Do breast implants need to be replaced every 10 years?

Posted on February 14, 2015 by Joyce

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

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

“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.

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 breast 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 23 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.

Breast 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?

Posted on January 9, 2015 by Joyce

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 recommend 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 of 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.

Here’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

Posted on November 13, 2014 by Joyce

Earlier 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.

Where does the saline in my implants come from?

Posted on July 3, 2014 by Joyce

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.

FILLING THE IMPLANTS: Saline implants are sterile as well, and during breast augmentation surgery, 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. Watch our video blog here.

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.

Breast Augmentation: How Much Does It Hurt?

Posted on April 30, 2014 by Joyce

By Dr. Ted

People experience pain differently – some are more sensitive than others, and according to an article on WebMD.com, both biological and psychological factors are at play.

After performing thousands of breast augmentations, talking with women at their first postoperative visit, and reviewing the results of a patient questionnaire that asks them to rate their level of pain/discomfort on the first few days after surgery, I’ve discovered that women usually describe the feeling as discomfort, not pain.

For three days after surgery, on average, women who have had children tell me that they feel like they did when their breasts were fully engorged with milk after childbirth. During recovery, women who haven’t had children describe the feeling as tightness, burning or pressure. The discomfort usually starts to ease up significantly on the fourth day after surgery. About 90 percent of my patients say they are comfortable enough to return to work in an office setting on the fifth day after surgery.

I prescribe medications to make patients more comfortable during the recovery period. These include a narcotic, muscle relaxant and anti-inflammatory. While some women take all three as prescribed, others might just take the anti-inflammatory and an occasional pain pill. They might take the muscle relaxant to help them sleep at night.

In addition to oral medications, some surgeons also give their patients a pain pump. They will insert a catheter (a small tube) near the surgery site at the end of the procedure. The tube is attached to a pump that automatically and continuously delivers a local anesthetic for several days after surgery.

I’m not a fan of the pain pump for the following reasons:

It can act as an entrance site for bacteria.
The patient can’t increase the pump’s rate because too much medication would be toxic.
When the patient sleeps, she has to be careful that the device isn’t under the covers or on the floor, because the tube could be pulled out.
The catheter site and pump have to be protected from water, making showering more difficult.
The device has to be removed at a post-op visit.
Most importantly, I find that post-op discomfort can be managed well with oral medications.

Women who must use their arms to lift, push or pull (such as nurses, hairstylists or waitresses) normally return to work toward the end of the second week, around the 14th day after surgery. Although they may experience a little discomfort, they manage and are fully good to go by the third week.

Titbit: Researchers report that redheads, smokers, and people who are obese report more pain. Also, depression and anxiety can make someone more sensitive to pain.

Is it normal for my breasts to be a little different in size?

Posted on November 17, 2013 by Joyce

By Dr. Ted

I got a private Facebook message today from a young teen concerned that one of her breasts was bigger than the other. She was wondering what she should do.

The short answer? I told her not to worry, to give it time. It’s not uncommon for breasts to develop unevenly during puberty, but by the time they stop growing they usually are more even. I also told her that there’s no such thing as perfectly identical breasts; most women have breasts that are slightly different sizes. It’s known as asymmetry.

The long answer: In puberty, breast development can start first on one side or on both sides at the same time. It takes about 3-5 years for the glandular tissue to fully develop and for breasts to reach their full adult size. On average, most women are finished growing by age 18, although some might continue to grow into their early 20s.

That’s about the time that the majority of women come into my office to find out about cosmetic breast surgery. They are still under the impression that breasts are supposed to be identical. Actress Jennifer Lawrence (star of The Hunger Games) made headlines earlier this year when she told Jimmy Kimmel that her breasts were uneven.

As one of my staff members said when she was interviewed for our recently released book, The Scoop on Breasts: A Plastic Surgeon Busts the Myths, “Before I started to work here, I had seen very few breasts. I didn’t have any sisters. We didn’t get undressed in front of each other in gym class; we didn’t talk about our breasts or look at each other’s. I think this is the case for most women.”

Time after time, when a woman comes in for a consultation and looks at dozens of before and after photos, she is relieved to find out that she isn’t the only one with breasts of different sizes.

Few women have identical breasts: Breasts are sisters, not twins. The difference might be slight or more obvious. Chances are one of their feet is slightly larger than the other one, too. That’s because the two sides of the body are not perfectly matched mirror images. They are asymmetrical.

Nipple position, chest diameter, the amount of breast tissue, and the location of the breast on the chest wall all contribute to the appearance of the breasts. When one breast hangs a little lower than the other, it might give the illusion of being bigger. It might also look bigger when there is a longer distance from the nipple to the inframammary fold (the crease beneath the breast). With all these variables, it is no surprise that no one has identical twins.

While some women are bothered by a size difference that’s as small as a few tablespoons, others don’t notice or don’t care. Some women address their concern by adding padding – or a “chicken cutlet” – to one cup of their bra; others opt to for cosmetic breast surgery.

If there’s a difference in the volume of the breasts, I can make them closer in size by enlarging them with breast implants of different sizes, augmenting the smaller breast, or reducing the bigger breast. I have operated on women whose breasts varied by as much as two-cup sizes, and I was able to make a significant improvement. You can see before and after photos here. While I cannot transform sisters into twins, I can make them look like sisters from the same family.

After surgery, do I have to sleep on my back?

Posted on August 28, 2013 by Joyce

By Dr. Ted
The information below is what I tell my patients to do and to expect after breast augmentation surgery: Each doctor has his or her specific postoperative protocol, and it might vary greatly from what you read here. It’s imperative that you follow your doctor’s instructions.

There’s a myth that after breast augmentation or breast lift surgery, you’ll need to sleep on your back for a week or longer. Many of my patients believe it, and they are worried that they won’t be able to get to sleep, because they normally lie on their side or their stomach.

They are not alone. According to the Better Sleep Council, fewer than 15 percent of people prefer to sleep on their back.

Let’s bust this myth: You don’t have to sleep on your back after breast augmentation surgery. You don’t have to stay up all night to make sure you don’t doze off and turn over onto your stomach. You can sleep any way you want.

Your breast implants won’t pop if you sleep on them; they are extremely durable and can withstand a lot of weight. In fact, Allergan, an implant manufacturer, tests its implants by exerting 55 pounds of force on them repeatedly, up to 6.5 million times. (That would be equivalent to sleeping on your stomach for the next 17,808 years.)

Just as your contact lens can’t slip behind your eye, your breast implants can’t disappear into your body. They are carefully positioned in a space (a pocket) behind the pectoral muscle. Just like contact lenses, the implants can’t go anywhere because they bounded by muscle and strong tissues. The normal movement in the pocket won’t disrupt your healing.

I instruct my patients to wear a sports bra for one week after their surgery, and they sometimes think that the bra’s purpose is to keep their implants in place. That’s not true. As stated above, the implants aren’t going anywhere!

The bra simply gives the bottom of the breast and the incision a little more support to counteract gravity as you sit, stand and walk around during the day. When you wear a bra, there is less pressure on the incision, which can make you feel more comfortable. The incision, which is made in the crease beneath the breast, won’t pop open, either. It’s closed by three layers of dissolvable stitches, which provide strength to the incision for months until it is completely healed.

The only factor limiting your sleep position is comfort. Most women tell me that they are fully comfortable sleeping on their stomach in about three weeks on average. They are comfortable sleeping on their side much sooner.

Sweet dreams.

How long does the drain stay in after breast augmentation surgery?

Posted on June 4, 2013 by Joyce

By Dr. Ted

I never use a drain after breast augmentation surgery. I don’t believe that it’s necessary.

A drain is inserted to remove blood or serous fluid (the body’s thin watery fluid) that can accumulate around a surgical site. The drain is a round tube that resembles a turkey baster. The smaller end is placed inside the body, the bulbous end sticks out of the body. When the bulb is compressed, it creates a suction action and the fluid is removed.

“I love Thanksgiving turkey. It’s the only time in Los Angeles that you see natural breasts.” – Arnold Schwarzenegger

The body can absorb up to about 50 ccs in a 24-hour period, so a drain is needed only if there will be more fluid buildup. During a breast augmentation, my patients consistently lose no more than a teaspoon (about 5 ccs) of blood. After surgery, there is very little fluid accumulation around the implants, so there’s no need for a drain. Likewise, I don’t use drains after breast lift surgery.

With no drains and no stitches on the outside to manage or remove, my patients report that their post-op care is easy. They go home with a Steri-Strip band-aid over their incision. All they have to do is apply ointment on top of the strip each day.

In the United States, there is general agreement among plastic surgeons that drains aren’t needed for these two procedures, although some surgeons believe otherwise. Many European plastic surgeons commonly use drains.

On the other hand, drains are always used for breast reconstruction surgery and frequently used after a breast reduction. In a breast reduction, a large amount of tissue is removed. Flaps of tissue with large surface areas ooze and need to be drained. I remove the drain the next morning following surgery. After breast reconstruction, the drain might stay in place for about a week. It’s usually removed when the drainage is less than 50 ccs in a 24-hour period.

A drain can help prevent a hematoma (large collection of blood) or a seroma (a large collection of fluid). In these situations, the advantages of the drain outweigh the possibility of the drain causing an infection by allowing bacteria from the skin to enter the your body.

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

Posted on April 18, 2013 by Joyce

By Dr. Ted

Technically, I could open your incision and add some saline to your breast implants, but it doesn’t make sense. Here’s why: Breast 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, 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.

How saggy is saggy enough to need a breast lift?

Posted on February 20, 2013 by Joyce

By Dr. Ted

“My husband said, ‘Show me your boobs,’ and I had to pull up my skirt, so it was time to get them done!” – Dolly Parton

Are you wondering if you are a candidate for a breast lift with or without implants? Try this at home:

1) The Pencil Test: Take off your bra and look in the mirror. Place a pencil horizontally along the crease under your breast, where your bra band would rest. Where does the nipple itself – not your areola – rest in relation to the pencil?
a. below
b. at
c. above

2) Put on your bra and take another look in the mirror. When your bra lifts your breasts, are you:
a. satisfied with their size
b. wish they were bigger

At a breast surgery consultation, the doctor will take measurements – without a pencil – to help you determine the right choice for you, but here is some information to get you started.

1a. If your nipple hangs below the pencil, your breasts would be considered moderately to severely ptotic (or droopy) and you would be a candidate for a breast lift, which would raise and reshape the breasts.

1b. If your nipple is at the crease and your breasts are mildly ptotic, it’s a borderline situation.

If you want a more natural look, you could consider breast implants alone. A saline or silicone gel implant placed behind the pectoral muscle might help create the illusion of perkiness. When the implant fills out the upper portion of the breast, it also fills out the bottom portion, which makes it look like the nipple is located higher on the breast. If you took out a ruler and measured, you would see that the nipple hasn’t moved; it is still in the same place.

If you want your breasts to be higher and perkier, a breast lift might be the better option, because during that surgery, the nipple is moved to a higher position and excess skin is removed.

1c. If your nipple is above the crease, relax. You are probably not a candidate for breast lift surgery. Use some of the money you save for some new, uplifting bras.

Lift and Implants?
2a. If you are satisfied with the size of your breasts, a breast lift alone may be the right procedure for you.

2b. If you want more breast volume, you could consider a breast lift and implants (an augmentation mastopexy).

While some doctors prefer to do two separate operations – the lift first followed a few months later by the augmentation, others perform both procedures at the same time (simultaneous augmentation mastopexy). Having one surgery rather than two reduces the time that you are in the operating room and under anesthesia. It is a safe operation that takes about 3-1/2 hours.

Prefer to take things into your own hands. Some women choose breast lift tape, and others have been known to try duct tape!

Other things to know:
If your breasts are moderately to severely droopy and you get implants, you could develop the appearance of four breasts, with your breast implants up high and your natural breasts down low. Not a good look.

After a lift, your breasts will be the same size as they were before, 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.