Breast Augmentation

A conversation about breast augmentation with Sheri Slezak, M.D., chief of plastic surgery at the University of Maryland:

If you are considering breast augmentation, consider the following questions to discuss with your surgeon.

Q: How can I determine what size is right for me?

A:

Some women want to be one cup size larger, and they do not plan to tell anyone that they had augmentation.  Others want to make more dramatic changes and will tell all their friends and family. Implants come in ccs, a measure of volume, not in cup sizes.  The same size implant on a 5’ 1” woman will look much bigger than on the wider chest of a 5’10” woman.  Most women choose a size between 200 and 450 ccs.  Final cup size depends on how big your breast is before augmentation, and what line of bra manufacturer you like. We have patients try on implants in the office to help choose their desired size.

Q: What are the differences between having the implants placed above versus below the pectoralis (chest) muscle?

A:

Each location has advantages and disadvantages. Below the muscle means that the top of the implant is covered by the muscle; the lower one third is generally not covered by the muscle as the muscle is quite short. Under the muscle is better on mammograms and shows fewer wrinkles. Implants placed under the muscle are deeper inside your body and tend to feel more natural. This placement has a lower rate of capsular contracture, or hardening of the implants.  However, you will be able to move your breasts a bit when you contract your pectoralis muscles. Above the muscle is less painful and has a shorter recovery.  Implants above the muscle age well as they sit lower behind the nipple.  Implants above the muscle do not interfere with any muscle action.  However, these implants are closer to the skin, therefore the edges and wrinkles may be more evident and palpable. Ask your doctor to point out any specific concerns about your breast anatomy (or your muscle use, job, hobbies) that make one position better than the other for you.

Q: Do I want saline or silicone implants?

A:

Both implants have the same outer membrane of silicone, but a saline implant is filled at surgery with salt water, and a silicone implant is pre-filled with a silicone cohesive gel. Saline implants feel firmer and more rubbery, like a water balloon.  Silicone implants feels softer.  Saline implants require no special tests to detect rupture. However, if you rupture, the water is dispersed throughout the body, and you are flat within 24 hours. Silicone implants look the same after rupture because the silicone is not absorbed by the body.  Ultrasounds or MRIs are needed for the detection of a rupture. Silicone has no known health risks at this time. All of the concerns about ruptured implants in the 1980s have been disproven. All modern implants are cohesive, meaning they have the consistency of gelatin and are no longer liquids that ooze. Read the FDA website on implants.

Q: What is the difference between round or profiled (teardrop-shaped) implants?

A:

Most augmentation candidates have small breasts and desire some upper pole fullness; therefore they like a round implant. Teardrop-shaped implants need a larger incision to insert and have a risk of shifting. Teardrop-shaped implants are more commonly used in breast reconstruction after cancer.  

Q: What are the different types of incisions for inserting the implants?

A:

The two types of incisions used for augmentation are areolar or inframammary incision.  An incision in the lower edge of the areola heals well, and the scar is hidden, but this can give some nipple numbness. Areolas must be a certain size to have this type of incision. An incision in the breast fold (inframammary) heals well, is not generally seen, and gives better entry to place the implant under the muscle.

Q: Where will the surgery be performed?

A:

Surgery can be performed at the hospital, surgicenter, or clinic operating room.  Breast augmentation is an outpatient procedure and most patients go home after they wake up from anesthesia. Patients may have an anesthesiologist or a nurse anesthetist. 

Q: How long will my recovery be?

A:

Most patients are in moderate pain for two to five days, requiring pain medicines. You wear a surgical bra day and night for the first week.  We let our patients remove it daily to shower and wash their hair, starting on the first day after surgery.  The second week is better, but activities must still be kept light. You will not be able to do chest muscle workouts for four weeks. Your surgeon will advise you when you can return to normal physical activity.

Q: How long do breast implants last?

A:

This is a very important question. It is critical for patients to understand that breast implants do not last forever, and will need to be replaced. Breast implants all eventually rupture. One estimation is that many implants rupture and need to be replaced after 15 or so years. Sometimes an implant manufacturer will replace your implant for free and help with operating fees if it ruptures within 10 years.  After a certain amount of time passes, the patient is responsible for the costs of having them replaced.

Q: What are the other possible complications of breast implants?

A:

Most patients have no complications, but possibilities include bleeding (2%), infection requiring removal of the implant (2%), nipple numbness (10%), capsular contracture (10%), wrinkling (5%), asymmetry (90%), scars (100%), and eventual rupture (100%).  Implants do not increase or decrease the risk of breast cancer, and patients will still need mammograms after age 40.

Q: How much does it cost, and will insurance pay for it?

A:

Costs range from $6,000 to $8,000, depending on where the surgery is performed, and whether the patient chooses saline or silicone.  Augmentation is a cosmetic operation and is not covered by insurance. Patients should ask their surgeons about financing options . The University of Maryland Division of Plastic Surgery also offers a resident cosmetic clinic with lower prices.

Q: Are most breast implants patients happy?

A:

Yes! They are pleased with their new look and enjoy increased confidence. They look proportional in clothing and swimwear, and are delighted with a fuller yet natural look.

This page was last updated: August 6, 2013

         
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