FAQ

Yes, you can have more than one surgery done at a time. Ideally they should total less than 5 hours of surgical time.

Yes, the surgeon see you in the holding area or pre-operative area. You will be marked for surgery, operative plan reviewed and final questions will be answered. You will be given a little bit of medications to make you just a bit drowsy and to relax you, but you will be awake. You will actually help us position you in the operating room.  You will be attached to several monitors to follow you while you drift off to sleep.  You will then be given some more medication in your IV and will fall asleep.

Typically it is recommended to not wear a bra for the first few weeks. After the breast implants start to settle, a bra may be worn for comfort. If a woman has very thin tissues, a bra is recommended to prevent the implants from stretching the skin too much.

There is no way to determine what will happen to the breasts during pregnancy. Previous pregnancies may prove to be some guide but some women will have different experiences with each pregnancy. Breast implants do not influence the breast glands response to hormones. So the glands will respond as they would normally do. The breast skin will typically contract down again afterwards, but it may or may not be able to return to the previous shape.

It is extremely unlikely to rupture a breast implant with a blunt trauma to the chest. The force required would have severe consequences to other areas of the body. If such a force was applied to that area there would be more significant injury concerns than the ruptured breast implants.

These types of products may be started usually about 4-5 days after the sutures have been removed. During the initial few days it is best to allow the wounds edges to heal completely prior to starting to apply scar improving treatments. A more detailed answer regarding scar management is listed in the faq about scar management.

Yes, veins may look larger in some women after breast augmentation.  This tends to occur in the women who have a history of veins showing with a pregnancy or breast feeding. It may also be more apparent on women with fair skin. There is no treatment necessary for the veins.

The areola may widen slightly in some cases when larger breast implants have been placed. The widening with breast implants occurs because their tissues are thin. This consequence does not need to be treated.

Any time a woman requests that her breast implants be removed, it can be done.  The individual characteristics, genetics and breast implant history, will be the primary indicators of the result. A breast lift may be necessary to reposition the breast gland and remove excess skin in some cases. Please visit the page about breast implant removal for more information.

Depending on what the problem may be, it is usually best to wait at least 3-6 months for a solid scar tissue layer to form. In some cases, this tissue layer can be used to correct or adjust the result.  Waiting too long for some revisions is not good because the breast skin may stretch too much and this will cause nipple areolar drift to a sub optimal position. If a woman just wants to be larger, the plastic surgeon may elect to go to surgery even sooner. It depends on the woman’s concerns and her anatomy and implant desires.

It is better to stop smoking before any surgery, but it is not required for most surgeries. It is the best thing to do though. If you are going to stop, it is best to stop at least 3 weeks before the surgery.  If you stop or cut back there will be less coughing and experience less discomfort. Wound healing has also been shown to be compromised in people who are actively smoking during the healing process. Smoking causes blood vessel constriction and this leads to less blood flow, delayed wound healing, and increase chances of an infection.

Yes, stretch marks can occur after breast augmentation. It depends on the size of the breast implants and the quality of the breast skin. It is more common that women with previous stretch marks may notice that the marks get red again after surgery. Stretch marks over time typically become less red and fade into the natural color of the woman’s skin.

There is no rejection of breast implants. An infection may result in requiring the removal of the implants, but this is not a rejection. Scar tissue around the breast implant is not a sign of rejection.  Rejection means that the body has created specific cells designed to destroy something. This is not the case with breast implants.

Non exertional sex without elevations in blood pressure may be entertained when a person decides that they are interested. As with other forms of exercise and elevations in blood pressure, it is best to not experience elevated blood pressure for 10-14 days. As an important side note, antibiotics taken after the surgery may make birth control pills ineffective. So it is best to use other sources of birth control during the first month after antibiotics

No, there is no known link or association of breast implants and the formation of breast cancer. There are actually studies which have looked into this subject and have found that the women with breast implants have a slightly lower risk of developing breast cancer.

A healing wound heals best when it does not move. Movement causes pulling or tension across the wound. Tension is perhaps the worst thing for a healing wound. Keeping tape or a steri-strip or silicone sheeting will help the best during the initial healing phase.

After the initial phase, some will use an ointment, vitamin E, etc to improve the scar. If the ointment or cream can penetrate the skin, then it may be of some limited benefit. Keeping  tape over the incision for a month really works the best. Unfortunately, most women prefer to remove the tape for comfort. Then apply the ointments, etc. If the scar starts to thicken or change color, please contact the office. In these rare events, medicated tapes and/or injections into the scar may improve the final outcome.

Flying or scuba diving with breast implants is not a problem. These activities may be done whenever desired. Have fun!

Sleeping on the belly or tummy may be started as soon as tolerated. It will not hurt the result. Most will recover sleeping on their backs, then their sides and eventually make it to the tummy. Again, there are no physical limitations and it may be attempted as tolerated. Most will be able to sleep on their tummy by the third or fourth week after breast augmentation.

Breast biopsies can be performed by a surgery or a radiologist via needle aspiration.  Subglandular implants are above the muscle so they are more at risk during a biopsy. Submuscular implants are below the muscle and have an extra layer of tissue to protect them and makes puncturing the implant less likely. If the implant damaged, it is not a problem and can be replaced after the cancer risk has been determined.

There are temporary and permanent sensory changes that a woman may experience after breast augmentation.  These changes can occur on the skin of the breast and or involve the nipple areolar skin. The most common nerve injuries are temporary. These may only last a few days but may last weeks to a few months. Some women will note that they have decreased sensation in certain areas of their breast skin or nipple.  These improve and then resolve. Some may note a dulled sensory change that as it heals becomes sensitive to the touch (hypersensitive) and also resolves with time. These hypersensitive changes usually last a few weeks. Rarely, some women may experience a very sharp, severe pain that limits their activities. This type of pain is short lived and typically goes away within a week or two. Permanent sensory changes still exist after a year.

This is a personal decision. Working from home can usually begin two days after surgery.  Returning to an office may require 5 days.  If the job requires using the arms a fair amount, i.e. nurse, police, construction, flight attendant, it may be better to take off more time. The time away from the office is usually directly proportional to the activities that the job requires. Some office based careers allow for the to return to work as soon as three days. We typically recommend surgery later in the week, recover over the weekend, then return to work on Tuesday or Wednesday. More strenuous careers need about two weeks for 80% return of strength.

Yes.  The operating room equipment and  surgical gloves must be latex free and this can be done. The hospital or surgery center will prepare all of the surgical supplies using non-latex materials. The surgeon and surgery personnel all wear non-latex gloves. This is not a problem at all.

Breast implant shells are made of the chemical polymer silicon. They do not have any latex in their construction. The equipment in the operating room, anesthesia supplies and  surgical gloves must be latex free and this can be done. The most important thing about allergies is to make everyone knows about them, including latex. The hospital or surgery center will prepare all of the surgical supplies using non-latex materials. The surgeon and surgery personnel all wear non-latex gloves.

It is best to not have to be responsible for small children for at least 2-5 days after breast augmentation. Picking up an infant will not hurt the result but may cause an increase in the pain when the chest muscles contract. Smaller children (less than 15 pounds) can be picked up a bit easier than a 30-40 pound child. It is important to check the range of motion and degree of tenderness that exists prior to trying to lift any child. Placing an infant into a car seat is usually tender for about two weeks, depending on the size of the child. So, other than the first few days, it will be patient dependent on their activity level. Having help for car seats, strollers, high chairs, cribs is recommended at least for a week.

It is best and recommended to avoid getting your heart rate or blood pressure up too high after plastic surgery to avoid complications. A bleeding complication may occur at late as 14 days to 3 weeks after plastic surgery. So it is the center’s policy to recommend avoidance of strenuous exercise for this period of time. Having said that, there are many patients who resume aerobic exercise as early as a few days after the cosmetic surgery. Again, it is not recommended. As far as weight lifting, the same 14 day to 3 week time limitation applies. After that, you may do any exercises that you chose.

As long as the surgical incision area is covered and protected from the sun’s rays or the tanning bed’s energy, you may resume tanning. It at your leisure when you feel up to it.  It is best to not intensely tan two weeks BEFORE your surgery. The dead skin can flake off during the surgery and may contaminate the breast implants. If this occurs during the surgery, there is an increased chance of infection.

Under the muscle breast implants do not influence the breast feeding. Above the muscle implants may possibly effect breast feeding but unlikely.   Breast implants do not influence the breast glands response to the hormones associated with breast feeding. The breast implants are placed under the gland or the chest muscle, so they do not interact with the breasts ability to make milk. It is best to avoid trauma to the breast gland during the surgery, this is achieved by not tunneling through the breast. The inframammary approach allows this to be accomplished most effectively.

Mammograms are recommended for all women over 40. Breast implants do not prevent mammograms, and having them under the muscle is a bit easier. Over the muscles implants may require more views.  It is recommended to ask the mammogram technician if they have experience in performing mammograms on women with breast implants. Occasionally an additional view(s) may be needed to completely assess the breast for anything suspicious. Saline and silicone gel breast implants will tolerate the compression of the mammogram. The density of the filler of the implants typically does not pose a problem for the radiologist’s interpretation. In women with longstanding capsular contracture, there can be calcium in the scar tissue. This makes mammogram interpretation more complicated.

Breast implant settling after augmentation can take a variable amount of time.  It will depend on the size of the breast implants, the woman’s body, and the plastic surgeon’s technique.  Larger breast implants will take longer to settle. Women with lose breast tissue,  will have their implants settle quicker than those with dense tissues. Saline breast implants will settle at different rates than silicone gel breast implants.  Saline implants will drop quicker. It is safe to say that most implants will settle by 3-6 months, some as early as one month.

Anesthesia medications are placed in the tissue and throughout the body using different medications. When the meds are administered through the the vein (intravenous or IV), it is believed that this is IV sedation and not a general anesthesia. IV only refers to the route of delivery of a medication. It has nothing to do with the level of anesthesia. Breathing gases is another route to administer medication and achieve sedation. Inhalational delivery of medications are delivered into the body using specialized airway or breathing tube.

A level of sedation is classified by how the body responds/or fails to respond to a stimuli. There is light sedation and deep sedation, the later category is referred to as general anesthesia. It does not imply a breathing tube but rather a level of unconsciousness. General anesthesia can be achieved using IV or inhalation access.  It is a misconception that IV anesthesia is less anesthesia than inhalation anesthesia.

Another misconception is that if you have general anesthesia and you will be paralyzed.  Being paralyzed has nothing to do with levels of anesthesia. Again, you do not need to be paralyzed to have general anesthesia. The important thing is that you will be asleep and will not feel anything. If you were to lighten and start to wake during the surgery, you would be able to move and this would signal to the anesthesiologist that you require more medicine. This is extremely rare, and you would not remember it even if it was to occur. Technically speaking, plastic surgery is performed under general anesthesia without a breathing tube and without being paralyzed. The anesthesia is administered both using IV and inhalational medications.

It is best to drive after breast augmentation only after good range of motion without tenderness has returned. It is safest to be sure that turning the steering wheel quickly does not cause any pain. Flinching while trying to turn the steering wheel could have life endangering consequences. Technically speaking, it is safest to wait two weeks. However, most women are driving within the first week.

You will be asked to provide your medical history. We will discuss your concerns, your reasons for  the cosmetic plastic procedure(s) and your expectations. After an examination, the discussion will center on the success of accomplishing what you desire and the details involved. After our discussion, you will probably require time to decide whether or not you would like the cosmetic surgery.

If you would like to think about our discussion or discuss it with your family before making a final decision, it is encouraged for you to do so. However, it is important that you are the one who makes the final decision, not anyone else. A second office visit may be scheduled if necessary. Preoperative photographs will be made so that your problem can be studied more thoroughly and will be taken and used for reference during the cosmetic surgery, if you decide to proceed. You should wear clothing to the consultation that is easily removed to expose the area to be examined. Also, please keep makeup to a minimum if your plastic surgery consult concerns your face.

As a general rule, insurance will not pay for operations that are cosmetic. Occasionally, insurance will pay for part of a cosmetic surgery if it improves function by relieving symptoms such as restricted vision, impaired breathing, back and shoulder ache due to heavy breasts, separation of the abdominal muscles resulting from multiple pregnancies, etc. If it does pay for part of the procedure, insurance usually will pay the related hospital and anesthesia costs. The center will be glad to assist you filing any insurance claims for you, however, we cannot fill out claims stating the surgery was performed to improve function if it was not. We will send all supporting information possible, but we are not responsible for the final decision of your insurance company. It is best to have an answer from them before you elect to have cosmetic surgery.

The fees for the different cosmetic plastic surgeries vary with each operation and the complexity of the problem. There is typically a fee to use the surgery center, anesthesia fee, plastic surgeon fee and perhaps implants or garments. Since cosmetic surgery is strictly elective, the fees are payable in advance. There are prescriptions for antibiotics and pain control. These are typically covered by insurance.

Every cosmetic surgery or procedure, no matter how simple, entails some degree of risk and the possibility of complications. These risks should not be taken lightly. Fortunately complications seldom occur and are usually amenable to treatment. You will be provided with an informed consent for the specific procedure(s) you will having. This document should be read and fully understood before signing. You should be aware of the risks and make an educated decision for any cosmetic surgery

All surgical incisions and wounds of human tissue heal by forming a scar that is permanent and cannot be erased. However, care is taken to try to make the scars as thin-lined and inconspicuous as possible. To accomplish this, they are placed in areas where they can be more easily camouflaged. While such scars are permanent, these are rarely noticeable or cause trouble. The experience of the cosmetic plastic surgeon is a valuable tool that aides in improving the outcome and result.

Most surgeries including cosmetic operations result in some degree of swelling and bruising. Some areas are more prone to swelling because of their anatomy. The amount of swelling varies with the different procedures and the individual patient. Preoperative medications and certain operative techniques are used to keep bruising to a minimum. The majority of swelling that does occur usually subsides within a few days, and any temporary bruising that remains may be covered up with makeup, if necessary.

Regardless of the type of anesthesia used during the cosmetic surgery,  there is no significant discomfort. Will there be pain? Yes, because the initial IV may hurt or the injections to numb an area. After the numbing or anesthesia has taken effect, there should be no pain.  If there is, it is easily remedied with additional medication.  After the surgery in the initial period the involved areas may be numb for nearly 12 hours. Then the area will become sore or be painful which can be remedied using oral pain medications. While discomfort and limitations of activity after plastic surgery are minimal, they do exist. Please remember that the healing process is temporary and the benefits typically long lasting.

The degree of success of an operation depends on the skill of the cosmetic plastic surgeon and the cooperation of the patient, but also on a variety of factors. Such as the characteristics of the specific problem, the person’s general health, age, skin, texture, bone structure and genetics. The healing process is influenced by these factors and is not entirely under the control of the patient or the plastic surgeon. While good results should be anticipated in properly selected cases, it would be unethical for the plastic surgeon to imply any type of warranty or guarantee. It is best to not think about perfection or guarantees, but rather good outcomes.

People who are seeking an improvement in their appearance is only part of the answer.  People with realistic in their expectations as to what cosmetic plastic surgery can accomplish are the best candidates. At certain ages and health conditions, medical clearance may be required. A person who is seeking absolute perfection or expects a transforming miracle from cosmetic plastic surgery is not a good candidate. While cosmetic surgery is often psychologically beneficial in increasing one’s self-confidence and esteem, it is not the solution for all of one’s problems. If a person is expecting more from cosmetic surgery than can be accomplished physically, psychologically or socially, I will recommend they not have cosmetic plastic surgery until they have worked out their other concerns.