I recently received an email from someone who had seen another plastic surgeon twice in the last 2 years. They had asked for my opinion on whether she should have a breast augmentation or a breast lift with an augmentation.  On her first visit, she was told a simple breast augmentation was appropriate.  She didn’t have the surgery after the first visit.  The more recent visit resulted in the recommendation to have a lift with the augmentation.

She stated she had put on some weight and the frontal pictures showed she went from a small A to maybe a B’ish size (She didn’t give specifics).Her pictures did not include the side views. The nipples appeared to be a bit above the bra line, but I couldn’t be exactly sure. She told me she wanted to be in a full C range.  She also wondered whether she should lose weight prior to having any breast surgery.

This is what I told her. I hope it is helpful for others.


Dear Jane, (all names have been changed to protect identities.)

A couple of points I’d like to make related to your letter.

It is difficult to completely tell if a lift is necessary.  Side views would be of further help. There are several factors that determine whether a lift maybe necessary.   First, what is the position of your nipples in relationship to the bra line?  Usually, the decision to do a lift starts by looking at the nipples position relative to the bra line.  If it is above the bra line then you usually get the nipple to elevate to a higher position, and if they are below the bra line, they hardly ever change position.

A second consideration is, where do you actually you want the nipple to be when everything is said and done?  Only a lift can be more exacting in this respect. Finding some pictures online that you feel are good representations of where you would like the nipples to be is good to bring to any consultation.

The third issue is weight loss. If you are going to lose weight, lose it before.  The reason is that the ultimate size of the breast will be the sum of the amount of breast tissue you bring to the table and what size implant the surgeon brings to the table. If you lose weight after a breast augmentation or augmentation with a lift, you end up “sucking air out the balloon, i.e., the breast.  The skin of the breast lacks elasticity and therefore will not “snap back” well and will have a tendency to sag.

Losing as little as a couple of pounds can make a difference in how much fatty tissue is lost from the breast and which breast will tend to lose more.  Since the skin envelope generally does not snap back well, the position of the nipple can lower with weight loss. (The amount of fatty tissue in each breast is not the same, therefore one breast can deflate and sag more than the other).

Based upon the pictures, you might consider going a little larger.

I’m not a big fan of specific cup sizes.  What make women happy is more about proportion.

I like to see pictures of breast that you like from the Internet.  I’m not interested in the size of the implant or the final cup size of the breast you find, I’m looking for the proportionyou like.  Put it this way, when you’re looking online and you stop on a picture you like, your stopping because your mind like the proportion it sees. (Our minds are geared to like things base on proportion and symmetry).  I don’t know anyone that types into Google, “Show me full C size breasts”and then makes their decision based upon those pictures.  Generally, they surf the web, they find a picture that they like, (subconsciously proportion of breast size to the frame of the chest).They then search the page for the specifics, i.e., cup size, implant size etc., thinking that those parameters will result in the look they want.  It may seem logical, but it’s wrong.

Proportion always trumps cup size and the proportions you like only exists in your mind, not the mind of the plastic surgeon.  Countless times, I have been surprised by women with teenage kids that will say to me, “I don’t want to be to big because I have teenage boys and I don’t want to embarrass them.  I just want to be in the full C range”. But when they show me pictures with the proportion they like, I’ll tell them,  “No, you actually want to be is the most popular mom on the block!”.

The reason proportion is key for breast surgery, is that any sized object that sits in a frame is judged relative to the frame’s size.  As far as cosmetic surgery goes, nose surgery and breast surgery fall into such a category. The breasts sit within the frame of the chest wall.  The width of shoulders count, height of the chest wall counts, and the width of the chest wall counts.

Liposuction, tummy tucks and other surgeries are not surgeries dealing with proportion, they deal with the frame’s shape. Those surgeries work to make the frame a better shape.  As far as breast surgery goes, the happiest women are those that end up with the proportion that they like.  I tell women to shoot for the proportions you like and whatever the cup size turn out to be, that will be your cup size. Always choose proportions you want, not proportions others may want you to have.

I if feel that a women is choosing a proportion based upon what someone else desires, I’ll tell them to “Choose the proportion you want because these implant will outlast 1/2 the of the relationships in America.”  It’s a sad social statement but, it is what it is.


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