Timing Your Breast Augmentation Surgery

Whether you are planning a beach vacation or a wedding, hoping to get pregnant or lose weight, or entering a sports competition, timing is everything when you are considering breast augmentation surgery.

Taking a Beach Vacation
Around three weeks after your breast augmentation surgery, you can go in a hot tub, swimming pool or the ocean. At that time,Screen Shot 2016-06-15 at 7.27.01 PM the incision will be healed enough so that water won’t penetrate it and possibly cause an infection. You can go tanning as early as three weeks after surgery, too. Ultraviolet light, whether from the tanning bed or the sun at the beach, can make a scar redder for a longer period of time, so protect your incisions with sunscreen that has a sun protection factor (SPF) of 15 or higher.

It’s best to wait at least eight weeks before making a major investment in new bras and swimsuits. At that time, you will be able to more accurately determine your postoperative size and shape and get a truer fit.

Wedding Planning
It takes about eight weeks for breast implants to begin to settle into their new size and Screen Shot 2016-06-15 at 7.28.34 PM shape. If you want to get a true fit, it would be unwise to go wedding gown shopping before then. Since wedding planning calendars usually recommend that you order your gown 8-10 months out, it means your surgery should be a year before the big day. If you can’t plan that far ahead, you could schedule surgery anywhere up to about four months before the wedding. That way, you’ll be able to get your gown’s bodice adjusted at the fitting, which is usually done about 6-8 weeks before the ceremony.

Pregnancy and Breastfeeding
If you are thinking about having a child in the next year or working on it now, I would suggest that you wait because your post-pregnancy breasts might look different from your current pair. During pregnancy, your breasts will enlarge from hormonal changes and milk production. Afterward, they might return to their original size or get smaller, bigger or droopier. You won’t know the verdict until six months after you have stopped breastfeeding or, if you are not breastfeeding, six months after childbirth.

If parenthood is further in your future and you are anxious to enjoy new breasts now, you don’t have to wait. Just understand that you might need a revision after pregnancy.

Weight Loss
When you lose weight, it not only reduces the size of your waist and thighs, but it might also reduce the size of your breasts, because breasts are made up mostly of fatty tissue. If this happens, you might be left with saggy breasts and stretched skin. If you are planning to lose 10 percent or more of your body weight, it makes sense to wait until you have reached your goal before you have breast augmentation surgery. In order to choose breast implants that will make you proportional, you need to know your true starting size.

Training for a Competition
Three weeks after surgery, it’s OK for you to do aerobic activity (treadmill, stationary bike, Screen Shot 2016-06-15 at 7.26.45 PMetc.), running and lower-body weight training. Women are usually comfortable doing arm exercises (upper-body weights) starting about six weeks after surgery. I have Triple Crown bodybuilders and kickboxers who go back into competition after getting implants. They start with light training at six weeks and heavier training after eight weeks. None of their implants has deflated.

For more information about breast augmentation surgery, click here.

10 Things to Consider Before Breast Lift Surgery

Are you a candidate for a breast lift? Should you also also get implants? What can you expect during recovery? Here are 10 things to consider.

Screen Shot 2014-10-13 at 10.18.04 PM1. A breast lift, or mastopexy, raises and firms the breasts, giving them a more youthful look. I do this by removing the excess skin, moving the nipples to a new, higher position, and suturing the remaining tissue together to create a sling – essentially a natural support bra – that raises and reshapes the breasts. I use the I.D.E.A.L. Breast Lift technique, which I created and have been teaching to doctors from around the world.

2. To determine if you are a candidate for a lift, try the “pencil test.” Take off your bra and look in the mirror. Place a pencil horizontally along the crease under your breast where Screen Shot 2014-10-13 at 10.02.39 PMyour bra band would rest. Does your nipple – not your areola – rest above, below, or at the pencil?

3. If your nipple is above the pencil, relax. You are probably not a candidate for breast lift surgery. Use some of the money you save for new, uplifting bras.

4. If your nipple hangs below the pencil, your breasts would be considered moderately to severely ptotic (or droopy) and you would need a breast lift to raise and reshape your breasts.

5.  If your nipple is at the pencil and your breasts are mildly droopy, it’s a borderline situation. You might get a good result with an implant alone because an augmentation can give the illusion of a lift. As the implant fills out the upper portion of the breast, it also fills out the lower portion, which makes it appear as if the nipple is located higher on the breast. After about 9 months, when the implant has settled, you’ll have a better idea if you are perky enough. You can always get a lift later if needed.

Titbit: 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.

6.  After a lift, your breasts will be the same size as they were before surgery, because only excess, stretched skin is removed during a breast lift; no breast tissue is taken away. You’ll look exactly how you look before surgery when you are wearing a good bra.

7.  To determine 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). To get an idea of the results, check out some of my before and after photos of breast lift surgery and breast lift with implant surgery.

8. Women report minimal discomfort after breast lift surgery. That’s because a breast lift involves removing only loose, stretched skin. If implants are added at the same time, the skin and muscle will be stretched, which may cause a little more discomfort.

When a Philadelphia DJ came to me for breast lift surgery,
she recorded her experience from start to finish in this intimate video blog.

9.  More than 90 percent of my patients are back to work on the fifth day after surgery if they work in an office setting. Women whose work requires lifting, pushing or pulling usually go back to work toward the end of the second week. They might be a little sore at the end of their workday, but by Week 3, they feel pretty much back to normal.

10. It’s very likely that breast lift surgery won’t affect your ability to breastfeed because your milk ducts, which run from the mammary glands to the nipple, are not disturbed. Only skin from the perimeter of the areola is removed, and there are no milk ducts there.

 

Breast Augmentation: The Second Time Around


Times change. And so may your breast size.

When women come in for a breast augmentation consultation, I tell them about two circumstances that could change their surgical results in the future: pregnancy and significant weight change.

During pregnancy, breasts enlarge from hormonal changes and milk production. Afterward, they could return to their original size or get smaller or bigger. And because breasts are made up mostly of fatty tissue, they will get bigger or smaller as you gain or lose weight. Often, they are the first indicators.

Although your breasts may change, your implants will remain the same. They don’t need to be replaced every 10 years. In fact, I’ve changed a woman’s implants after 19 years – she had a child, got smaller and wanted to go bigger – and the implants looked the same as they did the day I put them in.

About 10 percent of my breast augmentation patients come in for a consultation to get information about making a change. The average time elapsed is about 10 years, though it varies greatly.

They tell me, “I’ve gained a lot of weight, and I’m much bigger than I want to be. I’d like to go a little smaller.”

Or, “After my two children, my breasts got smaller. I just want to get my pre-pregnancy size back – and maybe a little extra.”

Others say, “I went for the gusto 15 years ago. I’ve enjoyed them and they served their purpose, but now that I’m 50something, I just want them a little smaller.”

Like the first time, we look at before and after photographs of women who started out similar to them in height, weight, frame size and breast volume. They tell me, “too big,” too small” or “just right” so I know what size implants to order.

Breast augmentation surgery is easier the second time around. Here’s what’s involved in upsizing or downsizing:

Less discomfort: To change each implant, I go through the same incision that I made initially in the crease beneath the breast. I don’t have to make a pocket beneath the chest muscle for the implant, so there is less manipulation of breast tissue and therefore less discomfort post-op. All you’ll feel is the incision. Consequently, you’ll likely need less medication after surgery for discomfort.

Shorter procedure time: This second surgery takes less time than your initial breast augmentation surgery, which means less anesthesia and a lower possibility of post-operative nausea and vomiting.

Shorter recovery time: You should still take it easy for a week, but you could probably get back to work on the third day because there is much less chance of bleeding. So if your surgery is on a Friday, you could return to work on Monday. First-timers are generally back to work in an office setting in 5 days. And you don’t have to wait until the sixth week to do upper body weights. You can start up again after three weeks.

Quicker results: Because your skin and chest muscle have already stretched to accommodate your implants, the implants won’t start off high like they did the first time. You’ll pretty much see the final result when you get home. After surgery, I’ll have you wear something supportive like a sports bra for three weeks to protect your incision. At that time, you’ll be able to wear and do anything and everything you want. No waiting eight weeks this time to go shopping for new bras and bathing suits.

 

 

“I love my implants, but I wish I went bigger.”

“Worth it but kinda wish I went bigger.” “Love ‘em but wish I went bigger.” Breast augmentation forums, such as RealSelf.com, are filled with comments like these.

After doing thousands of breast augmentation consultations, I’ve identified four reasons that women hold back from choosing the size they really want to be. If you can avoid these traps, you’ll likely be satisfied with your choice after surgery.

Holding back based on concerns that people will “know.”
Some women don’t want others to know they had a breast augmentation, so they choose smaller implants: “I don’t want to look fake.” “I don’t want people to notice.” “I don’t want people to judge me,” they say. They need not worry.

I assure patients that most women look natural and proportional after their breast augmentation surgery and can keep it a secret if they are so inclined. Patients tell me that their most observant friends and family members are often aware that something is different. They ask questions: “Are you just back from vacation?” “New haircut?” “New outfit?” “Are you working out now?” They can’t figure out exactly what has changed.

Choosing implant size by looking at pictures taken at 3 months after surgery or earlier, instead of looking at fully settled breasts.
When post-op photos are not labeled, you don’t know how far along a woman is in the Screen Shot 2016-01-19 at 9.12.18 AMhealing process. If you are looking at online photos taken 3 months or less after surgery, consider this: The implants have not yet settled into their final position. They are pressed up high, like your breasts would be in a push-up bra. They are not fully settled until 9 months post-op, and at that point they often will look smaller than they do at 3 months. You’ll likely be disappointed if you choose your implant size from pictures that were taken three months after surgery.

In general, your breasts look smaller when you are dressed than when you are undressed. So my before and after photo book includes pictures of women 9 months after surgery both unclothed and clothed, in a bra, tank top or blouse.

Making a decision based on cup size.
Our last blog post explained that being proportional doesn’t mean wearing a C cup bra. Click here to read “Can you make me a full C cup?”

Making a decision based on Internet forums and input from friends.
You might like the 375 cc implants you saw online, but are you comparing apples to apples? The woman whose breasts you were admiring might have started out with breasts that were larger or smaller than yours, and she might be a different height and weight, too.

If you’re starting with a full B cup and that woman started with a mid-A, you won’t end up the same size when you both get 375 cc implants. You’ll be about 1-1/2 cup sizes bigger – the extra cup you started with.

Likewise, friends who have implants might weigh in on your choice: “One of my girlfriends who has implants said that the implants I selected are too large for me. She has me second-guessing myself,” a patient told me.

My advice is that after you’ve looked at pictures of women who are similar to you and your frame, and you’ve chosen the size that seems right to you, trust yourself. Go with your gut or your heart – not your head. Remember that you’re the expert for yourself.

How soon after pregnancy can I get a breast augmentation?

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 your skin to stretch. When the milk is gone, your breasts might return to their original size or get smaller, bigger or droopier.

Screen Shot 2015-10-23 at 1.07.40 PMTo know your true post-pregnancy breast size and shape, it’s best to wait at least six months from the time you give birth or from the time you stop breastfeeding, whichever is later. At that point, you’ll be able to choose breast implants that will make you proportional.

Breastfeeding itself does not cause the breasts to droop. A study in the journal Aesthetic Surgery identified the following risk factors for an increased degree of breast sagging: body mass index (BMI), the number of pregnancies, a larger pre-pregnancy bra size, smoking history and age. Breastfeeding was not found to be a risk factor.

If you are thinking about having a child in the next year or so, I would suggest that you wait because your post-pregnancy breasts might look different from your current pair. But if parenthood is several years down the road and you are anxious to be more proportional, fit better into your clothes or correct some asymmetry, you don’t have to wait for a breast augmentation. Just understand that you might need a revision after pregnancy.

Did you know? During pregnancy, hormonal changes cause the nipple and areola to get bigger and darker. Scientists speculate that it is evolutions way of making it easier for an infant to find and latch onto the breast.

IF YOU ARE DIETING . . .

Like pregnancy, weight loss can take a toll on your breasts. When you lose weight, it not only reduces the size of your waist and thighs, but it might also reduce the size of your breasts, which are made up primarily of fatty tissue. If the skin doesn’t retract when some of the fat disappears from your breasts, you could be left with droopy breasts, stretched skin or empty-looking breasts, which might make you a candidate for a breast lift alone or with an augmentation.

If you are dieting, be sure to save a few dollars for shoe shopping. Some women report that along with losing a cup size, they lose a shoe size.

If you are dieting, be sure to save a few dollars for shoe shopping. Some women report that along with losing a cup size, they lose a shoe size.

If you are planning to lose 10 percent or more of your body weight, it’s wise to wait until you have reached your goal before you have cosmetic breast surgery so you’ll know your starting size. That way you’ll have the best chance of getting a satisfactory long-term result.

 

 

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.

 

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.

20100129SAWG_fg03a

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.