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Douglas A. Taranow, DO, FACOS

Breast Augmentation Guide: Everything You Need To Know

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Posted January 04, 2019 in Breast Augmentation

Breast augmentation is one of the most popular cosmetic surgeries. The procedure can help you gain self-confidence and elevate your self-esteem. Before the surgery, you will likely have many questions. While you should make sure to present any questions or concerns to your surgeon during your consultation, here are some of the basic facts about breast augmentation.

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What to Do Before Seeing a Plastic Surgeon

The first step is to write questions down as you think of them. Next, peruse the web to get some basic information, but not too much. There are so many self-proclaimed “experts” out there giving the wrong information. Next, it is time to choose a plastic surgeon. You may wish to look at websites that rate different physicians or speak to friends to try to get referrals. Make sure that your surgeon is board certified. Ask to see actual before and after photos of the doctor’s work. You can view before and after photos here.

Other Important Things You Need to Know

  • Breast augmentation will not stop sagging due to age or weight loss. Ask your plastic surgeon about a breast lift if you wish to address this issue.
  • If you plan on having children after your operation, let your surgeon know ahead of time if you intend to breastfeed. Certain incisions may interfere with breastfeeding.
  • Breast augmentation is an elective procedure and not covered by insurance companies.

Implant Types

Saline

Saline implants are filled with a sterile saltwater solution and do not require any monitoring outside of the recommended yearly mammograms for breast cancer detection. However, they are more likely to ripple or develop small creases on the outside of the implant, which may, in some instances, be felt or even seen.

Silicone

Silicone implants are filled with a soft silicone gel. They tend to feel more natural and ripple much less. As such, they are not as easily felt or seen through the skin. The FDA recommends to have an MRI three years after your initial surgery and every two years thereafter to monitor for leakage. Many of my patients are waiting for the 10 year anniversary to have an MRi for diagnosis.

There are two types of implant shell (the outside of the implant) available: smooth and textured. Both types are made of silicone. I do not use the textured implant due to the extremely rare instance of a rare type of breast cancer associated with the textured implant.

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Round Versus Shaped (Anatomical)

The round implant is the most commonly used shape for implants. Some surgeons prefer a shaped (or anatomical) implant. The shape of the implant used for your surgery will be discussed during your consultation.

Implants are man-made and will not last forever. A leak in a saline implant is easy to diagnose, as your breast will rapidly deflate over several days. A leaking silicone implant may not be detectable without performing an MRI. Implants typically include warranties that provide coverage for several years. Some manufacturers will provide insurance on your implants at a low cost.

Incision Placement

There are four types of incisions:

  • Transaxillary: The incision is made in the armpit
  • Periareolar: Around the bottom of the areola (colored area around the nipple)
  • Inframammary: In the crease below the breast

My favorite is the transaxillary incision, which leaves no scar on the breast. The periareolar is my second favorite with the scar hidden in the border between the areola and the breast skin. The inframammary is the easiest and most commonly used incision, but it leaves a visible scar on the bottom of the breast which becomes darker, especially in patients with darker skin. The transumbilical is the furthest incision from the breast, meaning a long tunnel must be made to insert the implants; it is rarely used and not recommended by the implant companies.

Implant Placement

There are two options for the placement of your implants: submuscular (under the pectoral muscles) and subglandular (under the breast tissue but on top of the pectoral muscles). Placement depends on your shape, size, chest wall, implant selection, and physician’s preference. I typically place implants under the muscle unless there is significant breast sagging (ptosis), very wide-set cleavage, asymmetries, or tubular breasts.

Preparing for Surgery

  • Quit smoking at least two weeks before your surgery. Smoking lowers oxygen levels in the blood, which can cause complications during your surgery and impede healing during your recovery.
  • Hire a helper to take care of household chores, especially if you have kids. You must also arrange a ride home after the procedure, as you will not be able to drive due to the effects of the anesthesia.
  • The evening before the surgery, remove all makeup and jewelry. Take a complete bath using an antibacterial soap.
  • Do not eat or drink anything at least six hours before your surgery.

After Your Surgery

After the surgery, you will stay in the recovery room until it is clear that the anesthesia has not had any adverse effects. After that, the doctor will transfer you to a normal bed. He will keep you there until he is satisfied that you are safe to return home.

You should not lift anything heavy after the surgery. You may experience bruising, but this will vanish eventually. It typically takes 14 days to one month to recover after the surgery.

Do not be afraid to ask your doctor any questions you may have. Consider their personality. You want to make sure that your surgeon is one you feel comfortable with and is available if you have a question or problem.

For more details on breast augmentation, or to schedule a consultation, contact our office at 212.772.2100 or fill out our online contact form.