Common Questions

Who is a candidate for breast augmentation?

The ideal breast augmentation candidate comes from one of two groups: the first are women whose breasts never developed proportionately, are limited in the clothing they can buy, and who would like more confidence in their appearance.  The second group is women who lost breast volume after nursing and want to restore what was lost and fill up what may have become an empty breast.  Women who want to be large and disproportionate, the “Baywatch look,” in fact make up a small percentage of women who get breast augmentation.  Less commonly, women whose breast are not just small, but are misshapen, get breast augmentation.  All women who get this operation should be doing it for themselves, not for a boyfriend or a husband.  They must be healthy enough to undergo an elective operation and must be mature enough to weigh the risks and benefits of the surgery.

What are the most important factors to consider when deciding whether or not to get breast implants?

Like most life decisions, it is weighing the risks v. the benefits.  Each woman will perceive the risks and benefits for herself differently.  On the positive side, breast augmentation patients studied after surgery report higher self-esteem and confidence, enjoying their appearance more both in and out of clothing.  But that must be weighed with the recognition that in all likelihood this is not a “once-in-a-lifetime” procedure – at some point a revision may be necessary.  Complications such as infection after surgery can occur. Scar tissue can form around implants; implants can break; implants can get out of the right position; there are additional costs in the future; there can be changes with mammograms, and much more that each woman considering breast augmentation should consider.  Despite all of these trade-offs, when women come in to have these problems treated, they are usually so happy with their implants they rarely are willing to give them up.

Do you recommend saline, regular silicone, or cohesive silicone ‘gummy bear’ implants?

Few patients ask for saline in my practice any longer.  There are only three reasons for saline implants: they are less expensive, they can be introduced through the smallest incisions, and some patients – despite all the evidence proving silicone is safe – remain skeptical.  Regular silicone is the softest implant and is FDA approved. The ‘gummy bear’ implants are a teardrop, firmer gel, which may give a better shape and may last longer. These too are FDA approved and  Dr. Teitelbaum recommends them to women who want a very proportionate augmentation and whose tissues are relatively tight.

How will you determine what type of implant is best for me?

There is a misunderstanding that round implants always create a round breast and teardrop implants always create a natural breast; this is not true. If a round implant is of the proper size, it can look beautiful. If a teardrop implant is too big it will look bulgy on the top and fake. So the determination of what implant is best is not based upon the shape. What matters is whether someone wants to participate in the trial of the gummy bear implant; whether they want a softer or a firmer implants; whether they feel more comfortable with an FDA approved implant or a newer implant not yet approved. Dr. Teitelbaum tends to suggest gummy bear implants more in a patient with a tighter envelope and the round standard softer silicone more often in someone with a looser envelope.
 

Will you use smooth or textured implants?

All gummy bear implants are teardrop; all teardrop implants are textured to help maintain their proper orientation in the body (the thin end up top and the thick end down on the bottom.) With round implants I recommend smooth in almost all situations. There is a widespread misperception among many plastic surgeons that texturing reduces the chances of scar tissue formation (capsular contracture.) This is only true – and minimally significant – if the implant is in front of the muscle, which is uncommonly done today. But even in that situation, there is a significant trade-off to consider, which is that textured round implants are more prone to develop folds that can be felt than smooth implants because of the slightly thicker and stiffer shell. In Dr. Teitelbaums experience, more patients with textured implants have this problem than smooth patients have the problem of hardening, but this is an issue I discuss with all patients getting implants in front of the muscle.

How will you help me select the best size implant for my body?

There is an ideal shoe size for your foot. Too small and your foot will be crammed and too large and your foot will not fill the shoe. The same thing is true with breasts: too large and it will look round and fake; too small and it will be loose and empty on the top. If you are reading this, it is probably because you thought the photos of my patients looked beautiful. The common denominator to the most beautiful breasts is that they were sized objectively on the basis of measurements. Dr. Teitelbaum measure five things, and from that he uses a formula to determine the ideal size. This formula has been published and thoroughly vetted by top plastic surgeons. Dr. Teitelbaum even has a patent for an implant-sizing device based upon these principles, so he is thoroughly versed in making this determination.

This remains one of the biggest concerns of every augmentation patient, so it will bears repeating: there is an ideal implant size for you. You can go smaller, but you won’t be filled up. You can go bigger, but you will look round. Think of a soft-sided purse: if you put only a couple of things, it will collapse and lose its shape. If you shove a lot of stuff into your purse, it will always look round. With a breast, the shape changes as the volume changes meaning you cannot have the same shape with any volume. If you want to look relatively natural, there is a limit to how large you can go. If you want to look relatively filled, there is a limit to how small you can go.

Sometimes Dr. Teitelbaum measures a patient and they want to look smaller than what anatomically is the ideal size for their breasts. That is okay, so long as they understand their breasts may not be totally filled up, and that they may be empty on the top.

At other times he measures a patient and they want to be larger than that ideal size. If they do go larger, they face two tradeoffs. The first is that they will look rounder and less natural. The second is that the size and weight of an implant that is too large for their tissues will more rapidly stretch their skin over time and compress their own breast tissue, leading to rippling, an implant that can be felt, and perhaps the need for a lift in the future.

Can implants help fill out drooping, sagging or deflated breasts?

If a breast is simply deflated or empty, falling back against the body, then an implant can fill it up. If the breast has drooped or sagged, with either the nipple low or tissue hanging down beneath the fold under the breast, oftentimes a lift is needed.

What is the best incision to use when inserting breast implants?

The best incision is under the breast, and I will explain why. I base this suggestion not on unsubstantiated anecdote, but upon objective scientific evidence.

Most patients decide on incision based upon where they want the scar. But each incision sets up an entirely different operation. Risks and complications are different, and those issues are more profound than the scar. The armpit incision tends to be more painful and less accurate than the other approaches. If a revision is necessary, another incision usually must be made.

The nipple incision yields a scar that is barely visible on most but not all Caucasians, but on patients of other races it very frequently gets pigmented and thick. It often results in a reduction of muscle coverage over implants due to technical issues, which means the implant can be more seen and felt. By cutting through the breast tissue, there is more pain, swelling, and changes in nipple sensation. Most important of all, is the fact that this incision requires pushing the implant through the breast. Though we do not really think about it, the ducts within the breast have bacteria within them. When the implant goes through the ducts, those bacteria get on the implant. And it is exactly those bacteria that cause the inflammation that causes capsular contracture. This remains the leading cause of revision surgery after breast augmentation, and it should be a priority to do everything possible to reduce this possibility. Significant experimental data demonstrate this to be true.

The best published results are with the under the breast – the inframammary – incision. The incision is hidden in the crease under the breast; there is less contamination with bacteria in the breast; more nerves are avoided; the breast tissue itself is not cut so there is less pain; the same incision is the ideal incision for any kind of future revision; and the list goes on. Most important of all is that the very best published data is with this incision. Plastic surgeons and plastic surgery patients too often make decisions based upon undocumented personal experience, and this is inaccurate. If we just look at the facts, the results are best with this incision, which is why I encourage all patients to select it.

Will there be scars?

Whenever the skin is cut there will be a scar. If you cannot tolerate a scar, you should not have the surgery. While some patient like the idea of the armpit incision since there is no scar on the breast, they end up with the only scar that is visible with a sleeveless blouse or dress. Some patients like the idea of a scar around the areola, and unless that heals very well, there is a very conspicuous “smiley face” in the area of the breast that is the focus of the most attention. The underneath scar usually is very faint. But even if it is not it is at least hidden in the crease underneath the breast.

Will you place the implants in front of or behind the muscle?

Today almost all implants should be placed “dual plane.” This means that the upper and inner areas of the implant are placed behind the muscle, where coverage is necessary in order to prevent the implant from being visible. The lower and lower outer part of the implant have no muscle in front, because in this area we need to usually expand the breast. With a modern dual plane technique, I can control the extent of muscle coverage based upon the requirements of your breast. The dual-plane technique combines the benefits of both being in front and being behind the muscle, while minimizes the downsides of each. Dr. Teitelbaum has taught this technique to many surgeons and many surgeons have written him back to tell him how thrilled they are with this method.

How will you be sure you placed the implants symmetrically?

The most critical measurement is the distance from the nipple to the bottom of the breast, and even if the nipples are at unequal height, these distances must be the same. If it is short on one side, that nipple will point down; if it is long on one side the nipple will point up. Once  that distance from the nipple to the bottom is determined, Dr. Teitelbaum precisely make a pocket that will fit the implant. This is yet another reason to favor the under the breast incision, as it affords the surgeon the most direct, well-lighted visualization of the operation, so that everything is done on good vision and nothing must be done blindly with a finger through a dark tunnel.

Will I lose sensitivity in my breasts after the augmentation?

You must accept a risk of some loss of sensation. The most common area to lose sensation is on the skin of the lower outer quarter of the breast. Whether this happens is related to the course of the nerve to this patch of skin. Less common, but more important, is whether sensation is lost in the nipple. The nipple incision is more apt to create this problem, but with all incisions this is a risk because the major nerve to the nipple comes from the very side of the breast, and any dissection puts this nerve at risk. The larger the implant, the wider the pocket has to be, and the greater the chance of this damage. The less accurate the dissection, the greater the risk of this problem. But even when everything is done perfectly, some women can permanently lose sensation and all patients must be able to accept that risk before proceeding.

Can I get regular mammograms after a breast augmentation?

Yes, but you usually need to get extra views, called displacement views. So you will get a complete set the usual way, and then another set with the breast tissue pulled forward, away from the implants. Sometimes the implants shadow a part of the breast tissue. Depending upon how significant this area is and your risk factors, the radiologist may order you to get an ultrasound or an MRI in addition to the mammogram. While insurance companies pay for a standard mammogram, some do not pay for the extra views or extra studies needed because of the breast implants.

Is my risk of breast cancer higher if I get implants?

No. The risk of breast cancer does not change if you have an implant. And the cancers are not detected later, larger, or with a worse prognosis. In fact, by having the uniform implant behind the breast tissue rather than the irregular rib cage, it is easier to feel the breast tissue and more breast cancers are picked up by the patient with implants than those without.

Will my breasts look fake?

They will only look fake if you want them to look fake. If your implants are properly sized for you, then they will not look fake. The only exception to that is patients who are literally skin and bones, upon whom you can see their ribs. The implant goes in front of the ribs, so if you can see the ribs, you will have to see the implant. But even in those cases, the lack of breast tissue is so profound that a small implant will usually look much more attractive.

The thicker the tissue and the smaller the implant, the more natural they will look. The thinner the tissue and the larger the implant, the more fake they will look. So the answer is to have your tissue measured, and to get an implant that fits your body.

How long will my implants last?

How long implants last and how long it will be until you have your next surgery are two different issues that are often confused. A broken implant is not even in the top five reasons for having a revision. The most common reasons patients have another surgery is the build up of scar tissue, drooping, implant getting out of position, wanting a change in size, etc.  Implants only break at a rate more or less of 1% per year. Sometimes those breaks can be noticed as a change in the breast. At other times the patient cannot detect a difference and the break can only be detected by an MRI.

If my saline implant ruptures will I get sick or be deformed?

When a saline implant breaks, it usually deflates over a period of days or weeks. There is nothing dangerous about it, but you will look very imbalanced.

If my silicone gel implant ruptures will I get sick or be deformed?

Sometimes when a silicone gel implant ruptures the breast feels different. Sometimes harder, but more often there is less of a sensation on careful examination of the discrete borders of an implant, but rather a more amorphous feel to the breast.  While we recommend that a woman with a ruptured silicone implant have the implant removed and replaced, there is no evidence that a ruptured silicone implant will make you sick.

If my cohesive ‘gummy bear’ silicone implant ruptures will I get sick or be deformed?

It is uncommon for these implants to break, but they can. Sometimes a break is detected on MRI and the patient and surgeon noticed no difference. Sometimes there is a change in shape or feel. We do recommend that they be removed and replaced, but there is no evidence that a ruptured gummy bear implant poses a threat to your health.

Will I be able to breastfeed after I have an augmentation?

We warn all patients that they may lose the ability to breastfeed, but in the scores of patients of my own who have had implants I cannot recall one who was unable to nurse.

Will I need to replace my implants after pregnancy?

Occasionally after nursing the skins stretches and the breast looks empty. Sometimes capsular contracture develops. Sometimes the breasts droop. For these problems, a revision may be necessary. But most of the time augmented breasts still look beautiful after pregnancy and do not require a revision.

What should I bring with me the day of surgery?

After you have scheduled surgery, you will be given a detailed list of what you need to bring. But you do not need to bring a special bra or anything in particular with you.

Do I need to go to an aftercare facility after my surgery?

You are well enough to go home and do not need to go to an aftercare facility. You will be up and around. We want you to leave the house, to take a shower, and engage in normal activities. When patients go to aftercare after a breast augmentation, they are often given too much medication and are not allowed to do enough activities. Dr. Teitelbaum’s patients enjoy a one day return to normal activities, and their recovery is typically hindered at the recovery centers because the nurses are not accustomed to patients who will recover so quickly.

How painful is the recovery?

Most of our patients go out to dinner and shower the night of surgery, needing nothing more than Ibuprofen (Advil, Motrin) for their pain. Most describe it as a pressure, or a weight on their chest, much as if they had worked out hard or their milk was coming in. Please see the video testimonials on plasticsurgeryvideoguide.com to see and hear what actual patients have to say about their pain.

Will I get a phone call from the doctor the night of my surgery?Will I get a phone call from the doctor the night of my surgery?

Dr. Teitelbaum will call you the night of surgery and will give you his personal cell phone number so that it is easy for you to reach him.

How soon can I go to work?

When you will feel ready to do your job is highly individualized. So long as your work doesn’t involve straining and heavy lifting, you can expect to be back to work after three or four days. Some people go back even sooner, and many work from home the next day.

When can I drive?

You can drive when you are off of all narcotic pain medication and feel totally unrestricted by your discomfort such that you could make any movement you might need to safely drive your car. That is ultimately a decision that I cannot make for you.

When can I travel by airplane?

There is nothing about an airplane ride that is inherently problematic. The issue is whether you are going to a place where there is a doctor who can take care of you if you develop a problem.

When can I resume exercise?

Dr. Teitelbaum suggests you wait 3 weeks. He wants to be sure that everything is healed. There is always a chance of causing bleeding if you start much before that time. When you start, listen to your body. You will be a little out of condition and a bit sore. But you will get back to where you were before surgery very quickly.

What is considered to be exercise?

Elevating your heart rate or blood pressure, bleeding hard, or straining or sweating. But light walking is beneficial starting the day of surgery.

Does not being able to exercise then exclude sex?

Sex can be resumed as you feel comfortable. Most often patients hit their level of comfort in 3-7 days. Again, respect the fact that you have undergone surgery and try to avoid the manipulation of the incisions.

When can I lift my child?

You can lift a cooperative child that is up to 35 pounds right away. But don’t try to pick up your child if he or she is fighting you or if you have to bend way over a playpen.

When can I drink alcohol?

A small amount of alcohol will not interfere with your recovery.

When can I smoke cigarettes?

We would like to say never, since they are bad for you. Smoking does slow down healing, and it would be best to avoid them for three weeks.

When can I sunbathe?

We would also like to say never, since nothing ages us as much as the sun, and the damage it does to the skin. This is particularly true in the decolletage area, where sun damage makes women look very aged. But it is okay to go out in the sun within days after surgery, provided that the incision is protected by something that will totally block the sun, and it is a good idea to keep the incision totally blocked form sun for a year or so.

When can I shower/take a bath?

You should shower the evening of your surgery. Your incision can get wet, but don’t rub it. Soap your breasts and let warm water hit them

What will my post-operative appointment schedule be like?

There are no drains or stitches to be removed after a breast augmentation, so there are really no compulsory visits or times at which something in particular must be done. Dr. Teitelbaum wants to see everyone the day after surgery to be assured that everything is okay. He offers patients frequent visits thereafter, usually at one week, one month, six months, one year, and yearly therafter. But some patients will come more frequently, some less frequently. He does not charge for these visits. Some people have little questions they want answered, and other people feel fine on their own. He is always available for a patient who wants to come in. The only exception to this schedule is for those patients who get cohesive ‘gummy bear’ implants. These patients do have a more specific follow-up appointment schedule that must be adhered to and this will be reviewed with you prior to surgery.

Why do my breasts appear to be high right after surgery?

It is not supposed to look perfect right after surgery! The upper breast almost always looks too full. Some of that is swelling; some of that is that the implant will drop down to the bottom of the breast. Pronounced upper fullness usually goes down between 4-8 weeks, but it continues to improve for a full year.

Why do I need to do arm lifts immediately after surgery?

Think of this surgery as having a mildly sprained ankle. If you don’t walk on it, it will get progressively stiffer. If it is only mildly sprained, the walking on it can get it loose. The biggest source of pain after a breast augmentation is a muscle that gets stiff. Just think about when you have sat in one position for a long time and the discomfort when you try to move that joint for the first time. By staying lose you will be more comfortable. By moving your arms you will keep the pocket from closing down on the implant and will help to keep the implant soft.

How long does the swelling last?

Swelling increases after surgery, usually peaking about 5-6 days after surgery. After that, the swelling will subside, rapidly at first, and then gradually. After one month, you’ll think the swelling is gone, but it will still go down more at three months, and even more at six months and even a year, though at that point changes are subtle.

Should I ice my breasts for the swelling?

We do not specifically require it, but it is okay to do it. Sometimes it can make your muscles feel a bit stiff, and moving your arms is important. But it can also be very soothing, and reduce pain and swelling. The choice is yours. But if you do it, you still need to do your arm exercises so that you stay loose.

Once the swelling subsides, how much smaller will my breasts be?

Everyone is different. Some swell a lot, some swell a little. Generally, though, the breasts do start off somewhat swollen, and that will go down. However, they will also get softer and more mobile, so that in a sense they can actually be made to look larger once they soften up enough to be pushed up and molded by a bra. Similarly, as swelling goes down, the borders of the breast become better delineated, so that they appear to be more distinct from the chest wall. They also lose the excessive upper fullness with time as they drop in the breast. Another way to think about it is right after surgery the tightness of your skin is compressing your breasts against your body. As the skin relaxes, even if the swelling goes down a bit, your breasts will project more and look larger.

What do I have to do to care for the incision?

You will either have steri-strips or a glue closure over the incisions. You should shower the evening of your surgery. Your incision can get wet, but don’t rub it. Soap your breasts and let warm water hit them. This will help them to feel better.
After about a week, the glue will start flaking and the steri-strip will start lifting. At that point you can start cleaning it with a wash cloth and teasing it off.

When do the stitches need to be removed?

Your stitches are dissolvable and therefore do not need to be removed.

What should I do to prevent scarring?

The bottom line is that the fate of your scar is mostly determined by your own genetics and by the surgery itself. It is not clear the extent to which putting things on scars will influence their final appearance. However, most patients want to do something. There has never been a direct comparison between the various products. Patient feedback has been the most positive from three sorts of things: Scar Guard, which is a liquid containing steroid, Vitamin E, and silicone that you brush on like nail polish; Silicone gel strips (such as Neosporin scar strips); and silicone ointment (such as Scar Fade.) You can get these from the office or the pharmacy, and you can start putting them on once the glue or the steri-strip is off, following the instructions on the packaging.

What type/size bra should I wear after surgery?

Wearing a bra is optional unless you were specifically told for your situation that you needed one. Some people feel comforted and supported by a bra, others feel it to be restrictive and uncomfortable. It is your own decision just based upon fashion and comfort. Even underwire bras are okay, so long as they are not rubbing against your incision or bothering you. You will be given a bra after surgery. Many people find that sports bras are the most comfortable for the initial week or two after surgery. Also, they are inexpensive, and it doesn’t make sense to spend a lot of money on bras until the swelling has gone down and the breasts settled a bit, which takes a few weeks.

Do I have to massage my breasts?

Breast massage has never been shown to be of benefit. But if you have a smooth implant, you will not hurt anything by doing it. If, however, you have a textured surface implant or a teardrop shaped implant, you should not massage them, as it could cause implant malposition.

What is capsular contracture?

It is a build up of an excessive amount of scar tissue by your body around the implant. It makes the implant feel hard, move upwards, and look round. It remains the leading cause for revision surgery after breast augmentation.

Is there anything I can do to avoid capsular contracture?

The first step is to avoid the nipple incision, as this leads to contamination of the implant with the bacteria that live in the breast. It is these bacteria that seem to be the leading cause of capsular contracture. You need to choose a surgeon who will do a gentle operation, with minimal bleeding and bruising. Finally, you must do your arm exercises to stay loose after surgery, and follow all the instructions we give you. But there is no special vitamin or medicine that we know will prevent capsular contracture.

When will I need to replace my implants?

There is no specific time that an implant will last. The rate of shell failure is about 1% per year. We know that about 30% of women have another operation by seven years, but most of those are not because a woman needed to have surgery, but because they wanted to improve something. There is a myth that they need to be redone at 10 years, but that is totally untrue. It is just that by around ten years, probably around half of the patients or so decide to have another operation, even though it is not required to do so.

Do breast implants have a warranty?

Yes, and these warranties vary between the manufacturers and the type of implant. They usually cover implant breakage and for some period of time will offer a replacement of that implant and the one on the other side, with varying degrees of additional monies offered to cover part of the cost of surgery. These warranties change all the time, so check with the office to learn the latest.

What do I need to watch out for?

Most of the things that could go wrong are sufficiently obvious that most people would notice them without being specifically warned. Since breast augmentation is really two surgeries at once, be alert for any significant difference between the two sides. Minor differences are to be expected, but contact the office for a significant difference in pain, swelling or firmness. Of the uncommon problems early after surgery, the one to be alert for is a hematoma, which is bleeding after surgery. One breast will suddenly swell and become hard and painful. This will require a return to the operating room to treat, and you need to alert us right away. Also call the office for any issues with the incision such as pain, redness, or discharge. Obviously, anything serious such as shortness of breath should be a cause for an immediate call to 911.