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Cosmetic Breast Surgery FAQs
Below you will find a list of some of the more common questions related to breast augmentation surgery that our patients have asked over the years. If you have a question for which you don't see an answer here, we welcome you to ask us.
How do I decide which breast implant size is right for me?
Choosing the correct size of breast implants for you is based on a three-part process. The first part considers your answer to the augmentation 'look' questions about Stages 1 through 4 (see BELOW). The second part of the implant sizing process is precise measurements made of your chest dimensions. The implant must fit your chest width and your breast tissues in order to look good and last for a long time. The third part of the process involves trying on some 'sizer' implants in front of a mirror while wearing a bra, and deciding which size is too large, and which is too small. Combining the decisions made from this three-part process allows us to help you decide on an implant size that is right for you.
During your consultation, you will be asked what type of 'look' you wish to achieve with your breast augmentation. To make this discussion easier, we have devised a series of four 'looks' that describe the appearance of breast augmentation results.
- Stage 1: The result appears totally natural and proportional. The causal observer could not tell if the clothed patient has had a breast augmentation.
- Stage 2: The result appears proportional to the patient's height and weight, but is a generous improvement to the bust line.
- Stage 3: The result is an 'augmented' look with rounded fullness in the upper pole and exaggerated cleavage. It does not appear to be natural.
- Stage 4: The result is an obviously augmented 'look', using an implant that changes the shape of the breast significantly, which looks 'fake'.
At What Age Are You Old Enough To Have A Breast Augmentation?
For cosmetic breast augmentation with saline implants, a patient must be 18 years old. For cosmetic breast augmentation with silicone implants, a patient must be 22 years old. For patients with severe breast asymmetry, such as amastia (absent breast) and Poland's syndrome, the use of breast implants is permitted for younger patients, as these severe breast asymmetry issues are considered to be reconstructive surgery problems.
Are There Visible Scars After The Surgery?
Yes. Three types of incisions are used for breast augmentation surgery. They are the infra-mammary, peri-areolar and axillary incisions. Although these incisions typically heal with a fine-line scar, they will never disappear. In most cases, a casual observer would not notice the scars, because of their careful placement. The peri-areolar scar heals particularly well because the tension on the scar is minimal.
How Soon Can I Resume Exercise?
I encourage patients to resume light walking, treadmill and light elliptical work outs as soon as they feel ready. This is usually at about 4 days for most patients. I restrict weight lifting for 4 weeks. I ask patients not to do pectoralis isolating exercises (bench press, push ups) for 8 weeks.
What Kind of Bandage or Dressing Is Used?
Small pieces of tape (Steri Strips) are applied along the length of your incisions. These tapes help the scars heal, and I leave them in place for up to 2 weeks. I place all breast augmentation patients in a post-operative bra that is designed for the purpose. The bra places light pressure on the fold beneath the breasts and light pressure on top of the implants. It is worn for 2 weeks post-op and can be removed to bathe. After two weeks, any comfortable bra can be worn. There are some new bras specifically designed for augmented women. We can give you more information about these bras if you're interested.
Are drains used in breast augmentation surgery?
I do not place drains in primary breast augmentation patients. For patients that have more complex revisional breast augmentation or breast lift surgery, I might place a drain. Surgical drains are typically removed 5-7 days after the procedure.
Do breast implants effect mammography?
The answer is 'yes', a breast implant does affect the amount of tissue that can be evaluated by mammography. A breast implant can conceal some of the breast tissue from the mammographer. During mammography, a series of extra mammographic displacement views (Eklund views) are recommended to view as much of the breast tissue as possible. When a breast implant is placed behind the pectoral muscle, about 15% of the breast tissue is not visible on mammogram. It should be noted that during standard mammography in un-augmented patients, about 10% of breast tissue is not visualized on mammography. Despite this finding, early breast cancer detection is still possible in augmented women. Augmented women should have their mammograms interpreted by radiologists experienced in this specialized type of mammography. Breast MRI is also an excellent early detection tool in women with breast implants.
Do augmented women develop breast cancer more frequently?
The answer is 'no'. Large groups of women that have had breast augmentation surgery have been tracked for many years to assess their development of breast cancer. In these studies, the rate of occurrence of breast cancer in the augmented group is no higher than in un-augmented women. Furthermore, the stage of breast cancer, once detected, is not higher in augmented women. In fact, some literature suggests that augmented women have their breast cancers detected at an earlier stage than un-augmented women. One explanation that has been suggested for this finding is that augmented women may have a heightened 'breast awareness' and do more breast self-examination.
Can breasts be augmentation with fat injections?
A very natural breast augmentation can be done by taking fat from one region of the body, processing it and inject it into the breast. The technique has several names, but Lipo Augmentation seems to be the most appropriate. The Lipo Augmentation procedure combines liposuction with augmentation of the breast with fatty tissue.
The procedure is best done after pre-expanding the breast skin envelope using the BRAVA system for a few weeks prior to surgery. The BRAVA system expands the skin envelope of the breast and creates more space and improved vascularity for the fat grafts to become living tissue.
Some of the grafted fat does create small calcifications within the breast tissue. Other breast surgical procedures (breast reduction and breast lift) also create calcifications in breast tissues. These calcifications can be discerned from cancer-related micro calcifications on mammography and MRI.
Fat grafting to the breast is also useful for patients that have had previous breast surgery done for cosmetic and reconstructive purposes. For example, fat can be injected into the breast of a patient that has had a breast lift done in order to add some additional breast volume. It is also acceptable to inject fat around the edges of a breast implant, in order to soften the implant's appearance.
Does breast augmentation incision location change my implant choices?
The answer is 'yes'. Both saline implants and silicone implants can be placed through three types of breast augmentation incision locations:
- Infra-mammary (under the fold of the breast)
- Peri-areolar (near the nipple area)
- Axillary (underarm area)
Most smaller silicone implants (225-300 cc) can be placed through an axillary or peri-areolar incision. Larger silicone implants require an infra-mammary incision. Any reasonably sized saline implant can be placed through any incision type because the saline implants are placed in an unfilled state, and then filled when they are properly positioned within the breast. In my practice, about 70% of women choose to have silicone implants for breast augmentation, and almost all of these women choose an infra-mammary incision.
Should the breast implant go above or below the pectoral muscle?
Both saline and silicone implants can either be placed over or under the chest muscles (pectoralis muscle). The decision depends on your breast anatomy and the 'look' that you are interested in achieving. Close to 97% of women in my practice have implants placed below the muscle. I believe implants perform better over a longer period of time in this protected sub-pectoral location.
Will everyone know that I've has a breast augmentation?
Not unless you tell them! You can choose clothing that conceals your newly augmented look. On the other hand, you may not want to! People may notice your new self-confidence and the fact that you've bought some new outfits to show off your new look. I strive to do very natural appearing breast augmentations for patients. In some cases, the casual observer will have no idea that you've had a breast augmentation. In other cases, with a larger implant, the new breast contour is more obvious. We spend a significant amount of time in clinic deciding together what is the right implant size and type for your figure.
How long does a breast augmentation surgery take?
A straight-forward breast augmentation takes me about 80 minutes. You are asleep for the entire procedure, so it will feel like its only been a couple of seconds! When a breast lift is involved, the procedure may take 2-3 hours. All cosmetic breast surgery is done on an outpatient basis.
How bad is the pain after breast augmentation surgery?
Pain is a very subjective experience. Almost all patients report that they initially felt uncomfortable, but as soon as they began moving around and getting outdoors, they feel better. My goal is for patients to feel comfortable enough on the night of surgery that they could leave the house and go out to dinner.
There are several things I do in the OR and post-operatively to maximize pain control. The first thing I do is use atraumatic and precise surgical techniques. Research has shown that precisely developed sub-muscular breast implant pockets are associated with less post-operative pain. I always use lots of local anesthetic during cosmetic breast procedures, so patients wake up feeling no pain. Breast augmentation patients are placed on pain medication, and also take Lyrica (pregabalin) that appears to calm some of the sensitive nerves that run through the pectoral muscles.
What if I have breast augmentation surgery and I am unhappy with the result?
The unhappy breast augmentation patient usually wishes she had received a different implant. Usually, a bigger implant. I have never re-operated on a patient for the purposes of placing a larger breast implant. The reason I think this is the case is because I spend a lot of time with patients talking about the 'look' they are after. Patients spend time alone with my female RN, in front of a full-length, 3-way mirror, trying on different implants in a bra, and deciding what implant is clearly too big and too small. This is a critical decision to make prior to surgery. I meet with patients at least twice prior to surgery to make sure they are happy with their chosen implant size. On the day of surgery, we all know exactly what breast implant we are placing, and why.
What are the risks of breast augmentation surgery?
The risks include bleeding, infection, capsular contracture skin numbness, asymmetry, revisional surgery and other issues. For each patient, these risks are thoroughly reviewed during the Informed Consent discussion by me, personally. Copies of all Informed Consent documents are given to patients to review at home, and ample time is allotted for questions.
If I like the way a particular model's breasts look, can I bring in her pictures for you to look at?
I think looking at photographs of women that match your height and weight and possess a breast shape that you admire can be very helpful. It gives me an idea of what type of breast shape you are interested in. It also gives me an idea of what your level of expectation is from breast augmentation surgery. It is impossible to replicate the surgical results that we see in a photograph. Reviewing photographs together is just another way that you and I can develop a set of shared understandings about post-operative results: what is possible, and what is not possible. Many patients will print out photographs from this database (enter your height and weight) and bring them into consultations.
http://www.implantinfo.com/photocenter/plastic_surgeons/heightwtsrch.htm
Patients will also bring in photos of models from magazine's such as Maxim or Playboy that possess the breast 'look' they desire.
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