Reconciling Desires With Reality:
What Do I Want and What Will My Body Allow Me to Have?
“If you and your surgeon don’t recognize and acknowledge what your body tissues will allow you to have now and for the future, one or both of you may pay a penalty you don’t want to pay.”
One of the first and most important steps on the staircase is understanding the importance of reconciling desires with reality—reconciling your wishes with your tissues. what you want with what your body will allow you to have. It’s much easier to find a surgeon who will tell you he can produce what you want than to find a surgeon who knows and will tell you how what you want is likely to affect you now and in the future. The choices you make now may decisively influence your risks of having problems and reoperations in the future.
It is critically important that you understand not only what you want but also how what you want is likely to affect you and your breasts in the future. Wishes are fine, but good wishes come true only when you and your surgeon reconcile your wishes with what your tissues will realistically allow you to have.
Why Define What You Want, and How Definitive Should You Be?
Let’s start by assuming that you would like to have breasts that are beautiful or, at the least, better than they are now. But what is a “beautiful” breast? What is “better than they are now?” You probably have some feelings about the answers to these questions, but the feelings may be general and not well defined. That’s okay for starters. In fact, that’s probably a good start. Think first in generalizations, then focus and define your desires more clearly as you learn more. You don’t like what you have now, but how do you make a surgeon understand what you want?
The more clearly you define your expectations and the better you communicate your specific desires to your surgeon, the more likely you will achieve your goals.
Once You Have Defined It, Is It Achievable? at What Price?
Assume we have defined our goals and expectations in detail. Great! We know what we want, but getting it can be another matter. Reality sets in. Is it achievable? What are the costs? Will circumstances allow me to get what I want? These questions always require answers.
Let’s assume you would like to have beautiful, full C cup or small D cup breasts with a naturally sloping upper breast (they look like breasts, not volleyballs), a nice hang to the lower breast without sagging, and nipples that point slightly upward that will maintain that look as you grow older. But, you are forty years old, have never had children, have virtually no breast tissue (your chest is absolutely flat); you are a workout fanatic with almost no body fat; and you hate wearing bras. Can you get what you want? Will your body allow you to have what you want? Is it doable with current implant options and surgical techniques? No way, no how, not gonna happen. Your body is not going to allow you to have what you want, and if you push it, your body and you will pay the price! If you get implants large enough to produce the D cup you want, your tissues will change due to the weight, your already thin tissues will sag and thin more, and you are likely to see edges of the implant and see visible rippling as the implant pulls on the thin overlying tissues! Over time, excessively large implants or very highly projecting implants can cause your breast tissue to shrink away (atrophy) and can cause deformities of your ribs and chest wall beneath the implant.
In breast augmentation, one of the most difficult steps on the staircase is reconciling what bq. you want with what your body will allow you to have.
To make the right choices, you will need to understand more about your tissues.
Unfortunately, few surgeons and even fewer patients spend enough time with this step before doing an augmentation. A skilled, experienced surgeon can deliver almost anything you can dream up. With today’s surgical techniques and implant options, you can create almost any size breast. What can be unfortunate is the price you may pay, now or later.
You come with only one set of tissues, you can’t change those tissues for the better, and you can’t replace those tissues.
If you choose options that exceed what your tissues can tolerate, sooner or later you are likely to pay with visible edges, loss of breast tissue, visible rippling, or other uncorrectable deformities.
Many patients never know before their augmentation what price they may pay years later if they don’t recognize and respect what their tissues will allow them to have.
A classic example? Too large an implant with thin overlying tissues, excess tissue stretch, excess tissue thinning, shrinkage of your breast tissue, further aging and thinning of tissues, visible implant edges, and visible rippling from implants pulling on thin overlying tissues. Maybe even operations to try to correct rippling or visible edges that usually can’t be corrected because no surgeon can change the qualities of tissues that have been compromised by excessively large implants.
Another classic example? An excessively highly projecting implant that is trying to force tight tissues to create a more projecting breast. The price over time is loss of breast tissue (atrophy) and possible rib and chest wall deformities, both uncorrectable deformities.
Unless you like problems, more surgeries, more costs, and more disappointments, you don’t want to ignore what your tissues will allow you to have.
Is there any excuse for not knowing and not respecting your tissues? Maybe not good excuses, but there may be some mitigating circumstances. Some surgeons, especially early in their careers, have not followed enough patients long enough to fully appreciate what happens to tissues over time and how implant options can affect the equation. Happy augmentation patients often do not return for long-term, follow-up appointments, so the surgeon can’t learn from what the surgeon doesn’t see. The last thing that many younger patients want to think about is getting older (to be honest, even I don’t like thinking about it, and I am older). But you will get older. Your tissues will change and not for the better (visualize your grandmother’s breasts). How your implant affects those tissues can change over time. If you make good team decisions now, you have a much better chance of having nice grandmother breasts in the future.