There are several special concerns or considerations when breast augmentation is performed in an athlete or fitness enthusiast. This topic arose when I recently performed a breast augmentation and breast implant revision for Vida Guerra, an internationally known model who has also been successful in professional fitness competitions. In the past, I have also done breast augmentations for female weightlifters and boxers, a college soccer goalie, many marathon runners, and countless other athletes. There are factors to consider for each of these patients and activities, requiring a plastic surgeon who understands the patients’ needs, and who will adapt the procedures accordingly.

First, it’s important to understand that breast implants are actually very strong and durable. They can withstand major trauma (such as slamming the chest against a car steering wheel in an accident) without rupturing in many instances. Participation in a highly physical sport should not prevent any woman from seeking breast augmentation.

I usually place breast implants in a subpectoral position (underneath the chest wall muscles). The muscle cushions and pads the implants, giving a more natural look and feel. Weightlifters or athletes who use their chest muscles in competition need to understand that contraction of the pectoralis muscles can distort or shift the implants temporarily. This is not harmful, but those women may not like the appearance of the breasts when the muscles are maximally contracting. One option would be placement of the implants in a subglandular position (above the muscle). The breast appearance would therefore not change much when the muscles are used. Each patient needs to weigh the advantages and disadvantages (with my help, of course) of subpectoral versus subglandular augmentation based on her needs and desires.

Fitness competitors and runners, who are often very thin, may want to consider silicone implants rather than saline implants to maintain a more natural appearance, especially during the activities involved in competition. Silicone is softer than saline, and tends to look more natural, especially in women with little fat or breast tissue to soften or cushion the implants.

I have operated on many runners who specifically request that I avoid excessive fullness on the sides of the breasts, in order to minimize any problems with arm movement while running. One of my patients, an avid marathoner, was “scared of losing my running stride and ability” after breast augmentation, yet she wanted “to look more feminine.” We discussed her concerns and developed an excellent surgical plan for her. She wrote me 2 ½ months later to say “I feel great. I just completed the L.A. Marathon and the twins (my new breasts) were great!”

It’s also important to remember that larger implants are heavier, which can be an issue for marathon runners and others. Using an implant size that’s appropriate for the patient’s anatomy can help to prevent unwanted stretching of the tissues or discomfort related to sports and training.

Any woman may seek breast augmentation regardless of her athletic activities or physical demands. It’s important to select a plastic surgeon (certified by the American Board of Plastic Surgery, of course) who will take the time to understand your specific needs and desires, and who will then create the ideal surgical plan. I’m sure Vida Guerra will grace many more magazine covers, but I also know that she will feel comfortable and confident in her appearance during her upcoming fitness competitions.

In recognition of Breast Cancer Awareness Month, I think it is appropriate, and very important, to discuss the impact of breast implants and breast augmentation on mammograms and breast cancer detection.

Breast implants do interfere slightly with the ability to visualize ALL of the breast tissue during a mammogram. Reputable breast care centers and mammography centers are very familiar with the techniques necessary to obtain the highest quality mammograms. Mammograms are still important and helpful for patients with breast implants. The likelihood of damaging the breast implants or the breast augmentation surgery during a mammogram is extremely low.

Perhaps most important is the fact that large scientific studies have documented that the outcomes for women with breast cancer are similar whether they’ve had a breast augmentation or not. The size of the tumor when first detected, the staging of the cancer (how advanced it is, and how much it might have spread), and the survival rate are comparable for women with breast implants and those without implants.

In summary, most physicians believe that breast augmentation is not excessively risky from the standpoint of cancer detection. Indeed, implants are often used to reconstruct the breasts after mastectomies for cancer, in women who are truly at higher risk. It remains important for women to perform monthly self-exams of the breasts, and to obtain annual exams from their physician, in addition to regular mammograms.

Breast augmentation is an extremely popular procedure for good reason: most women are very happy with their results, and with their decision to undergo this surgery. One of the conditions that can lead to dissatisfaction is capsular contracture, although this too can often be treated and improved.

The human body will naturally form a membrane or tissue layer around any foreign object. We call the layer that forms around a saline breast implant or silicone breast implant the “capsule.” There is always a capsule around any breast implant, but usually the capsule remains thin and soft. Occasionally, the capsule tightens and thickens, or “contracts,” around the implant. This can cause the implant, and the breast, to feel too hard. Capsular contracture can push an implant out of its proper position, creating a breast asymmetry. It can also produce an abnormal breast shape, or a very unnatural appearance to the breasts. At times, capsular contracture can be painful.

The cause of capsular contracture is not fully understood, despite extensive research on this topic. Certain factors that increase the likelihood of developing capsular contracture have been identified, however. Excessive bleeding around the implants immediately after surgery, touching the implants with gloves that are coated with powder, and patient smoking are some of these factors. Some surgeons believe that, if a breast implant is placed in front of the muscle, a textured implant may have a lower contracture rate than a smooth implant. Some surgeons also recommend massaging the implants after surgery, although it’s not established that implant massage makes a measurable difference. Clearly, there are things that your surgeon can do, and things that you can do (avoid smoking!), to decrease the chances of a capsular contracture.

Even when all precautions are taken, however, some women will still develop capsular contractures. As a plastic surgeon specializing in breast augmentation and breast revision surgery, I frequently treat patients for this problem. A “capsulectomy” is a surgical procedure that involves cutting out the capsule and scar tissue, leaving behind soft breast tissue. It’s basically like starting over. Some women may again develop a capsular contracture after the capsulectomy, but many will not. It’s very important to avoid smoking if you are undergoing a capsulectomy. Some surgeons prescribe a medication called Singulair when operating on a patient with a capsular contracture. This is actually a medication for asthma, but many doctors believe that a beneficial “side effect” of Singulair is a reduced rate of capsular contracture. When undergoing a capsulectomy, the implants may also be replaced, so that they are brand new, with no wear or bacteria. The implant size can be changed too if desired. Sometimes, the capsular contracture may be holding the implants and breasts up, giving a perky appearance even though the breasts are too hard. Once the scar tissue is removed, the breasts may look more ptotic, or droopy. To counteract this, it may be helpful to use a larger implant, or to include a mastopexy, or breast lift.

To give yourself the best chances for a great outcome after breast augmentation, or to obtain treatment if you’ve already developed a capsular contracture, it’s critical that you consult a plastic surgeon certified by the American Board of Plastic Surgery, the only organization that board certifies fully trained and experienced plastic surgeons. I treat patients with capsular contracture (and other problems after breast augmentation) from throughout Orange County, Los Angeles County, Riverside County, San Bernardino County and elsewhere. If you’d like to schedule a consultation to meet with me, either for a first-time breast augmentation or a revision surgery, please call my Newport Beach area office at 714-835-6500. Please also visit my website for more information: ataleisnikmd.com.

Differences in size are often improved with the use of breast implants. Different volumes or implant shapes can be used on each side, generally improving the symmetry. Usually, other modifications are needed a the same time in order to maximize the results. The position of the inframammary fold (the crease beneath the breast) may need to be raised or lowered. Changes might be necessary within the breast tissue itself, such as to allow a “cone-shaped” breast  to become more rounded. 

Some Orange County patients benefit from a mastopexy, or breast  lift. There are different types of mastopexies that are possible. Some patients may require a lift on both sides, with one side lifted or tightened more than the other. Some patients may require a lift on one side only. Yet other patients may benefit from a reduction on one side, and a lift or even augmentation on the other side.

Surgery for breast asymmetry is specialized, and every patient in Orange County is completely unique. It’s important to consult a plastic surgeon certified by the American Board of Plastic Surgery, as I am. It’s just as important to find a surgeon who will take the personal time with you to determine the best way to address your asymmetry.

Dr. Andres Taleisnik

Most implants used for breast augmentation are round, whereas a smaller percentage have a “teardrop” shape. The “teardrop” implants, sometimes referred to as “anatomic” implants, are thicker (project or stick out more) towards the bottom of the breast, and thinner (project less) at the top of the breast. In theory, this could provide a more natural breast shape. In actuality, other factors are far more important in determining whether the breast appearance looks “natural.” Round implants don’t mean that the breast will look round. If the space for the implant (the implant pocket) is created properly, and the size chosen is appropriate, the round implant can provide an extremely natural appearance. I’ve stopped using the teardrop implants in recent years, mainly because the teardrop implant must have a textured, or rough, outer surface. The textured surface is necessary to keep the implant from rotating in the pocket, which might put the thicker and thinner parts of the implant in the wrong places. In my experience, the textured implants don’t settle into the breast as easily and naturally as the smooth implants. As a result, I mainly use smooth round implants. It doesn’t matter if a round implant rotates in the breast pocket, since this would not affect breast shape.

Another factor to consider is the “profile” of the implant. This term refers to the relationship between the diameter of the implant and its projection (how far it protrudes from the chest). The standard implant  has a “moderate” profile. There are also “high profile” implants that have a narrower diameter, with greater projection, for any given volume as compared to the moderate profile implant. A high profile implant might be ideal, for example, for a patient with a narrow chest wall. The high profile implant would allow such a patient to use the desired volume without the implants being too wide for her chest. There also exists a profile in between the high and moderate profile implants, referred to as “moderate plus profile.”

The “art” of breast augmentation involves consideration of implant texture, shape, and size among many other factors. Every patient is unique, and requires an individualized assessment and plan to achieve the best possible results from surgery. During your consultation, I’ll discuss these and other issues and decisions that will help you to achieve the appearance you’ve dreamed about.

Andres Taleisnik, M.D. is a board certified plastic surgeon in Orange County who offers a wide range of cosmetic plastic surgery procedures, such as liposuction, tummy tuck surgery (“abdominoplasty”), breast lift surgery, and breast augmentation surgery. To learn more, contact Dr. Taleisnik to schedule a complimentary consultation.

Silicone implants can often look and feel a little more “natural” than saline implants. Since a silicone implant is pre-filled, a larger incision is needed to insert a silicone implant than a saline implant, which can be inserted partially filled. A woman with small areolas (the dark skin around the nipple) may not be able to receive silicone implants through an incision around the areola, and instead may require an incision in the crease under the breasts. There have been questions in the past regarding possible effects of silicone if it leaks. For this reason, silicone implants were available only to women who met certain criteria, and who were enrolled in the large silicone implant studies, until Fall, 2006. After years of extensive testing, including evaluation of the many women who received silicone implants as part of the study, the Food and Drug Administration (FDA) now allows any woman 22 or over to receive silicone implants. The FDA also recommended that women undergo an MRI examination of the breasts 3 years after receiving silicone implants, then every other year thereafter. Silicone implants are significantly more expensive than saline.

Saline implants remain the most popular choice in my practice. I can obtain very natural and beautiful results with saline implants too in most patients. Many of my patients prefer the firmer look and feel of the saline implants, which may result in a more “youthful” outcome. Most patients choose the peri-areolar incision, which generally is very inconspicuous (more on incisions for breast enhancement in another article). If a saline implant leaks, there are no concerns regarding a foreign substance in the body, since the implants contain only salt water. Saline implants may also be more helpful than silicone to counteract mild drooping or shape abnormalities of the breasts.

During your consultation with me, I will help you to decide which implant type will be best for you. There are a number of other decisions to make as well, including the shape or “profile” of the implants, the incision to use, the size, and others. I will guide you through the entire process, so that you will feel comfortable with your choices, and very happy with your results.

To schedule your consultation to meet with me (no charge), please call my office at 714-835-6500. Please also visit my website at www.ataleisnikmd.com.