Breast augmentation is one of the most performed aesthetic operations—and still one of the most revised. This episode is a practical, surgeon-to-surgeon breakdown of how to drive reoperations down by treating planning as the operation.

We walk through a tissue-based philosophy: objective measurements (not cup-size promises), pocket selection that matches coverage needs, and operative decisions that prevent predictable failures like malposition, rippling, and capsular contracture.

Key takeaways (resident-focused):

• Reoperation rate is the scoreboard—plan backwards from the revision causes.

• Use objective sizing frameworks (e.g., High Five™ / TEPID) to reduce size-exchange revisions.

• Dual-plane logic: coverage where you need it, expansion where you want it—without iatrogenic damage.

• Rippling prevention is coverage math (pinch thickness rules matter).

• Capsular contracture: think contamination + biofilm risk; incision choice and technique aren’t “small details.”

• BIA-ALCL: know the textured implant association and the classic delayed seroma presentation.

Disclaimer: This content is for educational purposes only and is not medical advice.

Hashtags: #PlasticSurgery #BreastAugmentation #AestheticSurgery #PlasticsResidency #CapsularContracture #DualPlane #BIAALCL

Citations (AMA; numbered; alphabetical bibliography):

1. Tebbetts JB, Adams WP Jr. Five critical decisions in breast augmentation using five measurements in 5 minutes: the High Five decision support process. Plast Reconstr Surg. 2005;116(7):2005-2016. PMID: 16327616.

2. Tebbetts JB. A system for breast implant selection based on patient tissue characteristics and implant-soft tissue dynamics. Plast Reconstr Surg. 2002. PMID: 11964998.

3. Pajkos A, et al. Detection of subclinical infection in significant breast implant capsules. Plast Reconstr Surg. 2003. PMID: 12655204.

4. Li S, et al. Capsular contracture rate after breast augmentation with periareolar versus other incisions: a meta-analysis. Aesthetic Plast Surg. 2018. PMID: 28916908.

5. Sharma B, et al. Breast implant–associated anaplastic large cell lymphoma. Lancet Oncol. 2020. PMID: 32302264.

   
   

   6. U.S. Food & Drug Administration. FDA requests Allergan recall of BIOCELL textured breast implants (2019).

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