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(314) 251-6250
969 North Mason Road
Suite 170
St. Louis, MO 63141
        American society of plastic surgeonsamerican society of aesthetic plastic surgeons


What makes someone a good candidate for breast augmentation?

The best candidates are women who never developed to the size they desired in the first place, and women who at one time had more breast tissue, but then lost size through weight loss or pregnancy. Most women seek an increase that is just enough to better fit into available clothing styles.

What makes someone a bad candidate for breast augmentation?

The woman who wants it for someone else's sake only. Who is ambivalent about whether she should get implants or not or who has multiple medical problems or issues.

Are breast implants safe?

Breast augmentation is a surgical procedure, and as such there are risks, just as with anything else in life. The decision to have elective surgery must rest on the balance between how strongly you want the benefits versus how worried are you about the risks.
The best advice when considering breast augmentation is to:

  • Read everything (both good and bad) that you can find;
  • Make certain your surgeon is certified by The American Board of Plastic Surgery;
  • Be sure you and your surgeon are communicating well and clearly;
  • Be sure your surgeon is the one who will be doing the surgery;
  • Be certain you are hearing about all the options;
  • Be sure you can follow all instructions completely. Then make your decision with a clear mind!

Can I still breast feed after I get an augmentation?

Yes. That is, if you would have been able to breast-feed even without implants. There is no known risk to the infant, no matter what kind of implant the woman has. There is no evidence that silicone from an implant enters the breast milk in any significant amount; in fact, the tap water that is used to make a bottle-feeding formula contains man-made silicone, which is absorbed, ending up in the infant's immune system. There is more silicone in cow's milk and in Infant Feeding Formula than in the milk from a nursing mother with breast implants. Additionally, many medicines given to colicky babies contain silicone, which goes into the baby's immune system, with no known harmful effects.

If I have a medical disease can I still get an augmentation?

Yes, you simply need your family doctors' clearance.

Will I lose feeling or sensation if I get an augmentation?

Most women do not lose the sense of touch of the nipples, however there is a very small chance it could happen. About 50% of women notice a change in sensitivity (either increased or decreased), which may require two years to return to normal. The primary factors that influence the chance of sensitivity loss are 1) the larger the implant, the more likely is loss of sensitivity, and 2) the location of the incision. Studies show that normal incisions result in a 3.0% chance of nipple sensitivity loss, and that navel incisions result in a 0.8% chance of nipple sensitivity loss. Therefore, there is only a very small chance of losing the sense of touch in the nipples.

Do implants sag or deflate after so long?

All breasts relax as time passes, because the weight stretches the skin, elasticity is lost with age, and the amount of breast tissue often decreases with age. These factors mean that breasts can be expected to relax and sag whether or not there are implants. Implants do add weight to the breasts, which may increase the rate of relaxation, and yet the implants and surrounding scar tissue can provide some internal support for the breasts; that is, the presence of the implant actually causes some degree of breast lifting. The overall result is usually that the breasts relax less rapidly than they would have if they had grown to that same size on their own, and yet somewhat faster than if they were left their original smaller size.

It is true after 10 years you have to get a revision surgery?

No, implants do not have to be changed every ten years. Some women will leave them as-is until a leak occurs, no matter when, and then get new implants. Implant replacement surgery must occur within approximately two weeks of when the leak occurs. Other women prefer to be pro-active, and as soon as the manufacturer’s 10-year warranty runs out, they arrange to come in voluntarily at their own expense to get new implants and start a new warranty. If an implants has leaked, most women prefer to replace both implants. The manufacturer's lifetime warranty applies only if an implant leaks.

What happens during a revision surgery?

Revision surgery is far less complex than the initial surgery. The major part of the original enlargement operation is the formation of a pocket for the implant where there was no pocket before. If a revision is required, the pocket is already there, and all that is needed is to slip the old implant out of the pocket, and slide the new one in. Usually the same incision site is used, including through the navel. Replacing a saline implant that has deflated is usually a very simple procedure for the patient to undergo, but replacing a silicone implant is usually a more involved procedure.

Does the implant have any warranty?

The implant manufacturers have such confidence in their implants that they have a lifetime replacement plan for them, providing a new implant without charge if an implant leaks. In addition, if such a deflation should occur within the first ten years, the implant manufacturer will even help with the costs of the replacement surgery itself. Moreover, an extended warranty is available which will assist with the costs of replacing the other side as well.

Does the implant have a tracking system?

Yes, the vender/supplier provides tracking numbers on the implants and also by patients' social security number.

Can bacteria get inside the implant?

Not once it has been implanted. Bacteria are too large to pass through the implant's sub-microscopic pores by osmosis once it is inside of a person. Any presence of bacteria would have had to occur during the operation, and only if sterile precautions and techniques had failed (an extremely rare occurrence in modern surgery). Additionally, because the salt water is actually sterile intravenous saline, it contains no nutrients that bacteria could live on. Dr. Hart implements a technique that makes contamination of the implant contents extremely unlikely. An entirely closed, sealed system is used to transfer the sterile salt water from its original container directly into the implant, without exposure to the air where bacteria could be present.

After breast augmentations can I still have mammograms?

Yes. A woman with implants should follow the same breast-care guidelines as a woman without implants. That is, self-examination each month, and mammograms at the standard intervals, at age 35 then every year from 40 on. If you have implants, the mammograms must be done in a special way in order to see the breast tissue effectively, so you must inform the technician that you have implants. Furthermore, there is no evidence that implants are preventing cancers from being detected. Breast implants do not cause breast cancer, nor delay its diagnosis.

Do I need to stop taking my medications prior to the surgery?

Breast augmentation is a safe procedure for healthy individuals, though prescription medications are not a problem, all should be reviewed with your surgeon well before an augmentation procedure. Bleeding is a concern, and therefore we ask all patients to stop taking any aspirin or aspirin-containing medications two weeks prior to surgery. This also includes anti-inflammatory medication such as Advil and Aleve, which should be stopped as well. Additionally, the following vitamins and supplements should also not be taken:
• Ginseng
• Goldenseal
• Kava-kava
• Licorice
• St. John's Wort
• Valerian
• Yohimee
• Dhea
• Epa
• Feverfew
• Fish Oils
• Garlic
• Ginkgo
• Vitamin E
Those that take vitamins can take the equivalent of a 'one a day' women's daily vitamin.

Do I need to remove my nail polish for the surgery?

Yes. Remove nail polish from at least one fingernail and toenail to help the anesthesia person monitor your blood circulation during your procedure.

Should I take off make-up or remove piercings before my surgery?

It is not necessary to remove all jewelry before operation. However, specific items may have to be removed for your safety, and you will need to discuss this with three different members of the team taking care of you. For example your surgeon may need you to remove an item that is within or near the sterile field, your anesthesiologist may require you to remove an item in or near your airway, and your nurse may require removal of an item that might interfere with placement of monitors or other equipment. Whatever you do, no body jewelry should ever be kept secret from your team.

Does it matter that I smoke cigarettes?

If you smoke, it is essential that you reduce or stop smoking before your procedure and for some time afterward. Be sure to discuss this openly with your doctor. Do your best to quit smoking 4-6 weeks before surgery. If this isn’t possible, it is crucial to reduce smoking as much as possible. Smoking reduces oxygen levels in the blood, which can slow down the healing process. However, if you are having a breast lift, you will definitely need to abide by these rules. Smoking increases the risks of necrosis (tissue death) in those having breast lifts.

Can I eat the morning of surgery?

No! You should not eat anything after midnight the night before your surgery. Because of the anesthesia, you do not want to risk nausea or an upset stomach.

How does the doctor put the implants in?

An incision is required in order to get the implants in. There are four locations for the incision: underarm, nipple-areola, lower breast crease, and the navel. The underarm and navel methods are possible thanks to special instruments, special training, and the same modern endoscopic technology that enables surgeons to perform so many of the so-called "Band-aid" operations. Usually, the implants are salt-water filled, so they can be put in empty, then filled in position with saltwater. The filling tube is removed so the internal implant valves can seal up, then a few sutures close the incision. Silicone gel implants require a slightly longer incision, and can only be put in via the underarm, the areola, and the lower breast crease incision.

What are the complications with breast augmentation surgery?

Complications can occur, simply because it is actual surgery. Possible complications include bleeding and infection, however breast augmentation is considered safe, with complications occurring in less than one percent of all patients. The chance of complications is even lower in the “through-the-navel” method.
Bleeding: A few ounces of blood can build up around the implant inside the pocket, making that breast swell and feel more engorged and painful. This is called a "hematoma" and requires a return to the operating room, to rinse everything out, and insert a drain tube, which can be removed in the office a few days later. To decrease this possibility, patients are given a long list of medicines that cause bleeding, which they can avoid for several weeks. The list includes Vitamin E, aspirin, herbals, nicotine, and about 100 other drugs. Lots of women have gotten by without bleeding even though they have not complied with these instructions, but the chances of problems are higher. Also, at the time of the original operation, if there is more bleeding than the average woman, a small drain tube can be inserted as a precaution.
Infection: Infection is even more rare than bleeding. Bacteria are present in your skin pores, hair follicles, and breast ducts, therefore the operative area will be thoroughly cleaned with antiseptic before surgery, and antibiotics given before, during, and after operation. However, not every single bacteria can be eliminated - your body itself must work to rid itself of all harmful bacteria. That is why infection is more likely if there is any nicotine in the system. If there is an infection, then there is a return to surgery, and the implants usually (but not always) need to be removed, left out for several months, and then new implants put in at a third surgery.
Complications, although rare, add expense, pain, and recovery time. Insurance does not usually cover the cost of the expenses, nor does the manufacturer of the implants. The greatest danger from breast implant surgery is to have it done by someone who is not properly qualified to do it. Many doctors not certified by the American Board of Plastic Surgery are taking quick weekend courses about breast augmentation, including the through-the-navel method. Every person should thoroughly research the qualifications of the surgeon and anesthesiologist.
It is highly significant to look at the statistics from surveys done among women with implants. Not only do they reveal that 97 to 98 percent of women with implants would do it again, but also that even most of those few patients who have experienced the rare complications would still do it again!

Can I die from Breast Augmentation?

Surgery and anesthesia impose stresses on the patient's system, and existing weaknesses or abnormalities in those systems could ultimately lead to death. However, the risk is no different than the cases we read about where young, fit athletes suddenly collapse and die unexpectedly. It is possible to die during or after any operation, not just breast augmentation. Dr. Hart has never had a patient die from surgery. Unfortunately, there are unqualified and poorly trained individuals who are performing breast augmentation, and deaths have occurred at their hands. There are many things you need to be certain about before deciding on a plastic surgeon:
1. Is the surgeon certified by The American Board of Plastic Surgery?
2. Does the surgeon have considerable experience with implant surgery?
3. Has your surgeon spent enough time explaining everything to you?
4. Is the surgical facility fully accredited for general anesthesia?
5. Will there be an M.D. Anesthesiologist?
6. Will your surgeon be the person actually performing your surgery?
7. Are you sure your surgeon is not just supervising residents doing the surgery?
8. Are you sure your surgeon will not be needed in another operating room while perforning your operation?
You want to be certain the answer is yes to all of these questions before deciding.
If you question whether or not your Plastic Surgeon is certified by the American Board of Plastic Surgery, you can call the American Board of Medical Specialties at 1-866-275-2267 and inquire. You may also log into the Board Certification Verification website, enter your surgeons name, and then click the Submit button. If the name is returned with the statement: "Certified By: The American Board of Plastic Surgery" then he/she is certified by the American Board of Plastic Surgery. If that exact wording does not appear, then he/she is NOT board-certified in Plastic Surgery.

Do I stay overnight in the hospital for this procedure?

No, but you should have someone with you for the first 24 hours. Having had an anesthetic can leave you drowsy and not fully clear-headed. Most of the strong pain medications add to these feelings. It is for this reason that patients are not allowed to drive or operate machinery while taking such medications. In addition, there is often some light-headedness the first night. Having someone with you can minimize the number of times you need to get up and walk around. Having someone stay with you all the first night is a requirement, not an option, if you want Dr Hart to perform your operation.

Will I have a drain inserted?

A drain is a thin soft tube that is sometimes used by surgeons to provide a way for fluids to exit from the surgical site so that they do not accumulate. During operation, if the surgeon decides that there may be a chance of fluids building up in the area (which could interfere with proper healing), then a drain may be used. The thin tube leads outside through a tiny incision and usually ends in a small collection bulb about the size of a lemon. This can be emptied and measured at desired intervals. When the draining has diminished, it can be easily removed in the office.
If a drain is used, there may be slightly more postoperative pain than usual, until the drain is removed. Drains are not very often used for breast augmentation, except for repeat or "redo" surgery.

Can I have a tummy tuck or another procedure done at the same time as augmentation surgery?

Yes, and that is quite often done. The procedures that have been combined most frequently include the following:
• Abdominoplasty (TummyTuck)
• Browlift
• Eyelid Lift (Blepharoplasty)
• Facelift (Rhytidectomy)
• Laser Skin Resurfacing
• Liposuction
• Mastoplexy (Breast Lift)
• Rhinoplasty (Nose operation)
• Tubal Ligation
• Umbilical Hernia Repair
Of course several of these can be combined together, but the plastic surgeon will need to determine which ones can be safely combined for a given patient. Doing more than one procedure together does lengthen the operating room time, although less than the total for the procedures done separately, and so there is often some cost savings.

What is a capsule?

Over the years, many attempts have been made to help prevent the tightening up of scar tissue around the implant, an event called "capsule contracture". The proportion of women who experience this contracture problem is low, approximately one out of every twenty women.
The methods used to try to prevent capsule contracture can be divided into external or internal.
External methods include massage, ultra sound, Diathermy, Vit E, MSM, compression devices, and Singulair, Papaverine or Accolate. Internal methods have included chemicals, and structural elements. The chemicals used (including antibiotics, steroids, and antiseptics) have been placed either inside of the implants, or inside the pocket outside of the implants. Structural elements have included alterations of the implant surface (such as texturing, or polyurethane foam covering), and also inserting between the outside of the implant and the surrounding body tissues various foreign materials, including Polyurethane and Teflon.

What if I get a capsule?

There are many different approaches to the problem, and not one particular method is completely 100% effective. You will need to consult with your physician on the best approach to your specific case.

Will you give me a special bra to wear right after surgery?

Yes. It is called StealthWrap, an elastic band about 3 inches wide that wraps around the upper chest. Usually it is put on in the operating room when the operation is completed. The purpose of it is to start shaping the breast, to hold the implants in position, and to start helping with the prevention of hardening of the scar tissue around the implants, known as capsular contracture.
Not every patient needs one, but if so it is worn almost continuously for about a week, and some patients are instructed to wear it longer. It is available in a lace-front version to resemble a camisole for use in public.
The first night and next day the band may feel tight and constricting. As you get accustomed to the band, you may appreciate the stability and support it brings. After time, however, most women grow tired of wearing it, and can hardly wait to do without it, at which stage it is often called the "Dreaded Strap".
The band can be purchased directly from the manufacturer at 800-500-0157.

How long do I have to wait before I take a shower?

You may shower 48 hours following your surgery. Do not shower prior to this, because it is important not to risk infection to the wound. Your skin is the best barrier to infection. Obviously with any incision your skin is opened and is the source for infection. It takes about 24-48 hours for your incision to become sealed enough to where it will be watertight. The dressings put on at the time of surgery are sterile and keep the area protected until your skin can be the barrier again. So, most would be OK with you taking a shower and getting your incision wet by 48 hours.

How long do I have to wait to exercise?

If your surgery is above the breast muscle or right under the skin, recovery time is faster. Pain and swelling subsides in a shorter time. My PS advises patients to rest for one week before going back to work for all types of breast augmentation surgeries.
If your implant placement is submuscular or below the muscle, it will be more painful and recovery will take longer as the breast muscles and tissue are cut and stretched while a pocket for the implant is being made. My PS advocates all precautionary measures. Better safe than sorry. Straining yourself may only result in complications or delay in recovery.
Going back to exercising will depend on each individual's recovery - around 2-3months but no heavy lifting. I know it's terrible! It's advisable to stop all pectoral exercises 3-4weeks before surgery to speed up healing and lessen recovery pain.

How long do I have to wait to have safe sexual intercourse?

Short answer: 2 weeks. Long answer: It depends on what you mean by safe! Immediately after breast implant surgery, there are millions of tiny blood vessels that are trying to their best to heal. These new vessel connections are extremely delicate, and even the smallest elevation in heart rate or blood pressure can cause them to break or leak. And more disrupted blood vessels mean more bruising and swelling, and a longer recovery. If enough of these new vessels break, you could wind up back in the operating room with a hematoma, and more importantly, with a higher risk of developing a capsular contracture in the future. It takes about two weeks for these blood vessels to heal, so keep it PG until then! After the two-week mark, it isn’t the blood vessels that you need to protect; it’s the implant capsule. The capsule is a layer of scar tissue that forms around the implant and eventually helps hold the implant in place. The capsule takes about 6 weeks to fully form, so before this time it is relatively easy to disrupt. If the capsule is disrupted, your implants could shift resulting in asymmetry. This is the reason why upper body workouts aren’t recommended until 6 weeks after breast augmentation, but it’s also the reason why you need to be careful in the bedroom!

How much swelling will I have after the surgery?

There is always some swelling after breast augmentation. Most of this swelling is gone, however, after two weeks, however a small amount remains up to six months in most women. That is one reason that some women later wish they had asked for a larger size after a year or two - they become accustomed to their new size when swollen, and then want to become that size instead of the size they originally asked for.

Do the implants make any noises like swooshing or squeaking?

Your breast implant should only make sounds during the first few weeks or so after the procedure.
A wide variety of sounds can emanate from the implant-augmented breast in the early postoperative period. These sounds are virtually always benign, and temporary. The sounds can include a wide variety: popping, crackling, swishing, sloshing or gurgling, and squeaking, rubbing, humming or vibrating. None of them are obvious and all require quiet conditions to hear.
Although the risk of these sounds may have you feeling anxious about the procedure, experts and those that have received the procedure assure that any sounds usually go away within the first couple days of recovery.

What is my total recovery time for breast augmentation surgery?

Recovery time depends completely upon the method used to install the implants and their position in relation to the muscle. Recovery time varies greatly, and depends upon the woman herself, the nature of the work she does, and her physical fitness and activity. Each situation is different.
Behind the muscle augmentation ("UNDERS") generally elicit a slower recovery, and are somewhat more painful. When the muscle is compromised in behind-the-muscle procedures, muscle cramping can occur. Medicines can control the pain, but if you are on medication, your ability to drive a car, work productively or exercise is limited. Return to work averages about 7 days. Full strenuous exercise usually averages about 4-5 weeks.
In front of the muscle augmentation ("OVERS"), have a little faster recovery because there are no muscle cramps. Some pain can be expected, however the recovery time is shorter than behind-the-muscle. Over-the-muscle patients typically do not need to stay overnight. Recovery time depends upon whether the incision is inside the navel or not. If it is not through the navel, the return to work averages about 5 days, Full strenuous activity averages about 3 weeks.
Breast enlargement via the navel ("TUBA") in general delivers a more rapid recovery than any other method. It is not usually necessary to stay overnight if the implant is inserted in front of the muscle via the navel, although it is recommended that patients from out-of-state spend at least the first night in a local hotel. With front of the muscle implants via the navel the return to work averages about 3 days, with full strenuous activity coming after about 2 weeks. The quicker recovery and lower pain with the through-the-navel method is due to:
1. There is no cutting within the breast. Unlike the other methods, the pocket for the implant is made solely by expansion.
2. The incision is far from the breast, so the stretching of the skin by the implant does not put tension on the incision.
3. For most women, navel skin is less sensitive than breast skin (try pinching your own to see if you are one of them).

What is a hematoma? Can I prevent getting a hematoma?

A hematoma is the accumulation of a small amount of blood around the implant. The steps that are taken to help prevent a hematoma include avoiding certain blood-thinning medicines before surgery, and not smoking for two weeks prior to surgery. Also, at the time of the breast augmentation operation, if it seems that there is a little more bleeding than typical, a drainage tube can be left in at that time, and removed a few days later in the office. Hematomas are considered rare with breast augmentation surgery.

If I get a hematoma what is the next procedure?

If that happens, it may require going back to the operating room to release the blood and rinse out the pocket, and possibly inserting a small drain tube.

After the surgery, can I wear any bra after I’m completely healed?

Yes. Including underwire. There may be specific recommendations, but the choice is yours. Most patients start wearing a bra on the second or third day. Of course, as you are getting accustomed to your new breasts, you may want to watch closely for any signs that the new bras might be irritating the skin. At first, while there is swelling present, the bras may not fit well, and some women like to temporarily remove the underwire for comfort during that time.

Can I have issues with my breasts if I go to low or high altitudes?

No. There is no truth to the stories about implants 'popping' under these conditions. A large number of flight attendants, pilots, and passengers have breast implants, and there is no risk of pressure problems, even in the event of a sudden loss of cabin pressure.

If I have dental work done after having my breast augmentation do I need to take antibiotics?

It is your choice. The chance of implant problems from dental cleaning without antibiotics is VERY small. You could probably have a hundred cleanings without antibiotics, and have no problems. Having breast implants does not increase your chance of an infection from dental cleaning - it just means that the consequences could be more of a problem if you did get an infection.
If you are undecided about what to do, simply ask both your dentist and your plastic surgeon the following question: "If you yourself had an artificial heart valve, or a penile implant, or an artificial hip joint, would you take antibiotics for dental cleaning?" Listen carefully for their answer, and you will get information to help you decide.

Do I need to have MRIs done on a yearly basis to always check the implant?

For Silicone implants yes. For Saline implants no. When saline implants fail, they rapidly get smaller, and the woman herself is aware that they have failed. When silicone implants leak, there is no way to tell externally. That is why the FDA recommends that women with silicone implants get an MRI at year 3, 5, 7, 9 etc every 2 years to check whether they have failed. The FDA specified MRI, rather than mammograms, because the mammograms are not sensitive enough and do not find leaks as well as the MRI can.
Some women prefer saline implants because they will announce a failure by deflating. Other women prefer silicone gel implants because they will not announce a failure by deflating - even when they fail there is no externally visible change of size, and they do not want to risk others being able to tell.

Can breast augmentation be done through the navel or endoscopic?

Thanks to special instruments, special training, and modern technology, it is now possible for surgeons to perform many kinds of surgery through very tiny incisions. Prior to the development of endoscopic surgery, these operations could only be accomplished using much larger incisions. These endoscopic procedures are also known as "minimally-invasive surgery" or "Band-aid" operations.
Endoscopic procedures require a surgeon who is comfortable operating without looking directly at his/her hands, watching instead a video monitor to have complete control over the procedure. Many surgeons, while skillful, are not comfortable with endoscopic surgery. It is important that you ask your surgeon if he or has experience in performing an endoscopic breast augmentation.
For through-the-navel breast augmentation, the surgeon makes a narrow tunnel beneath the skin, from the navel up into the loose tissue behind the breast. The operation is performed just under the skin, so there is no cutting of muscle or penetration into the abdomen. A temporary salt-water expander-implant is used to open the space to make room for the implant. After removing the temporary expander, the implant is slid up into place, and there it is filled with salt-water. The thin filling tube is then removed, which allows the implant valve to close and seal. Stitches are used to close the incision at the navel. The operation takes about an hour under general anesthesia, and the patient does not usually need to stay overnight.
Dr Hart has performed special endoscopic technique since 1992, and has found it to be an excellent method, with extremely few complications, and very high patient satisfaction.
Many women are choosing to have the implants inserted through a small incision inside the navel, the so-called belly-button technique.
With this method, there is less time under anesthesia, less discomfort, less chance of losing the sense of touch in the nipple, and of course no scars around the breast. A very small incision is made inside the rim of the navel; and then using an endoscope, the salt-water (saline) implant is inserted through a narrow tunnel just under the skin, into the loose tissue behind the breast. The result of this type of enlargement looks the same as after the older methods, but without the typical scar on the breast. At the present time there is no method for inserting silicone-filled implants via the navel. The advantages of having the breast enlargement through the navel are:
• less time under anesthesia than with the other incisions.
• generally a faster recovery than with the other incisions.
• very large implants can be used because there is no breast incision that could pull open from breast skin tension.
• no tell-tale scar on the breast, only a tiny one inside the navel.

The disadvantages of having breast enlargement through the navel are:
• can only use saline-filled implants, not silicone-gel-filled, via the navel.
• if the breasts have an actual pre-existing deformity, that may not be easy to correct completely via the navel.

What If after my surgery I want to go bigger or smaller is that an option?

If you decide, post-surgery, that you want a larger breast size, the process becomes more involved than the original surgery. Scar tissue, formed from the first surgery, must be dealt with, and the pocket size will need to be increased to make room for the new larger implant. Based upon decisions made by you and your plastic surgeon about your needs, fees are calculated and are usually more than the fee for the first surgery due to the additional work needed. Because of the need to remove scar tissue, the incision will usually need to be right on the breast or areola.
The operation to reduce your breast size is much less involved than the original operation, and is virtually the same as that needed for prompt replacement of a deflated saline implant. An incision will be made in the same location as the previous scar (axilla, nipple, crease, or navel), through which the old implant will be removed after fully deflating it, then the new implant inserted and filled with sterile saline. The procedure is less painful than the original operation, and the recovery is faster. Going to a smaller size with a silicone-gel implant is more involved than this, but may still be easier on the patient than when the silicone-gel implant was put in originally.

What If after my surgery I decide I don’t want implants? Can they be removed and will I look the same as before the surgery?

Some patients immediately adapt to the new size and shape of their breasts and others take a little longer. Before you make the decision to have your implants removed, it is recommended to wait at least three months after surgery. Talk to your surgeon about the options and consider talking to another medical professional (such as a psychologist) to help with this decision.
The decision to have implants removed is not something to be taken lightly. Even though the implants can be removed and the breasts will be smaller, there will be the scars from the placement of the implants. It is important to consider all options carefully before making your decision.
Depending upon the size of the breast implant removed and the amount of your natural breast tissue, you may or may not need a breast lift or mastopexy to regain your original look and to prevent sagging. It is highly likely that you will need some type of breast lift after removing breast implants.
A thorough discussion with your plastic surgeon is necessary to understand your treatment alternatives, their risks and advantages.

Is it possible for symmastia or bottoming out? How do I avoid both of these?

Symmastia is a visible condition in which the cleavage separating the two breasts becomes less deep and less clearly seen. The appearance is that of the two breasts blending into each other with less distinct cleavage than normal. It looks like the two breasts are meeting in the middle. In can occur with both overs and unders. The cause is that the two implant pockets actually are right up against each other, contacting in the cleavage area. That of course means that the skin is no longer adherent to the sternum or breastbone, but raised off of it.
Symmastia is difficult to treat, and may require more than one operation to accomplish. The skin needs to be secured with internal sutures onto the chest wall. The condition can return and require additional future operation. Symmastia is slightly less likely after TUBA than after other methods, due to the fact that the final appearance of the pockets is monitored directly during the procedure.
In most patients, the part of the breast that stretches out the easiest is the part surrounding the nipple, so with or without implants, breasts still look like breasts with the passage of time. In some patients however, the part of the breast that stretches out most easily is the bottom of the breast, down below the nipple area. In this case, the lower breast skin can bulge and sag downward, making the nipple (which does not descend) appear too high. The larger the breast, the more weight, and the more profound it becomes. In a predisposed patient, "bottoming-out" is equally likely with either over the muscle or under the muscle implants, because there is no pectoral muscle along the lower part of the breast. The only cure for this is a variation of mastopexy or breast lift.

How do I help my significant other accept my idea of breast implants?

Nearly all women who request breast enlargement do so because they themselves want the result. It is rare for a woman to want to have the surgery simply because her partner wants her to. Breast augmentation breeds confidence in a woman, and is the number one factor behind the decision to have the surgery.
Breast augmentation surgery is the woman's decision, and hers alone. Reassurance, strong and often, may be necessary to soothe any insecurities of a significant other. After time, your partner may discover that your newly found confidence is extremely attractive.

What are the differences between silicone and saline implants?

Breast implants are made of medical silicone (not silicon), a soft rubbery material, filled with either salt-water or silicone gel. Women without implants who are considering breast enlargement in the USA are eligible for the salt-water-filled implants if they are 18 or older, and for silicone-gel implants if they are 22 or older. Both the silicone-gel-fill and the saline-fill implants are excellent. But they have many differences between them.
The lifespan of your implant is the same for silicone-fill as for saline-fill. There are three major differences between silicone and saline implants: 1) Cost, 2) Feel and 3) How potential failed implants are handled.
COST: Silicone implants are more expensive than saline implants. Additionally, the surgery to insert silicone implants is slightly more than that for saline implants. Offsetting those costs a little is the fact that the extended warranty is provided free with silicone implants. An important cost consideration with silicone gel implants is the matter of the MRIs. The FDA recommends that every patient who gets silicone implants go for frequent MRIs (at her own expense about $2500-$3000) at 3 years after surgery then every 2 years thereafter.
FEEL: Some women prefer the way that silicone implants feel to the touch. It is difficult to put the differences into words, but the best term women have used are that the silicone implants feel "squishier" or more "doughy" than saline. However, it is typically extremely difficult to tell by squeezing the breast whether the implants are saline or silicone. Similarly, it is generally not possible to tell by appearance or photos whether the implants are silicone or saline.
POTENTIAL FAILURE OF THE IMPLANTS: Neither saline nor silicone gel make the woman ill, even after the implants fail. When a saline-filled implant fails, the salt-water first leaks into the scar capsule, then passes out through the scar capsule where it is absorbed by the body and then passed through the body’s natural system just as if a glass of water had been consumed. When a silicone-gel-filled implant fails, the silicone will be free to pass into the space between the implant shell and the scar capsule, (only a minute amount does so), where it remains trapped and is not absorbed by the body, except for a tiny amount of microscopic droplets or molecules. So it is easy to picture what effect these two events have on the size of the breast: the breast gets smaller when a saline implant fails, but stays the same size when a silicone implant fails. So which is better? It depends upon the patient's priorities.
Some patients want to know right away when their implants fail so that they can get them replaced promptly. With saline, they will know right away as the breast gets smaller, and there is no need for special tests to be done. Other patients do not want a leak to produce a noticeable decrease in their breast size, and certainly don’t want others to be able to tell. A common concern with silicone implants is the issue of being able to detect when it has failed, especially if there is no size change. The most common method of failure detection is via MRI or ultrasound.

• How to tell when the implant has failed.
o The failure is obvious to the woman, as the size decreases.
o No special testing such as ultrasound or MRI is needed.
o The failure is undetectable to the woman, as the size does not change.
o Special testing, such as ultrasound or MRI, is required.

• How to get the failed implant out.
o A tiny incision is enough, because the capsule stays in place.
o A new saline implant can be placed through that tiny incision.
o A new silicone implant requires a larger incision.
o A fairly large incision is needed, because the capsule needs removal.
o The new implant can be saline or silicone.

• How quickly the operation should be performed.
o If replacement is done within two weeks, it is a very simple operation, done through a tiny incision.
o If replacement is delayed beyond two weeks, the scar capsule probably has to be removed, which makes the operation just as large as that needed for silicone.
o The scar capsule usually has to be removed, which makes the operation a fairly large one.
The FDA recommends that replacement of a failed silicone implant be done promptly.
Which is better? It should be clear that both saline and silicone are excellent choices, but just different from each other. Both result in happy patients who are glad they chose to have the operation done!

Are there problems with having larger breasts?

The benefits of breast enlargement are well known and easy to understand, and most of them relate to greater ease of finding clothes that fit well, without the need for internal padding or special lingerie. Women contemplating enlargement need to consider that there are some drawbacks to larger breasts (with or without implants): Larger-breasted women:
• may need to wear a bra most of the day
• may need support during strenuous exercise
• may not enjoy sleeping on the stomach
• may get unwanted attention from men
• may encounter envious treatment by other women
Also, the woman who has breast enlargement may find that she needs to buy a new wardrobe.

After having surgery can I still get my nipples pierced or tattooed?

If you already have breast implants, and are considering getting your nipples pierced or tattooed, it is not recommended. If you are still determined to get a nipple pierced or tattooed, you need to be especially vigilant. Choose a reputable establishment, which uses sterile technique. Infections can occur with any piercing, and every infection has the potential to spread.
Nipple piercings can be especially problematic as the breast gland itself can become infected. This can put the both the breast tissue and the breast implants at risk, especially if your breast implants are in front of the pectoral muscle. If there is any redness, swelling, discharge or increasing pain at the piercing site, call you plastic surgeon, and seek immediate treatment. The jewelry may need to be removed, but it is better to lose a piercing than to lose a breast implant.

Will my implants feel hot or cold because of the silicone or saline?

Yes, they can feel either hot or cold. The implants store heat and tend to be at a temperature somewhere between body temperature and the temperature of the surroundings. The temperature will change slowly when the surroundings change. For example, breast implants will remain cool and below body temperature, and the breasts will feel cool to the touch, if you have been in a swimming pool for an extended period of time. Conversely, if you spend an hour lying in the sun, or in a hot tub, the implants will warm up above body temperature and your breasts will feel warm to the touch.
Heat will not harm the implant. Hot tubs, saunas, tanning booths, electric blankets or sunbathing will not harm either the implant or the breast in any way. But, if you put a localized source of high heat directly on the breast, like a hot water bottle or heating pad, the implant will gradually warm up, and your breast skin will then be getting heat from both outside and inside - and you can burn the breast skin. Because of this, it is best to refrain from using hot water bottles or heating pads on the breast.

If my breasts are saggy now can I have a breast enlargement to make them look higher?

Yes! The relaxation that occurs to breasts over time is the result of three factors in different proportions for different women:
1. Increase in the amount of skin due to:
o stretching of skin
o loss of elasticity
o actual increase in amount of skin
2. Loosening of the internal ligament support structures from: o weight gain
o puberty
o pregnancy
o aging
3. Decrease in the amount of breast volume due to:
o pregnancy
o breast-feeding
o weight loss
o aging
All of these factors combine to give the woman her unique situation, influenced by other factors such as skin quality, heredity, age at first development, and degree of enlargement with pregnancy or weight changes. Clearly, helping this situation depends upon either decreasing the excessive skin, or increasing the volume of what is inside that skin, or both.
Inserting an implant has the effect of increasing the contained volume, taking up slack in the skin, and lifting the breast. The larger the implant, the greater the lifting effect. The more relaxation there is, the larger the implant required to lift the breast.

Is there a consultation fee?

No Dr. Hart does not charge for cosmetic consultations because he feels that patient should be able to make a decision based on how they feel rather than the patient thinking “well I’ve already paid this doctor a fee so I might as well go with him”, He wants the patient to make the decision based on the overall consultation.
Dr. Hart does charge a consultation fee for insurance cases i.e. reduction and reconstruction. This fee is sent directly to your insurance company. We do this so that we can get the predetermination and precertification completed as soon as possible, and we have to prove to insurance that we have seen you in office for consultation.

What does a breast augmentation cost?

For Dr. Hart's patients, the cost of breast enlargement using saline implants via any incision ranges from $5000 to $6500, everything included, i.e. pre-operative examination and testing, operating room, anesthesiologist, recovery room, implants, medical supplies and dressings, surgeon's fees, and office checkups. Annual checkups are included. The variation within this range depends upon several factors, such as the type of implant chosen, and which facility is chosen for the procedure, and whether the patient stays overnight after surgery. Using silicone-gel implants will be more expensive. The price ranges from $5900 to $7500.
There may be surgeons who offer lower fees, and although lower fees do not always mean lower quality, there are several questions to which the patient must know the answers:
1. Is the surgeon certified by The American Board of Plastic Surgery (www.abms.org to find out)?
2. Does the surgeon have considerable experience with implant surgery?
3. Has your surgeon spent enough time explaining everything to you?
4. Is the surgical facility fully accredited for general anesthesia?
5. Will there be an M.D. Anesthesiologist?
6. Will your surgeon be the one doing your surgery?
7. Are you sure your surgeon is not just supervising residents doing the surgery?
8. Are you sure your surgeon will not be needed in another operating room while trying to do your operation?
9. Does the quoted fee include anesthesia, operating room, and implants?
10. Are the implants U.S. made and FDA approved?

You want to be certain the answer is yes to all of these before deciding. There are several factors that may make having surgery with Dr. Hart more expensive than some alternatives:
• Dr. Hart is fully certified by the American Board of Plastic Surgery.
• Dr. Hart has over 25 years experience with breast implant surgery.
• Dr. Hart spends at least two hours in consultation with the patient.
• The operations are done in an actual surgical facility, not in an office operating room.
• All the equipment used is of top quality.
• Dr. Hart believes that the surgeon should not be the one giving the anesthesia.
• There is an MD anesthesiologist and nurse anesthetist on every case.
• The operation is not performed by a trainee or resident.
• Dr. Hart himself does the operating, and does not hurry.
• The implants are made by USA manufacturers, are FDA approved, and have warranties.
A patient must be very careful before deciding to skip criteria such as these in order to save money.

Does insurance pay for breast augmentation?

There are some specific situations in which breast augmentation is not cosmetic surgery, and in which case insurance should cover it. For example, augmenting a breast that has completely failed to develop on one side, or to match an opposite reconstructed post-mastectomy breast. But these are very specific situations, defined by the AMA as not cosmetic surgery. If you have had a breast augmentation and need additional surgery for medical reasons, such as for capsular contracture, you might think that it would be appropriate for insurance to help with the costs of correcting that medical problem. But you must be aware that many insurance companies try to get out of coverage for that situation any way they can, usually by tricky wording in the contract or by blatantly disregarding the AMA guidelines. And even if they do assist with the costs, the insurer will not likely help with the expense of putting new implants in.

Does Dr. Hart take payment plans?

Yes. Dr. Hart accepts all major credit cards, upon which payments may be made. He also takes Care Credit. You can apply online @ www.carecredit.com or call 1-800-365-8295. Payments must be made in full to Dr. Hart before surgery.

How do I know if Dr. Hart is right for me?

Just like in other service industries, it is important for you to do your due diligence. During your consultation, be prepared to ask any and all questions you feel necessary to help bring you comfort. The decision to undergo any elective surgery is a major one, and not one you should rush into without a full understanding of the who’s, what’s, when’s and where’s of the procedure. Listen, and ask questions. Only you can decide if Dr. Hart is the right surgeon for you.

Am I a good candidate to/ for Dr. Hart? Can he turn me away?

Yes, it is entirely possibility that Dr. Hart may decline to have a particular person as a patient. During the consultation, while you are evaluating whether or not whether or not Dr. Hart is a good match, Dr. Hart is also evaluating what kind of patient sits before him. Does she understand fully? Does she follow instructions well? Is she interested in participating in the decision making process? Are her expectations realistic? Did she comply with all the instructions? Does she have a positive attitude? Is there good two-way communications with her?
In addition to those personality issues, Dr. Hart is also going to be forming an opinion about the probability of a successful outcome in physical terms, especially for women coming to see him for correction of problems resulting from previous surgery by other surgeons. If such reoperation surgery does not have a very high likelihood of significant improvement, Dr Hart will advise against it. That does not mean that it would be impossible for the woman to get a good result from another operation, simply that Dr. Hart does not see the probability as being high enough for him to recommend re-operation.
When a plastic surgeon performs breast augmentation for a woman, it should begin a long-term relationship, one that may require some effort from both patient and surgeon for continued long-term excellent results. Dr. Hart will choose to operate only on those patients who he believes will be likely to participate in such an ongoing cooperative medical relationship.

I’ve already had surgery and don’t like it. Will Dr. Hart redo my surgery?

A large part of Dr. Hart's practice consists of correcting what other surgeons have done. Unfortunately, it is a fact that many breast augmentation surgeries are performed by doctors not qualified to do so. Most of these call themselves plastic surgeons, but in reality, they are not certified by the American Board of Plastic Surgery.
However, even though Dr. Hart performs a large number of secondary corrections, it does not necessarily mean that he will recommend re-operation for every woman who seeks his advice in these situations. For re-operative surgery, Dr. Hart requires a very high probability that the result will be satisfactory for the patient. If he believes that there is not a sufficiently high probability of a very significant improvement, he will advise against operation.

I want to sue my previous doctor for bad surgery. After revision, will Dr. Hart help my case?

Not likely. Dr Hart makes every effort to never deprecate or bad-mouth other surgeons in terms of their work. He will explain any particular steps that he prefers to do differently, and why he does them the way he does. If the patient had surgery by a doctor who was not actually a plastic surgeon but represented himself as such, Dr Hart will educate the patient in that regard. And Dr. hart will try, whenever appropriate, to explain where and why his philosophy differs from other plastic surgeons.
There are, however, many doctors who regularly do testify. Those doctors are comfortable in the courtroom, and they do not have practices that are demanding of their time.
Patients seeking Dr Hart's surgical expertise in correcting the results from other surgeons, whether real Plastic Surgeons or fake ones, are expected to sign in advance an affidavit stating that they agree not to request Dr Hart to give any testimony beyond providing a copy of the medical records.

I live in a different state but want Dr. Hart for my surgeon, how will that work?

Our patients from other states generally prefer to make advance arrangements. We have patients from almost all of the states in the USA, and have systems in place, (including directions, and suggestions for nearby hotels and restaurants) that enable them to have both the nurse consult and the consult with Dr. Dowden during the same visit, which we call "back to back visits".
Sometimes, patients from far away prefer to actually reserve a surgery date in advance of coming to the office for the first time. Depending upon the timing, doing this may involve prepaying the surgical fee before even meeting Dr. Hart.
One of our staff nurses assists with coordinating your consults and surgery date, and would be happy to answer any questions.

I am currently overseas in the military and want to get a breast augmentation on leave how does that work?

Patients coming from other countries to see Dr. Hart often need special arrangements to make the best use of their time and travel limitations. We have both office and operation facilities located a short taxi ride from Lambert International Airport. We can provide the patient with documentation that may be required to obtain a visa. We can assist in obtaining translation services where required.
Sometimes, military patients on leave prefer to reserve a surgery date in advance of coming to the office for the first time. Depending upon the timing, doing this may involve prepaying the surgical fee before even meeting Dr. Hart.
One of our staff nurses assists with coordinating your consults and surgery date, and would be happy to answer any questions.

Is silicone a safe kind of implant?

Yes, according to the FDA and hundreds of accredited researchers around the world. That is why the FDA has approved silicone gel implants for augmentation, and why saline filled silicone implants have been in continuous use since the 1960's (except for a few months in the early 1990's).
Most people are surprised to learn that humans have man-made silicone in our bodies. It is located in our lymph glands, our immune systems and elsewhere. This silicone most likely entered our immune system from our drinking water, because silicone is used as a lubricant in the pipes, pumps and valves that carry our water supply. We also breathe in silicone aerosol from hairsprays, perfumes, and even in the air around copier machines. Man-made silicone enters our bodies in various medicines, and from hospital needles, IV's and syringes. None of this has ever been found to be dangerous. Moreover there are hundreds of implantable medical devices made of silicone, from pacemakers to artificial joints, and there is so far no evidence of this silicone being harmful.

How do I know what size to get?

It is essential to understand that implants do not come standard sizes. Instead, they come in volume such as ounces or cc's. That is because the implant must be the correct volume to take you to the size you want, from the size you are to begin with. A woman who is a size 34B will need a larger implant to get to a 34D than a woman who is starting with a 34C. It is also important to understand that the implant represents the difference between what you start with and where you want to end up. So, how do we decide the volume needed?
The first step is the most difficult: you have to decide what size bra you want to wear. Start by trying on different sizes of non-elastic bras. With breast augmentation, the band number does not change - only the cup size. Fill the bra with cotton or other padding material until you find the proportion that is right for you. Keep in mind that not all manufacturers use the same measurements for a given size - that is, not all 34C bras are the same size. Simply find the particular one that you look best in, and bring it to the office, along with any photographs that you feel illustrate aspects of the appearance that are important to you. At the office, we will put a selected adjustable water-filled insert into the bra, and fill it until it makes up for the difference from what you started with. Next, we measure your breast and chest dimensions, particularly the diameter of the base of the breast, but also taking into account other distances, such as from the nipple to the crease underneath. After measuring the volume of the insert and its contents, and adding in factors for the implant shape and position you chose, we then run a set of complex calculations to translate that into the implant size that will produce that effect for you. At this point, the number of cc's enter into the picture. This "dimensional" approach allows us to accurately determine the proper implant for meeting your needs.

What if I break my implant, what will happen?

Replacing a saline implant that has deflated is usually a very simple procedure for the patient to undergo, but replacing a failed silicone implant is usually a more involved procedure.
For removal and replacement of saline implants, the major part of the original enlargement operation is the formation of a pocket for the implant where there was no pocket before. So if an implant deflates, the pocket is already there, and all that is needed is to slip the old implant out of the pocket, and slide the new one in. Usually the same incision site is used, including through the navel.

Why do some people say implants are horrible for you?

There are risks to surgery, just as with anything else in life, skiing, swimming, flying, driving a car, etc.... The decision to do any of these things must rest on the balance between how strongly you want the benefits versus how concerned you are about the risks.
There is a small but highly vocal group of people who are strongly opposed to women getting breast implants. They want implants to be outlawed completely, and do not want women to have the option of getting them for any reason whatsoever. There are many different reasons behind this attitude, including:
• Religious opposition to cosmetic surgery.
• Opposition to anything men find attractive.
• Bitterness over inability to have implants themself.
• Resentment of attractive women.
• Personal preference for smaller breasts.
• Belief that implants cause illness. More on this.
• Desire to change the rules of society for women.
• Financial incentive to stir up fear.
• Personal insecurity.
Keep in mind that there is no scientific data available to support the claims these people make. If you have doubts about the safety of breast augmentation, ask yourself the following question: “If implants were harmful, why would 96% of all patients who had breast augmentation between 1962 and 1992 say they would do it again?” And then ask your plastic surgeon, “What are the reasons that the other 4% said they would not do it again?
The best advice is to read everything (both good and bad) that you can find; make certain your surgeon is certified by The American Board of Plastic Surgery; be sure you and your surgeon are communicating well and clearly; be sure your surgeon will be doing the surgery; be certain you are hearing about all the options, and be sure you follow all instructions completely. Then make your decision with a clear mind!

Are silicone implants FDA approved?

Yes, according to the FDA and hundreds of accredited researchers around the world. That is why the FDA has approved silicone gel implants for augmentation, and why saline filled silicone implants have been in continuous use since the 1960's (with the exception of a few months in the early 1990's).
Most people are surprised to learn that we all have man-made silicone in our bodies (most likely made by Dow Corning). It is located in our lymph glands, our immune systems and elsewhere. This silicone got into our immune system mostly from our drinking water, because silicone is used as a lubricant in the pipes, pumps and valves that carry our water supply. Also, we breathe in a silicone aerosol from hairsprays, perfumes, and even in the air around copier machines. Man-made silicone also enters our bodies in various medicines, and from hospital needles, IV's and syringes. None of this has ever been found to be dangerous. Moreover there are hundreds of implantable medical devices made of silicone, from pacemakers to artificial joints, and there is so far no evidence of this silicone being harmful.

Could silicone implants cause disease or illness?

No. According to the FDA and hundreds of accredited researchers around the world, they are safe.
Through the years, study after study has shown no connection between implants and illnesses. Moreover, these studies have revealed that any health complaints made by women with implants were the same complaints made by women who never had implants. On December 1, 1998, a court’s panel of experts issued a report finding absolutely no link between silicone breast implants and disease.
A comprehensive review of the report can be found at the American Council on Science and Health website. An exceptionally clear and incisive review of the entire breast implant situation, including both the scientific and the legal aspects, is also included in a book written by Dr. Marcia Angell, entitled "Science on Trial", published by W W Norton.

If silicone is safe, why are there still court cases involving these implants?

In short, it has everything to do with the legal system in America and the millions of dollars at stake: Sway a jury of our peers and reap the benefits of corporate bank accounts. When huge sums of money are at stake, a clever lawyer can convince jurors to ignore the facts, and make decisions based upon the empathy humans have for others.

Has Dr. Hart done any silicone studies?

Yes, both current and past. Feel free to inquire at our office for further details.

Will fat injections work on my breast?

No. After injection, some of the fat does not survive, and instead turns into calcifications. These calcifications can mimic breast cancer when seen on a mammogram. Until a method is found to prevent the calcification problem, fat injections into the breast remain not recommended.

Are there any natural supplements or pills that will make my breast larger?

Unfortunately, no, although there are many different pills marketed for the purpose of increasing breast size. For these methods to work, they would need to alter your hormone balance, and, if there is any effect at all, it would be minimalistic. Pills would also need to be taken continuously, and after stopping, the breast size would revert to its original size.

Why are Macrolane injections bad for my breasts?

There is a chemical called Macrolane which has been used by injection to plump up the breasts, producing a slight increase in size. The official term for the chemical is Breast Enhancement Filler. The advantage of this approach is that there is no actual surgery needed, only multiple injections of the material. The drawbacks of Macrolane are:
• Only a limited volume can be injected, comparable to a very small implant.
• Injections need to be repeated every 9-12 months because the material absorbs.
• Capsular contracture does occur around the injected material, making lumps.
• A major study showed that 69 percent of patients reported adverse events.
For these reasons, Macrolane is not recommended.

Can the filling of the implants harden?

The implants themselves do not actually harden, but they sometimes can come to feel hard. The reason is that any implanted medical device, from pacemakers to hip joints, will cause the body to form a scar tissue layer around it, and that happens with breast implants also, whether they are filled with silicone or with salt-water. In some ways, that scar tissue is helpful: it holds the implants in position, and it affords some protection against damage to the implant from trauma.
But in some patients, that scar tissue layer may tighten, which can make the implant feel like it is hard. The technical term is Capsular Contracture ("CC"). If that happens, the breast may feel and look unacceptably hard, or may even get displaced slightly out of position. Approximately 5% of women experience hardening, and surgery is required to reverse it. There is no way to tell in advance who is likely to get hardening and who is not. Hardening does not mean that the implants must be removed.
To help prevent hardening, the patient may be advised to take Vitamin E and MSM each morning and again at night, both of which help prevent contracture. The main preventive against contracture is that the implants need to be massaged or compressed for a few minutes every day. If the implants are in front of the muscle, the patient will deliberately compress them; if the implants are under the muscle then the muscle will automatically do the massage. Most hardening is evident within the first few years, but it can occur much later.
Because surgery for hardening is often a larger operation than putting the implants in originally, it is important for patients to keep their long-term postoperative appointments. If hardening starts to occur, and it is detected early, then certain treatments can be started to try to avoid the need for an operation.

What are the different types of implants?

High profile, Mid profile, Low profile and Spectrum.
High, Mid and Low profile implants pertain to the spherical shape of the implant. When comparing the shapes of implants with identical volume, the higher the profile, the more spherical the shape.
"Spectrum" implants are designed to allow increasing or decreasing of their volume even after surgery. They are identical to some standard saline implants in that they have a thin tube attached by a special valve in the implant. For use as a standard implant, the tube is removed in the operating room as soon as the implant has been filled with saltwater. But for use as an adjustable implant, the tube is left attached, and a special fill-port is connected to the tube. The fill-port and the tube are left under the skin, situated where the plastic surgeon can locate the port by touch later. Then, saline can be added (or removed from) the self-sealing port in the office, without surgery. Months later, when the desired final size has been achieved, a minor surgical procedure is performed to remove the port and tube, sealing the valve, and leaving the implant in.
Spectrum implants are used in many situations:
1. When matching a normally-developed breast on the other side, for example after mastectomy, or for a developmental asymmetry.
2. When the skin is too tight to permit an extremely great size increase, for example 34A to a 34F, that would otherwise require two separate implant stages.
3. When the patient needs, for a short time, to be able to change her breast size from week-to-week, an example being certain modeling situations.
4. When the underdevelopment of the breast is localized, to one area and skin expansion is needed to correct it.

What is involved in the determination of the profile?

The correct profile is determined by a person's height, weight, build and so on.

Could a doctor fill the implant with something more natural such as fat or oil so they feel more natural?

Attempts have been made in the past to use many other substances to enlarge the breasts, and these have not been successful. One approach was to take fat from another area of the body, and put it into the breast, either by injection or as a solid mass. This led to confusing lumps and x-ray shadows in the breast that could not be easily distinguished from cancer. Other experiments were done in which liposuctioned fat was used to fill a breast implant; this did not make lumps, but because the fat no longer had a blood-supply, the fat decomposed and led to serious infections. It is currently strongly recommended that no attempt be made to use any of these methods.
It is possible to use body tissue for the breasts. The most frequent way is to take fat, skin, and muscle from the abdomen, done in such a way as to maintain a blood supply for the tissues. This is usually reserved for breast reconstruction after mastectomy, because it has some strong drawbacks, specifically a long scar on the abdomen, and some degree of permanent abdominal muscle weakness.
Current experimental work is being done to evaluate the use of various vegetable oils to fill the breast implants. Theoretically this might have some advantage in making mammography easier, but there is great concern over the question of what happens if an oil-filled implant should leak. It may be several years before the answers to these questions are known.

Do the veins become more noticeable after surgery?

Some women have prominent veins without operation, especially just before their period, or during a pregnancy, or with weight gain. Larger breasts tend to show veins more clearly than smaller breasts. For this reason, veins are usually more apparent after breast augmentation, because the skin is stretched tighter and thinner, allowing the veins to show through just as with pregnancy.

What is the difference in putting the implants in above or behind the muscle?

The primary difference between in-front-of-the-muscle ('Over'), and behind-the-muscle ('Under') placement of the implant is the type of look that the breasts have. In front of the muscle, the implant has more definition up over the top of the breast. With behind-the-muscle implants, the definition on top is less distinct. However, if there is hardening in a thin person, there can be a lot of definition with either 'Unders' or 'Overs.' The degree to which the placement in front of or behind the muscle affects the final appearance always depends upon:
• how large are the breasts to begin with?
• how much enlargement is desired?
• how thick is the fat layer on the upper chest?
• how large are the implants?
• how thick is the pectoral muscle?
• how much firmness of the scar tissue is there?
Tastes vary from person to person. Approximately 60% of patients request the in-front-of-the-muscle look, while 40% desire the behind-the-muscle look.

Characteristics of in-front-of-the-muscle ('Overs') implants:
• More definition across the upper breast area
• A look that many people consider as suggesting that an implant is present
• Implants closer together in the cleavage area
• Usually no breast movement or flattening when muscle contracts
• No decrease in muscle strength
• Less painful during recovery
• Faster recovery and return to work
• Usually no need to stay overnight after surgery
• More lifting of a drooping breast
• May be advised to massage or compress the breasts for a few minutes each day
• Slightly lower cost

Characteristics of behind-the-muscle ('Unders') implants:
• Less definition across the upper breast area
• A look that many people consider less looking like an implant is present
• Implants not as close together in the cleavage area
• Some breast movement or flattening when muscle contracts
• Slight permanent decrease in muscle strength
• More painful during recovery
• Slower recovery and return to work
• May choose to stay overnight after surgery
• Less lifting of a drooping breast
• More chance of 'double-bubble' in future (see below)
• May not need to massage or compress the breasts for a few minutes each day
• Slightly higher cost

What is the difference between smooth and textured implants?

In smooth implants, the silicone rubber shell is made with a shiny polished surface. In textured implants, the silicone rubber shell is made with a finely rough surface. Data shows that smooth implants last longer than textured implants. The primary reason for textured surfaces is to prevent rotation of the implant once it is in position, which is vital with shaped (non-round) implants. Rotating is rare, but it does happen on occasion, which then leads to surgery to replace the implant.
There are a handful of drawbacks to textured surface implants. If there is significant rippling or wrinkling, it is more pronounced with the textured implants. Additionally, in some instances, Traction Wrinkles can show – especially with the larger-grain textured implants, Finally, if a textured implant has to be replaced, removing it is slightly more difficult than with a smooth one.
Because of a greater tendency to show wrinkling, it is vital that textured implants be filled to their optimum, even if that requires overfilling of certain implant types.

Do the implants make my skin look dimpled or rippled?

Every breast implant has at least a little bit of wrinkling or rippling, an irregularity of its surface. Some implants have very little, and some have a lot of it; if there is little, then it may not even be detectable. If there is more, it may be felt, and if there is a lot of wrinkling, it can be felt and even seen. In general, the degree of wrinkling depends upon several factors that work to either hide or reveal wrinkling or rippling. Factors that increase apparent wrinkling: • Thinner patients with thinner fat layer • Smaller pre-operative breast size • Larger implant size • Sialine rather than silicone fill face implants ("traction wrinkling")
• Inadequate volume of saline inside

Factors that decrease apparent wrinkling:
• Heavier patients with thicker fat layer
• Larger pre-operative breast size
• Smaller implant size
• Silicone rather than saline fill
• Smooth-surface implants
• Optimum volume of saline inside
The areas where wrinkling is usually most apparent are the outer side near the arm, along the bottom, and towards the cleavage. If the implant is not filled up to the optimum, there can also be wrinkling at the top of the breast.
Every implant has an optimum volume of saline fill, a volume that gives the best balance between either wrinkling (caused by not enough saline) or too firm/round (caused by too much saline). That difference in volume is amazingly small, oftentimes amounting to only a few tablespoons of water.


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