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High and Extra High Projection Implants: Happy Story with a Twist and Sad EndingThe plot: What you may think you want, and what you may get…It’s a simple story, but with a sad twist. Certain patients want more projecting breast–forward thrusting, perky, “lifted”, or even Dagmar-like (definition: missile or artillery shell-like, named after a famous cleavage, and used for the design of front bumper grill decorations in 50’s cars–find out more here: http://en.wikipedia.org/wiki/Dagmar_bumpers.) What patients want, surgeons historically provide. Simple demand and supply, but in this case, a story with a twist.The story begins something like this–patient wants, surgeon supplies, patient pays, patient has new breasts, patient is happy. Then the twist; the story doesn’t stop with “patient is happy”. Patient thought she knew what she wanted–she just never dreamed what she might get. Happy for a while, but then later…where did the projection go? “Perky? I don’t think so. Now they’re more like “rock in a sock?” “I nursed my first child; why can’t I nurse now?” And “why can I see the edges of my implant; why are these big ripples in my cleavage area; and why does my surgeon say these things can’t be corrected?” Like the movie Easy Rider (yes I know that dates me), a story with a great beginning, but with twists and a sad ending. High and extra high projection breast implants seem like a good idea for first-time breast augmentation patients who want them–until the story changes with a twist and sad ending. Can a high projecting implant create a high projecting breast that hits the aesthetic mark for what the patient wants? No question, and that’s why many surgeons implant them when patients ask. The problem is making choices without knowing the potential story endings.The more highly projecting (front-to-back dimension) of a breast implant, the harder the implant pushes on what’s in front of it–particularly breast tissue (the milk producing tissue that covers the implant and makes the breast feel like a breast) and the skin envelope (the skin that contains the implant and breast tissue, and supports the breast). What’s wrong with the story so far? Don’t we need a more projecting implant to push harder and create a more projecting breast? Yes, we do. Patient and surgeon have decided what they want, and they have selected the type of implant that will force the tissues to the desired result. But then comes the twist: forcing tissues to a desired result has consequences that patient and/or surgeon may not have considered when choosing an implant, changing a happy story to a sad ending.The twists and the sad ending are predictable. Excessive pressure from excessive implant size or projection compresses (squashes is a simpler term) the breast tissue against the overlying skin. Over time, two bad things happen. The breast tissue simply fades away or shrinks over time (medical term: parenchymal atrophy), and it’s gone–for good. No breast tissue, no milk, no nursing, and no coverage over the breast implant, so implant edges become visible. Excessive pressure from overly projecting implants overly stretches the skin of the lower breast. Like a blown bubble with chewing gum, as the bubble gets larger, it gets thinner. Larger bubble in the lower breast means emptying of the upper breast and a fuller lower breast–rock in a sock. Thinner bubble with less breast tissue covering the implant allows implant edges to become visible (yes, it’s ugly). As the weight of the implant pulls on the thin bubble (the skin evelope), the skin wrinkles and ripples in the areas where the skin is thinnest, often in the cleavage area where it’s most noticeable.Sad ending is, once the tissue is gone, it’s gone. Once the skin envelope is too thin–it’s forever. No surgical procedure can restore tissues irreversibly damaged by excessively projecting or excessively large imlants. What started out as a well-intended but poorly thought out story, often ends up as a sad ending with uncorrectable tissue deformities.Morals of the story? Decisions and choices without thorough knowledge can produce irreversible and uncorrectable deformities. Be certain that you balance what you think you want with what you are likely to get.You may know what you think you want, but you need to know what you may get before making a choice of implant projection and size. Keeping the happy story happy requires the right choices up front, because life (and breast augmentation) are about choices, and patients and surgeons are responsible for the choices they make. Avoiding the twist requires recognizing and avoiding choices that put a sad ending on a happy story. There is little or no place for highly projecting breast implants for primary (first time) augmentation if safety and preservation of patient tissues are priorities. Postscript: Breast reconstruction after mastectomy is very different compared to breast augmentation. The breast (or large portions of it) is gone. In carefully considered situations, more highly projecting implants sometimes have a place in breast reconstruction. Terrye Tebbetts

High and Extra High Projection Implants: Happy Story with a Twist and Sad EndingThe plot: What you may think you want, and what you may get…It’s a simple story, but with a sad twist. Certain patients want more projecting breast–forward thrusting, perky, “lifted”, or even Dagmar-like (definition: missile or artillery shell-like, named after a famous cleavage, and used for the design of front bumper grill decorations in 50’s cars–find out more here: http://en.wikipedia.org/wiki/Dagmar_bumpers.) What patients want, surgeons historically provide. Simple demand and supply, but in this case, a story with a twist.The story begins something like this–patient wants, surgeon supplies, patient pays, patient has new breasts, patient is happy. Then the twist; the story doesn’t stop with “patient is happy”. Patient thought she knew what she wanted–she just never dreamed what she might get. Happy for a while, but then later…where did the projection go? “Perky? I don’t think so. Now they’re more like “rock in a sock?” “I nursed my first child; why can’t I nurse now?” And “why can I see the edges of my implant; why are these big ripples in my cleavage area; and why does my surgeon say these things can’t be corrected?” Like the movie Easy Rider (yes I know that dates me), a story with a great beginning, but with twists and a sad ending. High and extra high projection breast implants seem like a good idea for first-time breast augmentation patients who want them–until the story changes with a twist and sad ending. Can a high projecting implant create a high projecting breast that hits the aesthetic mark for what the patient wants? No question, and that’s why many surgeons implant them when patients ask. The problem is making choices without knowing the potential story endings.The more highly projecting (front-to-back dimension) of a breast implant, the harder the implant pushes on what’s in front of it–particularly breast tissue (the milk producing tissue that covers the implant and makes the breast feel like a breast) and the skin envelope (the skin that contains the implant and breast tissue, and supports the breast). What’s wrong with the story so far? Don’t we need a more projecting implant to push harder and create a more projecting breast? Yes, we do. Patient and surgeon have decided what they want, and they have selected the type of implant that will force the tissues to the desired result. But then comes the twist: forcing tissues to a desired result has consequences that patient and/or surgeon may not have considered when choosing an implant, changing a happy story to a sad ending.The twists and the sad ending are predictable. Excessive pressure from excessive implant size or projection compresses (squashes is a simpler term) the breast tissue against the overlying skin. Over time, two bad things happen. The breast tissue simply fades away or shrinks over time (medical term: parenchymal atrophy), and it’s gone–for good. No breast tissue, no milk, no nursing, and no coverage over the breast implant, so implant edges become visible. Excessive pressure from overly projecting implants overly stretches the skin of the lower breast. Like a blown bubble with chewing gum, as the bubble gets larger, it gets thinner. Larger bubble in the lower breast means emptying of the upper breast and a fuller lower breast–rock in a sock. Thinner bubble with less breast tissue covering the implant allows implant edges to become visible (yes, it’s ugly). As the weight of the implant pulls on the thin bubble (the skin evelope), the skin wrinkles and ripples in the areas where the skin is thinnest, often in the cleavage area where it’s most noticeable.Sad ending is, once the tissue is gone, it’s gone. Once the skin envelope is too thin–it’s forever. No surgical procedure can restore tissues irreversibly damaged by excessively projecting or excessively large imlants. What started out as a well-intended but poorly thought out story, often ends up as a sad ending with uncorrectable tissue deformities.Morals of the story? Decisions and choices without thorough knowledge can produce irreversible and uncorrectable deformities. Be certain that you balance what you think you want with what you are likely to get.You may know what you think you want, but you need to know what you may get before making a choice of implant projection and size. Keeping the happy story happy requires the right choices up front, because life (and breast augmentation) are about choices, and patients and surgeons are responsible for the choices they make. Avoiding the twist requires recognizing and avoiding choices that put a sad ending on a happy story. There is little or no place for highly projecting breast implants for primary (first time) augmentation if safety and preservation of patient tissues are priorities. Postscript: Breast reconstruction after mastectomy is very different compared to breast augmentation. The breast (or large portions of it) is gone. In carefully considered situations, more highly projecting implants sometimes have a place in breast reconstruction. Terrye Tebbetts