What are the types of implants available?
There are different implant fill material, shapes, and textures for your Breast Augmentation. Implants can be filled with saline (salt water) or they can be filled with a silicone gel. Both have a proven safety record with the FDA. There are a variety of implant shapes. Both saline and silicone implants can be low profile round, medium profile round, and high profile round. This refers to the relationship between the diameter (width) of the implant and height (projection) of the implant. The newer silicone gel implants can also be anatomic, or tear-drop, shaped. The outer shell of the implants can be smooth or textured. Selection of the implant is a comprehensive decision made between you and your Plastic Surgeon. Your surgeon will discuss all your options and make recommendations based on your desires, body type, and specific surgical technique that you require.
How do I choose my implant size?
Choosing the size of your implant will be a decision made by you and your surgeon. It will depend on your body shape and what type of look you are going for. Implants come in sizes ranging from very small to very large. It will be a balance between what you want and what your body can handle. Some surgeons have computer software that allows them to morph your photos and show you what you will look like after the surgery. This software has a “wow factor” but I have found that simply trying on the implants in a variety of clothing will give a really good idea of what you can expect.
Where are the scars?
Scars are the result of the incision used to place the implants. Breast Implants can be placed through the underarm, around the areola, or the breast crease. Each has advantages and disadvantages. Your surgeon will go over all these options in detail, with specific attention to the potential complication of each approach. In some cases, a breast lift may also be required and will require additional incisions and resulting scars.
Should the implants be put over or under the muscle?
Breast implants can be placed either above or below the chest muscle (pectoralis major muscle). In general, placing the implants below the muscle have a lower complication rate because the muscle helps to protect the implant from infection and capsular contracture. In addition, implants under the muscle coverage tend to have a more natural result because the layer of muscle helps to camouflage the implant better. Placing your implants under the muscle does result in more pain during the initial recovery period. There may be some situations where over the muscle is better, such as in the case of mild pre-existing breast droop, competitive body builders and fitness models, or athletes who rely on the uninhibited use of their chest muscles.
What is capsular contracture?
Capsular contracture is the formation of a thick capsule of scar tissue around the implant. This can cause hardening, distorted appearance, upward migration of the implant, or pain. There are varying degrees of severity and mild contracture does not need any treatment but more advanced cases will need surgical intervention and possible implant removal. This may occur within months of your surgery or may take years to develop.
What causes capsular contracture?
Unfortunately we do not know all the reasons for capsular contracture formation. It is likely the result of bacteria, blood, foreign material such as lint and glove powder, or just an over active inflammatory response by your body to an implant. Fortunately, newer implant material and better surgical techniques have greatly reduced the incidence of capsular contracture. We also know that certain incisions carry a much higher rate of capsular contracture. This is why many surgeons have moved away from using the underarm or areolar incision for breast augmentation.
How long is the surgery and what is the anesthesia used?
The surgery is done under general anesthesia or a twilight anesthesia. It takes an experienced breast surgeon about 1.5 hours.
What is the recovery like?
The recovery will vary slightly depending on the technique your surgeon uses, your pain tolerance, and the size of the implants used. When using a rapid-recovery technique, my patients experience pain and pressure for a few days and most are back to non-strenuous activity in about 5 days. They can resume full exercise and heavy lifting in 2 weeks. Speak to your surgeon about what you should expect.
When will I see my final result?
You should expect to have some bruising and swelling for a about 2 weeks. During this time, your breasts may look slightly larger than you wanted. This is normal. The implants will drop into position over the first few weeks or months. Most people are extremely happy soon after surgery but will continue to look better and better and should expect to see the final result in a few months.
Can I breast feed after implants?
When implants are placed under the muscle through a breast crease incision, there should be virtually no effect on your ability to breast feed. I caution my patients that not every woman without implants is able to breast feed. Sometimes there is just not enough breast tissue to produce enough milk, but this is unrelated to having breast implant surgery. There are no health concerns to your or your baby if you breast feed with breast implants.
Do I need to change them every 10 years?
No. Breast implants are not car tires. As long as they are not leaking, have not capsular contracture, and you are still happy with the size, you can leave them forever. They do not need to be changed every 10 years. This idea came about because all the implant studies were only carried out to 10 years and showed that if you are going to develop an implant related complication, it is likely to occur within the first 10 years.
Will this affect mammograms and cancer detection?
No. Breast implants are extremely common and there are specific mammogram techniques used in women who have breast implants. When you schedule your mammograms, you need to make sure you tell them about your breast implants.
How do I choose my surgeon?
You should find a board certified Plastic Surgeon who is experienced in breast augmentation. You should view before and after pictures of their actual patients and they should be able to provide you with patients who are willing to speak with you about their experience. You should go on several consults to see whom you connect with. Do not base your decision solely on price. As you can imagine, the best and most experienced surgeons are not likely to be the cheapest.
What is the price?
The price will vary between region, surgeon, and implant type. Keep in mind that there are several costs that make up the total fee. These include the cost of anesthesia, cost of the operating room or operating facility, the implant cost, post-operative care, and surgeon fee. Most offices will be able to give you the price if you call and ask. Make sure that they are clear about what this price includes. Many unscrupulous offices advertise a very low price, but fail to tell you that the low price is the surgeon fee only, and there are additional fees that may be several thousand dollars more!