Types Of Breasts
Augmentation of Type I and Type II Breasts
What do I mean by “to the limits of the tissues”?
I subdivide all breasts (who are candidates for an augmentation WITHOUT needing a lift) into two categories:
- Breast Type I – The small, perky breast: these breasts are usually size A but occasionally a small B cup with a tight soft tissue envelope and no bottoming out of the breast. When I say “bottoming out” I mean that there is breast tissue that lies below the lower breast crease when looking from the side of the breast.
- Breast Type II – The post-partum breast: these breasts have lost fullness in the upper lateral (outside) of the breast and in the front. The glandular tissue sags below the lower breast crease. The nipple lies at or above the lower breast crease when viewed from the side.
Breast Type I
The anticipated aesthetic result from breast augmentation in both of these cases is considerably different, and that is what I mean by the limitations imposed by the tissues. The small, perky, tight breast will remain perky with little if any sag below the lower breast crease. The nipple will move forward. Some women like these breasts because they retain upper breast fullness and look large; however, they look less natural. One must be careful with these breasts because any attempt to over-augment these breasts might result in excessive stretching of the lower breast with loss of upper breast fullness and the nipple will look high (bottoming out of the breasts).
My approach is to determine ahead of time the ideal fill volume of the breast so as to minimize the risk of lower pole (breast) stretching, although that risk can only be minimized, not completely eliminated. There is no way, at least in the short term, that these breasts will have a straight slope on the top of the breast and a gentle curve of lower breast fullness that lies below the lower breast crease. That is the limitation of the tissues. This does not mean that you cannot achieve a beautiful result with breast augmentation; you certainly can, but you need to understand before surgery what the anticipated look will be after surgery.
Type I breast shown before and after augmentation with 304 cc round silicone gel implants placed under the muscle
Breast Type II
Augmentation of the post partum breast gives a totally different look. The superior fullness can be restored. Initially, this fullness is very high and many women love it, even though it looks a bit unnatural. As the breast remodels (I don’t like to say the implant drops because it doesn’t in most cases), this fullness changes from an upper convexity to a straight upper slope.
Many women post questions in the online forums about what size implant will give their post partum breast a full upper pole, but the reality is that no implant will do this on a long term basis; the breast will simply overstretch and descend under the weight of the oversized implant.
Unfortunately, with this type of breast, if you want that upper pole fullness, you will require the assistance of a bra. Again, this is not a deterrent to surgery; I find breasts of this tissue type to yield absolutely spectacular, natural breasts. They do require some extra work on my end during surgery to achieve this, but the results are definitely worth the effort expended.
Type II breast shown before and after augmentation with 304 cc round silicone gel implants
placed under the muscle using a dual plane III technique