Breast Augmentation - Questions & Answers  

        How do I check credentials?

An important credential of a qualified plastic surgeon is certification by the American Board of Plastic Surgery (ABPS) or to be a fellow Royal College of Physicians and Surgeons (FRCS) in England or Canada . Unfortunately, in most states any physician with a medical license can perform plastic surgery even if they are certified in another specialty or not board certified at all. Contact the American Society of Plastic & Reconstructive Surgeons at www.plasticsurgery.org or call 800-635-0635 to verify any surgeon you’re considering is certified by the American Board of Plastic Surgery. That way you can find out if someone holds the proper certification and when they got it…..so you have an idea of experience.  This at least lets you know you’re working with someone who trained exclusively to, and is devoted to, doing only plastic surgery. I hold both certifications since I got my FRCS when I was in England .

What is the most common complication you've seen?

Complications are really rare and women are generally very pleased with their results. I have seen a few hematomas. This is a collection of fluid or blood in the pocket, usually in the first 24 hours, causing the breast to become swollen, tense and painful. That’s why we put you in a compression bra, ask that you avoid aspirin products for 10 days before surgery and advise that you take it easy for the first three days. The few times I’ve seen this happen we’ve traced it back to something like taking Midol for cramps not realizing it's loaded with aspirin. Although it's more painful than usual, most of the time the body will absorb the fluid over time and you don’t have to do anything. However, if the swelling continued to increase or the pain was not tolerable, you might have to go back to the operating room to remove the fluid and relieve the pressure.  Of course, any return to the OR would mean additional expense

How common is implant rupture or leaking?

Almost everyone will need their implants replaced at some time.  We seem to see it happen around the 5-10 year mark.  You didn’t do anything wrong, I didn’t do anything wrong…. it just happens. An implant is just like any other manufactured device in that it has the potential (the literature says 7%) for failure. I’ve been using saline implants exclusively since the early 90’s. Your body absorbs any salt water that leaks out but it means a return trip to the operating room and additional expense, time off work, etc. By today’s standards, the implant company provides a replacement and some financial compensation but who knows what the policy will be in the future. There is also an additional surgeon’s fee. 

What about implant warranty and replacement?

The most important thing is that you can provide us your implant serial numbers.  You will be given a serial number card at the time of surgery.  Put copies of this in different places so you can always find it…..even 30 years later.  Also, be sure that you send the warranty papers off within the requested time frame.  By today’s standards, depending on timing, etc., it is unusual for a patient to have much, if any, out of pocket expense pertaining to implant replacement……..providing they have the serial numbers.  My fee for replacement is typically 50% of the going rate for augmentation.  You pay the surgeon’s fee, OR and anesthesia and send your bills in to the implant company for your reimbursement.  You can get information regarding the amount of your reimbursement from your original warranty papers or off the internet.     

Exactly what is an implant made of?

An implant is basically an empty plastic bag filled with saline (salt water similar to what’s in your body) at the time of surgery. A silicon implant has silicone on the inside instead of saline.  They come in different shapes and sizes. I use a tester implant during surgery to determine what size implant best suits your needs.

What shape of implant do you use?

The shape of the breast is primarily determined by the shape of the pocket that will hold the implant and the forces of gravity. I use a round implant. Because of gravity, a round implant takes on a teardrop shape regardless of it’s orientation within the pocket. We want the implant to have softness and be able to move with your breast so it’s not stitched or tethered in anyway. Some physicians use contour shaped implants that are thinner at the top and fuller at the bottom (teardrop shaped) but I’ve always been concerned, and I’ve seen reports, of the rotation of a contour implant causing an odd shape to the breast. One way isn’t wrong or right, we surgeons all have our favorite way of doing various procedures based on our positive experiences.

Why do some implants look so obvious?

In my opinion, this is largely due to two reasons. Let’s face it, the space on your chest I have to work with is limited by the size of your chest, how your skin attaches to your sternum in the clevage area and how much skin elasticity you have. If too large an implant is used the look will always be somewhat stuffed or over done. We can always give someone a breast proportional and womanly but we can’t do the Dolly Parton thing, even if you wanted it. Also, to some extent, the shape and position of the breast we start with influences the look we end up with.

The second thing is that the muscle the implant generally goes under actually starts at the collar bone. In the early stages, when the breast is swollen and the skin has not loosened up yet, it tends to pancake or flatten the implant out - pushing it up higher in the pocket than we prefer. That’s why almost all my patients will be asked to wear an elastic strap across the top of the breast (on top the bra) to give downward pressure and hold the implant in the bottom of the pocket. This isn’t comfortable, you can’t wear a V-neck shirt or it will show and, in general, patients don’t like this. If you don’t wear it as directed; however, the profile might stay higher than we like which makes the breast have a full look in the top. Most people have to wear the strap for about two to three weeks.

Why don’t you like the incision under the armpit, around the nipple or in the belly button?

I don’t know, maybe I’m just set in my ways or old fashioned but I really don’t like the idea of doing "long distance surgery and not being able to try on an implant." Picture this. If I go from the armpit or the belly button, I have to make a tunnel to the breast. Once I get to the breast area, I pretty much have to work by feel. I have to make sure my muscle dissection stays in the right plane, create a precise and evenly shaped pocket, control any bleeding or oozing, insert and then fill the implant through the tunnel then get out of Dodge. This just seems like too much to me, all for the price of a small scar. The only approach I use is the incision under the breast. In my experience, this incision heals nicely, gives me great access and visibility, has few complications or sensation changes and I can fine tune the size by using tester implants first instead of trying to guess what size implant is best for you. Patients just don’t complain about this small scar.  I don’t like using the approach around the nipple because of a higher chance of disturbing the sensation.

What if I change my mind?

Implants can be removed quite easily as an outpatient.

Do I need a mammogram before surgery?

This is between you and your OB/GYN. Some recommend that if you're 40 or older, it’s not a bad idea.

What if I get pregnant?

The breast will do just what they would ordinarily. Research says it’s safe, but we recommend that you not breast feed.

How long will I be at the surgery center and what do I take with me?

You’re usually there a full morning or afternoon or however long it takes before you’ve met the criteria for discharge.  Don’t wear makeup or jewelry. Wear loose, comfortable clothing that opens up the front and slip on shoes.

Can I participate in sports as usual?

After the initial healing period, it’s life like usual. Whether you jog, lift weights, etc., just start slow and work back up to your regular intensity gradually.  I don’t see any reason for women to work their pecs to an extreme.  If you flex the pec you may see the implant move. 

Will all my friends and co-workers notice?

Most women say that nobody seemed to notice specific changes but you may get compliments on an outfit you’ve worn for years that no one ever noticed before. You may weigh exactly the same but someone will compliment a weight gain or loss or ask how long you’ve been working out. So if you’re doing this for any reason other than just how you’ll feel about you, pass, because to tell you the truth, you’re the only person it’s really that important to.

Do I have to be concerned about cancer or other diseases?

No more than usual according to the current independent research. Recent studies have laid to rest the concerns that silicone may be a significant health risk. Research data has shown women with breast implants are no more likely than the rest of the population to develop cancer, immunologic or neurologic diseases. It’s too much to print here, but If you want more information on the research visit www.plasticsurgery.org and click on the Plastic Surgery Information Service page.

What can I do to speed my recovery?

Because your chest hurts, you will have a tendency to tense up, take shallow breaths and stiffen your upper body. It helps if you make a conscious effort to breathe normally and relax your muscles.

How much pain can I expect?

We give you adequate pain medication but, just like any other surgery, the first few days can be quite intense.  After this you may have soreness that gradually diminishes over the next couple of weeks.

I have a mitral vavle prolaspe.  Is this a problem?

Mitral Valve prolaspe is not a a contraindication to surgery. You will be given antibiotics through the IV at the time of surgery.

Will I have to stop my medications?

The medications that concern me are aspirin products for bleeding reasons and some antipsychotic drugs and diet pills have to be stopped before surgery since they have the potential to make the blood pressure drop too low when mixed with certain general anesthetics. Also, avoid herbal remedies for three weeks before surgery.

I'm diabetic.  Is this a problem?

It just means you need a little special attention.

My breast sensation is a big part of my sex life.  Is it likely to change?

For awhile after surgery the sensation may be heightened or dull. This is due to the tissues being stretched. It is very rare for anyone to have any permanent sensation change using the incision beneath the breast.