I pride myself as being one of the region's most respected aesthetic plastic surgeons. During three decades of practice, breast augmentation has been the procedure most frequently requested by my patients. Drawing from my many years of experience, I have created this portion of the web site using a "Frequently Asked Question” format to share with prospective patients the information they should know about breast augmentation. All answers reflect my own professional opinions, even though some may seem to be at variance with information to be found elsewhere. All questions resemble those I have frequently encountered from my patients. I address each topic just as I would if you were a patient consulting with me and struggling to arrive at your decision about proceeding with this surgery, or if, after having your surgery, you begin to question whether that was the right direction to take. I sincerely hope you find this to be a useful reference as you consider this surgical option.
This operation can be beneficial for women who have one or both breasts smaller in size than they would like for them to be. Prospective breast augmentation patients must meet certain criteria before they may be considered as good candidates. Some examples of patient problems that adversely affect their approval for this procedure include:
- Under Recommended Age: Patients should be over 18 years old (22 years old if they want silicone gel). There are certain situations in which this rule may be modified.
- Breasts are Too Sagged: Significant breast sagging usually means a breast lift, with or without implants, is required for the best results.
- Poor General Health: Breast augmentation, a totally elective procedure, should only be performed on patients who are sufficiently healthy to avoid posing an unnecessary surgical risk.
- Unrealistic Expectations: Some patients expect more benefit from the breast augmentation procedure than the surgeon is able to provide. Breast implants cannot make a patient's breasts look just like another woman's breasts. Nor can breast implants fix a deteriorating personal relationship. If expectations such as these cannot be dispelled, such patients should not be accepted for surgery.
- Existing Breast Problems: A current breast infection, lactation from recently nursing a baby, an abnormal mammogram that warrants further study—these are but a few examples of breast problems that may, at least, cause a delay before proceeding with breast augmentation
So, if you lack whatever you consider to be adequate breast size, and you don't fit into any of the above categories, then you certainly may be a good candidate for breast augmentation. Your next step would be to arrange a consultation with me so I too can help with that decision.
How do I decide between silicone and saline implants?
The original, widely accepted implants were silicone, which became available in the early 1960's. Those implants consisted of a silicone rubber outer shell, which was filled with a very fluid form of silicone and are now referred to as "first generation" implants. Later, in the early 1970's, saline filled implants came into being. These were made of a similar silicone rubber shell, but they were inflated with sterile salt water (saline) at the time of surgery.
Both of these implant types had their individual problems, for which subsequent "generations" of each type were eventually developed. Through the 1970's, 1980's and early 1990's, both silicone and saline implants were in use, with frequent improvements in the design and performance for each product, but never achieving a problem free version. In 1992, the silicone implants of that time were temporarily removed from the market because of related health risk fears. From 1992 until the end of 2006, saline implants were the only style available for simple breast augmentation surgery. It wasn't until November of 2006, that the Federal Drug Administration (FDA) became convinced regarding the safety of silicone implants (once again, having been re-tooled) and authorized them to be returned to the market for all suitable patients. This new generation of silicone implants differs significantly from all preceding generations with respect to the nature of the silicone gel within each implant. The new implant is filled with a very thick cohesive silicone gel, which is so thick that it stays safely inside the implant shell, even if the shell is punctured. Furthermore, one of these implants can even be sliced in half, and the silicone gel remains within each half. It can now be stated with a high degree of certainty that silicone implants are as safe to the body as saline implants.
That having been said, we now can better compare silicone with saline implants, knowing each product is equally safe for human use. Saline implants have certain advantages that make them a good choice for use in some patients. These advantages relate to the lower cost of saline implants (a pair of saline implants is approximately $1,000 less than a pair of silicone implants) and to the advantage of being able to fill the saline implant once it has been placed in the body. Because of this latter fact, saline implants can be placed through smaller skin incisions, and once placed, saline implants can be filled incrementally to varying size, allowing for better "fine tuning" the size than you can achieve with silicone implants (which are only available in an assortment of pre-filled, fixed sizes).
On the other hand, there are some disadvantages to saline implants when compared with silicone implants. The immediately apparent disadvantage of saline implants has to do with the manner in which they "ripple" when filled with saline and are placed within the body. This rippling effect necessitates positioning saline implants "behind" the pectoral muscle, in an effort to prevent the ripples from creating waviness of the breast skin located just above the "bra line." This, however, does not prevent possible waviness from showing along the lower, outer surface of the breast, where there is no muscle to hide the ripples. Another disadvantage of saline implants is their possibility of spontaneously deflating. Wear and tear as well as occasional faulty fill valves, account for unexpected deflation of some of these implants each year. Fortunately, the implant manufacturers, for 10 years after surgery, pick up the cost of treating such an incident.
Now, what about the new silicone implants?
We can easily grasp and squeeze one of these implants and see that it feels much more "natural" than its saline counterpart. When you come in for a consultation, you'll get a chance to do just that. This implies that for patients having very small breasts, in which an implant is going to be more easily felt, the "natural" feel of a silicone implant would be the preferred choice. With regard to implant deflation, we already know that won't happen with a silicone implant, because it's filled with a thick "cohesive" silicone gel, which will not leak when punctured or even when cut in half, as illustrated in the following photograph.
Additionally, if one of these new silicone implants were to become significantly damaged by some form of trauma, requiring its replacement, the same 10-year manufacturer warranty still applies. From my standpoint, I believe the biggest advantage of silicone implants over saline implants has to do with the option of placing them in front of the pectoral muscles. My reasons for finding this to be advantageous are discussed in the next section.
Is it better to have implants placed in front of or behind the muscles?
The main reason surgeons choose to place breast implants behind the pectoral muscles is the thought of being able to minimize implant visibility in the upper portion of the breast. This became particularly important with the use of saline-filled implants, which characteristically develop "ripples” when placed inside the body. Such implants positioned in front of the muscles frequently cause noticeable "waviness” above the bra level. It has, therefore, become customary to place most saline implants behind muscle.
Silicone implants have much less likelihood of rippling within the body, and for most patients, they can be placed in front of the muscle without experiencing visible breast waviness. In some patients, however, with negligible breast fat or even breast tissue, it may also be advantageous to position silicone implants behind muscle. This is done in these patients to minimize visibility of the curved outline of the implant in the upper breast.
Over years of treating implant problems in patients with "behind the muscle" saline implants, I have learned that for many such patients, the implants are not tolerated well in a position behind that muscle. Repeated activity of the pectoral muscle, whose action is to pull the arm forcefully toward the side of the body, causes the implants of many of these patients to gradually shift in a downward direction and eventually come to rest at a level too low in the breast. This condition (called "bottoming out") causes the breast to look abnormally proportioned, and surgery is then required to attempt to properly reposition the implant. This sequence of events can most often be avoided by placing implants in front of the muscle and away from the line of force of the pectoral muscle. This, in my opinion, is a valid argument to use silicone implants and to strongly consider placing them in front of the pectoral muscles.
Which of the several possible skin incisions is best for breast augmentation surgery?
There are three popular skin incision locations for inserting breast implants, and the choice can occasionally be made by the patient. Most frequently, I rely on a periareolar incision for this purpose and patients are usually in agreement. The periareolar incision is placed precisely where the darker color skin of the areola meets the adjacent lighter skin of the breast, and it runs along the lower half-circle of the border of the areola adjacent to normal breast skin.
When the periareolar incision heals properly, the scar becomes extremely inconspicuous.
The photograph above shows the appearance of the scar after only eight weeks of healing, and by the end of a year, it will be barely visible. Even more important, though, this incision gives me, as the surgeon (trying to create the optimum result for my patient), the best perspective of the surgical area, allowing me to position the implant exactly where it should be placed and with the greatest degree of precision. Finally, I also like the periareolar incision because, when re-operation is required to correct a problem, I can carry out most required procedures, re-using that very same periareolar scar and avoid the necessity of an additional scar elsewhere on the breast. It should also be noted that the periareolar incision does NOT hurt more, does NOT interfere with nursing babies and does NOT cause a greater likelihood of having numbness after the surgery. Having stated my overall preference for the periareolar incision, I'll now discuss the other two incisions I also use frequently.
Many patients state their preference for inframammary (located in the crease under the breast) incisions.
Their reasons are varied, but are usually result of a strong desire to not have the areola area of the breast "violated" by surgery. Also many feel the inframammary location is more hidden, because it lies behind the slight overhang of the lower margin of the breast.
Regardless of other considerations, the inframammary incision does rise to importance, from my standpoint, when a patient possesses very small areolae that severely limit the possible size of periareolar incisions that can be made along their borders. For these patients, the areolae are too small to permit passage of silicone implants and, in some cases, even saline implants. The inframammary incision in this situation is a better choice, because a sufficiently long incision for implant placement can always be created within the generous length of an inframammary crease.
The final incision I use with any frequency is the axillary (armpit) incision.
This location is suitable for patients who want to keep the incision completely off the breast, who have breasts with tight skin that will act favorably when implants are placed in this fashion and who require "behind the muscle” placement of implants (silicone implants aren't practical with this incision because of the limited incision length). The scars created by axillary incisions are very inconspicuous.
So, as it turns out, the incision choice is a bit of a "give and take" decision that depends on the patient's desires, the type of implant to be used and the physical characteristics of the breast. A discussion during your initial consultation will usually help with this decision.
How do I know what breast size to request?
For many patients, determining their desired breast size seems to be their greatest struggle. Most women seeking breast augmentation have never experienced breasts much larger than their current size, and they hope to achieve, not only a new larger breast size, but also a certain "look" they have in mind. Unfortunately there's no option to first "try on" some of the new implants and then glance in a mirror at the appearance. To make matters worse, many of these prospective patients are being counseled by friends, family and the media to "go bigger than you first think, else you'll be disappointed and wish you had gone larger." Add to that the unsettling fact that bra sizes are not standardized well enough to serve as a reasonable measure of breast size, and stuffing bras with various size implants, measured quantities of "uncooked rice" or anything else is doomed to fail as a good predictor. It's an exasperating dilemma that I encounter repeatedly with my patients who, up until the time of being put to sleep for surgery, often remain unsure of their decision. What is the answer?
At some point, it's advisable for patients to step back a little from this dilemma and realize that it's not really "all about” breast size. It's truly much more about that certain breast "look" that resides solely in the mind of each and every patient. Only the patient really knows what that "look" would be for her and then must determine a way to convey that vision to her plastic surgeon. The challenge often becomes deciding whether or not breast augmentation alone will produce that "look," even when we know implants can only be counted upon to increase breast size. The patient's current breast shape and, to some extent, her overall body shape will play a very large part in establishing the final "look" that can be expected to occur after implant surgery.
As with many of the decisions concerning breast augmentation, this is really another good place for an open "give and take" discussion between the patient and her surgeon (and his assistants). To the extent that size plays a part in this decision, it is best to follow the advice of the medical professionals who deal with this procedure on a daily basis and whose goal is always a happy, satisfied patient.
Is there any benefit, prior to surgery, from patients providing pictures of other women's breasts that seem to possess that desired "look"? Absolutely! That's an excellent way to assist by graphically displaying the desired look following their breast augmentation surgery.
Will breast augmentation give me cleavage?
What is cleavage? Webster's Dictionary defines cleavage as "the depression between a woman's breasts especially when made visible by a low-cut neckline.” So, in effect, the question is whether, following breast augmentation, there will be a line (or groove) between the two breasts, or will there, instead, be a wide space between the two breasts. My answer to this question is that cleavage is almost always produced by pushing breasts of adequate size together so they nearly touch one another, making a line of contact in the midline of the chest. This, indeed, is the whole purpose of the well known "push-up bra", a standard item in a woman's wardrobe. If the breast augmentation makes the breasts large enough, and the overall breast texture is pliable enough, then there certainly can be cleavage when wearing appropriate attire. For some patients, this will require less enlargement because their rib cage contour already has the breasts positioned close to one another. For others, the rib cage contour is such that their breasts are positioned farther apart, requiring larger implants and greater breast pliability to produce the same cleavage effect.
Will my implants have to be changed after a period of time, as is often stated?
If the question is whether or not I recommend surgery to replace a patient's implants just because they have been in that patient for a long time, the answer is absolutely not. On the other hand, if I must re-operate on the breasts of a patient for other reasons, but she has had her implants for a long time (eight to ten years, or more), I routinely advise that she take advantage of the now required surgery to also replace the old implants with new ones. It seems to be a fact, however, that women with implants frequently decide to return for additional aesthetic breast surgery. I think a woman planning breast augmentation should enter into this surgery, fully aware that this is unlikely to be her one and only operation involving implants, and, instead, this is very likely to be just the first of possibly several breast implant procedures that she may face over her lifetime.
Where is breast augmentation surgery performed?
Breast augmentation should always be performed in a fully accredited operating room, staffed by properly certified personnel. This can be a hospital operating room or a free-standing accredited outpatient surgery center, such as I have at my disposal. Patients should exhibit diligence and investigate the credentials of any location claiming to possess proper certification and adequate staff.
How long does the breast augmentation surgery take?
The actual time I spend in surgery performing a breast augmentation is about one hour. Patients are required to arrive at the accredited outpatient surgery center about one hour before surgery. The total time patients spend in the outpatient surgery center for this operation is about three hours.
After surgery are there stitches that must later be removed?
It's been many years since I used sutures for breast augmentation that required later removal. I always now use self-dissolving sutures, and removing them later isn't necessary.
Once I have breast implants will there be restrictions on my normal activities?
The period of time breast augmentation patients must observe some activity restriction is only during the first three weeks after surgery, if their implants have been placed in front (on top) of the pectoral muscle. On the other hand, if the implants are located behind (under) the muscle, they are well advised to permanently avoid certain activities. Those activities to be avoided by these "behind the muscle" patients are things that resemble "working out" the upper body and pectoral muscles. For some, whose work requires repetitive upper body exertion, an implant positioned in front of the muscle is a preferable choice.
Must I have someone with me on the day of my breast augmentation?
Breast augmentation is a procedure that requires the use of drugs and anesthetic agents. As a consequence, it's mandatory that you be accompanied by a responsible person who is capable of safely driving you home or to another suitable destination following surgery. There is also a necessity for the presence of a responsible adult to be with you throughout the first night following surgery.
Do I have to bring a certain type of bra to be placed in after breast augmentation surgery?
In an effort to be certain all patients are placed in the proper fitting bra following their surgery, my practice provides a complimentary bra to each patient on the day of her surgery.
What kind of anesthesia is required for breast augmentation?
Breast augmentation is an operation that can be performed either under conscious sedation (twilight sleep) or general anesthesia (fully asleep). I do the majority of these procedures under general anesthesia, but I allow each patient make her individual choice in that regard. I'm perfectly happy to carry out the operation either way.
What are the risks associated with breast augmentation?
All surgical procedures are associated the potential risks of post-operative infection, post-operative bleeding and medication or anesthesia problems. Breast augmentation, of course, shares those common risks, and it has the added element of an implant being placed within the body. It's important, therefore, that prospective patients understand how the presence of an implant introduces additional risks and makes some of the common complications somewhat more complicated. I'll enumerate those risks about which, I believe, all patients considering breast augmentation should be made aware:
Defective Implant
Most implants function as expected for a long time. On occasion, however, something may happen to the implant causing it to lose its integrity. For saline implants this creates the problem of implant deflation, necessitating replacement of the deflated implant with an intact new one. If the implant is of the silicone variety, it can't really deflate, but sufficient trauma (e.g. motor vehicle accident) could possibly distort and damage the implant to an extent that, once again, implant replacement is required. Fortunately for patients, implant manufacturers are very aware of the possible financial burden of having to undergo unexpected surgery to replace a defective implant, and they provide a 10-year warranty (on all of their breast implants) to offset such costs.
Nipple Numbness
Nipple numbness and other areas of breast numbness are possibilities after implant placement. This type of operation requires the creation of a large enough space deep within the breast to accommodate placement of a significantly large implant. Two things take place that can be damaging to nerve function. First, many of the nerves that normally run through the space to be used by the implant must be cut while creating that space. Second, for those remaining uncut nerves, the implant placement generates substantial tissue and nerve stretch (that's how the implant makes the breast larger). Stretched nerves cannot always be expected to function normally. Hence, if implants are to be placed, there is a risk of numbness. If this is a risk the patient is not prepared to accept, then she should think twice about undergoing breast augmentation.
Breast Capsules
Of all the risks, the one breast augmentation complication that accounts most for patients returning for additional surgery is the problem widely known as "breast capsules" (periprosthetic capsules). This problem has been associated with breast implants since the beginning (1960's). Many theories have been advanced as to the cause of breast capsules, but none have been proven, and there is no way to absolutely prevent capsules.
In my effort to explain this problem to prospective patients, I offer a somewhat simplistic view. In essence, I explain that implants, being composed of inert materials, act as foreign bodies within the patient's breasts. The healing process goes to work and it surrounds each implant with a membrane (encapsulation membrane). This, thus far, is completely normal and always occurs. For unknown reasons, some of these membranes gradually thicken and then constrict. This, in turn, places the implant under pressure, balling it up and confining it to a tight space. We call this a breast capsule, and it can cause increasing breast firmness, distortion of the breast's shape, movement of the breast position away from the ideal position, and even pain and tenderness. The only satisfactory treatment is to re-operate and surgically remove the capsule, knowing that it may still eventually return. In my patient population, I see, over time, approximately, 20% - 25% of patients showing some signs of having capsules, and approximately 10% of patients are eventually returned to surgery to correct the more significant capsule symptoms.
Bleeding
Postoperative bleeding is when a breast augmentation patient, soon after her surgery (usually within the first few days), starts bleeding into the space in which the implant is located. This causes that breast to develop increased swelling, to become the more painful of the two breasts and, soon, to become more bruised. The treatment is a return to surgery, where sutures are taken out, the implant is temporarily removed, the source of bleeding is stopped, the space is thoroughly rinsed out, and the implant is then returned to its space. I see this complication in approximately 1% (one out of every 100) of patients. Attempting to limit the chance of this happening, I restrict patients from heavy exertion for three weeks following surgery.
Infection
Postoperative infection, during the first few days following breast augmentation, rarely occurs. This, perhaps, is because of my very strict adherence to sterile surgical technique, the use of prophylactic intravenous antibiotics immediately before surgery and the avoidance of performing this procedure on sickly or otherwise unhealthy patients. There is, however, an occasional infection that shows up at a longer interval after surgery, and which, because it settles within the space around the implant, is termed "periprosthetic infection." It occurs in approximately 0.25% (one out of every 400) of my breast implant procedures. Patients typically notice unexplained breast swelling and, sometimes, pinkness, fever and/or pain. My treatment plan for patients with this set of symptoms has been an initial trial period of antibiotics, hoping to quickly eliminate any infection. Simultaneously, laboratory tests and ultrasound studies are requested. After one to two weeks, if the swelling remains (or worsens), and if the requested tests fail to reveal some different breast problem, it then becomes necessary to surgically explore the breast (and implant space). If infection is, indeed, confirmed, treatment requires removing the implant, culturing the infection and planning to replace the implant after the infection has been completely eradicated. Fortunately, these infections rarely occur and, when they do, I've usually been able to treat the patient and ultimately provide the "look” they were seeking.
Improper Implant Position
On occasion, a breast augmentation patient consults with me complaining about her undesirable implant position (malposition). I can assure all my prospective patients that, provided their breasts appear symmetrical (equal) before their surgery, they will not leave my operating room until their newly enhanced breasts, likewise, appear symmetrical. Why, then, is it that some of these "symmetrical breast" patients end up with implant position problems and frequently with one breast looking different from the other?
The answer lies somewhere within the fact that, in the instant a new implant is placed in a breast, a chain of events is started. The breast (and body) must make changes to adjust to the presence of the new "uninvited guest." The desired change, of course, is the immediate stretching and pushing of tissues to create a larger breast. That's the good part, but, over ensuing days, months and years, the implant continues to exert influence on the surrounding breast because of the physical implant properties of size and weight. Some of this is good (e.g. the implants dropping into desired position), but some may be bad (e.g. one implant dropping, but the other not). So breast augmentation starts an ongoing interaction between a patient's body and the implant. Fortunately, for the vast majority of patients, the implants eventually assume their desired location, and implant position problems don't occur.
There are, however, those less lucky patients in whom the implant position of one or both breasts moves to an undesirable location, creating unwanted breast appearance and, often, asymmetry (unequal breasts). The causes of this may be varied, including such things as capsule formation, muscular displacement (for implants that were positioned behind the muscle), gravity effects, extreme rib cage contour, physical trauma, loss of tissue (collagen) elasticity, and others. When this malposition problem exists, and is sufficiently disturbing to the patient to justify surgery, a surgical remedy can be carried out, often with improvement, but sometimes (depending on the cause of the malposition) with the problem occurring yet again. Many of these patients must come to a realization that though there is really no such thing as a "perfect result" from this or any aesthetic surgery, for them, a "near perfect" result may also not be attainable. They must then decide if they can adjust to their degree of ongoing imperfection, or if they should, instead, have the implants removed, "once and for all."
Are implants successful for all patients?
The answer to this question depends on what is meant by the word "successful." Of course, implants do make breasts larger in all patients. Then there are some patients, for whom larger breasts, alone, is not a sign of success. These are patients who want a particular breast "look,” which is not just larger size, and perhaps, is beyond the scope of what can be expected from a breast augmentation. For these patients, the result of having implants cannot be considered successful, because their expectation of a certain breast "look" has not been achieved. Breast implants, as much as they are an enjoyment to most women, do not bring happiness to all.
What are the normal return visits after breast augmentation?
Following an uncomplicated breast augmentation, for patients who live within easy access to my Baton Rouge office, I believe it's unnecessary to have the patient return for follow-up examination until seven to fourteen days after surgery. Communication during that time is easily handled by phone, and if anything occurs with which I'm not completely comfortable, I have the patient return to the office right away. For those who come from a distance and have spent the night following surgery in Baton Rouge, I make arrangements for them to be seen by my nurse or by me the first morning after surgery and before they travel, once again, out of the Baton Rouge area. That, at least, eliminates the possibility of those patients having to urgently return to Baton Rouge from afar during the first evening or night following surgery to be checked for suspected postoperative bleeding. These longer distance patients then return to Baton Rouge to be seen by me, just like "local" patients, in seven to fourteen days.
The next follow-up visit occurs two to three months after surgery, and the final visit is at one year after surgery. Thereafter, I have a "door is always open" policy, and I request that patients contact me and return if there is a future sign of any suspected problem.
Will implants interfere with my ability to nurse babies?
Breast augmentation surgery does not destroy breast tissue or the communication between milk glands and the nipple. Neither saline nor silicone implants contaminate breast milk and make it in any way dangerous. Consequently, for those women who would have been able to nurse babies (and not all women can) before undergoing breast augmentation, there should be no problem imposed by the presence of implants.
Will implants prevent me from having mammograms performed?
Women with breast implants undergo mammograms on the same routine schedule as women without implants. The difference is the requirement that the mammogram technique be somewhat altered so satisfactory breast images can be obtained. There is no way to keep the presence of your breast implants secret from those performing the mammograms, so definitely provide a "yes” response to the implant question on the mammography patient questionnaire.
Are women with breast implants more likely to develop breast cancer?
There is no suggestion that breast implants participate in causing breast cancer. In fact, breast implants have been used for decades in the reconstruction of women's breasts after undergoing mastectomy because of cancer. All aspects of any possible such association were extensively investigated using independent studies taking place at various times in the United States, Canada and Europe, and none of these investigations pointed to any breast cancer association. This was also one of the many factors considered when the FDA gave its favorable ruling regarding the widespread use of silicone implants in late 2006.
What if I'm pregnant when I show up to have my breast augmentation surgery?
Breast augmentation is a completely elective procedure. Anesthetic drugs are generally safe, but could be implicated in the case of a miscarriage or birth defect. For these reasons, I have a policy of performing a urine pregnancy test on all female patients, when they arrive at the office to under go their surgery (except, of course on those women no longer capable of pregnancy). If the pregnancy test turns out positive, surgery is canceled and the patient is given a partial refund.
Once I have implants, may I still wear underwire bras?
Once your breast augmentation surgery has completely healed, any type bra is OK to wear. Immediately after surgery, we provide you with your post-op bra so that's one less thing you'll have to worry about.
Can I have breast enlargement if I also need a breast lift?
Performing a breast lift at the same time as doing a breast augmentation is a very common procedure. It's called an augmentation mastopexy. Many patients are unaware whether or not they need to have a breast lift, but they know they want larger breasts. It's part of my obligation to determine if a simultaneous lift should be considered. We then discuss the options. Sometimes there are none, and a lift really must be done too. Other patients are aware of their need for a breast lift, but unsure of the possible benefit of implants. Once again, I help the patient sort through this question. It frequently is beneficial to place a small implant when performing a lift, hoping to gain a little more fullness to the upper half of the breast.
Which implant type, based on implant shape or "texture" is best?
Much has been written over the years concerning the advantage of one implant shape over another, or one implant surface texture over another. The fact of the matter is that the majority of implants in use are the smooth round style, which is favored by the vast majority of plastic surgeons performing this type surgery. Studies have shown that once in the breast, it's not possible to look at the breast and tell what shape implant was used. Even x-rays fail to disclose a difference in shape from one style implant to the next. Implants are soft and pliable, assuming the shape of the implant space created for them by the surgeon. It really doesn't matter what their shape was before being placed in the breast.
Regarding implant texture, there are two varieties, smooth and textured (not smooth). Textured implants were introduced when there was a feeling that a textured surface in some way prevented breast capsules from forming. That hypothesis proved to be wrong as the capsule rate was not improved by using textured implants. What did prove true, however, was that additional problems were introduced with the textured product, such as increased numbers of deflations and a higher number of patients with undesirable implant visibility. There is, in my opinion, no good reason to use a textured surface, bringing me back to using the smooth round implant with which I've always been pleased.
How long should I take off from work or school?
I advise breast augmentation patients to plan to miss about five to seven days of work or school. It's five days for implants in front of the pectoral muscle, and seven days for the more painful placement of implants behind the muscle.
What kind of pain medication will I be given to use after breast augmentation?
All breast augmentation patients are given a prescription for Tylox (acetominophen plus oxycodone) or similar analgesic, to use for pain management after surgery, if they require it. Many, however, are able to manage with Advil (Ibuprofen) and the muscle relaxant Robaxin (Methocarbamol), alone, and avoid some of the unpleasant side effects of Tylox. In any case, I like to be flexible with pain medications and use whatever is necessary for each individual patient.
Can breast augmentation be combined with other types of surgery?
Breast augmentation can be (and frequently is) combined with other types of surgery. If it's combined with another cosmetic surgery, there is also a reduction in cost. The most frequent cosmetic procedures to be combined with breast augmentation include tummy tuck, liposuction, labiaplasty and others. The final cost, once such procedures are combined, is calculated and then explained to prospective patients, usually at the time of their initial consultation.
Should implant surgery be put off until I have finished having babies?
The only relationship between having implants and having babies is the undeniable fact that through the months of pregnancy and nursing a woman's breasts will be larger than they would have been without implants. On the other hand, for women with breast implants, the "after pregnancy and nursing" empty breast appearance will also not happen. The implants will provide sustained volume through it all. Unless a patient is actively trying to get pregnant, with a good likelihood she will be successful, I question what the patient gains by putting off a strongly desired breast enhancement until after having babies at some unknown date in the future. Most patients see my point.
How can I make sure my breast implant scar will be inconspicuous?
There really is no such thing as an invisible scar, and the quality of a healed scar depends on the way the surgeon made and sutured the skin incision and also the scar forming characteristics of the patient. These factors are addressed, when you choose a reputable plastic surgeon and you have your surgery when you are in a state of good health and nutrition. Beyond that, the difference in scar appearance from one patient to the next is, most likely, genetically influenced and something you must "live with.”
Knowing we must have a breast augmentation scar following surgery, I make it inconspicuous by locating the scar where it will be least noticeable. Our choices are along the border of the darker skin of the areola (periareolar scar), along the crease under the breast (inframammary scar) or within the hair bearing skin of the armpit (axillary scar). All of these scar locations are good (but the armpit site is only good for saline implants, not silicone gel implants). So which of these locations is least conspicuous? My opinion is the scar at the border of the areola is the one that's the least conspicuous, but that's only an opinion—patients may think otherwise. I allow my patients to make that choice, themselves.
Why is taking photos of me necessary?
Photographs are the documents plastic surgeons require in order to retain a permanent record of a patient's pre-operative appearance. They are useful for planning and study of the procedure before surgery as well as to document the progress of healing after the surgery has been completed. Once surgery is finished, there is no other graphic medical record of how the patient appeared before treatment.
Dr. Gruenwald is a plastic surgeon in Baton Rouge, LA and provides services for those in and around the Baton Rouge and New Orleans areas.
