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Breast Surgery FAQs

What types of breast implants are available?

Although there are many different shapes, types, and sizes of breast implants for Vancouver area women to choose from, they all have some basic similarities. A breast implant has an outer shell made from solid silicone and the surface can be either smooth or textured. Texturing on the surface of the implant creates a slightly thicker shell and may modify the interaction between your scar tissue and the implant surface. The goal of texturing is to decrease the amount of scar tissue that forms. Unfortunately, studies have not shown this to work reliably. Texturing on the surface will also influence the movement of the implant in the body. In some circumstances, a textured surface may be beneficial but the majority of implants used today have a smooth surface.

Implants come in basically two shapes: round and contoured (pear shaped or "anatomical shape"). In some instances women may prefer a more rounded upper breast shape or a full shape with less distinct edges. Your tissues and the implant size and shape will determine the breast shape. A contoured implant can deliver excellent projection of the breast while decreasing the outward or convex roundness of the upper breast. A round implant will generally produce a rounder and more prominent upper breast contour. However, all breasts, with or without an implant change their shape with changes in posture. Round implants can become more pear shaped when a woman stands up depending on the amount and type of filling in the implant. Consequently, the difference in shape with these two styles of implants is quite subtle. Dr. Mosher will help you to decide which would be right for your goals.

Finally, women currently have a choice between implants filled with saline (salt water) and implants filled with cohesive silicone gel. Each of these has different features and considerations. Saline-filled implants remain the most popular in North America because women continue to feel safer with saline in their body in the event of an implant leak. The most recent studies have consistently provided reassuring evidence that silicone gel does not represent a measurable health risk. Consequently, Health Canada and the US Food and Drug Administration allowed silicone gel-filled implants to be sold again under special access in 2000. This was permitted because there is no scientific evidence to support the argument that saline-filled implants are safer than silicone gel-filled implants. Current silicone gel-filled implants have different degrees of cohesive silicone gel inside. This cohesive or thicker gel improves the likelihood that all of the gel would remain in one place if the shell ever breaks. This increased viscosity gel also decreases the frequency of visible or palpable ripples compared to saline-filled implants.

Saline-filled and cohesive silicone gel implants will be discussed with you during your consultation. The most common implant used by Dr. Mosher by far is a saline-filled, round, and smooth-surfaced implant.

What is the best incision for breast augmentation?

Most plastic surgeons make use of three traditional incisions for breast augmentation. The inframammary crease incision is made in the fold below the breast. A 3.5 cm-long incision in the crease is the most direct route for placing an implant and only minimally disturbs the breast. This incision is usually very discreet within normal swimsuit lines and is only visible when the breast is lifted often as a lighter coloured line just onto the undersurface of the breast. This is the preferred approach for patients not wanting a scar near the nipple and for placement of larger cohesive silicone gel implants. There is minimal damage to the breast gland with this approach. This incision also is very versatile when dealing with revisional breast surgery and complications such as capsular contracture. The periareolar incision is made along the coloured border of the areola and blends in to this area of colour transition very well depending on the pigmentation of the scar and the breast. During surgery there is somewhat more trauma to the breast gland as the surgery travels through the breast tissue to create space behind the breast gland for the implant. The areolar diameter needs to be sufficient to permit an incision 4-5 cm long so that the implant pocket can be seen and the implant can be passed through. There is potential for more damage to the nipple sensation and breast feeding function with this approach. The transaxillary incision creates a small scar in the armpit. This is usually reserved for ideal candidates that want a saline implant in a subpectoral position. An endoscope is often used to improve the surgeon's vision of the breast pocket from this more distant entry location. Trans-umbilical breast augmentation or TUBA is also possible. Each incision has different benefits and tradeoffs. Dr. Mosher most frequently recommends the periareolar or inframammary crease incisions.

Should the implant be placed under or on top of the muscle?

Breast implants may be placed in a subglandular position (between the chest muscle and the breast gland), subpectoral position (partially covered by the pectoral muscle), or submuscular position (completely covered by the chest muscles). There are pros and cons with each of these techniques and the right choice will be influenced by your anatomy, lifestyle, shape goals, implant choice, and recovery expectations. Dr. Mosher will recommend the choice that is most suited for you. The table below indicates some of the potential risks to consider prior to surgery.

How do I choose the right size implant for me?

This is the one area that women find the most difficult when choosing to have breast augmentation. I often get presented with general requests such as a "full C cup", "natural looking", or "more proportional". This is a very important part of the consultation process and you can ease this decision by doing some preparation prior to your consultation. One thing to always keep in mind is that the larger the implant is the less natural the breast will look and the more potential problems you can have in the long run. These problems are directly related to the added weight of the implant and the stretching of your tissues to accommodate the implant. Clearly, none of our tissue becomes more toned with time and gravity is always going to be influencing your breasts. With that in mind do the following:

Look at photographs that represent the breast shape and sizes that you desire or dislike. Many internet sites provide a starting point and give general descriptions of patient and implants sizes. Dr. Mosher will be pleased to show you a variety of before-and-after photos in the office.
Talk to women who have had breast augmentation surgery to learn what they have experienced and perhaps give you more information on the breast size you would like. Many women in the short term wish that they had chosen larger implants once they adjust to their new size. Although this should be factored in to your thinking, make sure you think about what you want over the long term.
You can try inserts into your bra at home to get some sense of the size change you are looking for. A small baggie filled with rice or water fitted into a sports bra can also give you some feedback. Keep track of the amount that worked best for you by using a measuring cup that indicates milliliters (ml) or cc's. Approximately 200-250 ml will increase the breast by one full cup size.
Part of your consultation will involve trying on implant sizers in the office with the help of our experienced staff. This is only an approximation but seems to allow patients to feel confident in their size choice. Dr. Mosher will select a narrow range of implant sizes that suit your body proportions and allow you to choose within that range.
The quality and amount of your tissue will strongly influence the size of implant that Dr. Mosher will be willing to offer you.

In the end, you will be able to choose the implant size that will work the best for you. Dr. Mosher will strongly encourage you to choose more conservative implant sizes in order to decrease your need for revisional surgery and breast lifts in the future. Balance what you want with what your tissues can support.

What activities are safe after breast augmentation?

The implants are designed to allow you completely normal activities including strenuous physical activity, contact sports, recreational scuba diving and sexual interactions. Once you have healed completely you can resume all your usually activities. General advice is that you should be as protective of your breast after augmentation surgery as you were before. Common sense indicates that you should support your new breast weight with appropriate fitting garments as much as possible and particularly during exercise. If your implants are placed behind the muscle you should decrease the intensity of chest muscle building exercises in order to decrease the chances of the implant gradually being displaced downward and towards your armpits.

How will I know if my implant breaks or what happens if it does?

Fortunately, this is no longer a common event. Current implants have a very low incidence of implant shell rupture. The incidence is on the order of 1% per year, or another way of thinking about this is about 10% of women have an implant rupture in the first ten years. When an implant breaks, the shape and feel of the breast is usually quite different. With saline filled implants the breast becomes smaller and softer over several days. Cohesive silicone-gel implants ruptures are more subtle but a change in the breast shape and feel is usually apparent. Regardless of the implant type, this is not a worry as there is no evidence that a broken implant of any kind will make you sick. Replacing the broken implant is usually very straightforward requiring a small surgical procedure and a short recovery time. You can read the implant replacement policies for the different manufacturers.

Will I lose sensation to my breast after surgery?

Most women experience some loss of sensation to some or the entire breast for a few months after surgery. In most cases the sensation returns to normal. About 1% of women will have permanent numbness of the nipple or area adjacent to the incision. For this reason some women prefer incisions in the breast fold or armpit. There is a lower incidence of sensation changes when smaller implants are used and when implants are placed behind the muscle. In rare situations, women can experience persistent increased sensitivity to the point of discomfort. This also usually returns to normal over time.

What happens to my breast if I have another pregnancy?

The breast will go through typical changes of pregnancy including enlargement of the breast, stretching and darkening of the areola and possible development of stretch marks. This is independent of the implant. The majority of women are able to breast feed their children after breast augmentation. Although the implant will be unchanged, the shape of the breast is often different after pregnancy due to the increased stretching that naturally occurs. Breast lift surgery can be requested to deal with sagging if necessary. You may choose to avoid incisions near the nipple to improve your chances of preserving lactation and sensitivity.

Do breast implants interfere with mammograms or breast cancer?

Having breast augmentation surgery does not change your risk for developing breast cancer or your chances of survival if you do develop breast cancer. The only issue of significance is that you do need to have special views taken of the breast when a mammogram is indicated. Rarely, the breast implant and any surrounding scar tissue may interfere with getting a complete assessment of your breast with a mammogram. Implants that are behind the muscle tissue generally make mammograms easier to perform.

How can I avoid getting ripples in my implants?

Ripples and folds in the implant shell can occur with any implant. What patients find most bothersome is when these ripples are seen or felt through the breast tissue. Salt water-filled implants are much more prone to developing ripples than silicone gel filled-implants. Strategies to reduce this risk are discussed with every patient. Choosing appropriate sized implants will stretch your tissues less making ripples harder to see and feel. Placing the implants behind muscle also makes it less likely that ripples will be apparent. Unfortunately, the implant usually extends below the muscle border making the implant edges and ripples easier to feel along the sides and under the breast. For saline implants, filling them near to the maximum volume for that implant further reduces the risk of significant rippling.

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