Part 2 of series – Frequently Asked Questions About Breast Augmentation Surgery

Breast Implant Surgery in Morristown, New Jersey –  Questions Answered by Brian S. Glatt, MD, FACS


Is there a warranty which covers a ruptured implant?
Both Allergan and Mentor, the two major breast implant companies, provide warranties for their breast implants.  If an implant ruptures, they provide you with a free implant.  Although there are slight differences between their coverage, both also provide funds to cover the costs of replacement if the rupture occurs within the first ten years after surgery.  In addition, each company will provide additional funds to help cover the costs of anesthesia and facility fee to have the implant replaced.  Currently, each company provides a warranty for up to $3500 at no additional charge. 


How do I know that my plastic surgeon is qualified?
There is no way to get a guarantee of results.  You should, however, at least make sure that your surgeon has had adequate training.  There are many physicians, some not even surgeons, masquerading as plastic surgeons with very little or no training at all in plastic surgery.  Neither the internet, nor the telephone book company, care about the truth, honesty, training or credentials of the person who would do your surgery.  They’ll let almost anyone advertise as a plastic surgeon.  Make sure that your surgeon is certified by the American Board of Plastic Surgery.  It is the ONLY legitimate plastic surgery board.  It is the only one that evaluates a surgeon’s prerequisite training, plastic surgery training, practice performance and requires passage of rigorous written and oral examinations.  One way to find out if your surgeon is truly board certified is to see if he or she is a member of the American Society of Plastic Surgeons, Inc. (ASPS).  All members of the ASPS are certified by the American Board of Plastic Surgery. Visit their website at

Would you let a plumber do the electrical work on your house? Would you have a mechanic do your taxes?  How about an orthopedic surgeon operating on your heart?  Then why have an untrained physician, maybe not even a surgeon (e.g. a dermatologist) perform cosmetic surgery on you?  If you wind up in someone’s office that doesn’t have the above credentials, don’t walk but run out of that office.  And forget the consultation fee. They don’t deserve to be paid for trying to deceive you.


What is the difference between smooth and textured implants?
Textured implants have an additional shell attached to a smooth implant to create a rough surface.  The purpose of texturing is to try and reduce the risk of capsular contracture.  There is no good evidence to show that texturing is successful in reducing the risk of capsular contracture, particularly when the implants are placed under the pectoralis muscle.  There are a few problems with textured implants.  Since the shell is thicker, they are easier to feel through the skin and breast tissue than smooth implants.  They also have a higher risk of implant rupture and visible wrinkling of the skin. Textured breast implants also do not allow the implants to move naturally in the pocket. 


Is it better to put the implants under or over the muscle?
There are very few circumstances where breast implants should be placed on top of the muscle.  Up until the late 1980’s, breast implants were routinely placed on top of the muscle.  Since then, multiple advantages of subpectoral (under the muscle) placement have been discovered.  These include a lower risk of capsular contracture, less visibility and palpability of the implants, less interference with mammography and, therefore, interference with cancer detection, and better support of the implants to reduce falling or sagging with gravity.  In addition, the implants have more soft tissue cover under the muscle so that they assume a more natural appearance, especially at the top cleavage area of the chest.  Disadvantages of under the muscle placement include a little more pain with surgery and unnatural motion of the implants with contraction of the chest muscle.
Everyone considering breast augmentation surgery should assume that, some day, they may want their breast implants removed.  When that happens, it is likely that many of them will want to have a breast lift (mastopexy) done at that time.  Performing a breast lift when implants have been placed on top of the muscle carries a significant risk of necrosis (death, loss of) the nipple and areola.  That risk is markedly reduced if the implants have been placed under the muscle.


Are round or shaped implants better?
Round implants are by far the most popular and most commonly used breast implants for cosmetic purposes in the United States.  Shaped implants can occasionally rotate into the wrong position in the pocket creating an odd shape to the breast.  Round implants tend to assume a natural breast shape in a standing position and become more round when laying down, similar to what a normal breast does.  Shaped implants tend to keep the same shape in any position, giving them a more “glued on” appearance. 


Why do some implanted breasts look more fake than others?
If you put a very small implant into a large breast, you will never see or feel the implant and it will look and feel very natural.  Of course, it won’t make much of a change in the size of the breast.  If you put a very large implant into a very small breast, there is very little natural tissue to cover up the implant, so it will look and feel very unnatural.   Therefore, women with larger breasts and smaller implants have a more natural look than women who have smaller breasts and larger implants.   In addition, implants placed on top of the muscle also may have more of a “rock in a sock” appearance because there is less natural tissue to cover up the implant and because there is frequently more capsular contracture.  This results in the implant assuming more of a round ball shape as opposed to a more natural disc shape in the breast.


What type of anesthesia is typically used for breast augmentation?
Most patients undergo general anesthesia where they are put completely to sleep.  This avoids any problem with seeing, hearing or feeling anything during surgery.  In addition, the muscle can be fully “paralyzed” so that the implant can be easily placed beneath it.  Some patients have a problem with nausea after general anesthesia so we normally give patients medications to reduce the risk of nausea.  The problem with a sore throat after anesthesia can usually be alleviated by using an LMA (laryngeal mask anesthesia).  This is a soft, inflatable mask placed over the vocal cords rather than placing a tube between the vocal cords. This reduces the chance of throat irritation.

Just local anesthesia with intravenous sedation is not a good option for implants placed under the muscle.


What are my options for where the scar is placed?
Under the breast, hidden in the crease (inframammary fold) is the most commonly used, most straightforward, and usually results in the least visible scar.  It is usually about 3.5 centimeters (about an inch) in length for saline implants and about one centimeter longer for silicone implants. This is the most direct route to the implant pocket.  A very popular alternative is placing the scar around the lower half of the areola from the 3:00 to the 9:00 position (periareolar scar).  This scar also heals beautifully and some consider it to be even better camoflauged than the inframammary scar.  Under the arm in the axilla (armpit) is also possible but this technique has the highest risk of implant malposition and is usually only performed for placement of saline filled breast implants.  In addition, this can be a very visible scar when wearing a bathing suit or a sleeveless shirt.  Theoretically, this incision can interfere with future breast cancer surgery.  Through the belly button is not generally recommended.  The complication rate is higher, there is difficulty placing the breast implants under the muscle, and using that approach may void the warranty on the implants.


Is it all right to have another surgery such as liposuction or a tummy tuck at the same time as breast augmentation or is it better to do them separately?
In recent years, combination surgeries (e.g. “mommy makeover“) have become very popular.  It is important, of course, to keep safety as the prime consideration.  For healthy patients, it is usually safer to undergo one larger surgery that two or three smaller surgeries.  There can be a considerable time savings in going through the recovery from surgery once as opposed to several times.  In addition, there can be a significant cost savings.  The most expensive part of the anesthesia and facility fees is usually the first hour, with additional time adding an incremental increase in cost.  Therefore, going through the first hour once as opposed to two or three times can markedly cut down on the costs.  Most surgeons will reduce the cost of a second or third procedure done at the same time as well.  This can result in savings in the thousands of dollars.  Common combinations include abdominoplasty (tummy tuck) and/or liposuction being performed at the same time as breast augmentation with or without a breast lift (mastopexy).  Combinations of these procedures are usually referred to as “mommy makeover” procedures. 


What is the typical recovery period for breast augmentation surgery?
Most patients who perform relatively sedentary jobs or who are going to school return to these activities within about one week.  Performing more strenuous jobs or physical activity such as exercising may take two to three weeks.  Most patients require the use of pain medication for 2-3 days.  After that, a muscle relaxant such as Valium may be used for another 2-3 days which reduces stress, muscle spasms and anxiety after surgery.  Most patients are able to put their arms above their head and shower within 24 hours and are driving with 6-7 days. It is important to not perform strenuous activities for the first week while you are recovering from surgery.  After that, you can gradually increase your activity depending on how you tolerate it.  Let common sense be your guide.  If it hurts, don’t do it.


If someday I need to have another surgery on my breasts, such as to replace a ruptured implant or change to a different size or style, do I go through the same recovery?
No.  Most of the pain from breast augmentation is from creating the pocket under the muscle.  Once that has been accomplished, performing a second surgery is drastically different and much easier.  The pain is usually minimal and most patients feel completely fine within a day or two.

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