Ten common breast augmentation questions answered

Below are some of the most common questions patients ask about breast augmentation, along with answers from a board-certified plastic surgeon.

Why do you put breast implants below the muscle?

There is very good scientific evidence in medical literature to show that breast implants look more natural and feel better if placed below the muscle. It also does not obscure mammography and there is good evidence-based data to support that the implants stay softer longer by a significant margin if placed below the muscle.

How do you prevent rippling in breast implants?

The ideal option to prevent rippling is to decide preoperatively what type of implant you need and whether it should be placed above or below the muscle. The optimal way to prevent rippling, or at least minimize rippling, is to place the implant below the muscle, make sure there is adequate breast tissue and not oversize or underinflate an implant if you are using saline or silicone implants. Sometimes the use of silicone implants may be better, especially in patients with no breast tissue as well as placement below the pectoralis major muscle. If you are using saline implants make sure you maximally fill it and not overfill or underfill, as that can cause more scalping or rippling. If you underfill, it can cause more deflation in saline implants. Remember, one can almost always feel any implant in the lower outside quadrant of your breast.

Why should you underfill or overfill saline implants?

One should never underfill a saline implant because there is a higher chance of having a deflation or rupture because of full flow problems. You should always maximally fill the implant so that it will get less scalping and no rippling in this area, plus it will deflate much less.

Do you have to replace a ruptured silicone gel implant and why?

Yes, if there is radiographic evidence or an MRI it should be replaced for several reasons. Primarily, because long-term the silicone can cause small granulomas or small masses in the breast which can mimic breast tumors that may be similar to breast cancer and can disseminate throughout the breast. It is optimal to remove the implant with the capsule and attempt to replace with a new implant below the muscle. All implants need to be considered for removal at 10-15 years, whether the implant is saline or silicone.

How long should I wait before I have a ruptured silicone implant replaced or removed?

Replacement of implants that have ruptured is not an emergent operation, but it is one that should be undertaken within several months from the diagnosis. Over time silicone implants that have ruptured tend to leak and can cause more scar tissue formed by interaction around the implant. The procedure requires removing the implants and also the scar tissue around the implant. Therefore, in most cases, you do need a drain when replacing the implant. The recovery is brief – about 3-5 days.

Should one use high-profile or moderate-profile implants for sagging breasts rather than a breast lift?

In most cases, I don't think that it is prudent to use high-profile or moderate-profile implants (saline or silicone) to correct sagging breasts, as this is not the solution. If you truly have breast ptosis or sagging breasts, you should do a breast lift with or without implants. Obviously, if patients want a lift and more upper fullness they should do a lift with (moderate-profile) implants in most cases.

The problem with high-profile implants is that they have not been adequately studied and may have much higher incidence of breast tissue and glandular thinning and subsequent long-term rippling effects, whether they are silicone or saline, although this has not been studied extensively.

Does the number of cc's in a breast implant correlate with the breast size?

It usually does not since it depends on the size of breast that you are beginning with. The resulting cup size does not directly correlate with the implant size. Just as different sizes, whether it is a B, C, or D cup, vary from patient to patient and from retailer to retailer, there is no way to guarantee that one will have B, C, or D cup breasts after implants. The goal is to make them proportionate to the patient's chest wall diameter, the amount of breast tissue the patient has and the size and shape. It is very important not to over-augment patients, as they will then have further movement of their breast tissue out to the outside (or lateralization) which will cause distortion and the breast will look too large for the patient's body and chest wall.

How can one breast be hard and the other breast be soft?

Yes, this can occur since we did not know the real cause of capsular contracture (breast implant hardness). It is uncommon for capsular contracture to occur, especially with saline implant below the muscle, but if saline implants do get hard they will begin getting hard earlier than later – usually in the first several months. If silicone implants get hard, they will get hard progressively over time. One can attempt to do early aggressive breast massaging for perhaps 6-8 weeks. However, if capsule contracture develops then a simple inferior capsulotomy or release of the scar tissue may be all that is needed, especially with saline implants, to restore shape and symmetry. This is done easily as an outpatient under IV sedation.

What is the potential for loss of nipple sensation on one side and not the other?

It is not uncommon to have some sensory changes after breast augmentation, especially if there is a larger implant. Most of the time, sensation does return, especially if placed below the muscle, therefore, one should wait 3-6 months for the sensation to return. However, it is acceptable to have some nipple sensation loss with breast augmentation. The ratio of sensory loss from breast augmentation is 5-10% with the inframammary fold incision having the lowest ratio of nipple sensation loss.

How do you make cleavage with breast implants?

It is somewhat a myth that breast implants will create significant cleavage. It depends more on the shape of your breasts and the diameter of your breasts preoperatively, as well as the degree of breast augmentation and the amount of breast tissue that you have. Often, if you have an average chest wall size, there is a better chance for having improved cleavage. However, it is not a guarantee and just increasing the size does not necessarily increase breast cleavage. It is actually counter-intuitive since the implant actually pushes the breast to the side, diminishing the amount of cleavage one would anticipate.