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Plastic Surgery Frequently Asked Questions (FAQ)

Plastic Surgery

Breast Augmentation

Will breast implants interfere with future mammograms?

Mammograms are slightly more challenging with breast implants in place. Special techniques have been developed, called Eklund views, to improve the accuracy of mammograms with breast implants in place.

How do I know if my implants are leaking?

Saline implants will gradually deflate and a size discrepancy will be easily detectable.

Should I get a mammogram more often if I have implants?

If you have a family history of breast cancer or have had a previous abnormal finding, then follow the instructions of your physicians for obtaining mammograms; otherwise, follow the American Cancer Society's recommendations for mammograms.


Should I purchase a breast implant warranty?

Remember that breast implants are man-made devices and so they can fail. Dr. Spence recommends that his patients purchase warranties with their implants in case of implant failure; this becomes a less stressful situation for them.


What happens if my implant becomes infected?

Prompt recognition and treatment of implant infections are important. It is important to notify your surgeon if any redness, drainage from the breast, excessive breast tenderness, abnormal swelling of the breast, or persistent fever following surgery occur. An infected implant will have to be removed with a period of waiting to ensure that all infection has cleared before replacing the implant.


Many of my friends say they wish they had gone a size bigger. Why is this?

During your consultation, when patients try on an implant size, it may appear slightly larger than it will when it is actually placed; in addition, some patients like their size after surgery when they are swollen and as the swelling goes down they may become slightly disappointed. Remember, however, that size is not always the most important factor in your decision; for some patients it is a more natural look that is important, as well as avoiding the long term issues which come with heavy large implants (such as skin stretch). Talk to your surgeon during your consultation about these specific issues.


Will I have to have multiple operations once I have my implants?

Though the majority of women that have breast implants are extremely satisfied, there are patients that may require multiple operations; this may be for various reasons such as capsular contracture, deciding to go with bigger or smaller implants, or implant deflation. Remember breast augmentation continues to be one of the most popular plastic surgery procedures performed in America with many gratified patients.


I wish to have my implants revised but I do not know what the current volume is. What should I do?

This is important information. An implant card detailing the data of placement, implant volume / fill, and implant type should always be requested on the date of your augmentation.


I am developing rippling of my implants. Can anything be done for this?

Yes. (Please see the section on Orlando Breast Implant Revisions for further detail).

  • Implants can be exchanged to silicone gel implants.
  • The implant placement can be changed from in front of the muscle to behind the muscle.
  • A repair of the capsule in the area of rippling can sometimes be performed.


I have heard of adjustable breast implants being used for breast augmentations.

In Dr. Spence's Orlando, Florida practice, adjustable implants are sometimes used in patients with significant asymmetry where one breast may be significantly underdeveloped. This may help achieve a better final size match.


My aim is to achieve a modest size C-cup with breast augmentation. I am afraid of being too large. How do I explain this to my plastic surgeon?

It is sometimes difficult to communicate a specific cup size, as a bra size will vary from manufacturer to manufacturer for the same breasts. It is necessary to spend time planning at your consultation. The following will help:

  1. Bring photographs to your consultation. (Remember that the person in the photograph did not have breasts like yours to begin with so an exact match could be unlikely; however, it does give the surgeon an idea of where you want to be.)
  2. The use of measurements of the chest wall, skin thickness, among others can be very useful.
  3. Trying on the implants gives the patient an idea of what volume implants they would be able to tolerate.


Is the best placement of the implant behind or in front of the muscle?

In our practice, the majority of implants are placed behind the muscle for 3 reasons:

  • Future breast cancer detection
  • Better implant camouflage
  • Effect on capsular contracture


When should implants be placed in front of the muscle?

Body builders or patients with enough breast tissue to camouflage the implant often have implants placed in front of the muscle.


What type of implant should I choose?

Only under special circumstances can you be enrolled in a study to receive silicone implants. This is an option you may discuss with Dr. Spence. Saline implants have provided excellent results for those choosing them.


Should I choose anatomic or round implants?

That often depends on your chest wall shape and your desires. Using a dimensional approach, Dr. Spence will help guide you in selecting the implant which is best for you. We always strive for a natural look.


What size will my scar be?

Most patients having straightforward augmentation will have a scar in the range of 4 cm. or less. This scar is barely visible with the approaches used in our practice.


How will my breasts look if I choose to have the implants removed over time?

This depends on the elasticity of the skin, with small to modest size implants with very elastic skin; the skin may be able to snap back to a youthful appearance. If the implants are large and the skin has lost its elasticity, the breasts may have an empty, deflated look.


How will my breasts look after breast-feeding if I have breast implants?

This is difficult to predict as it depends on the effects on the breast tissue of pregnancy, e.g. the results will vary depending on the extent to which the breasts become engorged and the skin stretched from the accumulation of milk and breast-feeding.


Should I choose textured or smooth implants?

Textured implants were intended to lessen the risk of capsular contracture (hardening of the breast from scar tissue forming around the implant). The success of this is controversial. Many surgeons prefer to use textured implants when they use contoured (anatomic implants).


Will my inverted nipples be corrected by my breast implants?

Breast implants will sometimes, but not always correct inverted nipples; if not, a separate procedure can be performed under local anesthesia to correct this.


How do I decide which breast augmentation scar would be best for me?

Dr. Spence uses 3 types of breast augmentation scars:

  1. transaxillary – through the armpit
    • Patients with small areolas, a poorly defined breast crease, and those who not wish to have a scar on their breasts are good candidates for a breast augmentation via the under arm approach.  This is done with the use of an endoscope and a camera.  This procedure takes slightly longer operating time than the other approaches.
  2. periareolar – around the nipple
    • Incisions around the nipple can be well hidden in the darker skin of the areola; however, there is a slightly higher risk for interfering with future breast-feeding and the areola must be large enough to hide the scar.
  3. inframammory – in the crease of the breast
    • The inframammory approach works well for patients with well-defined breast creases.

Does Dr. Spence over fill the implants during a breast augmentation?

No, each implant manufacturer gives a range of the amount to which you can fill the implant (for example, 320-340 cc). Dr. Spence's preference is for optimal fill to the manufacturers specifications, which would be as close to 340 cc in the example given.


Can a breast augmentation interfere with future breast-feeding?

A breast augmentation can affect your ability to produce milk; in addition, a breast augmentation does not prevent your breasts from sagging after pregnancy.  If you are planning a future pregnancy, discuss this with your surgeon.


Is there anyone that should not get a breast augmentation?

Yes, patients who should not undergo a breast augmentation include those who:

  • Have an existing malignancy of the breast that was not adequately treated
  • Have an active infection somewhere in the body
  • Are pregnant

Will my insurance cover my breast augmentation?

No, typically breast augmentations are purely cosmetic procedures and are not covered by insurance companies.


Can I lose nipple sensation from a breast augmentation?

Yes, change in nipple sensation is a risk of breast augmentation surgery.  The nipples may become less sensitive; this could be temporary or permanent.  There is also a risk of the nipples becoming overly sensitive.


Is implant rippling more common in breast augmentations when the implant is placed in front or behind the muscle?

Patients with very thin tissue have a higher chance of visible rippling when there is less tissue covering the implant (e.g. in thin patients when the implant is placed in front of the muscle).


How soon after pregnancy can I undergo a breast augmentation?

Dr. Spence does not perform breast augmentations while a patient is still nursing; he actually prefers to wait until milk production has completed.  During your consultation, if this is a factor, please notify him.


How soon after a breast augmentation can I return to work?

Most patients return to work in about 5 to 7 days after surgery.  Patients who undergo a breast augmentation when the implant is placed below the muscle tend to be slightly more sore and tend to take the full 7 days to recover.


Is it okay to undergo a breast augmentation with another procedure?

Yes, a breast augmentation can be performed in conjunction with other cosmetic procedures at Orlando Plastic Surgery, such as liposuction or a abdominoplasty. It is important to have a thorough assessment of your overall state of health to undergo combined procedures.


The responses to Frequently Asked Questions listed here are not intended to be medical advice, but are the practice of Dr. Spence and Orlando Plastic Surgery and will vary from surgeon to surgeon and patient to patient.

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To schedule a breast augmentation consultation with Dr. Spence at Orlando Plastic Surgery, call 407-999-2585 or request a consultation online.