Are They Real???
It's hard to believe that more than a decade has passed since Terri Hatcher stammered, "They're real and they're spectacular!" to a curious and dumbfounded Jerry Seinfeld.
Terri Hatcher informs Seinfeld in no uncertain terms that, "They're real and they're spectacular!"
In that time, breast augmentation has become the most common cosmetic plastic surgery procedure performed in the United States with approximately 307,000 women receiving implants in 2008. With such a high prevalence of breast augmentation, the inevitable question arises equally frequently: "Are they real?" The best plastic surgery is that which is undetectable - natural in appearance. So, how does one distinguish the actual natural breast from the augmented breast? A number of tell-tale signs are demonstrated in the gallery below:
In this gallery
Size, shape, symmetry, softness, position, proportion, and projection all matter when evaluating the result following breast augmentation.
If you can barely fit a pencil in your cleavage, you have probably gone too far. Symmastia, or 'uniboob', describes the situation where overzealous dissection of the pectoralis muscle, in an attempt to create increased cleavage, has actually permitted the implants to drift toward the midline, giving the appearance, in severe cases, of a single breast.
Or following surgery. Inadequate pocket dissection medially (toward the midline) and superiorly creates an unnatural separation of the breasts. Correction is performed by enlargement of the pockets or exchange for smaller implants.
The body's natural tendency is to form scar tissue (a "capsule") around any foreign object, including breast implants. A number of factors, including bacterial contamination, infection, implant position (implants placed below the muscle (subpectoral) have a decreased incidence of contracture compared with those placed below the breast (subglandular) but above the muscle), and hematoma (blood collection), cause that capsule to contract, producing a ball-like appearance. Further contracture can produce a hard and painful breast. Treatment often requires opening the capsule (capsulotomy) or capsule removal (capsulectomy).
Capsular contracture can occur on one side or both and create a "stuck on" appearance when the breasts are framed by implant 'step-off' lines perpendicular to the chest wall. The breasts are not intended to be used as shelves; ergo, they shouldn't look like shelves.
Either the swimsuit top is a tad too small or the implants are a tad too big. This is a subtle finding.
'Hockey stick cleavage' is due to inadequate pocket dissection resulting in a pocket that is too small for the implant used. A sharp line defines the edge of the implant and is an immediate indication of augmentation.
When more breast tissue is seen above the dress than in the dress, that is a problem. Repositioning of implants, either due to initial malpositioning or the result of capsular contracture (as seen here), is not infrequently necessary. The Baker classification of capsular contracture describes 4 types: Type I: looks good (natural, no obvious step-offs), feels good (soft); Type II: looks good, feels hard; Type III: looks hard, feels hard; Type IV: looks hard, feels hard, painful.
Symmetry is critical and pleasing to the eye when present. Asymmetry can be disastrous as the scrutinizing human eye can detect variations as small as 1 millimeter. Breast and nipple levels must be as close to equal as possible for a good result to be achieved. Meticulous pocket dissection and use of different-sized implants may be necessary in the patient who is asymmetric prior to surgery. Such asymmetries must be pointed out and discussed pre-op to ensure patient-surgeon expectations are on the same level as well.
Especially equal size. Pocket dissection and implant selection are critical factors in achieving breast symmetry. Although all women are naturally asymmetric to a greater or lesser degree (just part of the human condition) unnatural size discrepancies are dead giveaways of augmentation.
Implants placed in a submuscular position (completely beneath the muscle as opposed to subpectoral in which the implant is only partially covered by muscle) can shift to a position separate from the overlying breast mound, especially if aggressive dissection has occurred at the level of the inframammary fold (the natural crease beneath the breast). As a result, there is a visible line evident between the edge of the implant and the edge of the breast above it creating the appearance of a 'double bubble'. This can occur with subglandular placement of the implants as well.
'V' does not always indicate victory. A natural slope of the breast should begin at the level of the clavicle (collar bone) and proceed toward the nipple. Convergence of the breasts to a point between them and rounding of the breast superiorly to create a 'V' sign can result from inadequate pocket dissection superiorly or use of implants that are too large.
Many things occur in nature - including dimples. Just not on the breast. Such findings indicate inadequate release of the pectoralis muscle medially and a constricted pocket in one localized area which produces the unsightly 'breast dimple.' Smile!
Symmastia has resulted from aggressive pocket dissection and elevation of the pectoralis muscle attachments from the sternum (breast bone). The result is one breast.
The most common complication following breast augmentation is implant malposition due to discrepancies in pocket size between the sides. Correction is often possible using a garment or taping for a number of weeks to maintain the implants in proper position where they will hopefully remain.
Seen more commonly on the lateral aspect of the breast, this tell-tale sign of augmentation can result from underfilling of a saline implant. As a result, the implant shell ripples, creating weak spots in the silicone shell and increasing the chance of rupture. Proper implant size selection and filling are critical to a good outcome.
When an implant appears to be reaching for the clavicle, there is a problem. In general, a smooth, soft slope of the breast should flow from the level of the clavicle toward the nipple. Any abrupt shelving that occurs at or below the clavicle is most likely attributable to capsular contracture.
Constriction at a focal point due to inadequate pocket dissection can manifest as a pronounced depression.
Nice melons.
Size, shape, symmetry, softness, position, proportion, and projection all matter when evaluating the result following breast augmentation.
Got Questions? Ask Dr. Jeff!
Send them to askdrjeff@chicagoprs.com
5 Comments
Andy-Kid said:
I just got to look at 18 pictures of boobs. AWESOME!
Lauren Strec said:
"Shelf boobs"-- that is great! When I'm on an airplane, I always joke that I want augmentation just so I could have a little shelf to sleep on...
Leslie said:
yeah well mine would look like that if they were hoisted up and back !
Joe the Cop said:
Thank you for providing this invaluable service. Thank you for leaving out one of the biggest indicators: the under boob scar. That always makes for an awkward moment at the strip club.
Kiki said:
wow - I had no idea there could be so many booby-traps!
After seeing these pictures, I can't imagine going to anyone who is not board certified plastic surgeon....
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