Augmentation Consultation and Physical Exam

Prior to Your Consultation

Prior to your consultation we recommend you complile a list of questions to ask Joseph T Cruise, MD. Some of the common questions asked by patients are:

  • How many breast augmentations do you perform per year?
  • Do you recommend saline or silicone implants for me?
  • What are the incision options?
  • How do I determine what size and profile to choose?
  • Where do you place the implants?
  • What are the most common complications from breast augmentation?
  • When will the implants need to be replaced?
  • How long is recovery?
  • How many post-op visits will I have?
  • When can i resume driving?
  • When can I back to work?
  • When can I work out?
  • When can I resume sexual activity?
  • What surgery center do you use and is it accredited?
  • Is the anesthesiologist board-certified?
  • Will I need to purchase any special bras?


During Your Consultation

We have outlined below what you can expect from your breast augmentation consultation. Read carefully, as there are many suggestions that will save you time, clear up questions, and help you convey to Joseph T Cruise, MD what it is you want to accomplish. Depending on the results you want, the cost of your breast augmentation can vary, and your consultation is crucial to determining an exact cost for you.

Health History

All cosmetic surgery consultations begin with a thorough health history. This is especially true if general anesthesia is being used, but also applies to local anesthesia. Breast augmentations are usually done under general anesthesia. In rare instances when the implant is placed above the muscle,  local anesthesia can be utilized. Prior to meeting with Joseph T Cruise, MD you will be given a health history questionnaire to fill out in the waiting area. There are five areas of your health you will be asked about. Be sure to answer it with detail so that your surgery and anesthesia can be optimized for you.

General Health

General health problems are important to discuss so that your surgery is as safe as possible. Be sure to mention any chronic illness. Of particular concern are: high blood pressure, diabetes, heart problems, liver and kidney disease, stroke, cancer, bleeding problems, and wound healing problems.

What will Joseph T Cruise, MD do if I have medical problems?

In short, he will make sure your health is optimized as much as possible to ensure your safety. This may mean referring you to your private physician.

If you have a health problem you can often save yourself time by getting a letter from your private physician prior to your cosmetic consultation stating what the health problem is, how it is being treated, and whether or not you are able to tolerate general anesthesia safely.

If you are seeing any specialist (cardiologist, kidney doctor, psychiatrist, etc. ) be sure to bring a letter from them stating that you are able to tolerate surgery.

Past Surgical History

On your questionnaire you will be asked about previous surgeries. Be sure to identify any problems you may have had with anesthesia. Of particular concern are previous cosmetic surgeries especially if you do not like the result and are interested in revision. With breast augmentation it is especially important to mention all breast surgeries including breast biopsies.


Be sure to list all medications you take including aspirin and over-the-counter medications. These are important as they may increase bleeding and affect your surgery. It is extremely important to stop taking aspirin and aspirin containing products at least 10 days before surgery. Tylenol is a good alternative. Here is a partial list of aspirin containing products and other products to be avoided prior to surgery.

Allergies to Medications

Information about medications that cause allergies is very important so that these medications can be avoided. Of particular importance is the reaction you had, especially if you had trouble breathing. Be sure to include this information! Nausea is not an allergy but it is important to mention as well.

Smoking, Drinking and Drug Use

These three will certainly affect your surgery and MUST be mentioned so that your surgery can be optimized. Smoking causes a profound decrease in wound healing and will lead to worse scarring and a less favorable result. With large procedures such as a face lift, neck lift, tummy tuck, and breast lift smoking must be stopped at least 2-3 weeks before and after surgery. Otherwise, the results could be disastrous leading to non-healing wounds, poor scarring, and/or infection. With smaller procedures such as eyelid surgery, nose surgery, breast augmentation, and liposuction smoking will hurt the overall result but this may or may not be noticeable. In this case smoking cessation is strongly advised but is not mandatory.

Specific Breast Issues

During your consultation you must be very accurate with breast problems. Of particular concern is a history of breast masses and/or breast cancer. If you are over the age of 40, Joseph T Cruise, MD will require that you have a mammogram. Bring the results with you to your consultation so it can be documented. If you or a family member have a history of breast cancer then this age may be moved up to 35 or even 30. Breast augmentation has no effect on breast cancer. The only potential problem is mammogram screening. Mammograms are harder to read when there is an implant. This problem is minimized by taking special mammogram views called Eckland views. Eckland views show the breast tissue in multiple planes to see around the implant. It works very well but there still is a small (less than 10 per cent) amount of breast tissue that remains unseen. Mammograms work better when the implant is placed under the muscle. This allows better visualization.

Physical Exam

Height, Weight and Bra Size

Typically, your exam will begin with your height, weight, and bra size. You should be as accurate as possible. If you have been pregnant or have had a significant weight change be sure to let Joseph T Cruise, MD know.

Tell him what you would like to be. For example, I am a 34 A and would like to be a 34 full C. While cup sizes are highly variable depending on manufacturer, this still gives Joseph T Cruise, MD an idea of what you are looking for.

Once again, a picture of someone with breasts that you like is helpful. Be sure that this person has a similar body type as yours. Point out what you like about the picture, i.e. I like her size, I like her cleavage, I like her fullness up high, or her natural appearance, etc.


The second part of the exam involves evaluating the breasts for size, shape, and symmetry. It should be pointed out that all breasts are asymmetrical. Some are extremely asymmetrical while others have only minimal differences. These asymmetries will persist postoperatively.

Common causes of asymmetry include size differences, sagginess, nipple location, areola size and shape, scoliosis, chest wall asymmetries.

Palpation for masses

Typically, your plastic surgeon will perform a quick breast exam. Monthly, self exams are extremely important and are the best way to catch early cancers that are easily treatable.


Joseph T Cruise, MD will take measurements. This helps to objectively determine what would best obtain your goal.

Here are the most important measurements:

Distance from sternal notch to nipple.

This distance determines sagginess of the nipple. Normal distances are less than 21-22 cm. Over 22 cm usually means there is some component of sag. Minor sag can be corrected with augmentation but usually needs some type of breast lift in conjunction. See the section on Breast Lift for more information.

Distance from nipple to inframammary fold (IMF)

This distance determines if there is a bottoming-out of the breast. It increases as the breast tissue falls downward. Typical lengths are less than 8 cm in the ideal breast but may be more in large breasts and still be acceptable.

Relationship of nipple to IMF

This is, perhaps, the most important measurement. It determines whether the nipple is on top of the breast or has fallen. The ideal breast has a conical shape with the nipple on the top.

"Snoopy" deformity sometimes caused by poor breast implant placement

Notice how the nipple is well below Infra-Mammary Fold. In this case, augmentation without a breast lift will cause a Double-Bubble appearance.

The nipple should be at least 1 cm above the IMF. When the nipple falls below the IMF it should be lifted. Nipples that are at the same level as the IMF may, or may not be, corrected by augmentation alone. This must be determined by your plastic surgeon.

Width of breast

This measurement is important in determining the maximum size of an implant that will fit on the chest wall. This measurement can be anywhere from 11 cm to over 16 cm. If someone has a thin chest but desires a large augmentation she may need to use a high profile implant to accomplish this.

Gap between breasts

This is the distance between the breasts. Most people relate it to cleavage but cleavage also is dependent on breast size as well. Typical separation is about 3 cm. This distance can be made smaller by elevating the pectoralis major muscle along its medial border. Point this out to your plastic surgeon if this is important to you.

Areola size

The areola is the colored area around the nipple. It often enlarges after pregnancy as well as changes shape. Ideal areola size is subjective. Areola reduction is often done at the same time as breast lifting, but not routinely with breast augmentation. Reduction requires a scar that goes all the way around the margin of the areola.

Selecting Your A.S.S.E.T.S.

Everything mentioned in the physical exam outlined above will lead to selecting the proper implant type, size, profile, shape, etc. Joseph T Cruise, MD will provide his expert breast augmentation recommendations, but it is important for you to have a voice as well. Some of the decisions that will need to be made include:

  • Implant substance (saline or silicone)
  • Implant size (measured in cc's)
  • Implant shape (round or shaped)
  • Implant texture (smooth or textured)
  • Implant profile (low, moderate, high, ultra high)
  • Implant placement (above muscle, below muscle, sub-muscular)
  • Incision type (nipple, breast crease, arm pit, belly button)

More information about implant types and incisions can be found here: Types of Breast Implants Explained

Again, all of the decisions you will need to make will be done so with the guidance of Joseph T Cruise, MD and his qualified consultants.

If you are ready to move forward with scheduling your breast augmentation consultation with Joseph T Cruise, MD, please call our office at 949.446.1421 or visit our contact us page.