Breast Surgery

Frequently Asked Questions About Breast Augmentation

1. About Breast Implant Placement: Most saline implants are placed beneath the pectoralis major muscle to prevent or lessen the chance of any visible wrinkling through the skin. The muscle provides an extra layer of tissue between the implant and the skin to provide a more natural appearance. Silicone implants can also be placed beneath the muscle, but this is not universally necessary. Access to the space beneath the muscle can be made through any of the acceptable surgical incisions.

2. Accurate Bra Sizing And Measurement: The actual cup size does not always correlate with the volume of the implant. The bra size is a measurement between the circumference around the most full part of the breast and the ribcage beneath the breast. This varies depending on the patient’s height and weight. A general rule of thumb is that one-cup is approximately 250 cc. This is for the average sized female. Accurate breast implant sizing can be done in our office with the use of the breast implant sizers and a form-fitting bra. We would be happy to assist you in making a reasonable estimate of desired breast size.

3. Antibiotics: Do I Need Them To Get My Teeth Cleaned?: All the patients with breast augmentation receive prophylactic antibiotics before, during, and after their surgery. There is a slight chance that breast implants could become infected at a much later date, if there is a source of infection elsewhere in the body. One of these can be from the mouth. If a teeth cleaning or root canal is to be done, we typically recommend prophylactic antibiotics. A routine teeth cleaning, however, does not require antibiotics.

4. Arnica-What is it?: Arnica is an herb that is used in holistic medicine, but can also be used in conventional medicine and plastic surgery for the prevention of and treatment of bruising. Arnica does not prevent the bruising, but it facilitates the disappearance of bruising faster than would normally we expect. The bruising with breast augmentation is minimal and Arnica is not necessary. Arnica is typically used for facial surgery.

5. Body Building/Working Out Issues: Since the implants are typically placed beneath the pectoralis major muscle, this puts excessive stretching on the muscle and physical activity with this muscle should be minimized until healing is complete. Passive range of motion of the arms to stretch and help relax this muscle is advisable after 24 hours from surgery, but heavy lifting and bodybuilding should be postponed until complete healing has occurred typically four to six weeks after surgery.

6. Bottoming Out: Bottoming out is an unusual phenomenon that typically occurs months to years after breast augmentation when the position of the implant becomes too low in relation to the breast itself. This is a correctable problem, but would require another operation. The operation to correct this would require removing the implant, tightening the capsule that has surrounded the implant along the fold, and replacing the implant to higher position. Typically, this is very successful and long lasting.

7. Breast Implant Registry-How Do I Get Registered?: All breast implants are registered with a serial number and lot number. After surgeries, you will be given a registration card, which has this information. This information is also kept in our office in a computer program and in your physical record. If you choose to purchase an extended warranty, these numbers are used on the application for this warranty and the company will issue a certificate to you indicating this warranty.

8. Breast Lift And Mastopexy: Occasionally, breast augmentation alone is not sufficient to fill out the skin envelope that has resulted from weight loss or breast-feeding. If the nipple has descended below the fold under the breast, then a breast lift may be necessary. This is called a mastopexy and would require additional cutting and would result in additional scars typically around the nipple.

9. Breastfeeding With Implants-Safe?: Breastfeeding is commonly done after breast augmentation. There possibly could be difficulty if the incisions had been made around the nipple and this case some of the milk ducts would have been cut at the time of the breast augmentation. To assure best success with breastfeeding, it is recommended to place the surgical incision in the fold or through the armpit.

10. Capsular Contracture-What Is It?: Capsular contracture is a rare phenomenon that occurs when a layer of scar tissue, which normally forms around the implant, begins to tighten round the implant. In most cases, this capsule is kept loose by massaging techniques, but in some instances, this capsule can contract causing the entire breast to feel very firm and abnormal. This can also occur when the breast implant is ruptured; typically a silicone implant can stimulate capsular contracture, if it is ruptured. There is a treatment for capsular contracture, but it would require a surgery to remove the implant and the capsule and replace another implant. In these cases, the results are very satisfactory.

11. Children-Is It Necessary To Wait Until After Having Children Before Having Breast Augmentation?: About 50% of patients who have breast augmentation do so before having children. In these cases, the overlying skin is much tighter than a woman who has had previous children and the recovery may be more difficult. It also is possible that after having children, the new breasts will descend and become much lower possibly resulting in a need for breast lift. When a woman has had children and lost breast volume and then undergoes a breast augmentation, the results are typically better because the implant is replacing the loss of volume and the skin is not excessively tight.

12. Cohesive Gel Implants-Tell Me About It: Silicone implants several years ago were made of a gel, which was very thin and had the consistency of the syrup. The newer implants today are made of a cohesive type silicone gel, which resembles Jell-O and therefore maintains cohesiveness with itself. This is important because if an implant breaks and the removal of the gel is much easier.

14. Double-Bubble: Double-bubble can occur in a patient who has a very short distance from the nipple to the fold beneath the breast. In these cases, the fold needs to be lowered when a breast implant is placed. If the fold is very deep and well defined, then it can result in a crease along the lower aspect of the breast creating a double-bubble deformity. The surgical means of correcting this is by cutting the breast tissue internally to release the old fold and typically with time, this will resolve by itself. Occasionally, a breast lift is necessary to correct the shape and form of the breast, if the double-bubble occurs.

15. High Profile Implants: In the last few years, advancements have been made in the development of different profiles of implants. Both INAMED and Mentor make implants of various profiles. Typically, there are three profiles, a low profile, a moderate, and a high profile implant. The profile relates to the measurement of the projection of the implant in relationship to its width. Since there are many sizes and profiles to choose from, it is much easier now to find an implant that fits the patient’s body without being
extensively wide.

16. Implant Valves Failure and Leaks?: All saline implants are filled through a valve by a fill tube at the time of surgery. Once the fill tube is removed, the valve seals. It is possible for this valve to leak, especially if tissue grows into the valve at a later date. The valve failure is extremely rare and most often when an implant leaks, it is due to a physical breakdown of the portion of the shell away from the valve.

17. Incision Locations-Which Is Best For Me?: The three acceptable incisions for breast augmentation are around the nipple in the fold beneath the breast or through the armpit. The patient’s anatomy, with decision to breast-feed, the color of the skin and the nipple, as well as the type of scarring the patients experience will all be used to determine, which incision is best.

18. Inverted Nipples And Inverted Nipple Repair: If the nipple is inverted, placement of an implant may correct this problem. If this does not correct the problem, releasing an inverted nipple can be done at the time of her breast augmentation. This is done by cutting the ducts leading to the nipple and allowing it to project in a normal manner. The patient should be warned that correction of an inverted nipple would make it improbable that nipple will be successful in future breast-feeding.

19. Manufacturers Of Saline Implants: There are two main manufacturers of breast implants in this country today. The Federal Drug Administration has required expensive documentation of research and development for various breast implants and only two companies have fulfilled the requirements. These companies are Allergan/Inamed and Mentor Corporation. Both of these companies make excellent implants of various sizes and styles to fit every need.

20. Mondor’s Disease Aka Mondor’s Cord: A Mondor’s cord is a long and hard line, which is felt as a cord, which begins at the breast and extends down on to the abdomen and occurs after breast surgery. It is very rare. It is usually nonvisible, but is able to be felt by the patient. Typically, it resolves completely with time and no treatment is necessary.

21. Noises-Can Implant Slosh, Gurgle, Or Make Other Sounds?: Breast implants are placed at surgery into a space that is created beneath the muscle. In doing so, some air will enter into the space. After the surgery, it is common for the breast implant to make some sounds when massaged or manipulated. However, there is no air within the implant once it is filled and therefore, there should be no additional sloshing or gurgling, which can be heard or felt by any other people. The initial sounds that occur after surgery completely disappear in the first few weeks after surgery.

22. Overfill?-Please Fill Me In Saline: Breast implants come with a range of fill volumes recommended. The manufacturers allow us to fill implants between 30 cc and 50 cc of the documented size of the implant. We typically try to fill the implants to the maximum allowed fill volume to lessen the chance of visible or palpable wrinkling. It is possible to overfill implants, but if this is done, the implants will be much more firm to the touch and the leakage rate may be higher.

23. Ptosis-What Is It?: Ptosis is another term for breast sagging. It typically occurs with aging, with weight loss, and with breastfeeding. There are various types of ptosis and occasionally, it can be corrected by placing an implant alone, but most commonly, it will require a breast lift.

24. Scarring-What Can I Do About It?: Anytime a surgery is done, an incision is made in the skin, which will result in a scar. The scars are permanent and will never completely disappear, although some patients have very acceptable scars and other patients’ scars can be thick and raised. The scars from breast augmentation are approximately one-inch long. They can be hidden very inconspicuously in the fold or around the nipple between the dark and the light skin. The scars can be improved upon by correct surgical closure at the time of surgery and after surgery can be treated by massage therapy, topical application of silicone gel products, and vitamin E.

25. Silicone Breast Implants-Who Qualifies?: The Federal Drug Administration had previously allowed the use of silicone breast implants only for the patient’s who qualify to enter into a national study. To qualify for the silicone, one typically needed to have a reconstruction, most commonly from a breast removal or mastectomy due to cancer or reconstruction of a congenital defect. Recently The FDA has approved silicone implants for use in cosmetic augmentation as well. Ask Dr. O'Toole about these recent developments and if he feels they would be appropriate for you.

26. Smooth Versus Textured-What Should I Choose?: Although textured implants were quite common in years past, they are very rarely used today. The texturing on the implant was done in an attempt to minimize rotation of the implant and this was very important when teardrop shaped implants were used. Today, most implants are round and smooth and texturing is not necessary, since a round implant can rotate freely and it will always maintain a same shape and form.

27: Warranty On Breast Implants?: Both breast implant manufacturers, Mentor and Allergan/Inamed give the lifetime warranty on their implants to provide a financial reimbursement for a cost, if the implant ruptures in the first 10 years after the surgery, They also cover the implant itself for the lifetime of the implant due to a defect, which results in a implant rupture.

28. Weight Of Breast Implants?: Breast implants weigh approximately the same size as normal breast tissue. Water weighs one kilogram per liter, therefore, 1000 cc equals 2.2 lbs. In this case, two 500 cc implant would weigh 2.2 lbs combined. Silicone implants are slightly lighter.

29. Massage After Surgery-How Is It Done And Why?: We typically recommend breast massage after surgery to provide a space larger than the implant and to minimize firmness and tightness after surgery. Massaging can be done as soon as it is feasible and once the pain has subsided sufficiently. The technique is done by pressing the implant between the thumb and fingers and forcing it up under the collarbone and then squeezing it downward in a similar fashion. This allows the implant to move within the pocket and create a space larger than the implant, so that when the patient moves direction, the implant will move as well and not appear to be attached to the chest wall and look artificial. Massaging techniques will be instructed to the patient on the postoperative visits, typically at one to two weeks after surgery and should be done daily for the first 6 to 12 months.

30. How Long Will It Take To Achieve The Desired Result?: The end result can take three to four months. Occasionally, the patients who use smaller implants and have excess skin, especially after having breast-fed children, will get a much more natural look at her earlier date. The younger patients with small breasts who choose large implants will appear very tight at first and will eventually relax and loosen three to four months later and look natural at that time. Most patients look quite natural in clothing very early after surgery.