Preparing For Your Breast Augmentation Consultation

Decisions about breast implant type, size, incision, and pocket location will have a permanent effect on your breasts. Too often these decisions are based upon “patient choice” or “surgeon preference,” rather than the conclusions of the best scientific articles. As an astute observer of the unfortunate decisions that contributed to the problems he sees in revision augmentation patients, Dr. Teitelbaum will counsel you to make the decisions that will help you achieve the most beautiful result in both the short and long term. Three breast implant types are available: saline filled, silicone filled, and the so-called gummy bear. The natural feel of silicone filled implants has made them the most commonly used of all. Saline implants are available for patients who remain fearful of silicone (though the concerns of the 1990’s have been put to rest.) The highly cohesive or “gummy bear” implants are not FDA approved and patients wanting them are required to be a part of an investigational trial. Dr. Teitelbaum is a participant in all of the cohesive implant trials and will discuss with you whether these implants will be good for you (see additional sheet about these implants.) Deciding upon implant size is often difficult for patients and surgeons, but it actually should be very straightforward. Each breast has an ideal implant size if the goal is to make the breast look full and beautifully shaped. If a much smaller implant is used, the breast will not be full and the upper part will look empty. If a much larger implant is selected, the breast will look stuffed, round, bulgy on top, and less natural. This is true regardless of implant type and surgery technique.

If you want a natural look, or if you selected Dr. Teitelbaum because you were impressed with his beautiful results, allow him to size you based upon your measurements. Dr. Teitelbaum has taught sizing to many surgeons and received a patent in 2010 for an implant sizing device, so you can trust that his analysis will create the most beautiful breast possible. Some patients accept Dr. Teitelbaum’s suggestion because they realize he knows what will be the prettiest for their breasts. If patients are concerned that they could end up larger or smaller than they wish, he has them try on implants and see a 3D simulation of their results.

If you want to be larger than what the measurements determined is best for you, you must understand that to do so means that you will look more stuffed and round. If you want to be smaller, you must understand you will look less full. Going larger than ideal does not just mean that you will look less natural; it will lead to more skin stretch and thinning of your breast tissue from pressure, leading to problems years from now that can be impossible to correct. Dr. Teitelbaum has published articles on this topic and makes it a priority to help his patients avoid these sorts of problems.

The significance of the incision is far more than the resulting scar. Each incision involves different risks, recoveries, and long term results. Data has emerged demonstrating a substantial advantage for the underneath the breast (inframammary) incision. There is a better chance the implants will be accurately placed; there is a lower chance of the breasts becoming hard; there is a lower chance of needing another operation; the scar can be reused for any revision in the future; and the scar is often the most inconspicuous. He has experience with and can offer you all the incisions, but because the preponderance of data now favors the inframammary incision, he will probably suggest that to you. Dr. Teitelbaum will usually suggest the “dual plane” pocket, in which the implant is partially behind your muscle. This is one of the latest developments in breast augmentation surgery and Dr. Teitelbaum has written about it and taught other surgeons how to control the extent of muscle coverage to optimize shape. It allows maximization of coverage where necessary and enhancement of shape where desired, thereby realizing the benefits of both the in front and the behind the pockets. This optimizes breast shape, minimizes implant visibility, helps with mammograms, and reduces the chance of capsular contracture.

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