Breast Augmentation:

Frequently Asked Questions

These FAQ's are designed to help you with general information about a given procedure. They are not designed to give full detail, or take the place of informational consults with a Plastic Surgeon certified by the American Board of Plastic Surgery.

Are silicone implants available?

Silicone implants have recently been approved by the FDA for general cosmetic use. Patients choosing silicone implants are encouraged to register for national follow-up, but it is not mandatory.

What are saline implants?

All implants have two components: the shell (or envelope), and the filler material. In Saline (or salt water) implants the shell is made of a silicone polymer and the filler material is saline (salt water). In "silicone" implants, the envelope is the same silicone polymer, but the filler material is silicone gel. So both types of implants have silicone associated with them.

How is size determined?

We use a "biodimensional" technique to aid in size determination. Measurements of breast width, and height; the measurement of the distance between breasts, and the distance from the areola to the crease beneath the breast yield a group of implants which are anatomically appropriate for a given patient. From there, personal considerations, such as, activities, clothing styles, and artistic preferences, are factored in.

What incisions are used?

There are two basic incisions: transaxillary (in the armpit), and periareolar (below or around the areola). It is not that one is “right” and the other is “wrong.” There are good points and bad points to each incision.

A transaxillary incision leaves no scar on the breast, and the scar in the armpit is relatively unnoticeable (but you need to consider what you like to do and what clothes you like to wear). It is a more difficult approach, with a higher incidence of asymmetry, and will often need a general anesthetic.

A periareolar incision may allow for some lifting of the breast, Mastopexy, at the same time as augmentation. The scar is usually well tolerated as the color change between the areola and the normal breast skin tends to camouflage the scar. However, it may effect future breastfeeding; if the scar is suboptimal, it will be noticeable and there is a slightly higher risk of infection with this approach.

There are several other approaches which have been described (under the breast, through the belly button, etc.), I don’t think these approaches have any inherent benefit, and increase other risks.

Where are the implants placed?

Like incisions, implant placement has no "right" or "wrong" answer. There are two choices: Subglandular (under the breast tissue), and Submuscular (partially under the muscle of the chest wall - the pectoralis muscle).

Submuscular placement allows for better camouflage of the upper portion of the implant and a lower rate of capsular contracture. On the downside, it is more painful in the early postoperative period and gives less "lift" to the breast. Subglandular gives a better lift, but has a chance that it might show more.

It should be noted that these “downsides” are relative and depend on the size of the implant and the patient’s anatomy.

Will it effect my nipple sensation?

As many as 25% of women will notice a change in nipple sensation immediately after augmentation. This can present as either hypersensitivity (extra sensitive) or hyposensitivity (relatively numb). The bad news is that, it can effect both erogenous and tactile sensation.

The good news is that most women who notice a change, improve or return to normal over the next year. This sensory change is due to stretching of the nerve during the formation of the pocket for the implant. Over the next year as the nerve gets "used" to its new position, the sensation tends to improve.

Will it effect my ability to breastfeed?

Of women who have successfully breastfed one child, had breast augmentation, and gone on to have another child, most can breastfeed the second child. However, there may be some inability to breastfeed after augmentation, particularly with periareolar incisions.

What is “Capsular Contracture”?

“Capsular Contracture,” or hardening of the implants, is actually a natural reaction of the body to injury. When a surgical pocket is made to contain the implant, your body lays down a layer of scar tissue in the pocket, around the implant. As that layer of scar tissue matures, it contracts around the implant leading to hardening, and possible changes in shape.

Every woman who has implants has formed this capsule, but only a small percentage become symptomatic. There are various factors which may effect the capsule formation (implant type, position, etc.) These should be discussed with your surgeon. If a patient has symptoms, it may require removal or replacement of the implant.

What is the difference in implants?

As with incisions and implant placement, there is no “right” or “wrong” implant. They each have good points and bad points. There are now several choices in implants: “round” vs. “anatomic,” “smooth” vs. “textured,” and alternative filler material.

Round implants are the type of implant which have been around the longest. They may be either textured or smooth. If a patient wishes a smooth implant (see paragraph below), it will always be a round implant so it can move in the pocket while always looking the same.

“Smooth” implants are just that...smooth on the outside. This allows the wall of the implant to be thinner and more pliable. Textured implants, on the other hand, feel rough on the outside. While the wall of the implant is slightly thicker, the texturing appears to decrease the risk of hardening of the implants, and allows for use of an anatomically shaped implant.

“Anatomically shaped” implants tend to approximate the profile of the female breast better, which, has made them very popular. There are several different shapes. Because they have an orientation to them (wider at the bottom, narrower at the top when viewed from the side) they must be textured so as not to change that orientation once they are placed.

What effect do implants have on breast cancer?

Breast implants do not increase your risk of breast cancer. They can, however, make a cancer more difficult to detect in its early stage.

Women considering implants should have a baseline mammogram done. If you have risk factors for breast cancer, this should be discussed with your surgeon. Diligent monthly exams and regular mammography, as recommended by the American Cancer Society, should be observed. At the time of mammogram, you should make them aware of your implants and extra views will be taken to "see" around the implant. These precautions will reduce the risk of a delayed diagnosis.

Do implants need to be replaced after ten years?

The short answer is absolutely not. As long as a patient is happy with her implants they never need to be replaced. There may be reasons why one might desire implant replacement (usually related to the changes of aging). I had one patient who wanted her implants removed after twenty years as they “got in the way” during triathalons that she was now competing in.

How long will my implants last?

There is a risk that your implants may “wear out." As with all things, man-made, there is a certain failure rate with age. With saline implants this will lead to deflation. The risk appears to be about 1% per year (e.g., if you have your implants in for twenty years you have about a 20% chance they might deflate). If that happens, the implants can be replaced. Currently the manufacturers have warrantees which are designed to offset some of the costs should that happen.

If I need further surgery are there expenses?

It is the policy of this office not to charge a surgical fee for our patients who need surgery due to a problem with their implants. However, there may be other associated costs for which you would be responsible (new implants if needed, or hospital or anesthesia charges). We work with you and the vendors to try to keep these costs to a minimum.

See Breast Augmentation Procedural Photos