Breast Augmentation Frequently Asked Questions

1. Is it safe to have implants if having a  baby or should I wait?

Your timing of breast augmentation is a personal decision, but there are also pros and cons, please read below for more information:

Pro -  Enjoyment of breast enhancement (photos, appearance in and out of photos, etc...)
Con -  Pregnancy often changes shape and volume of the breasts which may require a second procedure.

Pro -  your breast changes can be compensated in hopefully a single procedure
Cons -  during this prior time period you will forego the benefits of improved breast appearance  

I recommend that you make several consultative appointments with Plastic Surgeons who are experienced and Certified by the American Board of Plastic Surgery. In addition ideally they are members of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).


2. Non-Narcotic Pain Medication for Breast Augmentation?

Hello, Asumming gentle surgical techniques here are several intraoperative procedures to reduce postoperative pain.

1) Bupivcacaine  
2) Exparel is along acting injectable Bupivacaine .
Price difference is significant.
Both can be injected locally.

A pain pump us a mechanical device where there is a external "pump" through which thin catheters are inserted into the surgical site. For the next several days the local anesthestic agent (usually Bupivacaine) is release at constant flow. The thin catheters need to be removed in 3-4 days .

1)one time local injection
2) works only where injected
3)longer 1/2 life of Bupivacaine (effects last longer)

1) a external delivery system through small catheters 
2) can diffuse throughout the surgical site: in breast augmentation or abdominoplasty the anesthestic (Marcaine) fluid can disperse throughout the entire surgical pocket and theoretically cover more area  in contrast to direct injection of the Exaparel or Bupivacaine in certain ares thus is only effective where locally injected.
3) Some pumps have a "on demand" function where additional local anesthetic volume can be intermittently delivered (with a corresponding lock out period so as not overdose).

I personally perfer the pain pump for long term pain relief (3-4 days) and  perform local injection of local anesthestic on almost every surgical case. I provide a pain pump to all my abdominaloplasty patients. The pain pump is optional for all other procedures.

I trust you have chosen a experienced Plastic Surgeon who is Certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).


3. Would I be able to get a breast augmentation now and in a year or so go forward with a lift?

Nothing substitutes for a personal evaluation, a review of your medical history/medications and a face to face discussion of your options.

Unfortunately with out a exam of your tissues I can can only comment based solely your photos. However, hopefully you will find them helpful.

The timing of when to perform a mastopexy is entirely dependant on the patients needs, wants and desires. Having a breast augmentation does preclude a a future mastopexy.

Mastopexy following a breast augmentation is often done following:
1. massive weight loss
2. Pregnancy
3. Borderline pre augmentation need for a mastopexy
4. Large implant placement and normal resulting sag (ptosis)

 I recommend that you schedule several consultative appointments with Plastic Surgeons who are experienced and Certified by the American Board of Plastic Surgery. In addition ideally a members  of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).



4. Why do you put breast implants below the muscle?

There is significant medical evidence demonstrating that breast implants have less chance for internal scarring (capsular contracture), look more natural and feel better if placed below the muscle. Most plastic surgeons feel that the breasts have a higher likelihood of staying softer longer when placed below the muscle. Likewise implants are separated from the milk producing glands, easier to examine the breasts and when mammograms are done the muscle is a natural separation plane between the muscle, the implant and breast tissue allowing the radiologist a better view of the breast tissue.



5. Why do you have to replace a ruptured silicone gel implant ?

When there is radiographic evidence or an MRI the breast implant is ruptured, it should be replaced:
1) Because long-term the silicone may cause reactions within the breast tissue causing benign granulomas or small masses in the breast which can mimic breast malignant breast tumors that may be.
2) Leaking silicone implants especially “non gummy” may stimulate internal scar tissue referred to as a capsule. It is optimal to remove the implant with the capsule. If breast implant on top of the muscle I recommend replacing with a new gummy bear implant below the muscle. All implants are now guaranteed for life. Thus if no evidence of rupture there is no need considered for removal after 10-15 years (as previous recommended).

6. How do you prevent rippling in breast implants?

The prevention of rippling is optimally discussed per-operatively:
1) What type of implant you need. Silicone gel filled breast implant is better than normal saline filled breast implant
2) The breast implants should be placed below the muscle. The optimal way to prevent rippling and minimize rippling, is to place the implant below the
     muscle. The muscle acts like additional padding and more likely cover up any breast implant wrinkling. However there is no muscle coverage in the lower
     outer quadrant of the breast. Fortunately bathing suits and bras cover this area.
3) Make sure there is adequate breast tissue. The more breast tissue you begin with the greater the the amount of padding to cover a breast implant.
4) If you choose a normal saline breast implant make sure not over or underinflate an implant. muscle. If you are using saline implants make sure you
    maximally fill it and not overfill or underfill, as that can cause more scalping or rippling. If you underfill, it has a increased rate of deflation in saline breast
5) If you are using silicone implants do not oversize. Sometimes the use of silicone implants may be better, especially in patients with no breast tissue as well as placement below the pectoralis major muscle. If you are using saline implants make sure you maximally fill it and not overfill or underfill, as that can cause more scalping or rippling. If muscle. If you are using saline implants make sure you maximally fill it and not overfill or underfill, as that can cause more scalping or rippling. If you underfill, it can cause more deflation in saline implants.

7. Why should you underfill or overfill saline implants?

In general one should never underfill a saline implant because there is a higher chance of having a deflation or rupture. However if you want the fake, round porn star look overfilling is the answer. Optimally should fill the implant for the designed volume so that it will get less scalping and no rippling and the breast implant is associated with less implant rupture.

8. Does the use high-profile or moderate-profile implants for sagging breasts prevent having to do a breast lift?

No, the problem is that the breast skin bra is out proportion and larger in comparison to the existing breast tissue. The profile of a implant will have very little to no affect on saggy breast skin.
If you truly have breast ptosis or sagging breasts, you should have breast lift (mastopexy). If you desire need a lift and desire more upper fullness you most likely need both a lift with the profile that fits your chest wall.

9. Does the number of cc's in a breast implant correlate with the breast bra size?

No it does not:
  1. Unfortunately bra manufactures have not standardized bra sizes. Just as different sizes, whether it is a B, C, or D cup, vary from patient to patient and from retailer to retailer, there is no way to guarantee that one will have B, C, or D cup breasts after implants.Whats most important is first that you obtain the size you want and choose a bra that fits you and is comfortable.
  2. Final cups size depends on the size of breast that you are beginning with. The resulting cup size does not directly correlate with the implant size. For instance if you placed the same size implant on miniature poodle and a elephant... on the poodle it would look huge and on the elephant you wouldn’t notice it!
  3. The goal is create breasts that proportionate to the patient's chest wall diameter, the amount of breast tissue the patient has and the size and shape.
  4. It is very important not to over-augment patients, as that oversized breast implants wills at faster and often lead to migration of the augmented breast implant to the outside (or lateralization) which can cause distortion and the breast. It also will look too large and non proportionate for the patient's body and chest.

10. If I know my silicone filled implants are ruptured how long should I wait before I have a ruptured silicone implant replaced or removed?

Replacement of implants that have ruptured is not an emergency operation.
However it is recommended that removal and or removal and replacement be undertaken at maximum within several months from the diagnosis. There is no evidence at this time that ruptured silicone implants can cause medically related problems. However over time the ruptured leaking silicone implants can stimulate the production of scar tissue around the implant. The procedure requires not only removing the ruptured silicone implants but in addition scar tissue around the implant. Some women elect for removal only. However most opt for removal and replacement.


11. How can one breast be hard and the other breast be soft?

Yes, this can occur. Unfortunately we did not know cause of the scar tissue causing a firm or hard breast (capsular contracture). It is least common for capsular contracture.
1) With saline implant
2) Below the muscle
However, but if saline implants do get hard they will begin getting hard earlier than later – usually in the first several months. If silicone implants get hard, they will get hard progressively over time.
Early non surgical treatment:
includes medications, cold lasers and early aggressive breast massaging.
Surgical treatment:
However, if the capsule contracture does not improve with non surgical treatment:
1) Then a simple inferior capsulotomy or release of the scar tissue may be all that is needed, especially with saline implants, to restore shape and symmetry. 
    This is done easily as an outpatient under just local anesthesia
2) However with the more scar tissue it may require surgical removal of the capsular contracture (which is causing the hard/firm feeling) and replacing with a
    new implant.

12. What can cause nipple sensation loss on one side and not the other?

It is not uncommon to have some temporary sensory changes after breast augmentation. The larger the implant the greater the stretching of the nerve. Occasionally the nerves can be hypersensitive or hyposensitive to touch. Most of the time, sensation does return, especially if placed below the muscle and using a inframammarry access incision. Therefore one should wait up to a year for normal sensation to return.

13. How do you make cleavage with breast implants?

It is a myth that breast implants alone will create significant cleavage. Cleavage depends on:

1) The shape of your breasts
2) The location of the breasts on your chest
3) The diameter of your breasts preoperatively
4) The degree of breast augmentation
5) The amount of breast tissue that you have
6) The size of the implant

It is a myth that breast implants alone will create significant cleavage. The profile of the implant can be helpful. Implant profile should be based on your chest width. For instance if you have a narrow chest and place a low profile implant you may have better cleavage but the breast implant may also be located to the outside of your chest. Conversely if you have a wide chest and have placed a high profile implant you may have minimal improvement of your cleavage
If you have an average chest wall size, there is a better chance for having improved cleavage. Especially if you do postoperative muscle stretching exercises. However, it is not a guarantee and just increasing the size does not necessarily increase breast cleavage. It is actually can be the opposite: since the breast implant can actually push the breast to the side resulting in decreasing the amount of cleavage.

14. How can you tell if a breast implant is deflated?

It depends on the filler material. If you have a saline filled implant your will notice a asymmetry. Similar to a flat tire.
If you have a silicone filled breast implant rupture it may be a “silent rupture” and be totally asymptomatic. This is most recently found with the new “gummy bear” type implants. It’s recommended that you undergo a MRI (non radiation) study 3 years after breast augmentation and the every two years. Ruptured and leaking silicone can cause a reaction caused capsular contracture resulting in a more firm or hard feeling of the breast,
Distortion of the breast shape or even pain.



R. A. Hardesty, MD, FACS

Diplomate and Certified by the American Board of Plastic Surgery

Awardee: Real Self Top 100

4646 Brockton Ave

Riverside, Ca 92506

(951) 686-7600 

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