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Breast Implants 101: Most FAQs

Breast Augmentation 101: Dr Fearmonti Answers Your Frequently Asked Questions  As a board-certified plastic surgeon, I find that patients have many questions regarding breast augmentation. In the age of social media flooding our feeds with pre- and post-operative results, it is often hard to delineate what is real from what is a gimmick. Here, I’d like to answer the top 5 most frequently asked questions about breast implant surgery.  Q: What size implant is right for me, and what cup size will I be after surgery? A:  Your resultant breast size is a factor of the amount of breast tissue you are starting with plus the implant size selected.  Implants have different widths, heights, and projections (how much they stand off of the chest wall).  Implants come in low, moderate, full, and extra-full profiles.  At your initial visit I measure your chest wall and allow you to try on implant sizers.  Don’t get caught up on the number of cc’s in the implant; large implants on a wide chest wall look smaller, and small implants on a narrow chest wall look larger. It really is all relative.  I then ask patients to compile a “wish list” of representative photographs of desired final results.  This helps us get on the same page and opens the discussion as to what is realistic. With regard to cup size, that varies depending on where you buy your bras and where you live, as almost every country has their own measurement system. A 2004 study by Consumer Reports found that 80% of department store bra fittings resulted in a poor fit, which translates into 80% of patients not wearing the correct bra cup size. Cup size is thus the least helpful criteria in guiding a surgical result.  Q: Saline versus silicone implants—what’s the difference, and what are “Gummy Bear” implants? A:  All implants have silicone shells or casings. Saline implants arrive from the manufacturer deflated and are filled inside of you with saline (similar to IV fluid) to an approved volume range. Silicone implants arrive from the manufacturer already filled with viscous silicone; they have a fixed size.  In the United States you have to be 18 years years of age or older to have saline implants placed, whereas you have to be 22 years or older to have silicone implants placed for a breast augmentation. Silicone implants come with a 10-year warranty; saline implants require the purchase of a separate warranty to cover leaks, rupture, and replacement.  Implants do not degrade after time. Manufacturers of implants have stated that implants last, on average, 10-15 years. They determined this after studying the average length of time women keep their implants - this includes women who get size changes or exchanges after childbearing, etc. This does not mean that, after 10-15 years, you must get them replaced. If you are happy with your implants and are not experiencing any problems, you could theoretically keep your implants for a much longer period of time.  Patients describe less implant visibility and rippling (implant folds) with silicone implants and comment that they may feel more like their own breast tissue. “Gummy” implants are the most cohesive silicone implants on the market; this describes the fact that if cut in half, they maintain their shape and if ruptured the silicone filling does not leak out as a liquid.     Q:  Are breast implants safe, and do they increase my risk of developing breast cancer?  A:  Yes, implants are safe. Breast implants are one of the most studied medical devices in history.  Decades of data demonstrate that they do not cause autoimmune diseases or breast cancer.  A recent poll of female plastic surgeons through the American Society of Aesthetic Plastic Surgeons revealed that 100% of them would recommend breast implants to their friends, mothers, or daughters.  Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has been studied by the FDA since 2011.  It is a type of T cell lymphoma (cancer of the immune system) that has been found in the scar tissue and fluid near an implant. Precise risks are difficult to determine due an incidence of less than .003 % worldwide—it’s very rare.  Most data suggest that BIA-ALCL occurs more with textured implants rather than smooth implants.  Textured implants are still FDA approved and used across the world; removal is not recommended. I have not placed textured implants since 2013 to lower that incidence even further. (source:    Q: What is a “No-Touch” technique? A: Some of the risks of any surgery include infection, bleeding, and capsular contracture (scar tissue forming around an implant).  I use a no-touch technique of implant placement that prevents your implant from coming into contact with your skin and minimizes any exposure your implant has once opened. The implant is transferred from its package into a sterile plastic pouch that allows it to be squeezed into the proper position on your chest wall. This has been shown to decrease both capsular contracture and infection rates.  We also teach you implant massage techniques that help to keep your capsule soft after surgery.   Q: What is a “Rapid Recovery” breast augmentation? A:  Recovery is unique to every patient, so that term is a bit misleading.  I encourage walking immediately after surgery but ask that you refrain from any strenuous activity or heavy lifting for 2-3 weeks. This allows your incisions to fully heal and avoids friction on the surgical site, which may result in a better scar. With close follow up, I release you to do more activity every week. Recovery is hastened with good pain control, and by avoiding narcotics and benzodiazepines, I find that patients have a quicker recovery. We use intranasal Toradol and I perform a nerve block at the time of surgery to get you back to feeling like yourself sooner.
Saline, Silicone, and Safety--Know the facts

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