FAQs: Breast Implants Fill – Breast Augmentation

Natural-Looking Breast Implant Fill Levels

Courtesy of John Tebbetts, MD, FACS, Dallas, TX

This is an excerpt from Dr. Tebbetts' book, The Best Breast 2:

 

What is ideal fill for breast implants, for each woman’s skin envelope?

If a woman has had previous pregnancies, her skin envelope is already stretched. Envision a funnel and pitcher pouring liquid into a breast envelope (Figure 4-2, A). If the envelope has already been stretched, the fluid will initially fill the lower breast. As more fluid is added, at some point, the breast appears full and natural with a natural appearing upper breast slope (Figure 4-2, B). If more fluid is added, the upper breast begins to bulge outwardly as the skin envelope is overfilled.

Exactly the same principles apply to breast augmentation. To achieve an optimal aesthetic result, enough filler must be added (the size of the implant) to adequately fill the envelope (Figure 4-2, B). If a woman wants a very bulging upper breast, more filler (a larger implant) is required. But the larger the implant, the more the stretch, the more the breast will sag in the future, and the greater the risk of tissue thinning with stretch, which allows the implant edges to become visible and visible rippling or wrinkling resulting from the implants pulling on the thin overlying tissues. Visible implant edges and traction rippling are often uncorrectable by surgery.

How much is enough?

If the best long-term result is the goal, the answer is to fill the existing envelope to ideal fill and a natural breast contour (Figure 4-2, B). Any overfill past this point virtually guarantees that the breast will sag more in the future, increasing risks of implant edge visibility and traction rippling, causing possible shrinkage (atrophy) of existing breast tissue, decreasing the quality of the result (Figure 4-2, C), and increasing risks of reoperations. For women who have never been pregnant, the surgeon must estimate a normal amount of stretch that would occur with pregnancy, given each woman’s breast tissue characteristics.

A key concept is that a properly chosen breast implant does not force tissues to where they have never been or were never intended to go. An optimum implant either optimally fills the space present or stretches tissues no further than they are likely to stretch with a pregnancy.