7 Frequently Asked Questions Breast Augmentation
What size will I be?
That depends. The final size of your augmented breast reflects the combination of your existing natural breast tissue and the size of the implant that is inserted. A common misperception is that implants are sized by bra cup size. Implants are typically labeled according to the volume of gel or saline they contain. Implants also vary in their base dimension or footprint, and their projection or thickness. In any given individual, the final breast size achieved by this combination of factors varies. In other words, a 300 cc implant in one woman might produce a C bra cup, and in another might produce a B cup.
Another issue to consider regarding size is that not all sizes are realistically achievable. In other words, you can’t necessarily expect to be able to achieve any size that you specify. Years ago, breast augmentations were planned primarily according to a patient’s size requests. This approach could lead to inserting an implant that was much too large or heavy for the tissues, and resulted in stretch deformities, implant visibility, and implant malposition issues. These problems typically require expensive additional surgery to correct. A more appropriate way to determine implant size, and therefore final breast size, is to carefully evaluate the capacity of the tissues to hold a breast implant. I prefer to use a planning system that reliably assesses this capacity. By following the principles of tissue-based planning for breast augmentation surgery, the risk of undesirable outcomes is significantly reduced.
How do you perform the procedure?
The typical breast augmentation in my practice utilizes general anesthesia for your comfort and safety. I usually place the incision in the lower breast fold. Incisions can also be placed around the areola or in the axilla. I then develop a pocket to hold the implant in place behind your breast. The implant can be placed immediately behind the breast, or it can be placed behind the pectoral muscle, which is located behind the breast. I then determine the most appropriate implant size based on our pre-surgical planning and intraoperative assessments. Prior to inserting the selected implants, the pockets are thoroughly evaluated to ensure a satisfactory pocket size with no continued bleeding. The pockets are rinsed to reduce the risk of infection and capsular contracture. The implants are inserted, and the incisions are carefully closed with absorbable sutures.
Where will the scars be?
Incisions and the scars that result can be located in several possible areas: the fold below the breast, around the areola, or in the armpit. Incision placement is determined by a number of factors, including your existing anatomy, your preferences and the preference of the surgeon, and whether you are considering additional procedures such as a breast lift. Most commonly, the incision is placed in the breast crease and typically results in an inconspicuous scar in the deep shadow of the fold or just above it.
What is the recovery like?
I utilize a recovery protocol often referred to as “Rapid Recovery” or the “No Down Time” systems. The goal of this approach is to minimize pain with anti-inflammatory medications and stretching exercises, and to allow you to return to many normal daily activities as soon as the day of surgery. Please refer to this link for a copy of my recommended protocol.
In terms of the immediate sensation after surgery, you will likely feel a tightness or heaviness in your chest that is mildly uncomfortable, similar to the ache you feel in your muscles when you over-exercise. Anti-inflammatory medications, warm showers, and the stretching exercises relieve this discomfort. Some patients may feel uncomfortable enough to use a light dose of narcotic for a day or two.
When can I return to work and exercise?
As long as your work does not involve strenuous activity such as heavy lifting, you can often return to work within a matter of a few days if you desire. For those of you who work in factories, warehouses, and other physically demanding jobs, you may need as much as 4 to 6 weeks off of work if no light duty is available. I will review the specifics of your job with you during your consult, and will provide you with an estimated timetable for returning to work.
Similarly, you can actually return to light exercise immediately after surgery. This includes walking and the recommended stretching exercises. Light arm, torso, and leg exercises are also feasible. Lifting is limited to about 10 pounds for the first week or two. By the second or third week, you can begin to lift 15 to 20 pounds, and can begin to increase your exercises to a more moderate level. I do recommend, however, that you avoid heavy lifting and aerobic activities that bounce the breasts for at least 4 to 6 weeks after surgery. We will determine the length of your recommended restrictions by assessing how you are feeling and healing.
Are silicone implants safe?
The short answer is that silicone breast implants do appear to be safe. This answer is based on the fact that most styles of silicone implants in use today are FDA approved. The FDA does caution, however, that device studies do have limitations, and there is no way to absolutely guarantee that any medical device is completely safe.
The FDA approved the use of silicone breast implants for breast augmentation in women 22 years of age and older in 2006. This means that the FDA reviewed study data involving the use of silicone implants for this purpose, and found evidence of acceptable safety and efficacy for these devices. In other words, the device does produce the desired effect of increased breast size, and does so with an acceptable level of risk. FDA approval does not mean that silicone implants and breast augmentation surgery are risk-free. The procedure does carry some risks that are known to occur, but at an infrequent enough rate to be accepted by most physicians and their patients.
This question originates from an awareness of the silicone implant controversy that occurred in the 1990’s. Some women with silicone breast implants were diagnosed with autoimmune diseases, and felt that their implants had caused their illnesses. No evidence existed to dispel this concern, and so the FDA restricted silicone implants to reconstruction use only. The possible connection between silicone implants and disease was extensively evaluated by numerous studies performed by manufacturers and independent research bodies, and no causal relationship was found. Review of these studies led the FDA to reapprove the most common types of silicone implants in 2006. Currently, some newer versions of silicone implants, such as certain styles of Allergan’s 410 cohesive implant, remain under study. The 410 styles most commonly used for breast augmentation, however, are approved.
The following links contain useful information regarding the safety of silicone implants in particular, and breast implants in general.
From the FDA - Click Here | From Web MD - Click Here
How often will I have to have my implants redone?
This is an excellent question because it reflects a realistic awareness that the implants and the procedure have limitations. The implants eventually wear out, and the tissues of the breast and chest change over time. You should therefore assume that you would need to have additional surgery related to your breast implants in your lifetime. Unfortunately, the question is difficult to answer precisely because there are several potential reasons to have additional surgery after breast augmentation, and many unpredictable factors are involved. What I can say unequivocally is that there is no reason to replace your implants at predetermined times such as every 10 years. As long as your implants are intact and comfortable, and you are satisfied with your breast appearance, you don’t need to replace them.
We do anticipate that most patients will experience worn out implants at some point in their lifetime. The timespan in which this occurs is broad, and likely resembles a population distribution or bell-shaped curve. A few patients will experience implant failure within a few years, and a few will have intact implants for several decades. Many patients, however, will have their implants for at least ten to twenty years. Most implant safety studies, which are typically 5 to 10 years in duration, suggest an approximate 10 percent risk of implant failure at 10 years.
Other reasons to have surgery after breast augmentation are less common and you might not experience these issues. Capsular contracture, or firm pocket scar, often requires surgery to remove or break-up the thick tissue. Over time, the tissues can stretch or thin, resulting in implant and nipple malposition, rippling, and breast sagging. These problems are often improved with pocket tightening and breast lifts. Some patients desire larger or smaller breasts over time, and request a size change. Hopefully, we can avoid the problem of early size change requests with careful communication and planning before surgery.