Frequently Asked Questions: Breast Surgery & Implants

1. Breast Lift vs. Breast Augmentation: How to tell which is needed?

This is often difficult for patients to figure out before they come in for consultation. The nipple position, in relationship to the infra-mammary fold (IMF) or lower breast crease, is the most critical factor in determining whether a lift is needed. If the nipple is above the IMF, an implant alone will give a nice result. If the nipple is at the fold, a lift may or may not be needed, and these patients are considered “borderline”. Other factors like skin quality and desired size are factored in to determine if an implant alone will achieve the patient’s desired result. If the nipple is below the IMF, a lift is necessary to reposition the breast tissue higher on the chest wall. Placing an implant but not performing a lift in these patients leads to a “snoopy deformity”, where the implant is at the proper position on the chest wall, but the breast tissue is too low. The breast tissue then slides or waterfalls off of the implant, and the patient’s profile view looks like Snoopy.

2. Can breast implants lift slightly sagging breasts?

If the ptosis or sagging is mild, an implant alone can lift the breasts. Again, it’s all about the position of the nipple in relation to the IMF. We sometimes have patients do the “pencil test” at home. This is where a pencil is placed under the IMF. In general, if the pencil stays, the breast tissue is too low and the patient most likely needs a breast lift. If the pencil falls, a lift is usually not needed. This “test” is not an absolute but is helpful for patients to try at home so they can begin to understand the importance of the nipple and the lower breast crease.

3. How do I choose a breast implant size that’s right for me?

We believe this is the most important part of the breast augmentation consultation. We’ll spend a lot of time with you discussing your desired look. Do you want a very natural look or a very augmented look or something in between? We’ll look at pictures together and try on various size implants in a bra to determine which one gives you your desired look. The sizes you try on will be based on several measurements taken of your chest wall and your desired fullness. The implant options are almost limitless with regard to cc’s and profiles. We take our job of finding the perfect implant for your body very serious. Intra-operative sizing will also be done before your final implants are selected. This allows us to see exactly what a particular implant will look like in your body before the final device is chosen.

4. Can I have breast implants if I’m planning to have kids in the future?

Yes, many women decide to undergo breast augmentation before starting a family.

5. Can I breast feed if I have breast implants?

Breastfeeding is a complex activity, and some women cannot breastfeed even though they haven’t had surgery on their breasts. Our surgical approach minimizes division of breast tissue to optimize your chances for successful breastfeeding.

6. What is the best shape of implants to achieve more natural looking results?

There is no best shape or best implant. It’s all about finding the best implant for you. We’ll examine carefully your native breast for things like shape, size, symmetry, and position on the chest wall. This analysis will guide us in choosing the best implant for your desired result.

7. Do silicone implants harden over time?

The implants themselves do not harden over time, but the tissue around the implant, also known as the capsule, can harden over time. This is called capsular contracture. Our goal is to minimize your chances of developing capsular contracture. Studies have shown that the inframammary approach (incision in the crease), placement of the implant under the muscle, use of triple antibiotic irrigation and use of the Keller Funnel all decrease the incidence of capsular contracture, and we utilize each and every one of these techniques.

8. Do breast implants need to be replaced over time?

We don’t know when and if you will ever need replacement of your implant(s). We no longer advise patients to change their implants every 10 years because current implants have lower rupture rates than implants of prior generations. Breast implants should not be considered lifetime devices, and all patients undergoing breast augmentation should assume at some point in their lives, they may need another operation or revision.

9. What can I expect during breast augmentation recovery?

Our patients always comment on how much easier their recovery was than expected. We utilize two different recovery programs. The first is the more traditional route, where the patient is given pain medication and muscle relaxants after surgery. Patients generally take these medications every 4-6 hours for the first 3 days after surgery and then start to taper off. Most patients take 4-7 days off of work. Our newer recovery program is called the 24 hour or 1 day breast augmentation recovery. A special medication called Exparel is injected into the muscle and surrounding tissues at the time of surgery. Exparel is a long acting local anesthetic that gives pain relief for 4-5 days. Patients will still take a muscle relaxer each night, but they don’t require narcotic pain medication, so they are able to return to work faster, and they report feeling “normal” the day after surgery. We’ll discuss both options and your lifestyle at your consultation and decide which recovery program is best for you.

10. What is your advice for exercise after breast augmentation?

We like for you to rest your pectoralis or chest muscles for the first few weeks after surgery. Avoid cardio and lifting heavy things for 3 weeks after surgery. This minimizes any bleeding around the implant and gives you time to fully heal. All restrictions are lifted at 6 weeks.

11. Silicone vs. Saline: Which breast implant is safer? Or are there any other safe options?

We recommend silicone gel implants to 99% of our patients. They offer the most natural look and feel. These implants are FDA approved and are very safe.

12. What are the risks of breast implants?

Risks of breast augmentation include bleeding around the implant, also known as a hematoma, infection, capsular contracture, rupture, persistent asymmetry, malposition, temporary or permanent loss of sensation, scarring, inability to breastfeed and generalized dissatisfaction. That being said, complication rates are low when the surgery is performed by a board-certified plastic surgeon that specializes in breast augmentation. Breast augmentation is one of the most popular cosmetic surgeries performed around the world with millions and millions of women who are thrilled with their results.