Okemos Michigan Plastic Surgeons Cosmetic Surgery Procedures

Breast Augmentation

FAQ's - Frequently Asked Questions about Breast Augmentation

(These answers apply to implant surgery at Trillium)

How soon can I go back to work after breast implantation?

At Trillium, if the procedure is uncomplicated, you should be able to return to most work and light activity after 2-3 days. Strenuous exercise should not begin for at least 7-10 days.

Will I have bandages after implant surgery?

One small bandage under each arm, no other incisions or dressings. A special support bra is placed in recovery.

Can I breast feed with implants?

Yes, assuming that it has been at least nine months since your implant surgery. The incidence of infection may be higher in women with implants who breast-feed, but this is debated. Nursing will not damage the implants in any way. The only difficulty may be if there is abnormal scarring after an areola/nipple incision.

Will my cleavage increase after implants?

Yes, but remember that cleavage is created by a bra or dress.

When can I have sex again after implant surgery?

This depends upon the surgeon and the surgery. At Trillium, we suggest that you wait one week, then carefully and gently for two more weeks.

Will my nipple or areola change after implant surgery?

Usually, yes. The nipple may either become more prominent, or flatten somewhat, depending upon your anatomy, the implant size, and implant position. The areolar area almost always enlarges, at least some.

Will I be bruised after surgery? For how long?

Most patents have some bruising, usually along the bottom of the breast. This may last for 7-10 days.

Will I need to wear a bra after implant surgery?

We recommend a supportive bra 24/7 for the first 2 weeks, then a supportive bra during the day at all times, and a jog bra for 3 months while sleeping.

With my implants, should I take antibiotics before any surgery?

Yes, for 6 months after surgery, you should take prophylactic antibiotics, even before dental work. Talk to us about this.

My breasts are smaller after my first child, and we plan to have at least one more child. When should I consider breast implants?

You may want to wait until you are through having children. If this is not acceptable, wait until at least six months after you are finished breast-feeding.

Can implant surgery change the shape of my breasts, or the "direction that they point?"

The shape will not usually change. If the breast point downwards, implants can sometimes provide some improvement. If they point outward, implants will not usually help.

If there is a strong history of breast cancer in my family, should I have breast implants?

No. Absolutely not.

I am a very active amateur athlete. I enjoy exercising, golf, tennis, running and other sports. Can I have breast implants?

Yes, but you should consider smaller implants, and avoid sub-pectoral (beneath the muscle) positioning.

Are there breast implants that can be enlarged or decreased after surgery?

Yes, they have a valve to allow filling and emptying in the weeks after surgery. Very few surgeons will use these, for a number of reasons. If you insist on them, choose your surgeon carefully. We will not use these at Trillium.

Is there any silicone in saline implants?

Yes, the shell is solid silicone.

My surgeon would like to perform breast "lift" surgery at the same time that my implants are placed. Does this work?

It can be effective, but carefully question your surgeon regarding his/her surgical plan. Do as much research as possible. The more incisions that are placed during implant surgery, particularly below the nipple, and on the inferior breast, the greater the chances of complications. I would be very wary of this type of "combined" surgery, particularly with a vertical or infra-mammary incision.

I have read that the only good implant shape is the "teardrop' or "natural" or "anatomic" shaped implant. Is this true?

Most breast surgeons do not agree, avoid these implants, and have had many problems with them. A well-known surgeon has highly touted these implants in his book (for which he has been roundly criticized) especially since he is a very highly paid spokesman for the company that makes this implant. This book is The Best Breast Book, by John B.Tebbetts, M.D. (I bought a copy in Barnes & Noble). He is extremely opinionated, and not often objective. Most surgeons strongly disagree with his statements regarding implant type, implant shape, and his bias toward the "plastic surgical guild" and its propaganda. Surgeons who place the implants in the sub-facial position also disagree with his statements regarding blunt vs. sharp dissection (since "sharp" dissection may actually cause more bleeding and scarring), and use blunt dissection routinely, with excellent results. Yet the book is informative, and has many true, valuable sections that may be helpful for those considering breast implantation.

Is there decreased nipple sensation after breast augmentation surgery?

10% of patients will have decreased nipple sensation (usually temporary) after implant surgery. Avoid incisions near the nipple.

My nipples are pierced. Can I have implants with them pierced?

You should remove the nipple piercing for at least 6 months following surgery. Many surgeons very strongly advise the avoidance of nipple piercing with implants. The rate of infection (which requires implant removal) is much, much higher with pierced nipples. The only exception might be if something is placed in your nipple to correct nipple inversion, after implantation.

Why does Dr. Sampson prefer the underarm incision and sub-fascia placement?

Aesthetically, he would like to avoid any scars or incisions of the breast, and cosmetically, this position gives some of the advantages of both sub-pectoral and sub-mammary placement. This placement also decreases some common complications of the other techniques. Also, this is the technique with which he feels most comfortable.

Can I see the results from Trillium's patients?

Yes, the photos on our web site are actual Trillium patients. You can also see many more before and after photos during your consultation with Dr. Sampson.

Will I have swelling and bruising of the breast after surgery?

Usually, yes, particularly bruising along the inferior breast. This may last 7-14 days. All swelling should be gone after 6-7 weeks. Until that time, your breasts may look 10-15% larger than they will eventually be.

Does breast implantation surgery increase the risk of breast cancer?

No. In fact, since the 1970s, the incidence of breast cancer in breast augmentation patients has been slightly lower than the average for those who do not have breast implants. At present, 1 in 8 women will contract breast cancer within their lifetimes.

I?m afraid that I won?t be able to choose the size implant that I want. Can you help me?

In general, choose the smallest implant volume that still gives you the visible enlargement that you want. Whenever possible, we will work with the volume which you have chosen. We want you to have your choice, but we also are obligated to counsel you regarding your choice. In some instances (for very good reasons) Dr. Erlich may suggest considering a different size. We can help you with this.

What if I require later surgery, for complications? How much will it cost?

Our prices include a 10 year implant warranty, sold to us by the implant manufacturer (Mentor), which provides a substantial allowance for future surgery, if it is needed. In this way, your expenses for future surgery (while not zero) may be substantially reduced.

Which complications sometimes require surgery and/or implant removal?

Both infection and hematoma require re-operation. With a hematoma, the same implant is replaced at the time of surgery. With an infection, the implant is removed, and a new implant is not placed for at least 6 months. Most complications do not require re-operation, and will improve with time.

Your literature emphasizes that implants smaller than 375 cc are strongly advised. What if I want larger implants?

Each patient and each situation are unique. If a woman truly wants larger implants, and understands and accepts that this exposes her to increased risks and complications (including more rapid sagging of her breasts, among other unwanted problems) this can be discussed, and considered, on an individual basis.

What if I would like another implant type, or another incision position, or another type of placement? Will Dr. Sampson consider doing this for me?

No. Not at this point in time.

Can't you inject some of my own fat into my breasts to enlarge them?

This can be, and is done, but only by a very few surgeons. Dr. Sampson can help you make an informed decsion about this procedure, nicknamed BAMBI. You can find information on the web regarding this procedure.

Do some breast implants leak? What happens when they do?

All implants leak a very tiny bit, with salt water crossing the silicone shell into the body. In 70% of implants, there is an equal flow of body fluid (mostly salt water) into the implants, so that the implant does not shrink. In 28% of implants, this leakage can cause shrinkage over the years, which may be noticeable. Implant rupture (occurring in 2% of implants overall) is different, when the silicone bag actually breaks, usually after trauma. The saline will not harm you, but the implant must be replaced.

Won't my body reject a foreign object like implants?

Your body builds a capsule around the implant, to hold it in place, and shield it from the rest of the body. This happens with every implant, for every patient. If that capsule becomes very thick or hard, the implants may feel very firm or hard. If the capsule contracts (or shrinks) you may have capsular contracture, causing distortion of the breast, usually requiring re-operation. Patients with some diseases may form very hard, tight capsules. They should not have breast implants.

How natural do breast implants look?

They rarely look entirely "natural," but "natural" varies with age. While a woman in her twenties will want breasts that appear "age appropriate," a woman in her forties may not be happy if her breasts appear "age appropriate" after implantation. The cosmetic result almost entirely depends upon the patient's anatomy and age, the surgeon's technical and aesthetic skills, and the implant type, size, and placement. These variables will create a more natural look if the implant size is moderate, and not overly large. We believe that by considering all of these variables when choosing the technique and implant that we use at Trillium, we are maximizing your chances of having an excellent cosmetic outcome.

How natural do breast implants feel?

Almost always, breast implants will make the breasts feel somewhat firmer. Remember that your natural breast tissue is over the implant. For many patients, some increased firmness is desirable. Many of the above criteria that determine how they look will also effect how they feel.

Are silicone implants softer then saline implants? Do they feel more "natural?"

The answer is no, not really. Not if the saline implants are properly chosen, placed, and filled to the appropriate volume. I know that it is breast surgical heresy to say that, but it is true. Unfortunately (for all of the women who would like to have a safe, soft, natural feeling implant) the answer that is always given is "Of course, everyone knows that silicone is softer." That depends on the surgeon, the implant, and the "fill" volume and percentage. Many surgeons continue to significantly (and often unnecessarily) overfill saline implants, because they were trained that way, and they believe that overfilling the implant will reduce rippling. It is the overfilling that makes saline implants harder than silicone. The newer, high profile saline implants have much less rippling, and do not require overfilling. An appropriately sized and filled saline implant can be every bit as soft as silicone. Given that, there is very little reason to rush into the use of silicone. Silicone can cause horrendous localized problems (forget systemic issues) when it leaks (and they all leak, silicone and saline), and re-operations are much, much more difficult than with saline.

Does the underarm incision affect the lymph nodes under the arm?

This incision should not interfere with breast lymph node drainage. The incision is high in the armpit, more superficial and anterior than the nodes. The dissection and placement of the implant are over the pectoral muscle and under the fascia, again, superficial to the nodes.

I have very thin skin on my chest wall, with no underlying fat. Can I have implants?

Maybe, if the placement of the implant is either sub-facial or sub-pectoral, and the implant size is limited to a reasonable volume. With this skin type, the breast/ implant complex will "fall" more rapidly over time. You should not have sub-mammary placement.

Should I insist that the facility where I have my surgery be accredited?

While we are very supportive of the concept of accreditation, it is not necessary to provide very safe surgery. Some of the least careful surgeons that we have known, with the worst results, the most complications, and the most frequent infections, worked in accredited surgical facilities. Some of the best, safest surgeons that we know work in facilities that are not accredited. Consider the following: Many of us have taken our children (our most precious possessions) to an oral surgeon to have their wisdom teeth removed. They have IV sedation (like we use for breast implantation), the oral surgeon works in their mouth (the most dangerous place for airway problems during surgery) and we patiently wait in the waiting room until they recover. The IV sedation is done without a nurse or medical doctor present, yet the surgery is extremely safe, the oral (dental) surgeons are excellent (with additional training in anesthesia), and problems are very rare. Have any of you reading this ever asked whether the oral surgeon's office was accredited? At Trillium, we have supplemental oxygen, a "crash cart," pulse oximetry with electrocardiogram, a defibrillator, a surgeon who is a medical doctor, a certified registered nurse anesthetist, a second registered nurse, we are not working in the mouth, and we do not put a tube in the throat. We also require blood testing before IV sedation. Trillium is not presently accredited. We have begun to work toward that goal.