Breast Augmentation - Frequently Asked Questions
Q. What incision do you use?
- Inframammary: The incision is located on the lower part of the breast, just above the crease under the breast.
- My second choice in periareolar as makes use of the natural border around the areola to hide the scar.
- I rarely use the axillary incision that leaves a scar in the armpit. It is more difficult to dissect the breast pocket because the incision is more removed from the area of dissection
Q. Over the muscle or under the muscle?
- Under the muscle. The breast appears more natural, feels more natural, and there is less risk of a capsular contracture.
Q. Do you use contoured implants?
- Rarely. As it turns out, it's hard to tell any difference between round and contoured implants when they are in the body. Contoured implants are textured and I prefer smooth implants because they don't leak as much. Also, contoured implants are more expensive.
- Do I have to have them changed out every ten years?
- This is a common question. No, there is no need to have breast implants replaced in ten years. If you do not have a deflation, they may last much longer than ten years. The warranty is for ten years (I think this is why some patients think they only last ten years. They think that, like the washing machine, it will break down immediately after the warranty expires). You should count on having another breast operation at a future date, whether it is in six months or 15 years, we do not know. The most common reasons are to change to a different size (usually larger), to release a capsular contracture, or to replace a deflated implant.
Q. Will I lose feeling in my nipples?
- Forty percent of patients report at least temporary decreased sensation of their nipples, but it almost always returns to normal.
Q. Should I wait until after having children?
- There is no medical reason to wait.
Q. Can I still breast feed?
- Breast augmentation does not interfere with your ability to breast feed. Keep in mind that not all women can successfully breast feed. However, if you've successfully breastfed your children before, it is likely that you will still be able to nurse after your augmentation.
Q. Should I have a mammogram first?
- It is recommended that women over 35 have a mammogram before having breast augmentation. You can have mammograms after the breast augmentation, but it is best to schedule this at least six months after your breast augmentation, unless there is a medical reason to do so earlier. Keep in mind that the mammographer has to do special views which involve more manipulations of the breast.
Q. What is the risk of deflation?
- About one to three percent over ten years, using saline-filled implants.
Q. Silicone or saline?
- Saline is recommended for most patients. In considering the pros and cons, most of the "pros" are in the saline category. However, if you are very thin and have very little breast tissue, and are concerned about wrinkling, you may consider silicone.
Q. How do you know what size to use?
- The selection of size is more art than science. Although there are measurement systems available, these tend to underestimate implant size. Inserting implants in the bra is not particularly helpful because this does not accurately reflect the change in size that is created by an implant that is placed in the body.
- Ideally, the patient achieves the size she wants in one operation. After talking with my patient, examining her, and looking at pictures of other patients with her, I have a good idea what she wants. Some women bring magazine photos, which is helpful too.
- In my practice, almost no one says they are too large at the time of their one-month follow-up appointment. This is not to say that surgeons do not put in overly large implants. Some do and I've certainly had the occasion to down-size patients treated elsewhere.
- I do have the occasional patient that wants to be larger. Over a five year period, five patients returned for larger sizes. No one returned to have the implants changed to a smaller size. It is often difficult even for patients to know what size they want before surgery. Some patients become more appreciative of their breasts after surgery and less inhibited about a larger size. That is why it is important for me to bring my own judgment and experience into the decision-making process.
Q. When can I return to work?
- Most patients return to work in a week, but there certainly is a range. Some women get back to work in a few days and others are glad they took a week off. If you have a physical job, two weeks off is better.
Q. Do you use a pain pump?
- No. Although it sounds like a good idea, "pain pumps" (actually local anesthetic infusion devices) have not worked well in practice. Patients find them cumbersome and pain scores with the pump were not significantly better than patients treated without a pump in a controlled double-blind study.
