The "pencil test"

[jennc]

Good afternoon Dr. Sorokin,

I was wondering what your opinion was on the "pencil test", where a breast is considered saggy if you are able to hold a pencil in your crease and have it stay once your hands are no longer supporting it.

I ask this because I had a breast augmentation in March 2008 (480cc saline, smooth/round, complete submuscular). My left breast dropped much quicker than my right, the implant is much more palpable, and rippling is very visible on the outside edge. In my opinion, it does not have a nice shape and does not sit high enough on my chest. I am able to hold a few pencils in my crease! LOL! My PS is 6 hours away and we have communicated through email, but through the pics I have sent him, he seems to see no problem. My right has never dropped completely, and all that he suggests is lowering that one to match the left. My suggestion of a lift was disregarded.

I visited another surgeon about 3 hours away, who suggested a full anchor lift on both of my breasts to get them how I'd prefer them. I'd just like to have a nice slope that doesn't start INCHES down from my armpit, and a roundness to the bottom of the breast, so I can go braless if I'd like without looking like I need support.

I have included a few photos if you wouldn't mind taking a look, as your opinion would be very much appreciated. Thanks for your time!

Before:



Around 1 year:



Right:



Left:

[DrSorokin]

Jennifer-
Thank you for writing. I would tell you that you have two issues here. The first one has to do with the rippling and palpability. This is a common problem with women who are on the thinner side especially with saline implants. I would believe that a switch to silicone would help (but not eliminate) this to a large degree. The question is how much this aspect of your result bothers you and if it does to a large degree, perhaps you consider an implant exchange. The next issue relates to the shape of your breasts and the pencil test. I think the pencil test only works to some degree. Just because you can hold pencils behind the base of the breast does not necessarily mean that you have a large amount of droop. The reason for your result is clear from your preoperative photos. You had nearly all of your breast tissue starting towards the base of your breasts to begin with. Your original nipple position was somewhat low and lateral on a longer torso. After an augmentation this tissue still exists in the same position and you will 100% of the time have a more natural appearing result. From your question I believe you are looking for a more "fake" appearing round breast result and thus you suggested a possible anchor lift. I do not believe this is a good idea. Your nipple position is already at the most projecting portion of the implant on the lateral view. So, what exactly would you have lifted? The entire breast and nipple? This will likely not make you happy in the long term. The position will settle down to almost exactly where it is in a year or two and then you will have significant additional scars. There are some women with natural appearing breast tissue to start with that will almost always have the result you have. I usually don't make such recommendations from a few photos but I would suggest leaving things alone for fear of making a good result worse. Sometimes the enemy of good is better.

[jennc]

Wow. Thank you so much for the response. It's a new angle for sure, and unfortunately, maybe something I was hoping not to hear. I'm not too thrilled with where the entire setup is on my chest, however, if that's just due to my longer torso, I'll have to live with it. The good thing about hearing all that though is that I'm not dropping 10k on a /redo with full anchor/pocket work, only to be disappointed with the results and them settling back down later on as you pointed out.

I have one more question for you if you don't mind though. Do you think I could improve the shape of my breast (in the side views you can see there is a lot of extra skin) by a more minor lift and possibly smaller implants? I understand I won't be able to get them as high as I'd hoped, but I'm not too thrilled with the shape, as they feel as if the implants are just swimming around in all the extra skin.

Thanks again for your time Dr. Sorokin. It's a wonderful thing for us gals with questions to be able to get a professional opinion here.

[DrSorokin]

The shape you do not like is caused by tissue excess towards the bottom of the breast and a vertical type (lollipop) mastopexy is the MOST I would suggest having to address it if anything. I think the anchor incision is far too much of a procedure for what you currently look like and would suggest against it. I reread my answer and if it was confusing, I apologize. Good luck!