Your Questions

Q:    Dr. Eppley I’m a 30 year old single mother of two and I need a breast lift badly to improve my self-esteem.  I got pregnant with my first child at 19 and I gained over a hundred pounds.  I’m now back down to 150 and still need to lose more but I’ve lost 56 lbs.  My body just isn’t the same after two children and I just need some self esteem back. I already have a very nice size to my breast and am just looking to put them back where they belong.  Could you please give me information on what needs to be done to get my breasts back in shape and looking good again. Thank you for your help.

A: Between children and your significant weight loss, your breasts have undoubtably take a turn to the south. Breast sagging, known as ptosis, is defined by how low the nipples sit relative to the lower breast fold. When a large amount of weight has been lost (greater than 50 lbs), breast ptosis is usually severe and the amount of skin exceeds how much breast tissue exists to fill it. This usually requires a full breast lift which will result in the typical anchor scar pattern that is more commonly seen in a breast reduction procedure. This will move the nipple up to the center of the breast mound and will tighten the skin on the bottom side of the breast. While this lifts the breast, it will not usually result in permanent fullness of the upper pole of the breast. This is why a small implant may needed with the lift to get the fuller breast shape that many women desire from a breast reshaping operation.

Dr. Barry Eppley

Indianapolis, Indiana

Q:  I have a ruptured implant and am in need of a breast augmentation revision. I have always thought they were a little too large.  I’m wanting to downsize 25cc; they are different sizes, 275cc on the left and 250cc on the right. When downsized, I would then have 225 and 250. I’m worried about the 275 to 250 because the diameter is so much different. Is this going to look change the look dramatically?

A: In answer to your question, I would have no concern about such a small implant volume change on the breast look. A change of 25cc in a 250cc implant is only a 10% change in volume and would be less than .5cm in base diameter of the implant. In a 275cc implant that volume changes drops to only 9%, a change that is hardly visible. With either implant, that would likely have a minimalistic change in the outer breast appearance. In the case of saline breast implants, there are a lot of variables in implant selection such as their base size and what they are filled to as well as the projection or profile that they have. Such variables can make a visible external difference and all must be considered. With silicone implants, they are prefilled and their only variable is the different projections. (low, medium, and high) As a general rule, visible changes in the size of the external breast when it comes to a breast implant exchange should be in the percent volume change of 20%. Therefore, if one wants to have a smaller breast size with an existing 250cc implant, the downsized implant should be 200cc.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I am 38 years old, have breast fed two children and definitely sag some. While I never had big breasts, they have now completely gone away! My bra size is 34A. In addition, I have a wide sternum and my breasts appear to be fairly far apart. I think a good breast implant size for me is around 350cc. In order to get cleavage, should the implant be placed above or under the muscle?

A: While implants do a wonderful job of making breasts larger, they do not usually result in cleavage on their own. With widely separated breasts, cleavage will definitely not result from the placement of any reasonably-sized breast implants whether they are placed above or below the muscle. At 350cc, a moderately-sized implant for your chest, cleavage is not a realistic possibility. Trying to make cleavage by going above muscle with your small breast volume is a mistake in my opinion. The implant is at much great risk of hardening over time (capsular contracture) and runs the risk of resulting in synmastia (the joinging of the two breast pockets in the middle, a uni-breast so to speak), which is a very difficult problem to correct. Settle for the better long-term breast augmentation result of under the muscle and accept that cleavage without a bra is not a possibility with your breast/chest anatomy.

Dr. Barry Eppley

Indianapolis Indiana

Q: I want to get breast implants but am concerned about the scar. I really don’t want  a scar on my breasts anywhere as I think that would look bad. Who would care how big my breasts were if they were badly scarred? I have read about the belly button insertion of breast implants and there seems to be a lot of negative comments about it from other plastic surgeons. Do you agree with these feelings? What are the problems with putting in breast implants this way? It just seems to make sense to me that it is the best way to go.

A: When considering breast augmentation, the size and location of the incision is one important consideration to most patients. But one must remember that the incision is not the operation, the breast implant and its proper positioning is. Going through the belly button does provide a hidden scar but does so at the expense of several significant disadvantages for the final breast implant result. Besides being only able to use saline breast implants, there are potential problems with getting them in the right pocket and having good symmetry afterwards. At the least, these risks are higher when going through the belly button as opposed to any of the other three options. If one wants a hidden scar, a transaxillary (through the armpit) incision can be used without incurring a higher risk of other potential implant-related problems. This approach is more direct and gets the implant immediately underneath the muscle. The belly button incision offers no advantages at all over the armpit incision.

Dr. Barry Eppley

Indianapolis Indiana

Q: Hi I actually live a few hours away and before I set up a consultation, there are a few questions I have. I am currently a small A cup and am wanting to go to a C cup. I was wondering how much that would be, just an estimate is fine. I know you can’t tell me exactly and also I was wondering how the payments work and what kind of insurance you take. I have Medicaid. i hope to hear from you soon. Thank you!

A: When it comes to the expense of breast augmentation, there are numerous misconceptions about that aspect of the surgery. The cost of getting breast implants is the same regardless of the size of the implant used. Cost differences in implants do exist, but it is based on the type of breast implant selected not its size. Saline implants will cost less than silicone gel as the cost of the devices from the manufacturer is different. Many patients do finance their breast surgery through outside companies such as Care Credit. Plastic surgeons do not finance the cost of the surgery for patients nor can patients make monthly payments until their breast implant surgery is paid off. Payment for the surgery must be all paid up front which is why patients acquire the necessary funds from a financing company and pay them back over time with interest. No health insurance covers breast augmentation or any breast implant surgery unless it is associated with reconstruction from breast cancer.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I would love to have breast augmentation before my 21th birthday which is later this spring. My preferred approach would be breast augmentation with an incision through armpit area But  I also considering the option of an inframammary incision using Memory gel breast implants. Which do you think would be better for me? Thank you.

A: Breast augmentation poses multiple choices for prospective patients to consider. These options are driven by implant choice which can secondarily control the placement of the necessary incision. Saline breast implants are often placed through a small armpit incision because they are inserted deflated and then inflated once into position. Silicone gel breast implants, unless they are very small, can not be placed through the ampit because they are inserted pre-filled or fully inflated. Thus, they are usually placed through a lower breast crease or inframammary fold incision.

But the incision is not the most important part of the breast augmentation procedure, the implant is. All incisions heal really well and are rarely of any secondary cosmetic consequence. Therefore, it is important to understand fully the differences between saline and silicone gel implants. While both work well and do an equally good job at making a larger breast, there are some important minor differences in them that are relevant in the long-term. This is especially pertinent to you at your young age since you will live to see them. These include such risks as implant deflation (saline) and silent rupture.  (silicone) You will be replacing these implants at least once on your long remaining lifetime so understanding these differences is important to you.  

Dr. Barry Eppley

Indianapolis, Indiana