Answers to Common Breast Augmentation Questions
Article by Jeffrey Horowitz, MD
Baltimore Plastic Surgeon
Breast augmentation is second only to liposuction as the most popular cosmetic surgery performed nationwide. I noticed that a lot of patients ask many of the same questions about the surgery, so I thought it would be helpful to list the answers here.
1. What size implants are the best for me? – I work with each individual patient to find the answer to this question. The implant base diameter has to match the width of your breast so some implants are simply too big or too small. Once we decide on the width of the implant, we then decide on the amount of projection, either low, medium or high. This decision depends on how large the patient wants to be and how elastic the breast tissue is. Finally, there is an element here that cannot simply be measured and calculated. You and I will discuss what your goals are in breast augmentation surgery and how to pick the size implant that satisfies these goals.
2. Are silicone or saline implants better? – Neither implant is “bad” but the consensus is that silicone gel implants look and feel more natural. I tell my patients that to get silicone implants, you need to be comfortable with two things : the safety and the cost of the implant. Although silicone implants lost FDA approval for cosmetic indications in 1992, they were re-instated in 2006 and there has never been any real evidence that the implants were harmful. The other issue is silicone implants are more expensive than saline.
3. I heard that “gummy bear” implants are better. – These implants, also called “highly cohesive” implants, are more “form stable” than the implants we use now. This means that they are more likely to retain their shape long term. This is misleading because the implants we use now are quite “cohesive” themselves. If you were to cut one in half, the gel is so thick it would only bulge out very slowly.
It’s not clear if the gummy bear implants will be superior because they are shaped and textured. I always use round and smooth implants now. Texturing may decrease the chance of the tissue around the implant getting tight, but it also may cause more visible rippling. Shaping the implant like a teardrop sounds good but it is not appropriate for the shape of every woman’s breast.
4. What incision is best? – I offer breast augmentation surgery through three incisions : In the underarm, under the areola or under the breast. (I don’t recommend placement through a belly button incision because it is difficult to place the implant precisely using this method and the scar may be unsightly).
If you don’t want a scar on your breast at all, the underarm approach may be right for you. The downside is that only small silicone implants can be placed in this way and the scar may be visible to others in clothing or bathing suits that expose this area.
oth infra-areolar and infra-mammary incisions are popular. The infra-areolar incision is camouflaged because it is at the junction of the areolar skin color and the breast skin color. The downside is that it is more visible in the frontal view. The incision placed under the breast (infra-mammary) is only visible from underneath but does not have the camouflage advantage of the infra-areolar scar. I work with each patient to help us decide which approach is best for you.
5. Will I need another operation in the future? – There are several reasons why breast augmentation patients may require another operation in the future. Reasons for re-operation include rupture of implant, or the tissue around the implant becoming tight, a condition called capsular contracture. Some patients have their implants replaced because they want to be even larger. Having said that, the implants do not have an “expiration date”, and if you remain pleased with your appearance, you may never require another operation.
6. What if the implant ruptures? - If this happens, the implants will need to be replaced. Both major implant companies offer warranties that cover replacement implants and provide financial assistance if your medical insurance does not cover all of the expenses.
7. What if I want my breasts to be larger and lifted? – Although the implant itself lifts the breasts, if your breasts are significantly ptotic (meaning droopy), you will require a mastopexy (breast lift) in addition to your augmentation. I frequently perform both operations at the same time.
8. How long will I be out of work?- This depends on what kind of work you do. You cannot lift anything heavier than 5 pounds, nor do vigorous exercise for two weeks after your operation. If your work does not require you to do this, you can go back when your pain allows, which is usually in one week.