Breast Implants – By the Numbers

1. In 2010, 1.5 million women around the world had breast augmentation surgery. About 300,000 of them lived in the United States, according to the International Society of Aesthetic Plastic Surgery.

2. Breast implants are measured in cubic centimeters (ccs) rather than cup size. On a woman who is completely flat-chested and has a medium-sized frame, a 450 cc implant would be equivalent to the average C-cup bra.

51oexEb-ArL._SY300_3. The largest standard saline implant is 775 ccs, while a silicone gel implant is 800 ccs. That’s equivalent to about 27 ounces, like this can of salsa.

4. The difference between a 375 cc and a 400 cc implant is less than 2 tablespoons – the amount of oil you would add to boxed pancake mix.

5. Outside of the body, a saline implant would freeze at about 28 degrees Fahrenheit, while a silicone gel implant would ice up at around 170 degrees below zero. Because your breast implants are close to your body, your natural body heat will keep them warm.

6. An implant’s silicone shell would melt at temperatures greater than 392 degrees Fahrenheit. A conventional sauna is typically between 150 and 190 degrees. If you were in an environment where your implants would melt, you’d melt, too.

7. If you get a pair of 350 cc saline implants, they’ll weigh about 1.5 pounds. If you get a silicone gel set, they’ll be closer to 1.7 pounds. To calculate how much your implants weigh, see below:Screen Shot 2015-07-23 at 9.09.52 AM

8. Breast implants are designed to be sturdy, and each manufacturer has its own testing protocol. Allergan tests its implants by exerting nearly 55 pounds of force on them repeatedly, up to 6.5 million times. By contrast, a routine mammogram exerts about 40 pounds of force when it compresses the breast, and if a woman had 50 mammograms in her lifetime, it would be a lot.

bag9. The TSA says that liquids and gels are safe to bring aboard an aircraft in limited amounts – 3.4 ounces or less. Thank goodness breast implants are “packed in your luggage,” so to speak, because one 425 cc implant is equal to about 14 ounces. It would be hard to squeeze it into one of those quart-sized plastic bags. To figure out how many ounces your implants are, divide the number of cubic centimeters in each of them by 30.

10. It’s rare for surgeons to charge more for a breast augmentation with larger-sized implants. Manufacturers don’t charge by the cubic centimeter either: They charge one set price for all off-the-shelf saline breast implants, whether they are 200 ccs or 600 ccs, and another set price (about $1,000 higher) for silicone gel implants.

Do silicone gel implants look and feel more natural than saline?

It depends on where you put them! If you hold a saline implant in one hand and a silicone gel implant in the other, the silicone gel implant feels softer.

Screen Shot 2015-07-23 at 1.45.01 PMLikewise, when breast implants are placed in front of the pectoral muscle, where they are camouflaged only by skin and breast tissue, silicone gel implants are likely to look and feel more natural.

But when they are placed behind the pectoral muscle, both saline and silicone gel implants look and feel similar in most women. That’s because the muscle blunts the part of the implant that peeks out of a tank top, bra or bathing suit, creating a more natural look. And if someone touches your breasts, he or she will feel your own breast tissue for the most part.

It is common to be able to feel the implant on the side or underneath the breast, where there is little or no muscle coverage. The thinner you are, the easier it is to feel the implants because you have less breast tissue covering them. You would feel the silicone implant, just a little less than the saline one. For most woman, this doesn’t seem to be an issue.

After breast augmentation surgery, many women tell me that their significant other didn’t notice much of a difference between their natural and augmented breasts – other than their size. They also tell me that while they had surgery to please themselves and not their partners, their partners are enjoying their new figure.

Did you know? Subglandular placement refers to implants placed behind the breast but in front of – or over – the pectoral muscle. Submuscular placement refers to implants placed behind – or under – that muscle. In general, I prefer to put implants behind the muscle because I believe they look more natural. Also, there may be less chance of infection and capsular contraction (hardness) and less interference during a mammogram (X-ray of the breast).

If you shine a flashlight underneath or next to your augmented breasts, they will cast an eerie glow, according to the “Glowing Boobs” YouTube video. The narrator claims, “They last much longer than regular glow sticks and you never have to put them in the freezer.” In case you were wondering, saline implants glow a little brighter than silicone gel implants.

Do breast implants glow in the dark?

If you shine a flashlight underneath or next to your augmented breasts, they will cast an eerie glow, according to the “Glowing Boobs” YouTube video. The narrator claims, “They last much longer than regular glow sticks and you never have to put them in the freezer.”

In case you were wondering, saline implants glow a little brighter than silicone gel implants.

 

Did you nickname your breasts?

Years ago, Glamour magazine published an article about the surprising number of women who nickname their breasts. Jay Leno couldn’t resist joking about it on The Tonight Show: “It’s hard enough remembering one name; now when we wake up in the morning we have to remember three,” he said.

To read more, click here.  mother_daughter_5

Do I have to tell my partner that I have breast implants?

This letter, which appeared in The Philadelphia Inquirer on January 28, 2015, caught my attention. I can’t resist offering my two cents!

Dear Abby,
I have been dating a wonderful man for two years and am in hopes of getting a proposal soon. We are both committed to staying pure before marriage and have not been intimate.

My question to you is: Do I have to tell him, now or ever, that I have had breast implants? I did it several years ago, and it greatly improved my self-esteem. I’m glad I did it.

Since he has never felt any breasts, if I tell him, my fear is he will get hung up on the thought, “I wonder what real breasts feel like.” On the other hand, if I don’t tell him and sometime in the future he finds out, he may be, like, “I can’t believe you kept that from me.”

What would you advise?
Reticent in Kentucky

Dear Reticent,
Many women have breast enhancement surgery so their figures will be more balanced. For the reason you have mentioned, you should tell your boyfriend. It should make no difference to him.

However, if it does, it’s better that you know now before you spend any more time on someone who measures the worth of a woman by how “real” her breasts are.

P.S. If he wants to know what “real” breasts feel like, tell him to go hug his mother.

I agree with Abby. If “Reticient in Kentucky” candidly explains why she chose to get breast implants and her boyfriend can’t be supportive, he’s not the right guy for her. If he truly loves her, he will likely be satisfied with what she has – real or not – if she is happy.

Screen Shot 2015-03-19 at 10.42.38 AMMaybe Reticient can take inspiration from Amanda. She had been with her boyfriend for more than a year and had met him after her augmentation. When he complimented her on her “perfect breasts,” she simply said thank you. He didn’t find out until he looked through one of her old photo albums and saw a picture of her at the beach – before her surgery. He still thought her breasts were perfect.

More than half of my patients bring a partner with them to their consultation. Though the exact words vary, the essence of the communication is that he loves her just the way she is. He doesn’t need her to do this. He’s there to be supportive and will let her know if anything is too crazy. And when the woman chooses her implant size and looks at her partner, she’s thinking, “Can you live with this choice of mine?”

Screen Shot 2015-01-09 at 9.15.34 AMAfter the surgery, many women tell me that their significant other doesn’t notice much of a difference between their natural and augmented breasts – other than the size. That’s because when implants are placed behind the chest muscle, they look and feel natural. When you feel the augmented breast, you are feeling natural breast tissue. When women lie down, their breasts could still fall to the side, like they did before the augmentation.

Most women look natural and proportional after their breast augmentation and can keep it a secret if they are so inclined. Nicole, in her late 40s, didn’t tell her family that she was getting implants. Afterward, she emailed them a photo of herself in a tank top and then called to ask if they noticed anything different. “New hairdo?” her mother said. “Are you working out now?” her father asked. “Keep looking,” she prodded them. After hearing her no responses to her parents’ questions, her brother guessed: “Boob job!”

 

Do breast implants need to be replaced every 10 years?

Several times a week in consultation, I answer questions like these:

“I need to replace my breast implants after 10 years, right?” Wrong.

Screen Shot 2015-02-13 at 10.42.02 PM“You did my breast implants 14 years ago and I’m still happy with their appearance, but a friend just had her 10-year-old implants redone because her doctor said she had to. Is that true?” False.

Breast implants don’t have an expiration date. They only need to be replaced if they deflate (saline) or rupture (silicone), and they’re not fragile.

It’s no surprise that women believe that implants have a shelf life, but what causes the confusion? Breast implants come with a free lifetime product replacement policy. Manufacturers also offer a 10-year warranty to defray some costs of implant replacement surgery. When women hear this, some assume they have to replace their implants after 10 years.

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Vintage refrigerator ad: Only new 1967 Admiral Duplex comes in 4 sizes, has the 5 features women want most!

Don’t be misled by the warranty. Your refrigerator comes with a warranty, too, but you don’t automatically replace it when its warranty expires. You’ll probably keep it until it breaks down, unless you are redoing your kitchen and want a bigger or smaller model.

Women sometimes opt to replace their implants for bigger or smaller ones after childbirth, weight gain or a change of heart. I recently removed saline implants from a woman who wanted to go bigger after 19 years, and her implants looked the same as the day I put them in.

About 1-3 percent of the 300,000-plus women in the United States who have a breast augmentation each year eventually have surgery to replace implants that have ruptured or deflated.

The most common reason that an implant breaks is because it develops a fold in one spot. Over time, that fold might move back and forth, weaken, and then break, in the same way that a paper clip might break after it has been bent multiple times. I’ve found that if an implant doesn’t deflate from fold failure in the first 6-7 years, the likelihood of this happening seems to decrease, not increase, over time.

Implant replacement requires time off from work, exposes women to the risks of surgery and anesthesia, and may require some out-of-pocket expense. As far as replacing implants every 10 years, my philosophy is: “If it ain’t broke, don’t fix it.”

 

 

When will you take out my drains and stitches?

Never. That’s because I don’t use drains in cosmetic breast surgery, and your stitches are dissolvable.

DRAINS
A surgical drain is a tube that’s inserted during surgery. It’s used to remove fluids or blood from a wound so that the tissues heal together better. I have never used drains and don’t imagesrecommend drains to my patients for elective cosmetic breast augmentation surgery.

Breast augmentation: No tissue is removed, and there is minimal bleeding.
Breast lift: Generally only skin is removed, and there are no spaces for fluid to collect.
Breast augmentation with lift: In my experience, this simultaneous procedure also does not require drains for the above-mentioned reasons.
Breast reduction: I commonly place a drain in the incision overnight. In reduction surgery, a significant amount of tissue is usually removed, which leaves a large surface area of tissue that could ooze before it starts to heal together. Because the drainage is minimal, the drain only needs to be placed short-term.

A study conducted by two British surgeons who placed drains after breast augmentation surgery reported a 10 percent infection rate in their patients. They suggested that the drains, which could act as entry site for bacteria, possibly caused this high rate. The bottom line: The advantages of using a drain have to outweigh the possible disadvantages. That’s likely the case in breast reconstruction surgery after a mastectomy, where drains are commonly used.

STITCHES
Some surgeons close the incision with stitches on the outside, which are usually removed five to seven days after surgery. During surgery, instead of using external stitches, and after deeper closure Stuff-and-Sewof tissues, I put a single strand of dissolvable stitches just beneath the skin edge to make for the nicest closure. Then I place an adhesive strip over the incision. These stitches dissolve in about six weeks.

Patients sometimes ask if the implants can fall out. The likelihood of the incision opening is extremely low: That’s because the deep tissue is brought together with multiple layers of thick, braided stitches that take about three months to dissolve. Even if the incision opened, the implant wouldn’t pop out. A thin, protective layer of tissue encases it as early as three weeks after surgery.

Screen Shot 2015-01-09 at 9.15.34 AMHere’s what you expect after you get stitches out – whether you’ve gotten breast implants or cut your hand slicing a cucumber and had to go to the ER for stitches:

Incisions stay a little red, lumpy and bumpy for six weeks. Around that time they form a solid healing ridge. From this point, it takes about six months for the firm ridge to start to soften (this is known as the incision maturing). It will take about a year for darker-skinned patients and up to two years for fairer-skinned patients to know their incision’s final color – which might be darker, lighter or the same as the surrounding skin.

Bra Rules I Didn’t Know

Screen Shot 2014-11-12 at 11.12.17 PMEarlier this month, Megan Mayer wrote an article for the Huffington Post entitled “The 6 Most Basic Bra Rules You Probably Didn’t Know.” When I saw the title, I was certain I’d know all of the rules, since I’ve examined more than 6,000 women who have come to my office for cosmetic breast surgery. Turns out I scored 50 percent: #2, #4, and #5 fooled me.

Below, you’ll find Megan’s rules in orange and purple and my comments in black.

1. Bras will never be a comfortable clothing item. Their primary function is to support your breasts, so they are supposed to be firmly hugging your torso.

When my wife, Joyce, takes off her bra at night, she lets out a great big sigh. She’s always in search of a comfortable bra and never seems to find one. It makes me glad I don’t have to wear one.

Joyce is the co-author of The Dictionary of Jewish Words, where you’ll find the Yiddish word mechayah, which perfectly describes the feeling of relief she gets when she unhooks her bra at the end of the day. My mother defined mechayah as the feeling she got when she took off her girdle. It also describes how it feels to take off your stilettos.

2. Clasp those babies. To preserve your bras, be sure to CLASP them while they live in your underwear/bra drawer so they don’t get caught on other articles of clothing.

Joyce doesn’t clasp her bras; she hangs them on the doorknob of our bedroom closet for easy access, which makes sense to me. I can throw my underwear in the drawer without arranging it a certain way. This is one of the benefits of being a guy.

3. You should definitely have more than one bra. Bras are like underwear — you should have more than one pair and rotate them.

Maybe I’m an optimist, but I thought that everyone would know and abide by this rule. Megan could have eliminated it and used this one instead:

You don’t need to wear a bra. A bra will keep your breasts from sagging, but only while you are wearing it. There’s little evidence that wearing a bra delays or prevents breast droopiness or the formation of stretch marks.

4. Be aware of the gore. The center of the bra that connects the cups in front is called a gore.

It’s interesting that someone picked a word that also means bloodshed and carnage to describe this bra part. When I looked it up in the dictionary, I found out that the gore, a triangular piece of material, is used not only in making bras but also for umbrellas and sails.

5. Hand wash your bras. No dryers and no dry cleaners. Hand washing will maximize the life expectancy of your delicates.

I never thought about how you washed a bra, but if I did, I’d imagine you’d throw it into the washing machine. Happily, I can throw my underwear in the washing machine. This is another of the benefits of being a guy.

6. Your bra size is subject to change. You are most likely a different bra size at various undergarment stores. Just like clothes and shoes, bra sizes run differently.

I run into this issue every day in the office when women tell me that what cup size they want to be after surgery. The problem is that a C cup can mean one thing if it’s made by Victoria’s Secret and another if it’s made by Vanity Fair. A woman might wear a B cup in a full-coverage bra and a C cup in a demi bra, even if the same company makes both styles.

Because there is no standard cup-sizing system, I prefer to call it a C look. And to achieve a C look, a 5-foot woman with a small frame might need a B cup while a 5-foot-8-inch woman with a large frame might need a D cup.

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Will implants make my breasts look perky again?

Implants will only make your breasts fuller. They will not lift your breasts, but they can create the illusion of a lift.

If your breasts are mildly droopy, a saline or silicone gel implant placed behind the pectoral muscle might help create the appearance of perkiness. That’s because as the implant fills out the upper portion of the breast, it also fills out the lower part, making it look as if the nipple has moved higher on the breast. It hasn’t. A silicone gel implant placed in front of the pectoral muscle might create the same illusion.

Screen Shot 2014-10-13 at 10.18.26 PMIf your breasts are moderately to severely droopy and you get implants, it could look as if you have four breasts – with the breast implants up high and your natural breasts down low. A breast lift (mastopexy) would be a better choice. It would raise and firm up your breasts, giving them a more youthful look. I would accomplish this by moving the nipples to a higher position, removing excess skin, and then reshaping the breasts.

In medical lingo, ptosis is the word for a drooping body part; breast ptosis is classified as mild, moderate or severe. Hint: The “p” is psilent.

To determine your degree of droopiness, try the pencil test: Place a pencil horizontally along the crease under your breast, where your bra band would rest. Look in the mirror. Is the position of the nipple itself (not the areola) above, at or below the pencil?

Screen Shot 2014-10-13 at 10.02.39 PMIf your nipple hangs below the pencil, you would need a breast lift to raise and reshape your breasts. If your nipple is at the crease, the approach is not as clear-cut; it depends on how much of a pick-me-up you are hoping for.

How do you know if you need a lift and implants? Put on your bra and look in the mirror. If you are satisfied with the size of your breasts, then a breast lift alone might be the right procedure for you. If you wish your breasts were bigger, you are probably a candidate for a breast lift and implants (an augmentation mastopexy).

Obviously, there are other measurements done during a consultation – without a pencil – to help you determine the best option for you.

Screen Shot 2014-10-13 at 9.57.46 PMBreasts can start drooping at any age depending on your genes, the elasticity of your skin, and if you’ve lost a significant amount of weight. If the skin doesn’t retract when some of the fat disappears from your breasts, you could be left with saggy or empty-looking breasts. It’s not uncommon for teens to have droopy breasts; some girls say that they were “born with saggy breasts” or that they “just developed this way.”

Age and pregnancy also take a toll. When you are pregnant, the developing placenta stimulates the release of hormones, causing your milk glands – and your breasts – to grow and swell. This rapid growth can also cause the skin to stretch. When the milk is gone, some women are left with less breast volume and/or droopiness. The same thing happens as women age: The skin naturally loses its elasticity, and breasts lose their shape and firmness.

Illustrations by Anoki Casey. 

Why did you decide to get breast implants?

Guest blog by Cara McCollum, Miss New Jersey 2013

I remember the first time I was really aware of breasts: I was 8 or 9 and at a church yard sale where I found gel cutlets for sale. They had probably belonged to a church member who had had a mastectomy, but I put them in my shirt and thought, So this is what it’s going to be like.

Growing up, it seems like I was always waiting for my boobs to develop. My friends and I all got our first trainer bras, but before long they were graduating to real bras and I was still stuck in training. Seems like I’ve spent my whole life training to have boobs! I kept waiting and waiting for them to grow and it just never happened.

I started considering a boob job when I was in high school and brought it up so frequently that my dad had to ban any talk of tits from the dinner table. My clothes didn’t fit properly, and I would only wear bras that added two cup sizes.

BEFORE: In my evening gown at the Miss New Jersey 2013 competition.

BEFORE: In my evening gown at the Miss New Jersey 2013 competition.

I’ve always been self-conscious about my breasts, but competing in pageants just seemed to highlight a fact that I already knew: I was flat. It seemed like I had to try so much harder to look good in my wardrobe – sewing in large foams pads to the cups of my swimsuit and evening gown, and drawing in cleavage and shadows with dark eye shadow. When I got fitted for my Miss America evening gown, the designer had to measure from my shoulder to my waist in the front and then in the back. He did it three times because he couldn’t believe that they were the same measurement, “Either you have a humpback, or you’re really as flat as you said!” he told me. (link to

Miss America is, above all, a competition, and it was impossible not to compare myself to the other girls. Plastic surgery is something we don’t really talk about, but it was everywhere. And it’s wild to think that I was one of those girls prancing around on national television in my swimsuit and heels making women at home feel bad about their bodies, and yet I was just as insecure!

Several months after Miss America, I decided to do something about it – not because of the competition, not because of the pressures placed on pageant girls to look a certain way, but because I wanted to feel beautiful underneath my clothes without the pads and the pushups and the eye shadow.

I came across Dr. Eisenberg on the radio. After hearing his commercial for the fourth time I thought, I have to check this guy out. I was drawn to him because he truly is an expert in his field. He only does breast augmentation. It took one consultation for me to know that he was the doctor for me. I walked in as a 22-year-old girl nervous about making such a big decision, but his level of professionalism immediately put me at ease and he earned my trust with his depth of knowledge and experience with breast augmentation

 

AFTER: Passing on the crown to Miss New Jersey 2014.

AFTER: Passing on the crown to Miss New Jersey 2014.

I remember being anxious about the surgery, as anyone would be, but I never think of that now that I have my new breasts. The surgery was easy, the recovery was easy (I began making appearances again just five days later), and I could not be more pleased with the results.

No one has questioned why I decided to get breast augmentation surgery; one look at my new body and how happy I am gives them the answer. My close girlfriends are jealous of my new boobs, but for the most part, I look similar in clothes to how I did before – only now I’m not hiding behind two cup sizes of padding. I look as good underneath my clothes as I do in them, and I feel even better.

Breast augmentation isn’t some magic cure-all that instantly fixes all of your insecurities, but it does make you feel better in your clothes – and without them – and that has done wonders for my confidence.

Where does the saline in my implants come from?

By Dr. Ted
Saline breast implants have a silicone shell that is inserted empty and then filled with sterile salt water. But where exactly does that salt water come from?

I don’t make period trips to the beach to scoop up buckets of salt water. Although seawater does contain dissolved salts, it is also home to various microscopic organizations, which have no place in your implants.

Saline implants are filled with salt water in about the same density as the ocean water, so when you're swimming, you'll be neutrally buoyant.

Saline implants are filled with salt water in about the same density as ocean water, so when you’re swimming, you’ll be neutrally buoyant.

Nor do I fill a glass with tap water and shake in a teaspoon of salt, like my mom did when I had a sore throat and she made me gargle. Tap water won’t hurt you, but it does contain minerals and trace elements and is therefore not sterile.

The saline solution that fills saline breast implants is manufactured by a few pharmaceutical companies. It is a mixture of sodium chloride, or salt, and sterile water, and it’s free of contaminants, microorganisms and bacteria. That’s important to minimize the chance of infection.

Although saline solution is a simple drug, making it is surprisingly complicated. More than 30 steps and a range of supplies are involved in producing sterile saline. According to Valerie Jensen at the Food and Drug Administration, “It takes about three weeks to make one batch of normal saline from start to finish.”

There’s a huge demand for that saline. The same sterile saline solution that fills your breast implants is used in contact lens solutions and in dialysis labs. It’s used to clean wounds, mix medications and fill I.V. bags to rehydrate someone who’s lost fluids from diarrhea or vomiting.

Screen Shot 2014-07-02 at 3.15.08 PM

FILLING THE IMPLANTS: Saline implants are sterile as well, and I take every precaution to maintain their sterility. Once the empty implant is in place but before the incision is closed, I draw the sterile saline solution out of an IV bag and into a filling syringe. The saline is inserted through a valve in the implant. The valve is self-sealing, which prevents the saline from leaking out. This is known as a “sterile closed fill system.”

In addition, to lower the already-low chance of infection, patients are given oral antibiotics before surgery, the skin around the incision site is prepped with an antiseptic solution, and the field is irrigated with an antibiotic solution.

If a saline implant shell tears and the saline solution leaks out, it cannot harm you. It’s the same concentration as the salt water that makes up about 60 percent of the human body. Your body absorbs the saline and then you urinate it out.

So this holiday weekend, if you’re thinking of taking your breast implants for a swim in the ocean, know that they are filled with salt water that’s the same density as the ocean but didn’t come from the ocean.

Happy July 4th holiday.