Frequently Asked Questions
Is there anything I should do to prepare for my surgery?
With regard to any cosmetic surgery, the biggest key to safe surgery is to be in good health. That includes control of your blood pressure if you have problems with even mild hypertension., or if you are mildly diabetic, good control of your sugar is important.
If you are in very good health, specifically eating right, exercising regularly and not smoking, you are an excellent patient for any type of cosmetic surgery and you should anticipate that your recovery should be uneventful.
Most plastic surgeons recommend that you avoid taking ibuprofen, Aleve or aspirin for at least 10 days prior to surgery. I advise my patients to take a multivitamin with minerals like Centrum, for example, every day especially prior to breast surgery. If you take any herbal medications, or even vitamins that are in higher doses than are normally recommended, it is better to discontinue those 7 to 10 days prior to surgery also. This is important because we do not completely understand all the potential interactions of these compounds especially at megadose levels, and their effects upon the anesthesia medications. Fish oil or anything that may contain vitamin E like substances should also be avoided around the time of your surgery and for a few weeks following surgery. The amount of vitamin E that is in a multivitamin is not harmful however.
Finally, minimizing your alcohol intake and avoidance of smoke exposure whether it be tobacco or marijuana, will benefit you in your body’s ability to heal. People that smoke commonly develop scabby healing along the edges of their incisions which tend to result in a more unsightly scar and can even lead to wound separation.
How do I choose which implants to get?
Currently, there are many differing opinions when it comes to the kind of breast implant that is best. To begin, all breast implants consist of a silicone rubber sac that is filled with either saline (salt water) or more commonly a silicone gel that ranges from a very fluid consistency to a semi-solid gel that tends to hold it’s shape. Most patients that undergo breast augmentation today request the silicone-gel filled implants. The silicone gel makes the breast implant feel very natural and soft much like native breast tissue. Saline filled implants feel less natural and are more prone to have ripples on the silicone rubber sac that can be seen or felt beneath the skin.
Breast implants have consisted of this combination for over 60 years. Almost 30 years ago, there arose a concern about the long-term safety of silicone gel in the human body. This prompted hundreds of studies carefully examining the health history of over ten thousand women and included women who did not have breast implants to compare the state of overall health to woman of the same age who had breast implants, many had implants for many years. who either had or did not have silicone gel implants. Based upon these studies we now have very clear overwhelming scientific evidence that silicone gel has NO adverse health effects if it comes into contact with the human body.
In the last several years, a new implant has become available which contains a semi solid silicone gel which allows the breast implant to hold its shape without requiring the help of the silicone rubber covering to support the shape. These implants are known as “gummy bear” or form-stable implants. They are made in round dome-shaped formats but also some are in the shape of a wedge or a teardrop which results in a more natural breast shape. These new form-stable implants, specifically the tear-drop shaped implants, allow surgeons to very specifically and accurately choose a unique implant for each patient based upon the size, the width and the height or projection of the patient’s breast. In my opinion, the most natural appearing breast shape results from the use of form stable implants specifically the teardrop shaped design.
The form-stable implants require a slightly different technique to insert and not all plastic surgeons are comfortable with the use of this new implant. If you schedule consultations with several surgeons before choosing the one that you feel most comfortable with, you may receive advice regarding the choice of implant which is based more on your surgeon’s preference or comfort level rather than what may be best for your particular situation. That’s why it’s important for you to question your surgeon about ALL of your options and be sure you get an answer that sounds logical and makes sense.
Are there risks to having surgery?
This is a very common discussion I have with patients who are considering surgery. I explain that there are certainly risks to having any kind of surgery but the frequency with which complications occur is very low. In fact, the chances of having a serious motor vehicle accident driving to the surgery center are 10 to 100 times higher than the risk of experiencing a complication from anesthesia or surgery.
Anesthesia is simply a strong sedative which relaxes all the muscles in the body including the heart. When the sedative wears off, the patient becomes conscious again. There are so many highly sensitive monitors placed on any patient having surgery in an outpatient surgery center that we are warned almost instantly of any change in vital signs and measures can be taken quickly to avert potential problems while under anesthesia.
Surgery centers are now required to be inspected and certified by state and federal institutions before they can open their doors and treat patients. They are reinspected frequently by people dedicated to the public’s safety. This helps make outpatient surgery centers some of the safest places to undergo out-patient surgery.
Other potential risks that could potentially occur from breast surgery are the same complications that may occur with any surgical procedure, namely infection, bleeding, and injury to deeper structures like sensory nerves or blood vessels. These potential complications even though they are significant, occur in much less than 1 to 2% of patients. Other more unusual complications like unnatural firmness developing following breast augmentation, noticeable scarring, or improper positioning of the breast implants are even less common.
Is it possible to lose nipple sensation?
Changes in nipple sensation following breast enhancement surgery are more common than is usually suggested. Many patients can end up with a very small patch of numbness in the skin of the breast that may disappear over several months. Nipple sensation will quite often be slightly diminished for a few days after the surgery then over time change from diminished to hypersensitivity then ultimately decreasing back to the normal sensation around the nipple itself. When a large implant is to be placed, the breast tissue needs to be separated much further away from the source of the nerves so that a proper size space can be created for the large implant. In those situations, either temporary or even permanent nipple sensory loss can be more likely to occur. Since nerve tissue is the slowest tissue in the body to recover and regrow, even if nipple sensation is absent or significantly diminished for several months after surgery, return back to normal happens quite often. Should there be diminished or absent nipple sensation right after surgery, many of these patients will have significant improvements in nipple sensation over time.
Will I be able to breast-feed with breast implants?
Most women are able to breast-feed normally after having breast implant surgery. One concern often raised is loss of ability to breast feed due to the location of the incision for access to place the breast implant. Of the three locations for breast implant placement incisions, it is felt by some that the incision at the junction of the areola and the normal skin potentially could result in inability to breast-feed because that location may disturb some of the ducts that carry milk from the milk glands in the breast substance to the nipple. The surgical pathway to place a breast implant through both the axillary incision and the infra-mammary incision (which is located in the crease of the breast) completely bypasses the breast gland so the ducts of the breast are not at risk. However, studies have shown there no higher propensity towards an inability to breast-feed based upon the location of the surgical incision to access the space beneath the breast during breast implant surgery. That being said, inability to breast feed has many causes but it appears that breast augmentation by either of the surgical methods does not influence the ability to breast feed after breast augmentation surgery.
How long will it take to recover?
The length of time that it takes to recover from any type of surgery is dependent upon many variables. In fact recovery is a very nonspecific term. I will often ask my patients this question in response: “Recovery to do what…..?”. Patients may want to know when they can resume work and of course the answer depends on the type of work that they do on a daily basis. Patients may want to know how soon they will recover enough to not need help to care for small children without assistance. Since every patient heals at different speed, patients are pretty well independent by 5 to 7 days after surgery. One study decided to look at recovery of the strength of the chest muscles following breast augmentation surgery and found a surprising result. The study found that at 3 weeks all patients were able to bench press the same amount of weight that they had been able to press before the surgery. In fact, many patients were found to be able to lift more weight than before the surgery. Am I recommending breast augmentation to improve your ability to benchpress? No. But still that was the finding of that particular study.
In general, I tell patient that they may drive if the car has power steering whenever they feel able to comfortably drive around the block without feeling nervous. Patients can shower the day following their surgery if their surgeon agrees. Many patients can return to their jobs in 3 to 5 days if they work in an office and there is no heavy lifting. Hairdressers dentists or dental hygienists may require a bit more time because there is some guarding of the chest and it is uncomfortable to use the arms to any significant degree or for any significant amount of strength for 5 to 7 days.
Can I have other procedures done at the same time as my breast augmentation?
Of course. This is often the case that patients have breast augmentation coupled with other operations. A breast augmentation may be accompanied by a breast lift which is necessary due to significant drooping of the breast. In some instances the aerial or nipple may be disproportionately large and can be reduced at the same time of the augmentation. Even surgery on other parts of the body at the same time are commonly performed. Liposuction, tummy tuck, facial procedures such as blepharoplasty or facelift can be performed during the same setting as breast augmentation surgery. In my practice the determining factor is the length of time that the patient is under anesthesia. Most board-certified plastic surgeons would tend to limit the number and types of procedures to no more than eight hours of general anesthesia. Beyond that point, experience shows us that recovery is a bit more difficult and takes longer than one would expect with 4 to 6 hours of surgical procedures.
What can I expect great after my procedure? Is it necessary to stay in the hospital?
Breast augmentation surgery is almost exclusively an outpatient procedure. It may be performed in a hospital setting that has same-day surgery facilities but rarely is the patient required to stay overnight unless there was an untoward event or some pre-existing condition that requires prolonged observation for reasons of safety.
Following breast augmentation surgery, once the patient is awake and comfortable they are sent home, usually within an hour of arriving in the recovery area. Sometimes a patient may experience mild nausea as a side effect of anesthesia but this can easily be resolved with medications. The amount of discomfort varies from person to person. In my practice, I will supplement pain management with the use a long-acting local anesthetic which is placed in and around the area of the surgery right after the patent goes to sleep and before the actual surgery. This can last from 12 to 24 hours, which can significantly reduce most of the discomfort during the first 24 hours following surgery.
For every patient, my overall goal is for your surgical result to be all that you dreamed that it could be and more, but also that your entire experience from start to finish is comfortable, with instructions that are simple and easy to follow, and all of your expectations met.
Why does choosing a board-certified plastic surgeon matter?
As you can tell from some of the answers provided above, breast augmentation is both art AND science. It requires an artistic eye, as well as an eye for beauty. But it also requires significant training and up-to-date knowledge. With better information, and better tools such as the shaped breast implants discussed above, and a surgeon that is a member of the American Board of Plastic Surgery (ABPS), you have everything you need to ensure a favorable outcome while at the same time ensuring that your journey is safe. Membership in ABPS requires the continuous commitment to lifelong learning and constant skill-set upgrading. There is no one more qualified than a member of this prestigious group of highly qualified surgeons when it comes to being the best the best in the world of plastic and cosmetic surgery.
IS COSMETIC SURGERY APPROPRIATE FOR ME?
Human societies admire youth and strength, and cosmetic surgery provides an important additional tool to restore or maintain a more attractive, youthful, vibrant appearance.
You may be an upwardly mobile executive at the top of the sales force who worries that your appearance does not reflect your inner energy and vitality. Or, you may exercise religiously and use extreme care in what you eat, but simply can’t shrink those wide hips or that roll at the belt line. It may be that no matter how many sit-ups you do, the tummy muscles that protected your child during pregnancy just won’t shrink back to where they were five years before. Sometimes our anatomy is just not responsive to non-surgical options. That is when cosmetic surgery can play a role.
Your parents may have resigned themselves to having an appearance that troubled them because there were few or no options available for their generation. Now there are many options to achieve the appearance you desire. Financing plans also enable more people to choose cosmetic surgery.
WHY DO I LOOK OLDER THAN OTHER PEOPLE MY AGE? HOW CAN I LOOK YOUNGER?
Both genetics and lifestyle determine the factors of aging. Since all of us are constantly under the effects of gravity, sagging skin is inevitable. We all know people who are blessed with timeless faces that appear decades younger than their actual age. Likewise, there are people who appear much older than their biological age. Aging of the face makes people look tired or angry, even when they feel just the opposite.
Aging is a process that can’t be stopped. The forces of gravity, the sun, and genetics seek to undermine our youthful appearance. Gravity constantly exerts a force on our skin, which slowly gives way. The sun emits light wavelengths that slowly but subtly age our skin, and our genetic programming tells the body to store fat in specific places in the body, rather than to burn it as energy.
No one can stop the aging process, but the good news is that we can correct some of the effects of aging. We can tighten skin that has been stretched by gravity. We can promote regeneration of healthy skin by removing layers that have been damaged by the sun. And we can remove fat deposits that come about as a consequence of age, genetics, diet or limitations in physical activity.
WHAT CAN COSMETIC SURGERY DO FOR ME?
Cosmetic surgeons are innovators in surgery and medicine. Improvement in cosmetic surgery techniques and new options are greater than ever before. No longer is cosmetic surgery always synonymous with major surgery. Many newer techniques involve more modest, subtle changes. As a result, colleagues and friends will have a hard time determining you have actually had cosmetic surgery (as opposed to a wonderful, relaxing vacation) and time away from your busy schedule is minimized.
WHO IS HAVING COSMETIC SURGERY?
Cosmetic surgery is becoming increasingly accepted in our society. Discussions are increasingly commonplace on television and radio, as well as in magazines and newspapers regarding peels, skin treatments and body contouring. The number of younger woman, men and even teens having cosmetic surgery is growing as it becomes more accepted and safer than ever before.
I AM CONCERNED ABOUT MAJOR SURGERY AND RECOVERY TIME.
Plastic surgeons have always been innovators in the fields of surgery and medicine. This innovative approach has resulted in improvements in cosmetic surgery techniques, as well as in a much broader range of treatment options than ever before. No longer is cosmetic surgery always synonymous with major surgery. Cosmetic surgery with less down time and less drastic changes are performed with greater and greater frequency.
Recent advances in cosmetic surgery techniques and approaches offer options for correction that range from subtle to dramatic. The use of endoscopes with small television cameras and small instruments allow more exact corrections with less swelling and faster healing. As a result, mini-facelifts, mini-abdominoplasty (tummy tucks), and other procedures involving relatively small corrections can be made with short recovery and minimal risk. Non-surgical options are also useful for maintenance of your look and more subtle improvements.
WILL MY FRIENDS KNOW?
Yes And No. People seek cosmetic surgery because they want to improve their appearance. They expect to look more youthful, more energetic, and more vibrant. They want to look like themselves, only better. Cosmetic surgery, when performed well, does all of this. Good cosmetic surgery is not obvious or un-natural in appearance. It gets you noticed in a positive way, partly because of the improvement in external appearance and partially because of what it does for the individual on the inside.
On the other hand, poorly executed cosmetic surgery is obvious. It can make people look too young for the rest of their face or body. It can stand out as un-natural and look un-balanced. What patients don’t want are drastic changes that look artificial or fake.
HOW LONG WILL MY NEW LOOK LAST?
Cosmetic surgery can turn back the clock on your appearance. But time marches on after surgery. The clock races no faster for you than for anyone else. If your surgery has turned back the clock 10 years, you will continue to age, but you will always look 10 years younger than you would have if you had never had surgery. Therefore, the positive changes that are a result of cosmetic surgery really do last forever.
IF I HAVE COSMETIC SURGERY, DO I HAVE TO HAVE IT AGAIN AND AGAIN?
Many people believe that once you have cosmetic surgery, you must have it repeated over time for the rest of your life. This is far from the truth. Some patients use cosmetic surgery to correct an aspect of their appearance that troubles them, and once it is corrected, never desire cosmetic surgery again. But many people who have experienced the joy and positive benefits of cosmetic surgery return for additional procedures or to maintain the look they had before time marched ahead and their face continued to age.
WHAT DOES IT TAKE TO BE BOARD CERTIFIED?
In general, board certification requires three things:
- Graduation from a recognized medical school
- Satisfactory completion of a residency-training program of a length that is deemed appropriate by the board in that specialty
- Completion of a written and usually an oral examination administered by the board in that specialty
When researching cosmetic surgeons, look for a surgeon that is certified by the American Board of Plastic Surgery. Other surgeons may perform cosmetic surgery, but their training may not be as extensive as that of a board certified plastic surgeon.
WHAT IS A MEDICAL BOARD?
The American Board of Medical Specialties (ABMS) oversees all medical board certifications in the United States. ABMS recognizes all the boards of the different medical specialties. To date, only 24 boards have met the strict educational and examination criteria of the ABMS. For example, the American Board of Plastic Surgery (ABPS), the American Board of Internal Medicine, and the American Board of Pediatrics, are all recognized by the American Board of Medical Specialties. They must answer to the American Board of Medical Specialties and comply with the rules and regulations with regard to allowing physicians the privilege of board certification.
ABMS only recognizes one board certification for plastic surgery, the American Board of Plastic Surgery. Although residency-training programs in Otolaryngology (ENT) require some exposure to cosmetic surgery, individuals with board certification in ENT and dermatology are not board certified cosmetic surgeons.
WHAT ARE MEDICAL SOCIETIES VERSUS MEDICAL BOARDS?
Medical societies are not medical boards. In general, medical society memberships only require payment of dues and submission of an application. Most do not require board certification in any medical specialty. The American Society of Plastic Surgeons only allows members who have already become board certified by the American Board of Plastic Surgery.
WHAT ABOUT FELLOWSHIPS?
Fellowships are largely unregulated periods of training that occur following residency. Any MD may take a fellowship in cosmetic surgery. Cosmetic Surgery Fellowships are offered at a variety of centers and private practices throughout the country and the world. The curricula and training credentials are not regulated by the ABMS. Despite claims to the contrary, taking a fellowship in cosmetic surgery is never a substitute for a rigorous two or three-year residency in an ABMS-approved plastic surgery training program. Board certification is never rendered for physicians completing only fellowships in cosmetic surgery because these fellowships are not recognized by the ABMS.
HOW CAN I TELL IF MY COSMETIC SURGEON IS A MEMBER OF A RECOGNIZED BOARD?
The ABMS may be contacted at 949-640-9570 if you would like to learn whether your cosmetic surgeon is board certified in plastic surgery.