by Terrye Tebbetts

Question ~

Thanks Nicole and Terry! I have visited Dr X’s site already. I’m also impressed with Dr. Y’s web site, there is sooo much info. on it regarding BA’s and he has a lot of certifications so I plan to consult with him also. I’ll check out Dr. Z’s info. If anyone knows of any other PS’s directly or from experience, I’d love to know, thanks!

Answer ~

Please remember that on the internet ANYONE can say ANYTHING about any subject – the internet allows anyone to “publish” their opinion.  When looking for a surgeon, you really need to look at how much they have published in the scientific arena – if they do not (which very few really have developed new techniques or studies to published), then you must speak with not one but 5 or more of their patients – - an impressive website is most likely not even the product of the ps but of a service or marketing/IT person. 

People – surgeons, marketing people etc pick up on buzz words and search terms – so 24 Hour Recovery, and  gummy bear implants and rapid recovery etc get more buzz because those who want to be….want to be.  It all goes back to buyer beware and prospective patients doing their research.  Your consults can only be as good as what you know  and you cannot get all of your “knowledge”  from friends or implant websites or quite frankly, most surgeons.  Because, again, anyone can put up their views as fact when all it really is is marketing and opinions. 

There has to be validated content  and publications or validated patient experiences for a flashy or “impressive” website to be real.  Just don’t  let the wool get pulled down too far over your eyes – -

Educate yourself on the fundamentals first – then you will be better educated to judge the websites, consults and performance of these surgeons.

by Terrye Tebbetts

Question ~

I hope you don’t mind me chiming in on this thread, I can relate to your question Lee. I am 5 9.5″, 140, A, and athletic and want overs as well (I think), and wondering how my body will do with this. More importantly, I want to go with saline, because in MY mind I’m not comfortable with the silicone issue, but that’s just me. So I want to fit every other decision around the saline decision, and I thought overs were best for athletic women. (Won’t unders show more when you flex your muscles? I am in the fitness industry so worry about this issue a lot). But I worry about the rippling issue and the possibility of downward displacement. From past consults, I’d probably go for the 400cc range so maybe I’d be safer from the downward displacement hopefully but not going bigger. And the rippling can be helped by going with smooth salines, correct? I still have consults to go through but am trying to get as much info. on here before my consult as possible.

Answer ~

We really need to talk!  Please feel free to call me at the office tomorrow 214-220-2712 but I will tackle at least one issue you mentioned here – rippling.

There are TWO basic types/causes of rippling – the first is an underfilled implant (a shell that collapses) – all round implants (saline and silicone, textured and smooth) all tend to collapse some in the upper part of the breast when filled to manufacturers specifications.  You can reference the TILT TEST in the book and it may explain it better to you.

The second kind is TRACTION rippling – this comes from ANY implant that is too big, and too heavy for the skin envelope it is place in (kind of like when you drop a grapefruit into a empty plastic grocery bag and the bag wrinkles and pulls at the weight).  Does that make sense?

So I have to wonder and WORRY when you are small, athletic and an “A” cup and yet you are entertaining a ROUND (all collapse) and 400 cc range in size (heavy on thin tissue!!) – you are going for the double whammy at this point!

by Terrye Tebbetts

Question ~

I saw your post below. In your experience can women who are thin (5′4 110 AA) get over implants? I want to be a full A, maybe small B, but want them to look real. I’m in my 40’s and have breastfed 3 children. Thanks!

Answer ~

It is all about how much breast tissue – soft tissue in the area where the new implant will live – that determines which pocket location you should use. The High Five Measurement rule is that if you have less than 2 cm of coverage in the upper portion of the breast, then you should put more coverage over the implant.

If you put implants under thin coverage, you are much more likely to see implant edges and rippling.

What makes an implant, a BA, breast implants – whatever you want to call it – natural is an implant that is the right size to simply fill the empty space in your breast envelope. The most successful, predictable way to figure that out is to use an objective measurement system, like the High Five System, to plan your operation and implant size selection. This way, you are never asking your tissue to go to a place it has never been. A really good idea of where you can go safely is back to the range of size you were at the height of your pregnancy and or nursing experience.

You can’t predictably get there by talking cup size – it is not a medical term and in fashion it varies so much depending on the manufacturer and what mood you are in when you buy one! Please don’t plan your operation on something this unstable (or sizers or pics of others either!).

I would love to know your reasoning for trying to go with “overs”. But I hope you understand now that its not the pocket location or the incision or the implant that makes a natural, pretty breast – - it is how the implant is used and making sure that it is the right size for you!

You can read more about pocket location in Chapter 6 of The Best Breast 2 or click here to read the scientific paper that Dr. Tebbetts published about the newest pocket location, Dual Plane       http://www.thebestbreast.com/news/downloads/pubs/04DualPlaneAugmentationPRSApril2001.pdf

by Terrye Tebbetts

Question~

Does anyone know of a saline pre-consult kit, similar to Natrelle’s silicone kit that you can order? Won’t the look and sizing be different in saline than in the silicone implants, or should I order the silicone kit as a guesstimate for the saline sizing as well? I’d like to be able to have them in my home and try them out since the consults go so fast and you have to pick your size during the consult. Thanks!

Answer ~

There is so, so much more to choosing implant size than just putting sizers in a bra.  See, fabric can do anything – can expand and be pushed – - your breast envelope,  your breast tissue cannot fuction in that same way – so using sizers to determine which implant you get can be VERY misleading.

Please go to our book website www.thebestbreast.com and click on the articles button the homepage – there are 3 excerpts about How to Determine Size – I know you will find them very enlightening as you research this procedure.  Pay special attention to the illustration that shows what happens if you don’t put enough fill in the breast, or when you put too much fill.  Figuring out the area of the empty space in the breast is what stumps most folks in this whole deal.  That is why High Five is so good and so predictable – using your own body and objective measurements produces just the right amount of fill that will last you a long time.

I hope this helps you!

By Terrye Tebbetts

Question ~

I’m having my implants (silicone 600 cc’s) replaced in the near future. I’m 5′5, 110# and started out as an AA. Right now I wear a 34C but I’ve got high profile implants and they look very plump and rounded on top.

I’m thinking of going down to about 325 cc’s and want the most natural look possible. I had my original surgery about ten years ago but I just feel they don’t suit my age anymore, even though I’m in nice shape.

Any implants out there that look like natural, slightly droopy breasts? Will smaller round implants (not the high profile) give this effect?

Answer ~

First, please remember that it is NOT the implant shape, shell type or filler that truly produces the end result you see in a breast.  In a primary operation it is really easy to explain – if you don’t put enough in the breast envelop it is ugly and empty, if you put too much then it’s a BOOB job because there is too much volume in the breast and the volume has not place to go  – so it bulges at the top and looks round and fake.  So even the most natural shape and filled implant, if it is too big for you, will look FAKE – does that make sense?  Please see the illustration about How to Determine Size on The Best Breast website – it really, very clearly shows you this lesson!  So it’s not the implant – it is how the implant is used that will primarily affect the look of your result.

Secondly, it is NEVER easy to simply downsize – especially after having had 600 CC for 10 years – I preach a lot about not asking tissue to go where it hasn’t been before, but it is equally as important the on the other end of the size spectrum – - if you don’t fill the envelope you have, then it all sits in the bottom of the breast and looks like a rock in a sock (empty upper breast).  Simply going with smaller implants may not lead to a desired result so just please be sure your ps measures (especially the nipple to IMF under stretch – in general if that distance is more than 9.5 cm under stretch, then a mastopexy or lift may be needed) so that you make decisions based not just on what you want but what your tissue – ten years into this – will let you have.

by Terrye Tebbetts

When I first got involved on the forums, all I saw was the tendency in breast augmentation for patients, for women, to keep going bigger – “bigger is better “- “once you get breast implants, you will always wish you had gone bigger so get more to begin with” – “booby greed” The attitude was ” a little bit of something is good – so get more!”  Well, I guess it makes sense as we tend to supersize everything from our happy meals to our McMansions.

But recently I am seeing more posts  like this one warning about what big implants can do to you over time…..

by Terrye Tebbetts

Question ~

I had my BA done on 12/28 and I don’t think I’m going to be happy with the size. I wanted a full C and I think I’m going to end up a med/full B. Even with the swelling right now I feel like I’m a small C and I’m assuming the swelling is going to go down even more. Am I going to be stuck paying full price for a revision?? Is the surgeon responsible in any way to make  my breasts look like I wanted them to?? Help!

Answer~

I wish I could have talked to you before your surgery – I think I could have helped you avoid this remorse!  First and foremost – you are only TWO days post op – ahhhh – please give this some time!  I tell all of my patients that they need to be prepared for 4-6 weeks of too high, and tight and that they will not be able to figure out what cup size they wear for at least 3 MONTHS!  So, please be patient – I hope you will be fine and not be looking at a revision!

But most importantly – had you and your ps planned your operation with objective measurements of your breasts and not just talked about cup size and other peoples photos or stuffed something into your bra – - you wouldn’t be in this state.  Cup size is not standardized and is certainly not a medical, clinical unit of measurement – - so with no standardization of what a “full C” really means and if that is what you are basing your happiness on, you may never get there.

When augmenting a breast – you want to affect change in size without harming the patient – without creating irreversible deformities…..so if three months from now they are bigger than what you started with and you don’t see implant edges and rippling and you are not bottoming out then I would count my blessings and try not to get too obsessed with the ever-present “booby greed” that is discussed so much on this and other forums.

It is all about understanding and accepting that each body has limitations.  When the ps and the patient work within those limits and respect those limits, BA results are really good and last a long time.

But let me reiterate, you are only fresh out of surgery – I hope and pray all will be ok with time for you….I just wish someone would have prepared you better for the post operative challenges so that you wouldn’t have to go through this right now.  Enjoy the automatic “cleavage” you have now and just try to be patient.

by Terrye Tebbetts

I am often asked, “What is the right age or best age to get breast implants?’   Not being one to be speechless very often – this one will always get me. 

I believe you can make a case for being in your young, mid twenties, sick of looking and feeling like a boy and wanting to have nice feminine curves to enjoy while you are young.  But the downside is that you still have life events to go through – like having babies – which may change your breasts and cause you to need another operation.  And too, the younger you get them, the longer the breast implant needs to last and since no device lasts forever, the more chance of reopertation.  But if you have read our book, then you know, that making really good, smart decisions preop can lengthen the life time of your result. 

The other case is for women who have had their families.  They have seen a change in their breasts that they cannot change thorugh diet and exercise and their own habits so having surgery to alter the size of their breasts becomes very reasonable.  And getting them after having babies and later in life, you reduce variables that might cause you to need another operation in the future.

I guess the old saying “to each his or her own” really applies here as we all have different goals and expectations.  As long as you make educated decisions and go into this life changing operation with your eyes wide open and with reasonable expectations then you have done your due diligence and I believe you will be more satisfied with your result.

The one thing that is happening now that I cannot be speechless about is the “off lable” use of silicone breast implants.  I think it is important to remind potential patients that the legal age to recieve silicone breast implants in the United States is now 22 years old.  This is not our rule or a national plastic surgery assoication rule – this is law.  And to use a silicone implant on a patient under the age of 22 is illegal.  Now I am hearing that some plastic surgeons are using them on young, under aged patients under the guise that they are using the product (the silicone implant) “off lable” and consenting patients to that and therefore justifying in their own minds that its ok to use silicone breast implants on women under the age of 22 years old.  This one makes me scratch my head on two accounts ~ why are we permanently changing such a young body with breast implants to begin with?  and if they (the plastic or cosmetic surgeon) will cheat on a subject as important as this, what else will they do?  Just makes me very uncomfortable and it should make patients really ask hard questions of themselves and the plastic or cosmetic surgeon they are thinking about using.

As you have probably heard us say before, Life is about choices….you are responsible.  Integrity is a very important aspect of a responsible choice!

by Terrye Tebbetts

Question ~

I am approx 7 months post revision surgery-my first set of implants were 450 cc mentor mod profile plus-silicone unders. The current implants are Mentor 500 cc’s high profile. One breast sits higher and appears larger. Is there a way to even out the breasts with fat injections? It’s a small difference but I am extremely unhappy with how they look.With the previous implants, I did not notice the size difference.

Answer ~

Whenever I hear questions like yours it just reinforces to me the value of making surgical decisions in breast augmentation based on measurements  - based on the High Five System – and the importance of being honest with patients about what an implant will and won’t do and factors each surgeon cannot control.

Had you read The Best Breast 2, you would have already known that NO TWO BREASTS are ever alike and exactly symmetrical – not  before surgery and not after.  It simply isn’t humanly possible.  Had your surgeon used measurements to plan your operation, you would have known exactly how different your breasts were before your first operation and would have realized that they would always be different.

It is common for women who have one breast that is a little smaller than the other one, why not put a bigger implant in the smaller breast?  But the smaller breast has a tighter skin envelope so if you put a bigger implant in it – there is no place for it to go and there for it sits higher and more prominent than the other breast – in other words, when you try this you end up with one that looks like a boob job and one that looks natural – - so in the end they are still different.  It’s just a different set of differences.

I am sorry you are unhappy with your result.   But I would not try to use fat injections or quite honestly anything else to balance them because they will always be different and you might end up creating a bigger problem.  You are already on operation number 2 – I wouldn’t want to see you have to go through anymore surgery!

I am constantly on my soapbox on the forums about the importance of education and knowledge and understanding before jumping into the world of breast implants  – but it is so important!  Again, had you known, you might not be in this position now.

by Terrye Tebbetts

Question~

Hi Terrye,

I had silicone implants in 1991, right before all the controversy, then in 2001 I had them removed for saline.  I had a very bad case of CC.  Then, one broke about 6 months ago (dont know how) so I had them recently replaced for the new silicone.  Sadly, I had CC with all of them. My doctor has me doing 4 untrasounds and taking Singular which has a whole host of side effects.  I have been researching these “fixes” if you will.  The spreadsheet is the different implant datataken from the FDA’s website or any that might be helpful. 

Answer ~

I don’t think implant selection data will help you now.  If you had been my patient, I would have warned you that once you develop a capsule, you are 50% more likely to develop another one and that it is only reasonable to reoperate one time.  If you develop another one, take them out.  You are caught in a vicious cycle that won’t change with another operation or sonograms or Singular or anything else.

I wrote a blog piece on this a while back called the Mystery and Misery of CC…..

http://thebestbreast2.wordpress.com/2009/09/16/the-mystery-and-misery-of-cc-how-can-we-avoid-it/  maybe reading this will help you understand.

I am really sorry – but hearing your story would make me say, you are probably better off without implants.