Answers to frequently asked Breast Augmentation questions:

1. How do I choose a plastic surgeon?
   The process in choosing a plastic surgeon can be quite extensive.  The combination of the following information will guide you through the process.  The surgeon should be board certified by the American Board of Plastic Surgery (ABPS), and should be in good standing in the American Society of Plastic Surgeons (ASPS).  In addition the American College of Surgeons (ACS) is a prestigious group in which only certified plastic surgeons are members.
   
   Web referrals, advertising and recommendations from friends are always good means, but be sure that the surgeons are credentialed by the above organizations.  Be sure that the plastic surgeon is a specialist in cosmetic surgery, not just general plastic surgery.  Look at ebreastaug.com's section on how to research your doctor.
2. What is the American Society of Plastic Surgeons, and who is a member? 
   This society is the only society in which includes only board certified and credentialed plastic surgeons from around the world. The society comprises more than 95% of all plastic surgeons.
3. What does board certification mean and how do you become certified?
   To be board certified, you must have graduated from an accredited medical school, do proper residency in both general surgery, ENT, and complete a residency in plastic and reconstructive surgery.  The surgeon must also pass written and oral board exams and practice in the field for at least 2 years after training.  The American Board of Plastic Surgery (ABPS) is the most important board certification for the plastic surgeon. This board should accredit your breast augmentation surgeon.
4. Are there different types of board certifications?
   Many boards exist, but be sure that your plastic surgeon is certified by the American Board of Plastic Surgery (ABPS).  Some surgeons call themselves "cosmetic surgeons", but are really not plastic surgeons with proper accreditation.
5. Where should the surgery be performed?  Does it matter if the facility is accredited?
6. 
   The surgery can be performed either in the office ambulatory surgery center, outpatient surgery facility, or the hospital.  Usually the procedure is performed as an outpatient, and the patient can be sent home the same day of surgery.  Most often the procedure is performed in the office surgical center.  It is of utmost importance that an accreditation board such as the AAAASF accredits the facility.
7. What does accreditation of a surgical facility mean?  What is the AAAASF?

The American Association for Accreditation For Ambulatory Surgery Facilities (AAAASF) is an organization that accredits office ambulatory centers.  Strict criteria must be met, which includes office procedures, staffing, supplies, safety equipment, board certification, and many other facets of the office.  Be sure that the office has this certification up to date.
8. What should I ask my doctor at my first consultation?


See ebreastaug.com's section of what should I ask my doctor.
1. What types of breast implants are available in the United States?
   Two manufacturers currently make FDA approved implants in the US. (See ebreastaug.com's section on Implant Manufacturers)  The manufacturers are Mentorand Inamed (formerly McGhan).  These companies manufacture a variety of products, which include both saline and silicone filled implants (see ebreastaug.com's General Information section). These are both made in a variety of sizes, and shapes.  The exact implant size, shape and texture should be discussed with your plastic surgeon. High profile, anatomic, expandable implants are available and the use is dependent on what the patient desires, and the pre-operative breast appearance.
2. Should I have my breast augmentation only after I am done having children?
   A large percentage of women have breast augmentation before having children (greater than 50%).  Although it is variable, in most cases breast implants do not interfere with breast-feeding. This is especially true when the implants are placed sub-pectorally (under the muscle).  Some drooping can occur after pregnancy, but not any more than if the implants were not done.  Some plastic surgeons feel that breast augmentation may decrease the overall drooping after pregnancy.  If women are actively trying to get pregnant, it is best to wait until after that pregnancy.
3. Am I too old or too young for a breast augmentation?
   The average age for breast augmentation is between 19 and 34 years of age. Many patients are 35-50 (35%) and about 3% are older than 51.  The FDA will not allow any cosmetic breast augmentation under age 18 (it is acceptable to do reconstructive and corrective surgery under 18 years old).  If health allows, there is no age cut off, and many breast augmentations have been performed in patients in their 60's.  As women age, it is more likely that a breast lift may be needed.  A breast lift procedure (mastopexy) can be performed either with or without a breast augmentation.
4. What are the most frequent types of implants that are used?
   The most common type of implant used in the U.S. is smooth, round. The vast majority of implants are filled with saline (salt water), but silicone gel implants are available under the FDA study protocol.
5. What is the difference between smooth and textured implants, round and anatomical?
   Many techniques have been developed over the years to decrease the scar tissue  (capsular contracture) around breast implants. Originally it was thought that a textured shell may decrease the capsule, but this in fact is probably not true.  Some plastic surgeons feel that a capsule may cause more rippling and other difficulties, probably does not decrease the capsule formation rate. 
   
   Smooth implants are used more commonly in the US.  The rate of rippling is probably less, and the deflation rate is also presumed to possibly be lower than the textured implant.
   
   Round implants are used much more commonly than anatomic or "breast shaped" implants.  This is a very personal decision but most plastic surgeons do not feel that the use of anatomic implants are warranted, and in fact may not look any better when placed under the breast or pectoralis muscle.  Anatomic implants can also shift or rotate causing an unnatural appearance, and possibly needing a re-operation.
6. What are expandable breast implants?
   The Spectrum breast implants are available from Mentor (see ebreastaug.com's General Information section).  These implants are manufactured in both smooth and textured.  They have a small removable "port" which is left in the patient at the time of the surgery.  This valve in easy to remove up to 6 months after the breast augmentation.  The implant can be either made larger or smaller while this valve is still in place.  The surgery to remove the valve is one disadvantage to using this implant.  The advantage is that size can be manipulated after surgery to meet the desires of the patient.
7. Are Silicone Breast implants available in the United States? Are they safe?
   The FDA passed a regulation on silicone breast implants.  Silicone gel implants are currently available to certain patient groups who meet the following guidelines:
1. Replacement or revision of saline implants
2. Breast augmentation to the opposite breast for symmetry
3. Augmentation with a breast lift (mastopexy)
4. Severe asymmetries of the breast
5. Tuberous breast deformity
6. Breast cancer reconstruction
7. Congenital breast reconstruction

The patients must be at least 18 years old, and can be excluded in the presence of infection, nursing mothers, autoimmune diseases, or other diseases that impair wound healing.

The implants are most likely safe bases upon prior research, but the final study results will not be available for some time.  This must be discussed with your plastic surgeon.

15. What are high profile implants?
Newer implants are now on the market that gives greater projection per base diameter.  This is greatly advantageous in those patients who have a narrow chest wall, and who want to have projection and size of their breast.

16. What are the warranties for breast implants?  Do they differ from company to company?
Both Mentor and Inamed (formerly McGhan) have similar (not identical) warranties on their implants (see ebreastaug.com's Implant Manufacturers section). Your plastic surgeon will give you this information.

In general, if the implant has a deflation or rupture, the patient will receive: replacement of the implant (for lifetime), and about $1200 paid toward the surgical fee, anesthesia etc. (See Mentor's Warranty or Inamed (formerly McGhan's Warranty)

The warranty is not valid if:  a)  the patient wants a replacement for cosmetic reasons, b) the deflation or rupture is secondary to a surgical procedure,  c)  the implants are replaced because of capsular contracture. The warranty does not extend to the opposite side implant in the event that one implant ruptures or leaks.

17. How long do implants last?
The data on implant longevity is variable.  Implant leakage is usually caused by a leak in the valve area.  Other causes of implant failure include a tear, hole or rip in the implant, this can occur over time.  If a saline implant leaks, the salt water gets absorbed by the body with no adverse effects.  Many women can get a lifetime out of their implants with no exchange needed, but it is best to think that you may need an implant exchange at sometime in your life.  Implant leakage reports between 1to 5% per year.

18. Why do breast implants need to be replaced?
The only reason to replace implants is if there is a problem with them.  For example; leakage, capsular contracture, change in shape, asymmetry, or a patient who is unhappy with size or position.  Some plastic surgeons will recommend changing silicone implants even if there is not a visible problem.  Speak with your plastic surgeon about implant exchanges.

19. What is the most common incision for breast implants, and what are the options?
The most commonly used incision is inframammary (crease incision).  Many plastic surgeons use this incision because it arguably gives good control in placement of the implants and the incision is usually not visible.

The periareolar (around the areola), is an incision in which usually heals well. Some plastic surgeons feel that there may be more of a chance in alteration of sensation utilizing this incision.  In addition, some feel that there may be a higher rate of implant exposure to the body's own bacteria from the patients milk ducts.

The transaxillary incision is a procedure in which an incision is made in the armpit. Some plastic surgeons feel that this incision gives less implant placement control.  Discuss this with your own plastic surgeon.

The Transumbilical procedure uses an incision inside the umbilicus (belly button).  Many plastic surgeons feel that the disadvantages outweigh the advantages. Speak with your plastic surgeon about this.

The correct incision depends on each patient's own anatomy, and your plastic surgeon's feelings about each procedure.  Listen to the guidance from your individual plastic surgeon.

20. Mammary (subglandular) placement of the implant?
This can be a confusing issue for most patients. There are two distinct pockets that the implant can be placed. The submammary and submuscular placement. The decision of where to put the implant depends on the patient's goals and anatomy. Discuss this with your plastic surgeon, because there are advantages and disadvantages to each placement. Subglandular (submammary): means that the implant is placed immediately below the breast tissue. This placement often creates a more visibleand "less natural" result. In addition, often more "ripples" or folds in the implant may be seen. Some plastic surgeons feel that other disadvantages to subglandular placement include the possibility of increase capsular formation rates, and more difficulty with mammograms. Subglandular placement may be appropriate for those women who have a large amount of soft tissue coverage (breast tissue), have a droop to the breast, and for some reason do not want to undergo a breast lift procedure. Submuscular (subpectoral): means that the implant is placed behind the muscle of the chest wall called the pectoralis muscle. With this placement, the implant is partially covered by the pectoralis muscle. (the upper aspect of the implant is completely covered) This placement has many advantages which include a more natural" look, less rippling, less ability to feel the implant, and perhaps less capsular contracture. If at all possible, this placement is preferred.

21. How long does the procedure take?
It usually takes approximately 1-2hours for the routine breast augmentation procedure.

22. Do I need to take antibiotics before and after surgery?
No good studies exist to determine the length of time a patient should take antibiotics, but it is common to take antibiotics for a short course after the breast augmentation procedure. It is questionable whether antibiotics are needed when a patient undergoes other procedures after a breast augmentation has been performed. Antibiotics should probably be used when a patient undergoes any procedure in which "bacteria" may be released into the blood stream. These include, but are not limited to: Dental work, colonoscopy, gynecologic procedures, other major surgeries, and others.

23. What is Arnica and should I take it?
Arnica is a homeopathic medication which is presumed to reduce pain, swelling, and bruising. Arnica can be taken by pill or cream form. Ask your doctor his feeling about arnica.

24. What is breast ptosis?
Ptosisis a term that means droopiness of the breast. There are degrees of how droopy the breast is, and the degree of droopiness will determine if a procedure needs to be performed. Often a breast implant alone will take care of the droop, but at times a breast lift (mastopexy) may need to be performed either at the same time as the augmentation or as a delayed procedure.

25.I have breast implants. I would like to learn to dive, but am afraid of what the pressure will do to the implants. Are there any studies on this?
Silicone and saline implants are used for cosmetic enhancement or augmentation of the normal breast size and shape of reconstruction, particularly after radical breast surgery for cancer or trauma. In one study, by Dr. Richard Vann, Vice President of Research at DAN, mammary (breast) implants were placed in the Duke University Medical Center hyperbaric chamber. The study did not simulate the implant in human tissue. Three types were tested: silicone-, saline-, and silicone-saline-filled. In this experiment, the researchers simulated various depth/time profiles of recreational scuba diving.

Here's what they found:

There was an insignificant increase in bubble size (one to four percent) in both saline and silicone gel implants, depending on the depth and duration of the dive. The least volume change occurred in the saline-filled implant, because nitrogen is less soluble in saline than silicone.
The silicone-saline-filled type showed the greatest volume change. Bubble formation in implants led to a small volume increase, which is not likely to damage the implants or surrounding tissue. If gas bubbles do form in the implant, they resolve over time.

Fitness and Diving Issues

Once sufficient time has passed after surgery, when the diver has resumed normal activities and there is no danger of infection, she may begin scuba diving. Breast implants do not pose a problem to diving from the standpoint of gas absorption or changes in size and are not a contraindication for participation in recreational scuba diving.
Avoid buoyancy compensators with constrictive chest straps, which can put undue pressure on the seams and contribute to risk of rupture.

Additional Considerations

Breast implants filled with saline are neutrally buoyant. Silicone implants are heavier than water, however, and they may alter buoyancy and attitude (trim) in the water, particularly if the implants are large. Appropriate training and appropriate adjustment of weights help overcome these difficulties.