“Welcome to Plain Talk About Plastic Surgery, a podcast that brings you down to Earth, honest and practical information about plastic surgery operations and procedures based on my 32 years of experience as a plastic surgeon.

I’m Dr. Elizabeth Kerner, and today we’re going to talk about breast augmentation. Most people will call this a breast aug. That’s just shorthand for augmentation mammaplasty, which means increasing the size of the breast.

Augmentation mammaplasty is one of the most popular plastic surgery procedures, probably only beat out by liposuction and Botox in the last couple of years statistics. Augmentation of the female breast has been around reliably since the late 1960s.

Doctors Cronin and Gerow, plastic surgeons in Houston, developed the first breast implants and began successfully implanting them in women’s breasts in the late 1960s, early 1970s. Prior to that, women had tried all sorts of things to obtain a larger breast.

The most popular was injection of liquid silicone, which had horrible, unintended consequences.

In the 1900s to 1950s, surgeons would try moving tissue around from the upper abdomen into the breast, but most of these did not work very well and left significant scarring on the torso such that trying to get a cosmetic result was not at all possible with that.

I think it’s very interesting to contemplate why women want to have larger breasts. It certainly revolves significantly around self-image and societal expectations of femininity.

Many centuries ago, Paul Rubins, the famous painter, popularized the lush female breast, I would say. If you look at his paintings, women are large breasted and voluptuous.

Of course, that was part of the time. A wealthy woman would be well fed. And of course if she’s had many children, which was considered successful, typically she would have large breasts that would bulge out of her clothing, which is what he painted.

Then you fast forward to the time of the flapper women in the 20s, and everybody was really small breasted, and you wanted to look like a boy.

Go way back in time to Greek mythology, and oftentimes the Noble women would be also very small breasted. And then it varies by European, to Asian, to Indian, to African, what is considered to be a pleasing breast.

But the funny thing is, it’s really what’s considered to be a pleasing breast to the male.

It wasn’t really until the 1960s when women started becoming “woke”, as they say now, but developing their own feminism that women would say, “hey, we don’t want to wear bras and we don’t want big breasts.”

If you listen to my podcast on breast reduction, we talk about that a lot. And also with sizer bras — kind of the bra and breast revolution.

Now, I don’t think society dictates quite so specifically that large breasts are in shape or small breasts are in shape. Certainly not the way they do with big bottoms nowadays.

But individual women would say, “Boy, I think I look too flat. I feel like a boy” or “I used to be a C cup. Now I’ve had three children and I just have little sacks of skin, and I just don’t feel feminine.”

The flip side of that, of course, is a woman who’s very large breasted and feels like her breasts are so big that it makes her look fat; or they get in the way of activities; she can’t wear clothing; on and on like that.

For me as a plastic surgeon, of course this works out just great because everybody’s either wanting to increase the size of their breast, or decrease the size of their breasts, or lift them up. This keeps me quite busy in my world of operating.

So I’m going to talk about what we do with the breast augmentation. This is just going to be the technical operation of what is done and how it’s done and choices that are made. And then we’ll have a whole another podcast on implants because choosing an implant is the most difficult.

We, of course, have saline and silicone right now, and the choice is not as clear cut as you would like.

Everybody would like choice C, which is the safety of saline and the softness and the natural feel of silicone. And then, of course, a breast implant that never fails. But we don’t have that.

So when you come into the office for your breast augmentation, I will eventually take a look at you and look at your chest wall and say you would be a good candidate or a poor candidate.

And what would make you a good candidate?

Well, your breasts aren’t really terribly saggy, so you don’t need a lift. You do have a good functioning pectoral muscle, but it’s not hugely thick. So if you’re a body builder and you have a really thick pectoral muscle, it can make it very difficult to do an augmentation. It’s nice if you have normal amount of subcutaneous tissue. So when you squish the fat about an inch or two above your nipple, if you can squish up about one to two inches of fat — fatty subcutaneous tissue in your fingers — that’s like perfect.

If you have some actual breast gland, that’s kind of nice because that’s going to camouflage more and make you look more normal. If your torso is a little shorter, meaning that the length of your chest from your collarbone to the fold crease under your breast is not terribly long, I think your implants are going to look better, meaning that your postoperative result is going to look better because they sit a little bit higher on your chest.

If you have a long torso, then your implants are going to sit lower on your chest. They’re going to be just above the inframammary fold or that crease under your breast. And unfortunately, there’s absolutely nothing that can be done about that.

Implants are all round. They don’t make like hot dog or oblongly shaped implants, so your fullness is going to be really above wherever your existing fold is.

I also look for things like:

• Do you have scoliosis? Is your chest twisted a bit?
• Is the sternum very prominent, or does it dip in?
• Do you have ribs that stick out more on one side or the other?
• Is one side of the breast broader than the other side of the breast?
• Are the folds not at the same level?
• Are the nipples not at the same level?
• Is one side significantly larger than the other?

Although I mentioned these are all negatives, most of these occur in every woman to some degree or another. It’s just whether they’re going to be prominent enough that it’s going to make it difficult to get you a really nice, symmetrical result with a breast augmentation.

So I got off my planned discussion a little bit because I was going to talk about the operation first.

So I do a breast augmentation in the operating room. I do put you to sleep for it. I understand that some surgeons do not use general anesthesia and will do IV sedation and just local. I don’t feel like I can make you comfortable. If that is very important to you as a patient, then you’ll certainly need to seek out someone else.

I insert the breast implants through a small incision in your inframammary fold.

The length of that incision depends on what type of implant I’m putting in and how big. Some implants, especially saline, we put them in empty so they fold up and they can go in through a relatively small incision, a little bit over an inch and a half.

Other implants that are larger don’t fold very much and have to be put in through a larger incision. You just can’t physically put them into your body through a little one.

So let’s just say we’re doing an average incision. I would mark you before surgery. We’d go back to the operating room, you’d go off to sleep. I’ll make a small cut along your fold underneath of the breast, situated a little bit to the lateral aspect, and then go in through the skin. I’ll go right to the edge of the pectoral muscle.

We don’t normally do anything with the breast tissue. That way, we don’t create scars or problems or infections. And then at the edge of the pectoral muscle, I’m going to lift that up and separate the pec muscle from your underlying ribs. We’re creating a pocket or a space between the muscle and the ribs.

This is done with a long retractor, which it looks like a long spatula that has a light on the end of it. And I use a cautery. So as I go and I see little strips of muscle that go down to the ribs, I’m just going to cut them with a cautery. That way, there’s very little bleeding with this operation.

There are usually one or two blood vessels that come up from the rib to the muscle that will have to be cauterized. We don’t put clips on them, because if you think that through, you’d have a soft implant on top of a little piece of metal, and that would, of course, lead to rupture of the implant.

Where the blood vessels are it’s, very difficult to get a stitch around them. Occasionally, if there’s a big one, I may try and put a stitch around it. Usually we just cauterize them.

Once that space has been created, then I like to use sizers. Sizers are just empty implants that are sterile, and we put them inside you and either fill them up with saline or air to mimic the volume that I think you want.

And then I sit you up and I look at your breasts and say, “do they look good? Do they look pretty? Are they like the picture that you’ve chosen?”

The sizer bra, which is another podcast, is sterile and I will take the sizer bra and put that over your breast and say, “Is your breast implant and breast filling your size of bra the way that you want it to?”

If it is not, then we either go up or down on the size of the sizer inside your breast. Once I know the volume, then the sizer is removed.

Also, when I have the sizer in it lets me look at my two spaces I’ve created to make sure that I’ve got them as symmetrical as I can — that the width and the height are about the same, or I’ve compensated for any underlying asymmetries that you’ve presented me that I need to put the implant in a specific spot to try and make it not so noticeable.

Then the next part of the operation is sort of like Part Two.

We know that putting an implant in we need to try and not touch the skin so that no bacteria travel inside. So we want to keep it as sterile as possible.

So gloves are changed, we use clean instruments that haven’t been touched. The implant is opened and covered with antibiotic solution, and then the pocket inside under the muscles irrigated with both Betadine solution and antibiotic, because we know that will kill the maximum number of bacteria.

And then to insert the implant, I’m going to put another sterile, sticky piece over top of your incision and cut a little hole in it and, then I will put the implant in. If it’s saline, I fold it up like a little cigar and insert it. So of course, it doesn’t touch your skin at all. If it’s silicone, I push it in through the incision, trying not to touch any bare skin at all.

Once it’s in, if it’s saline it will be inflated; if it’s silicone, we just position it in the pocket where it needs to be; and then sit you back up and look and say, “Looks good.” Hopefully it looks good, because if it doesn’t, I would have to go to a different size implant, and that means I’ve opened an implant that then has to get tossed away, which becomes an expensive proposition for me. That’s why I use sizers.

Once we have the final implant and sit you up and look at everything, make sure that you’re all symmetrical, then you lay back down and I will sew you up with just a couple of layers of stitches, and then a little butterfly bandaid and a piece of tape.

Prior to putting the implant in and prior to doing the irrigation, I’ll also inject lots of long-acting numbing medicine in along the muscle where I cut it to provide, hopefully, good post-operative numbness for at least 8 to 12 hours.

When you’re sitting up, you look very good because you’re asleep and your muscle’s relaxed and, I know exactly what you’re going to look like. As soon as you wake up and that muscle goes, “oh, dear, what have you done to me?” it’s going to spasm down. And so it’s going to push hard against your implants and you’re going to look flat, and a little too high, not very close, and somewhat misshapen.

So the next morning, when I see you in the office, I’ll be kind of all happy, like, “don’t you look great” and you’re going to be looking at your breasts going, “I think you need your glasses because they don’t look so good to me.”

Over time that muscle will relax. The implants will settle a little bit, and usually within two to three weeks, you’re back to what I saw you looking like in the operating room when your muscle was relaxed.

After surgery, you’ll go to the recovery room for 30 to 45 minutes to an hour as you wake up. We hope very much that you don’t have nausea. We do have pain medicine for you. And I am doing a new protocol now called an ERAS, which is Extended Recovery After Surgery, where we use differing medications to help with nerve pain and muscle pain, with hopes that you won’t need as much of the narcotics.

As everybody knows, the opioid crisis is a real deal, and so we’re doing our part to try and cut down on how many narcotics we prescribe you. I’ve been doing this about nine or ten months now with this new protocol, and I think it is making a significant improvement in patients’ postoperative pain.

The way everybody looks when they come in the morning, how much pain and discomfort they’re in, is just hugely, hugely improved. Now, of course, it’s not going to work on everyone, but it’s something we’re going to continue to do.

After surgery it will take you, as I said, two to three weeks for the muscle to begin to stretch and accommodate. Usually by six weeks, you’re starting to look pretty good, although the breasts are a little stiff and by three to four months, pretty much that’s what you’ve got.

Over time, implants do settle. It’s mostly because of gravity, and the pocket — remember the pocket is a space inside under your muscle — will stretch a bit, and it almost always stretches towards the outside part of your ribs, because that’s where there’s no muscle and there’s very little breast.

Women will come in and say, “Well, my implants are sitting too far over.” It’s been ten years, and I will nod and say, “yes, you’re right. That’s just gravity and the weight of your implant.”

If you go with a very large implant, that progression of drooping to the side will only be magnified. So the smallest implant you can go into that will give you the size that you want is certainly the best for you long term. And of course, implants don’t last forever. So eventually you’ll need to have them replaced, or removed if you decide that you don’t want them anymore.

I would say breast augmentation is highly successful. It is not successful in women that are very droopy because they need to have a lift done and a lift creates scars on your breast. You can see our podcast about mastopexy.

So if you’re asking me to put an implant in and take up a large amount of skin that really ought to be cut out, it’s not possible. Some surgeons will say, “Well, we’ll just put a really big implant in and it’ll take all that skin up,” and it does… of course, you look really, really large and you’re going to droop really, really a lot because there’s a lot of weight for gravity to work on.

So those are things to think about and ponder before you make your decision.

I don’t ever use an armpit incision. I was never trained on it. I don’t use an incision around the areola.

Actually, both of the armpit and the areolar incisions have been shown to have a higher infection rate, so I don’t do that. I don’t like the aerola, also, because you have to cut through the breast tissue and that creates more numbness. I don’t generally put implants under the breasts because they’re going to sag more. They can interfere with mammography and your potential for numbness of breast skin and/or nipple in areola is higher.

If you have specific abnormalities of the breast, you may be a candidate for going underneath of the breast, because that’s the only way to correct those. And then, of course, that’s a whole another discussion.

So that’s what you’ve got for breast augmentation. Pretty straight and simple. And next podcast, we’re going to talk about the implants.

Thank you very much for listening to this. And for more information, please check out my Facebook page or my website, which is www.drkerner.com. That’s D-R-K-E-R-N-E-R.com.

I have lots of before and after augmentation pictures. We also have lots in the office that we can show you.

I also send out regular newsletters with updates about important information on ongoing skincare specials or specials for CoolSculpting, or important information, such as when advisories come out about breast implants and the lymphoma. That will also be another podcast because that is definitely about a 30 minute discussion.

Thank you very much for listening, and I hope to see you as a patient soon. Have a great day. And don’t forget to use your sunblock.”

“I’m Dr. Elizabeth Kerner, and welcome to Plain Talk About Plastic Surgery, your source for all information about plastic surgery procedures and operations from a real live plastic surgeon, who is me!

I have been in practice for 32 years and am here to give you honest, down to Earth advice. If you think of it, as if you had a sister who is a plastic surgeon, this is what she would be telling you about questions you might have about plastic surgery.

Today, we are going to discuss breast implants.

As probably everybody in the United States knows, the history of breast implants has had a circuitous and somewhat tormented course to bring us to today’s implants that are available and are considered safe, and are on the market. Not everyone agrees about the safety of silicone or saline breast implants, and I’m going to touch on what I know and then what my experience has shown me over the years.

I do not plan to talk about breast implant associated acute large cell lymphoma. That’s a huge topic and the data on this is changing almost on a daily basis. I hope in another couple of weeks, I can do a podcast and summarize where we are today, knowing full well that this is most likely going to change data-wise in another couple of months.

Today we’re just going to focus on how implants came to be and what they are like now.

Way back in 1961, two plastic surgeons at Baylor College of Medicine in Houston, Dr. Frank Giro and Dr. Thomas Cronin, were brainstorming how they could come up with an implant.

As legend would have it, Dr. Giro happened to be feeling a bag of blood and thought, “Oh, we could put it in a blood bag container”, and “what material could we use?” And they came up with silicone, and lo and behold, with the help of Dow Corning Corporation, they created the first silicone breast implant.

A very interesting tidbit is that I knew Dr. Giro when I was there at Baylor College of Medicine as a medical student. He was a professor of plastic surgery. Very nice man and very good surgeon, and I had him operate on my wrist to get rid of a ganglion cyst. So, I feel a little bit of a kinship.

And then the second interesting thing is Dr. Thomas Cronin, who was his co-partner and arguably, probably the more scientific of the two, is well known in the Texas Society of Plastic Surgery circles because of his contributions to medical science and getting the Texas Society of Plastic Surgeons up off the ground and going.

Every year, we have an annual meeting. The highest scientific award that is presented, which is now to the residents, because we have a huge number of residents that come in and give papers, is called the Cronin Award.

His son, Dr. Ernest Cronin, is a plastic surgeon in Houston at the University of Houston. He was president of the Texas Society of Plastic Surgeons a few years after I was. I was in 2000.

So all of this is just a tiny bit of tales and legends that I have grown up with, if you will.

Doctors Giro and Cronin created a little silicone implant, and they implanted it into a dog. I believe her name was Esmeralda. Esmeralda did really well with having the silicone implant in under her skin. There was no evidence of rejection, but she did decide to chew her stitches out, so they took the implant out. When they looked at the little pocket where the implant had been, they didn’t see any problems and concluded (with unfortunately, just a few weeks test in a dog) that silicone implants would probably be safe for women.

So they convinced a patient of theirs, in 1962, Timmie Jean Lindsey, who was a factory worker and a mother of six, who really came in to get a tattoo off and to get her ears pinned back, that she should be the first breast implant recipient.

Evidently, they pushed pretty hard, and what she really wanted was to get her ears pin back. And so she said, “sure, you can go ahead and put these implants in me.” There is an interview floating around the internet, if you look, with Timmie Jean, I think at the 50 year anniversary. She still has her original implants. I am sure they’re absolutely hard as rock, but she was pretty thrilled about it.

So then implants took off and there were multiple types of implants. The type of envelope that they were in, the silicone formula for the internal gel saline implants came around in about the late 1960s. But they seemed to have a lot problems originally with high leakage from the valve because you had to fill them in the operating room and they did slosh quite a bit.

There was an implant called the Ivalon sponge, which was like a big wad of polyurethane foam rubber that would be put in. I had the opportunity to take several of those out very early in my practice and they were absolutely awful. If you ever go online and you see pictures of implants that they swear have mold and cruddy things coming out of them, I think those were probably the very old Ivalon sponges.

In 1976, the FDA finally decided to regulate the safety of medical apparatuses, and silicone breast implants fell under that but were given a grandfather out because they’d been in use for about 15 years at that point.

In 1977, the first lawsuits started because of increasing firmness around the implants, because of rupture.

And go forward, go forward, go forward: 1988. Now the implants are a Class III category, which means they have to prove their safety. Plastic surgeons and implant manufacturers realized that they had exceedingly little data in terms of safety in the human female breast.

Of course, the flip side to that is they didn’t have data that it wasn’t safe. What we knew at the time and still continue to hold out, as I would say, probably the two most negative things about implants is that they will not last forever, and women may, and frequently do, develop hard scarring around the implant, what’s called a capsular contracture.

By 1990, when the episode with Connie Chung came out, then lawsuits were filed just all over the country; actually really probably all over the world, eventually leading to the collapse of Dow Corning, and many lawyers got very rich in this time.

Unfortunately, in the courts, what was being offered up as expert testimony is now widely considered to be junk science. Plaintiff’s attorneys would say just about anything, Dow Corning kept settling, settling, settling, and then eventually there was a large settlement and all of the Dow Corning implants went away.

Also at that time, an implant that was in significant use was called the polyurethane implant, or it was manufactured as Même or Replicon. I used this a lot. It had an external coating that was textured, and when you would put the implant in, the body would integrate into the shell of the implant.

So, we’ll go back just a little bit to anatomy. When an implant is placed into the breast, either under the breast or under the muscle, your body is going to make a little layer of scar tissue around it.

That’s called the capsule. Everybody makes a capsule. As long as you have a functioning immune system, you’re going to make a capsule.

What happens to many breast implants, though, is as they fail, the silicone will begin to leak through the outer envelope. It’s captured by the scar tissue around it. That sets up the body’s immune response, and now you start getting more and more firmness as the body sends more scar tissue in.

And the old implants that we would take out, because there were significant incidents of silicone leakage and rupture, the inside of the capsule (remember that’s the shell around the implant) would really look like the inside of a bad water pipe. It would just be plainly calcified.

And of course, if that started to develop and the implant hadn’t ruptured by the time your nice smooth implant is rubbing on this calcified shell internally, then of course it’s going to completely rupture or bust.

So around 1992 or 1993, silicone implants were only approved for use in women who needed reconstruction, which I always thought was rather oxymoronic.

Basically, you’re saying “if you’re a healthy woman, we don’t know if it’s safe enough for you to have, but if you’re a woman with breast cancer, well, what the heck? You’ve already got breast cancer. I guess you can get a silicone implant.” That just always absolutely rubbed me the wrong way.

But about 14 years later, manufacturers came up with enough safety data to satisfy the FDA that implants really are safe with the two known caveats: they don’t last forever, and women will develop capsular contracture around the implants.

So let’s talk about what implants are available right now. You still have silicone options and you have saline options.

I’m going to briefly discuss old silicone. So, generally a smooth outer envelope, and a liquidy silicone gel internally. The old polyurethane implants had a textured coating that would help to keep the implant in position and reduce the encapsulation. But that company went out of business because it turned out that they had falsified their data (another big black eye on the silicone industry).

But the remaining manufacturers realized that despite the fact that the data had been falsified showing the original safety, the track record of those implants showed that women did not develop nearly as much encapsulation around that texturization of the implant, the polyurethane foam. So they have tried to simulate that texturization on more current implants, and it really seemed to be working and became really quite popular, I would say, in the mid 2000s to do those.

But then along came the development of the acute large cell lymphoma in response to the textured portion of the implant. So now all texturization is pretty much gone. Mentor still has a textured implant, but I don’t think it’ll be on the market for terribly long.

Let’s go back to silicone. So right now, what we have are forms of cohesive silicone. The most formed is the fully form-stable cohesive gel, or what women and certainly the media’ called “the gummy bear”.

I don’t think it really feels quite so gummy-ish. It’s a little bit more like a softer foam rubber, if you will. And when you cut that implant, there is a solid gel that you cut through. It’s like a block of Jell-O with just a tiny bit of stickiness to it.

I have cut some in half and had them sit in a bag for a very long time, and there are not really any grease rings that occur on the paper towel like it used to be with the old implants, where the silicone was coming out. It doesn’t really even stick to your finger.

I have had the occasion to only take a few of these out. Very different removal than regular old silicone where the sticky gel was everywhere and you had to do a lot of removal of breast tissue and sometimes muscle just trying to get the silicone out. These implants really just sort of wipe out. I tell my patients it’s a lot like if you took unflavored gelatin and hydrated it. It’s that same consistency.

The negative to these is that in some women who are thin, they are I think just a little bit too formed, and a little bit too foam-rubbery, if you will.

But if you’re looking for an implant that has more shape and more projection and you feel like your breast is way too soft and you want it to be slightly firmer (though these aren’t going to be hard) then this would be a great implant.

They also have the old silicone gel type implants, but I don’t offer them because when they rupture, then you’re going to have to clean out all the silicone and that’s a mess.

And then the intermediate step is called a Soft Touch, which is like a soft brie, if you will. So it’s not fresh out of the refrigerator, which would be like the cohesive one, but has sat out on your counter for a little while. So that when you cut that, again, there’s no flowing, sticky gel. It doesn’t flow. It looks like the cohesive, but it’s just got a little bit more stick to your finger when you touch the gel.

I have had no patients with a ruptured implant of this type, so I unfortunately have no experience to tell you how hard it is to take out. But if someone doesn’t like the firmness of the fully cohesive, I think the Soft Touch is a good alternative.

So those are the two silicone implants that I offer in my office, and they both come from Allergan. I do like Allergan products better. There’s also Mentor and Sientra. I don’t use them, so I don’t really have any track record with them that I can tell you about safety or problems.

Saline implants use the same outer envelope as the silicone. So, shells are manufactured the same way, and then there’s a little valve, and in the operating room (with a little tube that’s connected to an IV) we can fill it with saline and put it into the body.

The nice thing about saline is you will be inflated until your implant fails. Unlike silicone where you could have a rupture, especially with the old ones, and you might not know.

With saline, if you get a hole in it, that salt water is coming out. It’s just salt water. There’s absolutely no risk to you, and you will physically deflate. It could take a couple of days, which is normal, or it could take a few weeks, but you’re going to go flat and pretty much anybody could look at it and know.

Because there’s no silicone to deal with, removal of a deflated saline implant is a little bit of a tire change. We just go in, take the one out, put a new one in, inflate it, sew you up, and you’re on your way.

Of course, all of this is done in the operating room under anesthesia for sterility because implant infections would be huge if we just did them in the office. But it’s way easier than the initial augmentation and of course, much less expensive.

Drawbacks of saline are: the regular saline is just a round bag of saline, so it tends to have more wrinkling and have a sloshy sensation to it. If you think about a waterbed from the 1970s, you’d sit on it and this big wave would go across the waterbed, and that’s why they weren’t very popular after a while.

Then the waterbed got baffled, so they put internal walling within it so that it’s still a waterbed, but because the water is contained in chambers, it feels more like a real mattress.

Well, Dr. Hamas here in Dallas did the same thing with the saline implant. He baffled with the implant. He put multiple shells within the outer shell so that the saline is contained within separate compartments.

When you feel it, there’s very little wrinkling and there’s no sloshing. I love the Ideal Implant because I think it’s got the safety of a regular saline implant… well, I don’t think I know it has the safety of a regular saline implant.

Again, when it fails, you’re going to deflate. Because there’s multiple compartment, you’re not going to go all the way down, but it’ll deflate enough to be able to tell. It’s just saltwater, so there’s no concern about silicone, and I think it feels very natural.

My patients that I’ve done the Soft Touch silicone, remember, that’s the intermediate soft brie one, versus the Ideal Implant, I have a really hard time telling which implant I’ve put in. I have put the Ideal Implant in very, very thin women and really haven’t had a wrinkle issue at all.

Both implants (both silicone and saline) can encapsulate, meaning the scar tissue around it can become firmer. Although with saline, the percentages are way less than they are with silicone.

Ideal Implant, if you go to their website, will list out percentages of encapsulation by year and whether it’s a primary augmentation or re-augmentation versus various silicone, and the numbers are pretty striking.

So that’s where we are right now. You’ve got in my office two types of silicone to use and one saline. I don’t offer the older saline because I think it’s too wrinkly and sloshy.

They are all safe. They will all eventually fail. So if you get an implant, you have to figure sometime in 15 to 25 years, your implant is going to fail. So you’re going to need to have another operation to remove it and either put a new one in or just take it out or do a lift; those would be all the options that you’d have.

You do have to have regular mammograms. Typically, if you listen to my breast augmentation podcast episode, I do put these underneath of the muscle, so mammography is not an issue with it.

Let me think, I can’t think of much else to tell you.

There are interesting articles out on the internet about the history of breast implants. If you’re quite interested in that, please go out and look at it. Remember, when you’re looking at data, you cannot compare the old implants to the new implants. The composition of the implant; the safety range or profile of the implant; encapsulation; and deflation or rupture; leakage are all completely different with these new fifth generation implants as they were with the old ones.

And to that I say, “That’s wonderful news! Thank you so much!” Because the old implants were not that great.

That’s it for today’s podcast all about the history of and currently available breast implants. You can find lots more information about this out on the internet. But again, please be careful what you’re looking at because the old implant styles and risks and complications are very different from the new ones.

We also have information on my website, www.drkerner.com, that’s d-r-k-e-r-n-e-r.com. And there are before and after pictures there as well.

If you are interested in implants, I encourage you to come in and let me discuss this with you in person. The topic of the history of breast implants and what they are like now is a bit more lengthy than what I’ve just done in this podcast. And I do have implants for you to feel and look at. I think that helps to explain the differences a bit more clearly when you actually have an implant that you could put in your hand.

Remember when you look on the internet, data from the ’70s and ’80s and ’90s really doesn’t apply to our new fifth generation implants.

Feel free to contact us if you would like to receive our newsletter where we have regular specials for skin care and Botox and fillers. And then, of course, there are other podcast episodes on the website.

I hope that you have enjoyed listening to this podcast all about breast implants.”

Introduction

“Welcome to Plain Talk About Plastic Surgery, a podcast that educates you about all things concerning plastic surgery procedures and operations, and other topics of relevance, with down to earth and honest information.

I’m your host Dr. Elizabeth Kerner.  The title of this episode is “How to Find a Sizer Bra for Your Breast Augmentation Procedure.”  Look for an upcoming episode on “How to Find a Sizer Bra if You’re Having Breast Reduction or a Mastopexy.”

So you might be wondering, “What is a Sizer Bra, and why are you doing a podcast on it?“

Well, a Sizer Bra is simply a normal bra of the cup size that you’d want to fit into comfortably after your operation. It’s a bra that you’ll buy from a local store such as Dillard’s, or Target, or Victoria’s Secret; and I’m going to go into detail about the type of bra that I’d like you to buy. I will then use this bra in surgery so that your breasts will fit comfortably into it so you get the size that you want, and I don’t make you either too large or too small.

I do find that lots of patients seem to be a bit confused about finding a sizer bra – how to find it, what we’re looking for – or they’ll bring in an inappropriate size. So today I’m going to talk to you about how to find a sizer bra and what to look for. But before that, I’d like to give you a little history about the brassiere.

The History of the Brassiere

In researching this subject, I found so many fascinating little tidbits that it’s hard not to try and share them.

So the first bikini-like garments that are noted for women to wear were in female athletes in the Minoan civilization about 14th century BC. That’s pretty amazing because you know that women have had breasts, and they’ve had breasts that have hung and been too large and been uncomfortable for probably since the first cave woman came around. But this is the first historical documentation of a brassiere type garment to help support the female breasts.

In the Western world, at about the 1400s on, women of means abandoned the loose tunics that everyone wore in those days for tighter fitting clothes. And this became the development of the corset, and the corset was used to shape the waist and also to restrain, or conceal, or significantly uplift the breasts.

At this time corsets were desirable to try and create a 17-inch waist. Who can possibly have a 17-inch waist? But there were many opponents of the corset back in the late 1880s and 1900s, including physicians, and of course women themselves. The corsets would lead to all sorts of health problems including respiratory issues, deformed ribs, digestive issues, bladder issues, fainting, lack of mobility.

But what the corset did was to reinforce the idea that women were the weaker sex. And of course they were; they couldn’t defend themselves and they couldn’t even undress themselves or dress themselves because of the corset.

The First Modern Bra

In response to this, slowly but steadily in Western Europe, women, dressmakers in particular, began to develop corset substitutes – something to control the breast appendages. In 1876, a dressmaker by the name of Olivia Flynt was given four patents for corsets that would support larger breasts. They were still corsets. It’s largely thought around 1890 that a woman in France invented the first modern bra. She had a lower corset for the waist, but had an upper bra-like design that had straps on it.

And then in 1910, a New York socialite decided she was going to a debutante ball, and she and her maid fashioned silk hankies and pink ribbons into a bra. This caught on hugely with her friends, and she began to create these early brassieres for her friends, and eventually had the first US patent for a backless bra. However, her husband, discouraged by the fact that she was working outside of the home, basically forced her to sell her patent, and she did to the Warner company. She sold it to them for $1,500 and it’s widely thought that they went on to make over $15,000,000 from this patent.

The Invention of Cup Sizes

They eventually popularized using elastic thread, and also were the very first company to create a system of cups, and this became the model for brassier sizing around the world. And this is important because I think before this, it was just basically a one size fits all. And now we have this cup system. This was quite uniform, really up into maybe the ’80s. And then manufacturers began going off of the accepted, “This an A cup, a B cup, a C cup, a D cup,” and now really, there’s almost no bra uniformity at all.

So when you go out to buy a Sizer Bra, you’re going to find pretty quickly it’s very difficult to compare a Maiden Form, with a Warner, with a Victoria’s Secret because a 36 C won’t be the same across all of the manufacturers.

Just a couple more interesting historical facts. In 1922 a Russian immigrant, Ida Rosenthal, began to design bras for all ages and shapes, taking the Warner concept of the cup, and she called it a ‘Maiden Form’ bra. And the reason she called it Maiden Form is that there was a competitor who had a bra called the ‘Boyish Form’, and this was a bra that flattened the breasts and she said, “I don’t think women want to have flatter breasts.” So hers was Maiden Form to create a more uplifted maiden-looking breast, if you will.

Girdle Burners

And then the last little interesting tidbit, in then late 1960s when the feminists were protesting the Miss America contest, everyone said they were burning their bras. In actuality, they might have thrown their bra into the what they called the Freedom Trash Can, but what they burnt were their girdles. And some pundits have said, if instead of being called bra burners, they were called girdle burners, then the women of the ’60s might have really been much more behind the feminist movement.

Oh, and I have one last little interesting tidbit. In 1977 the first sports bra was invented in, of all places, a costume shop at the University of Vermont theater. You can see it if you go they actually have a little museum and they have it sprayed with plastic so you can see the first one that was designed. And brassieres, and everything relating to brassieres, is now considered to be a $15 billion industry in the United States.
So that’s your little history of the bra.

How to Select a Sizer Bra

So when I ask you to get a Sizer Bra, what I need is a bra that you want to fit in after your surgery. And this is important because I can certainly use my own judgment and say, “Well, she looks like she’s a 36 C. Or this looks pretty.” But if you bring me a bra, and it’s the one that you want to fit in, I will do everything I can to make sure that, at the end, your breasts fit into that bra appropriately.

So to begin with, you need to go to the store and try on a bra. For a breast augmentation procedure you can probably use the same under-breast measurement bra that you’re using now.

The under-breast measurement is the circumference underneath of your breasts around your chest. So that would be taking a tape measure and just run it around your chest and seeing what it is, and those are numbers. So that would be 34, 36, 38, 40, etc.

The cup size is the actual fabric that your breasts sit into. And this is a letter A, B, C, D, Double D, Triple D.

How to Measure

There are all kinds of websites and YouTube videos that tell you how to measure yourself to find the most appropriate under-breast and cup size, and I’ve looked at all of them. I think that the easiest is putting a tape measure under the breasts and it says 34, 36 that’s probably about what you’re in.

So when you’re looking for a sizer bra and you’re going to have a breast augmentation, let’s say you’re currently in a 34. You’re probably going to still be in a 34 circumference or under breast band after surgery. So then you would go to the store try on a 34 bra – you already know that it’s going to fit so that you can hook it normally – and then look at the cups. All the manufacturers will have different cups.

Cup Size Inconsistency

In the old days, it used to be there was a standard cup for each under-breast circumference. But nowadays, each manufacturer decides how small or how large they want their cup to be. So 34 Cs across the different manufacturers will not all be the same. You need to go look at some bras, look at your 34 Cs and decide, “Oh, I like the 34 C in the Warner, or I like a 34 C in Victoria Secrets – something like that. Pick out a couple of bras, or maybe you look across manufacturers and find that there’s two or three that you really like.

You’ll find very quickly that between manufacturers there can be significant variation in a 34 C cup. So at home, you might want to take that bra, take some bags or baggies of rice and put them into the cup and put your T shirt on and see if that’s how you want to look.
It’s really just as simple as that.

Final Sizer Bra Tips

I would like a full coverage bra, meaning that it’s not a demi cup. So that way when we put it on your breast and you have the sizer in, it doesn’t look like you’re spilling out too much from the very first. So pick one bra or two, bring them back to me – don’t take the tags off – and we’ll check and if everything looks appropriate, we can use that.

Try and get bras that don’t have minimizer panels at the bottom because that will make you look a little flattened, and will also squish you more towards the middle. And choose bras that don’t have padding for uplifting.

Obviously something like a water bra, the Wonder Bra which is the water bra, wouldn’t really work. An underwire is perfectly okay, and hopefully it would be cheap because this is going to be sterilized and then eventually we’ll have to get it back to you, but I can’t guarantee that it’s going to be in the same pristine condition as you give it to me to begin with.

So bring that bra to me, I will look at it and if it’s appropriate we’ll use that in surgery. I’ll sterilize it and, as I’m putting that sizer implant in, I will put the bra over your breast and make sure that your breast’s filling up that cup.

I hope this has cleared up how to find a sizer bra. Again, don’t take the tags off, bring them in to me. If that’s what we need we’ll sterilize them and then we’ll give them back to you after surgery.

That’s all for this topic, “How to Find A Sizer Bra for Your Breast Augmentation Procedure.”

Have a great day and don’t forget to use your sunblock.”