Most women have a good idea what is a nice looking breast and what size they would like to be. And what they don’t like. They may remember their breasts when they were younger or pregnant or have seen others with a similar build or appearance. Cup sizes are classified as A, B, C, D or DD, E and so on. These reflect a look as much as a size. I always ask my patients the look they want and then translate the look into a cup size and shape. The bra size number is just the chest size measured under the breasts and should be close to dress size.

Most surgeons speak in terms of volume but much more important are dimensions which take into account the desired cleavage width and the patients height and breast width. Height determines implant height. Together with breast width (and therefore implant width) as well as implant projection (reflecting desired cup size), these dimensions will give the volume of the most appropriate implant.

This depends on the look you want. Everyone is different. A fake look? A natural look? Has she/ hasn’t she? If natural, is it a natural rounded look or is it a teardrop look? This helps me decide on the type and shape of implant. Generally I prefer cohesive gel implants (rather than saline) because they feel the most natural, and a textured surface rather than a smooth surface because of its lower published capsular contracture rate (firm scar formation around the implant). Smooth implants have a place in certain situations but they need a larger pocket and regular massaging to stop them going hard.

This is a very important decision for the surgeon to make and often the most difficult. As always, there are pluses and minuses with either placement and often it’s a compromise. The main reason to use the subpectoral position is to avoid seeing the implant, especially the upper border and to avoid visible rippling or wrinkling of the implant. It is most useful in those with thin breast cover. It can also be useful in creating a natural look when using a round implant especially in the D to DD cup sizes where the risk is creating an unwanted fake look. If you have good breast cover and especially if your breast is a little droopy, but not enough to need breast uplift, then the better position is prepectoral, on top of the pectoral muscle behind the breast.

This I usually discuss with the patient. I’m happy with all approaches. Personally, I don’t like inserting the implant through the nipple, for a number of reasons. Apart from small risks to nipple survival and denervation, there are important risks from scarring. Usually scars heal very well in the areola (the darker or pinker area around the nipple). However there are two situations which worry me. One is trying to get a larger implant through a smaller areola and the risk of the incision tearing into breast skin with subsequent uncorrectable bad scarring and second is the risk of scar contracture deforming the shape of the nipple itself. For those reasons I recommend either under the breast or through the armpit.

It is not uncommon for breasts to be slightly different in size. However, this difference may be very obvious (difference of 2 to 3 cup sizes) in some, causing great embarrassment and low self-confidence. Breast asymmetry can be corrected with breast augmentation.

There are a number of options that may involve the use of different sized implants with or without nipple repositioning on one or both sides. Implants can be inserted into the smaller breast to match the other, or both breasts may be augmented (with different sized implants) to achieve symmetry. The options are discussed in detail before selecting the ideal technique or combination of procedures that will help you achieve your aesthetic goals. It may require more than one operation to get good symmetry. Although correction is possible, it is important to note that even after surgery, the breasts will most likely not be entirely identical. Naturally, no two breasts are identical, but I will make all efforts to ensure your breasts look as natural as possible.

Along with the correction of asymmetry, the procedure may also involve the correction of breast droop.

Breasts in young women are firm and taut, but with age, weight gain or breastfeeding, the skin and underlying supportive tissue start to stretch. This stretching causes the breasts to sag or droop. There are varying degrees of breast sagginess. Low grade drooping may be perfectly well treated with implants alone (usually teardrop) if the nipple is above the fold (under the breast). The implants can provide the required projection, nipple-areola rotation, fill and lift to achieve the desired youthful look. However, in some cases a full mastopexy may be required to tighten the loose skin and lift the nipples.

When it comes to breast reconstruction surgery, the most important thing to remember is to have realistic goals as to how you want your breasts to look after the procedure.