Published November 6, 2008 By Adam Lowenstein

It seems that more and more and more surgeons are performing breast augmentation in the same techniques that Dr. Sheffield and I have been proponents of for quite some time. The dual plane breast augmentation seems to be gaining favor by many plastic surgeons around the country. On of the most respected breast surgeons in the world, Dr. Dennis Hammond, is a friend who has been kind enough to participate on my panel at the ASPS meeting for two years running. He and I additionally share responsibility for much of the educational program at the ASPS meeting pertaining to surgery of the breast, and I have the highest opinion of Dennis as a great, thoughtful surgeon and educator. He is also a proponent of the dual plane approach for many patients, and like me, believes in an individualistic approach to breast augmentation and breast lifts. Breast implants should be chosen on the basis of individual patient anatomy, including length and width of the chest wall and torso, as well as specific patient expectations.

I was somewhat surprised to find that utilizing breast implant sizers in the pre-operative visit (as I do) is not a practice often performed by many surgeons. Several well-known surgeons presented this as an approach that helps tremendously with postoperative patient satisfaction. I have been a proponent of using pre-operative sizers for many years, and I agree that it allows improved visualization of an anticipated outcome by the patient. One way that I seem to differ with some surgeons is in the intra-operative management of the breast implant choice. Some surgeons have their patients choose specific implants and then use that specific size during the subsequent breast augmentation procedure no matter what it looks like. While I will proceed in that fashion if the patient desires, I prefer to evaluate your shape with the use of the breast implant sizers, to get a sense of your postoperative expectations. Sizers utilized over the skin of the breast, however, do not lie in the same anatomical fashion as they do in the breast augmentation pocket. I therefore use intra-operative breast implant sizers as well, evaluating the expected form before choosing the final breast implant to use. If you wish to choose the exact breast implant for me to use- that’s fine. I find, however, that most patients prefer to allow me to utilize my judgment in the operating room to achieve their optimal breast augmentation form. I think the use of sizers before the operation is a great way to allow you to guide me toward your postoperative goals, and the use of sterile sizers during the operation allows me to more accurately provide you with just the right breast implant for just the right breast augmentation.

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