I do a lot of breast augmentations. Most women seeking breast augmentations do not have a lot of tissue coverage- fat, breast tissue, muscle thickness- that is why they want an augmentation. But you need to really consider how thin the tissue is to get the best result now and have it age well.
Think of the tissue over your implant like a comforter. How thick is your comforter? Is it a plush down one? A thin summer blanket? A super thin sheet? Your tissue will help determine the support for the weight of your new implant. It will help hide the underlying implant- make it softer, blunt any edges, hide any wrinkling or rippling of the implant.
- Your tissue thickness thins with time. The weight of the implant will compress the thickness of the overlying tissue over time. So your comforter of tissue will thin.
- Your tissue quality (the elastic in it) worsens with time– weight changes, pregnancy, breast feeding, menopause.
- The size and weight of your implant will affect how it ages. The bigger the implant, the more stress on your skin over time. If you have super thin tissue, bigger is not always better. You may overwhelm your skin’s ability to hold up the weight of the implant. To help “hold” the implant in place better, you may consider a textured implant. There are issues with textured implants (they don’t move as much, don’t feel quite as bouncy and soft, and have a risk (low) of ALCL), but they do stay where you put them.
- Support is key. The breast tissue is not a muscle. You cannot tone it up. Once the skin has stretched, it will remain stretched. Good bras (see my blogs on bras HERE), even sleeping with support at night (particularly if you are a tummy sleeper), can help.
- If you have a prior implant and “it did great,” there are factors which may have changed. YOU ARE NOT THE SAME.
- you are now older.
- your tissue has thinned.
- if you had a textured implant, it helped “hold” the implant in place.
- if you had a capsular contracture, even if it is mild, that helps “hold” the implant in place- it is like you were wearing a bra made of scar 24/7, which prevented the skin from stretching.
There are so many choices now with implants: size, saline/silicone, profile (low, medium, high), types of fill (firmer vs. softer), textured/smooth, shaped/round. There are pros and cons to these. When you have thinner tissue cover, you need to consider all of these things. There is no “right” answer. But you need to understand what you are choosing.