Saline-filled (silicone elastomer shell) Expandable Implants: This implant was designed by Dr. Hilton Becker under Mentor Corp. in 1984 for use primarily in breast reconstructive (mastectomy) patients, to gradually expand the tissues with out severe trauma to the tissues. By the late 1980's. the Becker expandable implant gradually wound its way into the cosmetic breast augmentation market. A decade later the Becker expandable implant was replaced by the Spectrum breast implant (sometimes referred to as the Spectrum-Becker). The Spectrum implant is a permanent solution to expansion breast augmentation with the the Becker-designed valve, filling tube and reservoir system.   

The original Becker saline-expandable implant (gel also available) is still available although highly restricted by the FDA. But it's not the restriction that makes it inappropriate as an expansion breast augmentation device, it's the expensive price. Hence, the reason why the Spectrum implant has taken over the market of expansion breast augmentation.

The Spectrum expandable implant comes in ranges, or different sizes, like standard implants. The implants cannot be filled up indefinitely. You must have a general idea of what size you would like to be post-operatively, then build on this size. They come in textured and smooth models and can be placed either sub-glandular or sub-pectoral.

When they are first implanted, especially if you are small breasted in comparison to your size goal, your surgeon may not fill them to their starting volume. The gradual filling will give your tissues and muscles, if applicable, time to adjust and not traumatize or over exert the tissues to the point of fissures, tears or excessive stretch marks. Just remember with augmentation, stretch marks are always possible. There is a dime-sized filler port in each implant, that is left in near your incision (crease, peri-areolar) for ease of injection until after it is determined that you are at your volume goal.

You will probably have another fill (usually in 30 to 50cc increments) about 1 week post-operatively then on to 2 weeks, then perhaps a few weeks later. Most patients report that the fill-ups do cause them minor discomfort and that after all the settling and dropping you have accomplished over the weeks is for naught. You see, you become rounder, fuller, higher and tighter after each fill up so your body has to get back to work to accommodate the implant all over again. You should expect to pay about $400US more for a Spectrum and remember, until the filler port is removed (through your original incisions) you will be able to feel them and the area may become chafed if your bra or support garment rubs up against this area during natural body movement.  It is reported that the extrusion rate for the filler ports is about .76% -- very rare.

Although a saline filler is the most popular, there are other options. If some women meet certain criteria (reconstruction, thin skin, asymmetry, congenital deformities, replacing an already existing silicone-filled implant, etc.), they may be eligible for silicone filled implants, which brings us to the next option...

Silicone-filled (silicone elastomer shell): So much controversy has arisen in the last two decades pertaining to the silicone-filled breast implant. Certainly enough to cause alarm in even the most skeptical person. Now that the Internet era is in full swing, more and more anti-implant websites are popping up.  Silicone sensitivity may be a problem in some patients; just as one may be sensitive to latex, nut oils or eucalyptus. However, there are far too many happy women with NO complaints whatsoever with implants in for literally decades. According to our nation's FDA and the Institute of Medicine (IOM) there is no conclusive evidence regarding diseases and/or chronic illnesses directly related to silicone-implant products. 

However, there is evidence of granuloma and macrophage accumulation with silicone injections and gel bleed from mammary prostheses. Lower molecular silicones do tend to migrate and cause granulomatous fibroses (nodules of inflamed tissue) as well.  Thankfully, today's implant shells are safer, more durable and last longer than their predecessors. Although the lower weighted silicone permeates this elastomer shell due to the belief that "same does not hold same."  This being the lower weight extruding through the higher cross-linked elastomer shell. Capsular contracture (CC) and thicker capsules have been reported to occur more often with silicone filled implants  than in saline-filled implants due to the permeation of lower molecular silicones, called "gel bleed", into the surrounding tissues.  The body treats this like an irritant, comparable to a grain of sand in an oyster, and continues to surround it with fibrous collagen.  However, newer implant shells tend to have less gel bleed and less complications

Cohesive Silicone-filled (silicone elastomer shell): In use since 1995, this implant's filler is a thicker silicone gel that enables the patient to be free of silicone seepage even in the unlikely event that a rupture should occur. This implant is presently in clinical trials in the United States.  Cohesive-Silicone filled implants are an approved medical device in Australia.

Poly Implant Prosthesis (PIP) Hydrogel:  This product is Manufactured in France and was distributed by Clover Leaf Products Ltd. The PIP is pre-filled with a hydroxypropyl cellulose hydrogel (polysaccharide) gel filler. The same substance which is a main ingredient in Reviderm Intra soft tissue augmentation injectable filler.  This implant was voluntarily recalled due to a "request" by the MDA (The UK Medical Device Agency) for more studies "due to the lack of long-term toxicity data or clinical follow-up, together with methodological flaws in some of the pre-clinical tests." For more information regarding their safety concerns see - Medical Devices Agency - MDA Safety Warnings on PIP Implants. http://www.medical-devices.gov.uk 

Poly Implant Prosthesis (PIP) Saline: This product, also manufactured in France, was distributed by PIP - USA. Due to the implant manufacturer's failure to provide sufficient studies regarding the safety and efficacy PIP salines are currently not approved. PIP has since applied for yet another study.

*Two other such implant/companies which are allowed to conduct clinical trials are Hutchinson International and Silimed L.L.C.

 Round vs. Contoured, or Anatomical
The contoured (anatomical, teardrop, or biodimensional) implants are more expensive and there is the possibility of them flipping over or inverting themselves if the surgeon did not form the pocket correctly. Especially in the dominant side. However, this implant's surface is textured to help prevent the displacement of the implant. They create a natural slope instead of a pronounced cleavage look when in the sub-glandular placement.  It has been reported by some surgeons that the round implant looks just as natural once it settles into place and as long as it is not overfilled very much. Overfilling creates a pronounced augmentation of the upper pole of the breast. You will read more on overfill very soon. This subject is pretty controversial so go over this at your consultation and view photos of patients with contoured implants. The decision is up to you. Different surgeons will have different opinions and not everyone's body will result in the same look.  It is also reported that there is no agreement on optimum fill when volume of anatomical implants are concerned.

 Smooth vs. Textured Surfaces
The textured surfaced implant has an almost foamy feel to it and was originally designed to lessen the occurrence of capsular contracture (CC).  However, not much concrete evidence exists to suggest that the incidence of capsular contracture is indeed reduced with its use.   In fact, it is not yet known why some patients are susceptible to CC and others are not. Some surgeons suggest the presence of blood in the pocket can later cause excess scar tissue however, no true study supports this as a definite causative factor.  

Whether the placement be sub-glandular, sub-pectoral or fully sub-muscular, the smooth-surfaced implants are the most commonly used choice today. 

Please speak to your surgeon more regarding your options in implant surfaces, and why he or she feels either would be best for your case.

The Available Incision Placements

• Infra-mammary or "Crease" Incision: This incision placement was once very popular with surgeons; this is where the incision is placed a little above where the breast and rib cage meet, on your breast lobe. This creates a long scar but doctors are beginning to use an short-scar approach in this area as well. This leaves a scar only about an inch to an inch and a half wide, some doctors even less.  However with pre-filled implants, a larger incision will be necessary.

• Peri-Areolar Incision: This incision is made at any area on the border of the pink or brownish skin that surrounds your nipple.  An areolar incision is a good placement when an Areola Reduction or Peri-areolar Mastopexy is performed. There is a small chance of decreased nipple sensation but this is normally temporary. Also the increase of a Staph infection may be relevant when an incision is placed in the nipple area. Reason being there is a natural inhabitance of bacteria in the milk ducts and inner workings of the nipple. Some surgeons use a sleeve of sorts to shield the implant from the milk ducts during placement.

• Trans-Axillary, or "Armpit," Incision: This technique is also endoscopic and leaves a small 1 to 1.5 inch scar in the axillae, or arm pits. This is sometimes thought to be the best incision used with full sub-muscular placement.

• The Trans-umbilical Incision (TUBA): TUBA is an acronym for Trans-Umbilical Breast Augmentation and is a technique performed endoscopically, creating a shortened recovery time as it is minimally invasive in comparison. Unless of course you choose subpectoral placement because that recovery is something in itself.  However, the recovery is reported to be lessened regardless.  The incision is shorter than an incision near the breast or under the arm due to the increased elasticity of the abdomen area. The incisions are usually J shaped or C shaped within the confines of the navel.

The Available Implant Placements

• Sub-glandular (overs): is where the implant is placed over the pectoral muscles under the glands and tissue of the breast. With this placement there is an increased chance of palpability (detection by feel or sight) of the implant, especially if you have little or no natural breast tissue present.

  There is more difficulty in detecting breast abnormalities if more views are not taken during a mammogram.  The advantage of overs is for a quick fix of mild ptosis (sag).  Although it will not significantly lift the breast so if your surgeon suggests a breast lift--you should listen.  There is less pain and healing time reported by patients post-operatively as the underlying muscles in the chest are not traumatized during surgery.  The definite disadvantage is of course the slight mammography difficulties and the obviousness of having implants.  Although some women, do prefer a high and tight implant look.
  
  Sub-glandular placement gives a more natural movement as you walk or use your chest muscles.  You'd be surprised at how much you actually use your chest muscles.  When you have unders your muscle will squeeze or contract around the implant, making them appear temporarily distorted or look unnatural, especially when lifting yourself into a boat, out of a pool or onto a table and while lifting weights.  Some women report that there are days when they can feel the implant and on others, they cannot.  This can be caused by the presence of a menstrual cycle as a woman's glandular tissue is swollen and tender during this time and the presence of possible edema (fluid retention) and hormonal factors can make them temporarily larger.  Other times it may be from weight loss.  Weight loss does affect the breasts and when this does happen, your implant may be more apparent.

• Sub-pectoral-only (partial unders, partial sub-muscular): The purpose of being placed under the pectoralis major muscle is to provide better implant coverage on the outer and inner top area only (cleavage).  This way if you have little existing breast tissue or would like a more natural look instead of a rounded, pronounced cleavage line without rippling to the upper inner and upper outer regions of the breast, then partial sub-muscular (sub-pectoral only) placement may be for you.  The sub-pectoral placement surgery is a bit more involved. Surgery involves the act of separating the pectoralis majora (or major) from the pectoralis minora (or minor) and chest wall and placing the implant between these two.  With this placement, some believe that the chance of capsular contracture is lower, although not impossible. although there really is no hard evidence which determines this.  One plus that concerns many women and cinches their decision is that the breast takes on a more natural slope on the top if you have little natural breast tissue.  You must realize that when you have sub-pectoral only coverage, it is anatomically impossible for a patient to have full implant coverage.  The pectoralis major muscle branches over the breast area from the arm like a fan.  The fingers of the pectoralis major muscle cover only about 2/3 of the breast implant.  Remember that if you work out at the gym or lift objects your pectoralis major muscle will contract around the implant in an unnatural sort of way.  Also, it is reported by many women with sub-pectoral only implants that swimming is quite an odd experience to get accustomed to post-operatively.  However the patients report that having gotten accustomed to the feel of the contractions, they tend not to notice.

• Full Sub-muscular (complete unders): Not really full muscular placement, per se, this placement also involves the act of separating the pectoralis majora (or major) from the pectoralis minora (or minor) and chest wall as well as separating the fascia (or thick muscle covering) from the muscle itself of the rectus abdominus and also the use of the serratus muscle fascia.  However, for ease of wording and for terminology recognition we will refer to it as full submuscular placement.

  "The pectoralis majora muscles are either of the muscles that connect the ventral walls of the chest with the bones of the upper arm and shoulder of which in humans there are two on each side. This muscle arises from the clavicle, the sternum, the cartilages of most or all of the ribs, and the aponeurosis of the external oblique muscle and is inserted by a strong flat tendon into the posterior bicipital ridge of the humerus -- called also pectoralis major" (Merriam-Webster; Medical) 
  
  "The rectus abdominus muscles are the long flat muscles on either side of the linea alba extending along the whole length of the anterior (front) of the abdomen, arising from the pubic crest and symphysis, inserted into the cartilages of the 5th, 6th and 7th ribs."  (Merriam-Webster; Medical) 
  
  "The serratus muscle is a thin muscular sheet of the thorax that arises from the first 8 or 9 ribs and from the intercostal muscles." (Merriam-Webster; Medical) 
  
  "The Muscle Fascia is a sheet of connective tissue covering or binding together body structures"  or "a thick, white covering that envelopes the muscles." (Merriam-Webster; Medical)

  The implant is placed under all of these for complete coverage and partial support.  The increased coverage reportedly allows virtually no rippling and a complete support of the implant. However fascia can stretch out.  Although with larger implants, one cannot expect full coverage.  This procedure is not as common as the other placements but is quickly catching on.  With this placement, the chance of capsular contracture is reportedly much lower and the breast takes on a more natural slope on the top as well as no visible rippling on the sides and breast lobe, or lower pole (underneath, bottom portion of the breast), that may otherwise be present in sub-pectoral only placement.  There is a learning curve to the full sub-muscular placement and surgeons must learn yet another technique in the ever-changing world of breast augmentation.
  
  Also, with full sub-muscular placement the breasts may appear high and tight and even somewhat square looking for some time but, patience is a virtue -- patients with this placement report that it is worth it in the long run. 

  There is some controversy surrounding the idea that the full sub-muscular placement is possible with the trans-axillary (underarm) approach without any cutting of the pectoralis major. With the peri-areolar (nipple) incision it has been said that this placement is possible with cutting of the pectoralis major, which does heal in time.  However it has been brought to my attention that a few well-known surgeons do NOT cut the muscle and that it can be accessed through the areolae without any cutting of the pectoralis major by blunt dissection with a special tool which one of them invented.  But considering that I do not know of too many surgeons, in general, who offer this placement, I cannot say for sure if another does or does not cut the pectoralis.  To be sure, please ask at your consultation.  And remember, as I have stressed before, different surgeons will have different opinions and methods.

 What Are The Risks & Complications Of This Procedure?
First and foremost there could be an allergic reaction to the anesthetic.  General is considered to be more risky yet any anesthetic could bring on a negative reaction.  Although extremely rare, it is possible to bleed post-operatively resulting in another surgery to control and drain the collected blood.  Another possibility is hematoma (a collection of clotted blood), seroma (a collection of the watery portion of the blood) and thrombosis (abnormal clotting). 

Loss of sensitivity is common, although temporary.  Permanent sensation loss in the areola and nipple area or breasts, in general, can and may happen.  There is also a risk of excessive scarring or inner scar tissue.  Also, you must have more views (films) taken when having a mammogram if you have breast implants, especially in sub-glandular placement. 

There is also a risk of calcifications, especially when there is a definite, thick capsule around the implant.  Galactorrhea, which is when you start producing breast milk, is also a complication.  This is usually remedied on its own and may stop spontaneously although some cases may need medication or implant removal.  Although very rare, it is worth mentioning,  full disclosure is the key to an informed consent. 

Breast tissue atrophy (loss, shrinking) is a possibility. According to the FDA, "the pressure of the breast implant may cause the breast tissue to thin and shrink.  This can occur while implants are still in place or following implant removal without replacement".

Necrosis (death) of the breast tissue, breast envelope and or incision line can happen. Although extremely rare. The chances of necrosis are increased after radioactive/chemotherapy treatment, if you smoke and have poor circulation, or have temperatetherapy or cryotherapy post-operatively.

Extrusion is also an extremely rare occurrence but a scary possibility.  Extrusion of the implant is where your body rejects the prosthesis and pushes it out of the skin, like when a piercing is pushed out or like when a thorn or splinter is pushed from the body.  Then the implant may become visible under the skin and must be removed before it breaks through resulting in possibly an infection and definite major scarring.

Infection
You could develop a post-operative infection and need to have the implant removed, the infection dealt with and still have to wait for several months before an additional surgery can be performed to re-implant.  Infections usually occur with the first 4 to 6 weeks.  Some possible infections and a more common one being Staphylococcus, or simply Staph.  The general consensus is that infection with Breast Augmentation occurs in less than 2% of patients, however this incidence varies from practice to practice and surgical environment.

Capsular Contracture (CC)
This is caused by the tissue that forms around the implant contracting and squeezing the implant. It is quite normal for tissue to form around an implant.  This is how your body naturally reacts to a foreign body. The problem is when the encapsulated implant is squeezed by this tissue.  Some women's bodies do not react well to implants and will develop CC.  CC occurs in about 5% of patients.  That translates into 5 out of every 100. When the tissue squeezes the implant it becomes compacted and very round, resulting in the tell tale look and feel of baseball breasts.  Your breast can look extremely, for lack of a better word, deformed, not to mention, it can be very painful.  It may happen repeatedly to one breast over and over or it may happen to both breasts only once.  This rarely ever goes away on its own.  Nor does it tend to lay dormant after a revision surgery is performed. It may happen due to bacteria on the implant, surgical implements or airborne and the body attempting to place the foreign body as far away from itself as possible.  Or it may develop after an injury. If this happens, you can develop pains, hardening, deformity and deflation of the implant.  

The Baker grading system of CC is as follows:

• Grade I: the breast is normally soft and looks natural

• Grade II: the breast is a little firm but looks normal

• Grade III: the breast is firm and looks abnormal (visible distortion)

• Grade IV: the breast is hard, painful, and looks abnormal (greater distortion)

*Please see our Capsular Contracture Section for more information.

Future Breast Feeding Complications
A lot of women ask if they can breast feed after Breast Augmentation Surgery.  The answer is a resounding yes.  For the vast majority of women who have a BA breastfeeding is no more difficult with implants than without.  In fact, some women who have breast fed with and without implants say that breastfeeding with implants is easier!

Breastfeeding is a growing concern with patients who have had Breast Augmentation surgery.  In previous years, women who received implants were married and had already finished with childbearing.  However, more and more single women, and women who have not finished or even begun childbearing are having the surgery.

*Please see our Future Breastfeeding Complications Section for more information.

Deflation
The implant can deflate or rupture from an injury or from wear and tear from an improperly under filled implant (even your breathing motions can cause creasing in the implant causing it to weaken at these creases). Even an overzealous technician performing a mammogram can rupture your implant. You can have a complete deflation within several hours if it is an un-encapsulated (or thinner encapsulated) saline-filled implant. If it is a silicone gel-filled implant, you may not know for months or years. Of course either way, they will have to be replaced. If there is a thick scar capsule around an implant it may impede the rate of absorbance with saline, especially if calcified. But with silicone you may not know you have a rupture, even with an MRI, if you have a thicker capsule. The lower molecular silicones may diffuse and permeate your tissues but the higher molecular silicones may stay trapped by your capsule resulting in a clean MRI. When this happens it is called intra-capsular rupture. You many not even know you have had a rupture with silicone gel-filled implants if this should happen.

Just remember that breast implants do not last forever so always have it in the back of your mind that you very well may have to undergo at least one replacement surgery in the course of your life.  This is where implant warranties are very convenient.

Rippling & Contour Irregularities
There is a chance of rippling (indentations from the implant resembling the edges of a blow-up pool toy, or a scallop) being apparent, especially when one has no breast tissue and chooses to go OVER the muscle. Even when there is significant tissue, it is possible that the implant can shift and make an indentation which shows and can be felt through the skin. 

Many woman who do prefer silicone gel-filled implants choose to get them, even changing from saline to silicone filled, to correct their wrinkling problems. This is an option that many women feel has corrected their rippling problems. 

High Profile Implants have less wrinkling, increased projection and need less volume to reach the same size as a standard implant in patients with less lateral breast mass, so you may want to ask about this implant. They are narrower at the base and are ideal for smaller diameter ribcages.

Also some women choose to go completely under (full sub-muscular) with the help of the serratus muscles and rectus abdominus fascia as well as the pectoralis major to help cover the implants.

Synmastia (aka Symmastia)
Yet another risk is Synmastia (breadloafing or uniboob).  Syn- is the combining form for joined [:with, along with, together], such as syndactyly in patients with joined digits.  Synmastia, or symmastia, is where the implants cross the breast bone, where the breasts separate and actually touch under the tissues. This results in a tell-tale sign of no cleavage and con-joined breasts. This can happen when the surgeon excessively dissects the tissues and muscles over the sternum to further bring the breasts closer together to result in more cleavage. The surgeon should not disturb the natural barriers of the breast in this area unless there is a definite natural wide area between the breasts and he is very skilled in doing so.  If your surgeon suggests this, inquire as to how many times he or she has performed this particular technique and ask to see photos of patients and to possibly speak with them as well.

Although you may not know it at first, it becomes apparent after a few days to weeks and sometimes, months. as the swelling and binding ace bandages and bras, etc exert the pressure on the sides of the implants (or when you try to lie on your side during your sleep) and they move to the center of your chest -- crossing this natural barrier. 

Unfortunately the only way to correct this is for a re-operation. This means possible implant removal, correction and replacement (if applicable). Not to mention many weeks of immobility, wearing an uncomfortable, backwards T-back sports bra with rolled up gauze to put pressure on the sternum and the possibility of a failed revision. 

The revision surgery entails suturing the tissue that needs to be rolled out from the sternum to give it something to "hold" onto. Your surgeon will most likely have to use permanent sutures and pocket the breast area as though it were an actual pocket on a garment - that way the implant will not be able to cross this barrier. The cleavage area will will re-attached to the sternum internally with dissolvable sutures so that once it heals there are no obvious lumps or filaments. Be advised this area may not look pretty directly afterwards but when it fully heals -- it will be undetectable.

Bottoming Out
This is when the lower poles (halves) of the breast have lost their tissue support and the natural crease is slowly lowering itself. This can be somewhat avoided with full sub-muscular coverage with the abdominus rectus fascia and serratus muscles supporting the lower pole of the breast. The surgeon may incorrectly predict where the new crease will be when lowering the natural crease either surgically or by force with the STRAP. Especially if the surgeon is overzealous when making the pocket. Be wary of the surgeon using the electro cautery technique in making the pocket -- not everyone can do this correctly.

Correction for this complication requires re-operation although it can usually be remedied by permanent sutures only and a firm band supporting the lower poles of the breast for many weeks. 

Double Bubble (double boob or quadruple boob)
A double-bubble is a slang term for when an implant is placed under the muscle(s) of a patient with ptotic (sagging breasts). Now, slight ptosis is perfectly fine for an over placement -- in fact some surgeons choose this when a patient doesn't want a lift but isn't saggy enough to insist upon it. If the patient is given unders but has substantial sag, the breast tissue may fall further and create one set of breasts and the implant staying in its rightful pocket under the muscle creates the "second set of breasts". 

Also be aware that this problem can happen after a woman was pregnant and the tissue now sags with the excess weight and stretch of the full mammary but the implant remains where it was originally placed,  under the muscle in it's intended pocket.  The moral of the story is, if you need a breast lift, get one. 

Mondor's Disease/Cord
First discovered by French Surgeon, Henri Mondor (pronounced ahn-ree mon-door), Mondor's Disease (or cord) is thrombophlebitis (inflammation) of an epigastric vein of the thorax. That is a bulging vein under your breast lobe on your abdomen and breast.

thrombophlebitis 
throm*bo*phle*bi*tis; plural -bit*i*des ( plural)
(noun): inflammation of a vein with formation of a thrombus 

epigastric
epi*gas*tric
(adjective)
2 a : of or relating to the anterior walls of the abdomen <~ veins>

thorax
tho*rax (noun), plural tho*rax*es or tho*ra*ces
[Middle English, from Latin thorac-, thorax breastplate, thorax, from Greek thorak-, thorax]
First appeared 15th Century
1 : the part of the mammalian body between the neck and the abdomen; 
also : its cavity in which the heart and lungs lie

This condition appears rather spontaneously and is of no worry, you can remedy this by warm, compresses (a very warm, wet washcloth or a microwaveable pack wrapped in a warm, wet washcloth will suffice) and taking some Motrin (an anti-inflammatory). It is usually nothing to be alarmed about and will disappear on its own. If you have further worries please consult with your surgeon.

Silicone Issues
For information regarding silicone-filled implants or silicone, in general, please read our Silicone &Your Body section.

Fungal/Fungus Issues
For more information regarding fungus infections resulting from contaminated saline filled breast implants please read our separate section on Fungus & Breast Implants. 

General Dissatisfaction
Also, there are the risks of it just not living up to what you expected. A lot of women wish they would have gone bigger. Realize that when you are doing the rice test that they will have to add a little more to make up for the tissues and/or muscle flattening the implant a little. When you pre-operatively try on the larger bras and fill them out a bit, they are on top of your body, probably lifted, as well, by an under wire. Take this into account and communicate with your doctor, the results you really want. There is also the disappointment in the implants not lifting the breasts as you would like. This is not a breast lift this is an augmentation. If it is lift you want as well as augmentation, get them both. After your augmentation surgery, the breasts will be heavier than what you are accustomed to. Breast implants won't cause ptosis, the weight and gravity will, especially if you go around braless all of the time

 Who Should Perform This Procedure?
Choosing a surgeon can be the most difficult and important part of the process.  While many advise only to choose a board certified plastic surgeon, meaning only choosing a surgeon who is a member of the American Board of Plastic Surgery, verifiable on the American Board of Medical Specialties website, there is more to consider before choosing a surgeon.  Please see our special Choosing A Surgeon section with tips on how to locate and decide upon a surgeon to perform your procedure.  This section will launch in a new window for ease of reference and so you don't lose your place. 

 What Should I Expect At My Pre-operative Consultation?
Pre-surgical consultations are designed as meetings with surgeons so that you are able to evaluate what they have to offer, their preferred technique, before and after photos, anesthesia preferences and other protocol.  This is a very important step in the surgical process as this is how you will ultimately choose who to book with.

You may wish to ask if you may bring a friend for emotional support when you call or email to book an appointment.  Some surgeons don't allow this practice, while others fully understand and do not mind.  This fact will vary from practice to practice so be sure to inquire ahead of time.  You should also determine ahead of time if there is a consultation fee, more often than not you will have to pay a fee which may range from $50. to $500. to meet with the surgeon.  This fee is usually designed to separate the serious patients from those who are just interested but have no intention of ever having surgery.  Consultations may range from only ten minutes to several hours, depending upon the surgeon and sometimes this duration does not reflect upon consultation cost.

Upon arrival and check-in, you will be asked to fill out paperwork which will include your name, address, contact information as well as the contact information of an emergency contact.  Health information will be taken as well including known allergies, lifestyle (prescription and/or recreational drug-use, alcohol consumption, smoking, etc.).  Completely disclosing any known or possible condition is vital to your safety.  If you are having general anesthesia, something such as asthma or smoking can severely impact your health while you are under.  Also, be very truthful about medications you may be taking or have taken recently.

You will then meet with the surgeon for a physical examination of the body part you are consulting about, as well as discuss your options, the techniques available, anesthesia questions, or anything else you wish to inquire about.  This is an important meeting so do not be afraid to ask the surgeon anything, or give your input in any way.  

You may also wish to bring photos of breasts which you find appealing, however, with augmentation only surgeons may only be able to give you a larger version of what you have already.  

After the consultation you may be directed to a patient coordinator's office to discuss fees, financing, etc.  You am either choose to book at this meeting or wait until you are finished consulting with other surgeons.  Estimates are usually only valid for one to six months so be sure to inquire about this before you leave.

 What Are The Average Costs Of This Procedure?
This procedure averages at $3,500. to $8,000. and does not include anesthesia, operating room costs, medications or laboratory tests.  Check with each surgeon regarding costs as all practices have different fees and these fees may prove to be less if the surgeon has his or her own operating suite.  Having your procedure in a hospital often increases the associated costs.

 How Do I Prepare My Body For This Procedure?
Once you book your surgery, you are usually asked to come by for a separate meeting called a pre-operative appointment.  This procedure is designed to allow discussion of more concerns, protocol specific to the preparation, surgical and recovery process, pre-operative and post-operative instructions. At this meeting you will receive instructions on what to eat, what to take and how to prepare your body for your procedure as well as how to care for yourself after the procedure.

Typical instructions include cessation of all aspirin or vitamin E-containing products and supplements, as well as cessation of diet pills, alcohol consumption, recreational drug use, and smoking.  You should attempt to get your body in its best condition to decrease your chances of complications.  Complications can arise if you continue to consume alcohol, recreational and some prescription drugs, some supplements, and smoking.  View our chart below to give you an idea of what can happen if instructions are not followed:

Although many vitamins and supplements can be harmful before and after surgery, there are also helpful vitamins and supplements recommended to stimulate healing.  These may include Alpha Lipoic Acid, Arnica Montana, Vitamin A, Vitamin B Complex,  Bromelain, Copper, Vitamin C or Vitamin C Ester, Chromium polynicotinate, VItamin D3, Folic Acid, L-Carnitine, L-glutathione, MSM (Methyl Sulfonyl Methane), N-acetyl-L-cysteine, Niacin, Selenium, taurine and Zinc.  Please see our Helpful Vitamins & Supplements section.

You should discuss the desired breast size during this meeting, as well.  Although breast tissue is measured in grams, breast implant size is measured in cc/ml.  There are several available options so please discus them all with your surgeons.  You may wish to ask about High Profile (HP) implants for those who have a smaller ribcage.  HP's offer more projection and less lateral spread at the base.  This is a great option for women who are smaller framed but wish to have medium to larger breasts for their body size.  This is also the better option for medium to larger framed women who wish to have large breasts post-operatively.  

Mental preparation is also a good idea as not being prepared for your experience can cause unnecessary anxiety and fear.  Also, not knowing what to expect and cause anxiety when something as normal as bruising and discomfort arises.  Be sure that you know what to expect, what is normal, and what is not so that you are better prepared during your recovery.  Support during this time is vital, so we invite you to join us on our Breast Surgery Message Boards to speak with other patients who may be feeling exactly the same as you currently are or others who have already been through your current phase in the recovery process.

 How Is This Procedure Performed?
Please chose an incision technique for more information.  For your convenience, these pages will launch in a new window. 

• Infra-mammary Crease Incision

• Peri-areolar Incision

• Trans-axillary Incision

• Trans-umbilical Incision (TUBA)

 What Should I Expect During My Recovery?
Although everyone's recovery will vary slightly, below is basically what to expect, barring any complications.  Levels of pain and bruising depend upon the individual, however if any sudden swelling, intense pain or discoloration should occur, alert your surgeon immediately and seek emergency care.

Day 1
Your surgeon should give you post-operative instructions that you should follow carefully.  These instructions will include activity levels, icing instructions, wound care, personal hygiene instructions, etc.  If you should have any questions or concerns or feel pain which is not manageable, call your surgeon or the on-call nurse immediately.  Should you begin bleeding or vomiting uncontrollably, have your caretaker bring you to the hospitable and call your surgeon or the on-call nurse immediately to have them meet you at the hospital.

You will usually sleep most of the remainder of the day, waking only for medications or bathroom breaks.  You should try to eat something light such as soups, Jell-O or protein shakes (although please check the labels carefully for problematic additives such as high levels of vitamin E or other anti-coagulants).  Eating will help keep nausea at bay and keep your strength up as well.  You should also be drinking plenty of fluids.

You may feel more alert later on that night and feel like watching TV or reading a book.  However, do not over-exert yourself any time during your recovery.  Even if you feel well, you mustn't cause your blood pressure or heart rate to raise as this can cause a hematoma to occur.   You will more than likely have slight to moderate bruising, as well as swelling and breast tenderness.  Any discomfort should be alleviated by your prescribed pain medications.  Should any severe pain develop, please contact your surgeon or the on-call nurse as soon as you can.

More than likely, you will just sleep, waking only to eat, take medications or go to the bathroom.  Be sure to take your temperature regularly.  A high temperature could mean an infection.

You should not lift any items over 3 lb., nor should you bend over nor reach above your head.  Do be careful when walking up or down stairs, or even so much as down the hallway to the bathroom.  Your medications can make you dizzy and possibly cause you to fall.  Wearing a shirt which buttons or snaps in the front is recommended.

If your hair is long, keeping your hair in a ponytail or braid is recommended as your hair can become quite tangled.  This will keep your hair tangle-free and out of your face.

You may notice sensations such as sharp pains, tingling, tickling, intermittent throbbing and other sensations during the course of your recovery.  Know your body, although these are usually normal, anything intolerable could be a warning sign.

Day 2
By the next day you may feel more alert and but may not feel like being very active.  Remember not to over-exert yourself in any way, as you are still at risk for a hematoma.  Your appetite may be increased and you may doze off throughout the day.  Continue to take your medications and temperature regularly.  Your surgeon's instructions should guide you throughout the course of your recovery.

Day 3 - 5
You will notice your awareness and restlessness will increase during these days, as well as your appetite.  Should your medications make you nauseated, you should take them with food if directed.  Be sure to continue drinking plenty of fluids.  Your surgeon might have you begin showering a few days after surgery.   Sponge baths may be taken before then if you feel as though you are in need of freshening up.  

Day 7 - 10
Your first scheduled post-operative appointment is usually within 5 to 10 days, depending upon your surgeon's protocol.  Your surgeon will be able to evaluate your recovery and make any adjustments in your care.  Your surgeon may or may not change the bandages or have you remove them completely.

Any remaining swelling, bruising and tenderness will usually dissipate over the next few weeks.  Your resorbable sutures may begin to fall out by now, if not your surgeon may have you return for removal or instruct you on removing them yourself.  If irritation develops around the sutures, please let your surgeon know.

Day 14
Your bruising should be faded or almost faded by now, however this will depend upon your body's propensity towards bruising.  You will notice the incisions will begin to darken and begin to enter the unattractive stage.  This should last about 3 months. The scars will get worse usually before they get better, so patience is a necessity during the recovery stage.

You should no longer need pain medications and should have well completed your course of antibiotics by now, barring any problems which require additional medications, of course.  You are usually still under activity restraints for another week and should still be wearing a supportive bra.  Support is vital during the scar maturation and general recovery stage.  

Day 21
Oftentimes, activity restraints are lifted at the 3 week mark, but always listen to your own surgeon.  Should you be allowed to return to normal activity levels, please do so cautiously.  You may find that you tire easily during this stage as your body is still recovering.  You may feel as though you can sprint a mile, it is often advised you should not.  Go easy and always wear a supportive bra or other garment which supports your breasts.

You may still notice odd sensations throughout the course of your recovery.  This will occur as your feeling returns and your body heals.

What To Look Out For
Please contact your surgeon or the on-call physician immediately if you notice any of the following: 

• bleeding from your suture lines 

• pus or cloudy discharge from your incision areas, nipples or elsewhere 

• a foul odor from your incision areas, nipples or elsewhere 

• uncontrollable pain 

• blisters or implant extrusion 

• bottoming out of the implant

• displacement of the implant 

• temperature over 100.5 F 

• inability to pass waste (both liquid and solid) 

• numbness of the legs (unless you had lipo as well) 

• uncontrollable dizziness not related to the pain relievers 

• deflation 

Please contact your surgeon or the on-call physician AND go to the emergency room as soon as possible if you notice any of the following:

• passing blood through urine, feces or spitting up blood 

• abrupt and severe swelling and discoloration (aside from normal swelling) 

• blackening of the skin (which is clearly NOT a bruise) 

• uncontrollable vomiting 

• loss of consciousness not related to sedatives 

• temperature over 105 F 

• convulsions 

What to do in case of a complication:

• #1 STAY CALM 

• Have your emergency numbers handy and contact, or have your caretaker contact, your surgeon or the on-call physician to let them know of your problem as soon as you can. 

• If you are going to the emergency room don't forget to tell your surgeon WHICH hospital 

• Bring all of your medications with you to the hospital 

• It may be cautionary to pack an overnight bag ahead of time "just in case" 

• If you are able, keep a written journal (and if possible photos) of your symptoms and complaints 

Scarring Concerns
This procedure will result in scars, placement of which depends upon the chosen technique.  For some these may be faint, for others, very obvious.  Depending upon your body's healing capability, this scar may result in a thin, light line or a darker red, or raised scar.  Clearly, there are several stages of scar tissue development, often the redness of the incision line is most visible at three (3) months post-surgery.  After this stage the scar may continue to fade and the tissue flatten.  Please discuss scar treatments with your surgeon in advance so you know what to do while the scar tissue is forming, instead of after when it can be too late.  Please see our Scar Treatment Section for more information.

Scars can also result in a hypo-pigmented [: lacking pigment, or color] line in some patients, resulting in lightened areas of skin where the melanin production has been compromised.  Areola tattooing, also know as micropigmentation, can counter these effects by depositing pigments into the scar tissue thereby blending the lightened parts into the surrounding tissue.  Please know that scar tissue is more difficult to tattoo than normal skin so be sure to choose a micropigmentation technician who is well-experienced in tattooing scar tissue.  Please see our Areola Repigmentation Section for more information.

 Anything Else I Should Know?
Temporary and permanent puckering may be an issue for peri-areolar incisions.  This results in an appearance similar to the gathered section of a drawstring bag.  Oftentimes, puckering dissipates between the second and 6th week, others may take longer.  Steri-Strips, or other paper tape may assist in hastening this process, however, fluid can also collect under paper tape so use caution and only under your surgeon's advice.

Revision surgery is possible, although usually uncommon.   

Inflammation of the permanent suture, if utilized, is also a possibility and should be watched during the initial recovery stage.  Although, always an infection possibility, delayed infection is very rare.  Inflammation, however depends upon the individual.  This may result in wound opening, pus or weeping, and raised scar tissue under the areola wherever the underlying permanent suture is.  If this continues, do alert your surgeon.  Inflammation soon ceases after the removal of the nonresorbable suture.

Irregular scarring may be an issue for some patients.  If this should occur, there are options available.  Again please see our Scar Treatment Section if this turns into a permanent issue.

 Where Can I Read More About This Procedure?
Breast Implants 4 You Patient Education & Support Network
Breast Implants Support & Discussion Forum
eMedicine Medical Information Resource