The Best Breast

by Terrye Tebbetts

Question ~

My boobs are set wide natrually. I know that implants wont change that, but I wonder if overs or unders are better at all for cleavage…..even just a little? Any advice will help!!

Answer ~

The pocket location, or “overs” vs “unders”, is all about soft tissue coverage in the upper portion of the breast. By the High Five System, if you have less than 2 cm of soft tissue coverage in the upper pole, then you need to put the implant under more of you to avoid seeing implant edges and any wrinkling or folding of the implant.  There is also a school of thought that says mammograms will be easier if the implant is partial sub pec.  There are different ways to place the implant under more coverage – traditional PRP, sub facial and Dual Plane are the most common.

If you need more coverage – you need it – but for the reasons I mentioned, not because you hope it might create cleavage or support an implant long term or any of the other mythical things associated with pocket location.

The distance between your breasts, the intermammary distance, is a very sacred place of skin over sternum – - when toyed with, either by over dissection or by an implant that is too large and too wide for the breast, a condition called symmastia – or Uni-Boob, is created and it is VERY difficult to fix.

Breast implants do not create cleavage – they were never meant to create cleavage and when used to do so, they can create problems!  Bras create cleavage.  So if you are wide set now, then that distance will always be the same, but when the breast is full with implant, then at least you will have something to push up into that space.

I hope this helps shed some light on an often misunderstood concept of breast implants!  The bottom line is, everything gets better when the breast is full and firm, even if the space between them cannot be changed!

by Terrye Tebbetts     

I found this commnet on a discussion board and wanted to share it.  Since so many comments and questions are negative or problematic, it is nice to read about a success story for a change…..

Question/Statement ~ 

One year to the day….and ladies…I just couldn’t be happier! I had an amazing surgeon with amazing results. I am blessed and lucky – so many times we hear about the bad stories so I’m here to share a positive one. Scars are barely visible, the gummy bears which take longer to settle in and soften feel/look natural and most importantly I actually LOVE my breasts – something I NEVER thought I’d feel, say or believe. My self-esteem is 500% improved and I feel sexy and womanly.

Do I have a little boob greed? OF COURSE – I think all of us do. But when my surgeon told me today the next size up is 25cc which isn’t worth the risk and that the next size after that is 375 cc’s which would be huge on me…I finally let it go. The bottom line is I’ve got way more than I ever dreamed, I had a pitch perfect surgery/recovery/result and I feel marvelous about myself. I really hope it doesn’t sound like I’m bragging – simply just so so so so VERY grateful.

I want to thank Patty and the rest of the women on here for being such a tremendous resource. Just knowing there are others going through what you are/what you did/what you will is so comforting.

If I can ever be of help on the gummy bear implants from the Allergan trial study don’t hesitate to let me know.

Thank you all for your support – this is an amazing community of women.

 Answer/comment ~

I am so happy and pleased to welcome you to the gummy bear sorority!  I am an 8 year alum with mine and feel the same way about mine 8 years out – that you feel about yours at 1 year!

Congratulations!  And the next time you see your ps, give him or her a big hug for laying out the reality about size for you – - they obviously had your health and well-being at the top of the priority list!

by Terrye Tebbetts

Every day when I talk with patients or go on different internet forums, there is always a question about how to figure out what size implant a woman should use or choose.  They get differing opinions from the surgeons they have had consults with.  They get different advice from their friends and women who have had implants.  They are told that a certain amount of CC equals a certain cup size or that just simply bringing in a photo of what they want to look like will work.  Or my favorite method of determining size…….stuffing something into your bra – be it rice or soaked panty hose or sizers - just stuff it on in there and we will make it happen!  Then there is always putting your breasts into a computer image and just changing and morphing it all over the place while the disclaimer scrolls across the bottom of the screen “This is not a guarantee of result”. 

The problem is, as I see it, patients and surgeons have taken the surgical planning of breast augmentation so far away from the patient’s body that nothing makes sense any more.  It’s just a sea of grey that fosters confusion and often leads to unhappy patients.

Preoperative planning using measurements of the patient’s body and a scientifically published and peer-reviewed formula to decide the size of the implant (like the High Five System) puts objectivity back into the decision-making process.  It eliminates the GREY area.  No longer will a patient have to wake up at 3 am and wonder if her surgeon really, truly understood what she meant by “full C Cup” any more.  When you respect the body and the tissue you are operating on, everything gets easier — for the patient and the surgeon!

Here’s one more example…..

Im a petite girl..5′4 110 with a 34A. My doc recommended 300cc moderate silicone unders and Im concerned they are going to be too small for my liking. However, with the moderates he cant go any bigger because they will be too wide for my body. He also doesnt want to use HP’s because I have rather prominent nipples that will just project them more. What do you guys think? I would like to be a C. Will this do it for me or am I being ultra paranoid? I did the rice test (not sure how accurate it is) and they looked okay.

 Answer ~

There are 3 really good articles on how to determine size on the home page of our book website.  Just go to www.thebestbreast.com and click on the articles button.

Pay real close attention to the illustration where Dr. Tebbetts is pouring water into the breast with a funnel.  This is a simply illustration but it really says it all – - if you don’t put enough fill or volume in a breast then it sits in the bottom of the breast like a rock in a sock – in other words, its ugly!  But if you exceed the amount of stretch or room in the breast – the volume has nowhere to go so it bulges at the top and instantly becomes a “Boob Job”.  So if you want a natural, proportionate breast, you have to figure out just want the empty room or space is in each patient.  We use the High Five Measurement system to figure out what the Ideal amount of fill for each woman is.  Because when you measure – you know what the limits are and when you simply fill a breast – it is a pretty breast that is least likely to cause you a problem long-term.

Balancing what you want with what your body can realistically and safely have is the key to a really good result and a really pretty breast!

by Terrye Tebbetts

We had the pleasure of operating on this really nice lady, who just happens to be a physician too, in January of this year.  She traveled from the West Coast to use Dr. Tebbetts and experience a true 24 Hour Recovery.  I just received this note from her this week and she was kind enough to give me her permission to share it with you…….

Dear Terrye, 

Everything is going well and I feel great. Things are going exactly as you predicted. 

Since I came back after surgery I have been trying to find words to describe my experience with Dr. Tebbets. All I can say is that your team does ordinarily what is considered extraordinary and even impossible by some plastic surgeons. As a doctor and as a patient I am still amazed!! I have experienced in person 24 hour recovery after breast augmentation. I am one of many living proof that 24 hours recovery does exist! I was able to shower, raise my arms, go out for dinner the night of your surgery, with minimal disconfort just taking 800 mg ibuprofen. I hope I can find some way to thank you all.

Thank you,

Traveling Doc

by Terrye Tebbetts

Question ~

Hello, I will be 29 this month; 5′8″, 122 lbs. I was a B cup, went to a C while breastfreeding for a year, then down to an A after having to stop nursing suddenly following an appendectomy. I am simply looking to return to a full B or small C; I am wondering if anyone has advice on whether saline or silicone is better in this case? Thank you!

Answer ~

Please remember, your end result is not just the device or the implant.  It is how the device is used that makes you a really pretty breast that will cause you the least amount of risk long term.

You have so many decisions when thinking about BA for the first time.  Incision, pocket location, how to determine size, the style and type of implant and the filler and then how is the surgery done and what kind of recovery can you expect.

All of these questions and more are answered in our book, The Best Breast 2.  You can read most all of it on line at www.thebestbreast.com    – I know it will help you feel more confident as you research and make decisions and interview surgeons – you always feel better with more knowledge!

As for your specific Saline vs Silicone question – I have a spreadsheet that Dr. Tebbetts put together that compares all the available information on implants from the FDA’s site in a very easy to read format.  Just email me at TTebbetts@plastic-surgery.com and I will be happy to send you a copy.  It will let you compare CC rates, deflation rates, rupture issues – all on one sheet.

by Terrye Tebbetts

Yes, it is true!  In the February issue of Allure magazine you will find both my dear hubby, John Tebbetts AND Beyonce!  Our 11 year old thinks this is just about the coolest thing Dad has ever done!!  Granted, Beyonce is on the cover and the breast implant article is back on page 108 – but they still in the same issue!

The implant article is called Implant Nation and discusses the issues of breast implants and how main stream they seem to have become.  Even sites college seniors getting breast implants from their parents as graduation gifts!  The author, Joan Kron, explores Dr. Tebbetts’ new innovations for advancing  surgical techniques in breast augmentation and developing amazing 24 Hour Recovery practices that allow patients to be up - returning to normal activity like showering, shopping and going out to dinner the night of surgery.  The story also challenges conventional decision making practices and looks at the future of measuring the breast.  But then, as most media pieces about breast implants do, the story delves into the world of obnoxiously large implants and women that wear double K bras – go figure!  There has to be some hype and sensationalism somewhere to make it interesting, right? 

That is ok – because we know the breast augmentation patients of today are doing their research and trying to make better decisions.  The very fact that a national magazine is helping point out the advances in breast implants and breast augmentation recovery is a true sign that there is something really new and different here that is worth talking about and that patients need to know about.

You can read the article on-line at our book site www.thebestbreast.com  ~ enjoy!

by Terrye Tebbetts

Question ~

I don’t think its crazy to go with 400ccs at all. I am 5′7 115 lbs and went with 330ccs (salines, HP, unders). I started off as AAA and ended up looking like a B cup, and measuring a C cup. I wish I was bigger.

With that said its true that the larger you go the greater the complications could be. Because of the amount of tissue I had it was not physically possible for the Dr. to go any bigger with 330 ccs (I am thinking of a redo now that my body has had time to accomodate the change).

I would reccomend getting a second opinion…see what another p.s. recommends. It’s not a good feeling to go through a surgery and be disappointed with the results….but you also want to make sure you arent putting yourself at risk.

Answer ~

Your questions above…”With that said, is it true that the larger you go, the greater the complications could be?”  is a critical question and one that needs to be answered and the answer needs to be heard by all women contemplating breast implants.

I understand your disappointment, “wow, these 330’s are great, but wouldn’t bigger be better?” but if you knew that to add to your volume – to make your breast bigger could cause:

excessive sagging

bottoming out

edge visibility

traction rippling

tissue atrophy (esp. with extra high projection)

symmastia (one big una-boob)

loss of sensation

Not to mention, that every time you go back into a healthy breast for size exchange, you risk capsular contracture, hematoma and infection….

Would you still want to have more?  Would you still want a bigger breast at the risk of destroying your body, your breast tissue?

Yes, ladies, there are LIMITS in breast augmentation.  You cannot just put any implant in ANY breast with out significant tradeoffs long term.  Breast augmentation was meant to enhance a woman’s breast – to fill the empty space in a way that she could never do on her own through diet and exercise etc.  But somewhere along the way both patients and surgeons have decided they can ignore the bodies they are operating on and just do whatever they want.  I think that is dangerous long term.  I believe you can have a pretty and better breast and for a really long time as long as you can reconcile what you WANT with what your body can realistically HAVE.

Supersizing our Happy Meals may be common and ok cause it only goes to your butt anyway and you can run an extra mile next time.  Supersizing your breast implants – - – now that is another story, because you cannot repair destroyed tissue.

I hope this makes sense, we can have better and more, but within limits to achieve the ultimate safety!

By Terrye Tebbetts

Question ~

Has anyone here had rippling that improved or went away?

Answer ~

There are 2 basic types of rippling…

1.  The first is caused by Under Filled Implants ~ an underfilled implant (which all  round implants are by manufacturers fill definitions - saline or silicone) will collapse in the upper portion of the implant causing the shell to ripple – in thin  skin patients or patients who opt for “overs”  – visibility is more of a risk.

2.  TRACTION rippling – caused by an implant that was and is too big for the breast envelope it was put into the other variable is coverage – - you cannot manufacture more soft tissue coverage over an implant….so if you are small, thin and opt for a very large implant….the hand writing is on the wall.

Now to answer your question….once there is rippling….it is unlikely that there is a viable, clinical solution.

It once again boils down to making REALLY good, educated decisions with your ps in the beginning – - BEFORE the operation – instead of finding out after that you now have something to deal with…..that is why we wrote The Best Breast 2…and you can read most of it on line at www.thebestbreast.com

Your consults can only be as good as the knowledge YOU have going into them!!  Education, knowledge, facts are power….

 by Terrye Tebbetts

Question ~

ok ladies, i need you to clear something up for me. is this “memory gel” silicone implant the only kind on the market, or are there other kinds that are less superior? i hear great things about the memory gel as it apparently doesn’t leak all over if a rupture occurs but rather sticks to itself? am i understanding this correctly? Can they be used in re-ops and revisions?  i was curious if that is the type that is primarily used these days? thanks!

Answer ~

There is a distinct difference between the “memory” gel and the form stable or gummy bear implants. 

Memory gels are available on the open market.  No study is required to receive a round, smooth memory gel product.

If it is truly a form stable product, the ps must be enrolled in the FDA study as an investigator.  There are 3 companies that I know of – Allergan, Mentor and Silimed.  (Allergan has only 150 ps investigators – some can do all cohorts of the study some only do one or the other (ie – cosmetic, recon or revision)

We do only primary, cosmetic BA with the Allergan style 410 or with the Mentor CPG when we were enrolling with Mentor. 

I hope this helps clear the confusion – but understand – not all silicone is created EQUAL.

Buyer  beware and educated!

By Terrye Tebbetts

Whether it is a 270 cc, 250 or 700 cc implant – if it is not the volume your breast envelope needs to simply fill it – - you are liable to end up feeling like this lady.  Making operative planning decisions with your plastic surgeon based on your breast envelope and what it can safely handle long term can only be determined by measuring the breast and applying those measurements to a scientifically proven formula like The High Five System of Measurement. 

A revolution in thinking about breast implant size and the process of choosing size really needs to come from the people it (size) effects most in the future—–from the patient.  If patients demand operative planning based on measurement, change will come.  But you guys have to ask for it.   You have to want to make an improvement in your breasts, in your self image, but not want to damage it long term.  Patients have to reconcile what they want with what they can realistically have with their plastic surgeons.  Take the decision making to an objective level – - take the guessing game out of this process by eliminating cup size and sizers and 3-D imaging. 

You are choosing to have breast implants.  Make the choice about YOU!!!

Question ~

Ugh! I am feeling very low self esteem lately and worried that I made a big mistake getting a BA. I am 5′5″ about 115 and sometimes think my boobs look freakishly big! I was a 34 b pre surgery and and was measured at nordstroms at a 32E! I don’t understand how 350 on other girls gives them a nice C cup and on me I am trying to squash these gazoombas into ugly minimizer bras all the time! It has been 2 1/2 years and I am really struggling with the way I look at times. Especially in pictures! All of my girlfriends have perky little boobs, and I just feel I stand out even more. If I don’t go smaller I don’t think i’ll ever be happy, but don’t have the money or time. I am just dreading another summer not being able to find a bathing suit that fits! Does anyone else ever feel this way? I thought this was going to make me more confident, but I feel anything but.

Answer ~

I am so sorry you are having remorse at this time. 

Your situation is exactly why I harp on the importance of measurements to plan an operation and not just what others choose, photos of others or stuffing implants in a bra or choosing based on cup size.

When you ask tissue to go somewhere it has never been and past its limits, you end up with –  what you are feeling now.

Although you can put ANY implant in ANY breast, you cannot do so without significant tradeoffs long term.

Please, please, make decisions about your body based on your body.  I believe you can avoid much heartache and disappointment and reoperations if you use measurements to plan your BA to begin with.