Breast Implants are Not Created Equal

by Bruce J. Nadler M.D.

A young lady came to my office requesting breast implants. She was very specific about her desires. "My friend has 300 cc breast implants. I like the way she looks. I want 300 cc breast implants." Many plastic surgeons fall into the same trap. They give the patient implants to place in their bras. Sometimes, if they think they are being more scientific, they tell the patient to fill a plastic bag with water until the bra is filled enough and then measure the amount of water in the bag. That volume is then used to determine the size of the implant selected. Again, they are missing the important factors.

The good plastic surgeon has to be a combination of an artist and a draftsman. You have to know what looks good and then have an organized plan as to achieve it. It's not the volume or so called cc's that are important. It's the height, the width and the projection of the breast that has to be conceptualized. Only then is a specific style and size implant chosen to achieve this objective. To start with a predetermined number of ccs is in reality working backwards.

The final result of the surgery is a combination of the patient's existing breast tissue and the size and style of the implant selected. It's these dimensions that have to be determined. Dimensions of both the patient and the implants. The shape and symmetry of the breasts have to be considered. The shoulder girth and rib cage also have to be taken into account. Careful measurements of the shape of the existing breast tissue as well as the thickness of this tissue are taken.

Next it's important to go over with the patient the type and size of breast she desires. Does she favor a very natural look or more of the Victoria's Secret perky appearance? How important is cleavage? Would she mind if the breast extended a bit past the rib cage the balance more medial fullness to give cleavage. Only now can the size and type of implant determined.

All implants are not created equal. Implants come in low profile, medium profile and high profile configurations. For example, a 300 cc low profile is wide and flatter. A 300 cc high profile is narrow and tall. Using one or the other, both 300 cc will give totally different looks to the breast. Placing them in front or behind the muscle will give different looks. A patient with a wider or narrower rib cage, taller or shorter height, more or less elasticity to the breast tissue will have marked different looks with even the same style implant.

These same factors may limit the range of possible surgical results. If the breast has some droop to it, a high perky breast may only be possible by combining some type of uplift procedure. The trade off is that there will be some additional scarring to achieve the desired contour. The surgeon has to honestly tell you what cannot be accomplished as well as what can in order to prevent disappointment.

After 26 years of performing plastic surgery, I can honestly tell the patient the limitations as well as the benefits of the procedure. I can explain that things change with time and some maintenance and future surgeries may be necessary to maintain the appearance of the breasts. Breast implants simulate larger breasts. Implanted breasts can come extremely close but never totally equal large natural breasts. The more care the surgeon takes in determining the best implants in each case, the closer this will be.

Bruce J. Nadler, M.D., plastic surgeon has offices in New York City and on Long Island. For more information, please visit "The Liposuctionator" at or call 1-800-445-0505.