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Breast Augmentation - Questions & Answers?

Will Breast Implants Affect My Ability to Have Mammograms, Detect Breast Cancer, or Have Breast Biopsy?

Women with breast implants can have mammograms. You should notify the Mammography technician that you have implants so that a special technique, the "Eklud's Displacement Technique", could be used for your mammogram. However, Breast implants can obscure approximately a 10% area of the outer breast in those who have very small breasts and have their implants in the sub-glandular pocket.

Breast implants do not hinder a woman's ability to perform breast self examination, nor does it impede palpation and detection of breast masses through breast examination. If you are going to have a breast biopsy, the placement of an implant under the muscle (sub-muscular placement) reduces the chance of potentially damaging your implant.
Do Breast Implants Interfere with Sentinel Lymph Node Mapping Procedures?
Breast augmentation procedures (peri-areolar or Trans-mammary) that involve cutting through breast tissue, similar to a breast biopsy in order to place breast implants, can potentially interfere with diagnostic procedures to determine lymph node drainage of breast tissue to stage breast cancer. This procedure is only performed on those who have a biopsy-proven breast cancer and need to have further determination of their cancer progress. If this is a concern, individuals considering Breast Augmentation by these approaches may elect to consider another surgical approach such as the Inframammary approach.

Should I Avoid Implants if I'm an Avid Bodybuilder or Exercise Heavily?
One of the inevitable side effects of working out and body building is the replacement over time of breast tissue with more lean body mass. While this is great for your overall fitness, you may not like the impact on the size of your breasts. If this is the case, Breast Augmentation could help you to regain your curves. If the patient is very lean, however, the surgeon will probably want to place the implant under the chest muscle. For resuming your exercise routine, it’s good to know that implants are designed to withstand a lot of impact. Kick boxers, police officers, and wrestlers enjoy implants without any deflation or other bad side effects.

Another consideration for fitness enthusiasts is that an armpit incision may leave a more visible scar for those who like to wear sleeveless clothing.
As far as resuming your exercise routine, most women can do light cardio within a week. However protect the outcome of your Breast Augmentation by avoiding strenuous lifting and workout for several weeks. It will be worth the wait.
Can You Breast-Feed After Having Had Breast Implants?
Many women who have had breast implants have successfully breast fed their babies. Some surgeons believe that peri-areolar approach can increase the chance of injury to milk ducts. In my personal experience, I have found peri-areolar approach not to be any different than other approaches with regards to the patient’s ability to breast feed.

Breast milk does not contain silicone in women who have silicone implants.

Should I Delay Breast Augmentation Until I Have Had All of My Children?

Not necessarily! Breast implants neither hinder your ability to have children, nor affect breast feeding. Furthermore, breast implants which are placed under the muscle (submuscular) do not increase the chance of breast sagging with pregnancy. If a woman develops sagging as a result of pregnancy, a Breast Lift procedure, called Mastopexy, can be performed.

Therefore, there is no reason for a woman to put off enjoying the benefits of a Breast Augmentation until after having her children. In fact, according to the American Society of Plastic Surgeons 2005 Statistics (www.plasticsurgery.org) 49% of women who get breast implants are 19-34 years old, and 42% are 42-50 years old.

Of course, if a woman is actively attempting to get pregnant, and it is a priority, it would make sense to wait until after the baby is born and she has stopped nursing.

Will I get Stretch Marks When I Have my Breast Augmentation? Can I Prevent Them?
It is literally impossible to determine whether you will get stretch marks after your Breast Augmentation.

Many doctors believe that your skin elasticity is a large factor. However, you can always take preventative measures. Many women have moisturized heavily prior to their surgery by using Palmer's Cocoa Butter, Shea's Butter Lotion, and Vitamin E. It certainly will not hurt to try it.

If you have pre-existing stretch marks due to pregnancy, breast-feeding, etc., the implants will most likely help to "fill them out", thus making them less noticeable. If this is not the case for you, or, you get stretch-marks after your surgery, you can try using Mederma. It has helped diminish the appearance of stretch marks in many women, while others have noticed little to no difference at all. Results vary.
Laser treatments have not been scientifically proven to remove or diminish stretch marks. However, it is rare to get stretch marks from breast implants, unless they are extremely large.

Do Breast Implants Last a Lifetime?
Anything is possible, but in general, the answer to this question is no. In fact, breast implant manufacturers, such as Mentor and Inamed (Allegan) state that implants are not considered lifetime devices. There is a reasonable chance of having at least one more breast surgery in your lifetime. However, there are women who have had implants for 20 or more years, and have never had a problem. According to the Institute of Medicine, the average life expectancy of a breast implant is 16 years.

What Do Implants Feel Like Once They're Inside the Body?
Many women equate the feel of their breasts implants to that of a teenage girl with young, healthy, firm breasts. Saline breast implants feel a bit firmer (both inside and outside the body), while silicone gel breast implants have a softer, and more natural feel. On the other hand, silicone implants are heavier.
Do Breast Implants Expire, or Have an Expiration Date?
No, implants do not have an expiration date.

Do Implants Make Noises Like Sloshing, Squeaking, etc.?
These noises are common during the first few days after surgery. Air in the pocket causes these types of noises, but they will dissipate anywhere from a few days to a few weeks post-op. Sloshing may also be the result of an under-filled implant. For example, if you have a Mentor 300cc implant, Mentor recommends that the implant be filled to at least 300cc, and no more than 325cc. If the implant is filled to, say, 275cc, you may get a sloshing effect. Thankfully, the vast majority of doctors fill the implant to the minimum manufacturer recommendation, at the very least. Overfilling the implant seems more common than is under-filling them.

"Why is One of My Implants Rock Hard?"
You have developed Capsular Contracture. Scar tissue, which forms internally around the breast implant, can tighten and make the breast round, firm, and possibly painful. Excessive firmness of the breasts can occur soon after surgery or years later. The occurrence of symptomatic Capsular Contracture is not predictable. The incidence of symptomatic capsular contracture can be expected to increase over time. Capsular Contracture may occur on one side, both sides or not at all. There are four grades of capsular contracture - Baker grades I through IV.
The Baker grading is as follows:

Grade I

The breast is normally soft and looks natural.

Grade II

The breast is a little firm but looks normal.

Grade III

The breast is firm and looks abnormal.

Grade IV

The breast is hard, painful, and looks abnormal.

Capsular Contracture may be more common following infection, hematoma, and seroma. However, it is not known for sure why Capsular Contracture happens. The literature also discusses other factors, such as a textured implant surface and submuscular placement of the implant, which may decrease the Capsular Contracture rate. In severe or symptomatic cases, such as grade III or IV, there are different treatment options ranging from cutting or removing the implant capsule tissue (Capsulotomy vs. Capsulectomy) with or without replacement of the implant itself. Capsular Contracture may happen again after this additional procedure.

What is Capsulectomy, Closed and Open Capsulotomy?
When a woman develops painful and deforming Capsular Contracture (grade III & IV), there are several treatment options available to them. Previously, surgeons manually squeezed the contracted breast in order to break the implant shell. This technique is called Closed Capsulotomy. Besides being very painful, this maneuver could also damage or even rupture of the implant itself. Because of this, closed Capsulotomy is no longer recommended by implant manufacturers or the medical experts.

Today, the technique of Capsulectomy or Open Capsulotomy, is performed. This is a surgical procedure where several incisions are made in the capsule in order to release the contracture-Open Capsulotomy; or the entire capsule is removed-Capsulectomy. At this time, if the implant is smooth, it is changed with a textured implant which carries a lower incidence of Capsular Contracture.

Will Capsular Contracture Cause The Implant's Shell to Weaken, or Rupture?
There seem to be varying opinions on this. Some say no, because there are equal amounts of force being exerted on the implant. However, according to Mentor and Inamed (Allergan), it is possible for very severe cases of Capsular Contracture to rupture the implant. Thankfully, this does not seem to be a common problem.

What Are the Symptoms of a Ruptured Silicone Implant?
Some women may notice a decreased size and/or shape in their breast, pain and/or tenderness in the breast, numbness, tingling, burning, swelling, or hard knots (also known as nodules). Sometimes, silicone implants can silently rupture, meaning that the patient has no idea that she has experienced a rupture. An MRI (Magnetic Resonance Imaging) with equipment specifically designed for imaging the breast may be utilized for evaluating patients who have a "suspected" rupture or leakage of a silicone gel breast implant.

Can I Have My Nipples Pierced After Breast Augmentation?
Women with breast implants seeking to undergo body piercing procedures to the breast region must consider the possibility that an infection could develop anytime following this procedure. Should an infection occur, it is possible that it could spread to the breast implant space. Treatment including antibiotics, possible removal of the implant, or additional surgery may be necessary. Infections with the presence of a breast implant are harder to treat than infections in normal body tissues. If an infection does not respond to antibiotics, the breast implant may have to be removed. Individuals who currently wear body-piercing jewelry in the breast region are advised that a breast infection could also develop.

What Happens to Your Breasts if you Decide to Have Your Implants Removed at a Later Time?
Breast implants permanently change the shape and form of your breasts. Therefore, before having your implants removed you must consider how to deal with these permanent changes. For example breast implants do stretch and thin out the breast tissue and the chest muscles. Once implants are removed, you will have excess, loose breast skin which will require a Breast Lift. You must also be mentally prepared to deal with a dramatic reduction in your breast volume which can affect the proportions of your figure and how you fit in your clothes.

During your consultation Dr. Younai will try to answer all your questions and will review your treatment options for Breast Augmentation, including pros and cons of each techniques, potential risks and complications, recovery course, pre and post operative instructions, and esthetic outcomes. You will also have an opportunity to "try on" different types of saline or silicone breast implants. There are also many before-and-after pictures and high resolution images of breast augmentation available in our photo gallery.

Dr. Younai is a board certified plastic surgeon who receives patients at the California Center for Plastic Surgery from the Northern as well as the Southern California region. Some of these cities include Beverly Hills, Los Angeles, Santa Monica, Hollywood, Burbank, Sherman Oaks, Encino, Calabasas, Woodland Hills, Thousand Oaks, Westlake Village, Pasadena, Glendale, Valencia, Palmdale, Fresno, and Oxnard.

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Dr. Sean Younai
is a Board Certified Cosmetic Plastic Surgeon, who practices in Encino, Los Angeles, Southern California.
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