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Your Breast Augmentation Questions Answered

Deciding to get a breast augmentation is a very personal decision. For some women, the decision is easy and they feel confident that a breast augmentation is exactly what they want. For other women, it may take more research and time to think to decide whether a breast augmentation surgery is right for them. No matter where you are in your decision making process, you will probably have some questions related to getting a breast augmentation. 

Many of my patients like to research and read all they can about breast augmentation surgery so that they can generally know what to expect during the entire process. Some patients, however, come to the consultation with an interest in the procedure but rely on their surgeon to cover the essential information and will do additional reading or research after the consultation, which is ok too.

This guide answers the most commonly asked questions about breast augmentation surgery that I hear from my patients during the initial consultation. Reading this will provide you with great information and may even bring up topics that you’ll want to discuss in more detail with your surgeon during the consultation process. Remember to jot down any of your own questions that pop up to bring with you to your consultation. 

Without further ado, here are the most frequently asked questions about breast augmentation:

My Most Popular Consultation Questions Answered

Here are the most common questions that I am asked during consultation:

Q: “Will my breasts look natural?”
A: They can, but they don’t have to.

When performed properly and correctly sized implants are used, most people won’t even be able to tell that you had a breast augmentation. As long as the right implant which fits your natural breast anatomy is used, a very natural result is achievable. Appropriately sized implants also tend to maintain an aesthetic result longer than overly sized implants.

A breast augmentation will begin to look more unnatural or augmented when the implant is either too wide or too large for your proportions, so instead of increasing the natural shape of the breast, an overly large implant instead distorts the breast shape so that it mimics the shape of the implant.

Whatever your ideal look is, it’s a good idea to bring some “boobspiration” pictures to your consultation with your surgeon so that you can discuss which implant style would be best to give you the look you’re going for.

Q: “Will my breasts feel natural, or will they feel hard?”
A: In a majority of cases, your breasts will feel natural and like a part of your body.

Right after a breast augmentation, your breast implants may sit high and feel hard and tight under the skin. This is due to swelling right after surgery, and because your body hasn’t had a chance yet to become accustomed to your new implants. Over time, the muscles will relax, the swelling will go down, and your implants will soften and settle into their pocket.

The way your breasts will feel depends on a few factors, including the type of breast implant you have, how much breast tissue you have that will cover the implant, and whether your implants are placed over or under the muscle.

Silicone implants feel softer and more flesh-like than saline implants, which tend to feel more like water balloons. Having more natural breast tissue to cover the implant, and having implants placed underneath the muscle will result in a more natural feeling breast. In the majority of cases, silicone breast implants feel very natural and many of my patients have reported to me that over time, they become a part of your body and my patients forget that they have breast implants.

One caveat is that the most common (although still rare) complication after breast augmentation is called capsular contracture. Although the body forms a capsule around all implants, in rare cases a hard dense capsule may form around one or both breast implants within the first two years after surgery. In mild cases, there may be very little perceptible change to the look and feel of the breast, but in more severe grades of capsular contracture the breast(s) may be visibly distorted and the implants may feel hard and painful.

The precise cause of capsular contracture is unknown, but it’s believed that the body identifies the implant as a foreign object and threat, and therefore forms a capsule around the implant to isolate it from the rest of the body. Depending on the severity, the capsule(s) may need to be removed surgically. Although it is a complication of breast augmentation, plastic surgeons do everything they can and use several techniques to reduce the risk of their patients developing a capsular contracture.

Q: “Will I need to have my implants replaced in ten years?”
A: Probably not in ten years, but eventually they will.

This is a very common question having to do with the durability of breast implants. The ten year number comes from some of the original FDA studies, which evaluated silicone breast implants using MRI during the course of the study which was ten years. Because the study only lasted ten years, the FDA deemed implants to be generally safe within that time period but couldn’t make any assumptions about the implants past ten years.

We are currently using 5th generation silicone implants. The FDA studies were mostly looking at 3rd and 4th generation implants, which were found to have a rupture rate of approximately 1% per implant per year. This means that in 50 years, there’s a 50% chance that your implants will rupture.

Since we are using 5th generation implants, which have been improved from their previous versions, the exact life of your breast implants can’t be predicted but we should expect silicone breast implants to last at least 20 to 30 years, probably longer. It’s important to note, however, that breast implants are not considered lifelong devices so you should expect to have them removed or replaced at some point in the future.

Q: “Can I still breastfeed?”
A: Yes, usually…

The risk of a breast augmentation affecting breastfeeding depends on where the incision is made. When a breast augmentation is performed through an incision in the breast fold, none of the ducts or glands responsible for producing milk for breastfeeding are damaged during the surgery.

However, if an incision is made around the areola, even though some of the glands and ducts are disrupted, you should still be able to produce a sufficient amount of breast milk to meet the dietary needs of your baby.

Q: “How would I know if my breast implants have ruptured?”
A: If you have saline implants, you’ll know. It’s a bit trickier with silicone implants…

If you have saline implants, it’s easy to know because you’ll have a sudden loss of volume in the breast when the saline (salt-water) flows from the implant and is absorbed into the body.

With silicone, it can be a little more tricky to tell because the gel is cohesive and doesn’t migrate outside of the capsule. Currently the best way to tell if you have a rupture in a silicone implant is with ultrasound, either at your doctor’s office or an imaging center. If the practitioner is unable to tell from the ultrasound, you may need to have an MRI done for more detailed imaging.

Q: “I heard breast implants cause cancer, is this true?”
A: Kind of.

Image Source: fda.gov

There is a very rare type of cancer called Breast Implant Associated Anaplastic Large Cell Lymphoma, also known as BIA-ALCL. This rare cancer has been found to be associated only with textured breast implants.

It usually takes ten to 15 years for BIA-ALCL to form, as it is a very slowly progressing disease. It most commonly presents as unilateral swelling in one of the breasts approximately ten years after surgery.

The treatment consists of removing the breast implant and surrounding capsule. It’s similar to skin cancer in that it forms slowly and is treatable with a simple excision. The prognosis is very good with treatment.

Q: “What’s a gummy bear implant?”
A: It’s a term used to describe highly cohesive gel implants that retain their shape.

Image source: Semantic Scholar

“Gummy bear”, also known as “highly cohesive” or “form stable” is a term used to describe the feel of a newer type of 5th generation silicone implants. These new implants contain a silicone gel which is more highly cross-linked, leading to a soft yet firmer feeling to the breast implant that maintains its shape, even if it would be cut in half.

Most manufacturers have varying degrees of cohesiveness, allowing for a range of implants from soft to more firm. The gummier (firmer) implants retain their shape better, leading to more fullness in the upper pole of the breast.

The idea behind the different gumminess is that you want the characteristics of the breast implant (or feel of the implant) to mimic that of the breast tissue. So in someone with firmer, more dense breasts, it may be better to use a firmer implant for a “one breast” feel.

Firmer implants are also used in patients who are dependent on the breast implant to help create a breast shape. They’re also used in patients who have had previous problems with rippling due to thin soft tissue coverage over the breast implant.

Q: “Which incision is best?”
A: The inframammary incision is the one that I use and recommend the most for my patients…

1- through the belly button (trans-umbilical), 2- through the armpit (trans-axillary), 3- through the areola (periareolar), or 4- in the breast fold (infra-mammary).

The best analogy is to think of someone fixing the engine in your car. It’s very difficult to see or understand exactly what you’re doing if you’re only able to open a small part of the car hood (trans-axillary). It’s even more difficult to fix the engine through the trunk (trans-umbilical).

The most commonly used incisions are periareolar (through the nipple) and inframammary (in the breast fold), which in surgical terms would be like lifting up the hood of the car so that the surgeon can see more easily exactly where to make the pocket for the implant.

The issue with the periareolar incision is that the surgeon has to cut down through the breast glands and ducts to create the pocket for the breast implant. The glands and ducts have bacteria, which can lead to greater rates of implant infection as well as capsular contracture. Cutting through the glands also can increase the chances of having more difficulty with breastfeeding after augmentation.

The inframammary approach places an incision underneath the breast in the fold. It allows for precise creation of a pocket, and because it does not cut through any glands or ducts, it has the lowest incidence of complications. For these reasons, the inframammary incision is my preferred method for a majority of my patients.

Q: “Will my breast augmentation affect nipple sensation?”
A: It probably will temporarily….

Almost 100% of women experience either hypersensitivity or numbness during their breast augmentation recovery. The reason this happens is because the nerves get stretched out during the surgery and from the swelling afterwards. As the swelling goes down and the tissue relaxes, the nerves become more accustomed to their new orientation, and nipple sensation slowly normalizes. It’s very rare for patients to have permanent sensory changes after breast augmentation.

Q: “Do I need to wait to be done having kids before having a breast augmentation?”
A: It depends.

If you have large breasts now, they will likely become even larger during pregnancy. This in turn will stretch the skin, and as a result, the breast tissue will be compressed, ultimately reducing the amount of overall breast tissue. Although pregnancy, not breastfeeding, affects the size and shape of the breasts, the end result is a ptotic (saggy) deflated breast, having lost volume with excess skin.

Patients such as this ultimately will need a mastopexy with a breast augmentation to restore their pre-baby breasts. Placing an implant prior to having children removes the need for an implant after having kids, but the patient will likely still need a breast lift due to excess skin after pregnancy.

The other class of patients are those who have smaller breasts prior to having children. After breastfeeding, these patients are most commonly left with a deflated breast but do not have excess skin. In this group, a breast augmentation can be performed either before or after having children, with a similar end result.

So if you have small breasts or large breasts, you can have a breast augmentation prior to having kids, but those with larger breasts may or may not need a mastopexy once done breastfeeding.

Conclusion

There’s a lot of information out there, and it can certainly get confusing. While you’re researching breast augmentation surgery, it’s helpful to keep a list of questions you may have that you can bring with you to your consultation with your San Francisco breast augmentation doctor. Hopefully this list of most frequently asked questions helps to clear up any questions that you may have about breast augmentations. 

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*Disclaimer: Results may vary from person to person. Editorial content, before and after images, and patient testimonials do not constitute a guarantee of specific results. All images feature models except for before and after images.

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