Breast Augmentation (Breast Implants) Questions and Answers

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Question:

I am interested in breast augmentation. I am a 36A (I used to be a B Cup before having 2 children)I went to see 2 dr's in my area for a consultation and I didn't really care for either of them, they really didn't listen to what I wanted. I would like to be somewhere between a B/C Cup They both thought I should go bigger...if I was going to go through surgery I should make it worth my while! I am 37, small boned, 5'8, 130 lbs. How do I find a Dr who will work with me? I also would like to know more about removing spider veins on my legs. Thanks so much, Michele

Answer:

Sorry, Michele, I forgot to mention that there are two ways of treating spider veins: sclerotherapy and lasers. For the most part, sclerotherapy works better on larger vessels with less recurrence and lasers are useful for the smaller vessels.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

I am a 41 yr. old woman who has had four big babies over the past twenty years. I was always small a size 7 and put on 65lbs or more with each pregnancy. As a result I have loose sagging skin so bad, when I bend at the waist my stomach hangs to the point where you could litterally fit a soccer ball in there. No exaggeration! I have stretch marks above my navel also. I'm considering a tummy tuck. The problem is I have a Gi motility disorder which frequently causes my abdomen to distend to the size of a fourth or fifth month pregnancy. When I'm not distended my abdomen protrudes naturally comparable to a three month pregnancy size, due to all the loose skin. I really want a tummy tuck but I have concerns that my abdomen wouldn't be able to distend and I would have internal pain symptoms. Do you think I would be ok to have this procedure if the abdominal muscles were left untouched , and only the excess skin removed? I'm also thinking about getting my breasts enhanced. I was barely a b cup and increased to a d while pregnant. I also nursed all of my children. My breasts sag down and feel like all flat chest wall. I'm considering implants to correct this, but what can be done to correct the nipple pointing down? I don't want a lot of scarring.Is capsular contracture always painful. I've learned thats to be expected over time. I live in the Boston Ma.area, could you please suggest some names of qualified surgeons in my area, or advise me on how I go about finding someone and pointers what to look for. Thanks So Much, I eagerly await your response.

Answer:

Dear Jane, You ask a number of interesting and rather difficult questions. Regarding the motility disorder and bloating. I would suggest that you get this straightened away first (if possible). The pain you have from the distension would be far more than from the abdominal wall being stretched. I would think that you would not have nearly as good a result if your rectus muscle was not tightened. Incidentally, that may be why your bloating is so marked. Regarding the breast augmentation: Itsounds as though you would be best served with a breast lift. I doubt that you could possibly raise the nipple and areolar complex high enough with just an implant unless it was massive. Despite the scarring, the lift is a much better way to go with or without a small implant placed. I would suggest that you visit the ASPRS (American Society for Aesthetic Plastic Surgeons) web site for the name of a qualified plastic surgeon near you.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

I am considering having a breast lift done. And also maybe an augmentation. How much does each of these cost seperate and how much if they were done at the same time?

Answer:

Costs vary across the country and with what exact procedure needs to be done. A breast lift costs about $6000.00 and a breast augmentation about $5000.00. If done together, the cost would be about $8000.00 in my practice.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

I have had my breast augmentation for over 2 years. I am happy with the size, but not my nipples. They are to high and portrude from my breasts a little bit. Can the"snoopy" effect be repaired. I went from an A to a Full C, under the muscle, and have smooth teardrop implants. I didn't want to have another full operation, unless absolutely necessary, to repair the problems. Is there something you reccommend doing or a doctor who has successfully fixed this type of deformity?

Answer 1:

Dear Mary, I dont' know if this will fix the acutal nipple position, but it sounds like you might benefit from some reduction of your areola. But I really dont' know without seeing the problem. I would suggest you contact a local plastic surgeon or call the American Society of Plastic Surgeons to get a name. Good luck

Josh Korman, M.D., F.A.C.S.
Mountain View, CA

Answer 2:

Dear Mary, Correcting nipples that are too high requires raising the implants. This is best done surgically but is a lesser procedure than the original surgery. Making the nipples smaller is a relatively easy procedure and can be performed by most competent and trained plastic surgeons.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

I am thinking og having breast Augmentation for a little more size and more shape. Right now I am a 36b-34-c, and have somewhat drooping breasts, almost pointy. Now I only want to go to a full C, small D, but want a nice round shape. Will I get the roundness that I want or will I just have bigger drooping breasts? Thanks so much!

Answer 1:

Dear Shelly, That depends upon how droopy they are to start with. With modest size increase, the amount of lift may not be enough to cure the ptosis (drooping) problem. I would suggest that you contact a good plastic surgeon to seek out an answer to your problem. A breast lift (mastopexy) may be necessary to lift your nipple and areola enough to give you the shape of breast that you want but there is the down side of extensive scarring with a full breast lift procedure. Sometimes an abbreviated breast lift and implantation can be the answer to your problem. I just can't tell without examining you.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Answer 2:

Dear Shelly, It sounds like you might have what is called a "tuberous breast". In that case, an augmentation along with removing a doughnut shaped piece of skin around your areola will help the shape. A plastic surgeon in your area would be the best one to evaluate this.

Josh Korman, M.D., F.A.C.S.
Mountain View, CA

Question:

Hello, I'm 20 years old and strongly considering breast augmentation I was just wondering if silicone gel implants feel more natural than saline filled implants why don't they offer then as a first choice? Why are they only a available for patients that already had the surgery? Thanks for your time

Answer 1:

Yes.the silicone gel implants do feel more natural than saline but only slightly. In about 1993 the F.D.A. banned the use of the gel implant because of related health concerns. They are not permitted for use in those women considering breast augmentation for the first time at this time. However, they are allowed for those women needing reconstructive breast procedures such as post mastectomy and for those women already having gel implants that require replacemnt. Those are the rules/

David Ross, MD
Chicago, IL

Answer 2:

Yes.the silicone gel implants do feel more natural than saline but only slightly. In about 1993 the F.D.A. banned the use of the gel implant because of related health concerns. They are not permitted for use in those women considering breast augmentation for the first time at this time. However, they are allowed for those women needing reconstructive breast procedures such as post mastectomy and for those women already having gel implants that require replacemnt. Those are the rules/

David Ross, MD
Chicago, IL

Answer 3:

Dear Courtney, The answer to your question lies in the court systems. It is disadvantageous for the companies making the implants to produce them when there is risk of lawsuits. There will likely be a cohesive silicone implant which will feel very natural yet not allow migration of silicone. I personally believe that some people have problems with silicone gel the same as some people are allergic to peanuts. It would be nice if we could test for this but it seems to be a very slow process in those so affected. All large studies to date have shown no risk with silicone-filled implants.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

I was wondering if there there was a way of transfering fat cells from one part of your body to your breasts to fill them out more, as I am not interested in implants, I feel body fat should be body fat any which way you look at it so why should it not be transferable. thank you for your time

Answer:

Dear Tara, You are aking about a procedure which has been thought of being performed for centuries. The problem is that fat cells require a large blood supply in order to live. If you just take the cells from one area (especially in the volumes required for signigicant breast augmentation, or lip augmentation), and move them to another area, most will die for lack of adequate blood supply. We do have procedures for moving muscles and fat from one area of the body to another and linking up a new blood supply to it but this is deforming, affects the muscles and requires very large incisions. We use these techniques for reconstructive cases. We are hoping that, in the future, we will be able to clone people's own fat, complete with a blood supply and then "custom make" a vascularized (blood flow containing) breast implant and place it through a small incision. So far this is science fiction and the technology for cloning complex tissue is not yet available.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

Question:

I am 3 weeks post op from breast augmentation, im crease lowering and nipple raise. i still have quite a bit of discomfort. Was wondering if this is normal and how long before i don't have these stinging and shooting pains. Just want to know if this is normal.

Answer:

Dear Kimberly, This is quite unusual although not alarming. If the implants were placed under the muscle, these types of pains can continue for up to 6 weeks. I would suggest that you visit with your surgeon and make certain that your healing is proceding as expected.

Gregory Caputy, MD, Chief Surgeon
Honolulu, HI

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