Breast augmentation surgery has always been a popular procedure. According to the statistics published by the American Society of Plastic Surgeons, nearly 300,000 women undergo breast augmentation each year. On average plastic surgeons perform 2 to 10 breast augmentations per month.

Do breast implants last forever or do they have a limited lifetime?

Breast implants are made of solid silicone shells, which may deflate with time. The degree of deflation has been described as a “bleed “(least leak) and as a “rupture” (complete deflation). Saline implants will completely deflate over time even if there is only a bleed; this is in contrast to silicone implants, which may look and feel normal when bleeding. Over all, the deflation rate for an implant is 1 % per year. This means that over a 10 year period there is a 10 % chance of your breast implants deflating.

Are breast implants safe or are they harmful to your body?

Breast implants are not a risk to your body. This was proven as a result of multiple clinical studies that were initiated following the silicone scare in the late 80s. As a result of the “silicone scare” of the late 80s, the FDA moratorium in 1992, and subsequent research and development, far superior implants have been developed. Today implants are made stronger yet they feel softer and more natural than those we were used to in the past.

What is the average age group of breast augmentation patients?

The age gap for breast augmentation has begun to spread. Plastic surgeons are seeing patients as young as 18 and as old as the 70s. The popularity of cosmetic makeover shows has prompted younger patients, even in their teens, seeking cosmetic surgery. In contrast, surgeons are also seeing older patients in their 70s desiring breast augmentation as patients are living longer and wanting to look younger.

What about women whose breasts are sagging due to old age or from having kids?

The medical term for “sag” is PTOSIS. Sagging describes the drooping of the breast mound and nipple areola position that is observed following childbirth and with age. In general breast augmentation alone will only correct sagging minimally. As a rule of thumb, the nipple areola complex position while standing will be lifted by 1 to 1.5cm.

How do I know if I need a breast lift?

First, you need to examine where your nipples lie relative to the breast crease. You can do this by placing your index finger underneath the breast. If the nipple lies below your fingers/breast crease, they you could benefit from a breast lift procedure.

How do you go about deciding what size implant would be best?

The best way to decide what size implants to get is to try out the sizer implants available at your surgeon’s office. Implant sizers range from 200 cc’s to 800 cc’s and go up in 50cc increments. If the client still has a difficult time choosing the implant size, then the patient can use the “baggie test” in which a sandwich bag is filled with sand and placed in their bra. When the desired size is determined, then we can calculate the appropriate size by measuring the amount of sand in the bag. This is only an aid to do at home, and should not be a substitute for an experienced surgeon.

How do you decide how to insert the implant?

Currently there are three options for inserting breast implants. These include:

Inframammary fold (under the breast)
Nipple/Areola (underneath the pink portion of the areola)
Trans-axillary (through the armpit)

Breasts are an intimate part of a female; as such, this decision needs to be made together with your doctor. There are pros and cons of each approach and they should all be discussed with patients. Most plastic surgeons prefer the approach from under the breast. This avoids loss of sensation of the nipple, less interference with mammography, avoids a potentially ugly scar on the center of your breast mound. In the event that you don’t scar well, this is the ideal site for a scar; it will be hidden in the shadow of your breast and it can be treated with laser and scar management therapies.

Do you recommend inserting through the bellybutton?

The consensus among surgeons is that this approach is still in an experimental stage. When more cases have been performed, then we can evaluate whether this approach is more effective than the above options mentioned. From the limited experience gathered, it seems that there may be a slightly higher incidence of asymmetry of breasts associated with this approach due to the fact that dissection of the pockets for placement of implants is performed far from the pocket, i.e. the belly button.

What about scarring after surgery?

Special plastic surgical techniques for closure of the incisions are utilized to minimize scarring including:

Closure in multiple layers so that the tension is taken off the skin
Specialized sutures, which will stabilize the incision line for several months
Specialized Band-aid dressings that create a pressure effect on the incision line, thus preventing scar formation.

In the event that individuals do develop prominent scarring, we can offer laser therapy, steroid injections, and even medical tattooing.

Is it true that breasts sometimes will squeak after surgery when I run?

Squeaking of the breasts after surgery is rare. There are two reasons why this occurs:

If you had saline implants, it is possible that your implants were underfilled so that the water within the implant is swishing around, but this is probably not the case.
The more likely cause is that the dissected pockets are larger than the placed implants and so that the implants are able to move around in the pocket. Within 2 weeks following surgery, the pockets will tighten down around the implants and the squeaking will resolve on its own.

How can you tell if your surgeon is an expert?

It is easy to pick a qualified surgeon by making sure that he is a plastic surgery trained physician. Unfortunately, there are a few organizations that will give you an impressive certificate claiming that you are a “cosmetic surgeon” but only after a limited amount of training. What clients have to look for is a certificate of completion from a “plastic surgery” training program.

I am concerned about my breasts getting harder. I had my breasts done 15 years ago with silicone implants.

There are currently several indications for having your implants replaced due to the hardening that you are concerned about. This hardening is nothing to get worried about since it is caused by the body’s own response to having a foreign material implanted in it.

If your breasts are being distorted by the hardening or if you are having pain associated with the hardening of your breasts, then you should be evaluated by a plastic surgeon.

If your implants are silicone and more than 10 years old, your implants are considered older generation implants which have a higher propensity for leaking and hardening. Hardening of the implants is due to the development of a thick scar that surrounds and squeezes around your implants; this scar as well as the implants need to be removed in order to return your breasts to the soft and aesthetic appearance that you once had.

Can breast surgery fix asymmetrical breasts?

Plastic surgeons can fix breasts that are different in breast volume, mound shape, or nipple position. It is critical to assess the reason for the asymmetry so that the proper surgical revision can be performed.

I know that implants can be placed either over or under the muscle. It seems like everyone I know is getting implants placed under the muscle. Why is that?

When you put an implant under the muscle you benefit from three things. First there is less scar formation around the implant, this is because the muscle continuously messages the implant and breaks up any large scar depositions. In addition, implants tend to tether the overlying skin, which is caused by the implant sticking to the skin; The muscle gives a protective layer that prevents tethering of the skin, especially over the upper pole of the breast mound. In addition, going under the muscle gives you a bigger cushion so that you are less likely to feel the implant. But most importantly, by placing the implant under the muscle, you avoid dissection through the breast tissue and subsequently improve detection of breast cancer.

What happens if the implant hardens or deflates somewhere down the line?

It used to be that deflation rates were 1% per year per implant. That meant that you could tell a client to expect a 20% chance of one of their implants deflating over a 10-year period. However, due to the wonderful improvements in implant technology that we have witnessed over the last couple of years, the most current statistics have shown a 3 to 7 % rate of deflation over 10 years. These studies have been performed by the Mentor and Inamed Corporations, both of which provide extended 10-year implant warrantees.

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