Despite the popularity of breast augmentation procedures, it can be pretty hard to find out all the information you need before making an appointment with your surgeon.
How does it work? What are implants made of? What size should I choose? These are all questions that our patients want to know, but the answers aren’t always readily available.
At Dr Robert Schwartz’s Plastic Surgery clinic, in Dallas, Texas, we want to give you as much information as possible even before you walk through the doors. After all, knowledge is power, and this way you can make an informed decision when you come for your initial consultation.
Breast augmentation is a procedure in which the breasts are made larger or a different shape, using a variety of implants and techniques. It is one of the most common cosmetic surgery procedures and can benefit a wide range of women, no matter their age, weight or build.
When it comes to what your implants will be made of, there are two main options: silicone or saline.
Silicone gel implants are the closest in feel to a real breast: they have a similar weight and density to real tissue. This means that once implanted, they will also look and move more like a real breast, sitting naturally on your chest. In most women, they feel so natural that it’s hard to distinguish the implant from the natural breast tissue.Silicone gel breast implants are, by far, the most popular and widely used breast implants in the U.S. and worldwide. Most ongoing research and development is in silicone gel implants. They come in the widest variety of sizes and shapes.When silicone leaks the gel is thick and not absorbed and will not move around the body. However, the downside to this is that it can be hard to tell if they have leaked, which is why the FDA recommends that a woman with silicone implants have an MRI or an ultrasound every few years.Silicone gel implants are best if you want the optimum aesthetic results with the most natural look and feel. They are the first choice of almost all breast implant patients.
Saline implants, when they leak, deflate over a few days. This is almost always obvious to see making it easy to tell when they need to be replaced. For some women, this is a plus because they do not have to get periodic tests to make sure their implants are intact. For others, the thought of two different sized breasts - even if temporary - is a no-go.Saline implants look and move less naturally than their silicone counterparts. Though they are soft, saline implants are less viscous than real breast tissue. This means you can usually feel them inside your breasts to some degree.Saline implants are best for women who want easy maintenance and simplicity down the road. By deflating, they literally tell you when they need to be replaced. And, though large scientific studies have proven the safety of silicone gel implants, some women do have qualms about silicone gel. Rather than worrying about the implants inside them, these women are often happier with saline.
A third option is the IDEAL implant: a type of saline implant constructed with multiple internal shells to keep the water from sloshing around. This gives the IDEAL implant a look and feel somewhere in between silicone gel and traditional saline.The IDEAL implant has two downsides when compared with standard saline breast implants:IDEAL implants are several hundred dollars more expensive than regular saline implants. This is due to the cost of the implants themselves. The more complex design of the shell makes the IDEAL implant more expensive to manufacture.The IDEAL implants come in fewer sizes and shapes than standard saline implants. This is rarely a problem since the IDEAL product line offers an appropriate implant for most women’s needs. Also, each IDEAL implant size can be used as either a moderate or high profile projection. The shape is controlled by how much saline the surgeon adds to each implant chamber.For women who want a saline-filled breast implant, we would recommend the IDEAL implant over a standard saline breast implant. The ingenious design does make it feel much more natural.
When it comes to choosing the right shape for your implants, you can choose between round or teardrop.
Round implants resemble a flattened sphere, while teardrop ones are manufactured in a more bottom-heavy shape.
While, in theory, you would think this would create a more realistic look, in reality, it doesn’t, at least not significantly. Added to this is the risk of it rotating and looking very peculiar, which is why the vast majority of surgeons, myself included, would always recommend round.
The next thing to consider is profile, or how far the implant sticks out. There are, broadly speaking, five different profiles, from flatter to more globular, and the final choice depends on the look the patient is hoping to achieve, along with her build.
We were the first surgery in Dallas to offer breast augmentation with fat transfer and it’s a service we still provide.
The thinking behind it is simple: taking fat from a place it isn’t wanted, such as the stomach or thighs, and implanting it into a place where it is, such as the breasts.
However, in reality, it’s not so simple.
The first issue is that, no matter how much fat we collect through liposuction, there is limited room to inject it into the breasts. That’s because you can’t transfer it all in one go; instead, it has to be injected in tiny little droplets all around the breast to make sure they pick up the blood supply.
As you’ll know, most women looking for breast augmentation surgery do not have large breasts to begin with, so there are limited options for adding these droplets.
The second problem is that, during liposuction, not all of the fat survives, so ultimately we do not collect enough fat to produce a visible result.
However, fat transfer is a great choice if you are primarily focused on the liposuction, and don’t want to waste the fat; it can create a modest impact so is ideal if breast augmentation isn’t your main goal.
This is the 64 billion dollar question and one we can’t answer without meeting you.
While you may have an idea of the material you want and how you want the result to look, finding the ideal size depends on many variables – not least that there’s no standard definition of cup sizes.
That’s right: a C cup to you may mean something totally different to me, or anyone else, which is why it’s not a measurement we use, focusing on CCs instead.
We also don’t rely on holding an implant up to your chest and guesstimating. This gives no indication of what the result would be inside your body; it’s like buying a dress after holding it up in front of you.
Instead, we take a more considered approach to make sure the client gets exactly what they want.
We’ll ask you to bring along a photo (or ten) of your ideal breasts to consider every aspect, not just size. From here, we’ll take detailed measurements of you before coming up with a potential shortlist of implants.
Once in surgery, we’ll test out each of the options in the breast cavity before making sure we’ve got the absolute perfect fit for you.
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"He is by far the best surgeon out there! My breast augmentation is amazing!"
Some surgeons suggest changing every ten years, but there is no hard and fast rule, and it’s not a target we set.
The main reason for changing implants is because there is an issue with the original, whether it’s because they have leaked or the implant has shifted, or if the woman simply isn’t happy – after all, the core purpose of breast augmentation is to make you feel proud of your breasts.
We specialize in revision surgeries, for whatever reason it becomes necessary, and there are a number of ways we can ensure you are happy with your breasts.
Should you have suffered a leak, this is obviously a time for revision surgery, but the cases present differently depending on the type of implant.
With saline implants, which are filled with saltwater, when a leak develops the saltwater rushes out of the implant, and it is pretty obvious it has happened.
With silicone versions, which are made of a cohesive gel, it is not as obvious, which is why the FDA recommends women with silicone implants get an MRI or an ultrasound five years after the original surgery and then every three years thereafter.
The simple answer is, if you are unhappy with your breasts for whatever reason, then yes.
There are a few criteria you’ll need to meet. You need to be physically healthy, at least 18 years old your breasts should be fully developed; we won’t operate on anyone who is not of appropriate age and development.
And while we feel that breast augmentation is potentially suitable for everyone who is unhappy with their figure, we will never rush or pressure you into having any procedures. We want you to be completely confident in your decision – the ultimate aim is for you to be happy.
There’s a lot to consider when it comes to the techniques used for breast augmentation surgery, which can be broadly summarised into venue, anesthesia, incisions, and pockets.
When it comes to choosing a venue, the surgery should always be performed in a true operating theatre in a sterile environment, which is what we offer here in Dallas.
We always recommend your surgery is done under general anesthetic (GA), as it is nearly impossible to fully numb the whole area with a local. Should you have a debilitating fear of a GA then local is an option, but we would always prefer to get to the bottom of the fear of the GA and proceed that way.
There are three potential sites for incisions: the crease beneath the breast; between the breast and the nipple; and through the armpit.
While all are valid, we prefer to use the crease beneath the breast, as it allows us enough space to correctly place the implant, while any scarring is hidden by the breast itself.
The last consideration is where to place the implant pocket, and here there are two choices: on top of the pectoral muscle or beneath it.
In most cases, the ideal option is beneath, for three reasons: one, you end up with more natural padding above the implant; two, the muscle can help to support it; and finally, and possibly most importantly, you can still get a good mammogram.
Before having any procedure, you will meet one of our surgeons to talk through all of the above in more depth and make sure we come up with the right solution for you.
In the weeks leading up to any surgery, it is a good idea to be as healthy as possible. If you smoke, it’s best to stop before your surgery. Though, this isn’t essential for breast augmentation, stopping for even a few days can make your recovery easier and improve healing. Stop taking any herbal medications at least two weeks beforehand and don’t take any anti-inflammatory medication or aspirin in the ten days before the procedure.
On the day, arrive in plenty of time and wear comfortable clothes. One of our nurses will deal with any paperwork, before showing you to your private room. You will then meet with your surgeon again for a final chat. Following this you’ll have a general anesthetic and go into surgery.
The good news is that, in the majority of cases, recovery is a lot easier than you may expect.
While it is not totally pain-free – this is surgery, after all – the pain is more muscular, similar to when you do too many bench presses at the gym. In fact, we find that most of our patients don’t even need narcotics beyond the initial surgery.
In terms of what activities you can do following the surgery, each case is different. As a guide, most are back up doing jobs around the house after two or three days and driving within a week. As for work, it depends on what you do for a living: office work, you could be back at your desk in four days; something more manual, a bit longer.
Exercise is a slightly different matter; walking is fine, but we’d recommend waiting around three weeks before attempting a full workout.
When it comes to appearance, you can expect to be swollen for a few days and the implants will sit higher on your chest for a while, before they settle.
How long does it take? Our rule of thumb is you will see about 75 per cent of your end result by the end of a month and about 90 per cent of your end result by the end of two months.
The last 10 per cent of healing consists of some softening and fading of the scar tissue, which can take between six and 12 months from the time of the surgery.
Considering breast augmentation surgery? There are many decisions to be made - silicone gel or saline implants, over or under the pec muscle, round or teardrop breast implants, what implant size?Read article
Did you know that the reoperation rate for breast augmentation is over 20%? And one of the most common reasons patients get breast implants changed is because they (or, more commonly, their plastic surgeon) chose the wrong size implant.Read article
You might have heard of a deformity called symmastia. In this post, we’ll explain everything you need to know about this cosmetic surgery complication.Read article
Dr. Robert Schwartz is the founder and director of Robert Schwartz Plastic Surgery in Dallas, TX. He is certified by the American board of Plastic Surgery and member of the American Society of Plastic Surgeons. He graduated from the David Geffen School of Medicine at UCLA in Los Angeles, CA and has been in practice for over 20 years. Dr. Schwartz is gifted with a keen eye and the unique skill to visualize you at your best, and he will execute that vision throughout every phase of your treatment to consistmently deliver stunning results. This is what makes him a world-class plastic surgeon.
Women dissatisfied with the size, shape or appearance of their breasts are candidates for breast augmentation. The procedure is also useful for reducing the differences between asymmetric breasts and for restoring the appearance of breasts that have been altered by pregnancy. Breast augmentation should not be performed on women under the age of eighteen. There is, however, no absolute upper age limit provided the patient is in good physical health.
Breast augmentation is a surgical procedure in which an implant is inserted behind the breasts in order to enlarge and shape them.
We perform our breast augmentations at a JCAHO-certified ambulatory surgery center.
Your breast augmentation will be performed under general anesthesia (i.e. you will be asleep). We use only board-certified physician anesthesiologists.
All surgical procedures result in scars. Fortunately, breast augmentations can be performed through small incisions that leave very short scars. The most common incision locations are in the crease underneath the breast, around the lower edge of the areolas, or in the underarms. Incisions in these locations heal very well in most women.
Most women with desk jobs can return to work in 4-7 days. Women with more physically demanding jobs will require a longer recuperation.
We use advanced electrosurgical techniques that are gentler on the tissues and reduce post-operative pain. Most of our patients liken the discomfort following their breast augmentation to the soreness felt after an overly intense workout.
Most women can resume driving one week after breast augmentation.
In rare instances of trauma or significant deformity, medical insurers may pay for a breast augmentation. The vast majority of breast augmentations are cosmetic and therefore, not covered.
Breast augmentation patients should not sleep on their stomachs for at least 3 months after surgery. After that, they may sleep on their stomachs as soon as it feels comfortable.
Most types of exercise can be restarted 3-4 weeks after breast augmentation. Performing physically strenuous activities earlier than this can impair healing.
This is a situation that often occurs after breast-feeding. Loss of breast tissue after lactation makes the breasts look deflated even though the breasts and the nipples haven’t dropped much. Most often, this problem can be corrected without a breast lift. Placement of breast implants to restore the lost volume will usually produce a pretty and natural-appearing result.
We will usually perform breast augmentation and lifting at the same time in women who need and want both procedures. Sometimes the procedures will need to be separated if there is marked asymmetry, very advanced sagging, or health issues that prevent a single-stage procedure. The wait between stages is usually three to six months.
Many women will benefit from the placement of a modest-sized breast implant in conjunction with their breast lift. The implant adds shaping and firmness to the breast. Most importantly, the implant helps to restore fullness to the upper part of the breast. There are no breast lifting techniques that effectively and reliably restore upper breast fullness without an implant.
Not all women will want or need breast implants with their lift. In most cases, though, the breasts will look perkier and prettier if an implant is added.
Fat can definitely be used to fill and enlarge many areas of the body. It is particularly good for buttock augmentation and it will work for modest increases in breast size. Unfortunately, as transferred fat heals, it often develops tiny calcium deposits. These calcifications can look like breast cancer on mammograms making breast cancer screening difficult.
Because of this problem we do not currently recommend fat transfers to the breasts. This procedure may become useful in the future as improved techniques and/or increased use of breast MRI eliminates the calcium deposit problem.
Signs of a ruptured silicone gel implant may include:
You should also consider the possibility of rupture after a strong blow to the chest (fall, car accident, etc.)
In most cases, breasts with ruptured implants look and feel the same as they did before the rupture; the history and physical exam are not reliable for detecting rupture.
The best test for rupture is a breast MRI. MRI's will detect 80-95% of ruptures.
Yes, but they are minor. Silicone gel implants are heavier than water and will subtly alter your buoyancy and trim in the water. This may require gear or technique adjustments. This does not apply to saline implants which are buoyancy-neutral. Divers are also advised to avoid buoyancy compensators with constrictive chest straps, which can put undue pressure on the implants.
Pressure changes themselves are unlikely to damage the implants. In a study performed by the Divers Alert Network (www.diversalertnetwork.org), implants experienced a very small increase in gas bubble size and overall volume. The effect was more prominent in silicone gel implants because nitrogen is more soluble in silicone. Regardless, the volume change was not sufficient to damage the implants and the gas bubbles disappeared with time.
The first thing to determine in these situations is why this is happening. In most cases, it is because the implant pocket is extending too far to the side. This can happen over time due to pectoralis muscle pressure on the implants. The treatment for this is a capsulorrhaphy - a procedure where the outer part of the pocket is tightened with sutures.
Sometimes, the pocket is not too wide and the implants lie to the side because the the breast skin has stretched. This can sometimes be improved with a breast lift but there is a significant chance of at least partial recurrence.
In all these situations, we should keep in mind that natural breasts fall to the side when a woman lies down so not all of these laterally displaced implants need treatment.
Sore throat can happen after surgery. It is usually caused by the endotracheal tube the anesthesiologist uses to help you breath. It is somewhat more common in women than in men. The soreness is usually mild and goes away within a few days. A severe sore throat or one that lasts for more than a few days should be reported to Dr. Schwartz.
Donating blood causes a temporary anemia. This usually corrects within 1-2 weeks. Nonetheless, we recommend that patients do not donate blood for at least one month before cosmetic surgery.
Some patients have expressed interest in donating blood for their own use, if needed. Since most cosmetic procedures are designed to produce minimal to moderate blood loss, transfusion is almost never needed. While you are, of course, free to self-donate blood, this would almost always be unnecessary.
I do recommend that my breast implant patients take a dose of antibiotics before dental work.
The problem is that dental work introduces bacteria into the blood stream. If that bacteria gets to the breast implants, it can cause an infection or a capsular contracture. Either of these may require surgery to fix.
Now it's unlikely that a dental cleaning will lead to any problems with your implants but since the consequences can pretty significant, it's worth taking the antibiotics as a precaution. Ask your dentist to prescribe whatever antibiotics he or she uses for patients with heart valves or other implants.
One additional note: You should avoid any dental work for the first 2 months after your breast implant surgery.
*Individual results are not guaranteed and may vary from person to person.