Breast Augmentation

This is an interactive process and is a combination of customizing the implant to achieve the final look that the patient wants to achieve, as well as balancing realistic factors such as the patient’s pre-existing breast size and shape and overall frame. We also take into consideration things like the patient’s lifestyle and level of activity – how heavily they use their chest muscle, as well as their tolerance for implant weight. During your consultation, Dr. Xu will have you try on sizers in the office that give you an idea of what a certain sized implant would look like on you. In addition, she will have you wear sizers at home during a trial period to get a better sense of how this works with your lifestyle, how it looks in various clothing, and how the weight feels to you. Finally, Dr. Xu will ask that you collect some photos of your ideal look to get an idea for what breast projection and overall aesthetic you are seeking.

Instead of just ordering one implant size for your surgery, Dr. Xu always makes sure she has a range of implant sizes on hand.  During your surgery, she will also use sizers in the operating room to see how different volumes look prior to deciding on the final implant; this ensures that the final size selected is exactly the right fit.

Silicone implants look and feel much more natural than saline implants, which are essentially a silicone bag filled with water. Saline implants look and feel like a water balloon. They came into popularity during the 1990’s but now most patients are getting silicone implants, which have evolved as newer generation implants are more cohesive and stable than their older counterparts.

The degree of cleavage you have can be enhanced by the increased volume you achieve through a breast augmentation with implants; however, cleavage is mostly determined by how close your breasts are on your chest, and this is something that is genetically set by the natural blueprint of your body called your “breast footprint.” Some women have breasts that are far apart with a wide space in the middle, while others have breasts that easily touch in the center making cleavage more pronounced. In general, cleavage can be accentuated with the use of bras designed to push the breasts closer together, and is not necessarily created by the use of implants alone.

As a continuation of the concept of your natural “breast footprint,” your implants should be placed where this is, centered behind the breast and nipple. Thus, it cannot be placed higher on your chest that where your breasts naturally sit – otherwise, you will have a deformity. Patients who wish for their breasts to have more volume in the upper pole will be happy to know that implants naturally boost volume in this area. If a patient is looking for her entire breast to be in a higher position on the chest, she is probably seeking something more like a breast lift (can link to breast lift section).

The Keller funnel allows placement of the implant using a “no touch” technique where the surface of the implant does not come into contact with anything else (such as gloves and instrumentation used during the surgery). The implant is pushed into the breast pocket using this Funnel, which reduces the risk of any contaminants or bacteria making their way onto the surface of the implant due to additional handling. This “limited exposure” concept is important because it reduces the risk for infection and “seeding” an artificial device in your body like an implant with potential sources for infection. It also in turn is thought to reduce the risk of biofilm formation and capsular contracture, which is the #1 long term complication with having implants.

Most patients typically don’t need something like this. It becomes relevant when a very thin patient with minimal tissue of her own wants to have implants that are likely too large for her natural body structure to support. This can be assessed during your consultation when Dr. Xu examines your breast tissue.

This depends on the position of your breasts and nipples in relation to the breast crease known as the inframammary fold. If your breasts and nipples are lower than the crease, or appear sagging and low on your chest, you may need a breast lift for an optimal aesthetic outcome. Dr. Xu will take measurements and also examine you during a consultation and give you her assessment as well as recommendations on what to do.

Yes, typically breast augmentation requires general anesthesia because the implants are usually placed under the muscle which requires partially releasing / cutting the muscle which cannot be tolerated while awake. However, if the patient is having implants placed above the muscle, it may be possible to perform the surgery using local anesthesia and IV sedation.

You are not required to have someone with you after surgery, but especially due to the effects of having general anesthesia, it is recommended to have someone look after you and just be around in case you need help the first day after surgery.

Yes, you will need to wear a post-surgical compression bra, which helps reduce swelling and closes down the breast space to minimize bleeding as well. You should wear this for 2 weeks as much as you can, after which you can transition to a different form of supportive bra, but typically wear something like this for 4-6 weeks after surgery.

Recovery will depend on whether you have a partial muscle release for implant placement under the muscle. In most cases, that is the most uncomfortable part. Assuming that is the case, you will typically be sore in your chest and arms during the 1st week, but this should get substantially better by the 2nd week. You can start gentle exercise (walking /hiking) at 2 weeks, the moderate lower body exercise at 4 weeks, and then unrestricted activities at 6 weeks. During the 6 weeks, it is important not to do any type of bouncing activities (jogging, trampoline), to keep the breasts stable, as well as avoid heavy lifting, raising your arms high above your head, or heavy use of your arms.

This depends on the nature of your work and how strenuous it is. Most patients can return after 1 week for a desk job. For jobs that are more physically active, it depends on how much you use your upper body, so it may range from 4-6 weeks. Dr. Xu can also write you a note to return with modified duty.

Yes, most mammographers are familiar with how to obtain a mammogram in the presence of implants. There are special techniques and views that they can do to get a good study. Implants may make the process a little more uncomfortable, but in short, mammograms can and should still be done.

No. Dr. Xu uses internal sutures that are under the skin and dissolve naturally over time.

You should not. This is typically not a risk with breast augmentation, but in the rare case that an individual has unusual anatomy with nerve supply to the nipple in an area that requires dissection during the surgery, it might be possible to have some decrease or loss of nipple sensation.

Implant manufacturers will each have various recommendations regarding implant replacement, with some saying to replace your implants every 10 years. However, if your implants are fine and not bothering you at all, there is usually no reason to go back in and perform essentially an unnecessary surgery and subject your body to another round of surgical trauma, wound healing, and potential risk for infection and capsular contracture. If you are developing any signs of implant rupture or capsular contracture though, it would be recommended to have your implants removed and possibly replaced.

Implant rupture or deflation, malposition, capsular contracture (hardening, pain, deformity), rippling / wrinkling, dissatisfaction with size or shape.

Yes, there is always a scar any time you have surgery and an incision is made. Scars never disappear, but they often fade and become imperceptible with time. In addition, scar placement is often strategically designed in breast augmentation to lie in the breast crease, hidden from view in the natural shadow of the fold.

Implants can rupture when the outer shell of the implant breaks. If you have a saline implant, the saline inside will then leak into the breast pocket and get absorbed by your body; in that case, your breast would deflate and become smaller and you would thus know right away. If you have a silicone implant, you would not be able to know whether the implant has ruptured and it presents as a “silent rupture” that can only be detected with medical imaging such as a mammogram, ultrasound, or MRI. The silicone may leak outside of the shell and usually stays in the breast pocket but can migrate outside of the capsule. Newer generation implants also known as “gummy bear implants” are highly cohesive and stay in place even after they are cut, making migration and leakage much less likely. A ruptured implant may aggravate the process of capsular contracture, which can thus be a sign of possible rupture. If you have any signs of encapsulation, it’s best to see your plastic surgeon for evaluation and obtain imaging if needed to confirm the diagnosis.

• It is common for breasts to feel tight and swollen immediately after surgery. In the initial post op recovery period, it is important to follow activity restrictions and limit heavy use of your arms. If you strain or overuse your pectoral muscles, you may cause bleeding or create problems with the healing process and thus hurt your final results. 
• If your breasts feel tight several months or years after surgery, it could be a sign of encapsulation which should be evaluated by your plastic surgeon.