Breast Augmentation

What can I expect after breast augmentation (breast implant surgery)?

You should expect a moderate degree of swelling and discoloration for 1-2 weeks after surgery. The expected postoperative recovery would be approximately 1 week during which time you should limit your activities and rest as much as possible. The first 2-3 days are likely to be the most uncomfortable for you with a moderate degree of pain, which is easily relieved with oral pain medications. After 3-4 days, you should be able to attend to minor activities around the house and go on short walks. By the 5th or 6th day, you should be able to return to work. The majority of patients return to work within a week. Although some patients feel good enough to exercise in the 2nd week, most do not resume their normal exercise routine until the 3rd or 4th week. With the placement of the breast implants, there will be some changes in your lifestyle. These would include the protection of the breast implants from injuries during strenuous activities and the protection of the breast from injuries sustained during mammography.

What size implants should I choose for my breast augmentation?

You should choose a size that is becoming to your body and you think is right for you. Many patients come to the doctor's office and say that they don’t want their breasts to be too large. However, you must know that the most common complaint of a patient after this operation is that she wishes they were a little larger. Therefore, we recommend that a patient choose a size that is a bit larger than what she thinks is ideal. During the operation, Dr. Marefat chooses breast implants that are appropriate for the frame of the patient by placing a temporary sizer and looking at the breasts while she is in a sitting position. Based on this sizer, Dr. Marefat chooses the permanent breast implants for the patient. Dr. Marefat generally increases the size of her breast by one or two cup sizes.

What risks are involved with breast augmentation (breast implant surgery)?

Virginia breast implant surgery is one of the safest operations we perform. However, like any surgery, there are risk factors associated with it. Dr. Marefat generally discusses the following complications with the patient in her second consultation prior to surgery. You should understand that all these complications are extremely rare and are not a deterrent to surgery for most people.

A complete list of possible side effects and complications will be provided to you when you schedule your surgery. You should talk to Dr. Marefat for more information on each of these possible risks.

• Capsular contracture: With breast implant surgery, the most common complication is capsular contracture. This term refers to firmness of the breast caused by the shrinking of the scar tissue surrounding the breast implants. Unfortunately, there is no way to predict in whom this problem will occur. It may occur in one breast but not the other. If this problem occurs, we may have to perform a corrective procedure. The treatment option for resolving this type of problem is typically surgical correction. Closed capsulectomy (release of the contracture by external pressure) is no longer done. Open capsulectomy would entail returning to the operating room for releasing the capsule by making incisions in the scar tissues or by removing the scar tissue completely. This allows the breast implant to sit comfortably in its pocket and stay soft. The risk of developing capsular contracture is approximately 10%, although higher numbers have been reported in some studies.
• Implant failure: The breast implants themselves have a failure rate. They may leak or rupture. The risk for future implant replacement is approximately 1% per year for each implant.
• Calcifications: Sometimes with breast surgery, there may be a small degree of trauma to the breast tissues or the fatty tissues in the area, and this may result in late calcifications. Occasionally, these calcifications may create some doubt as to the presence of breast cancer. If this occurs, it may be necessary to biopsy the area in order to rule out cancer.
• Anesthesia risk: Anesthesia has its own risks and complications. With modern equipment and techniques, the risks from surgical anesthesia are minimal.
• Bleeding: Any surgery will have risks of bleeding or infection, but the likelihood of such problems is very small.
• Scarring: Occasionally, there may be excessive or obvious scarring in the incision. This happens very rarely and does improve with time. Sometimes, we may need to revise the scar at a later date. We generally do this after 9-12 months from the time of the initial surgery.  
• Sensory changes: There will be temporary breast and nipple sensory changes that usually resolve in 6-8 weeks. Very rarely, there may be permanent loss of nipple sensation. Unfortunately, there is no relationship between the type of incision used and the development of this problem.
• Chronic pain: A few patients have been reported to have chronic pain as a result of breast augmentation.
• Minor asymmetries: Most women have minor asymmetries in their breasts, and this is completely natural.  If there is a major difference between the two sides of the breasts, this can be corrected to a certain extent. Major problems of asymmetry cannot be completely corrected and may persist after the operation.  
• Implant movement and visibility: Certain position changes may cause indentations in the breast that reveal the presence of the implant. This has generally been a problem in women who are very muscular and whose muscle contractions can displace the implant in its pocket.
• Disappointment with results: Some patients are disappointed with the results of their breast implant surgery. This is sometimes related to the fact that they had unrealistic expectations in terms of the outcome of the operation.

Am I at risk for breast cancer with breast augmentation? 

There may be a slightly increased risk of compromised detection of early breast cancer by having breast implants. With improved, state-of-the-art radiological techniques for detection of breast cancer, this is unlikely. Furthermore, the saline breast implant is completely clear in the x-ray, making it easier for the radiologist to see all the breast tissue. Patients who have breast implants are more likely to examine themselves and to be examined by a health professional. For this reason, the likelihood of having an undiagnosed tumor is lower.

What about risk of connective tissue disease and arthritis with breast implants?

The rare and unsubstantiated risk of connective tissue disorders, such as arthritis, relates to silicone implants; you should not worry about this with saline breast implants.

Will breast implants affect future pregnancies or breast-feeding?

You should not have any problems with nursing; however, there have been a few cases in which the patient has not been able to nurse. Certainly, this is not a common complication of this operation.

When are the breast augmentation (breast implant surgery) sutures removed?

Sutures are generally removed 2 weeks after breast implant surgery in Virginia.

How many visits do I have after breast augmentation (breast implant surgery) in Virginia?

We like to see our patients frequently after surgery. You are seen by the doctor or nurse within 2-3 days of breast implant surgery. Then, the normal postoperative routine is 1 week, 1 month, 3 months, 6 months, and 12 months. Of course, if there is a need, you may be seen more often. After the first year, we encourage our patients to come in for routine follow-up visits every 3-5 years.

When can I cover my bruises with makeup?

You should be able to put makeup on the bruises after the first week. However, we do not recommend putting makeup on your incisions until they have completely healed. This may result in tattooing of the skin by the pigments of the makeup.

Will insurances cover costs for future problems with my breast implants?

Most insurance carriers may not cover you for problems related to breast implants since they were placed for aesthetic reasons. You should have no problems, however, in obtaining coverage for breast diseases unrelated to the implant surgery. The breast implant manufacturers give a lifetime warranty for their products. Some manufacturers will also cover for costs of surgery if the product was found to be defective. You should ask your Virginia plastic surgeon for details about coverage.

Should I get a baseline mammogram before breast augmentation?

It is a good idea to obtain a baseline mammogram prior to placement of the breast implants. Dr. Marefat recommends this in all patients over 35 years of age.

Am I a good candidate for breast augmentation (breast implant surgery)?

The best candidate for breast implants is a woman who has small or underdeveloped breasts or who has lost the natural firmness of her breast after pregnancy and breast-feeding. Women who have very asymmetrical breasts are also good candidates. Generally, the younger you are, the better a candidate you are for cosmetic surgery. But the physiological age of a person is more important than the chronological age. That is to say, you may be 60 years old, but your skin and general health could be better than that of most 50 year olds.