From what you have described, it seems that a breast augmentation with possibly a lift would be the best solution. Please keep in mind that without examining you or at least a picture it is difficult to give you the exact solution for you. I am guessing that you have a significant amount of extra skin and as you said, "... absolutely flat chested." For this situation, you would need implants to help with the volume. Depending on the size of the implants you choose, and how much extra skin you have, you might still have loose skin (because the implant does not use up all of the extra skin), which would need to be corrected with a breast lift. Of course, if the extra skin does not bother you, then you would need only implants. I hope this helps.

I agree with him.  If you were having skin resurfacing, I wait 2 years for safety.  Accutane severely inhibits wound healing and skin regeneration.

Unfortunately you will need new implants. Each implant has a specific volume guide line and the size you wish will need at least 75 cc more. Please consult with your board certified plastic surgeon for further evaluation.

I have not had a patient who had feeling in their nipple after having surgery, which then lost feeling 11 years later. Unfortunately, when the surgery is completed, if there is no feeling to the nipple after surgery, and it hasn’t returned in the next year, it is usually lost. This is more frequent with the periareolar incision (5 to 15 percent). The inframamary incision loses nipple sensation less (3 to 5 percent) and least with the armpit incision (1 to 3 percent).
Sorry, but if it is numb now, and has been for years, it probably will not come back.

There is no absolute "life span" of breast implants, whether silicone gel or saline filled devices. The implant manufacturers currently recommend follow-up examinations regularly by the surgeon as well as routine monthly self examination by the patient. They emphasize that the implants are not lifetime devices, but do not state any specific expectation of the longevity of the implants. Magnetic resonance imaging (MRI) evaluation of silicone gel devices is recommended by both manufacturers starting at 3 years after implantation, and then every two years as the best means of detecting a "silent" rupture. Mammograms are recommended for women with breast implants on the same schedule as for women without implants.

Replacement of the breast implants, or their removal is recommended only to treat problems associated with the implants, such as rupture, leakage, clinically significant capsular contracture (hardening), malposition, asymmetry, desire for style/size change, etc. If no problems occur, there is no need to replace breast implants.

It's difficult to give an accurate response without actually examining this patient. For example is the "titanium chip" in an area outside the proposed surgical site? If it is, then one might proceed with the surgery. However, without a more complete history and exam, my inclination would be to recommend against this patient having surgery, because of the "breast health issues" described.

Nipple inversion is a condition caused by milk ducts that are too short between the breast tissue and the end of the nipple it self. This condition is not uncommon and can be corrected surgically. This surgical procedure may be carried out at the same time as a breast augmentation. Correction of the inverted nipple may interfere with the ability to nurse in the future and may result in partial numbness of the nipple itself.

I believe most doctors would agree that whenever an implanted device breaks it should be replaced. The short answer is that the implants, the silicone, and any silicone lumps should be removed. During a consultation with your Board Certified Plastic Surgeon, the two of you should decide based on your expectations, family history of breast cancer, and your recent mammogram findings whether replacing the implants and with what material, saline or silicone, makes the most sense. The calcifications should have been identified as benign appearing or suspicious, and their location should have been described. You can ask the mammographer-radiologist and your Plastic Surgeon based on the mammogram report whether your calcifications are from the implants.

Stretch marks are actually scars within the skin....the result of broken elastic fibers. There is no treatment available to remove those stretch marks without removing the skin itself. Stretch marks which are initially red will usually fade and whiten with time, and become progressively less noticeable. Sometimes the appearance of persistently erythematous (red) stretch marks can be improved with lasers used to lighten them, and there are other "light-based" treatments that claim to improve (but never remove) obvious stretch marks.
Breast implants, by re-stretching the skin, will usually make stretch marks appear far less obvious....not worse. But one word of caution - stretch marks indicate a loss of skin elasticity and support. Too large an implant may place too great a stress on that already damaged skin, and may accelerate skin thinning and breast sagging, so it's important to carefully discuss with your board certified plastic surgeon what implant and procedure would be best for you.

It is difficult to give a specific answer without examining you or with no photo. Often after a large weight loss the breast tissue and skin have little tone remaining and a mastopexy may require a revision to tighten the result further. This may be the best first step for you. The type of implant I would recommend would depend on your goals and your exam. Although any implant can result in palpable and/or visible ripples, this is less common with silicone compared to saline. I would have to assess the thickness of your breast tissue, the quality of your breast skin and the width of your breasts and compare this to the size implant you would like in order to make a proper recommendation. However, on the basis of your question and without any exam, I think you should revise the mastopexies first.

If you are going to get pregnant soon, then definitely wait. Your breasts may change in size and the implant size you choose then may be wrong. Also you may develop sag, and the decision to do or not do a lift may also be wrong. Hope this helps.

The major concern with over exertion post-op breast augmentation would be development of a hematoma that would necessitate a return to surgery to evacuate. Hematomas are quite painful. Over use of the arms such as putting arms over the head, and lifting more than 5 pounds are examples of overexertion. It is very important to follow your surgeon's advice for the best post- operative recuperation and the best final outcome from surgery.

The short answer is "yes" - you certainly can have breast enhancement surgery to improve breast symmetry. You should understand that this surgery will not reduce any further issues with your fibroadenomas, and in certain situations may make them more symptomatic (i.e. more prominent, or more painful) - it is difficult to comment on that aspect without examining the patient directly.



I would caution you that precise symmetry (i.e., making both breasts exactly identical) is probably too lofty of a goal: all women have some degree of asymmetry of their breasts. One final note: depending on the degree of size disparity between your breasts, your surgeon may suggest augmenting both breasts (although with different sized implants) - this may be an attractive option to you anyway if you would like to increase your overall breast size at the same time as improving symmetry.

Yes, the areolar diameter can be made smaller at the time of augmentation by removing a doughnut shape of the dark skin from the outside of the areola. This does not affect sensation. While the size will be smaller the areola has more of a stuck-on look because the edge no longer blends softly with the surrounding skin but instead there is a sharp demarcation at the junction between the dark and light skin. Because of this, diameters up to 5 centimeters are acceptable and should probably not be made smaller. A portion of the incision around the areola is used to put the implant in.

There is no "scheduled maintenance" for breast implants. Patients should have regular breast exams, mammography, ultrasound or MRI, as recommended by her treating physicians.

Breast augmentation is generally performed on women aged 18 and older.
However, in the case of severe asymmetry (A on one side, C on the other), it may be performed for a 17-year-old provided that:
a. Your breasts have stopped growing (no change in cup size for at least 6 months)
b. You are interested in saline implants (silicone gel is restricted to women ages 22 and up)
c. Your parents are in agreement with your decision (and will co-sign your consent forms)



If both breasts are "perky," augmentation with different sizes of implants will probably be sufficient to improve a size asymmetry. If the larger (C cup) breast is sagging, you may wish to consider simultaneous lifting (mastopexy) for this side to improve your breast shape asymmetry.
Insurance does not generally cover these procedures, as there is no "functional impairment" associated with breast asymmetry.
Ronald M. Friedman, MD, Plano, TX

There are at least 3 aspects to this question, not all have the same focus.


Medically---There is probably not much chance of her breasts developing more now, but it could happen. I don’t know if she is or has been on birth control pills. Sometimes that will be the start of hormonal growth that increases breast size. Another would be pregnancy. That could start more breast growth. She probably will not have many other influences on her breast growth.


Legally---She is over 18, and so can, and probably will, have this done on her own. If she pays for it all on her own, she will be tempted to pay the lowest fee that she can find, and that usually isn't the best surgeon (sometimes not even a surgeon). There is no way legally to stop her.


Family---I would encourage you to go with her to consults, and be supportive. Help her pick out a Board Certified Plastic Surgeon, who does a major amount of Aesthetic Surgery. You could have these conversations with her surgeon and her at the same time. If it was me, I would help her with the cost of surgery to the point of picking a good Plastic Surgeon. This way she would be invested into the surgery herself. You said she had two jobs. So if she can do it by herself, by your helping, you gain her confidence more, direct her to a good surgeon, and show that you are being supportive of her ideas.

Thank you for asking such an important question. Breasts with implants change with time and weight fluctuations. It is very likely that your implants can be removed safely and a breast lift performed. Often the remaining breast tissue can be rearranged to fill in the space made by the implant. Women are able to get smaller, up-lifted breasts without deformity. It is important to know that in some instances, your surgeon may want to do surgery in two steps. If your surgeon thinks that your breasts will pull up/fill in after the weight of the implants are removed, that may be an option. It is important to seek a surgeon certified by the American Board of Plastic Surgery and to discuss all of the risks and benefits of surgery.

If the implant is removed carefully, without any damage to it, and is stored on a sterile table under sterile conditions, and is tested to show its integrity (no leakage), then it is safe to put the same implant back in.

Having two different size breasts gives you the unique opportunity to see which size you like better. You could need an augmentation on the small side, a reduction on the large side, or both to arrive somewhere in the middle with respect to size. Often the best procedure is determined as much by shape issues as they are by size. Usually the best results are achieved with surgery on both breasts.

Yes, it is certainly possible to have a breast augmentation after having had a breast reduction; and your case is not unique. I sometimes see patients such as you who have either had breast reduction at a younger age and naturally lose breast size through the years, or have lost breast size following pregnancy or significant weight loss. Some additional factors must be considered, though. The quality and elasticity of your breast skin and the possible need for tightening the breast skin at the time of augmentation must be evaluated even though it will be "filled" to some degree with the implant. Even if the skin is tightened, however, it may not be ideally supportive, and the size and weight of the implant may accelerate the natural stretching and sagging of the breasts over time. And finally, you should be as close to your goal weight as possible before the surgery to both minimize the potential future additional loss of some of your own natural breast size and to permit the most appropriate implant size to be selected.

Stretch marks can look worse after augmentation, especially the initial two to six months, and also if the implants are large (eg. >350 cc). Occasionally the acute stretching of the skin during augmentation (again with larger implants) can cause new stretch marks.



The "beauty mark" can often times be removed at the same time but it will depend on its exact size and location. Each surgeon will provide you with the pros and cons of doing it simultaneously depending on those two factors.

In general, it is best to have breast enhancement surgery when you are at least 18 years of age, if it is done for purely cosmetic purposes. The breast can take 18 years or more to reach full development, which is the best time to consider surgery. The second issue is consent. Breast enhancement surgery is very safe and rewarding, but there are risks that exist. At 16 years of age, your legal guardian must consent to breast augmentation for you. This may make your family and your surgeon uncomfortable. The last major issue is the likely change in your desires after high school. I have followed young women, who ultimately have breast enhancement at 19 or 20 years of age. Their desired size and shape changed over time. They also seem to appreciate the process more when they are making all the key decisions with the surgeon. Ultimately, I recommend you wait.

Permanent loss of nipple sensation is rare, but can occur after first time breast augmentation surgery or after revisionary surgery. Women can experience some altered (diminished or hypersensitive) nipple sensation after surgery for a few weeks, but it usually normalizes. Permanent loss of nipple sensation is a rare occurrence. This is a known risk of breast surgery.

Six weeks for complete recovery with unrestricted activity.

Before specifically answering this, I need to know how old you are. If you are still a minor, I would not recommend augmentation/implants unless you had some obvious deformities.
Assuming you are older than 18, and that your breasts have essentially developed as much as they are, you will have to decide whether you want to have the procedure or not. Benign tumors alone are not a contraindication to breast implants. However, breast augmentation can make mammography and biopsies more difficult in the future. If you have a very strong history of breast cancer, it would seem more prudent not to have a procedure (augmentation) that will make screening exams (mammography) more difficult. Nevertheless, the ultimate decision rests with you.


If your tumors are so large as to be causing visible deformities, you will have to deal with them first. Also, if your tumors have a known history of continued growth, this will also have to be resolved before considering breast augmentation.

Unfortunately this question needs to be answered by the surgeon who the patient is contemplating seeing as it will vary greatly.

First I would like to ease your mind regarding the association between polyurethane coated silicone implants and cancer. To date there is NO evidence to support this claim. Secondly, there is no perfect test to detect leakage, and unfortunately ultrasound is not that helpful. An experienced Radiologist at a Breast Center can help you decide whether any of the available tests are really cost effective (e.g. MRI of the breast can cost as much as $2,000 yet not always give you the answer). I suggest to all patients with silicone implants over 15 years old that have symptoms of pain, and who have also experienced a change in breast shape, that they consider surgery. The breast pocket can be explored with the plan to remove the implant if broken, and replace it if you desire. As far as the details of exactly how this should be performed, including specifics regarding anesthesia, incisions, capsulectomy or capsulotomy and replacement in the same or different position (above or below the muscle) – this should be decided after a careful examination of you and all the facts regarding your previous surgery.
We can give you the names of three of our surgeons in the Baltimore area, Navin Singh, MD, Alexander M. Guba, Jr., MD, and Paul N. Manson, MD. All are Board Certified by the American Board of Plastic Surgery.

The usual recommendation is to wait until all drainage has ceased, and the breast fullness has subsided. This is a variable period in women, but it is best to wait until the true breast volume is evident, and the tissues are back to normal in terms of swelling and firmness.

I will focus the discussion on saline (sterile salt water filled) implants. Typically, saline implants are very durable and retain their form very well. The primary risk unique to breast implants includes leakage, which is not a health risk, and scar tissue formation around the implant, leading to a change in the feel or appearance of the breast. Fortunately, these complications do not happen very often and your board certified plastic surgeon can assist you if these problems occur. Breast implants that are currently approved for use do not have expiration, so you do not remove them unless there is a problem. It is important to understand that breast, with or without implants, age like the rest of the body. The heavier the breast, relative to the support of the skin, the greater is the tendency for sagging over a lifetime. Your surgeon will help you find the right size to minimize these changes. The most important thing to remember is that with realistic expectations and understanding of the risk/benefits, the vast majority of breast augmentation patients are very happy. For additional information, refer to www.surgery.org and www.plasticsurgery.org.

When considering augmentation of the breasts, it is vital that the breast implant chosen is the appropriate size for the anatomy of the breast and the chest wall. The preoperative planning of the augmentation is therefore critical. If an implant is chosen that is the proper size for the individual, there should be no reason to have a "round ball” appearance.
I have previously used the Brava device in many patients and do not feel that it provides either adequate or predictable results and would not recommend its use. The system uses a vacuum cup device that is worn 8-12 hours each day by the patient to create expansion of the breast tissues over a period of approximately 3 months. Unfortunately the results are frequently much less than the patient desires, and many of these patients ultimately proceed to have a surgical augmentation of their breasts. Breast augmentation is a safe surgical procedure that can provide excellent results when performed by a skilled, well trained Board Certified Plastic Surgeon.

It is possible that breast implants may affect your ability to produce milk, but it is unlikely to do so significantly. The placement of the implant will also have an effect. You should discuss your concerns and options in a personal consultation with a plastic surgeon who is a member of the American Society for Aesthetic Plastic Surgery (ASAPS). He or she can explain in detail both the risks and benefits of breast augmentation.

Correction of inverted nipples can be performed by a board-certified plastic surgeon as an office procedure using local anesthesia. Recovery time is 5 to 7 days. Although loss of feeling in the nipples can occur, most patients retain normal sensation postoperatively.

It is difficult to pinpoint a "best age" for having a facelift, since people of the same chronological age may present very different appearances depending on such factors as heredity and exposure to the sun. Aesthetic plastic surgeons very often recommend a first facelift for women in their mid-forties or early fifties, because at this age the skin still has sufficient elasticity to achieve the best possible results. Excellent results can still be obtained, however, for women in their sixties, seventies or older who have maintained good health and overall fitness. Men rarely seek advice on facelifts before their fifties or early sixties. Normally, results of a facelift will last eight to ten years. Most people who have had one facelift will, at the appropriate time, want another. Patients are pleased to find that the results of a second facelift are usually as good, and often better, than the first.

Limited scientific research has been conducted on the potential impact of breast implants on breastfeeding. However, based on the current research, as well as the fact that many women with breast implants have successfully breastfed, there is no evidence that breast augmentation necessarily will affect the ability to nurse. Breast augmentation surgery may be performed with different surgical approaches to the breast and different incisions. If the approach used is via the armpit (the axillary approach) or the crease under the breast (the infra-mammary fold approach), the likelihood of alteration to the milk ducts is extraordinarily low.



As you are considering having breast augmentation and choosing a plastic surgeon, you should feel comfortable asking your plastic surgeon this and any other questions you may have about the surgery, and also discussing your goals and expectations. One of the most important parts of your consultation is the discussion that you and your plastic surgeon will have about the risks associated with breast augmentation. You should be sure that you fully understand all of the risks as well as the benefits of the surgery.

Breast augmentation requires the placement of an implant through a small incision beneath the breast tissue to enhance the shape of the breast. The implant may be placed directly beneath the glandular tissue (subglandular) or beneath the glandular tissue of the breast and beneath the pectoralis major muscle just beneath the breast (submuscular). As a general rule, implants that are placed below the muscle result in slightly more discomfort postoperatively. However, this discomfort is easily controlled with pain medication in the typical patient. Submuscular implants have more tissue between the implant and the skin (muscle + breast) than those placed below the glandular tissue alone. The appearance is slightly different from implants placed subglandularly, so you may want to look at pre- and postoperative photos. It is generally felt that placement of the implant under the muscle makes it easier to obtain a good-quality mammographic x-ray of the breast. However, women who work out a lot may feel that placement of the implant under the muscle gives the breast an unnatural appearance when lifting weights. As to which approach is superior, it is up to the patient and her plastic surgeon to discuss the pros and cons of each and to make the best choice for the individual patient based on anatomy, the surgeon’s experience and the patient’s desires.

The safety of combined procedures depends on a variety of individual patient factors as well as surgeon preference. In my practice, I try to avoid simultaneously performing procedures that are lengthy, may cause increased patient discomfort, and may have an increased risk of certain complications by their association. However, many plastic surgeons do combine a variety of procedures, and this is a matter to be discussed between the surgeon and patient.

You can have the areola reduced at the time of breast augmentation, but there is a chance the incisions may spread due to tension on the skin from the implant volume. You may need an enhancement of the periareolar scar at a later date. Or you may choose to have the areola made smaller with a subsequent, separate procedure. A lot depends on the quality and elasticity of your skin, and your current size versus your desired size. I suggest a consultation with an ASAPS surgeon who will have the opportunity to examine you and make a recommendation.

I am considering a breast enlargement and a tummy tuck. Can I have these procedures done at the same time?"



Answered by
Gary R. Culbertson, MD
Sumter, SC



For properly selected patients, it can be both safe and cost effective to have these two procedures (breast enlargement/ augmentation and a tummy tuck) performed at the same time. Your recovery time will be slightly longer. Also, you may want to consider a 23-hour observation or overnight stay in an ambulatory surgery center or hospital, depending on the length of these combined procedures. Please discuss this safety issue with your surgeon.

There are a variety of factors that influence the decision of whether implants should be placed above or behind the pectoral muscle. In women who are relatively thin with minimal breast tissue above the nipple, saline implants are better concealed behind the muscle and the appearance may be more natural. On the other hand, women who have some drooping of the breast gland and thicker fat above the nipple often will get a better lifting effect from placing the implant on top of the muscle. The larger and heavier the implant is, the more gradual stretching of the skin and breast you will have over time. You will want to discuss these and other factors – such as how implant placement may affect mammography -- with an ASAPS-member plastic surgeon. In healthy patients, breast and facial surgery can be safely done at the same time.

Yes, breast augmentation is usually done as an outpatient procedure. No overnight stay is required. You may be permitted to go home after a few hours, unless you and your plastic surgeon have determined that you will stay in the hospital or surgical facility overnight.

Breast augmentation is a proven way to improve the size and shape of your breasts, but it requires a great deal of thought before proceeding with surgery. The U.S. Food and Drug Administration (FDA) prohibits cosmetic breast augmentation on women under 18 years of age, and most of my patients are 21 or older. Decisions regarding having children, breast feeding, breast cancer history in your family, possible complications from the surgery and the necessity to replace your implants, sometimes many years after your initial surgery, are only some of the topics that patients need to consider with their plastic surgeon. As for a change in breast shape, I am unaware of breast growth being related to breast implant surgery. Although it is possible that breast growth occurs after breast augmentation, it is unlikely to be related to your surgery.

Fat cells that are removed from one part of the body frequently are injected elsewhere. For example, fat can be used smooth facial lines or augment the lips. It can be used to fill in minor depressions or "dimpling" of the thighs and buttocks. The breasts are one of the few areas for which fat injection is not recommended. There is the possibility that fat injected into the breast may become liquid and drain from the injection site or may calcify, becoming a scarred mass within the tissues. The calcification of injected fat can mask the presence of breast cancer, making the disease more difficult to detect with mammography screening. It also can mimic breast cancer, making biopsies necessary to determine whether cancer is present. In addition, the increase in breast volume from fat injection may not be permanent. The American Society for Aesthetic Plastic Surgery (ASAPS) has a position statement on Breast Enlargement by Fat Injection that cautions women about the possible dangers of this procedure. If you are interested in enlarging your breasts, you should consult with an ASAPS-member plastic surgeon about breast augmentation with saline implants. Saline implants have been approved as safe and effective by the Food and Drug Administration (FDA). A board-certified plastic surgeon can thoroughly discuss with you both the benefits and risks of implant surgery.

This is one of the most frequently asked questions of my patients concerning breast implants. I do not have a great deal of military personnel in my practice, but I do have a many weight-lifting females.



My recommendations are as follows. If the breast implants are placed above the muscle then I tell my patients that they can resume all exercise, including weight-lifting and sports, in 6-8 weeks after the surgery. This is assuming that there are no complications postoperatively.



If the breast implants were placed under the muscle, which I do in about 95% of the cases, then my instructions are as follows: no exercise and no weight-lifting for the first two weeks. You can start walking either outside or on the treadmill after two weeks. You can resume lower body training and sit-ups after one month. You can start jogging and light upper body weights after two months and resume all unrestricted weight-lifting, exercise and sports after three months. Some other physicians may consider this postoperative plan conservative and cautious; however, I have seen postoperative bleeding even after 3-4 weeks in patients who start exercising too early.

As your breasts only "droop a little," it is quite possible that you may not need a lift at the same time. Often after having children, the breast may lose some volume or the skin may have stretched. Frequently, an implant alone will fill up the skin envelope and improve small amounts of "droop" without the need for the added incisions of a lift. Each patient however is different, and your plastic surgeon will advise you after an examination. Thank you for your question.

The best location for the incision depends on individual patient factors including the shape and size of the breasts. If possible, I prefer an incision at the lower border of the areola (the pink skin around the nipple). However, given your specific concerns, it is important for you to have a personal consultation a qualified plastic surgeon who can give you the best advice for your particular situation.

It is generally believed that mammography can be more effective if breast implants are placed under the pectoralis muscles. Statistically, the presence of breast implants does not increase or decrease the early detection of breast cancer, although it can make mammography more difficult. There are radiology facilities that specialize in the diagnosis of breast conditions in most larger cities -- contact your local hospital for assistance in locating a facility near you. No specific preoperative or postoperative exercises are recommended to assist with recovery. However, you should not run or bike for two weeks after surgery. You should not do any pectoralis muscle exercises for one month after surgery.

In my opinion, it is highly desirable in most patients to place the saline implant behind the muscle as it looks and feels more natural and has less chance of becoming hard (developing a contracture) over time. This technique also preserves the pectoralis muscle. Seek out a board-certified plastic surgeon, preferably one who is a member of the American Society for Aesthetic Plastic Surgery. You can expect to receive complete information about the procedure, postoperative care and potential risks. According to the ASAPS Bylaws, all ASAPS members must perform this type of surgery only in an accredited outpatient facility, so you have reassurance about the quality of care you will receive. Confirm that your surgeon has privileges to perform your breast augmentation in a hospital setting, as well. Ask to see patient photographs and results, but remember that every patient is different.

Sensory changes, both increased and decreased, can result following breast enlargement/augmentation surgery. This can be temporary or permanent. Fortunately, most sensory changes resolve spontaneously with time. It has been quoted that 15% of patients may experience permanent sensory changes of the breast and/or nipple after breast enlargement surgery. However, this figure varies among clinical studies and is, therefore, not definitive.



Sensory changes to the breast or nipple may result from direct injury to the nerves, as a result of surgery, or may result from the stretch placed on the nerves from implant placement. Surgical technique and anatomical location of these nerves makes the submuscular (under the muscle) placement less likely to cause permanent sensory changes. However, both submuscular and subglandular placement of breast implants has caused permanent sensory loss in a small percentage of patients. Implant size and extent of dissection may also play a role. Smaller implants may have a lower incidence of permanent sensory changes.



Unfortunately, if permanent sensory loss occurs, there is no known reliable treatment for this condition. If nipple sensitivity is important to you for sexual response, you may want to reconsider your decision to undergo breast enlargement.

It is true that sometimes one implant may "settle" into position more quickly than the other. But excessive swelling of one breast during the immediate postoperative period could indicate a problem. In such instance, one should always consult with the operating surgeon.

Assuming that the only issue is the size of your breasts, I will describe the options available to you. Other complicating situations like scar capsules (excessively "firm" breasts), implant displacement, or sagging of breast tissues would require additional surgical procedures.



Your implants could be removed under a light anesthetic -- either conscious sedation, or a light general anesthetic -- and new implants placed which you feel are more proportional to your body frame. Currently, most plastic surgeons use saline-filled implants. They can be placed either behind the breast tissue, or beneath the pectoralis muscle. For my patients, I prefer submuscular placement (beneath the pectoralis muscle), because this placement may interfere less with mammography and provides a natural-looking result.

Soybean oil-filled breast implants were removed from the market some years ago. These were only implanted as part of clinical trials, and only a very small number of women in the U.S. participated in the studies. It was found with a much larger number who received the implants in Europe that the oil became rancid and the implants had to be removed. There are no plans, in the future, to bring this implant back to the market.



Saline-filled implants remain safe and effective, FDA-approved devices for breast augmentation. Although some years ago, there were a few reports of mold forming inside saline implants, researchers have concluded that this was due to contamination that occurred at the time of filling the implants. Today we know that implants should be filled directly from an IV bottle containing sterile saline solution. This is done in the operating room at the time of implantation. Utilizing this "closed system," there have been no reported cases of contamination of the saline.



Silicone gel-filled implants are also available on a restricted basis, and through research protocols, for those patients who qualify. The patient must be followed for five years, with reports filled out at one, three and five years and submitted to the implant manufacturer who, in turn, submits them to the FDA. It is possible that silicone gel-filled implants may become more widely available in the future.

It is entirely possible to match the size of your breasts. First, you should consult with your breast surgeon and/or oncologist to see it they are comfortable with this decision. Your next step would be to consult with a plastic surgeon. During this evaluation, your plastic surgeon will examine you to assess the quantity and quality of the breast skin. Radiation therapy can lead to scarring of the remaining tissue of the breast. Thus, there may be limitations on the final size of the breast on the lumpectomy side. The easiest option would be placement of an implant. If the skin is deemed to be of poor quality, a flap (movement of skin with its own blood supply) may be necessary either with or without an implant. Surgery on the opposite breast, which may involve reduction, mastopexy, or mastopexy with an implant, may be necessary to achieve symmetry. Remember, the effects of radiation (skin discoloration, scarring, and uncertain healing) are chronic and slowly progressive over time. Your plastic surgeon is best able to discuss these options with you.

There is no health-related limitation to how much of a breast augmentation one can have. Breast implants per se are not harmful whether large or small. The size of implant that you choose should be a function of your height and chest wall width but mainly it should correspond to the body image that you see for yourself, i.e. do you see yourself as a "B" - cup, "C" - cup etc. Your surgeon can help you with your choice by showing you photographs of other patients who have had this surgery and by having you try on sample implants of different sizes by letting you insert them inside your bra. Then you can choose the size with which you feel the most comfortable.

In response to your question regarding the life expectancy of implants and decisions regarding replacement, Mentor Aesthetics, one of the 2 major implant manufacturers in the United States , has studies that show the deflation rate of saline implants is approximately 3 percent at 5 years and may be higher than 10 percent after 10 years. Although some implant manufacturers have estimated the life expectancy of saline-filled implants to be between 10-12 years, there are many patients who have had saline implants in place for over 30 years without any problems. I expect that a significant number of patients may have saline breast implants in place their entire lifetime without any problems. It is usually not difficult to ascertain if a saline implant has lost integrity or leaked, as the breast volume will decrease. The saline solution that would leak out of a deflated implant is the same as the fluid that runs through an intravenous catheter during surgery, and it is rapidly absorbed by your body. One potential hazard, which has been postulated, is the possibility of bacteria colonizing the inside of the saline implant and subsequently causing an infection if ruptured. I have never seen this, and the clinical incidence of this is probably insignificant. Aside from this potential hazard, there aren't many good reasons to replace a perfectly good implant on a routine basis. In my practice, I replace implants for problems such as rupture or capsular contracture and I do not recommend the routine replacement of implants. My incidence of implant replacement for rupture has been less than 3 percent over the past 10 years. In regard to your question, I would not recommend that you replace your breast implants unless you are experiencing a specific problem.

A prior history of keloids would likely increase the risk of a thicker scar with any skin surgery, and possibly an actual keloid. Options would include careful consideration of the location of the incision. One could consider an axillary (armpit) approach to keep the scar away from the breast and adjunctive techniques aimed at minimizing hypertrophic scarring, such as steroids and other therapies.