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Breast augmentation continues to be one of the most popular esthetic surgeries, growing in popularity every year. If you are considering having a breast augmentation, the following information should help you come to a well-informed, safe decision. We developed this page to answer the most common questions asked by our patients and to provide you with the latest, up to date information on breast augmentation. We have addressed the following questions:

Are you a candidate for a breast augmentation?
How is a breast augmentation performed, and what decisions must I make before having one? (silicone vs. saline implants…)
Do I need a “breast-lift” as well?
Do I need to be put to sleep for the operation?
What happens in the days following a breast augmentation (how long is the recovery time)?
Will my breasts look natural after the augmentation?
What are the differences between saline and silicone implants?
How long do breast implants last?
Do breast implants affect breast-feeding?
What is the role of 3D imaging in breast augmentation?
What are the potential risks and complications?

Are you a good candidate for breast augmentation?

Patients who seek breast augmentation typically range from 18 years of age to their late sixties. Breast growth and development must be complete before considering augmentation. If you have no significant medical problems, have no breast health issues, and would like to increase the size and perkiness of your breasts, then you may be a good candidate for breast augmentation.
The most important thing is to make sure that you have an in-depth discussion with your plastic surgeon regarding all aspects of the surgery, including how your breasts will appear after the surgery and what you can expect to gain from getting breast implants.

How is a breast augmentation performed, and what decisions must I make before having one?

There are FOUR CHOICES you must make prior to having a breast augmentation:
1) Choose what type of incision the surgeon will use to insert the implants
2) Choose whether to have the implants placed “over” or “under” your chest muscles
3) Choose the type of implant you would like (silicone or saline, round or “shaped” implants)
4) Choose the size of the implants

Breast augmentation can be performed using one of three types of incisions: Transaxillary, periareolar, or inframmamary incisions.

Transaxillary incision:
A two to four centimeter incision in the hair-bearing area under your arms.

Periareolar incision:
A two to four centimeter incision at the lower edge of your areola.

Inframmamary incision:
A two to four centimeter incision in the fold under your breast.

All three options are safe and effective. However, your surgeon can help you determine which one is most beneficial to you.

Implants can be placed under the chest (pectoralis) muscles or over them. The benefits of placing them under the muscle include a lower chance of seeing “rippling” in the upper portion of the implant, in some cases a lower chance of having a “capsular contracture” (see below for explanation), and in some patients, a more natural appearance.

Implants should be placed over the muscle in patients who are bodybuilders, gymnasts, or serious weightlifters, where powerful use of the chest muscles can shift the implant position during contraction.

Silicone vs. Saline

Silicone and saline implants both have very similar safety profiles. During the early 1990’s, silicone implants got a lot of negative publicity for three reasons. First, the implants lacked the quality of what is available today, and they were prone to breaking and “leaking.” Second, the implant manufacturers had not performed enough long-term scientific studies to prove the safety of their implants. Third, there were no guidelines as to how closely patients with breast implants should be followed by their surgeons. Over the last two decades, the implant manufacturers have not only dramatically improved the quality of their implants, but have also studied and shown the long-term safety of their products, dispelling many of the fears that patients had in the past. Adding to the improved safety is the fact that we see all of our breast augmentation patients every few years to make sure their breast implants are intact.

The major advantage of silicone over saline implants is that they provide a more natural look and feel, because they are filled with a soft, silicone gel. The advantages of saline implants include a slightly shorter incision and, if they break, they deflate almost immediately, with the body absorbing the salt water. When a silicone implant breaks, it can be trickier to detect, but can be easily confirmed by an ultrasound or an MRI. Your surgeon should discuss with you the pros and cons of silicone vs. saline implants so that you make an informed, comfortable decision.

The final choice to be made is the size/volume and shape of the implant. Implants come in round or “tear-drop” shaped forms. Which one is most appropriate for you depends on the shape and dimensions of your breasts and chest wall. It is particularly important that your surgeon guide you through this process, and provide you with “sizers” during the consultation, as it will help you choose implants that are in proportion with the rest of your body. Your surgeon’s most important role at this point is to make sure that the implant you choose fits with the dimensions of your chest/breasts, ensuring a good-looking, long lasting result.

The Procedure:

A breast augmentation takes about 45 minutes to an hour to complete. We perform the entire operation via a 2-4 centimeter incision, through which we create a pocket (under or over the muscle) for the implant. Once the pocket is made, we sometimes use “sizers” (temporary implants) to determine which final implant size looks best for the patient. The sizers are removed immediately and the final implants are placed in the pockets. After confirming a nice, symmetric result, we close the incisions with absorbable stitches that are placed deep to the skin, leaving only a fine line at the incision site. At the end of the operation, we place small, waterproof dressing over the incisions so that the patients can shower at their leisure. After awakening from anesthesia, our patients are brought to the recovery room and are cared for by a dedicated recovery room nurse. Once the patients are comfortable and ready, they are brought home by a friend or family member. We provide everyone with antibiotics and pain medication for a few days.

Do I need a “breast-lift” as well?

The technical name for a breast-lift is “mastopexy.” Patients who have excess breast skin and whose breasts sag significantly often benefit from a breast-lift at the same time as the augmentation. While the implant does fill some of the extra skin, any excess must be addressed by doing a breast-lift at the same time. The benefit is a much-improved shape and better nipple position, resulting in perkier breasts. At the time of consultation, your surgeon can determine whether or not you would benefit from such a procedure

Do I need to be put to sleep for the operation?

We perform all breast augmentations under general anesthesia, and patients are completely asleep during the operation. This provides the safest and most comfortable environment.

What happens in the days following a breast augmentation (How long is the recovery time)?

For the first 48 hours, patients may experience some discomfort and are encouraged to take the prescribed pain medication as well as a 5 day antibiotic course. Showering is allowed immediately after surgery. The first post-operative appointment is typically 48-72 hours after the surgery. Implant “massage” (only for certain types of implants!) is demonstrated to the patients at this time. Patients can choose whether or not to wear a bra. The decision is based solely on their comfort. As for restrictions, patients can begin their daily lives as soon as they are comfortable, provided they avoid exercise, strenuous activity, or heavy lifting. Most patients will schedule a week to 10 days away from work. Most restrictions are lifted four weeks after the date of surgery, at which time low-impact cardio exercise can resume. There are no limitations after eight weeks. Follow-up appointments are scheduled at two days, two weeks, three months, one year , and every four to five years thereafter. The current recommendation from implant manufacturers is that all breast augmentation patients get an MRI of their breasts every few years to check the integrity of the implants.

Will my breasts look natural after the operation?

Patients are often concerned that their breasts will look “fake” after a breast augmentation. We reassure everyone that a natural-looking breast augmentation can be achieved. It all depends on technique and the choice of implant. Whether our patients want full, perky breasts or a subtle increase in size will determine how we perform the operation and what implant to use. These important details are discussed at length with all of our patients during the consultation.

How long do breast implants last?

Silicone and saline breast implants both last about the same amount of time before they “break.” Contrary to popular belief, there is no such thing as a breast implant that lasts forever. In fact, we tell all of our younger patients that their implants will likely have to be changed some time in the future. The chance that a breast implant breaks is about ½ percent a year. This means that, ten years after surgery, there is a 90-95 percent chance that the implant is intact.
If an implant does break, it should be removed and can replaced through the same incision.

Do breast implants affect breast-feeding?

It is a misconception that breast implants affect breast-feeding. Patients who undergo breast augmentation can expect to breast-feed normally, with no effect whatsoever on the breast milk or the baby.

What is the role of 3D imaging in breast augmentation?

The VECTRA 3D imaging system allows us to capture a patient’s face, breast, and body images in ultra-high resolution and show them the possibilities of their esthetic procedure. For our breast augmentation patients, we use their own image to explore possible outcomes (showing them how different implant styles and sizes may look), educate them about their options, explain limitations, and set appropriate expectations. It is a tool that has earned rave reviews from our patients!

What are the potential risks and complications?

Breast augmentation is a safe, predictable procedure. As with any surgery, there are associated risks and complications. These include infection, bleeding, asymmetry, decreased nipple sensation, implant malposition, “rippling,” and implant rupture. There is also a risk of capsular contracture, which is when the body produces a tight shell of scar tissue around the implant, causing it to “harden” and possibly shift position. While complications are relatively rare, they should all be discussed with your surgeon during the consultation process.

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