Breast Augmentation Questions

Serving Chattanooga, Tennessee

Every woman is endowed differently. Time, weight loss, pregnancy and nursing may decrease the volume, shape and symmetry of the breasts. Some women are dissatisfied with breasts they consider too small. Other women are bothered by an imbalance in their overall appearance, either because their hips are larger than their bustline or one breast is smaller than the other.

Many women find that making the breasts larger - technically known as augmentation mammoplasty - can help create a more comfortable, more flattering, more balanced look. For more information on breast enlargement, contact our Chattanooga breast surgeons at The Plastic Surgery Group, P.C. in Chattanooga, Tennessee. We will be happy to schedule a confidential consultation to discuss your questions and concerns regarding breast augmentation surgery.

1. How big can I be with breast augmentation surgery?

The overall shape, body habitus, and skin available for breast augmentation will be important in determining the size of the breasts. The patient's expectations are important in this decision. If you have little or no breast tissue, very tight skin or are young, you typically can expect to increase your size from an A cup to approximately a C cup; however, stretching the muscle and skin too tightly can be detrimental. Patients that want to be very large can do so if there is available skin for coverage; otherwise, this may require more than one procedure.

Breast augmentation patients who have lost breast volume as a result of childbearing, breast feeding or weight loss typically have sufficient skin to restore their breasts to their original size or larger; and patients with moderate breast size usually can increase the size of their breasts easily.

2. How long do the breast implants last?

The breast implants used today are the latest in a long line of technically advanced materials used over the years. Most women receive saline-filled breast implants with silicone rubber shells that are filled with saltwater. They are guaranteed for a lifetime; that is to say that manufacturers will replace the implants if they deflate. In addition, the implant manufacturers provide financial assistance towards covering operating room expenses, anesthesia and/or surgical fees should a deflate occur. Each manufacturer has a slightly different time limit for this coverage, ranging from 5-10 years. If the saline implant leaks, the saltwater is harmlessly absorbed by the body. If the implant does not show deflation, it can potentially be left in for a lifetime. A deflated implant is not a serious event or an emergency. Replacement can be performed at a convenient time for the patient.

3. What is the difference in round and anatomical breast implants?

The implants used today are basically round or teardrop shaped. The teardrop shaped implants were designed to achieve a more natural, mature appearance; however, if they become displaced and turn within the breast pocket, this could cause distortion in breast shape. Round implants in a submuscular position can achieve the same result without the possibility of breast distortion.

4. What is the difference between saline and silicone breast implants?

As described above, a saline implant has a silicone rubber shell filled with sterile saltwater. A silicone implant has the same shell filled with a silicone gel. Saline implants are used for the vast majority of augmentation patients. Silicone implants are available at present for selected breast augmentation patients and for reconstruction patients. Some surgeons feel that silicone breast implants are somewhat superior, as they tend to be somewhat lighter than saline and more natural feeling. It is very difficult to detect evidence of a silicone implant after breast augmentation; however some patients with saline implants report they feel the sensation of implants sloshing in their chest. Saline breast implants are somewhat heavier and will pull more on the breast tissue over time and may result in earlier drooping or a mature breast sooner than would be hoped for. Good bra support over the years is important in preventing this appearance. A saline breast implant with a flaw will deflate slowly over several days or weeks and be easily noticeable; however, a flawed silicone implant will leak into the capsule surrounding the breast implant and may not be detectable by the patient, physician or even a mammogram. There is no urgency for exchanging silicone implants once this has happened unless the breast appears misshapen.

Studies have reported an increased incidence of capsular contracture in silicone implants. In the previous generation silicone implants the contracture rate was up to 30‰, comparing unfavorably with the roughly 7‰ rate with saline breast implants.

5. Am I a candidate for silicone breast implants?

Silicone breast implants have been utilized in breast augmentation and reconstructive surgery since the early years and have been a valuable aid in achieving a very natural result. However, the FDA took silicone breast implants for use in augmentation off the market in the early 1990s. They have been continuously used in breast reconstruction where a patient usually has limited soft tissue available to hide the implants as a result of mastectomy surgery. All reconstruction patients are candidates for silicone breast implants, as are patients who currently have silicone implants and have certain pre-existing conditions. Previous augmentation patients who have developed local complications such as significant capsular contracture (tightening of natural scar tissue around the implant causing breast firmness) are also candidates. Some patients who require a breast lift (mastopexy) in addition to breast augmentation are candidates, as are patients who have shown severe wrinkling of an existing saline implant over time. Studies have shown no correlation between systemic illnesses and the use of silicone for breast augmentation. For this reason, sometime in the future, silicone breast implants may once again be widely distributed for all breast surgery.

6. Can I breast feed after breast augmentation surgery?

Breast feeding after breast augmentation isn't any more challenging than it would be otherwise. There is no danger of breast implant material, saline or silicone, being passed into the breast milk and affecting your child in any way.

7. How will I know if I have a problem with my breast implants?

Breast implant surgery, like all surgery, carries risks. Your plastic surgeon will provide you with comprehensive patient education materials, show you a film about breast augmentation and ask you to read and sign an informed consent. The immediate concerns after surgery relate to healing and bleeding.

Bleeding occurs with any surgical incision and rarely is a problem; however, on occasion a hematoma (collection of blood) will cause one breast to be significantly larger. If this should occur, your surgeon will address the situation immediately by removing the blood. Capsular contracture (tightening of natural scar tissue around the implant causing breast firmness) is unpredictable but may require corrective surgery if severe. A capsulectomy or capsulotomy would be performed to alleviate the problem. As mentioned above, deflation can occur and is generally harmless but will require another surgical procedure to replace the implant. Infection associated with breast implantation is rare due to the use of a closed filling system to fill the implant with saline at the time of surgery. If infection does occur and healing problems result, you will be treated with antibiotics in an effort to avoid further surgery. Ultimately, it may be necessary to remove the implant until the infection is resolved. The breast implant can then be reinserted.

8. When can I return to normal activities after breast implant surgery?

Within a day or two after surgery, you will be up and about and any discomfort can be controlled with prescribed pain medication. You will be able to shower almost immediately and you will return to the office for follow up and for stitch removal (unless dissolvable suture was used) within a week. You can resume sexual relations although breasts must be treated gently.

Patients usually return to work within a week. Work activities requiring significant lifting, pushing or arm stretching may be uncomfortable at this time and the work may need to be modified accordingly. Implants in the submuscular position (which are the majority) take longer to be pain free. Returning to exercise is a personal decision. After the first two weeks few exercises would injure the incision or breast implant placement; however, strenuous activity that stresses the pectoralis muscle - bench presses or push - ups should be avoided. Most patients wait a month or so before a full return to their vigorous workout schedules.

9. Will I have a dressing on after breast augmentation surgery or a bra and when can I wear an underwire?

Usually, steri-strips are applied over the small incision and a bra with minimal dressings is worn. Your chest will feel very tight. Some bras used following surgery will put pressure on the upper edge of the breast or implant to hold it in a lower position as the implants initially tend to sit somewhat high. This high position is due to the fact that the fold under the breast must stretch into the new relaxed shape to accommodate the larger implant. This process may take several weeks or even several months. Usually this surgical bra is worn for a week or more. Some surgeons may advise you not to wear a bra depending on the placement of your breast implants.

Once the breast implants are in good position, a bra of your choosing is advisable. A bra is recommended when exercising or even for normal activity if you have a very large breast augmentation. You may also wear an underwire bra after the implant has settled into the desired position. Your surgeon will advise you when that has happened.

10. When can I get in the tanning bed after breast augmentation surgery?

The tanning bed should not be used for approximately two weeks after breast augmentation surgery. Tanning rays should not be allowed to tan the incision site for 2–3 months. Sun on the incision will cause the scar to be dark and less likely to fade with time. The darkness may be permanent. Protect the incision with sunscreen.

For more information on breast augmentation surgery, contact our breast augmentation surgeons at The Plastic Surgery Group, P.C. in Chattanooga, Tennessee. We will be happy to schedule a confidential consultation to discuss your questions and concerns regarding breast augmentation.