Expert Doctor

Breast Augmentation in Thin, Athletic Women

Posted January 30, 2017
elite image

Karen Horton, MD

San Francisco, CA

Breast Augmentation in Thin, Athletic Women

Breast augmentation is a way of enlarging or changing the shape of the breast by using an implant. Although the implant shell is silicone, the implant is filled with saline or silicone. Saline is sterile salt water and silicone is a cohesive gel.

When it comes to implants, especially with thin athletic women, there can be some challenges in getting natural looking breasts. Women with small breasts often want fuller breasts that are more proportional to their body. However, a thin woman doesn't usually have very much padding. In this case, inserting large breast implants could cause the outline of the implant to become prevalent. In addition, ripples in the implant may be noticeable and could cause the breasts to look unnatural.

Many doctors will perform an intraoperative sizing during the surgery. This is where a temporary implant called a sizer is inserted into the breast. The doctor can inflate, deflate and perform volume changes in order to discover the best volume implant to achieve the patient's desired outcome.   



Breast implants must be chosen with a realistic size pertaining to a woman's lifestyle and proportion. Some people believe that a woman whose build is particularly thin is limited in receiving breast implants. However, that is not true. During the appointment, the physician will measure the base with the breast and help the patient find an implant size which is right for her.

It is important to remember that breast implant size is not necessarily about size but more about the desired look and proportion. Many physicians will recommend that a patient do an Internet search for nude breast images when considering breast augmentation. Create a file of "likes" and "dislikes" and then add the photos in the appropriate folder. It is recommended that a patient choose images of women with similar frames to their own body. These images will assist the patient in discovering what she really wants as well as giving the physician an idea of the desired look.

A woman with a small frame and small breasts may not have enough breast tissue to cover a very large implant. Therefore, some women opt to have an initial breast implant with the intent to further enlarge their breasts. They achieve this by having follow-up procedures in order to attain larger implants each time. The tissue which was not big enough to support the size they initially wanted becomes stretched. As a result, their tissue can become saggy and need further cosmetic surgery if they ever decide to have the oversized implants removed.

Other women decide to have fat grafting done in order to enlarge their breast area to accommodate a larger implant. In this instance, fat is sucked out of unwanted areas and injected into the breast area. However, only 30% of the fat cells survive. This leaves hard calcium deposits which can show up like cancerous cells on a mammogram. Fat grafting procedures can cause unnecessary biopsies and put women at risk for undetected breast cancer due to the belief that it is just another calcification from the fat grafting.   



One of the biggest risks of breast implants is capsular contracture. Capsular contracture is scarring around the implant and usually occurs due to an infected implant. Some studies have linked bacteria from an infection with capsular contracture. In order to prevent this from happening, it is important to maintain proper breast health. This means that anytime a patient is going to have their teeth cleaned or a facial procedure done, they need to take one dose of amoxicillin or other antibiotic. Furthermore, this includes any gut procedure or even a colonoscopy. Taking antibiotics prior to any procedure is a commitment for the duration of the implants.

Other risks involved with having breast implants include asymmetry and deformity. Many doctors place the implant behind the pectoralis muscle. However, this muscle is used when pushing or pulling anything with the arms. Therefore, the muscle is constantly being worked outwards and upwards which pushes the implants in those directions as well. Over time, the implants can migrate upwards and outwards leaving the breast tissue to eventually droop off of the implant.  



After the procedure, a patient can expect more pain and soreness if implants were placed below the muscle. Also, the recovery is much longer. A patient is not permitted to exercise for up to 3 months after the surgery. When the implant is placed on top of the muscle, there is less pain and narcotics are only needed for the first few days after the procedure. After the first few days, Tylenol can be used for discomfort. The patient is advised to take a week off of work for recovery. After 3 weeks of recovery, the patient can resume all activities including exercise. The swelling will last between 3 and 6 weeks and after 3 months a patient can see some of the final results. It can take a full year for all scars to mature and for the breasts to conclude their changes.   



The incision becomes a scar anywhere from 4 to 6 weeks after the procedure. It will appear pink and may become itchy as immature collagen is deposited to that area. With time, that collagen is replaced by a white collagen known as mature collagen. Whether the scar becomes lighter or darker depends on genetics. A patient can look at other scars on their body and get a relatively good idea of how their scar will look. In the meantime, scar therapy with a silicone based gel will begin around this time. The scar will most likely become unnoticeable with time especially since most breast implants are done by making an incision in the inframammary fold which is the natural fold located under the breast.



The best possible method is to make the incision in the inframammary fold. This is especially recommended for younger women and those who are planning to breastfeed. Most physicians do not make the incisions around the armpit or areola any longer since the incision may sever the sensory nerves which deliver sensation to the nipple or milk ducts. Even a careful surgeon might accidently cut a blood vessel leading to the nipple if they should choose to do the incision around the nipple or areola. Furthermore, more bacteria are located in those areas and the bacteria can contaminate the implant.



Each physician has their own technique. Some prefer one type of procedure over the other so it is a good idea to evaluate each type of procedure when determining the best option. A thin patient must realize that choosing the appropriate implant size for them is far more important than the average person with more weight on them. This is especially true if the implant is placed above the pectorial muscle instead of under it because, with less breast tissue, an implant may be more obvious to others.


Written by Cosmetic Town Editorial Team- SP

Based on an exclusive interview with Karen Horton, MD in San Francisco, CA

Article Last Updated on January 30, 2017