Frequently Asked Questions - Breast Augmentation

What is a breast implant?

A breast implant is a sac (implant shell) of silicone rubber, which is surgically implanted under your chest tissues.

There are two basic types of breast implants:

Saline filled breast implants

The saline breast implant is inflated with saline (saltwater) solution through a valve. Saline is similar to the fluid that makes up 70% of your body’s weight. It is harmless and non allergenic.

Silicone gel-filled breast implants

A silicone gel-filled breast implant is filled with silicone gel, a semi-solid substance. Newer silicone implants are better designed and more durable than older models. The silicone filler material is now called a coherent gel. Coherent gels maintain their shape and do not flow like a liquid. Coherent gel implants are also called “gummy bear” implants. Patients selecting silicone implants are strongly encouraged to participate in the adjunctive study.

What is silicone?

Silicone Material

Silicone is derived from silicon, a semi-metallic or metal-like element that in nature combines with oxygen to form silicon dioxide, or silica. Beach sand, crystals, and quartz are silica. Silica is the most common substance on earth. Heating silica with carbon at a high temperature can produce silicon. Further processing can convert the silicon into a long chemical chain, or polymer, called silicone - which can be a liquid, a gel, or a rubbery substance. Various silicones are used in lubricants and oils, as well as in silicone rubber. Silicone can be found in many common household items, such as polishes, suntan and hand lotion, antiperspirants, soaps, processed foods, waterproof coatings, and chewing gum.

Silicone is an extremely biocompatible material and has been used in medical implants for many decades. Biocompatibility means how well an artificial substance is accepted by the body. Silicone is very non reactive which means it do not cause a large inflammatory response.

Are silicone implants safe?

Safety of Silicone

Special studies have been done and have determined that much higher levels of silicone have been found in cows' milk and commercially available infant formula than are found in the breast milk of women with implants. The Institute of Medicine concluded that "There is no evidence that silicone implants are responsible for any major diseases of the whole body. Women are exposed to silicone constantly in their daily lives."

For more information regarding the safety of silicone please refer to the Institute of Medicine Report (IOM) at: www.nap.edu.

Do implants influence the occurrence of breast cancer?

Breast Cancer

No studies have ever shown this to be a concern for humans. There is no evidence that implants cause cancer.

How do breast implants affect mammography?

Mammography

It is important that you tell your mammography technologist that you have implants before the procedure. Because of the large number of women with breast implants nearly all mammographers are skilled at performing the special views needed to visualize the breast. These special displacement techniques are called Eklund views. Discuss any family history of breast cancer with your doctor.

Is it possible to get a silicone allergy?

Silicone Allergy

It is possible for anyone to develop an allergy to almost any substance on earth, however silicone allergies are very rare. We are all exposed to silicone in our environment every day. It is found in many household items, such as polishes, suntan and hand lotion, antiperspirants, soaps, processed foods, waterproof coatings, and chewing gum.

What is the average life expectancy of an implant?

Implant Life Expectancy

Implants are not lifetime devices; therefore it is likely that they may need to be replaced sometime in your life. The time period varies from woman to woman. Some women need replacement surgery in only a few years while others may go 10-20 years. There are several different reasons why a woman might need replacement surgery. Sometimes it is a matter of choice, such as a size change or an implant style change, and sometimes removal and replacement is necessary because of a complication, such as deflation, or shifting of the implant.

How long should I wait to resume exercise and other strenuous activities after implant surgery?

Recovery / Activities / Exercise

Dr. Zemmel will be your best guide regarding how long you will need to remain off work and will advise you when and how to resume activities. Recovery periods vary from woman to woman. Generally the first few days are the most uncomfortable. The average time to return to full activities is three to four weeks.

It is important not to stress the incision while it is healing. Therefore curtail activity and sun tanning until after the incision is healed and sealed. Don't over-do activity, especially of the upper body, too early. Let your body rest and heal. You want to minimize swelling around the implant.

Going into a Jacuzzi or bath after a couple of weeks is usually ok. During the first one to two weeks following surgery, you don't want to soak the incision.

Be sure you check with Dr. Zemmel before returning to your workouts. Patients vary greatly in recovery times. Walking is generally recommended to encourage circulation. The larger the implant you receive the heavier the breasts will be. You should wear good support bras while running to minimize pull on the skin and ptosis (drooping) of the breast.

Can I go to a tanning salon or sunbathe if I have implants?

Tanning Salon / Sun Bath

You should refrain from tanning at salons or sun bathing the breasts during the first 3 to 6 months after surgery. The skin around the implants and the scars are still healing during this time. Deep tanning can cause damage to the skin and make scars worse. You should avoid getting sun or tanning rays on the incisions for at least one year after surgery as tanning rays will turn the incisions dark permanently. The implant may feel warm and may take longer to cool down than your body.

When can I fly and/or scuba dive?

Flying / Scuba Diving

Many women scuba dive and fly in airplanes with implants. There may be slight expansion and contraction of the shell with changes in pressure. This may result in a small amount of air bubbles in the implant. With gel implants as with saline filled implants you may feel or hear fluid sounds (gurgling). This should correct itself within 24-48 hours.

When can I wear an under wire bra again?

Under Wire Bra

Dr. Zemmel will ask that his patients wait 3-4 weeks before wearing under wire bras after implant surgery. Your body will be forming a thin capsule around the implant “locking” it into position. Dr. Zemmel does not want any upward pressure on the implant during this time. After this initial healing time under wire bras should can be worn whenever the patient chooses.

Will my breasts sill move like normal breasts?

Breast Movement

This depends upon multiple factors, such as the type of implant you receive, the pocket dissection, the way your body holds the implant and whether or not there is any degree of capsular contracture. It is possible for many women to have breast implants that are soft and move nicely, while other women have results that are firmer with an implant more fixed in position. Dr. Zemmel will provide you with a result that optimizes you specific body type for breast implant surgery giving you the most natural look possible.

Will getting implants cause stretch marks on my breasts?

Insertion of implants rarely causes stretch marks. Most of the time this results from a very large implant placed in a small breast with thin skin. Dr. Zemmel prefers to place implants that are proportional to your body type giving you an enhanced and natural look.

What effect does smoking have on the healing process after surgery?

Smoking causes the blood vessels to constrict, reducing the blood supply and the oxygen carried by the blood to the surgical area. The tissues need this blood supply and the oxygen that the blood carries in order to heal. When the blood supply is reduced the tissues heal more slowly. Different doctors have different time frames for patients to refrain from smoking before and after surgery. Dr. Zemmel will require you to refrain from smoking 4 to 6 weeks prior to surgery and 6 weeks after to ensure proper healing.

Will I lose nipple sensation?

Although rare, there can be changes in nipple sensation after implant surgery. Feeling in the nipple and breast can increase or decrease. The range of change varies from no feeling to intense feeling and can be temporary or permanent. Dr. Zemmel will go over this issue with you during your consultation.

Should I be at my ideal weight before I have a breast implant procedure?

Your weight should be stable prior to implant surgery. Dr. Zemmel does not believe in ideal weights as each has their own body weight and form. However a significant loss of weight after receiving breast implants could alter the results in a manner that changes the shape and projection. There could be some ptosis (drooping) and a reduction in size. A significant gain in weight could cause an increase in breast size.

I'm over 50 years old. Am I too old to get breast implants?

Your overall health status is what is important, not chronological age.

What will happen during pregnancy?

Each woman has a unique pregnancy experience and there are many changes to the body that vary dramatically from one person to another. Your breasts will enlarge and will go through all the usual changes associated with pregnancy. The amount of enlargement will vary from woman to woman and the size of the implants will factor into this as well. Depending on your overall weight gain, amount of milk production, and quality of your skin and tissues your breast shape can be relatively the same or different after pregnancy.

Why did my breasts get small and droop after pregnancy?

A loss of volume, often associated with drooping, is very common after pregnancy and is called post-partum breast involution. Volume loss with a small amount of sagging can be corrected with breast augmentation surgery. The additional volume from the implant can correct sagging in many cases. For an excessive degree of sagging, a mastopexy or 'breast lift' may be the solution. Dr. Zemmel typically performs a minimal incision breast lift with augmentations. This means that the lift incision is only a circle around the nipple and areola. Severe drooping requires the removal and tightening of more skin and therefore needs a larger incision.

Can I still breast-feed?

Breast Feeding

Most women with breast implants successfully breast feed their babies. Current studies indicate that women with breast implants, either gel or saline, do not have any higher levels of silicone in their milk than women without breast implants. Dr. Zemmel performs all primary breast augmentations under the muscle layer (sub-muscular). As this does not effect the breast tissue it should not affect your ability to breast-feed. For sub-glandular augmentation (under the breast tissue, but over the muscle layer), like any other surgery that disturbs the breast tissue itself, there is a risk of losing the ability to breast-feed. Dr. Zemmel does not perform sub-glandular primary augmentations. Dr. Zemmel will cover this issue extensively during your initial consultation.

Can plastic surgery correct inverted nipples? Can I enlarge or reduce the size of my areola?

With inverted nipples, the problem is that the ducts are too short and tether the nipple. This can be corrected in the office under local anesthesia. The incision is small and located on the underside of the nipple so that it is difficult to see.

The areola can be reduced in size or enlarged. This may be done as a standalone type of procedure under local anesthesia. Or, it may be done in conjunction with an augmentation, reduction or lift.

Do implants rupture?

Mechanical failure of breast implants is possible. Over the past 10 to 15 years implant designs have been significantly improved which has drastically lowered the rate of rupture. However all manufactured mechanical parts have a lifetime. Dr. Zemmel performs cosmetic breast augmentation with saline filled implants. If a rupture occurs, the implant will rapidly deflate. The saline is harmless to the body and will be absorbed and excreted normally. Dr. Zemmel will then see you as soon as possible to schedule an implant replacement. Both implant manufacturers guaranty the implants (for 10 to 15 years) and will provide you with a free or significantly discounted implant as well as subsidize the cost the procedure. The replacement procedure is much easier than the initial augmentation procedure and can be done under local anesthesia with some sedation in the office. While rupture is possible, it is infrequent and Dr. Zemmel will give you all of the detrails during your consultation.

Do I have to have my implants changed after a certain number of years?

No. You do not need to change your implants unless there is a problem. The implants have a warranty, and if they deflate during the warranty, the manufacturer will give you an implant and pay towards replacement.

What can you do to correct asymmetries or differences between the breasts?

Nearly everyone Dr. Zemmel examines has some asymmetry of their breasts. Statistically 85% of women have some degree of asymmetry. Sometimes these differences are subtle and other times they are more pronounced. It can be a difference in size, height of the nipple, amount of drooping, height of the breast fold, contour of the ribs, height of the shoulder tips, etc. Many times we can attempt to correct or improve upon the asymmetries. This can be done by lowering the breast fold, inflating one implant to a larger size, and raising and lowering the nipple. If there is asymmetry before surgery you will likely have some afterwards as well.

Do breast implants cause you to get breast cancer?

No. Breast implants do not cause breast, or any other cancer. Studies have shown that women who have implants and get breast cancer have the same prognosis as women that get breast cancer and do not have implants. However, you still should get mammograms as recommended by your physician. Women with implants require special mammographic views (called Eklund views). Please make sure that your mammographer is familiar with this special technique.

Do you put the implant under or over the muscle?

Dr. Zemmel placed all implants behind or under the pectoralis major. Placing the implant behind the muscle hides the implant giving a more natural feel and look. Placing the implant under the muscle also significantly reduces the rate of scar formation around the implant (called capsular contracture). There is also more support for the implant to protect against drooping, and as discussed above mammograms are more accurate when the implant is under the muscle.