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Breast Augmentation

Breast augmentation is a procedure that enhances the shape, size, and proportions of a woman’s breasts using implants.

Beautiful Breasts. Not Just Bigger

Should You Consider Breast Augmentation?

Breast augmentation can create beautiful breasts that can enhance and restore balance to your figure and increase your self-confidence.*

Are You A Candidate?

Our Breast Enhancement Cosmetic Self Evaluation can help you decide if breast augmentation is the right procedure for you.

TAKE OUR SELF EVALUATION

Overview

Breasts That Are Beautiful, Not Just Bigger

Breast augmentation is the single most popular plastic surgery operation chosen by women in the US.

Breast augmentation can create beautiful breasts that can enhance and restore balance to your figure and increase your self-confidence. From work outfits to evening wear to swimsuits and lingerie, clothes will fit better, your figure will be more balanced, and your breasts more attractive.

It is very important to choose a surgeon who has a similar innate aesthetic to your own. If you want breasts that have a bulge on the top and look like a grapefruit, then Dr. Fan would not be your best choice. But if you want to have breasts that will look gorgeous clothed or undressed, then San Francisco's leading breast augmentation plastic surgeon, Dr. Larry Fan is a great choice.

Read on to learn more about Dr. Fan’s expertise and approach to breast augmentation. 

 
 

Two More Quick Questions

Candidates

The ideal breast augmentation candidate comes from one of two groups:

  • Women whose breasts never developed proportionately, are limited in the clothing they can buy, and who would like more confidence in their appearance.
  • Women who have lost breast volume after breastfeeding and want to restore what was lost and fill up what may have become an empty breast.

Women whose breasts are not just small, but are misshapen, are also good candidates for breast augmentation.

Women who want to be large and disproportionate, the “Baywatch look,” make up a small percentage of women who get breast augmentation.

Women with drooping breasts may require a breast lift.

All women who are considering breast augmentation should be doing it for themselves, not for a boyfriend or spouse.

You must be healthy enough to undergo an elective operation and mature enough to weigh the risks and benefits of surgery.

Are You a Breast Augmentation Candidate?

Procedure Steps

Procedure Planning: Careful Planning is A Critical Step

Perhaps more than any other plastic surgery procedure, breast augmentation requires careful preoperative analysis and planning. Dr. Fan uses a consistent, proven, and highly effective method for measuring your tissues to determine your ideal implant size. He will also discuss with you other important choices related to your procedure including; implant type, implant size, implant shape, implant texture, incision location, and pocket location, which you can read about more in our FAQ section.

Step 1: Anesthesia

Medications are administered for your comfort during your surgical procedure. The choices include general anesthesia and intravenous sedation. Dr. Fan will recommend the best choice for you.

Step 2: The Incisions

Incisions are made to gain access to the breast so that a pocket can be created for each implant and the implants are placed through the openings. The incision can be made in one of four places:

  • Inframammary crease: Underneath the breast, just above the crease
  • Transaxillary: Within the armpit, where the arm meets the chest area
  • Periareolar: Around the lower edge of the areola, which is the dark area surrounding the nipple
  • Transumbilical: In the navel, ie. belly button

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Incision Options for Breast Augmentation

Incisions vary based on the type of breast implant, degree of enlargement desired, your particular anatomy, and your preference.

It is important to note that no single incision / approach is universally considered preferable for all patients. Dr. Fan is skilled with all four approaches and will help you decide which incision options are appropriate for your desired outcome.

Step 3: Inserting the Implant

After the incision is made, a breast implant is inserted into a pocket that is created either:

  • Under the pectoral muscle (subpectoral placement)
  • Over the pectoral muscle and behind the breast tissue (subglandular placement)
  • Partly under the pectoral muscle and behind the breast tissue (dual plane placement)

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Under The Muscle vs. Over The Muscle Placement of Breast Implants

Positioning of the breast implant depends on the type of implant, degree of enlargement, and your body type.

Placement of implants under the muscle may interfere less with mammograms and breastfeeding and are associated with lower rates of capsular contracture.

Dr. Fan will help you decide which positioning is appropriate for you.

Step 4: Closing The Incisions

Incisions are closed with layered sutures.

Once healed, the incision lines from breast augmentation are typically concealed in inconspicuous locations.

Breast augmentation usually takes one to two hours to perform. While it is technically possible to perform the surgery as quickly as 20 minutes, we believe that performing a careful, precise dissection with full control of bleeding and meticulous pocket control leads to better results. You will typically be discharged home after surgery.

Some women will require a breast lift.

Breast augmentation is often combined with liposuction and a tummy tuck as part of a Mommy Makeover procedure.

Benefits: The end result of breast augmentation is fuller and more shapely breasts.

Tradeoffs:

There are a few main tradeoffs for breast augmentation:

  • Need for Future Procedures: Breast implants are designed to last for many years, but there is a chance they may break or develop issues with ripples, malposition, sagging, scar tissue, etc. It is more likely than not over the course of your lifetime that one of these problems will arise. If one of these problems arise, you will need to have another procedure.
  • Need for Special Mammograms: Breast implants are considered safe and not known to cause cancer, but you will need to undergo special mammogram views when undergoing mammography for breast cancer screening.
  • Your breasts will have a different feel or consistency to them after surgery. For most women, this is a positive change, as their breasts will feel more full and shapely than ever before.

Women are often worried about looking unnatural or “fake.” This is avoided by choosing an implant sized appropriately for your tissues.

Read More: How to Get Natural-Looking Breast Implants 

Recovery

Rapid Recovery After Breast Augmentation

With our careful technique and attention to detail, many patients can return back to normal activities within 24 hours.

However, it is important to realize that breast augmentation surgery stretches the breast tissue and can be uncomfortable. The highest level of discomfort is typically experienced within the first 24-48 hours after surgery. Your pain level will typically decrease each day, and you will be given medicine to help alleviate the pain. You should expect mild to moderate swelling and possible bruising. The breast implants often ride high early in the postoperative period and may take two to four months to settle into final position. The recommended time off work is typically three to seven days.

Dr. Fan will give you specific instructions that will include how to care for the surgical site, what medicines to take to aid healing and reduce the potential for infection, what activity limitations to follow, what concerns to look for at the surgical site or in your general health, and when to follow-up with our office.

Dr. Fan will also discuss with you how long it will be before you can return to vigorous activities and exercising.

It is important for your safety and outcome to return to our office at prescribed intervals after surgery and whenever you have any questions about your healing and results.

You can find more detailed information about your aftercare and recovery here: What To Expect After Breast Augmentation Surgery

Choose Your Surgeon Wisely

It is very important to choose a surgeon who has a similar innate aesthetic to your own. If you want breasts that have a bulge on the top and look like a grapefruit, then Dr. Fan would not be your best choice. But if you want to have breasts that will look gorgeous clothed or undressed, then read on to learn more about Dr. Fan’s expertise and approach to breast augmentation.

Dr. Fan’s Approach to Breast Augmentation Surgery

Dr. Fan’s approach to breast augmentation is the result of years of study, research, and practice.

He is known for his exacting surgical technique and his highly refined aesthetic sensibilities born out of a passion for art. Together, these skills allow Dr. Fan to create breasts that are natural and simply beautiful.

Beautiful, Proportional, and Natural Breasts

Dr. Fan’s highest priority is creating beautiful, proportional, and natural results that last, leaving your tissues undamaged so that your breasts remain attractive for decades. As a surgeon who sees many women for revision of earlier breast augmentation procedures, he is particularly sensitive about avoiding surgical decisions that can lead you to long-term complications.

It is with great precision, planning, execution, and attention to detail that Dr. Fan’s breast augmentation patients just look beautiful and proportional, with nothing obvious or unnatural about their appearance.

You will not wake up from surgery with breasts that are bigger or smaller than you expect because you will understand and participate in every decision made about surgery. You can rest assured that it is Dr. Fan's highest priority to give you a safe and clinically excellent procedure that results in the most beautiful breasts possible.

Read more about Dr. Fan's San Francisco plastic surgery center.

 

Cost

Exact Costs Vary Depending On Your Specific Needs and Desired Results

The cost of breast augmentation varies from person to person and depends on a number of factors including your specific needs and desired results.

Factors that contribute to the cost of treatment include:

  • Your particular needs and goals
  • The specific type of breast augmentation procedure chosen
  • The type of breast implants chosen
  • The experience and reputation of the plastic surgeon
  • Any advanced technology or surgical techniques that may be used
  • The geographic location where the procedure takes place
  • The surgical facility used
  • The type of anesthesia a patient selects

Costs of surgery may include fees for the surgeon, anesthesia, operating room, facility, equipment, implants, garments, aftercare, lab tests, and medications.

The cost for breast augmentation ranges from $8,000 to $15,000.

For breast augmentation patients from outside the San Francisco area, travel and accommodation costs should also be considered.

We offer a range of patient financing plans including low monthly payment plans and plans for those with suboptimal credit histories.

You can find more information about our Financing plans here

See Your Results

Get The Boost You’ve Always Wanted

The results of breast augmentation are immediately visible.

Final results will be visible over the course of a few months as swelling dissipates and your tissues relax.

Breast augmentation will help you obtain fuller and more shapely breasts. Women are often worried about looking unnatural or “fake.” This is avoided by choosing an implant sized appropriately for your tissues.

Most women have at least minor degrees of natural breast asymmetry. It is common for these asymmetries to persist after breast augmentation.

Dr. Fan is known for his artistic eye, expert hands, experience, and meticulous attention to detail. He is also known for his outstanding breast enhancement results.

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Actual Patient Before and After Breast Augmentation*

 

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Actual Patient Before and After Breast Augmentation*

 

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Preview Your Breast Augmentation with 3D Imagery

New breakthrough technology enables 3D Before & After imagery for your Breast Augmentation.

Crisalix 3D is a cutting edge software that can simulate a visual and realistic result for breast surgery patients.

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Breast Augmentation FAQ

What are the most important factors to consider in deciding whether or not to get breast implants?

Like most life decisions, it is important to weigh the risks versus the benefits. Each woman will perceive the risks and benefits for herself differently. On the positive side, breast augmentation patients report higher self-esteem and confidence after surgery, enjoying their appearance more both in and out of clothing. But that must be weighed with the recognition that in all likelihood this is not a “once-in-a-lifetime” procedure – at some point, a revision may be necessary. Complications such as infection or bleeding after surgery can occur. Scar tissue can form around implants; implants can break; implants can move away from the proper position; there may be additional costs in the future; there can be changes with mammograms, and much more that each woman considering breast augmentation should consider. Despite all of these trade-offs, women are usually so happy with their implants that even when one of these problems arise, they are rarely willing to give them up.

Do you recommend saline, regular silicone, or cohesive silicone “gummy bear” implants?

Few patients ask for saline any longer. There are only three reasons for saline implants: they are less expensive, they can be introduced through smaller incisions, and some patients – despite all the evidence proving silicone is safe – remain skeptical. Regular silicone is the softest implant and is often a good choice for women who want the softest feel. The ‘gummy bear’ implant comes in both round and teardrop shapes. They have a firmer gel, which may give a better shape and may last longer. The round gummy bear implant is often a good choice for women with looser tissues who want a more durable implant that remains soft. Dr. Fan often recommends teardrop implants to women who want a very proportional augmentation and whose tissues are relatively tight.

Read More: Saline vs. Silicone vs. Gummy Bear Implants: which is Best?

How do I determine what type of implant is best for me?

There is a misunderstanding that round implants always create a round breast and teardrop implants always create a natural breast; this is not true. If a round implant is of the proper size, it can look beautiful. If a teardrop implant is too big it will look bulgy on the top and fake. So the determination of what implant is best is not based upon the shape. Dr. Fan tends to suggest tear drop implants more in a patient with a tighter envelope and round silicone implants more often in someone with a looser envelope. 

Read More: The Pros and Cons of Breast Implant Types

Will you use smooth or textured implants?

All teardrop implants are textured to help maintain their proper orientation in the body (the thin end up top and the thick end down on the bottom.) With round implants, we typically recommend smooth in most situations. There is a widespread misperception among many plastic surgeons that texturing reduces the chances of scar tissue formation (capsular contracture.) This is only true – and minimally significant – if the implant is in front of the muscle, which is uncommonly done today. But even in that situation, there is a significant trade-off to consider, which is that textured round implants are more prone to develop folds that can be felt than smooth implants because of the slightly thicker and stiffer shell. In Dr. Fan’s experience, more patients with textured implants have this problem than smooth patients have the problem of hardening, but this is an issue we discuss with all patients getting implants in front of the muscle.

Read More: Smooth vs. Textured Breast Implants: Which is Best?

What is the best size implant for my body?

There is an ideal shoe size for your foot. Too small and your foot will be crammed and too large and your foot will not fill the shoe. The same thing is true with breasts: too large and it will look round and fake; too small and it will be loose and empty on the top. If you are reading this, it is probably because you thought the photos of our patients looked beautiful. The common denominator to the most beautiful breasts is that they were sized objectively on the basis of measurements. Dr. Fan measures ten things, and from that he uses a formula to determine the ideal size. This formula has been published and thoroughly vetted by top plastic surgeons.

This remains one of the biggest concerns of every augmentation patient, so it bears repeating: there is an ideal implant size for you. You can go smaller, but you won’t be filled up. You can go bigger, but you will look round. Think of a soft-sided purse: if you put only a couple of things, it will collapse and lose its shape. If you shove a lot of stuff into your purse, it will always look round. With a breast, the shape changes as the volume changes meaning you cannot have the same shape with any volume. If you want to look relatively natural, there is a limit to how large you can go. If you want to look relatively filled, there is a limit to how small you can go.

Sometimes Dr. Fan measures a patient and they want to look smaller than what anatomically is the ideal size for their breasts. That is okay, so long as they understand their breasts may not be totally filled up, and that they may be empty on the top.

At other times he measures a patient and they want to be larger than that ideal size. If they do go larger, they face two tradeoffs. The first is that they will look rounder and less natural. The second is that the size and weight of an implant that is too large for their tissues will more rapidly stretch their skin over time and compress their own breast tissue, leading to rippling, an implant that can be felt, and perhaps the need for a lift in the future.

Read More: Choosing the Best Implant Size for Your Frame

Can implants help fill out drooping, sagging, or deflated breasts?

If a breast is simply deflated or empty, falling back against the body, then an implant can fill it up. If the breast has drooped or sagged, with either the nipple low or tissue hanging down beneath the fold under the breast, oftentimes a lift is needed.

What is the best incision to use when inserting breast implants?

Many patients decide on the incision location based upon where they want the scar. However, the risks and complications of each approach are different, and these issues are more important than the scar.

The inframammary incision is most popular. The incision under the breast is generally recognized as the best approach for a number of reasons. It is very versatile, gives excellent access to the breast, and can be used for virtually all breast augmentation procedures including challenging cases such as misshapen breasts, tight tissues, and revisions. The incision is hidden in the crease of the breast; there is less contamination with bacteria; more nerves are avoided; the breast tissues are usually not cut so there may be less pain; the incision can be used for revision procedures.

The armpit incision is a popular choice for women who would like to avoid scars on the breast. This is can be a good choice for some, but not all, patients. This approach is best suited for thin patients with little natural breast tissue who desire a small to medium augmentation, where there is an insufficient inframammary fold to hide the crease incision. The transaxillary approach is not well suited for women with abnormally shaped breasts or those who desire a large or very large enhancement. If you are going to select the transaxillary approach, make certain that the procedure is performed using a small camera called an endoscope. Using an endoscope is a critical part of using this technique because it allows the surgery to be performed under direct vision so that a precise pocket can be created and bleeding is minimized. By contrast, the traditional non-endoscopic technique is performed using blunt dissection that is performed blindly, which, as you can imagine, leads to a lot more bleeding, a less precise implant pocket, and improper release of the pectoralis muscle. The endoscopic technique produces significantly better outcomes than the traditional non-endoscopic transaxillary approach including a lower risk of implant malposition and capsular contracture. Dr. Fan is one of a small number of surgeons in the country who is skilled at performing transaxillary breast augmentation using the endoscopic technique. His results are excellent with this technique.

The nipple incision yields a scar that is barely visible on most but not all Caucasians, but on patients of other races it very frequently gets pigmented and thick. It often results in a reduction of muscle coverage over implants due to technical issues, which means the implant can be more seen and felt. By cutting through the breast tissue, there is more pain, swelling, and changes in nipple sensation. Most important of all, is the fact that this incision requires pushing the implant through the breast. Though we do not really think about it, the ducts within the breast have bacteria within them. When the implant goes through the ducts, those bacteria get on the implant. And it is exactly those bacteria that cause the inflammation that causes capsular contracture. This remains the leading cause of revision surgery after breast augmentation, and it should be a priority to do everything possible to reduce this possibility. Significant experimental data demonstrate this to be true.

The transumbilical approach is generally not recommended, as control of pocket creation and bleeding are suboptimal. This results in suboptimal outcomes including higher rates of capsular contracture and malposition. The transumbilical approach is also limited to use of saline implants.

It is important to note that no single incision / approach is universally considered preferable for all patients. Dr. Fan is skilled with all four approaches and will help you decide which incision options are appropriate for your desired outcome.

Read More: What You Should Know About Breast Augmentation Incisions

Will There be Scars?

Whenever the skin is cut there will be a scar. If you cannot tolerate a scar, you should not have the surgery. While some patients like the idea of the armpit incision since there is no scar on the breast, the scar may be visible with a sleeveless blouse or dress. Some patients like the idea of a scar around the areola, and unless that heals very well, there is a very conspicuous “smiley face” in the area of the breast that is the focus of the most attention. The underneath scar usually is very faint. But even if it is not it is at least hidden in the crease underneath the breast.

Will you place the implants in front of or behind the muscle?

You must accept a risk of some loss of sensation. The most common area to lose sensation is on the skin of the lower outer quarter of the breast. Whether this happens is related to the course of the nerve to this patch of skin. Less common, but more important, is whether sensation is lost in the nipple. The nipple incision is more apt to create this problem, but with all incisions this is a risk because the major nerve to the nipple comes from the very side of the breast, and any dissection puts this nerve at risk. The larger the implant, the wider the pocket has to be, and the greater the chance of this damage. The less accurate the dissection, the greater the risk of this problem. But even when everything is done perfectly, some women can permanently lose sensation and all patients must be able to accept that risk before proceeding.

Can I get regular mammograms after a breast augmentation?

Yes, but you usually need to get extra views, called displacement views. So you will get a complete set the usual way, and then another set with the breast tissue pulled forward, away from the implants. Sometimes the implants shadow a part of the breast tissue. Depending upon how significant this area is and your risk factors, the radiologist may order you to get an ultrasound or an MRI in addition to the mammogram. While insurance companies pay for a standard mammogram, some do not pay for the extra views or extra studies needed because of the breast implants.

Is my risk of breast cancer higher if I get implants?

No. The risk of breast cancer does not change if you have an implant. And the cancers are not detected later, larger, or with a worse prognosis. In fact, by having the uniform implant behind the breast tissue rather than the irregular rib cage, it is easier to feel the breast tissue and more breast cancers are picked up by the patient with implants than those without.

Will my breasts look fake?

They will only look fake if you want them to look fake. If your implants are properly sized for you, then they will not look fake. The only exception to that is patients who are literally skin and bones, upon whom you can see their ribs. The implant goes in front of the ribs, so if you can see the ribs, you will have to see the implant. But even in those cases, the lack of breast tissue is so profound that a small implant will usually look much more attractive.

The thicker the tissue and the smaller the implant, the more natural they will look. The thinner the tissue and the larger the implant, the more fake they will look. So the answer is to have your tissue measured, and to get an implant that fits your body.

Read More: How to Get Beautiful, Natural-Looking Breast Implants

How long will my implants last?

How long implants last and how long it will be until you have your next surgery are two different issues that are often confused. A broken implant is not even in the top five reasons for having a revision. The most common reasons patients have another surgery is the build up of scar tissue, drooping, implant getting out of position, wanting a change in size, etc. Implants only break at a rate more or less of 1% per year. Sometimes those breaks can be noticed as a change in the breast. At other times the patient cannot detect a difference and the break can only be detected by an MRI.

If my saline implant ruptures will I get sick or be deformed?

When a saline implant breaks, it usually deflates over a period of days or weeks. There is nothing dangerous about it, but you will look very unbalanced.

If my silicone gel implant ruptures will I get sick or be deformed?

Sometimes when a silicone gel implant ruptures the breast feels different. Sometimes harder, but more often there is less of a sensation on careful examination of the discrete borders of an implant, but rather a more amorphous feel to the breast. While we recommend that a woman with a ruptured silicone implant have the implant removed and replaced, there is no evidence that a ruptured silicone implant will make you sick.

If my cohesive ‘gummy bear’ silicone implant ruptures will I get sick or be deformed?

It is uncommon for these implants to break, but they can. Sometimes a break is detected on MRI and the patient and surgeon noticed no difference. Sometimes there is a change in shape or feel. We do recommend that they be removed and replaced, but there is no evidence that a ruptured gummy bear implant poses a threat to your health. 

Will I be able to breastfeed after I have an augmentation?

There is a slightly higher chance you may have difficulty breastfeeding, particularly if the nipple incision is used, but in the scores of patients of our own who have had implants we cannot recall any who were unable to nurse.

Read More: Can You Still Breastfeed With Implants?

Will I need to replace my implants after pregnancy?

Occasionally after nursing the skins stretches and the breast looks empty. Sometimes capsular contracture develops. Sometimes the breasts droop. For these problems, a revision may be necessary. But most of the time augmented breasts still look beautiful after pregnancy and do not require a revision.

What should I bring with me the day of surgery?

After you have scheduled surgery, you will be given a detailed list of what you need to bring. But you do not need to bring a special bra or anything in particular with you.

Read More: Getting Ready for Breast Augmentation Surgery

How painful is the recovery?

Most of our patients go out to dinner and shower the night of surgery, needing nothing more than Ibuprofen (Advil, Motrin) for their pain. Most describe it as a pressure, or a weight on their chest, much as if they had worked out hard or their milk was coming in. However, it should also be recognized that pain is a very subjective experience, and everybody is different.

Read More: Breast Augmentation Recovery: What to Expect

How soon can I go to work?

When you will feel ready to do your job is highly individualized. Most patients are able to return to work after three or four days. Some people go back even sooner, and many work from home the next day. If your job involves heavy lifting or straining, you will need extra time.

Read More: Breast Augmentation Recovery: What to Expect

When can I drive?

You can drive when you are off of all narcotic pain medication and feel totally unrestricted by your discomfort such that you could make any movement you might need to safely drive your car. That is ultimately a decision that we cannot make for you.

When can I travel by airplane?

There is nothing about an airplane ride that is inherently problematic. The issue is whether you are going to a place where there is a doctor who can take care of you if you develop a problem. If you do get on an airplane, train, prolonged car ride, etc. within one month of surgery, it is recommended that you get up and walk every two hours and perform leg exercises while sitting to reduce the chance of developing blood clots in the legs.

When can I resume exercise?

Dr. Fan will instruct you to wait 4 weeks before exercising. We want to minimize the chance of developing a problem with healing. There is always a greater chance of causing bleeding if you start much before that time. When you start, use common sense and listen to your body. You will be a little out of condition and a bit sore, so start lightly and increase your conditioning gradually.

Exercise is considered to be elevating your heart rate or blood pressure, breathing hard, straining, or sweating. Light walking is okay and in fact beneficial starting the day of surgery.

Read More: Breast Augmentation Recovery: What to Expect

When can I lift my child?

You can lift a cooperative child that is up to 35 pounds right away. But don’t try to pick up your child if he or she is fighting you or if you have to bend way over a playpen.

When can I drink alcohol?

You can resume drinking a small amount of alcohol after you have stopped all pain medications. Becoming tipsy should be avoided until you are fully healed as falling could jeopardize your healing.

When can I smoke cigarettes?

We would like to say never, since they are bad for you. Smoking does slow down healing, and it would be best to avoid them for three weeks.

When can I sunbathe?

We would also like to say never, since nothing ages us as much as the sun, and the damage it does to the skin. This is particularly true in the decolletage area, where sun damage makes women look very aged. But it is okay to go out in the sun within days after surgery, provided that the incision is protected by something that will totally block the sun, and it is a good idea to keep the incision totally blocked form sun for a year or so.

When can I shower/take a bath?

You may shower the evening of your surgery. Your incision can get wet, but don’t rub it. Soap your breasts and let warm water hit them

What will my post-operative appointment schedule be like?

There are no drains or stitches to be removed after a breast augmentation, so there are really no compulsory visits or times at which something in particular must be done. Dr. Fan would like to see you during the first week after surgery to be assured that everything is okay. He offers patients frequent visits thereafter, usually at one month, six months, one year, and yearly therafter. But some patients will come more frequently, some less frequently. Some people have little questions they want answered, and other people feel fine on their own. Dr. Fan is always available for a patient who wants to come in.

Why do my breasts appear to be high right after surgery?

It is not supposed to look perfect right after surgery! The upper breast almost always looks too full. Some of that is swelling; some of that is that the implant will drop down to the bottom of the breast. Pronounced upper fullness usually goes down between 4-12 weeks, but it continues to improve for a full year.

How long does the swelling last?

Swelling increases after surgery, usually peaking about 5-6 days after surgery. After that, the swelling will subside, rapidly at first, and then gradually. After one month, you’ll think the swelling is gone, but it will still go down more at three months, and even more at six months and even a year, though at that point changes are subtle.

Should I ice my breasts for the swelling?

We do not specifically require it, but it is okay to do it. Sometimes it can make your muscles feel a bit stiff, and moving your arms is important. But it can also be very soothing, and reduce pain and swelling. The choice is yours. But if you do it, you still need to do your arm exercises so that you stay loose.

Once the swelling subsides, how much smaller will my breasts be?

Everyone is different. Some swell a lot, some swell a little. Generally, though, the breasts do start off somewhat swollen, and that will go down. However, they will also get softer and more mobile, so that in a sense they can actually be made to look larger once they soften up enough to be pushed up and molded by a bra. Similarly, as swelling goes down, the borders of the breast become better delineated, so that they appear to be more distinct from the chest wall. They also lose the excessive upper fullness with time as they drop in the breast. Another way to think about it is right after surgery the tightness of your skin is compressing your breasts against your body. As the skin relaxes, even if the swelling goes down a bit, your breasts will project more and look larger.

What do I have to do to care for the incision?

You will either have steri-strips or a glue closure over the incisions. You should shower the evening of your surgery. Your incision can get wet, but don’t rub it. Soap your breasts and let warm water hit them. This will help them to feel better.
After about a week, the glue will start flaking and the steri-strip will start lifting. At that point you can start cleaning it with a wash cloth and teasing it off.

When do the stitches need to be removed?

Your stitches are dissolvable and therefore do not need to be removed.

What should I do to prevent scarring?

The bottom line is that the fate of your scar is mostly determined by your own genetics and by the surgery itself. It is not clear the extent to which putting things on scars will influence their final appearance. However, most patients want to do something. There has never been a direct comparison between the various products. Patient feedback has been the most positive from three sorts of things: Scar Guard, which is a liquid containing steroid, Vitamin E, and silicone that you brush on like nail polish; Silicone gel strips (such as Neosporin scar strips); and silicone ointment (such as Scar Fade.) You can get these from the pharmacy, and you can start putting them on once the glue or the steri-strip is off, following the instructions on the packaging.

Do I have to massage my breasts?

Breast massage has never been shown to be of benefit. But if you have a smooth implant, you will not hurt anything by doing it. If, however, you have a textured surface implant or a teardrop shaped implant, you should not massage them, as it could cause implant malposition.

What is capsular contracture?

It is a build up of an excessive amount of scar tissue by your body around the implant. It makes the implant feel hard, move upwards, and look round. It remains the leading cause for revision surgery after breast augmentation.

Is there anything I can do to avoid capsular contracture?

The first step is to avoid the nipple incision, as this leads to contamination of the implant with the bacteria that live in the breast. It is these bacteria that seem to be the leading cause of capsular contracture. You need to choose a surgeon who will do a gentle operation, with minimal bleeding and bruising. Finally, you must do your arm exercises to stay loose after surgery, and follow all the instructions we give you. But there is no special vitamin or medicine that we know will prevent capsular contracture.

When will I need to replace my implants?

There is no specific time that an implant will last. The rate of shell failure is about 1% per year. We know that about 30% of women have another operation by seven years, but most of those are not because a woman needed to have surgery, but because they wanted to improve something. There is a myth that they need to be redone at 10 years, but that is totally untrue. It is just that by around ten years, probably around half of the patients or so decide to have another operation, even though it is not required to do so.

Do breast implants have a warranty?

Yes, and these warranties vary between the manufacturers and the type of implant. They usually cover implant breakage and for some period of time will offer a replacement of that implant and the one on the other side, with varying degrees of additional monies offered to cover part of the cost of surgery. These warranties change all the time, so check with the office to learn the latest.

What do I need to watch out for?

Most of the things that could go wrong are sufficiently obvious that most people would notice them without being specifically warned. Since breast augmentation is really two surgeries at once, be alert for any significant difference between the two sides. Minor differences are to be expected, but contact the office for a significant difference in pain, swelling or firmness. Of the uncommon problems early after surgery, the one to be alert for is a hematoma, which is bleeding after surgery. One breast will suddenly swell and become hard and painful. This will require a return to the operating room to treat, and you need to alert us right away. Also call the office for any issues with the incision such as pain, redness, or discharge. Obviously, anything serious such as shortness of breath should be a cause for an immediate call to 911.

What types of breast implants are available?

Surgical techniques for breast augmentation and breast implants are continually being refined, increasing the safety and reliability of the procedure.

Current options for breast implants include:

Implant Fill Material: Saline vs. Silicone Gel vs. Gummy Bear Implants vs. Fat Transfer

Saline breast implants are filled with sterile salt water. Should the implant leak, a saline implant will collapse and the saline will be absorbed by the body. Saline breast implants provide a uniform shape, firmness, and feel.

Silicone breast implants are filled with silicone gel. The silicone gel feels a little bit more like natural breast tissue. If a silicone implant leaks, the gel may remain within the implant shell or may escape into the breast implant pocket. A leaking silicone breast implant will not collapse. If you choose silicone implants, you may need to visit us regularly after surgery and/or undergo periodic MRI screening examinations to ensure that the implants are functioning properly. Placement of silicone breast implants requires a slightly longer incision in the skin compared to saline breast implants.

Highly cohesive silicone gel breast implants, also known as "gummy bear" or "form stable" implants, are filled with a cohesive gel that makes them a little bit thicker and firmer than traditional silicone implants. Highly cohesive silicone gel implants are considered less likely to break compared to traditional silicone implants. Placement of highly cohesive silicone gel breast implants requires a slightly longer incision in the skin compared to traditional silicone implants. Highly cohesive silicone gel breast implants may come in round and anatomic shapes.

Autologous fat transfer removes fat through liposuction from areas of your body in which there is excess fat, such as your thighs, abdomen, or hips, and the fat cells are injected into your breast. This is a less common and somewhat less reliable method than breast implant augmentation. Fat transfer breast augmentation is typically limited to a one cup size increase in breast size, and the transferred fat may be resorbed by the body.

Implant Shape: Round vs. Teardrop

Round breast implants are circular in shape and have a tendency to make breasts appear fuller than anatomic implants. Because round implants have the same shape all over, there is no concern about them rotating out of place. Round implants often adopt an "anatomic" shape in the body when not oversized.

Teardrop implants are shaped like a teardrop, with a higher degree fullness in the lower pole compared to the upper pole. Teardrop implants may produce a more “natural” look compared to round implants with less fullness of the upper pole. Teardrop implants have a slight risk of rotating, causing a rotational deformity, feel slightly firmer than round implants, and are generally more expensive.

In general, round implants are more popular than teardrop implants, but teardrop implants can be a good choice for women looking for the most natural looking result.

Implant Surface: Smooth vs. Textured

Smooth breast implants are covered by a smooth outer shell. Smooth implants are the softest feeling and move with the implant pocket, which may give them more natural movement. Smooth implants may have some palpable or visible rippling.

Textured breast implants are covered by a grained outer shell. Textured breast implants tend to stick to the body's tissues, making them less likely to move around inside of the breast and get repositioned. Textured implants have less natural movement but may be associated with a slightly lower risk of capsular contracture when implants are placed above the muscle.

About Breast Implant Types:

It is important to note that no single type of implant (eg. standard round silicone vs. gummy bear round silicone vs. gummy bear teardrop vs. saline) is universally considered preferable for all patients. Dr. Fan will help you decide what is best for you, and entering our conversation with an open mind is most likely to lead you to a satisfactory result.

How Do I Decide My Ideal Implant Size and Shape?

Breast augmentation involves many choices, including:

  • Implant Type
  • Implant Approach
  • Implant Position
  • Implant Size

Factors that influence the size and type of breast augmentation recommended for you include:

  • Your medical history
  • Your goals for breast enhancement
  • Your existing body frame and mass
  • Your existing breast tissue
  • Your preferences related to breast size and incision placement

Our goal is to help you achieve the best results and to make your experience as easy, safe, and comfortable as possible.

We will help you navigate these decisions, as there as no perfect way for you to make these decisions on your own.

A Few Words on Choosing An Implant Size:

Choosing the best implant size can be challenging and confusing for many patients.

Close, two-way communication with your surgeon is extremely important. It is therefore very important for you to communicate your size goals with Dr. Fan:

  • Goal Photos: We find the use of photographs as "goal" pictures and breasts that are too large or too small helpful. So please bring in photographs of goal pictures, and we will show you several additional photos in our office for comparison purposes. However, please keep in mind that your body and breast tissues may differ significantly from those of the person in the picture, so results may vary.
  • Bra Cup Size: Referencing bra cup sizes is somewhat helpful, as a "C" cup, for example, generally differs significantly from a "DD" cup. However, cup size may also be inaccurate, as it varies depending on the bra manufacturer as well as bra fit.
  • It is also important to note that there is no universal correlation between implant size and resulting cup size. The resulting cup size depends on a number of factors including the amount of breast volume you start with, the shape of your chest wall, the type, profile, and size of breast implant used, the degree to which the breast fills the bra, and the bra vendor.
  • Breast Implant Sizers: We encourage patients to try on breast implant sizers inside a bra in the office as a general aid for selecting implant size. This is generally helpful and about 80-85% accurate, as the fit of an implant within the body will be slightly different than outside the body.
  • 3D Computer Simulations: We offer Crisalix 3D simulations to help you visualize your result. This is extremely popular with patients and also helpful in choosing implant size. Keep in mind that the computer simulations are generally only 80-85% accurate as well, as the computer cannot measure or account for differences in the elasticity of your breast tissues.
  • "Natural looking:" We find that the use of subjective words such as "natural looking" and "fake looking" means different things to different people and is therefore not particularly helpful.
  • A tip from Dr. Fan: Most women are very happy with the size they chose, but the most common regret after the operation is "I wish I chose slightly bigger."

Choosing an appropriate implant size for your body and breast tissues is also important:

  • Choosing an overly large implant: If you choose an implant that is too large for your tissues, you may be putting yourself at significantly increased risk of a poor cosmetic outcome and long term complications including tissue thinning and stretching with bottoming out, implant rippling, implant malposition, sagging, and pain.
  • Choosing an overly small implant: If you are restoring lost breast volume due to pregnancy, weight changes, or aging and choose an implant that it too small for your tissues, you may be left with residual sagging and a suboptimal breast shape and size.

The bottom line is that close communication between patient and surgeon are very important. Dr. Fan and his team will lead you through a series of exercises to help ensure that you choose the best implant size.

What Are the Risks of Breast Augmentation?

The decision to undergo breast augmentation is a very personal decision. You will have to decide if the benefits of breast augmentation can achieve your goals and whether the recovery and risk profile is acceptable to you.

Breast implants are intended to last your lifetime, but replacement may become necessary. Replacement is only necessary if a problem (eg. rupture, malposition, capsular contracture, etc.) arises, contrary to the popularly-held myth that implants need to be replaced every ten years.

All surgical procedures have some degree of risk. Some of the potential risks of breast augmentation surgery include:

  • Hematoma or seroma (an accumulation of blood or fluid under the skin that may require removal)
  • Infection
  • Scarring
  • Adverse reaction to anesthesia
  • Delayed healing
  • Tissue loss
  • Altered sensation
  • Damage to underlying structures
  • Allergic reactions
  • Unsatisfactory results that may require additional procedures

Other risks specific to breast augmentation include:

  • Changes in nipple or breast sensation
  • Wrong or faulty position of the implant
  • Implant leakage or rupture
  • The formation of tight scar tissue around the implant (capsular contracture)
  • Wrinkling over the skin of the implant (rippling)
  • Pain, which may persist
  • Mammography shadows

These risks and others will be fully discussed prior to your consent. It is important that you address all of your questions directly with Dr. Fan.

Are Breast Implants Safe?

Breast Implant Safety

Breast implants do not impair breast health.

Breast implants have been under scrutiny for many years, but after gathering detailed and meticulous data and research, the FDA has approved both silicone gel and saline breast implants for use in cosmetic breast enhancement surgery, finding no link between breast implants and connective tissue diseases, autoimmune diseases, breast cancer, or reproductive problems.

It is also important to consider the following:

  • Breast implants are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants
  • Pregnancy, weight loss, aging, and menopause may influence the appearance of your augmented breasts over your lifetime
  • You should undergo periodic, regular examination of your breasts and implants after surgery

Breast Cancer Detection

If you are of an age in which you get regular mammographic examinations, it will be important for you to select an x-ray facility that is experienced with taking mammograms of augmented breasts. Additional views of your breasts are often required. In some instances, your primary care doctor or Dr. Fan may recommend other types of examinations, such as ultrasound or MRI.

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Dr. Larry Fan is an award winning, Harvard educated, and nationally recognized plastic surgeon. He is a progressive, compassionate thinker who is committed to achieving the highest levels of excellence and the very best aesthetic results. Dr. Fan is an expert facelift surgeon who is known for achieving natural beauty, never “overdone.”
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