How soon after pregnancy can I get a breast augmentation?

Posted on October 23, 2015 by Joyce

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.

To 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 breast 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 evolution’s 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 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

Posted on August 12, 2015 by Joyce

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.

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:

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. Watch our video about mammograms and breast implants.

9. 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: There is one cost 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?

Posted on July 23, 2015 by Joyce

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.

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. View our Before & After Photo Gallery.

It is common to be able to feel the breast 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.

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).

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?

Posted on March 21, 2015 by Joyce

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.

Maybe 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?”

After breast augmentation 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?

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.”

Will implants make my breasts look perky again?

Posted on October 14, 2014 by Joyce

Breast 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.

If 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?

If 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). Click here to see our before and after photo galleries.

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

Breasts 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.

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.

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

Posted on July 22, 2013 by Joyce

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.

It’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 breast 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.

Will my breast implants boil, melt, or keep me afloat?

Posted on June 19, 2013 by Joyce

By Joyce
Summer officially arrives this Friday, June 21, which means it’s time to tan, swim, dive, sunbathe and unveil your new bikini. If you are also unveiling a new set of ta-tas, it’s time to get answers to some pressing questions like these:

When can I go tanning?
You can start working on your tan as soon as three weeks after your breast augmentation surgery, but be sure to protect your incisions with sunscreen that has a sun protection factor (SPF) of 15 or higher. Ultraviolet light, whether from the tanning bed or the sun at the beach, can make a scar redder for a longer period of time.

Will my implants cook in a tanning bed?
If you want to get a tan before you head to the beach, you can go to a tanning salon without worry. Tanning salons use ultraviolet rays, which don’t cook anything. They don’t use microwaves, even though some people think they do. This was proved by a 2005 episode of MythBusters when the crew placed two raw chickens in a tanning bed for one hour. The skin got a little darker, but the chickens were still raw inside.

Will my breast implants keep me afloat in the ocean?
Don’t count on it. Here’s why: Most people are neutrally buoyant, which means they don’t float up or down; they hover. More fat makes you float; more muscle makes you sink. It is gravity that eventually pulls you down.

Saline breast implants are filled with salt water in about the same density as the ocean water you are swimming in, so they are neutrally buoyant, too. You will float more easily in the ocean than in a pool because salt water is heavier than fresh water, but the same basic principles apply.

Silicone gel implants are slightly denser than water. Although they won’t make you sink, you might have to doggie paddle just a little bit harder. That’s why it is recommended that after getting silicone gel implants, a scuba diver does a checkout dive to see if she needs to adjust her dive weights.

Will scuba diving harm my breast implants?
A research team at Duke University Medical Center placed silicone gel and saline implants in a hyperbaric chamber to simulate the pressure experienced by scuba divers at various depths. When a diver is underwater, the increased pressure causes nitrogen, a component of the air we breathe, to build up in the blood and body tissues. If a diver surfaces too quickly, the nitrogen gas can form dangerous bubbles, similar to the bubbles you see when you first open a bottle of soda.

The moon jelly, a species of jellyfish, is round, translucent and gelatinous. That’s why, when it washes ashore, it’s easily mistaken for a silicone breast implant.

So what happened to the breast implants? The medical experts at DAN, the Divers Alert Network, summarized the findings on their website: “The bubbles that formed in the implants led to a small volume increase, which is not likely to damage the implants or surrounding tissues. If gas bubbles do form in the implant, they resolve over time.” No implants were harmed in the study.

Do breast implants melt in a sauna or in the sun?
Implants have a silicone shell, which would melt at temperatures greater than 392 degrees Fahrenheit. A conventional sauna is typically between 150 and 190 degrees. Unless you are sunbathing on the sun, you’ll be fine. If you are really worried, expose them only at dawn and dusk. See more on our video blog.

Can my implants boil in a hot tub?
Your implants are inside of your body, and you would have to boil the outside of your body before the inside boiled. The average hot tub temperature of 102 degrees Fahrenheit isn’t hot enough to do that.

Nuff said. Have a great summer. And if you find some men staring at your cleavage, remind them of what Jerry Seinfeld had to say: “Looking at cleavage is like looking at the sun. You can’t stare at it. It’s too risky. You get a sense of it and then you look away.”