Patient - Breast Augmentation

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Some plastic surgeons only show you their very best results on their websites. This is OK because at least you know they are capable of getting good results. The reality of plastic surgery, however, is that not all patients get that ideal outcome. If your surgeon says they do, run. Patients come in with all sorts of challenging circumstances and there are countless variables that can affect the outcome, not all of which can be fully controlled. This lady came in for breast augmentation. She essentially had no breasts. Her bra size was an A cup but that was a stretch. Her challenges were very tight skin, a very constricted base to her breasts with a wide space between them, and almost no tissue to hide even a small implant. These are among the most difficult cases to do. I elected to use a round, smooth, high profile saline implant placed under the muscle, with implants sizing done in the operating room. Today, I would probably have suggested she consider cohesive gel implants as these look very nice in patients with no breast tissue. I forewarned her that a “natural” result was unlikely in these circumstances.

Breast Augmentation - Dr. Richard Bosshardt
Breast Augmentation - Dr. Richard Bosshardt


Her surgery went well and, at first, she looked very nice, however, over time it was clear that she was developing bilateral capsular contracture, a known and frustrating complication of breast augmentation in which the scar tissue (capsule) that forms in all patients around the implants contracts, squeezing the implant. This makes the breasts firm, unnaturally round, and more widely separated than ideal. In her case, they also bottomed out a bit. This is when the implants seem to sit a little too low in the breast. This was probably a consequence of artificially lowering her crease under the breasts. This can only be corrected with surgery but the problem of contracture is ever present with implants and some patients seem prone to this. We do not have a proven, effective means of preventing this in all patients and the incidence ranges from around 3% to 15%. I offered this revision to her multiple times but she declined, professing to be satisfied with her breasts. She looked very nice in clothing and was having no problems with the implants otherwise. It has now been 7 years and she continues to be OK with them but is now considering having a revision done.

Breast Augmentation - Dr. Richard Bosshardt
Breast Augmentation - Dr. Richard Bosshardt

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