Breast Augmentation - Frequently Asked Questions

Who are the best candidates for breast augmentation?
Breast Augmentation can enhance your appearance and self-confidence, but it won’t necessarily change your looks to match an ideal. Before you decide to have surgery, think carefully about your expectations and discuss them with me.

The best candidates have minimal or no breast sagging and are in good health. Every patient looks different with breast implants. I have done breast augmentation on over a thousand women. No two look exactly the same. Breast augmentation enhances what you already have. As no two women start out with identical breast shape and size, it stands to reason that they will look different with implants. 

What types of implants are available and how do you decide which will be best for me?
There are two saline manufacturers in the U.S. market. They are Inamed and Mentor. Both companies have FDA approval for their saline implants. I currently use implants from both companies and am very satisfied with them. The type that is chosen for you depends on various criteria such as, your body shape and size increase you  desire. 

Do you place the implants behind the pectoral muscle or in front of it?
For most patients I place implants “subpectoral” or behind the chest muscle. I believe this offers certain advantages. The two main ones are a reduced risk of capsular contracture (see below) and less difficulty interpreting mammograms. The only significant disadvantage is that there is more pain for about a week after surgery. I feel that the advantages clearly outweigh the disadvantages.

Patients that have some sagging, but not enough to warrant a breast lift, may be best-suited for “prepectoral” implant placement. If you fall in that category I will tell you during your consultation. 

What type of anesthesia do you use and how long does surgery take?
I strongly recommend general anesthesia for most patients. The average procedure length is less than one hour. 

How much pain should I expect after surgery and what are my  limitations?
Breast augmentation is quite painful for about a week. Although everyone differs in their pain tolerance, most patients take narcotic pain pills for about a week and then taper off. You will be given adequate pain medication to control you pain.

You will not be allowed to lift anything the first week with gradual increases thereafter. It will be four to six weeks before you can do heavier lifting. 

What about time off work?
The first week after surgery is very important for positioning of the implants. For the first week after surgery you will not be allowed to lift anything. I will allow a gradual increase in what you can lift after a week. It will be four to six weeks before you can lift any heavy weight. I recommend a week off of work for anyone with a desk job and four to six weeks if you have to do significant lifting. The most important thing about returning to work is that you are able to obey the lifting restrictions. Do not underestimate the first week after surgery. Most patients are very sore and don’t feel like working.

Where will the incisions be?
I perform breast augmentation through two different incisions: inframammary (below the breast) or axillary (under the arm). There are other methods, but these are the two that I prefer. Most patients are allowed to pick their incision site. I will recommend a specific type of incision for some patients depending on their build and breast shape.

Do the implants look different with different incisions and is one incision more painful than another?
The implants should look the same regardless of incision site. The main thing to focus on is the location of the scar. Also, I believe that pain is about the same with either incision. The main source of pain in this operation is from placement of the implant under the muscle and inflating it with saline. The implant is placed in the same location regardless of the incision site.

Do implants ever leak?
Yes. The implants have a life span of approximately ten years. Eventually every implant will leak or deflate. When an implant leaks the patient notices a loss of size of that breast. This usually occurs rather quickly. There is typically no pain or side effects. Physical activity does not seem to play a role in causing deflation.

If an implant has leaked the only option for correction is to replace it. There is a warranty on most implants. Ask us for further details during your consultation.

What is “encapsulation” or “capsular contracture”?
A capsule occurs when the patient’s body forms a thickened tissue layer around an implant. Think of it as similar to scar tissue. When it occurs, the patient notices that the breast becomes firm or hard. It might also change shape or become painful. It can occur on one side or both.

The cause of encapsulation is not known. Any patient who gets breast implants runs the risk of getting this problem. It can occur with any type of breast implant. The risk appears to be decreased with implants beneath the chest muscle. That is one good reason to place them there. 

If I get a capsule what can be done?
There are several options. If the capsule is mild, a patient might choose to do nothing. For others, the options include surgical removal of scar tissue or removal of the implants. However, the problem might recur after surgical removal of scar tissue. 

How will my breast look if I ever have the implants removed?
That varies. The larger implants and the longer they’ve been in the more likely it is that there will be significant ptosis (or sagging). Some patients will require a mastopexy (breast lift) after implant removal. 

What is rippling?
Rippling represents visible edges of the implant, usually seen around the periphery. It is more likely to occur as the implant size gets larger or in patients with very little natural breast tissue.

Are there other potential problems that I need to know about?
Yes. Other concerns include changes in nipple or breast sensation, need for subsequent surgeries, shifting of the implants and calcifications in the tissue around the implant.

What about mammograms?
You should still have a mammogram when indicated whether or not you have implants. Mammograms can still be read and interpreted even with implants. Generally, mammograms are easier to interpret in patients with submuscular implants. This is yet another reason to place them at this level when possible. 

Can I breast feed after augmentation?
For most patients the answer is yes, and there is no known risk to the baby with saline implants. Of course, no woman knows for sure if she can breast feed until the day comes.

How do I choose the size that’s right for me?
This is what patients agonize over the most. This is an individual decision. When you come for you consultation you will be shown photographs of other patients. That, along with your exam, will help guide me. I will discuss this with you in detail and help you make the right decision. 

What is the cost?
You will be given an exact figure during you consultation. This will include the total cost of your procedure and all fees.