Breast Augmentation FAQ

How do I know if there's a problem with my incision?  

If your incision is slow to heal, or is red, feverish (hot), or painful, appears to be opening up, or has pus oozing from it, you need to contact your doctor immediately. These symptoms could very well be a sign of infection. 

My incision itches, what causes it, and what can I do about it?    

Itching occurs when the incision starts healing. It's perfectly normal, and nothing to worry about. Applying something warm or cool (not too hot, not too cold) to or around the site can sometimes alleviate the itchy feeling for a while. Though it's not fully understood, many women claim that the change in temperature helps. You may also try scratching “around” the incision. Many times, this helps as well. Do NOT apply anti-itch creams to your incision (i.e. Cortizone, etc.), or anything else until the wound has completely closed.  Once it has completely closed, you probably won't experience anymore itching.

My breasts itch, what can I do about it?

If your breasts are itching, it's most likely due to the skin stretching.  You can apply a moisturizing lotion on them, but make sure you do not get any on your incisions (assuming they're in the crease, or around the areola.) 

How long are the incisions used for breast augmentation?   

If you get an inflatable saline implant, the incision will probably be around an inch long, but maybe even shorter than that, depending on the skill of the surgeon. If you get a pre-filled implant, such as silicone or PIP (which, by the way, are no longer available in the US), the incision will be a little longer. I've heard of pre-filled implants as large as 500cc going in through an incision only 1-1.5" long, so a lot depends on the skill of your surgeon, as well as the type and size of implant you choose. Because textured implants are a little firmer than smooth implants, they require longer incisions (for textured pre-filled implants). Textured implants have been equated to trying to squeeze a ball of sandpaper through a small incision, though this is certainly not the opinion of all plastic surgeons.  Some incisions will need to be longer than others. 

How can I "care" for incision after the surgery, so that it heals as nicely as possible?

See Scars. 

Can I get silicone implants for my first breast augmentation?

In order to get silicone implants for your first breast augmentation, you must meet certain requirements.  The Adjunct Study requires that you:

- have pectus excavatum, pectus carinatum, or some other type of chestwall deformity.
- you are are having a breast lift (mastopexy) in addition to the breast augmentation.
- you are a reconstructive surgery patient.
- you have had saline implants, and had less than desirable results.

If a surgeon allows you to have silicone for your first surgery, and you do not meet any of the above criteria, your doctor is breaking the laws set forth by the FDA.  

Occasionally, there are studies that do allow silicone for first-time patients.  Two examples would be the Core Gel Study by Mentor, or the Cohesil study by McGhan.

Can silicone gel move outside the pocket, or scar capsule?    

Yes, according to the FDA, it is possible for silicone to migrate away from the breast. The free silicone may cause granulomas to form in areas in and around the breast, as well as other areas of the body that the silicone has migrated to, such as the abdomen, arm, armpit, and chest wall. Usually, the free silicone stays within the scar capsule, and does not migrate to other areas. 

Will I get stretch marks when I have my breast augmentation?  Can I prevent them?   

It is literally impossible to determine whether you will get stretch marks after your breast augmentation. Many doctors believe that your skin elasticity is a large factor. However, you can always take preventative measures. Many women have moisturized heavily prior to their surgery by using Palmer's Cocoa Butter, Shea's Butter Lotion, and vitamin E. It certainly will not hurt to try it. 

If you have pre-existing stretch marks due to pregnancy, breastfeeding, etc., the implants will most likely help to “fill them out”, thus making them less noticeable. If this is not the case for you, or, you get stretch marks after your surgery, you can try using Mederma . It has helped diminish the appearance of stretch marks in many women, while others have noticed little to no difference at all.  Results vary. 

S tretch marks, regardless of where they are located, can be treated with laser surgery.  However, I know of very few women, myself, who have gotten stretch marks due to breast augmentation surgery.

Will I have to massage my implants (smooth and textured)?  

All surgeons have different opinions regarding massaging smooth breast implants implants. Some doctors ask all their patients to do it, and others say that it is not necessary or beneficial. The doctors who suggest it believe that it helps to keep the pocket open, thus helping to deter capsule contracture. Whether or not your doctor asks you to massage has nothing to do with how the surgery is performed. It's simply a matter of whether or not your surgeon prefers and recommends massage. 

Most, but not quite all surgeons will advise against massaging textured breast implants. The purpose of the textured shell is for it to adhere to your tissue. Moving the implant around will only inhibit tissue adherence, which is why most doctors don't normally recommend massaging textured breast implants. 

In any event, do exactly as your doctor asks you to. This is important, because if you do not follow his or her instructions, and you encounter a complication, you can easily be held responsible for it. However, do not be afraid to ask your doctor things like "why do want me to massage my smooth implants", or "why do you want me to massage my textured breast implants", etc. The only stupid question is the one that isn't asked. 

Below is Dr. DeWire's breast implant massage technique.  Click on the picture to go to Dr. DeWire's web site.

 

Will smoking affect my recovery?   

Most doctors will recommend that you stop smoking prior to your surgery, especially if you are having a breast lift. Smoking decreases the amount of oxygen in the blood, which can slow healing by constricting the capillaries. Capillaries are a system of microscopic vessels that link the arteries and the veins. Through their walls, which can be so small that only one red blood cell at a time can pass through, blood and tissue cells exchange various substances. The blood gives oxygen and nutrients to the cells and collects wastes from the cells. While blood flows rapidly through the arteries and veins, the flow through the capillaries is much slower. This allows time for the exchange of oxygen, nutrients, and wastes between tissue fluids and surrounding cells. If the capillary is constricted, the exchange of the nutrients is compromised. 

Breast lift patients have even more reason to stop smoking. Lack of oxygen to the tissues can cause necrosis (death of healthy tissue). Due to the amount of incisions that are using during a breast lift (depending upon what type of lift you get), you will most certainly not want to compromise the level of oxygen that is supplied to those tissues. In severe cases, lack of oxygen can lead to necrosis, which can lead to extrusion of the implant, not to mention putting you at a much higher risk of infection, as well as ugly scarring. 

Will I have swelling?   

Swelling is very common post-operatively, so you will most likely have swelling to some degree. It is not uncommon for the swelling to migrate downward, to your abdominal area, as well as the groin area. This is nothing to be alarmed about, as the swelling will dissipate within a few days to a few weeks. It's unadvisable to take diuretics without getting permission to do so from your plastic surgeon. Sleeping in a reclining position until your swelling goes down a bit is a good idea, as well as a common post-op instruction. This helps the fluid move away from the breast (downward, as mentioned earlier). Less fluids mean less tension on the breast, which means less pain. 

Will I have bruising? 

You may or may not have bruising.  Like the swelling, bruising may also migrate downward. Bruising can work it's way down to your ribs, abdomen, groin area, and even as far as your upper thighs, though this doesn't seem to be really common.  However, it does happen, but is not a complication. 

A bruise that looks really bad, and feels firm, should be reported to your plastic surgeon.  This could be a hematoma.  Read more about hematomas here.

Will my areolas stretch out after I get implants?   

This varies from woman to woman. If you get really large implants, then you may very well notice a difference in nipple/areola size. Personally, I went from an A to a D cup, and don't notice that big of a change, if any at all. 

What is the minimum age you have to be to have breast augmentation? 

As of May 2000, Federal regulation prohibits breast augmentation for purely aesthetic surgery in women under the age of 18.

Will my insurance pay for my breast augmentation? 

No, your insurance will not pay for any surgery that is for cosmetic purposes only.  If you have a physical deformity, such as having one breast larger than the other, etc., if you have had trauma to the chest which requires repair, or if you are a mastectomy patient, your insurance will help pay for the costs. 

Can I sleep on my stomach after my surgery?  Will this be comfortable?

Yes, but it may take a little time before tummy-sleeping is comfortable for you.  Basically, it depends on how you recover.  Some women can sleep on their stomach as early as 2 weeks post-op, while it takes others a little longer.

How long will it take my implants to “settle” into place?

This depends on the individual.  Most women are pretty much able to see what they're going to look like by around 2-3 months post-op.  Slight settling may still occur after this, and may continue for up to a year.

 

 

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