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.

I’m getting married next year. When should I schedule my breast augmentation surgery?


Dear Dr. Eisenberg,
I got married in May 2008, and as I reflect back on old photos, I cannot imagine the old self-conscious, flat-chested me wearing my strapless, sweetheart neckline gown. My dress was perfect and I couldn’t have worn it without your work. I can’t thank you enough for giving me the chance to choose any gown I wanted for my wedding day.” – Angela

Like Angela, many women come in for a breast augmentation consultation before their wedding: They want to be able to wear the dress of their dreams on wedding day and not be limited because of their cup size. They’ve read sites like TheKnot.com’s Neckline Glossary, which explains that Strapless is bad for “smaller chested women” and Sweetheart is bad for “the décolletage-impaired.” What should they buy? The Jewel (“a t-shirt neckline that sits at the base of the throat”) or the Sabrina (“cut straight across so less of the décolletage shows”), the site suggests.

wedding-dress-necklines-590ac120110It’s not surprising that my patients include a lot of brides-to-be, who want to go bigger before their big day. In the United States in 2012, the average age for women to marry was 27. About half of my patients are in their early 20s; the rest are in their 30s and are coming to me post-childbirth to recapture what they lost after pregnancy.

Often, these prospective brides have been considering breast enhancement surgery for years, and their wedding provides the impetus. They are no different from the vast majority of my patients, who tell me they want to look proportional and have their clothes fit better.

After all, what clothing is more important than a wedding gown? Women know that on their wedding day, all eyes will be focused on them and more pictures will be taken than on any other single day of their life. And it won’t hurt to look great in a bikini on their honeymoon, either.

PLANNING AHEAD
While you can get your hair and makeup done the morning of your wedding, you need to plan way ahead for cosmetic breast surgery.

Wedding Planning Calendars tell you when to reserve the date, pick your bridal party, meet with the caterer, and order your gown (usually 8-10 months out.) The calendars don’t tell you when to schedule your breast augmentation surgery, so I will!

Ideally, you should pencil in “Have cosmetic breast surgery” in the “12 Months Before” category on your calendar. That way, you’ll be ready for your wedding gown-shopping trip about two months later. You’ll need that much time to heal in order to get a true fit on your gown.

That’s because when implants – especially saline – are placed under the pectoral muscle, the muscle presses the implant flat, as your hand would compress a sponge ball or a balloon, and the implant needs a place to go. It moves toward the area of least resistance – the collarbone and the armpit – which is why the implants are up high right after surgery. They begin to settle down in about 6-8 weeks.

Having your surgery a year before your wedding is ideal, but 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. This will also give you plenty of time to heal before your honeymoon, so you’ll be ready for swimming and other activities.

Looking Your Best
In 1991, I was doing reconstructive surgery, I treated a patient who had lost an eye to cancer when she was a child. She wore eye patches for years to conceal the damage caused by the radiation treatment. Her wedding was approaching, and she wanted to walk down the aisle – and be photographed – with two eyes. In a series of three procedures, I used a new technique to implant an artificial eye prosthesis in her contracted eye socket. I was a guest at the wedding and was asked to make a toast. It was an honor.

 

 

 

 

 

Can you add more saline to my implants so I don’t have to have surgery again?

By Dr. Ted

Technically, I could open your incision and add some saline to your implants, but it doesn’t make sense. Here’s why: Implants come in various sizes, like 325 ccs or 450 ccs, and they can’t be expanded an infinite amount. If implants are over-expanded, they will feel hard, like balloons that have been blown up too much. There might be room for a little bit more saline solution (salt water) – maybe two tablespoons at most ­­­– the amount of oil you would add to your pancake mix. This small amount would be barely noticeable. In fact, you could get the same look by wearing your bra one notch tighter.

In 1937, Warner’s introduced its “Alphabet Bra” with A, B, C and D cups. Before too long, these cup sizes got nicknames: egg cup, tea cup, coff ee cup and challenge cup.

In 1937, Warner’s introduced its “Alphabet Bra” with A, B, C and D cups. Before too long,
these cup sizes got nicknames: egg cup, tea cup, coffee cup and challenge cup.

Women come to me with the request to “go bigger” often after significant weight loss (about 10 percent or more of their body weight) or after pregnancy, when their breasts may have changed because of hormonal fluctuations and milk production.

In my experience, women want an increase of about one cup size or more, which would be equivalent to anywhere from 150 to 225 ccs, depending on the size of their frame. To accomplish this, they would need larger implants.

By the way, bigger implants aren’t more expensive than smaller ones. Manufacturers don’t charge by the cubic centimeter: 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.

Breast augmentation is easier the second time around, because the pocket around the implant has already been made and has already healed. During surgery, I would place a larger implant through the initial incision, which was made in the crease below the breast where the breast and the chest meet.

Post-operatively, to protect the incision, I ask patients to wear a supportive bra or a sports bra for three weeks. They report significantly less discomfort than the first time around, and women who have surgery on Friday are usually back to work on Monday if they work in an office setting.

The saline implants used during breast augmentation surgery are different from the temporary tissue expanders used during breast reconstruction surgery. These have a tube that runs from the expander to the skin near the outside of the body. Saline can be added over a period of months to gradually stretch the muscle and skin. The expander is then removed and replaced with a permanent implant.

P.S. While saline implants come empty and are filled after they are inserted, silicone gel implants come filled. There’s no way to add silicone to them.