Your Questions
Your Questions
Q: I would like to know some information for breast augmentation. Specifically I need to know about the recovery time as well as any long term problems associated with breast implants.
A: Depending upon what kind of work you do affects recovery time after breast augmentation. For a less active sit-down occupation, one could return to work with 5 to 7 days. For more physical or strenuous activities, it may take 10 to 14 days until one is completely comfortable with those efforts. There are no restrictions after surgery other than one’s level of comfort. I place my patients on range of motion arm exercises beginning the first night after surgery. The more and the sooner you move your pectoralis muscles, the quicker you will recover and feel better. Breast augmentation is essentially two big pulled muscles. Like rehabilitation from any muscular injury, early active range of motion is important.
While breast augmentation is exposed to all of the traditional risks of surgery (infection, bleeding), those risks are relatively small. The biggest concept to grasp about breast augmentation is that it is an implant-driven operation…meaning that most of the risks long-term are related to having an implant. One has to recognize that the implant is not going to last forever, they will eventually ‘fail’ and need to be replaced. This is not a maybe, it is a certainty. It in just a question of when it will occur. On average, many patients experience 10 to 20 years of use before replacwmwnt of one or both becomes necessary. So one needs to bear in mind that all breast augmentation patients will over their lifetime have more than just the initial placement surgery.
Dr. Barry Eppley
Indianapolis Indiana
Q: Do you do fat injections for breast augmentations? I read your article and have already been in to be seen and I am planning to have surgery in June. Is this a possibility for me? I did not know about this before the time I had my breast augmentation consultation or I would have asked.
A: Fat injections for breast augmentation (FIBA) at this time is a procedure that is in a state of development. The reliability of the procedure and whom is the best candidate for it will take time to know better. The fairest statement one can make about the FIBA procedure is that the result can not guaranteed (breast volume and shape), can cost more than traditional breast implants, and may likely take two or three injection sessions spaced 3 to 6 months apart to get the desired result. Then there are the very real risks of fat necrosis and lumps throughout the breast.
To the best we know at this time, FIBA may be a reasonable alternative for a woman whose breast size goal is modest (B cup, maybe small C) and is willing to assume multiple procedures and the associated risks. This is not to mention that one must have enough fat to harvest on one’s body for transfer.
Compared to the success of traditional breast implants, FIBA is not for the vast majority of women considering breast enlargement today. It may be a different story (or not) five or ten years from now.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I’m considering a breast reduction with the hope of going from a 36DD to a C cup. The surgeon is anticipating approx 300 cc reduction on each breast. Will that leave me with a C cup or less?
A: I would have to say that this is a question that your surgeon should answer for you since he/she has actually seen you and is in a better position to answer.
That being said, a 300cc reduction in breast volume for most women will not take a DD cup down to C, let alone less than a C cup. A 300cc reduction is quite small and would not qualify for an insurance-covered breast reduction because of the small amount of breast tissue being removed. Unless you are quite a small person, this will not cause a significant reduction in your breast size. I would go back and revisit this issue with your surgeon as there appears to be different levels of expectations in the end result. Breast reduction is a significant operation that is changing breast size at the expense of permanent scars. You want to make sure that in accepting this trade-off you are getting the breast size reduction that you desire.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am the mother of 3 children and am soon to be age 35. After going through 3 pregnancies my breasts are definitely not what they used to be. They not only have gotten smaller but they seem to sag more now than before. With each pregnancy they have gotten progressively worse. I know that I need an augmentation but am uncertain if I need a lift also. How do you know if you need a breast lift when getting an implant?
A: An implant will do a great job of adding volume to a deflated breast but it will not lift up a sagging breast. This is contrary to what most women think an implant can do. When the position of the nipple is close to, at, or below the lower breast crease/fold, some type of breast lift will be needed. This is regardless of whether one is getting an implant at the same time. Without a breast lift, the implanted bigger breasts will merely drive down the position if the nipple and may even make it look worse. This can be predicted before surgery by carefully looking at the nipple position and the amount of loose breast skin. When lifts are done at the time of breast implants, the procedure is known as augmentation mastopexy.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I need breast implants to make my breasts more even. I think insurance should pay for them because I think my genes didn’t have them grow right. They are quite uneven. My left breast is about a C cup and my right breast is just a small B cup. I think two different sized breast implants would work to make them both D cups. What do you think are the odds my breast implant surgery will get covered by my health insurance?
A: Quite frankly, I think those odds are as close to zero as you can get. Despite your wanting breast augmentation to be a reconstructive procedure, it is not. Breast asymmetry, despite it causing some understandable anguish and embarrassment, is not viewed as a congenital deformity. (caused by ‘poor genes’) It is viewed by health insurance companies as both cosmetic and elective. There was a day many years ago when they may have in some severe cases prior to 2000, but those days have long passed now.) For insurance to cover breast implants, it would have to be done for reconstructive purposes which insurance views as due to cancer resection or a traumatic injury. Breast reconstruction is viewed as a medically necessary surgery in cases of lumpectomies and mastectomies. Incredulously, I have numerous cases today where insurance even fights covering it when cancer is involved!
Dr. Barry Eppley
Indianapolis, Indiana
Q: Dr. Eppley, I have a couple of questions for you. I had breast augmentation about 10 days ago. I am still a little swollen which I have expected. However, I can’t quite put my finger on it to describe it, but after wearing a bra for a while, I get the feeling like I am rubbed raw. But you don’t really see anything and it was mainly around the bottom of the bra. I even bought a bigger size around thinking that was the problem, but it didn’t seem to matter and again, you don’t really see anything so I couldn’t figure it out.
Over the past two days not only is it around where the bottom of the bra hits but on the sides of my breasts as well. I realized last night its like they are extra sensitive. I have worn a silky night shirt throughout the weekend up to last night. It didn’t bother me before but last night it was bothering me a lot. I had to buy a new one since my other ones no longer fit. Since it is bigger, it moves around when I walk etc. and moves over my breasts. It was very irritating to the point I was holding the nightie each time I walked so it wouldn’t move. So I realized, its like my breast are very senstive to anything moving against them like that…if this even makes sense. Its not like that if I touch them myself, but clothing. Is that normal and will it stop?
Also, I think I read I am not supposed to wear underwire bras. Is that only during healing time or never? All the bras I find in department stores look like my grandma would wear them and of course all the pretty ones are underwire. A friend suggested Victoria Secrets, so I plan to try there I just didn’t want to invest in a lot of bras until swelling, etc. is all gone so I buy what I really need, etc.
Thanks for your help.
A: You have inquired about two very typical issues after breast augmentation. The skin feelings that you are having are the tiny skin nerves, which have been temporaily disconnected or stretched, trying to recover. Think of it as the pins and needsl feeling you get when your foot falls asleep. That will typically subside around four to six weeks after surgery. That is different than some longer lasting numbness which may remain on the skin on the bottom part of the breast.
Not wearing an underwire bra for 6 weeks after surgery is to relieve any pressure on the healing inframmary incision It is also to make sure the breast implant and its lower pocket is not pushed upward as it is healing so the implant sits down in a more natural position.
Dr. Barry Eppley
Indianapolis Indiana
Q: I would like to get a breast reduction on just my right breast. It is a couple of cup sizes bigger than the left and its very painful. I think people notice and I can’t find a bra that fits right and looks good without one of my breast falling out. Also, I can’t wear any cute shirts I like and I’m very self consious when my husband sees it. I know I would be so much happier in life if they were both the same size. How much would it cost to get tissue removed from one breast so that they are the same size and that is all? Also what do I need to do to to get started? Please help!
A: Breast reduction can equally be done on just one breast as it is on two. It just takes half the time and close to half the cost of a two-sided breast reduction. When reducing just one breast, you have the ‘advantage’ of the other breast as the cosmetic goal. While perfect size and symmetry cam never be absolutely achieved, they can be made very close. The trade-off you make is that for better size and symmetry, the reduced breast will have fine line scars that the other breast does not. The best way to get started is to visit a plastic surgeon and discuss the specifics of your breast goals. On average, the cost of one breast reduction done as an outpatinet procedure will run in the range of $ 3500 to $4500.
Dr. Barry Eppley
Indianapolis Indiana
Q: I am interested in making my existing breast implants bigger. I am unsure as to whether it is better to just add more saline to my existing implants or to get new implants altogether. I currently have Mentor smooth round moderate plus saline implants which are 325cc. I am fairly small being 5’ 3” and weigh 108 lbs. I started out as an A cup and am now a C cup. Would adding 50cc to my implant make enough of a difference?
A: The answer to your question can be partially deduced by analyzing the percent change by ratio assessment. With existing 325cc implants, an additional fill of 50cc will make a 15% change in their volume. This will make a noticeable size difference with your small frame but don’t expect it to make a 1/2 or full cup size difference. Also, further saline fill will make the implants feel a little firmer. Assuming that the base size of your implants was 325cc, an additional 50cc will not make them feel abnormally firm. This is a good approach to enhance what you already have for a little ‘perk-up”. But if you are looking for a significant difference in breast size like a D cup, you will need to redo your breast augmentation with new implants that have a larger base size.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I am 24 years old, 5′ 4” tall, weigh 135lbs, and have 38DD breasts. Am I a good candidate for breast reduction and could it be covered by insurance? My back, shoulders and neck are always sore and I get migraines in the back of my head all the time. I wear loose clothes to hide my hideously large breasts and I would never even think of wearing a swimsuit for fear that I might fall of it! I just want to be physically and emotionally happy, but its hard with my unproportioned body due to my large breasts. Insurance is the only way possible for this surgery to happen if I qualify.
A: Based on the size of your breasts and your height and weight, it would seem likely you’re your breast reduction would qualify for insurance coverage based on my experience. But whether one’s medical insurance will provide can not be determined by your plastic surgeon. Insurance coverage for breast reduction requires a predetermination letter to be sent by your plastic surgeon with specific qualifying information. Your height, weight, breast cup size, history of medical symptoms associated with your large breasts, what non-surgical treatments have been attempted, and how much breast tissue in grams is to be removed is the needed information. This letter, complete with photographs of your breasts, will be submitted for their review. They will then determine if you qualify and their decision with be returned by letter to you in about 4 to 6 weeks after submission.
Dr. Barry Eppley
Indianapolis, Indiana
Q: I had saline breast implants placed two months ago. Today I felt the implant at the bottom of my breasts. When i touch the bottom of my breast I feel the implant itself. I don’t know if this is normal or not?? Please advice.
A: The feeling of saline implants at the bottom of your breasts could be one of two phenomenon. First, it is likely it is completely normal if it is present on both sides. Initially breast implants can be initially high and then they eventually settle lower. Because the implant is only partially covered by the pectoralis muscle (the upper half), the bottom pole of the breast has the implant covered by just skin and whatever breast tissue you had to start with. Since saline implants will usually develop a little rippling in the implant shell, this is most palpable at the bottom and the sides of the breast. This is initially not able to be felt because of the tissue swelling and skin stretching which takes several months to go away. Since you are two months out from surgery, you are exactly in the time frame when this will occur. The other possibility, particularly if it has happened on just one side, is that one of the implants has bottomed out. (dropped too low) You would know this because the breasts would be asymmetric. (unless it has occurred on both sides) But either way, it would be apparent because the implants look too low. That is a surgical (revisional surgery) problem.
Dr. Barry Eppley
Indianapolis Indiana
Q: I would like to have breast augmentation. I have never had because I feared the curvature of my spine might be a problem. I have curvature of the spine, two curves to be exact. I have NEVER really had any problems with it. However, I am not even an A cup and want to go to a D cup. Any issues I should be aware of??
A: Curvature of one’s spine could pose two potential problems for breast augmentation, although neither is preventative from having the operation. The first issue is the potential impact of any significant curvature might have on the lungs or pulmonary capacity. If severe one would have some obvious pulmonary restrictions and this could be a problem for general anesthesia. But your curvature does not sound that severe since you have never had any known problems with it. The second issue is an aesthetic one. Curvature of the spine may give the chest some asymmetry when standing which could give the breasts small differences in size or horizontal position. Any breast asymmetry from spine curvature could be magnified when the breasts become enlarged, particularly up to a D cup size. While all breast augmentation patients must accept the risk of implant asymmetry, that risk may be increased in patients with visible spine curvatures. Short of these potential issues, I see no other issues that would not be standard in you having breast augmentation.
Dr. Barry Eppley
Indianapolis, Indiana