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Myths and Facts Northern Virginia

Dr. Desman strongly encourages you to read the book "The Best Breast". Detailed information discussing the 20 myths below can be found referenced to the appropriate book chapters within the brief explanations below.

Common Myths and the Facts

Myth #1

Augmentation of the breast is a simple operation-any surgeon can do it!

The truth? Augmentation is NOT a simple operation. Any surgeon may be able to do it, but how well? Chapter 6 reviews the details of the many surgical options available-why it's not simple. Chapter 9 tells you in detail how to find qualified surgeons, and Chapters 10, 11, and 12 tell you how to evaluate the information you get from surgeons, how to prepare for your consultations, and how to compare and evaluate the surgeons you consult!

Myth #2

If a surgeon does augmentations only one way, that's better.

The truth? Surgeons who do all augmentations one way usually only know one way to do an augmentation! Only a surgeon skilled with all of the options can offer you all of the options. If a surgeon is doing all augmentations one way, it's probably because it's the only way the surgeon is comfortable with and the only implant and incision the surgeon has experience with! Women's breasts are very different. Women's desires are also different. Women's choices are often different. One way isn't best for every woman! Chapter 6 lists all of the surgical options that should be available to you. If you aren't getting the choices, go to Chapter 9 to find other qualified surgeons!

Myth #3

Cup size is a predictable way to measure the size of a breast.

The truth? Look in your bra drawer! Are all the bras one size? Ever buy bras that are labeled with different sizes, but both fit your breast? Is a B cup the same in a 34 as it is in a 36? Although bra cup size is a popular way of discussing breast size, it is extremely variable from one bra manufacturer to another. Although we discuss cup size with patients, we have many more accurate ways to discuss desired breast size, based on measurements and on demonstrations with your own tissues. See Chapters 4 and 6.

Myth #4

There is one best way to do an augmentation-one best implant, incision, and pocket location that is better than the other options.

The truth? If there were really one best way, all augmentations would be done the same way. Different sets of options fit different women's needs and desires. The key is finding a surgeon who has experience with all the options and can offer you all the options. Chapter 5 reviews all the implant options (and the tradeoffs of each one-they all have some tradeoff!), and Chapter 6 reviews all of the surgical options that should be available to you.

Myth #5

I like the result my friend got. If I choose the same surgeon and the same implant, I'll get a similar result.

The truth? Are your breasts exactly the same as your friends' breasts BEFORE she had her augmentation? Of course not! And if your breasts weren't the same before, even if you choose the same surgeon and the same implant, your breasts won't be the same as hers AFTER! Your breasts and your tissues don't match any other woman! They're unique. And your tissues are what your surgeon must work with! If a surgeon doesn't recognize and explain to you how your tissues are unique, and explain to you which options will take the best care of your tissues over your lifetime, go to Chapter 9 and look for some other qualified surgeons! Chapter 4 helps you understand how your choices now can affect your tissues as you get older.

Myth #6

The bigger the breasts, the better.

The truth? Think about an 18 year old girl with gorgeous D cup or larger breasts (no augmentation). What will her breasts look like when she is 40? Where will they be located? It's very important to get what you want when you have an augmentation, but it's also important for your surgeon to make you aware of how those choices may affect your breast as you get older. Are larger breasts more likely to sag? More likely to require more surgery in the future? Are you more likely to see the edges of your implants, or see visible rippling with larger implants? Is there a way to get full, beautiful breasts without running excessive risks of problems in the future? All of these are questions that are answered in Chapters 4, 5, and 6.

Myth #7

The most important decision to make is where the scar is located.

The truth? Actually, scar location is one of the things patients are most concerned about before their surgery, and least concerned about after their surgery. If a woman has a beautiful breast, no one pays attention to a stretch mark, or a small blemish, or a scar. If the quality of a scar is good, it's no more apparent than a stretch mark.

Myth #8

Implants last a lifetime.

The truth? Name a device that lasts a lifetime! There aren't many. Today's most state-of-the-art implants are the best implants that we have ever had, but they aren't perfect, and they won't necessarily last a lifetime! For the details, see Chapter 5: Breast Implants – The Devices and the Choices.

Myth #9

A certain number of cc's in a breast implant produces a certain cup size breast.

The truth? This is a very popular misconception, but it is absolutely not true! The size of the breast following an augmentation consists of 1) what was there before the augmentation PLUS the implant that was added at the operation! What this means is that a 300cc implant might make a C cup breast in a woman with very little breast tissue before augmentation, and the same implant might make a D cup breast in another woman who had more breast tissue before the implant was placed. If you want the most accurate size after your operation, your surgeon must measure and estimate how much breast tissue you have before the augmentation! Then choose the most appropriate implant! Chapters 4, 5, and 6 provide a more in-depth perspective of all the issues involved in selecting implant size.

Myth #10

Putting implants "under muscle" helps support the implants better.

The truth? There is absolutely no evidence that putting an implant under muscle supports the implant better. The two major issues that affect implant support (and therefore, how much the breast will eventually sag) are 1) the genetic characteristics of your tissues, and 2) the size of the implant you select. The thinner and more "stretchy" your tissues, and the larger the implant, the more you can expect your breast to sag over time-guaranteed! Chapters 5, 6, and 11 help you understand the important issues that are involved in selecting an implant and pocket location that meet your desires while protecting your tissues as you get older.

Myth #11

Implants should never be placed over the muscle.

The truth? Neither over the muscle or under the muscle is right for every woman. The three most important considerations are:1) the thickness of your tissues that will be covering the implant (everyone is different, and the thickness should be measured),2) how the particular implant you select will affect your mammograms, and3) which set of tradeoffs (implant edge visibility, effects on mammography, and control of implant position) are most acceptable to you. All of the issues are addressed in Chapters 5 and 6.

Myth #12

Round implants produce more upper breast fullness compared to anatomic implants.

The truth? If ROUND implants are filled to current manufacturer's recommendations, when they are upright (when you are standing), the implant collapses and shortens vertically, allowing the shell to fold and decreasing upper breast fill. If you overfill the implants to prevent shell collapse, you void the manufacturer's warranty! McGhan Style 468 and 410 ANATOMIC implants have manufacturer's fill volumes defined so that shell collapse and vertical shortening does not occur-you can maintain fill in the upper breast and not void the warranty! The overall size of the implant also affects upper pole fullness-the bigger the implant, the more fullness! But can you expect the fullness to STAY in the upper breast when you use larger implants? There are definite tradeoffs and long term implications that you should understand thoroughly before selecting your implant! See Chapters 4, 5, and 6.

Myth #13

Textured shell implants are easier to feel inside the breast compared to smooth shell implants.

The truth? Whether you can feel an implant inside your breast really depends on two factors: the thickness of your skin, fat, and breast tissue overlying the implant, and 2) whether the implant is placed over or under muscle. If you want an implant to last longer, you want a thicker shell on the implant. The differences in thickness between textured and smooth implants is only a few ten thousandths of an inch-not as important an issue as the thickness of your tissues. Read more in Chapters 4 and 6.

Myth #14

Textured shell implants are more likely to produce visible rippling compared to smooth shell implants.

The truth? The two most common causes of rippling are 1) under-filling an implant (underfill rippling)-all ROUND implants are under-filled by manufacturer's recommendations), and 2) LARGE implants in patients with thin overlying tissues where the implant pulls downward on the thin envelope (traction rippling). Textured or smooth shells have very little to do with rippling-the amount of fill the surgeon places in the implant, and choosing an appropriate size implant for your tissues are more important! Check out Chapters 4, 5, and 6.

Myth #15

Silicone gel filled implants are dangerous and cause diseases.

The truth? Several large scientific studies and the findings of an expert panel appointed by Judge Sam Pointer (the judge in charge of class action implant litigation) show conclusively that SILICONE IMPLANTS DO NOT CAUSE ANY KNOWN DISEASES. Chapter 2 and Appendix 1 give you the answers in detail, and provide Internet references to all of the most important scientific studies, FDA recommendations, and links to important additional information.

Myth #16

Saline implants are better than silicone gel filled implants.

The truth? Saline implants are not necessarily better or worse than silicone gel filled implants, but they are different! Every type of implant filler material has advantages and tradeoffs-there is no such thing as one best type of filler! Which is best for you depends on what you want and which tradeoffs you are willing to accept. Before you select any type of implant filler or implant design, you need to know about the tradeoffs of each type of filler, which fillers are currently available in your country, and important issues about how implant fill (saline or silicone) can affect the life of your implants. Chapter 5 gives you comprehensive information about all of these issues-read it carefully before you select an implant!

Myth #17

If one breast is smaller than the other (and it always is), all you need to do is to put a larger implant (more fill) in the smaller breast to make it match the larger breast.

The truth? It's not that simple. The smaller breast has less skin compared to the larger breast. When you try to put too much additional fill into a smaller skin envelope, you risk significant SHAPE differences. Every woman has breasts that are different sizes-different is normal-different is what you see every time you look at a woman's breasts! If you try to put too much volume in a small skin envelope, the SHAPE change that results creates more visual difference than a SIZE difference. The key to matching breasts as closely as possible (and they NEVER totally match!) can be very complex-not as simple as putting a larger implant in the smaller breast. Chapters 4 and 6 address many of the issues.

Myth #18

You shouldn't lift your arms above your head, drive your car, and lift normal objects for at least a week after your augmentation.

The truth? We encourage all of our patients-with implants over or under muscle to begin these activities IMMEDIATELY! Over 90% of our patients do all these activities in the first 2 days! What you should or should not do after surgery depends on HOW THE SURGERY IS DONE! Get all the details from Chapters8 and 14.

Myth #19

You should expect to have bruising after your augmentation.

The truth? Over 98% of our patients have NO BRUISING following augmentation. Bruising is bleeding from underneath that stains the skin. The amount of bleeding that occurs during and after an augmentation, though not totally controllable by your surgeon, can be dramatically reduced or eliminated in most cases using specific techniques to create the pocket for the implant. Learn more from Chapters 6, 8, and 11-know the right questions to ask about recovery before having surgery that will tell you a lot about how the operation is done (Chapter 8)!

Myth #20

You may need to have drain tubes coming out of your body after your augmentation.

The truth? Drain tubes are almost NEVER NECESSARY in a first time augmentation, provided specific, state-of-the-art techniques are used to create the pocket for the implant. Drains are commonly necessary following reoperations. To understand why, see Chapters 8 and 14.

The Three Greatest Lies in Breast Augmentation

1. The biggest possible breast is the best breast
2. A certain size (ccs) implant creates a certain cup size breast
3. What is good today is good tomorrow

What do you get with a large natural breast compared to a large augmented breast?

Large normal breast with time: You get a large, sagging breast

Augmented breast: You get a large, sagging breast with any or all of the following: tissue thinning, visible implant edges, visible traction rippling, stretch marks, and tissues with higher risks if a reoperation becomes necessary.

Please choose from the sections below to read more about The Best Breast:

1999 CosmetXpertise. All rights reserved.
John B. Tebbetts, M.D.

The information in this section of our web site is from the book The Best Breast: The Ultimate, Discriminating Woman's Guide to Breast Augmentation by John B. Tebbetts, M.D. and Terrye B. Tebbetts, and is included on our web site with Dr. Tebbetts' permission. You can visit their web site at www.thebestbreast.com. You can purchase The Best Breast book at Amazon.com or Barnes and Noble.com. Dr. Desman urges you to read this book**! It is a tremendous resource for you.

**Dr. Desman has no financial interest in the referral or sale of this book.

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