Bra Cup Size is a Made-up Number: How Breast Implant Sizing Really Works

Dr. G (00:00):
She left, didn't book with me because I said she needed a lift and then she came back a year later and was like, "I went to this guy." You're listening to another episode of All the B's with me, Dr. G, and my scrub tech, Bri. Cup size is a bra industry invention. It isn't standardized between two brands in your own closet and it isn't standardized amongst plastic surgeons. So we're going to talk a little bit about how to decide what size you want to be and how to talk about that with your plastic surgeon. Because when people say full C, for the longest time I wanted to have my license plate say full C MD because when prompted, everyone just wants to be a full C. It just means different things to different people. So we're going to try to talk through it so that you get the results you're hoping for and not somebody's idea of a full C.

Bri (01:01):
Yeah, I love it because patients will sometimes they want a full C and then they show you triple D boobs. Their wish picks and what they think they want are so different.

Dr. G (01:11):
Yeah. I mean, that's why I'm always like, "You have inspo pics? Let's see them." Once somebody showed me an inspo pic where that person doesn't have implants, you know what I mean? I'm just waiting for the day when someone says natural, small, and they show somebody with natural breasts.

Bri (01:30):
Yeah. I haven't seen that yet either.

Dr. G (01:32):
They always show these girls with these pretty large breasts, honestly.

Bri (01:39):
I feel like it's hard to get caught up on cup size.

Dr. G (01:43):
Yeah. We're going to break down cup size later, but let's talk about some news. Jason Kelce, are we still talking about this Kelce Taylor Swift situation? Is amazed that their wedding photos haven't leaked. It's remarkable.

Bri (01:58):
Yeah, truly.

Dr. G (02:00):
I know. They're getting the highest bitter for these photos, I'm guessing.

Bri (02:04):
You're telling me not a single person brought in a second camera.

Dr. G (02:08):
I know. I don't know how -

Bri (02:10):
Or any photographer didn't sell them off. I guess they would know, right?

Dr. G (02:13):
Yeah. They probably had to sign something that said, "Don't leak the photos." But for a thousand people, it is kind of remarkable that there were no violators.

Bri (02:23):
No like meta glasses?

Dr. G (02:29):
Yeah. I don't know. It's wild. And then we've found out that she wore Dior to the wedding styled by JW Anderson, who I love, but we haven't seen photos again. So I feel like it's kind of weird that we're just not going to do anything. And then when everyone. What are they waiting for? A slow news cycle? Now it seems so calculating.

Bri (02:55):
When is she going to release them?

Dr. G (02:56):
Because by now the photos are prepped, so let's move on.

Bri (03:00):
Yeah. It's weird that you do your wedding in the most public place possible with a thousand people, but then you don't want your photos. I don't know.

Dr. G (03:08):
Oh no, they're going to get released.

Bri (03:11):
Yeah.

Dr. G (03:12):
It's just going to be some giant spread in some magazine. I don't know. Oh, just a side note in celebrity news, my oldest daughter went to a Padres game yesterday and saw somebody from Love Island. I have to look.

Bri (03:27):
Oh, wait. My girlfriend also posted she got a picture with him.

Dr. G (03:32):
Cody question mark?

Bri (03:33):
Some guy.

Dr. G (03:35):
Caleb. Caleb from Love Island and Tara. And I have -

Bri (03:44):
Are they all from San Diego? Oh, who's that?

Dr. G (03:47):
No.

Bri (03:48):
I don't even watch Love Island. I would've not recognized him.

Dr. G (03:51):
Yeah, this dude.

Bri (03:54):
Oh, that's two.

Dr. G (03:56):
Oh yeah, that's him. Caleb.

Bri (03:58):
The whole crew was there.

Dr. G (03:59):
Yes, and Tara. Yeah. So I have a little picture where my daughter and her friend -

Bri (04:03):
Oh, that's cute.

Dr. G (04:05):
Leaned their heads in and took a picture.

Bri (04:07):
Aw.

Dr. G (04:08):
And then she said the lady sitting next to her was trying to tell her that her son's a ball boy and single and get their numbers.

Bri (04:16):
Wait, I love that.

Dr. G (04:17):
I was like, oh, did you say you used to know, one of the girls that used to work in this office, Malia was a ball girl. She freaking loves the Padres. People love the Padres. It was hot as hell yesterday. I can't imagine sitting out there for that.

Bri (04:31):
Yeah, in the sun, that sounds miserable.

Dr. G (04:33):
Yeah. She said it was a good time. Okay. So that's really D list celebrity news. But then speaking of Jill Zarin's daughter from Real Housewives of New York, York, Ally Shapiro reveals she got a boob job after a 50 pound GLP weight loss.

Bri (04:54):
Good for you, girlfriend.

Dr. G (04:55):
I feel like boob job is such a, what does that mean? To me, it should mean breast augmentation, but if you're having a 50 pound weight loss, then it 100% means you got to lift.

Bri (05:09):
Yeah.

Dr. G (05:10):
And then if your breasts are deflated, then maybe. Yeah. My sister and I, back in the day when we first moved to Southern California, we shortened boob job to bob. Look at bob. And whenever we saw somebody had a really obvious boob job, that was our secret nice bob. Did you see bob? Bob's here.

Bri (05:36):
That's so funny.

Dr. G (05:39):
But yeah, so I guess she referred to it also as a boob job and yeah, put them up and at them, which is common now after weight loss. I would say if you're going to do that, you really do need a good evaluation to assess what tissues you have left, whether or not you might need mesh, what kind of mastopexy. Unfortunately, people are like, "But I don't want the incisions from a breast lift, but it just really looks so much better if you do the lift, honestly."

Bri (06:09):
Yeah. I'm also surprised more people aren't getting just other skin excisions before getting a boob job if you lose that much weight.

Dr. G (06:17):
I know. It just depends on the person where they lose the weight.

Bri (06:23):
Yeah. I've seen some people who have lost the 50 pounds and I'm like, "I don't even see any loose skin on you."

Dr. G (06:29):
Oh yeah. It's so confused. I think if you lose the weight slowly and/or your skin's in good condition, then you tend to do better. But the older you are, the more sun damage you've had. If you've had big weight shifts in the past, all of that's going to contribute to loose skin moving forward. Okay. And then Kelly Ripa reveals the cosmetic procedure she got on her butt as a desperate measure, which I will have to say, I mean, I feel like I haven't tried it, but we did try it in this office. So she had somebody on the show that was talking about microneedling and she was like, "Oh, microneedling. Yeah, I had that. I had it done on my butt." And everyone was in shock and awe. Girl, no. I love that. If you want to try and tighten the skin, she's like, "I just wanted something." She said it didn't work though.

Bri (07:26):
Oh, really?

Dr. G (07:27):
But I feel like just straight microneedling is probably going to be mid. I mean, it's not going to not do anything, but it's not going to be dramatic enough.

Bri (07:38):
Do you think skin tight would give you better results?

Dr. G (07:41):
Maybe. I feel like skin tight, radiofrequency microneedling we know is helpful. That's probably your best bet or some skin tight because you need to get some heat in there. And then you can do biostimulators like Radius or Sculptra to stimulate collagen. But yeah, nothing's as tightening as skin excision, unfortunately. Rough crowd. And living somewhere where there's no gravity. But God bless her. I do remember we used to have this patient that would come in for a diamond glow to her booty. I love that. To get it all

Bri (08:15):
Exfoliated and shiny. I'm going to make sure you start giving me one. A weekly diamond glow on my butt to make sure that it is smooth and shiny. She's going to hate me.

Dr. G (08:26):
Yeah.

Bri (08:27):
Cynthia, stop showing up to work.

Dr. G (08:29):
I just feel like it's good. It's just most people don't have that. If you're going to invest money in something, you're going to go for your face first. But Kelly Ripa has disposable income and time, so why not? I would totally be down for that.

Bri (08:45):
And her face already looks perfect.

Dr. G (08:47):
Yeah. I feel like she talks about Botox a lot, about how she was getting Botox somewhere else and then maybe in her masseters or something. And then she finally was like, "Do you think I need some on my face?" And her plastic surgeon or whoever's her injector was like, "I thought you'd never ask." Wow, I love that. But she says she just does it around. She makes a lot of expressions. So I think she says something like she does it just around her crow's feet, which is fair because she needs to be able to move her face.

Bri (09:21):
Does she have a facelift?

Dr. G (09:24):
Not that she's copped to, but she looks good.

Bri (09:27):
The corners of her mouth and she's such a sharp little jawline.

Dr. G (09:31):
But she's always had such a sharp little jawline.

Bri (09:34):
Has she?

Dr. G (09:35):
Yeah. Jealous. She's tiny. And then I guess she also teased the idea. Kelly Ripa is all over the news. The idea of getting trendy new breast augmentation on show. I can only imagine that's Preserve.

Bri (09:52):
The ballerina boob job.

Dr. G (09:54):
Yeah.

Bri (09:54):
Got a little implant here.

Dr. G (09:57):
Did she talk to Terry Dubrow about it? Is that what happened? Peptides. Yeah.

Bri (10:04):
That's a two for one special.

Dr. G (10:06):
I know. Yeah. Of course she has a podcast, but yeah, anyway, I mean, she's the perfect candidate for a Preserve because she's teeny tiny. I guarantee she doesn't want to look like she just had giant boobs placed. And so it would be subtle. I mean, I would say why now? But J-Lo just showed up with some new boobs. Did you see those?

Bri (10:33):
Did she?

Dr. G (10:34):
Oh yeah.

Bri (10:34):
I didn't.

Dr. G (10:35):
They're legit.

Bri (10:36):
I'm surprised she didn't get that before.

Dr. G (10:39):
I know. What were you waiting for? But I think maybe they were waiting for a less recovery and something a little more subtle, but not J-Lo, but Kelly Rippa. But I don't think she'll do it. Why bother now, honestly?

Bri (10:53):
Maybe she's going through a rough patch. Oh, she got new boobies.

Dr. G (10:59):
She did not fuck around.

Bri (11:00):
Wow. They look good. Ben Affleck did her so dirty she had to get new tits.

Dr. G (11:06):
It's very controversial in my women's chat because people kind of hate them. I love them. But I was like, no, she's going for a look and she got it. Achieved the look. They're like, "There's not enough cleavage. There's not enough." I'm like, "Girl, she probably just got them done. She's not even waiting for the swelling to go down. She's like, look at my fun bags."

Bri (11:30):
I'm a little surprised that she doesn't have more cleavage with that type of dress because that dress just kind of

Dr. G (11:35):
Shoves it all together. Those are massive.

Bri (11:38):
Yeah. She looks great. I'm here for the big boobs. I don't think they're rumors. I think they're just there.

Dr. G (11:45):
Ignores rumor. I mean, I'm pretty sure that's just olive oil.

Bri (11:49):
Yeah. And horseback riding.

Dr. G (11:51):
And some PRP.

Bri (11:54):
No, they look good. She needed a little something.

Dr. G (11:58):
It definitely balances her out.

Bri (12:00):
Maybe Ben will come back.

Dr. G (12:02):
Ben will come back. I feel like she was seen with, oh, I never remember his name, but he's this comedian guy from Ted Lasso, blah, blah, blah. The guy -

Bri (12:13):
Really?

Dr. G (12:13):
Yeah, the foul mouthed guy.

Bri (12:15):
Stop it. Wait.

Dr. G (12:17):
There was a photo of her with him.

Bri (12:18):
The hot English guy?

Dr. G (12:20):
Yes.

Bri (12:21):
There's no way. Can we pull this up? If it's who I'm thinking of.

Dr. G (12:27):
It's the guy with the beard. He's dark beared.

Bri (12:29):
Is he monotone? Very just like -

Dr. G (12:31):
Yes. He's a comedian, actually. He does standup and stuff.

Bri (12:34):
Really?

Dr. G (12:35):
Yeah.

Bri (12:37):
They're going to work out. I already know.

Dr. G (12:39):
I mean, she doesn't make it work with anybody. She's got to be such a diva. I can't, but fair.

Bri (12:45):
He seems also like maybe it's just the show so miserable in life that he could just put up with it.

Dr. G (12:50):
Yeah.

Bri (12:50):
Yes. I love him.

Dr. G (12:52):
Such a little hottie.

Bri (12:54):
Wow.

Dr. G (12:55):
Yeah.

Bri (12:55):
No wonder she needed new boobs. She's like, "I got to keep this one."

Dr. G (12:59):
Hold on to him.

Bri (13:01):
Yeah.

Dr. G (13:01):
Okay. So do you think J-Lo got a full C? I bet that's what she asked for.

Bri (13:09):
I like a full C, please.

Dr. G (13:11):
Full C.

Bri (13:11):
But I need them up to my chin.

Dr. G (13:13):
I would say, what would you call those? Double Ds?

Bri (13:16):
I would say double Ds.

Dr. G (13:17):
Yeah. So let's break down cup size. First of all, it depends on what your bra bandwidth is. Whenever I ask, people are like, "Oh, I don't know. I just wear sports bras." Or they say, "I'm a C." I'm like, "That's actually not the number I care about. I need to know, are you a 32C? Are you a 34C? Are you a 36C?" All that math. The bra band size dictates the amount of volume you need to fill that out. So I'm a 34C. One of my kids is like a 30C, because if you're a 30, you don't need that much breast volume to fill out a C cup. And then God forbid you switch brands. So at Victoria's Secret, you're probably up a cup size. They like to size you up. So a 34C in normal land might be a 34D. Yeah. I mean, I do ask what your goal cup size is because it gives me a reference point.

(14:18):
And then I go with inspo picks and before and afters. People often will bring before and afters a breast dog to give me an idea. I do find that actually better though than I've had some patients who were like, "I want 160 cc breast implant or a 180 or whatever it is." And then they show me the patient after and I was like, "Okay, but she actually had breast tissue to start with."

Bri (14:47):
And then she has this in.

Dr. G (14:49):
Or she started with a lot more breast tissue than you did.

Bri (14:53):
We also had that one patient. She really wanted to. So my implants are 535 CCs. I had zero breast tissue. This girl was so caught up on the size of what my implants were versus. I was like, "You have probably already at least a B cup. So if you get five 35s, you're going to have enormous boobs. You already have a good solid, I don't know, what, 200 ccs or something of breast tissue." I had zero girlfriend.

Dr. G (15:22):
Yeah. We've had a fair amount of people who come in with -

Bri (15:25):
You can't judge that way.

Dr. G (15:26):
With a decent amount of breast tissue and then you don't need very much. So I always reach for. Well, we don't have it, but the basic bitch of breast implants is a 310 and this is very close. So I would say this implant, if you're a normal size person and you have some breast tissue, this is going to get you pretty good. If you're maybe a more narrow breasted. This is a SRM, so moderate profile 330, but I usually use the 310. It's an SRF. If you're a narrow chested person, this is pretty much the same volume, but it's a narrow base diameter. So it's for someone who's. If you're more narrow, you don't need the implant coming out here. And I'm not a small person or a petite person, but my base width, which is the width of my breast, isn't very wide. So I have high profile implants because to put 300 CC implants in with a moderate implant, it was going to be next to me. So I had to go for a high profile. But that's because we're not moving where your breasts are on your chest. So we do look at how wide your actual breast is. And like I said, even though I'm not bird-like or anything, my breast base width was pretty narrow.

(16:58):
I always say I have a whole area code in between my chest. They're just set a little bit farther apart, which means my implants are also going to set farther apart. And if I want cleavage, I'd have to wear a dress like J-Lo was wearing and shove them together. So I couldn't do a pretty wide, moderate profile implant. I had to do either a high profile or a lot smaller, like a 200, which is trending now. So the things we look at and consult base with how wide your breast is, how much space you have between your breasts, maybe your bra size, what your inspo picss are like, how much breast volume you're starting with. Yeah. All of that is relevant. And then what are some of the things you've seen help people when we're coming to sizing? Because despite telling people at their pre-op, sometimes people forget.

Bri (17:56):
Sizing's hard. We do do imaging, which you can kind of play with it a little bit. It's not so precise. I don't know how precise it is, but it kind of gives you a good idea of what this implant, you can make it look. Put in a 375 CC implant and see what you would look like with the amount of tissue and the measurements that you have specifically. But other than that, just we do imaging measurements, bring in your wish picks. Don't hone in too much about being a full C.

Dr. G (18:33):
We do have them. I try to get people to bring in a tight tank top or a bra and a tight t-shirt, a bra without padding. And then we'll put either actually these implants in or we have what I call the chicken cutlets, which are just kind of adding volume. They're a little bit more anatomic. The thing about those, that sizing kit and most sizing kits are in 50 cc increments. So 250, 300, 350. If you're trying to decide between 295 and 310, I feel like the sizing kit's not going to help. You can put these in. We can look at it. Right now we're using Crisalix, which is the 3D imaging that we like. You can look, but when you do a 295 and a 310, the difference is subtle, which is actually true. It's going to be subtle in real life. If that's where you're narrowed down to that -

Bri (19:28):
Do the 310.

Dr. G (19:29):
Then it's probably not going to matter which one you do. I do like the 3D imaging though, because sometimes people are all over the map. Either they have it in their head, they wanted a certain CC. And when I throw the 160 into their 3D rendering, they're like, "Oh, that's not how I thought it would look." And then we start inching up. A lot of my Preserve patients are like, "Oh, I want a 180. I really want small, natural." And then the next thing I know, we're pushing up to 265, which is the largest moderate profile implant you can do with a Preserve. And I'm like, Okay, most of these girlies are ending up at 245, 265. And I say, "Hey, if you want more than that, you can do that. You're just doing a traditional breast augmentation, which is no big deal. But Preserve is really for the smaller breast implants. And so if you're leaning towards 310, go for it, but just do a regular aug.

Bri (20:29):
Just do the three tens. Boob greed is a real thing. And then once the swelling goes down, you're like, oh, I kind of liked them bigger. But also with your wish picks, it's really good to find somebody that has the same body type that you have. If you're really broad shouldered and have a big ribcage, don't go find some petite ballerina and be like, oh, but I like her boobs because those may look great on her size body type, but not yours. So I think finding similar body types is also important.

Dr. G (20:56):
Yeah. I like the wish picks. It helps, but you need to look at people who look like you to start with. That's why we'll often do before and afters because I can say, hey, look, this person got three tens. She has some breast tissue. She was a mom. She's a little deflated. Didn't need a lift. That's what this looks like. This person wanted to stay small, but did 295, still looks good. Also, originally when we used the Vectra, because your arms are out, the imaging gave no cleavage. And you can see in the real life 2D photos, the implants will give you more cleavage than you had. They just might not be shoved together. So just depends. But you can see that on these photos. People who are pretty wide apart are still wide, but they have that perception of cleavage because you're rounding out that medial upper pole. Then let's talk about the actual choices. Saline, silicone, gummy. I mean -

Bri (21:56):
I think saline should just be out.

Dr. G (21:59):
Saline does not feel.

Bri (22:01):
It doesn't feel real. You kind of see the rippling. And I understand the theory that it's great that you know when it ruptures and your body just reabsorbs it. But implants these days are so well made. I agree. It's contained within a capsule for the most part. Just get the good feeling silicone ones.

Dr. G (22:21):
Yeah. If you're going to worry about rupture, even if it does rupture, the one where the silicone gets everywhere is the really old style implants and then people who just ignore it. So just don't ignore stuff.

Bri (22:33):
For 20 years and then freak out and are like, "Oh my God, it's ruptured." But they're so cohesive. They have videos I think of them running implants over with a truck and it comes up, but it just comes right back in.

Dr. G (22:46):
So yeah, I agree. Saline's not the best choice. I think the patients that do saline at this point just had saline in from when it was still a thing and are changing them out. And about half of them will switch to silicone and the other half are -

Bri (23:01):
It gives me mothers who won't get Botox, but want implants. But you know what I mean? It's like the gluten-free non - GMO of implants.

Dr. G (23:14):
Do the real thing?

Bri (23:14):
Do the real thing.

Dr. G (23:16):
Yeah.

Bri (23:16):
Yeah. Which is my personal opinion.

Dr. G (23:19):
Saline implants are fine for those who are. I'm okay if you already have saline implants in and now you need to exchange them and you just want to stay with what you know. Yeah. That's fine. But I'm telling you half those patients switch to silicone anyway. Yeah. And then gummy is just, it's a description of the cohesivity of the implant. All the implants now are gummy. It was a branding thing by Natrelle. They're all cohesive gel implants. They're all fifth or sixth generation gel. I would say Motiva, the only difference between their gummy and everybody else's is that they have a more en bloc. So the shell gel interface is tighter. So it's harder to pull away the shell of the implant from the underlying gel, which I like. They're also velvety, which is nanotexturing. Yeah.

(24:16):
So I do like that about them because I feel like it's less likely to rupture if you don't have any pain points. And they do have a very low rupture rate, but all the gels are cohesive gels now. So if you cut this implant and push on it, the gel squeezes out, but then comes back in. It's pretty elastic. I think most people will do a silicone implant. And then the profile is dependent again on your body shape. And I would say low profile are for people who want a very, very, very subtle flat. And moderate profile works for most people. And high profile works for those who want a lot of projection or have a very -

Bri (24:58):
Ultra high.

Dr. G (24:59):
Ugh. No. I don't like the ultra high. Is that what you have?

Bri (25:05):
Uh-huh.

Dr. G (25:05):
I don't like to put ultra high in because if it flips, it looks wonky. But I do think that comes from a time where we made the pocket, especially in dual plane, we used to make it a lot bigger than the implant.

Bri (25:21):
I think that's why it's in my armpit.

Dr. G (25:23):
Yeah. And now I feel like we all make a really tight pocket. And so the problem with the ultra high is if it flips upside down, then it looks a little weird.

Bri (25:35):
Yeah. I like the projection of mine.

Dr. G (25:38):
Yeah. Yeah. Well, because again, you're a small frame. So to get that kind of volume, you need to go to an ultra high.

Bri (25:44):
Yeah. But I do even then they're still, I have a lot of side boob, even though they're SRFs or whatever.

Dr. G (25:52):
Ultra up?

Bri (25:54):
Maybe ultra. Yeah, I have to look at my implant card.

Dr. G (25:57):
Maybe you just have full.

Bri (25:59):
They're ultra high something.

Dr. G (26:01):
Oh, okay.

Bri (26:02):
I know for a fact because I looked at my implant card six months ago. I found it. I thought I threw it away because I threw up all over it, but I got it.

Dr. G (26:10):
Oh, after surgery?

Bri (26:11):
Yeah, on the way home. I threw up in my going home bag. That's how I learned Oxy wasn't for me.

Dr. G (26:21):
Boo. Yeah. Okay. Yeah. So I think when people say they want a more natural or subtle look, then moderate profile or less is probably the way to go. A high profile or ultra high is going to give you definitely more projection. Round versus shaped, nobody's using. I mean, I never say nobody. Somebody's using shaped implants. But Allergan Shape, the 410s came off the market because of their association with breast implant associated lymphoma. And the other two companies, well, Mentor still has their shaped implants on the market, but no one's using them because of the bad press related to the ALCL. And I think most companies have different cohesivities of implants. So Motiva's done a really good job of branding this. So they have the ergonomics, which is a more soft and moves with you. And then the round, which is a more cohesive gel. And even with different projections, the ergonomic is going to be less projecting than a round when you stand up.

(27:30):
And so I always tell people, it's essentially teardrop when you stand up because a silicone's going to slide to the bottom. And that's -

Bri (27:39):
This one slides a little bit, this one does not. The round one does not.

Dr. G (27:42):
The round holds its upper pole. And so Natrelle does the same thing. They have cohesivity. They have this soft touch. This is a responsive, which is most like the ergonomic. And then you have the soft touch, which is middle of the road, and then the highly cohesive. And I feel like the highly cohesive I don't really use. I've had a few people ask for rounds in Motiva. The highly cohesive are pretty stiff. So it does get overwhelming with all these different choices. I feel like Natrelle has 70 different kinds. Once you take in all the sizes, all the profiles, all the cohesivities, they have a really extensive catalog. Mentor is the same way. They have different types of silicone. They have the overfilled silicone. It's wild. And then Motiva has a more narrow size catalog offering, but they have a lot more smaller sizes.

(28:40):
So it a little bit depends on what you're looking for. And I try to explain all these different choices as we're going along, but most people are looking for an ergonomic or soft implant moderate profile. That pretty much in the middle of the road.

Bri (29:01):
Nanotextured versus smooth?

Dr. G (29:05):
I think it probably doesn't matter, but don't quote me on that. I mean, the nanotexture is supposed to be very low inflammatory and help prevent CapCon. But I think I was thinking about this the other day. It was brilliant marketing because they did their studies and then they did post-market. And just like any implant company, they're not obligated to repeat those studies. And they showed a very, very low CapCon rate and a very low rupture rate. But now people are putting them. The low rupture rate, low CapCon rate was dissociated. Most of those implants were put in dual plane. Well, no one's doing that anymore. So it'd be like saying, oh, this is our rupture rate and our CapCon rate. And now people are doing a different style of breast augmentation. Let's say if everyone just started doing it through the nipple all of a sudden, or you're subglandular or you're not using a Keller funnel Or whatever it is, the implant isn't magic.

(30:04):
It has to do with the technique. So I think the CapCon rate is going to go up. You cannot say that you can't get CapCon with this implant. You can't say that you're not going to get malpositioned with this implant. The nanotexturing actually makes it slide around a little bit. So you want that tight pocket, which is fine because I think that's probably the best move for all implants at this point. But yeah, you don't have to redo the study so we can still quote those low rupture rates, but people are doing all kinds of wild shit and I know it's going to catch up to us.

Bri (30:39):
Yeah.

Dr. G (30:41):
So over the muscle versus under, again, I feel like a lot of these are trade-offs. So dual plane was the way to go for the longest time. The thought was that had a very low CapCon rate. Now because of all the other things we're doing during surgery, not doing it through the nipple areolar complex, using the Keller funnel, using phase one, Betadine pocket, blah, blah, blah. I think we're seeing more and more subfascial. And I think that's because the recovery is easier, faster. And then you don't have implant movement when you flex your pec muscles. You do lose support of the implant. So the pec muscle is kind of holding up that implant and it makes it a little bit easier to do a mammogram.

Bri (31:27):
And we do get a lot of questions from patients who are really big into working out. Is it better to have a under the muscle implant or a subfascial implant if you're like, do a lot of lifting?

Dr. G (31:38):
Yeah. No, you probably want to have it over the muscle. But then those same patients who are super athletic are usually really thin. And so, okay, so I just explained all that. Everybody's like, "Oh, okay. Well then why would I go under the muscle?" Well, if you go over the muscle, you're going to have more implant visibility, especially in the upper pole because the implant isn't covered by that extra layer of pec muscle. And so there can be more rippling, there can be more of a step off. So then people will do fat grafting or alloclae to kind of camouflage that, which is totally fine, but now you're adding all these elements to it. Some people argue that if you're going to go subglandular or subfascial, that you need to do mesh. It's been interesting to see all this evolve amongst those who are on the speaking circuit, if you will, because maybe three years ago, everyone was like subfascial, motiva implant, and a lot of people were putting mesh in their primary breast augmentations.

(32:41):
Well, now those same people are doing preserve. There's no way. So first of all, the argument was that subfascial was not the same as subglandular. You needed to be subfascial, period. And that was a big deal. And that also mesh was important. Then those same people are now doing preserve, which is a subglandular. So we're over the muscle, but also over the covering of the pec muscle, which is the fascia. And you can't do mesh in a preserve. It's a minimally invasive technique. You're not cutting. You're not really suturing too much. You're pushing the implant in through this tunnel. And then there's nowhere to put mesh. Now granted -

Bri (33:22):
Don't even ask.

Dr. G (33:26):
Don't even say the word mesh during the case. So now that's a primary aug where you're not doing mesh. So is the argument that the implant is much smaller? Probably. My point is that there's just so many variations and so many subtleties. And if there was a perfect way to do it for everyone, we would do that, but there's not. So it really is patient dependent, surgeon dependent, and it's a series of trade-offs. Do you want the implant under your muscle and it's going to move every time you do a pushup? No. Okay. But if you put the implant over the muscle, are you going to see it? Maybe. It's not like we're not going to know you have implants anyway. So what's the big deal? If it really bothers you and you're that thin, then we can put some fat or alloclae in. So if you're not going to be doing pushups and you are going with a larger size implant, then I would say go under the muscle. It'll support it.

Bri (34:21):
I can do about five girl pushups at this point.

Dr. G (34:25):
I mean, legitimately, I can still do pushups. So mine are under the muscle. It's just I wouldn't videotape my breasts while I was doing it, but it doesn't -

Bri (34:32):
Yeah. My breasts though, mine are under the muscle, irrelevant. They don't bother me at all when I'm working out or when I'm doing anything. And I've lift heavy and all that. I just actually can't do pushups. I'm just not good at it.

Dr. G (34:47):
Regardless.

Bri (34:47):
Yes.

Dr. G (34:48):
Yeah. But - I kind of hate pushups. But yeah, it doesn't bother me. I feel like now I might consider switching them out if I had to do it again. But also my peck and my upper chest is pretty thinned out. So I feel like you can still see my implant. So it's not really offering that much coverage. I don't know. When we had Kelly on, she had saline and silicone, both. She's had four breast surgeries, so she can compare and contrast. Love silicone. And she had them under the muscle and over the muscle, and she loves them over the muscle. And she has pretty large implants.

Bri (35:26):
Does she?

Dr. G (35:27):
Yeah.

Bri (35:27):
I just need a bunch of alloclae.

Dr. G (35:29):
Yeah. You probably would.

Bri (35:31):
Yeah.

Dr. G (35:32):
All right. So does implant choice change what the first two weeks feel like? No. Once they're in there, you're not going to know what's in there.

Bri (35:41):
No. Nope.

Dr. G (35:43):
Unless they're massive. If you put somebody I did do 770s and she was like, "It really hurts."

Bri (35:49):
I remember her.

Dr. G (35:51):
Yeah. Yes, girl.

Bri (35:52):
She was also very young. Very young.

Dr. G (35:56):
Okay. So let's see. Bri, what's the things patients most say often they wish they'd known before choosing implants?

Bri (36:04):
I feel like we give them the runaround. I feel like through the consultation process and the pre-op process and the emails we answer and the phone calls and their pre-op the day of surgery, there isn't really anything that people have come back and been like, "I wish I would've done this." The only thing I really generally think boob greed is a real thing because once the swelling goes down, they're like, "Oh, I liked him kind of perkier." Yeah, of course you did. But I think people are pretty well prepared. We go through the imaging, the sizing, we go through what they want. We go through post-op care. We go through what to expect. Since we've all had implants, it's also really nice because I generally relate all my experiences. So I give my feedback and my two cents.

Dr. G (36:50):
Yep.

Bri (36:50):
So I don't think there's a whole lot of things patients, at least not in this office that.

Dr. G (36:56):
No.

Bri (36:57):
There are so many questions. When I got my breast aug, I was so unprepared. I had zero questions asked. I met the doctor for about 30 seconds in between his cases. I worked with the MA the whole time. I didn't even have a post-op day one appointment. It took me two and a half weeks when I had a concern to get him after surgery to see him. They just don't see you.

Dr. G (37:20):
That reminds me of an attending I worked with who was like, "Don't schedule post-ops for my patients. They'll come if they need them."

Bri (37:26):
But they did make me sign a -

Dr. G (37:29):
NDA?

Bri (37:30):
NDA about you have to go through, there's no suing. And I had no idea. I thought this was standard practice. I didn't work in plastics at the time.

Dr. G (37:40):
Oh, Jesus.

Bri (37:40):
If we have a problem, we have to go through the practice. We cannot sue them. Which I think is so crazy now. Just now that I know better, I'm like all the things I wasn't prepared for, all the things that they didn't tell me. They were terrible with post-op care.

Dr. G (37:56):
The NDA thing hadn't come up until recently again, because somebody called -

Bri (38:00):
I need to see if I can find it. I hope I didn't throw it away. I think it's in my paperwork somewhere. I'm going to bring it in because -

Dr. G (38:05):
I've seen one before. I saw somebody who had had actually a relatively famous person in Miami had done her surgery and I think fat grafted her breasts. Had done a really good job with that, honestly. But where he had taken the lipo from, she had some pretty big contour deformities. And she starts telling me about the NDA she signed. And I was like, "Oh my God." But then somebody just recently who was booking a consult with me asked Ava about it. Am I going to have to sign an NDA? I don't want to have to sign an NDA. I'm not coming in if I don't. And poor Ava's like, "What are you talking?" She asked me and I'm like, "Oh, well, somebody in town must do it then." Well, besides -

Bri (38:47):
Also the same doctor that forgot to put fat in my girlfriend's butt for BBL.

Dr. G (38:52):
The guy's on drugs though.

Bri (38:53):
Did pass out from Ambien prior to surgery. Just things you don't know. He's not an actual board certified plastic surgeon. And I didn't think about that because I just went, my girlfriend got her boobs done there. And I was like, just word of mouth. I'm like, oh yeah, I'm going to go to the same place.

Dr. G (39:09):
Not board certified.

Bri (39:10):
Yeah. Also said I didn't need a lift.

Dr. G (39:11):
Not plastic surgeon. Yes, that's

Bri (39:13):
Which was terrible. I had to go back and didn't talk about anesthesia with me. It was just under twilight sedation. I had no idea. And I have a very. I don't know. There was just so many things I was so not prepared for. And then day before, they're like, "Oh, it's an extra thousand dollars cash if you want to go under general anesthesia." And I was like, "I don't know." I was so young at the time. I was like, "I can't afford that." And I already have such a hard time. Even my C-sections, my epidurals never work. Just things I was like, I wish I would've known more than a day prior to my procedure.

Dr. G (39:47):
That's crazy work.

Bri (39:48):
I know.

Dr. G (39:50):
No, I had somebody I saw who I said, listen, I can't do your breast augmentation without a lift. It's going to look terrible. I do have some people that come in and they already have their breasts in and they need a lift. I just saw somebody like that. I have a couple of those patients and I'm like, "You really need a lift if we're going to exchange these and they don't want them." I'm like, "Okay, well, it's going to look exactly the same. So you know what you're getting and they're fine with it. But if you need a lift coming in the door, I'm not going to do it because you don't know what that's going to look like." Anyway, she left, didn't book with me because I said she needed a lift. And then she came back a year later and was like, "I went to this guy, got the aug.

(40:30):
They tried to do a curcumareolar. It was bad." And I was like, "Oh, can you downsize?" They usually go up in size because they're trying to get away without doing a lift. That never works. Yeah. So you definitely need to have those conversations. And I think if somebody wants bigger than their tissue can safely carry, I mean, it's rare. The girl who did put 770s could handle it. It just also, she was very asymmetrical and I tried to get her to be symmetrical, but she did not want that.

Bri (41:02):
I remember that she wanted the same size implants even though she had two very different size breasts.

Dr. G (41:09):
But I did recently have someone who was very small framed wanted large implants. And I said, "We're maxing out here."

Bri (41:16):
They just come down.

Dr. G (41:18):
Yeah.

Bri (41:18):
Just bottoming out.

Dr. G (41:21):
And then what about how long they're going to last? I tell people 10 years is just 10 year data. So that 10 year gets thrown around. You do not have to have them exchanged at 10 years, but know that now you're starting to push the lifetime of your implants. You should be checking them. You should be getting either an MRI or a high resolution ultrasound, and you should just be prepared. You don't need to get them exchanged at 10 years, but you have to, if you're in your 20s when you get it done, understand you're going to have another surgery at some point. That I can guarantee. And what it's for, who knows? But you're going to need to save for that. So don't do that.

Bri (42:06):
No, no, no, no, no. Don't do that.

Dr. G (42:09):
We're having a nice day. Okay. Let's do this myth or reality because we just talked about the first one, which was they have to be replaced 10 years, false.

Bri (42:19):
Myth. You get to pick your cup size.

Dr. G (42:22):
Myth.

Bri (42:23):
Bigger implants always sag faster.

Dr. G (42:25):
That's true.

Bri (42:26):
But still get them. Under the muscle looks more natural on everyone.

Dr. G (42:30):
That is not true.

Bri (42:31):
Silicone is risky. Absolutely. I almost said a bad word. Not.

Dr. G (42:35):
Not, not, not, not. Silicone's fine. Calm down.

Bri (42:39):
Girl, get those 600 silicone implants. Don't let anyone tell you not to.

Dr. G (42:43):
Just put a little mesh in, maybe. All right, that's all the time we have today. So if you have questions, if you want the most extensive breast augmentation consultation you're going to find in San Diego, come see me because we do spend a lot of time talking about this stuff with our patients. And if you have questions in general, reach out. So we're going to scrub in.

Bri (43:02):
And scrubbing out.

Dr. G (43:06):
If you're listening today and have questions, need info about scheduling, financing, reviews, or photos, check out the show notes for links. Restore SD Plastic Surgery is located in La Jolla, California. To learn more about us, go to restorestplasticsurgery.com or follow us on Instagram @restoresdplasticsurgery. If you enjoyed this episode, please share it and subscribe to all the Bs on YouTube, Apple Podcasts, Spotify, or wherever you like to listen to podcasts.