5 Tips For Finding Your Best Breast Augmentation Surgeon

How to examine breast augmentation surgery before and after results like a plastic surgeon.

Unless you have done a lot of research, I think it is difficult for prospective patients to identify “good” surgical outcomes both in breast augmentation and other popular aesthetic plastic surgery procedures. We plastic surgeons can generally identify subtleties in technique with a trained eye, and I’d like to share some of my own techniques for critiquing patient before and after results of breast implant placement. I use some of my own before and after results to demonstrate these ideas.

Only consider board-certified plastic surgeons for breast augmentation.

There is a surprising amount of confusion as to what constitutes a plastic surgeon. Plastic surgery training is a grueling six years, requires certification by the American Board of Plastic Surgery, and is not the same as a cosmetic surgeon. If you visit the national organization for plastic surgeons, the American Society of Plastic Surgeons (ASPS), and their surgeon finder to search for your plastic surgeon, you will have taken one big step in the right direction. Please be skeptical of cosmetic surgery forums and other commercial websites. Many of these resources do not represent professional surgical organizations, may only identify paid listings ambiguously or not at all, and may advertise non-surgically trained physicians to perform plastic surgery procedures.

Tip: Ask if your surgeon is credentialed by a full hospital to perform breast augmentations should they wish to. A hospital will only allow those with the proper plastic surgical training for this operation.

1. The best outcomes involve round, symmetric breasts where both breasts and nipples are similar size and shape and similarly positioned.

This is the most fundamental aspect of a high-quality breast augmentation surgery outcome. The plastic surgeon should place breast implants in such a position as to create a round, left to right symmetric, natural-looking result. After surgery, the breast implants should not sit too low, often leading to the nipples pointing upward or “star-gazing”, or too high, which can cause an unnatural appearance to the upper pole of the breast.  Successfully achieving this aspect of breast augmentation is almost entirely due to the plastic surgeon’s particular technical surgical skill, and his/her ability to create the properly situated pocket inside the breast will determine how the breast implants ultimately sit once placed.

Tip: While somewhat subjective if the viewer is not surgically trained, I suggest examining the nipples in a surgeon’s breast augmentation before and after results to see if they appear to be in a natural position.

2. The plastic surgeon should achieve high-quality results for both large and small augmentations.

Many of my prospective patients come to their cosmetic surgery consultation wanting to discuss a few particular breast augmentation before and afters of mine that closely mimic the result they would like to achieve. These “goal” photos are very helpful and help guide my recommendations to the patient and how we decide together what surgical course of action to pursue. However, plastic surgery really is a made-to-order specialty, meaning that the most talented plastic surgeons are able to generate great results for the entire range of potential augmentation sizes and breast implant types. At left, you can see both a small augmentation I performed and a large one. In both cases, the breasts look natural and symmetric. As a side note, even if you do not wish to undergo a large augmentation, I find it helpful to ask a plastic surgeon their philosophy on large augmentations.

The most common reason for breast augmentation reoperation is to increase the size of one’s breast implants. In addition, some surgeons are heavily guided by their own aesthetic of “what looks good” and may be hesitant to listen fully to your desires. I have encountered prospective patients who would like a second breast augmentation, because another surgeon “didn’t listen to what [they] wanted” the

first time around. I suggest you find a plastic surgeon that melds with your communication style and whom you feel listens to what you would like to achieve.

Tip: Can you tell that the large augmentation of mine above is quite large? The breasts simply look enhanced but not overly artificial. Large augmentations, when performed well, do not appear overly exaggerated. Look for this effect.

3. The plastic surgeon should perform a body appropriate result for both patients with little breast tissue and those with significant breast tissue preoperatively.

Performing a breast augmentation for a patient with little breast tissue preoperatively versus for one who already has significant tissue is a significantly different operation. In the former case, it’s doubly important to position the implant properly and to select the appropriate breast implant profile, because there is little existing breast tissue to “hide” any mistakes. For a patient with significant preoperative tissue, as in the example at right, there are other challenges such as: correcting deficits in upper pole fullness as I did in this particular case and working with the existing tissue to correctly position the implant to avoid the issues I identified in item one.

Tip: There is a limited amount of correction possible using breast augmentation for a patient with wide-set cleavage. This width can be somewhat improved by placing the correct width breast implants, not volume but physical width against the chest wall. However, the surgeon should not make this issue worse. Look at before and after results to see that the surgeon avoids this.

4. The plastic surgeon should correct any preoperative left to right asymmetry and any vertical deficits.

Most women have some degree of size asymmetry naturally between their breasts. The plastic surgeon should be able to correct this with breast augmentation, using different size breast implants if needed. In addition, as in my example above where the patient had significant breast tissue preoperatively, I successfully corrected an upper pole fullness deficit in volume for her breasts.

Tip: Even after correction of aesthetic issues, all breasts have subtle natural differences in shape and position. A high-quality breast augmentation should result in breasts that still look like they belong to the owner!

5. Look at the plastic surgeon’s revision breast surgery work (correction of prior suboptimal results).

Revision breast surgery is significantly more complex from a surgical perspective than primary breast augmentation. Often scar tissue makes many traditional intraoperative techniques difficult. Looking at a surgeon’s revision work can be highly informative as to their level of technical skill. The patient at left had the “double bubble” effect where she exhibited sagging, or ptosis, over the top of the implant. She had previously undergone surgery outside the United States that had been poorly performed. I performed a breast lift in this case, which I successfully corrected her asymmetry while maintaining a round, natural-looking breast.

I hope this post is helpful in helping you identify surgical skill in breast augmentation! I once operated on a patient who had undergone five prior breast surgeries with which she was unhappy, so choose your breast augmentation surgeon carefully!

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