Breast Procedures - Frequently Asked Questions
Q: Are silicone gel implants safe?
A: Yes. They are approved by the FDA for use in all patients. The silicone gel implant is the most extensively studied medical device over all and shown to be completely safe.
Q: Are there different shapes of implants?
A: Yes. There are many different options of implants shapes and sizes (i.e. round, teardrop, textured, smooth, high profile, moderate profile, low profile). You will be able to see and try on everything available at your consultation.
Q: If I want to be a full C, what size breast implant do I need?
A: No one implant will look the same on two different people. For example, if your friend has a 375cc implant and is a full C, that same implant will not necessarily produce the same result in you. You need to take into account how much breast tissue you are starting with, your height, chest wall shape, and shoulder breadth, among other factors. Dr. Godat can give you a better idea of what size range will fit your body best at your consultation. You will be able to try on a wide range of implant sizes at your consultation.
Q: Will insurance cover a breast augmentation?
A: Insurance will not cover breast augmentation plastic surgery unless it is part of reconstruction after breast cancer surgery. Insurance will pay for any procedures on the unaffected breast in conjugation with reconstruction of the affected breast, including breast augmentation and breast lift plastic surgery.
Q: What is a breast capsule?
A: This is the body’s reaction to the implant. Within three weeks after placement of the implant, your body forms a thin shell or capsule that surrounds it.
Q: What is capsular contracture?
A: This is an abnormally thick capsule that forms around a breast implant in approximately 5 to 15% of patients. It can cause pain and distortion of the breast.
Q: How is capsular contracture treated?
A: In its early stages, it may be treated conservatively with the oral medication Accolate. There is some evidence to show that this asthma medication can cause a capsule to thin and soften in some patients due to its anti-inflammatory affects. Most patients will require surgical removal of the capsule and replacement of the implants. The capsule needs to be completely removed. Women who develop capsular contracture are more likely to develop it again. Dr. Godat therefore recommends placement of the internal bra in these patients to prevent recurrence of contracture.
Q: What is the internal bra made of?
A: The internal bra is a biologic tissue from the deeper layers of skin from a cadaver or pig. The material is treated in a proprietary fashion to remove all of the cellular components so that only a strong scaffolding remains. By the third week after surgery, the patient’s blood vessels have grown into the tissue and incorporated it into her body.
Q: Do I need a mammogram before I have breast surgery?
A: All women forty years of age and older will need to have a screening mammogram done within twelve months prior to their surgery date. If this has not already been done, Dr. Godat can arrange this at the time of your consultation.
Q: Will insurance cover a breast reduction?
A: Yes, some insurance companies will provide coverage for a breast reduction. We can discuss whether you are a good candidate for a medically necessary breast reduction after your exam on your consultation day.
Q: What are the factors that insurance companies use to determine coverage for breast reduction surgery?
A: Insurance companies usually require at least 16 ounces or 500 grams of breast tissue be removed from each breast. This will vary depending on the height and weight of the patient. Symptoms that need to be present are at least two of the following: upper back pain, shoulder pain, neck pain, or shoulder strap grooving. A few insurance companies may require a history of treatment for these symptoms. This may include over-the-counter medications such as Motrin, Alleve, or other non-steroidal, anti-inflammatory medications for a period of time of at least one year. Some insurance companies may require a history of physical therapy treatment for the back pain and a letter from a primary care physician confirming these physical findings and symptoms. If there is a history of rash or skin breakdown under the breast that has been treated, a documented history of this from the primary care physician may be helpful.
Q: Will insurance cover a breast lift?
A: Insurance will not cover a breast lift unless it is done in conjunction with breast reconstruction for breast cancer. Breast lift plastic surgery can be performed on a normal breast to match reconstruction of the affected breast. Also, in cases of extreme weight loss, some insurance companies will approve some patients for breast lift plastic surgery if it is associated with rash or breakdown of the skin under the break due to extreme sagging or ptosis.
Breast Plastic Surgery Questions:
Q: Is it safer to place the implants above or below the muscle?
A: Placement of the implant is based on each patient’s individual factors, such as breast tissue present, and implant desired. Dr. Godat will discuss which option is best for your body type at your consultation. No one technique, above or below the muscle, is best for all patients.
Q: Are the nipples detached when I get breast lift or breast reduction plastic surgery?
A: No, the nipples stay attached to the central, underlying breast mound. In breast lift surgery, the nipple with the underlying breast tissue is transposed superiorly after it is freed up from surrounding skin. In breast reduction surgery, the nipple and underlying tissue is also transposed superiorly after the removal of excess breast tissue from the lower pole of the breast.
Q: Where are the incision placed for breast augmentation plastic surgery?
A: With silicone gel implants, Dr. Godat uses an incision in crease under the breast. The incision is usually no longer than two inches. With a saline implant, Dr. Godat may use, at the patient’s choosing, an incision through the armpit.
Q: How is the internal bra placed?
A: The internal bra is attached to the lower border of the breast through the chest wall. The upper border is attached to the upper pole of the breast, thus cradling and supporting the implant by transmitting the weight of the implant to the chest wall.
Q: Are there more incisions involved in placing the internal bra?
A: No, the internal bra is placed through incisions already being utilized for breast augmentation or breast lift.
Q: Where are the incisions placed for breast lift plastic surgery?
A: The incisions are around the areola, from the areola to the inframammary crease in a vertical direction, and in the inframammary crease.
Q: Where are the incisions placed for breast reduction plastic surgery?
A: The incisions are around the areola, from the areola to the inframammary crease in a vertical direction, and in the inframammary crease. The length of the incision along the inframammary crease depends on the amount of tissue and skin that must be removed. If there is a great deal of excess skin and breast tissue underneath the arm, the incision will extend accordingly.
Q: Will my breasts be lifted during breast reduction plastic surgery?
A: Yes. Breast reduction surgery and breast lift surgery are essentially the same operation. By definition, breast reduction surgery is a breast lift in which at least four grams or 100 ounces of tissue are removed. For a typical breast reduction surgery that is covered by insurance, 16 ounces or more are removed from each breast.
Q: Do my implants require any kind of monitoring after breast augmentation plastic surgery?
A: Yes. Monitoring with MRI is recommended two years after placement of silicone gel implants and annually thereafter.
Q: What is the best diagnostic test to determine if my implant has rupture?
A: MRI is the most sensitive test for implant rupture. Sometimes, routine screening mammography or ultrasound can detect an implant rupture. However, most ruptures are too small to be detected by these tests.
Q: What are chances of my implant rupturing?
A: Saline implants currently used have a rupture rate of up to 15% at 15 years. The newest silicone gel implants that were approved in November 2006 are projected to have a rupture rate of less than 10% at 15 years based on the data already accumulated. This is by far the lowest rupture rate of any implant ever used.
Q: What happens if my implant ruptures?
A: With the newest silicone gel implants, nothing. The gel is cohesive and will stay in place after rupture of the implant. With the saline implant, many times rupture is not detected because the saline solution is contained within the capsule that the body forms around the implant. This is called an intra-capsular rupture. Occasionally, a rupture will go through the capsule and completely deflate the implant. The saline is absorbed by the body, but the rupture causes a significant deformity that is immediately detected by the patient. It is recommended that all ruptured implants be replaced immediately, even if only detectable by MRI.
Q: How often will I need to get my breast implants replaced?
A: Breast implants should only be replaced if necessary. That is, if they have ruptured or if a capsular contracture has formed.
Q: Will I ever need a breast lift again after breast lift plastic surgery?
A: Breast tissue continues to sag during age due to the aging of breast tissue and skin, and the effects of gravity on breast tissue and skin. A breast lift may be necessary again. Patients with an implant may require a breast lift sooner as the weight of the implant cause sagging to occur at a faster rate. Use of the internal bra can counteract some of these sagging issues.
Q: Does the internal bra ever need to be replaced?
A: No. The internal bra is a biologic material that become part of the patient’s own body and therefore never needs to be replaced.
Q: Will my breasts grow again after breast reduction plastic surgery?
A: Breast tissue is dynamic and changes throughout a patient’s life. In some patients, breast tissue may grow during pregnancy, after pregnancy, or even after menopause. Changes in breast size during the course of a women’s life are impossible to predict. On occasion, a woman may need another breast reduction surgery.
Q: How soon can I go back to work?
A: Plan on taking at least one week off. Most patients feel well and want to return after a few days. You can return to work when you feel able, but you should still abide by the activity restrictions (i.e. no heavy lifting). This time frame applies for all procedures.
Q: When can I begin to exercise after breast plastic surgery?
A: You can return to regular activity and exercise after surgery, whether it is augmentation, lift, or reduction. You should start your routine slowly and work up to pre-operative levels by six weeks. Placement of the internal bra requires that the patient wait six weeks before she begins exercise.
Q: Does Dr. Godat use any drains for any of his breast procedures?
A: Generally no, with the exception of the internal bra. In this case, drains are used for three to four days and drain removal is painless.
Q: Can I breast feed after any breast procedure?
A: Yes. Breast augmentation plastic surgery should not affect the ability to breast feed. Breast lift and breast reduction surgery can affect the ability to breast feed by reducing milk production. If breast feeding is an important consideration, then defer breast lift and breast reduction surgery until after all planned breast feeding is completed.
Q: If I am planning on a future pregnancy, should I delay having breast surgery?
A: If you have plans to become pregnant in the next year, then yes, delay your plans until after your pregnancy. However, if you do not plan on becoming pregnant for at least a year and your concerns with your breasts are serious enough to bring you to a doctor’s office, then Dr. Godat recommends that you address these concerns now.
Q: Should I always wear a bra after breast plastic surgery?
A: Wearing a bra is recommended after the breasts are healed after breast plastic surgery to help prevent sagging in the future.
Q: When can I get fitted for a new bra after breast plastic surgery?
A: Generally at three weeks after surgery when the incisions are completely healed.
Q: Will I have sensation in my nipples after breast plastic surgery?
A: Nipple sensation may be decreased after surgery. This is rare in the augmentation patient, but more common after breast lift or reduction. In most cases, sensation returns near normal levels in these patients.