Click on the appropriate question below or scroll down on the webpage for answers to Frequently Asked Questions
8. What is the difference between putting implants “under” the muscle (submuscular) and “over” the muscle (subglandular)?
1. Who is a candidate for breast augmentation?
To be a candidate for breast augmentation, you need to be physically healthy and have a good idea that breast implants will enhance the appearance of your body. Breast implants should not be sought to please someone else such as a spouse or a boyfriend or as a “quick fix” for other issues.
The best candidates typically are women who over a long period of time have had a desire to increase the size of their breasts to improve the shape of their body, fit better in a dress and clothing styles and otherwise to better proportion their body. Good candidates also are women who may have delivered and breastfed one or multiple children and have had significant changes in the shape, size and appearance of their breasts as a result.
Contrary to popular opinion, most women seeking breast augmentation live ordinary, everyday lives and otherwise work as householders, secretaries, teachers, professionals, mothers, nurses, lawyers, flight attendants, doctors, etc.
2. Who should not have a breast augmentation?
A woman should not have a breast augmentation to please someone else or to save an otherwise failing relationship. Implants should be placed only for her own self-image, not a perceived image that she has of someone else.
3. Should I wait to have a breast augmentation until after childbirth?
The decision to have a procedure is a personal one. There is never a “right” or a “wrong” time. A woman may enjoy the results of an augmentation prior to her decision to have a family. Breast augmentation will be unlikely to change the ability to breastfeed a baby. However, there is a slight risk that sensation could decrease following augmentation and may possibly interfere with the reflexes required for breastfeeding.
Breasts, whether they are augmented or not, will often lose volume and fall after the increase and subsequent decrease in size after childbirth and breast feeding. This volume loss may occur due to natural hormonal changes and may occur whether or not a woman actually breastfeeds her baby.
4. What are the different types of breast implant incisions and which one should I have?
The placement of incision for breast augmentation is highly individual and falls into four categories:
- Underneath the breast in the breast fold.
- Around the nipple and areola.
- In the axilla (armpit).
- Through the bellybutton.
This is a very frequently asked question from women who have never had breast implants, and they tend to worry quite a lot about where the incisions will be. However, it is extremely unusual for any woman to have issues or complaints with the appearance or location of the incisions after the surgery is completed and the incisions have healed.
Most breast implants placed in the United States are placed through an incision around the nipple or underneath the breast. The advantage of these approaches are that the position of the breast tissue in relation to the breast muscle and implant can be better and more accurately shaped from these approaches. This can allow a “dual plane” procedure to be performed where the implant is partially or mostly placed underneath the muscle with only a small amount of exposure underneath the breast tissue itself. This provides for a greater chance of a better result and a more natural appearing augmented breast. These approaches are also hidden in even a very tiny bikini as they are placed underneath the standard bikini lines.
The axillary (armpit) approach is used by some surgeons. It is more difficult to shape the breast tissue from this and implants tend to sit higher in the chest and take longer to come down to the proper position lower in the breast on the chest wall. These incisions typically also heal quite well, although they may be visible in a bikini or tank top.
A bellybutton (umbilical) incision has also been touted by some surgeons as a new way to “keep an incision off the breasts.” Special instrumentation is required and a long tunnel is made underneath the skin to place the implant in the breast. This approach carries significant disadvantages, including the fact that only saline and not silicone implants can be placed through this approach. It is also much more difficult to place an implant underneath the muscle using this approach and it is much more difficult to release the pectoralis (chest wall) muscle properly for optimal implant placement, especially without lifting or tearing the muscle.
5. Will breast implants interfere with a mammography?
Breast implants may interfere with mammography readings in some patients, primarily those that have implants which are placed subglandularly (above the muscle). However, this obstruction is greatly reduced with submuscular implants (behind the muscle). This is a very important issue for a woman with a strong family history of breast cancer.
6. What is the recovery time following surgery?
Recovery times for breast augmentation vary considerably, however most of Dr. Granzow’s patients return to the majority of their normal activities 48 to 72 hours after surgery. Dr. Granzow will discuss this in further detail with you at your first consultation.
7. Will breast implants interfere with physical activities?
In the long term, breast implants are unlikely to affect range of motion, muscle strength or other physical abilities.
8. What is the difference between putting implants “under” the muscle (submuscular) and “over” the muscle (subglandular)?
During breast surgery, breast implants can be placed under the pectoralis (chest wall) muscle (submuscular), or between the breast tissue and chest muscle (subglandular).
Most surgeons place most breast implants submuscluar, or underneath the chest muscle as this makes the contour, especially in the upper inner portion of the breast, which is the “cleavage” area, better and provides a more natural shape in that region. It will also smooth out and improve the appearance of an implant in women who are thinner or requesting larger implants. Breast cancer surveillance and mammograms after breast implants are also easier to perform for implants placed underneath the muscle.
Subglandular placement of breast implants means that your implants are inserted closer to the surface, underneath the existing breast tissue, but atop the pectoral muscle.
An subglandular implant placed directly underneath the breast then will look “more like an implant” and look more full and round especially in the upper inner area. Also, it is easier in the short run to correct the “sagging” or ptotic breast with a subglandular (over the muscle) implant to try to avoid a breast lift. It can be very difficult to change an implant from a position on top of the muscle later to a position underneath the muscle without a breast lift.
Subglandular placement has been thought by some to increase the potential for a condition known as capsular contracture, in which the scar tissue surrounding the implant tightens around and squeezes the implant, causing it to harden. In cases of capsular contracture, you may need additional surgery to remove the capsule tissue or replace the implant.
Mammograms are easier to perform and read and there is a decreased risk for capsular contraction with submuscular implants.
Depending on the size of your breasts and the distribution of breast tissue, subglandular implants may be more noticeable. WIth but submuscular and subglandular implants, if there’s insufficient breast tissue to cover the implants, you may find that you can feel and sometimes see the edges of the implants under their skin. Saline implants are more likely to be seen in such a way than silicone implants
9. What size breast implants should I get?
The size of implants you choose depends on a number of factors, including your ultimate appearance goals and your individual frame. Just as the same bra or even a T-shirt may fit different individuals completely differently according to their chest size and shape, the same size implant may look completely different from patient to patient. During the consultation the implant size and placement will be carefully chosen to fit each patient individually.
10. Do my breast implants need to be replaced every 10 years?
Breast implants do not need to be replaced after 10 years or any other specific time period. Although the exact source of this statement is uncertain, this is a myth possibly related to the fact that some models of older implants carried warranties which lasted only 10 years.
11. What are “gummy bear” breast implants?
“Gummy bear implants” is a term often heard to describe silicone gel implants which are firmer than average and hold their shape more closely. The implication is that some current breast implants do not hold their shape. In fact, all silicone breast imlpants currently sold in the USA are contain some form of cohesive silicone. This means that a current US silicone implant which is cut in halfon a table will still hold most of its original form without the silicone material inside simply running out. The material inside has the consistency more of a “gummy snake” than, for example, maple syrup. Implants containing such syrup-like liquid silicone are no longer sold in the USA. Both silicone and saline implants may leak, although this is unlikely.
12. Are silicone implants safe?
Properly performed studies reported in the medical literature have failed to show any differences between the safety of silicone filled and saline filled breast implants. For a more complete discussion of this topic please click here.
13. Is there a chance that I might lose sensation in my nipple after breast augmentation?
The chance of losing nipple sensation, or sensitivity, after breast augmentation is present but it is quite low. Overall, the chance of losing sensation in one or the other nipple is several percent.
14. Can a sagging breast be “lifted” with placement of a breast implant?
Most breasts will be “lifted” at least moderately with the placement of a breast implant. The degree to which this happens is quite variable and depends mostly on the individual characteristics and stretch of a woman’s skin and the size of the implant that’s placed. Dr. Granzow will review these questions carefully with you during the consultation.
15. Will insurance pay for my breast augmentation?
Medical insurance covers procedures that are reconstructive and not cosmetic in nature. Breast implants placed purely for cosmesis or for enlargement of breasts are typically not covered by insurance companies. Implants typically are covered for patients who have or are undergoing treatment for breast cancer or for implants in the breast opposite to the one that has had cancer or breast reconstruction. Otherwise most breast augmentations are not covered by insurance.
16. What are the risks associated with breast augmentation?
The following risks of breast augmentation are inherent to the procedure itself, regardless of the surgeon or location of the procedure.
While they are rare, standard surgical risks intrinsic to any surgical procedure include breast augmentation, include reaction to anesthesia, bleeding, infection and poor healing. Other risks which occur rarely include permanent loss of sensation in the nipples or areas of breast skin or the need for additional revision surgery due to aging and the effects of gravity. Complications are uncommon and include:
Capsular contracture refers to the formation of scar tissue around the breast implant. This is a normal part of the healing process, and in the vast majority of cases, presents no problem to the patient. In some cases, however, the body creates too much scar tissue, which can squeeze of the breast implant so that it hardens and becomes painful.
In cases of such excess capsular contracture, the surgeon can perform one or more additional procedures t oremove the excess scar tissue.
Obstruction of Mammography
Particularly in the case of implants placed subglandularly, breast implants may obstruct mammography results. This obstruction is less in the case of submuscular implants.
Regardless of the placement of the implant, however, it is important to inform the technician performing your mammogram of any breast implants, so that he or she can adjust the procedure to avoid these problems.
While breast implants are carefully designed and regulated to stay intact, the possibility still exists that an implant will leak. Implant rupture is unlikely during normal activities.
Rrippling is an effect that takes place when a breast implant becomes settled and pulls on scar tissue, causing a rippled appearance on the surface of the breast.This is more common with saline implants.
Rippling can occur in implants either above or below the pectoralis muscle, although it is more common in implnats placed above the muscle..