Warner's Friday Wire Free Bra Style #2085 & #2081
• Bali Double Support Cotton Bra Style # 3036
• Donna Karan Casual Comfort Soft Cup Bra Style # 35237
• Nike Dri- Fit Running Bra Style #223977

List of Underwire Bra Styles that would work well after Mastopexy and Breast Reduction Surgery:

*Following bras below can be purchased online @ www.barenecessities.com or retail stores

• Lily of France In Action Sports Bra Style # 2101755
• Natori White Label Underwire Sports Bra Style # 7234439
• Lunaire Coolmax Underwire Sports Bra Style # 11111
• Donna Karan Intimates Underwire Sports Bra Sytle # 35137

*Following bras below can be purchased online @ www.championcatalog.com or Target & Mervyns

• Champion Shape Scoop Back Full Figure Underwire Bra Style # CH6843SB
• Champion Underwire Comfort Strap Sports Bra Style # CH161SB
• Champion Full Support Underwire Sports Bra Style # CH6242SB