A patient came to Southwest Plastic Surgery for a breast augmentation, between an A and a B and hoping for a full C or small D. One breast sat lower than the other, and her areolas were larger than she liked. The exchange below is nearly as it happened, identifiers removed.

The Visit

Dr. Agullo: So you’re thinking about a breast augmentation? And you’re right now between an A and a B and you want to be a full C small D?

Patient: I think I might, I like don’t know what it would look like on me, so I don’t know if I want bigger than that.

Dr. Agullo: “Yeah, we’re going to do that. I’ll take some measurements first and then we’ll go from there.”

Dr. Agullo: “Six and a half, six and a half, fifteen, and fifteen. So they are a little bit low, and this one’s a little bit lower. So the nipple is still above your fold, which is good. So if we wanted them to be a little bit more symmetric and perkier, we can do a donut lift at the same time, which is a circle around the areola, and with that I can bring them up about an inch so that then they’ll be more centered on the actual breast implant, and then they’ll be more symmetric, because this one’s a little bit saggier than the other one. And then we would go in through that same incision for the implants.”

The Diagnosis

Dr. Agullo: “I think you have a little bit of a tuberous breast, which is something you’re just born with where the gland is kind of more, instead of being spread out, it’s very concentrated. And then it creates a little bit of that areola stretching. And so the gland is kind of pushing through the areola. So when we make it smaller, we’ll fix that, and then also we’ll score the breast gland so it spreads out.”

The Sizes

Dr. Agullo: “We would do the donut lift, which is this one. That brings everything up. That makes it pretty even there. It makes the areolas a little bit smaller too. And then on top of that, we can add an implant. We’ll start with 300, and then you tell me.”

Patient: Can I see a little bigger? I was also going to ask about the internal mesh bra.

Dr. Agullo: “I do recommend it, because these implants you don’t have to change every ten years, like the old ones. So they’re going to be in there for a very long time, so we want that added support so that they don’t sag over time.”

Dr. Agullo: “So this is a demi, which is a moderate profile. Because of the width that you have, it fills it in. So this is the full. It just gives you a little more projection, but it doesn’t fill up as high. So that’s the difference between full and demi. I think they look very close, almost the same.”

Over the Muscle

Dr. Agullo: “Because you have the tuberous breast, we put it over the muscle because it fills in the breast better. And it expands that tissue. And then of course we’ll use the mesh underneath to give you the extra support.”

Patient: So it won’t be under the muscle?

Dr. Agullo: “Right. So the reason we used to put them all under the muscle was because we were using the older implants, and those had a very high capsular contracture. The problem is when you have them under the muscle, when you do exercise, they flex. So we call that animation. And then when you have them under the muscle, your muscle’s always pushing to the side. So they eventually go a little bit to the side, and you get a little bit more gap in the middle. So when we go over the muscle, you don’t get any animation, and we can get a closer cleavage, and it expands the breast a little bit better. And there’s also less pain.”

Patient: Does it look just as natural as under the muscle?

Dr. Agullo: “So the ones that you see that look like super round, those are usually saline implants. So this will look natural.”

Recovery Questions

Patient: When will I see my final results?

Dr. Agullo: “So final results is usually between three and six months.”

Patient: Will I get side boob with that?

Dr. Agullo: “Not a lot. It’s pretty much the way you saw it on the picture. Because we don’t really want to go past your width, because that’s when you start having problems.”

Patient: Where is the incision for the donut lift?

Dr. Agullo: “So it’s around the areola, right on the edge of the difference between the skin and the darker color. So it hides really well on that edge.”

Dr. Agullo: “So the most important thing is that two weeks you’re gonna feel great, and that’s when it’s easy for you to start doing a little more than you should, and that’s when you could get into trouble. If you stretch too much or you pull your hand back too much, you could bleed, and then you have a hematoma. So we don’t want lifting more than twenty pounds, no major stretching, no running, no jumping. So just, you know, easy mode. For the first month.”

The surgery takes about an hour and a half under general anesthesia and is outpatient. Recovery is five to seven days to easy activity and driving and four weeks to the gym, with a surgical bra for four weeks. Dr. Agullo injects Exparel between the ribs to numb the area for the first three days. Skin care after surgery can be arranged alongside a MedSpa visit.

Dr. Agullo is a double board-certified plastic surgeon, a Mayo Clinic fellowship alum, and a Clinical Associate Professor of plastic surgery at Texas Tech University Health Sciences Center.

Call the office at (915) 590-7900, text us at 1-866-814-0038, or book a consultation at drworldwide.com.

#StayBeautiful