Tips for Flat-Chested Women Considering Breast Augmentation

As its name suggests, breast augmentation is performed to augment the bust size of patients, making this particularly appealing to flat-chested women or those with AA and A cup.

Flat-chested women have very little tissue and fat, a feature which must be given importance to achieve natural results and prevent complications particularly wrinkling and rippling.

First and foremost, patients with small breasts should stay away from textured implants that have a rough surface, a feature always found in teardrop-shaped implants to prevent them from rotating and causing visible deformity. 

Some textured implants also come in round shape.  The theory behind this is that the rough outer shell can prevent the tissue from becoming too thick—a condition called capsular contracture—that it results to deformity and pain.  However, no extensive study has proven this claim.

Textured implants, particularly those with large “graininess,” should be avoided by flat-chested women because they face a higher risk of palpable and visible wrinkling.  For this reason, they are generally advised to choose smooth implants, which are also believed to last longer because they are less prone to “folding” that can lead to rupture over time.

Aside from smooth shell, the breast implants for flat-chested patients are ideally filled with silicone gel rather than saline (or a sterile mixture of salt and water) to simulate the feel of natural tissue—something which they definitely lack.

The result between the saline and silicone implants is the same when there is an ample amount of tissue and fats, although this is not the case if the breasts are very small as the saline implants, more often than not, lead to an unusually round appearance.   

A dome-shaped breast is one of the most common telltale signs of plastic surgery, so it is not surprising that most patients do not want this look.

Another technique to avoid the “fake” look is to choose the appropriate implant size.  The general rule is that natural appearance is easily achieved if the breast volume mostly consists of natural tissue rather than implants.

When plastic surgeons refer to large breast implant, it often means a size that is more than 600-700 cubic centimeters.

Meanwhile, the amount of tissue also dictates the most ideal breast augmentation technique.  More often than not, flat-chested women have undefined breast crease, making this incision site more challenging, although not impossible.

Plastic surgeons are extra careful when using the breast crease incision site on small-busted women to avoid a low- or high-riding scar. 

Cohesive Breast Implants—Benefits and Disadvantages

In March 2012, the US Food and Drug Administration has approved the cohesive breast implants which use a form-stable gel; this means that unlike the 4^th generation silicone implants, they do not leak in case the shell cracks.

The cohesive silicone implants, also referred to as gummy bear implants due to their firm structure (just like the popular sweet candy), have benefits over the ordinary silicone- and saline-filled implants.  However, they also have shortcomings, which must be considered.

The Main Benefits of Cohesive Breast Implants

*  Less prone to shell collapse

Because the filler material is form-stable, it does not shift from one area of the shell to the other (which is the case in saline and traditional silicone implants).  For this reason, the folds and wrinkles—which are known to affect the device’s durability in the long run—do not occur.

It is safe to surmise that cohesive breast implants can last longer than the other types since they are not prone to folds and wrinkles.

*  Leak is almost not a concern

While the shell is susceptible to breakage, leak is not a problem since the filler material maintain its shape; however some microscopic diffusion of silicone will always occur, but some experts believe that it will be somewhat harmless.

*  Lower risk of capsular contracture

Some studies—while not as extensive as they should be—conducted in Europe suggest that capsular contracture occurs less often with cohesive breast implants.

Capsular contracture happens when a layer of scar tissue becomes too dense and thick that it squeezes the implant.  Some experts say the implant’s cohesiveness, firmness, and/or less diffusion of silicone (than traditional silicone implants) are the reasons why there is a lower risk.

The Disadvantages of Cohesive Breast Implants

*  They only come in teardrop shape

Because the cohesive breast implant is form-stable, it does not come in round version and is only available in teardrop shape, which has more volume at the bottom than the top.

By contrast, ordinary silicone and saline implants are available in round shape because their filler material is affected by the gravity and forces of the breasts.

While teardrop implants provide natural results, some women still prefer the round version which can give them the dome-shaped breast in which there is an exaggerated fullness in the upper poles.  

*  Feel

The cohesive breast implants do feel a little bit firmer than the traditional silicone implants, although the level would depend on how much breast tissue a patient has, how supple or flaccid the tissue is, and how large or small the implant is.

However, most patients—particularly those who would choose implants with an “appropriate” size—do not have problem with the firmness of cohesive breast implants.

*  Cohesive implants require longer incisions

Because the filler material is form-stable, these implants need longer incisions (between 4.5-5.5cm) to squeeze through inside the breast pocket.  For this reason, plastic surgeons rarely recommend the areola incision site when using this type of implant.

Armpit incision is also difficult when using cohesive breast implants, which is why doctors prefer the breast crease technique.

*  Risk of rotation

With the teardrop shape of the cohesive implants, rotation can result to deformity.  Fortunately, this can be prevented with the right pocket dissection and insertion.

But still, rotation is more of a problem for patients wanting to replace their teardrop breast implants with smaller ones.  Meanwhile, round implants do not result to distortion even if they rotate inside the pocket because their sides are all symmetrical.

*  More expensive

As with most new technologies, cohesive breast implants are hundreds of dollars more expensive than older designs. 

Gummy Bear Implants Seen to Create a New Trend

In March 2012, the US Food and Drug Administration has finally approved gummy bear breast implants (from implant manufacturer Sientra) after several years of clinical trials.  Meanwhile, the new devices have already been around for 10 years in Europe.

Compared to earlier versions of silicone implants, gummy bear implants have a more cohesive silicone gel that even if their shell is cut in half, the filling would not leak.  And with this characteristic, many plastic surgeons around the world believe that the new devices are probably safer than other types of breast implants.

Plastic surgeons coined the term “gummy bear” because the implants’ soft but firm structure is somewhat similar to the sweet candy.

Leading Los Angeles plastic surgeon Dr. Tarick Smaili believes the recently approved breast implants may further push the popularity of breast augmentation surgery in the country.  Last year, the procedure ranked first on the list of the most commonly performed cosmetic plastic surgeries.

In terms of advantages, Smaili said that gummy bear implants are “quite notable” particularly when it comes to safety.

“With the cohesive silicone gel, the possibility of rupture and leak is close to nothing.  Another advantage is that the implant is form-stable and would not lose its shape,” Smaili said.

And because the risk of leak is almost not a concern, regular MRI screening is no longer needed.  (This is a requirement for women with traditional silicone breast implants because their somewhat fluid gel would seep out in the event of rupture.)

Another advantage, Smaili said, is the lower risk of capsular contracture which happens when the surrounding scar tissue squeezes the implant shell to the point that it causes breast deformity, pain, and other complications.

The newest implant is also called “type 5 gel” because it is the fifth generation silicone implant in the market since 1962.  Meanwhile, silicone implants currently produced by Allergan and Mentor fall under the category of “type 4 gel” which is cohesive but not form-stable.

But because gummy bear implants are firmer than the earlier versions of silicone implant, they require a longer incision. Fortunately, patients can choose from four incision sites which are designed to make the scar less visible.

Another consideration is the risk of rotation.  Since the implants come in teardrop shape, they may result to deformity in case they rotate inside the breast pocket (though the textured or “grainy” surface can prevent this problem from happening).

FAQs About Breast Implant Surgery

1.     Question: What kind of implants is used during breast augmentation?

Answer:  Currently, the US Food and Drug Administration only allows silicone- and saline-filled breast implants.  However, there is some speculation that the gummy bear implants (these are filled with a more cohesive type of silicone gel) which are under clinical trial, will be made available to the public in the next few years.

2.     Q:  Which can provide a more natural result?

A: Siliconeimplants are designed to mimic the feel of breast tissue, making them a more popular choice of women these days.

3.     Q:  Any benefits in choosing saline implants over silicone version?

A: Yes.  Patients are not required to undergo MRI screening, a test necessary for those with silicone implants because they are at risk of having silent leak (no visible manifestation that the shell has already ruptured),And in case of rupture, patients with saline implants can immediately see the problem because their breasts will become deflated within hours.

4.     Q:  What is capsular contracture?

A:  This happens when the scar tissue—which naturally forms around any implant—becomes extraordinarily dense that it ends up squeezing the implants.  Fortunately, there are many surgical techniques and post-operative treatments that can minimize the risk of capsular contracture.

5.     Q:  What is the difference between smooth and textured implants?

A:  Smooth implants have a balloon-like surface while textured implants have a rough, somewhat “grainy” exterior.

All teardrop-shaped (or anatomical) implants come in textured surface to prevent it from rotating inside the breast pocket, something which may lead to visible distortion.  On the other hand, round implants often come with smooth exterior because they can rotate without causing any problem.

However, some round implants have rough surface which is said to minimize the risk of capsular contracture.  But this claim has not yet been proven.

6.     Q:  Which can provide more natural breast contour, round or teardrop implants?

A:  Both implants can provide natural appearance as long as with the proper placement.  And contrary to popular belief, round implants do not automatically lead to a dome-shaped, unnatural-looking breast because their shape turn into a teardrop once inside the breast pocket (due to the pull of gravity).

      7.  Q:  How long do breast implants last?

A:  According to a study conducted by the Institute of Medicine, breast implants last an average of 16 years, although their lifespan still depends on many factors such as the patient’s lifestyle, certain features of the body, and type of implant used during the procedure.

Breastfeeding After Augmentation Mammaplasty

One of the most common concerns of patients considering breast augmentation is its effect on breastfeeding.  However, many studies have suggested the surgery does not prevent women from producing milk.

Is It Possible to Breastfeed After Breast Augmentation?

Breast augmentation patients will most likely be able to breastfeed their babies following the surgery, particularly if the incision is made along the breast crease and armpit.  However, a U-shaped incision around the edge of areola may increase the risk of having breastfeeding problems because the technique causes more trauma to the glands, nerves, and ducts.

Can Silicone Implants Contaminate the Milk?

Breast implants do not pose contamination risk to babies; in fact, the milk produced by a woman with siliconeimplants has a significantly less amount of silicone than formula milk.

Potential Problem

Patients should know that breast augmentation does not prevent them from producing milk, although there is a risk of having less sensitive nipples, which in turn may lead to difficulty in breastfeeding.  Fortunately, a study has suggested that five years after breast surgery, most of the damaged nerves have already been repaired by the body, significantly improving the ability to breastfeed.

Why Some Patients Can’t Nurse Their Babies

It’s not about inability to breastfeed, but more on the unwillingness of some women to nurse their babies.  According to a recent study conducted by the American Society of Plastic Surgeons (ASPS), women with breast implants who think that breastfeeding can lead to sagging breasts are less likely to do this successfully.

However, the ASPS said that breastfeeding does not affect the result of breast implant surgery and even highlighted the significant health advantages for both baby and mother.

Solution for Those Experiencing Difficulty in Breastfeeding

Women with breast implants should tell her child’s pediatrician about the surgery; in this way, the doctor can keep a close eye on the baby’s weight and make sure he or she is getting enough milk.

But for patients who had breast augmentation to address hypoplasia or underdeveloped breasts, they may experience trouble producing enough milk.  For these mothers, they are often advised to use pump after each nursing session to stimulate production.  But if this is not enough, they should use formula milk or donor milk.

Should Breast Augmentation Be Postponed?

Some plastic surgeons recommend postponing breast implant surgery for women who are considering having babies since pregnancy may change the appearance of their breasts.

What Is the Most Ideal Age to Have Breast Augmentation Surgery?

Breast augmentation is one of the most sought-after cosmetic surgeries not just in the US but also in many countries.  In fact, it has been estimated that 5 to 10 million people have the procedure; they consisted of women who wanted to improve their appearance, post-cancer patients who had mastectomy, and transgender.

To date, many countries including the US require patients to be at least 18 years old before they can undergo breast implant surgery.  But take note that this age requirement generally applies if you will have the procedure solely for cosmetic purpose—e.g., you want to increase your bust size.

By contrast, age requirement is not important if you will have the procedure as a way to treat developmental abnormalities.

You have to remember that patients between 18 and 21 can only have saline implants which are filled with a sterile saltwater solution.  But when you reach the age of 22, you would be allowed to use silicone implants during your breast augmentation surgery.

The main reason why silicone implants require a higher age limit is because of the risk of rupture.  To prevent serious complications, you will be required to undergo MRI screening at least every two years.  By contrast, you will not need this if your implants are filled with saline, which in case of a leak, can be safely absorbed by your body, though your breasts will immediately appear somewhat “flat.”

While 18 years old can already have breast augmentation, many plastic surgeons believe that a woman should wait until she has reached her twenties because there is a likelihood that her breasts will further enlarge.

Imagine that if your breasts become larger after having plastic surgery, you may end up with a bust size bigger than what you really want.  While you can always have revisions to downsize your implants or even remove them without replacement, this means additional expenses and possibly more scarring.

If you decide to have breast augmentation in your teenage years, you will likely need revisions sooner than later.  Take note that breast implants are not designed to last a lifetime and are subjected to the natural wear and tear.

According to a data collected by the American Society of Plastic Surgeons, 65 percent of breast implant surgeries were performed on patients aged between 20 and 38, a clear indication that most women waited until their body has fully matured before they had the procedure.

Can Breast Implants Lead to Stretch Marks?

As its name suggests, the primary aim of breast augmentation surgery is to increase the bust size using either saline or silicone implants.  In the US, only Allergan and Mentor are allowed by the Food and Drug Administration to sell these products to the market.

One of the most common concerns of patients considering breast augmentation is stretch mark, which happens when the skin tissue is stretched to its limit, resulting to purplish, reddish, or whitish stripes.  This often occurs after a significant weight gain/lose and pregnancy.

In some cases, breastimplants can cause stretch marks although a patient’s predisposition to have them depends on many factors including the implant size.  The rule of thumb is that the larger the device is, the higher the risk of developing the whitish or purplish stripes on the skin.

One effective way to lower the chance of having stretch marks after breast augmentation surgery is to use smaller implants.  Most plastic surgeons will likely agree that a 300 to 350 cubic centimeter (cc) range is a reasonable size.

By contrast, breast implants that come in 500cc size and above are often considered relatively large especially if these are going to be used on petite patients.

Aside from large breast implants, the age also seems to affect the likelihood of developing stretch marks.  According to some surveys, the problem is more common on younger women (those who are in their 20s and younger) than adult patients.

Plastic surgeons have also noticed that placing the implants on top of the muscle (subglandular technique) can increase the risk of stretch marks than positioning the devices below the muscle (submuscular technique).

Perhaps the reason why the subglandular implant placement increases the risk of stretch marks is that only the skin and tissue provide support to the weight of the device.  On the other hand, the submuscular technique offers more coverage and support to the implant, preventing the skin from stretching too much.

Also, most patients who developed stretch marks after breast augmentation have previously experienced the problem, although choosing a reasonable implant size and using the proper implant placement can reduce their risk.

By contrast, it is very unlikely for patients who have not experienced stretch marks to have the problem after breast augmentation surgery.

Fortunately, most patients who have developed stretch marks after breast augmentation reported that the purplish stripes turned white and became barely noticeable within three to four months.