Dr. Belsley's Philosophy of Breast Augmentation

Size

When it comes to deciding what approximate breast size you wish to achieve, the best advice I can give you is that you should be guided by your physical frame.  Indeed, you may in fact be limited by it.  In my practice, I select implants based upon your chest measurements, the quality of your breast skin and the size of your breasts prior to surgery.  What this means is that I cannot recommend an implant size until I examine you.  Bringing photographs of results that you like is very helpful for me as well, but I caution you that a given volume implant looks different when inserted into every women’s chest.  Add to that the fact that there are now more options in terms of implant shape and dimension and you realize that the consultation process for breast augmentation surgery is a very important and not short one.  You should also take into account your lifestyle and fashion preferences.  Having large implants can be problematic if doing so results in body proportions that are not represented in typical ready to wear clothing sizes, you experience discomfort from their weight or they get in the way during physical activities.  My goal is to help you select a size that achieves the most natural looking result for your frame.  I recognize that size is a personal preference and I will work with that preference, while taking into account the realities of your tissue characteristics and your frame size.  I feel that these innate characteristics cannot, in good faith, be ignored when preforming this procedure.  I have declined to operate on patients who wish to have implants that I feel do not fit their tissue characteristics and/or frame size.  I do this because in the end, I must feel that I have acted in every individual’s best interest and that I have upheld the principles of non-maleficence.

Shape

Anatomically shaped breast implants tend to produce a more naturally shaped breast than round breast implants, but not every woman is a good candidate for these implants, which can “rotate,” resulting in an abnormally shaped breast that may require surgical correction.  There are some patients in whom I would recommend anatomically shaped implants, while some women are able to achieve excellent results with round implants.

Fill Material

My patients are welcome to select either saline or silicone filled breast implants.  Silicone filled implants can in some cases achieve a more natural feel and may be a particularly attractive option for women with less breast tissue prior to surgery. 

Saline filled breast implants were and to some extent still are considered a “simpler” option by many women, mainly because in the unlikely event of rupture, the fact that they are “leaking” would be quickly identifiable and therefore less likely to result in the need for multiple investigative studies (mammograms, MRI’s, etc.) aimed at addressing the possibility of leakage.  They are also less prone to capsular contracture and their insertion results in shorter scars as they are filled after insertion and therefore require a smaller incision for insertion.  The anatomically shaped, cohesive gel filled implants may be associated with a significantly lower rate of capsular contracture than round silicone gel filled implants, but they require a longer incision for insertion and may feel firmer.  Because newer silicone filled gel implants are less likely to “leak” silicone filler even if their shell is compromised, I do not feel that the argument for saline filled implants being “simpler” is valid and I encourage patients to select saline versus silicone filler breast implants based upon their preference.

Most people are of the impression that silicone filled breast implants “feel” more like natural breast tissue and this is probably the most important reason for their increasing popularity relative to saline filled breast implants.  In my opinion, they look virtually identical when inside the body and at least partially beneath the pectoralis muscle, which is where I put the vast majority of my implants.  But, I agree that they do “feel” more like natural breast tissue. 

Incisions

I perform breast augmentation through a peri-areolar or inframammary approach and I place that vast majority of implants at least partially beneath the pectoralis muscle.  I insert saline filled breast implants through an incision that is approximately 3 centimeters in length and silicone filled breast implants through an incision that is at least 5 cm in length.  Larger silicone filled breast implants typically require incisions longer than 5 centimeters. 

All of the following women are candidates for breast augmentation in my practice:

  • those who wish to enlarge small breasts,
  • those who wish to restore volume to breasts that have decreased in size as a result of :
    • weight loss
    • changes common after pregnancy
  • those who wish to achieve symmetry between the breasts
  • those who wish to enhance the shape of aesthetically suboptimal breasts including:
    • tuberous breasts
  • those who wish to camouflage certain chest wall abnormalities by enlarging their breasts including
    • mild pectus excavatum (a concave or “scooped out” breast bone)
    • mild pectus carinatum (a convex or “bowed out” breast bone)

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