Breast Augmentation FAQ
Breast Augmentation is the most common surgical procedure performed by cosmetic surgeons. Currently there are two primary implant companies based in the – U.S., Mentor and Allergan. Both companies produce implants with a silicone shell. These implants are filled with either saline (salt water) at the time of surgery or are pre-filled with silicone. Just as there is a tremendous amount of variability in the size and shape of women’s breasts, there are multiple options that must be considered when having a breast augmentation. The primary issues when having a breast augmentation are the following: shape of implant, size of implant, location of implant placement, access incision, type (Mentor vs. Allergan), and whether the implants are smooth or textured.
Who is the ideal candidate for breast augmentation?
Women who would like to enlarge their breasts to improve the overall balance and proportions of their body. Women may wish to “fill out” their clothes better. Commonly, women may feel that their breast have gotten smaller after pregnancy and would like to return to their pre-pregnancy size. Finally, some women are very asymmetric in size and would like to be more even.
Who is not a candidate for breast augmentation?
Women within three months of pregnancy or breast feeding, women in poor physical and emotional health and those with unrealistic expectations about what can be achieved with breast augmentation.
Who are poor candidates for breast augmentation surgery?
Women with a personal or family history of breast cancer should be discouraged from breast augmentation surgery. Also, the fact that there is a small but real chance of losing some or all nipple sensitivity or ability to breast-feed needs to be considered carefully. Finally women who have sagging breast (ptosis) will not be well served by breast augmentation and will need a breast lift (mastopexy).
Are breast implants safe?
No other medical device has been studied to the extent that breast implants have. The FDA has determined breast implants to be safe after studying over 10,000 women with implants.
What is the best breast implant size for me?
Every patient who is considering breast augmentation is naturally concerned about choosing the right size implant. Most are very concerned with overdoing it and having that ‘Dolly Parton’ look. The key to picking the right implant size is to understand the patient’s desires and to appreciate the body’s proportions and unique tissue characteristics. This requires a surgeon that is both a talented clinician and a skilled observer. There is also an element of ‘art’ involved with implant selection. We conduct several measurements of different landmarks on your chest to determine the best size that fits your frame. We also evaluate the quality of your breast tissues to determine what size and type of implant is best for you.
Most women choose implants between 250 cc and 675 cc. The largest implant available in the United States is 800 cc. The average implant size in Texas is 425cc while the average size in Rio de Janeiro is 125cc!
Should I choose silicone or saline breast implants?
There is no difference in how the implants look once in the body. I use both types and the distribution is about 65% silicone and 35% saline. The main differences are:
Cost: Silicone implants cost $1000 more per pair than saline. The increased cost is due to the cost of the studies over the last 15 years to demonstrate their safety.
Incision Size: The incision, regardless of location is usually 3.5-4.5 centimeters long. The incisions usually heal very nicely and may be difficult to detect after 6 months. Saline implants are placed uninflated through a small incision and then filled with saline once they are in place. Silicone implants are prefilled and requiring larger incision for placement.
Feel: No matter which implant you choose you will always be able to feel it regardless of the type. Saline implants do not feel quite as natural as silicone implants. Silicone implants tend to feel more like breast tissue. However, if you have adequate breast tissue to cover the implants, you are a candidate for either saline or silicone. If you are thin with minimal breast tissue, silicone may be a better choice.
Knowing if it is leaking: If a saline implant ruptures you will know it almost immediately. Saline leaves the implant and is absorbed by the body causing no harm. Most silicone implant ruptures are initially undetected. This is because the silicone is contained by the capsule the body forms around the implant.
The only real way to tell will be through imaging studies such as an MRI. Studies show that leaking silicone poses no risk.
What is the difference between a smooth and textured breast implant?
Implants may be smooth or have a textured surface. The textured implant surface feels almost like sandpaper. The textured surface has been shown to decrease capsular contracture. In addition, it minimizes the amount of movement of the implant. This is a particular advantage if one is having implants replaced. One disadvantage of texturing is an increased incidence of wrinkling of the implants and a slightly higher deflation rate. The textured surface is not palpable through the skin.
Should I go above the muscle or below?
Implants may be placed in one of two locations. They may be placed above the pectoralis muscle, deep to the breast tissue (“subglandular”) or under the pectoralis muscle just above the chest wall/ribs (“subpectoral”). Women who have a moderate amount of breast tissue are candidates for a subglandular placement. The majority of women, however, do not have sufficient breast tissue and are better off with a subpectorally placed implant. In order to place the implant deep to the muscle, the lower portion of the muscle is sometimes partially cut during surgery. The advantages of a subpectorally placed implant are a decreased rate of capsular contracture and a decreased incidence of implant wrinkling. In addition, less breast tissue is obscured on a mammogram.
How long does breast augmentation surgery take?
Surgery generally takes anywhere from 60 to 75 min. to perform.
What type of anesthesia is used for breast augmentation surgery?
Many surgeons, especially older school surgeons, use general anesthesia. We have found that this is overkill and places patients at unnecessary risk. Surgeons who are skilled in the newer techniques of administering expert local anesthesia with monitored IV sedation usually have a happier postoperative patient. IV sedation and local anesthesia is less of the stress on your physiology and recovery is much quicker and smoother – not to mention much safer!
Where is the incision made for breast implant surgery?
There are generally three different incisions which can be made for placement of a breast implant. The three options are 1) below the breast in the fold (“inframammary”); 2) around the lower half of the areola (“periareolar”); 3) In the armpit (“transaxillary”). Some patients may be better candidates for using one incision over the other but most patients are good candidates for at least two if not all three of the incisions. The patient should decide where they would prefer to have their scar. The good news is that in the vast majority of cases the scars heal well and eventually, will be minimally noticeable. The most common incision used is the inframammary. With the patient sitting straight up or standing, the scar is often not visible as it is blocked from view by the breast. It is more noticeable when the patient lies down. The periareolar scar, if placed correctly, heals very nicely and is often difficult to find even by a trained eye! In order to use this incision the areola has to be a minimum size (Usually 3.4-4.0 centimeters across). The transaxillary approach has become more popular with the introduction of endoscopic surgery. The disadvantages to this access site are that for women who enjoy wearing sleeveless shirts during exercise (ie, during aerobics, lifting weights, etc) or bathing suits during the warm months, the scar will be noticeable initially when they raise their arms. Finally, all patients must realize that if their breast implants need to be removed for capsular contracture in the future, most surgeons will do this through an inframammary incision as this is the best way to remove the capsule that has formed around the implant. If their original implants were placed through a different incision, they will now have scars in two locations.
What happens after surgery?
Bandages will be placed and your chest will be wrapped in an ace bandage. You will recover for 1 to 2 hours in the recovery room. You will then be driven home by a friend or family member. Your activities will be limited for the first few days. It is advisable that you not drive for at least 3 to 5 days after surgery. As the pain and swelling decreases you will be able to resume normal activities. Dr Wigoda will allow you to resume strenuous exercise with your arms after 4 to 6 weeks. You may be able to resume exercise with your legs (walking, jogging, bicycling, etc) slightly sooner.
What is the recovery time following breast augmentation?
By using a gentle and meticulous technique most ladies can return to normal daily activities 48 – 72 hours after surgery. On average, most patients use pain medication for only two days following this procedure. Patients need to avoid heavy lifting or intense exercise for approximately 4 weeks after surgery to allow the chest muscles to heal.
How much bruising, swelling, and pain is there?
After surgery, it is expected that the breasts will have a moderate amount of swelling. Most of the swelling will resolve over 2 to 4 weeks. The breasts will appear slightly larger than they will ultimately be because of this swelling. Both breasts may have some bruising although it is generally mild and resolves over 1 to 2 weeks. The amount of pain post-operatively is very patient dependent. Some patients will experience mild discomfort, particularly with raising the arms and with increased activity. It is unusual to have significant pain. The vast majority of patients report the pain as tolerable. Some patients have reported difficulty getting comfortable when going to sleep for the first 1 to 2 weeks. Patients may also experience hypersensitivity of their nipples. For the most part, all of the pain and discomfort resolves completely with time, generally 2 to 4 weeks.
Will I have drains after breast augmentation?
Do you use pain pumps?
No. With our gentle surgical technique we find that our patients do well with pain control and do not require the added, risk, hassle and expense a pain pump causes.
When can I shower after breast augmentation surgery?
The next day.
How long will I be out of work?
This depends upon the type of work you do. Upper arm movements like reaching should be avoided for the first one to two weeks. Driving can begin as well during this time as long as there is no impairment from pain medication. Patient should avoid lifting anything heavier than a gallon of milk for six weeks after the operation.
How long before I can exercise?
We recommend that patients begin walking immediately after surgery. Women should not perform intense physical exercise for six weeks following surgery. Physical exercise such as weightlifting, jogging, and biking may cause implants to shift position or impair wound healing that could ultimately affect the appearance of the breasts.
Will breast implants affect my physical functioning such as working or exercise?
It is highly unlikely to experience functional changes following breast augmentation surgery. Weightlifting, or lifting heavy objects will not affect the implant was discarded properly healed. The only population that could be affected by breast implantation surgery are ladies involved in competitive weightlifting.
When can I resume sexual relations?
Any time you want as long as it is comfortable and you don’t place the surgical area under ‘stress’.
Can I still breast-feed after breast augmentation?
Yes. Placement of the breast implant below the breast or deeper, under the muscle, does not affect the ability of the breasts to produce milk. There is a small increased risk of breast-feeding problems with ladies who have had a peri-areolar incision. Problems are almost never seen with the inframammary or trans-axillary incision.
Is breast-feeding safe after breast augmentation?
Yes. Studies have shown no increased risk to babies who are breast-fed following breast augmentation.
When will I see the final results?
It will take 3 to 4 weeks for most of the swelling to resolve and probably 3 months for all if it to resolve. After this you should have a reasonably good idea of what the final look will be. Your breasts may still be a little firmer than they will ultimately be, however. It often takes months before the breasts and the implants feel very soft and natural. It also takes about 3 months on average for the implants to drop to their final position if they are placed under the muscle.
Is it normal for my breasts to make noises after breast augmentation?
Yes. These noises have been described as anything from a squeaking to a sloshing or gurgling. Noises from the breasts after breast augmentation are the result of air bubbles or fluid in the space around the implants. Within a few weeks after surgery, the air and fluid completely absorb the noises and the noises cease.
Does Dr. Light recommend antibiotics before dental procedures?
Any patient with implants of any kind should receive antibiotics prior to any surgical or invasive medical procedure to avoid seeding that implant with bacteria causing infection of the implant.
Should I have my breast augmentation only after I am done having children?
Not necessarily. A large percentage of women have breast augmentation before having children. However, if one intends to become pregnant in a year or two after surgery, then breast augmentation should be postponed until after pregnancy.
Will breast implants affect cancer detection?
It is been filed that cancer detection is not delayed with breast implants. Additionally, the risk of developing breast cancer is the same as in women without implants. Women with implants that do develop breast cancer have the same survival rates as women without implants. It is slightly more difficult to perform mammograms on augmented breast. However special techniques have been developed over the years to compensate for this. It is slightly more difficult to see breast tissue with mammography when the implants are placed over the muscle versus under the muscle.
Will a breast augmentation lift the breasts?
A breast augmentation does not lift the breast, it makes them larger. In cases of very early breast sagging, and implant may appear to lift the breasts due to replacement of missing volume. If your breast is lying lower on your chest in your happy with, then a breast lift is what you need. Many patients need both breast augmentation and breast lift to achieve their goals.
What happens if I get pregnant after breast augmentation?
Your breasts will still enlarge during pregnancy and will become engorged with milk following the birth of the baby. Obviously, they will be bigger than if you didn’t have implants. You can still breast-feed and there is no change in the quality the breast milk.
What are some of the potential risk with breast augmentation surgery?
Although not common, the risk include: capsular contracture, rupture of implants, asymmetry of breast mound, asymmetry of nipple/areola, loss of all or a portion of nipple sensation, loss of or decreased ability to breast feed, wide scar, extrusion of implant, palpable implant, malpositioned implant (too high or too low), numbness on breast, upper arm numbness with axillary approach, infected implant requiring removal, pneumothorax (collapsed lung), rotated anatomic implant, skin rippling, pain, nipple hypersensitivity.
How long do breast implants last?
There is no need to change out breast implants unless you have problems with them. The main reasons to exchange implants are to change the size (bigger or smaller), remove scar tissue that is formed around the implant, or for implant rupture. Some ladies are changing out their saline implants for silicone. Based upon the best currently available information, patient should assume that the need for replacement at five years would be about 1%, by 10 years 5%, by 15 years 25%.
How much does breast augmentation cost?
The cost of breast augmentation varies widely based on geography, experience and ‘the market’. Many surgeons with a high profile and lots of press (marketing) are not necessarily great surgeons. You need to pick the best surgeon you can with whom you have a comfort level with them and their staff. This is a relationship thing as much as it is a technical skill issue. You need and want both! The average cost for saline implants is $4500 – $6500 or for silicone $5500 – $8000. Don’t be fooled by pricing online that seems cheap………the fine print will reveal that the price is only the surgeons fee and does NOT include anesthesia and the facility fee – a common marketing trick.