When doing elective surgery you want it to make you feel better about yourself. Breast augmentation continues to be one of the most popular procedures we do, whether you never had breasts in the first place, your body proportion is off, you breastfed and what you had is gone (or you liked having bigger breasts when pregnant/breastfeeding)… the list goes on and on.
But is there a way to predict if you would be happy?
In the April 2024 issue of Aesthetic Surgery Journal, there was a study of “Main Factors Influencing Patient Satisfaction after Primary Breast Augmentation: A Prospective Study Based on Patient Reported Outcome Measures.” I liked it because it was trying to assess WHAT factors led to patients being happy with their outcomes.
Study: 131 patients with primary breast augmentation. Follow up done at 1 year. No complications. (so you were excluded if you have a hematoma, implant migration, capsular contracture, etc) They looked at:
- BMI
- pinch test of thickness of the upper pole of the breast
- surgical access
- implant pocket
- implant volume
- bra size increase
- age
- smoking
- civil status
- education level
- pregnancies
- psych disorders
What did they find?
They found that three factors affected the satisfaction the most.
- BMI. Those who were underweight were LESS satisfied than normal/overweight patients
- Thicker pinch test. Those with a pinch test of over 2cm were more satisfied
- More volume/bra size increase. Those with >300cc implants/more than 2 bra size increase were more satisfied.
My thoughts?
Love science, and I thought this was interesting.
I love what didn’t matter- where your scar is, what implant pocket you used, your age, your education, if you have had kids.
For what did matter, the thicker pinch test makes sense- the thicker this tissue, the more it is like a comforter over the implant, It can hide ripples and wrinkles, it makes everything feel softer, and it just looks better. (though the pocket under the muscle helps “thicken” the upper pole, so I’m surprised this wasn’t discussed more.)
BMI being lower were less satisfied. Why? Is it that they are thinner so have less tissue cover? Is it that they are perfectionistic? Is it that they saw edges and irregularities more, could feel the implant more? Likely some portion of yes to all the above.
The one finding that gave me pause though was the size increase. I don’t know if it is because I am a female plastic surgeon, or because I do tons of breast reductions so know the issues of larger breasts, or know the issues of jogging with big breasts, or my Bay Area patients are more natural/active/subtle, or see lots of my patients in their 50s wanting to be less matronly and smaller, but I personally do NOT think you have to do two cup sizes changes or go above 300cc.
For many of my patients, a small implant gives an elegant change. It fits with their body and does exactly what they wanted. Larger volume can mean higher profiles, which don’t look as “natural,” particularly in thin patients.
My advice for size? Demo it. Wear it. I have all my patients try on sizing implants at least twice, and recommend doing the rice test to “test drive” the size first.