Breast augmentation has become the third most common cosmetic surgery performed in the U.S. The major reasons for this are the development of safer implant techniques, the improved safety of the implant itself, and the ability to perform the procedure without general anesthesia.
We hope the following information will help you decide if this operation is right for you, and which size and type of implant route you would prefer. Please note that this page is designed to give you a brief overview. It is NOT a complete discussion of this procedure and its risks. A final decision should only be made after you have had a physical examination and an opportunity to ask all questions important to you regarding the procedure. Please contact our office if you have any other unanswered questions.
The most important factors in a successful outcome is your own attitude, desire and approach to this surgery. It is important that you do this for yourself and not for someone else. When you come in for your operation, we want you to be absolutely sure this is what you want to do. Finally, your satisfaction with this operation is very important to us. Please be sure we answer all of your questions and concerns before surgery.
Thank you for considering our office to perform your breast augmentation.

SHOULD I GET MY BREASTS ENLARGED?

It is very important that your decision to undergo this operation is based on your personal desires and what you want. If you want breast enlargement to please someone else, like a husband, partner, or boyfriend, you should carefully reconsider your decision. It is also important to have realistic expectations. Breast implants make small breasts larger. They can often be used to help improve the shape as well. However, breasts made larger by implants have the same tendency to droop as the same size breasts without implants. Significant drooping and sagging cannot be corrected with implants alone, unless it is due to loss of volume (such as after pregnancy or breast-feeding). Only an illusion of a lift and not a true breast lift can occur
with implants. The shape and exact size of your breasts after the surgery are impossible to predict beforehand. However, nationally, 90-95% of all women who have undergone this procedure are happy they did so.

WHAT IS A BREAST IMPLANT?

A fluid-filled or Silicone plastic form, usually round, which is placed under your normal breast tissue to enlarge and shape the breast. The goal is to give you larger breasts. Sometimes, the implant will also lift the breast somewhat.

SALINE OR SILICONE?

Silicone gel implants have now been approved by the FDA. Silicone breast implants have been a source of great controversy since the 1980ʼs, when a variety of illnesses were blamed on leakage of silicone from the implant. Prior to that, they were the most common form of breast implant. Due to some safety concerns (most of which were not nearly as serious as first thought), these products were withdrawn from the market. They are now available. What’s the difference between gel (silicone) and saline? The major advantage of silicone is that it is more natural feeling than saline. Disadvantages: larger incision, increased cost (implants cost nearly twice as much as saline), and higher risk of leakage (about 15% of patients will have a leak within 10 years), so they cannot be considered a permanent implant. Also, an MRI (looking for evidence of leakage) is recommended in 3 years from the date of implant, and every 2 years after that. This cost may not be covered by insurance plans.

WHAT SIZE SHOULD I GET?

This mostly depends on your own wishes. Implants come in a large variety of sizes. However, based on your anatomy, we may only be able to go up to a certain size. We can typically achieve a 2 cup difference. We will do our best to give you what you want, but the final decision as to the exact size will have to be made at the time of surgery, when we can see how the implant looks on you.

HOW IS IT PLACED INTO THE BREAST?

There are numerous ways to place the implant into the breast. Our office uses 2 methods: periareolar, and inframammary. Periareolar involves making a small incision (cut) in the areola, directly under the nipple, and creating a pocket to hold the implant. Then the implant is inserted and the incision is closed. It usually heals with minimal scar or deformity. Inframammary placement involves making a short (about 2-3”) incision under the breast itself, in the breast fold, placing the implant through it, and then closing the incision. It leaves a small scar that is usually covered by the breast itself, but it can be seen if the breast is lifted. Each of these techniques has their advantages and disadvantages. We will discuss these with you in detail during your consultation, and help you decide which is best for you.

SHOULD I GO ABOVE OR BELOW THE MUSCLE?

Nowhere in cosmetic surgery is there more controversy than whether to place implants above (subglandular) or below (subpectoral or submuscular) the pectoralis muscle. Each side argues passionately about the benefits of their approach. The major arguments for subglandular are that it is more natural (after all, your own breast tissue is above the muscle), and some droopiness can be corrected. The proponents of the submuscular approach believe it gives a less artificial contour, hides rippling better, and has a lower rate of capsular contracture. A newer technique, called subfascial, may offer the best of both worlds. In this technique, the implant is placed above the pectoral muscle, but below the fascia (covering) of the muscle. This way, the muscle does not have to be lifted off its attachments to the ribs, but its fascia can be used to cover the implant, giving it a smoother look and camouflaging any rippling that may occur.

WHAT ARE THE RISKS?

Although this is a generally very safe procedure, it is still surgery, and complications can occur. Possible problems with the surgery itself may include bleeding, bruising, infection, hematoma (blood collection), seroma (fluid collection), numbness, unsightly scar or discoloration. If you are a smoker, the risks of infection and poor wound healing are much higher. Possible problems with the implant include capsular contracture (scar tissue formation around the implant squeezing it and causing hardening), deflation, asymmetry, rippling, and leakage. In some people, the implant edges may be visible or palpable. The areola (the brown skin around the nipple) may stretch to a larger size. On rare occasions, if the problems are severe enough, repeat surgery or removal of the implant may be necessary. Mammography may be less sensitive in patients with breast implants. It is important that you understand these, and other risks which may occur with this operation. We will discuss these with you, and they will be detailed in the consent form. Please read the consent form carefully before signing. It is important to us that you are fully aware and informed before consenting to a procedure.

DO I NEED GENERAL ANESTHESIA?

No. One of the most significant advances recently has been the ability to perform this procedure under conscious sedation and local anesthesia. You will be very drowsy and have NO recollection of the procedure and experience no discomfort. General anesthesia is available if requested, but there is an increased cost.

DO I HAVE TO GO TO THE HOSPITAL?

No. All procedures are done in a fully-accredited surgery center. You will be able to go home approximately 1 hour after the surgery, when you are fully awake. Because of the sedation we use, you will not be able to drive, so you must arrange for a ride home.

WHAT IS THE RECOVERY TIME?

Just a few days. You will be up and around immediately, and can return to non- strenuous work in 2 or 3 days. You should not exercise or do hard physical work for about a week. We will have you to wear a sports-bra for about 3 weeks, after which you can wear any type of bra you like. Initially, your breasts will be higher and project further out. This settles down in a few weeks, and the breasts assume a lower, more natural position.

IS THERE MUCH PAIN?

No. Before we start the surgery, you will feel a few small pinpricks as we put in the numbing medicine. You should feel nothing during the surgery itself. As you can guess, there is a little discomfort afterwards, from the inflammation and swelling caused by the surgery, and the distention caused by the implant. This is typically mild, and Tylenol or prescription pain medication is usually all you need to control the pain. If the implant is placed under the muscle, pain is a little more significant. Doing arm exercises, which we will teach you, will significantly reduce post-op pain and recovery time.

WHAT DO I NEED TO DO TO PREPARE?

You will need to get a few simple lab tests to check for anemia, clotting ability, and a pregnancy test. If you are over 40, a recent mammogram (within a year) is needed.