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Frequently Asked Questions

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My question is regarding anesthesia for breast augmentation. The surgeon I am thinking about using says he uses conscious sedation and will place the implants either under the muscle or above the muscle depending on my body frame. I really have no doubt that I want them under. Can intravenous sedation be used for implants placed under the muscle? I like the thought of conscious sedation, I believe there are less risks than general, do you agree? I read on this web site that general is used for under the muscle. I have wanted this for so long and am just so nervous and wanted to get another professional thought on the anesthesia part of it. Thanks so much!

Whether the implant will be above or below the muscle is a question that you should decide during your consultation. It depends on your anatomy, your weight and your breast tissue volume. Very thin women with small breasts usually prefer implants under the muscle and look better with sub-pectoral placement.

Check with your physician whether an anesthesiologist will be present for your surgery. Check if the facility is certified by AAAASF (American Association for the Accreditation of Ambulatory Surgery Facilities.) Check if your physician is board-certified by the American Board of Plastic Surgery. Check if he is 1) a member of the American Society of Plastic Surgeons, 2) a member of the American Society of Aesthetic Plastic Surgeons, or 3) a Fellow of the American College of Surgeons. Check if your doctor has privileges to perform breast surgery at an accredited hospital in your area. If you are confident that your plastic surgeon is well-trained and fully certified, talk to him about your anesthesia options and the credentials of the anesthesia staff who will be present for your plastic surgery. When you have finished checking, you should have the information to answer your questions.

What exactly is capsular contracture regarding breast implants? What is meant by encapsulated?

The body forms a natural barrier to the implant. Most often it is a smooth, thin layer of tissue called a capsule. Sometimes, and more so with a subglandular implant placement, the capsule thickens and distorts the natural look. This is rare but a real complication of the implants. The literature shows a smooth, submuscular implant will decrease your chances of this happening.

I am 34 years old and last July I had my first breast augmentation (under the muscle). After the first surgery I had to go back three times (due to capsule problems and my breasts not lining up and a lot of pain). During the fourth surgery I had a non-cancerous cyst removed. I am now again in severe pain and went to see my plastic surgeon who said the implants had moved and turned, and that the lump I am feeling is the valve. I am now having my fifth procedure on both breasts. Why do they move?

Implants naturally move in the pocket created for them in the surgery. This is not unusual.

My breasts are more to the sides of my body, and I want them to be centered, and make cleavage. Will implants do this?

Your anatomy usually dictates the results and what you will look like after the surgery. If your breast tissue is more to the side then the implants will also be slightly to the side. There are ways to move the implants closer to the center to create greater cleavage.

I am wondering if you do anything regarding a lift on breasts. I am not looking for breast implants just something that could lift my breasts. They are not drooping but are somewhat not perky looking. I wear a size 36 D cup and they seem to be in need of a lift. Is there something that can be done and not implanted?

Yes, there are several options for you. An implant is not always necessary and not at all if you do not want one. A simple breast lift may be appropriate for you.

I am 40 years old and have 2 kids, and I ended up with very saggy breasts. Do you think I am too old to have this procedure done, and would there be any complications? By having this surgery, am I more apt to get cancer?

At 40 years of age, if you are in good health, that is not too old at all. The implants do not cause cancer; if there was a chance of that, the FDA would not approve them.

I had silicone implants put in about 2-1/2 years ago on top of the chest muscle. I noticed more and more the left breast has a lot of wrinkling toward the cleavage side of the breast, even from the beginning there have always been little pains in the breast, I don't think they have leaked because they feel the same. If there is a problem with leakage what should I do?

Mammagram, MRI and physical examination are all reasonable ways to proceed to determine if a rupture has occurred. You can have them removed and replaced with new implants if they are ruptured.

I've seen some African Americans with darker skin have scars after breast enlargement ... somewhat like keloids and bumps. What causes this irritation and how long after surgery before it subsides?

African Americans are more at risk of keloid development. The reason is unknown, but this does not preclude breast augmentation in dark skin.

I was considering having breast augmentation surgery. A friend of mine just had it done and her breasts aren't very close together to show a lot of cleavage. Her doctor had told her that she should keep pushing the outside of her breasts together and they will come in closer—is this true?

Massage will help, but anatomy is a very important determinant of what you will look like after the surgery.

I really found your website to be informative. My concern is saggy breasts. After nursing two children my breasts are not firm and sag. Is there any way of getting rid of the loose skin without having to obtain implants. I do not care about the size as much as I do of the sagging.

You are describing typical development in women after having children. No, you do not need implants if you do not desire them. A breast lift can be done, and you will have the shape you lost from years ago.

Seven years ago I had silicone implants by Dow Corning. I now want them taken out and replaced with saline. Could you describe the risks of removing implants and more importantly, how would I choose a doctor to perform the operation?

You need to choose a board-certified plastic surgeon who does mainly breast surgery and is very fluent with these types of problems. The risks are unchanged from surgery to surgery. Meaning you need to know that you will always incur some risk, albeit small.

I'm 26 years old. I was wondering if I decided to get implants will I have to replace them in the next 10 years? If so, what is the reason for additional or replacement surgery?

There is no planned obsolescence with these implants. Although they are not problem-free the manufacturer makes a product they believe will last.

I understand that it is recommended that a doctor be a member of the American Board of Plastic Surgeons. Is that the same as the American Society of Plastic and Reconstructive Surgeons? If not what is the difference?

The American Board of Plastic Surgery is the governing body which sets the standards for qualification of plastic surgeons and determines board certification. The American Society of Plastic Surgeons is the society that board-certified plastic surgeons belong to, to share research and to improve and set standards for plastic surgeons in the community.

I noticed that on most of the before/after photos, the implant was placed under the pectoral muscle. Why is this method preferable to placing the implant over the muscle, under the breast tissue?

Several reasons—a more natural look, the implants will stay softer longer, and there is less incidence of capsular contracture and rippling.

I would like to know more about the implants being placed through the navel.

Advantages are remote incision with no incisions in the breast area. Some disadvantages are that it is more difficult to place the implant exactly where the surgeon desires.

I am 21 years old, 135 lbs, 5'6" and the mother of one who does not plan to have any other children. Before I became pregnant I was a large 36D and my breasts were saggy. I have a small shoulder span and it is very hard to find a swimsuit or bra that lifts my breasts. Everything still seems to droop. I have constant back pain in the upper and mid regions of my back. I have been considering a breast reduction to a medium size 34C with a lift. Do you think that this would help at all?

Breast reduction surgery does help to relieve the neck and back pain associated with large breasts. This surgery also will serve to raise the breast upward like a lift and give you a better shape.

I am 45 years old and a size 34A, would like to be a 34C. I'm afraid of needing additional surgeries due to complications from the implants eventually leaking or other defects. What are the chances that this may happen to me?

The FDA has studied that question while looking at the implants available today. They determined there is a 20% complication rate with this surgery. I have found this is not the case with my patients
and in fact it is much less.

I am 21 years old and am currently a 36DD/DDD, about 175/185 lbs. I have saggy, uneven breast and have been thinking about this procedure for some time now. I am wondering if I should get a lift and a reduction, or get a lift and implants to even me out. Which procedure do you recommend and why?

The best procedure it seems for you is a breast reduction. This one operation can create symmetry, elevate your breasts and make them smaller. It takes about three hours.

I am a 36a but very small and I would like to be a full b. I am 35 and weigh 118 lbs. and am 5'5" tall. Do you think putting in a tear-drop-shaped implant size 240 and overfilled to about 270 would be appropriate or would this be too small? I have very narrow shoulders as well.

The best way I have found to let the patient determine what size is appropriate for them before the surgery is to let you try on implant sizers. You place these under your bra and place your blouse on. This will give you a good idea.

I have been contemplating implant surgery, but have been a little skeptical as to whether or not I should! Some answers will aid in my decision/consideration to get breast implant surgery:
1.) Do breast implants cause the nipple to continuously stay erect? Some of my friends have implants, and report that the nipple is always in this state...is this true and what causes it?
2.) Is there a lower fee for smaller implantation? Is the fee "size" related or procedure/product related?
3) Do offices provide any "visual" idea (esthetically speaking) of what the breasts would look like post-surgery? (To aid in the decision to have it done.)
4.) How can a patient be certain that a doctor isn't using certain ingredients to prolong the implant life? e.g., antifungal medications, etc. which can actually breakdown the material, or cause infection.

1) No, the nipples will not stay continuously erect. 2) No, the fee is not related to the size of the implant. 3) There is imaging software available to help you see what you will look like after the surgery, but remember that this is not perfectly accurate. 4) A board-certified plastic surgeon will assist you in the best way she/he knows how.

I am interested in finding out the advantages and disadvantages of over the muscle implants and under the muscle implants. I am still not certain which is the right choice for me. I am a full B cup size and according to the doctor I do have breast tissue.

Placing the implants under the muscle can give you a more natural look, the implants will stay softer longer, and there is less incidence of capsular contracture and rippling.