FAQ About The Condition Breast Implant Illness 

Q: What is Breast Implant Illness (BII)? 

A: There are women with breast implants who self-identify and present with various systemic symptoms and believe that these are related to their breast implants. They refer to these symptoms as Breast Implant Illness (BII). 

Breast Implant Illness (BII) is a term used by women who have breast implants and who self-identify and describe a variety of symptoms including (but not limited to) fatigue, chest pain, hair loss, headaches, chills, photosensitivity, chronic pain, rash, body odor, anxiety, brain fog, sleep disturbance, depression, neurologic issues and hormonal issues that they feel are directly connected to their saline or silicone, textured or smooth breast implants. 

The recent increase in patients reporting Breast Implant Illness (BII) symptoms appears to be related to social media. There is one Facebook group alone with more than 50,000 members, all of whom report Breast Implant Illness (BII) symptoms. This is not to say that social media is the cause of Breast Implant Illness (BII) however, it may account for the rapid increases in patient reporting. BII is not an official medical diagnosis. 

Q: Is there a link between medical grade silicone implants and any disease? 

A: Silicone is an element that exists in nature as crystalline silica, which has been shown to activate the immune system in conditions such as systemic sclerosis which has been seen in stone masons. Silicone used in breast implants is different and to date has not been proven to cause any disease. This silicone does not exist is nature, it is created by hydroxylating silica to form polydimethylsiloxane. Medical grade silicone has had antioxidants, dyes, and plasticizers removed during processing. 

Q: Are there any tests that would indicate a connection between breast implants and symptoms that are being labelled Breast Implant Illness (BII)? 

A: There is no diagnostic testing specifically for Breast Implant Illness (BII). This is one of the current areas of focus for the Aesthetic Surgery Education and Research Foundation, the research arm of the American Society for Aesthetic Plastic Surgery. There are tests for autoimmune diseases that can be performed to evaluate for potential causes of a patient’s symptoms. There are patients who have symptoms they attribute to Breast Implant Illness (BII) with positive immune testing and others with all laboratory tests which show no abnormalities. 

Q. Is there any scientific data showing causation between implants and these symptoms or any disease entity? 

A: In 1999, The Institute of Medicine Committee on the Safety of Silicone conducted an extensive review of the available literature and concluded there was no demonstrated clear link between silicone implants and any systemic illness. There have been studies of many different sizes and design to look at the safety of breast implants themselves. These have looked at specific autoimmune disorders and diseases. In aggregate, these studies show little to no links between breast implants and any disease. Studies of patients who have symptoms that they have related to their breast implants have not shown consistent laboratory abnormalities to 

define a distinct syndrome. To-date, there has been very little in the way of research into this entity that has been labelled Breast Implant Illness (BII) by women with breast implants. 

Q: Does implant removal improve patient’s symptoms or cure a patient who has a medically diagnosed disease entity like an autoimmune disease? 

A: Various studies show different degrees of improvement in patient symptoms after removal of their breast implants, some of which are temporary, and some showing permanent resolution of symptoms. There are no studies which specifically show which symptoms may or may not improve with implant removal with or without capsulectomy. 

There is no current definitive epidemiological evidence to support a direct link between breast implants and any specific disease process. However, this does not mean further research is not indicated. In rare and unusual disease processes, it can take years to come to a scientific conclusion. There are many factors that can affect the interaction between a patient and her breast implants. Further study is required to determine the best way to potentially screen patients prior to breast implant surgery and to determine which of the multitude of reported symptoms might improve with implant and capsule removal. 

A lack of a direct, proven scientific link does not mean that the symptoms experienced by these patients are not real. Some patients have legitimate concerns about a potential link between breast implants and symptoms, so it deserves our attention and further scientific research to better determine what symptoms may improve with explanation of implants. 

Q. What are ASAPS and ASERF doing to better understand this group of systemic symptoms being called Breast Implant Illness (BII)? 

A. Because there are many women that self-identify as having Breast Implant Illness (BII), we are listening. ASAPS and ASERF are developing a new scientific study to examine this entity. We are also providing our members with a questionnaire to use to collect a record of complaints from patients with implants, as well as one to utilize for post-explantation. We cannot yet define BII and therefore cannot say with any certainty that it exists, because we do not have any tests we can run to prove or disprove its existence. However, we can listen to and partner with our patients to determine what is the best course of action to address their complaints, be it explantation or otherwise. 

Q: What should a physician do when a patient complains of Breast Implant Illness (BII) symptoms? 

A: Do not ignore your patient’s concerns. Their symptoms are real and whether or not they can or cannot be attributed to their implants isn’t relevant since there is simply no existing way to prove nor disprove causation or association. 

Options can include: further medical work up with or without the consultation of a rheumatologist, observation without medical work up, implant removal without capsulectomy, exchange with or without capsulectomy, removal with total capsulectomy, or removal with en bloc capsulectomy. 

Patients who present with concerns of Breast Implant Illness (BII) have real symptoms that often cannot be categorized into any specific know disease entity. This does not mean their symptoms are not real and they deserve a full evaluation. The various options need to be 

discussed and hopefully, with further research, we may be able to determine which patients may see symptom improvement or resolution with removal of their implants and which may not see any change. 

Q: What is the risk of developing Breast Implant Illness (BII)? 

A: As there is no definitive link between the often subjective and divergent list of symptoms, and no means for testing, there is no ‘known’ risk. Many of the symptoms described by breast implant patients are experienced by the general public on a regular basis with or without implants. That isn’t to write-off a potential connection, but no connection has been established to-date. 

Patients should however be informed of the risks that can be associated with breast implants, including (but not limited to) BIA-ALCL, a rare spectrum of disorders that can range from a benign accumulation of fluids around the breast (seroma) to an extremely rare lymphoma. They should know that BIA-ALCL is not a cancer of the breast tissue itself and that when caught early, it is readily curable. If the disease is advanced, chemotherapy or radiation may be required. 

Q: If after the discussion of risks and the possibility of no improvement of symptoms post-explantation is discussed with a patient, what should be done if the patient demands an “en bloc” or “total” capsulectomy with their explantation? 

A: There are many medical inaccuracies perpetuated by the internet. BII patients tend to believe that a total capsulectomy is necessary to remove all causative agents and they prefer it en bloc, oftentimes without having a full understanding of what size incision is necessary for en bloc. Rather than react, first discuss the reasons you would perform a total capsulectomy with any patient. Not all plastic surgeons routinely perform a capsulectomy with explant, but some do. 

If you wish to perform capsulectomy on a patient, it is important to explain that it is not always possible to remove all of the capsule. Sometimes a portion of the capsule must be left behind or is disintegrated with the use of electrocautery to prevent significant damage to muscle, rib or lung. Explain what size incision is necessary for an en bloc (as many may not be aware of how large an incision may be necessary). If they had an axillary approach or periareolar approach for breast implant placement, it must be explained to them that they cannot have the procedure done through those incisions. It is recommended to reinforce that there are increased surgical risks associated with en bloc capsulectomy which requires a complete dissection of all the tissues surrounding the breast implant and, that we do not have enough collective data to guarantee any improvement in their symptoms they have labelled Breast Implant Illness (BII). 

Do you have questions about your breast implants and the recent FDA hearings?

Frequently asked questions about BI ALCL

FAQs as of February, 2019 

Q: What is BIA-ALCL? 

A: BIA-ALCL (Breast Implant-Associated Anaplastic Large Cell Lymphoma) is a rare spectrum of disease that can range from an indolent accumulation of fluids around the breast (seroma) to a potentially metastatic lymphoma especially when there are delays in diagnosis. It is a disease that ranges from indolent to full-blown metastatic disease when not caught early. BIA-ALCL is not a cancer of the breast tissue itself. When diagnosed early, it is readily curable. If the disease is advanced, chemotherapy or radiation may be required. 

BIA-ALCL is currently classified as a lymphoma. Many experts believe that it behaves clinically as a lymphoproliferative disorder (LPD) that encompasses the spectrum of disease from benign CD30+ seromas, to CD30+ malignant seromas, to invasive capsular disease, and finally metastatic disease. Current ASERF research is underway to further understand the proper classification of this disorder. Similar to LPDs, BIA-ALCL is a highly treatable disease with high cure rates. 

Q. Have there been any deaths due to BIA-ALCL? 

A. There have been 17 confirmed deaths globally, (9 in the United States), attributed to BIA-ALCL since the disease was first reported nearly 20 years ago. 

Q: What are the symptoms of BIA-ALCL? 

A: The first symptom of BIA-ALCL is usually a swelling of the breast between 2 to 28 years after the insertion of breast implants, with an average of about 8 years after implantation. The swelling is due to a collection of fluid surrounding the implant. This fluid can cause the breast to enlarge significantly over a period of days or weeks. It can also present as a lump in the breast or armpit, firmness of the breast, or pain. It is usually easily and completely treated if patients see their doctor at the first symptom. 

Q: What is the risk of developing BIA-ALCL? 

A: The FDA reports that it is 1:3,817 to 1:30,000 in their latest statement. These risk assessments are changing on an ongoing basis, but this is the most accurate information currently available. 

Based on current data, the risk can be further explained by the texture grade of the implants as follows: 

Grade 1 (Smooth only) – In global databases, there has not been a confirmed case of smooth only. In the Feb 2019 FDA statement, it was reported that “there have been reports of BIA-ALCL in patients with smooth-surfaced implants and many reports do not include the surface texture of the implant at the time of diagnosis.” At the time of this publication it is known that a single case of smooth only BIA-ALCL was originally reported to the FDA; however, it was later determined that this was not accurate and the case was a mixed implant case, and the report to the FDA was amended. 

Grade 2 (e.g. Microtexture, Siltex and similar) – 1:82,000 

Grade 3 (e.g. Macrotexture, Biocell and similar) – 1:3,200 

Grade 4 (e.g. Polyurethane) – 1:2,800* 

*Based on data form an Australian study – however this was 100% Silimed PU implants that had a manufacturing defect and have since been taken off the market. 

Loch-Wilkinson, A., et al. (2017). “Breast Implant-Associated Anaplastic Large Cell Lymphoma in Australia and New Zealand: High-Surface-Area Textured Implants Are Associated with Increased Risk.” Plast Reconstr Surg 140(4): 645-654 

Q: If a breast implant patient sees a plastic surgeon when she develops a first symptom, will she be cured? 

A: That answer is not known and is a very important piece of information for patients and plastic surgeons. Most of the time patients see their plastic surgeon right away when they develop significant swelling of the breast. In these cases, the disease is almost always caught early and cured with a straightforward operation. Some women with advanced disease ignored earlier symptoms or saw a doctor who did not properly diagnose them. There are a few patients who presented with advanced disease who said that they never had earlier symptoms. 

Q: Can you explain the differences in implant texture and what role that factor plays in the research? 

A: Although it is rare, BIA-ALCL appears to currently develop exclusively in women with textured implants. To date there has not been a case of BIA-ALCL in a patient with only smooth implants. There are several theories which attempt to explain the higher rate for textured implant patients: many believe that the increased surface area of textured implants allows a higher number of bacteria around the implant, which forms a biofilm in some patients, and can result in chronic inflammation, ultimately leading to a proliferation of lymphocytes. Less accepted theories are that textured implants create greater inflammation because of chronic mechanical irritation, and another postulates that microscopic shedding of silicone from the textured wall induces inflammation. 

Q: Is it a problem with Saline or Silicone implants? 

A: Of the 457 unique cases of BIA-ALCL (FDA 2-2019) implants are both silicone and saline. It appears to purely be related to the surface of the implant and not to what the implant is filled with. 

Q: How does this impact those with breast implants? 

A: ASAPS and ASERF emphasize that the most important issue for women with breast implants is to screen for breast cancer with self-exam, a regular physician exam, and mammography/ultrasound/MRI as recommended by their physician. Regardless of BIA-ALCL, all women should see their plastic surgeon immediately if they note a change to the size, feel, or shape of their breasts. 

Q: What about those considering breast implants? 

A: Patients considering textured breast implants should discuss this issue with their plastic surgeon. Since our knowledge of this condition is continuing to evolve, thanks in large part to ASERF-sponsored research, patients should check surgery.org and the FDA website for any updates. 

Q: What if a doctor is recommending textured implants to a patient? 

A: The choice of implant type is ultimately a decision between an educated patient and her board certified plastic surgeon. There may be certain circumstances where a textured implant is recommended for particular patients. 

All patients should have a detailed conversation with their surgeon about the risks associated with textured implants, beyond what is published online or in pamphlets. Ultimately, there are instances where textured implants are the best choice for them. 

Q: How is BIA-ALCL diagnosed? 

A: If a woman develops swelling in an augmented breast, she should undergo an ultrasound scan. If fluid is detected, it should be drained and tested for: 

1. Cytology 

2. CD30 

CD30 immunohistochemistry is not diagnostic for BIA-ALCL; however, it is a marker for activated T-Cells. If a patient’s seroma is CD30 positive, and the cytology is negative, this likely represents a precursor to BIA-ALCL, and should be treated with total capsulectomy. If the seroma test is CD30 negative with negative cytology, then it should be treated as a benign seroma using the individual surgeon’s protocol. 

The majority of seromas seen clinically are benign seromas and not BIA-ALCL. 

Management of all seromas should be by a board-certified plastic surgeon. Mammograms are not useful in diagnosing BIA-ALCL. In confirmed cases PET or MRI/CT scans may be used to help stage the disease. 

If a patient wants to have their textured implants removed and replaced, the options are: 

Exchange to smooth implants 

Exchange to smooth implants with a capsulectomy 

Q. How is BIA-ALCL treated and what is the prognosis? 

A. Current recommendations for the treatment of BIA-ALCL call for bilateral capsulectomy (removing all the scar tissue) and removal of the old breast implants. This is a very common procedure performed by plastic surgeons, identical to what is done when an implant has ruptured or capsular contracture has developed. Smooth implants can be put back in or the 

patient can choose not to have implants. In all early stage cases, the disease has been fully resolved by this surgery alone. The majority of patients require no additional treatment. However, if the disease has spread to lymph nodes or grown into the adjacent tissues, chemotherapy and radiation may be necessary. These are very serious treatments with significant side effects. 

Q: Are some patients at greater risk than others? 

A: The rates of BIA-ALCL seem to have different rates throughout the world. This may be due to different reporting and registries, but there is likely to be a genetic predisposition that is not yet fully understood. For instance, as of this time there are very few cases in Asian patients. The risk is only with textured implants and not smooth implants; the rate is no different between silicone and saline; it occurs in both cosmetic and reconstructive patients. There is no test to determine whether one textured implant patient is at any more risk of developing this disorder than any other patients. 

Q: Should patients have their implants removed because of BIA-ALCL? 

A: For textured implant patients, neither the FDA nor any plastic surgery society currently recommends that women should preventatively remove textured breast implants to prevent BIA-ALCL. However, there are women who have been concerned enough about BIA-ALCL and have chosen to have their implants removed. There are some women who were already considering a breast implant revision, and the BIA-ALCL issue gave them one more reason to decide to proceed. 

Breast implant patients should have ongoing follow up. Current FDA recommendations and ASAPS recommendations indicate that patients with textured implants with no issues should not do anything and implant removal is not recommended. 

Q: Should women with breast implants be screened for BIA-ALCL? 

A: There is no blood test to specifically screen for BIA-ALCL. The expert opinion is that asymptomatic women without breast changes do not require more than routine mammograms and breast exams. But if a patient experiences a change in her breasts – especially if there is swelling or a lump – she should undergo immediate examination, imaging, and consultation with a plastic surgeon. If there is fluid around the implant the fluid should be aspirated under ultrasound guidance and sent for analysis. 

Q: What causes BIA-ALCL? 

A: ASAPS, ASERF, the FDA, and the implant manufacturers are intensely studying BIA-ALCL. To date, no specific causal factors have been identified. Implant texturing, bacteriologic contamination, and genetic factors have been implicated and are undergoing further study. 

The best theory today is that a combination of four factors are required for the development of BIA-ALCL: 

1. Textured implants (surface area to sequester bacteria) 

2. Chronic bacterial-inflammation 

3. Genetic predisposition 

4. Time 

The source of the chronic inflammation is thought to be bacteria that have been identified around the implants in affected breasts. Evidence is accumulating that a long-term inflammatory response to the presence of these bacteria is one of the factors that may cause BIA-ALCL. Research is ongoing and cases are being monitored. 

Genetic factors may play a role. Some geographic areas have reported very few cases. Ongoing data collection worldwide will help to determine whether or not there are any genetic propensities for this disease. 

Q: Does ASAPS recommend against the use of textured implants? 

A: The available data does not support discontinuance of textured implants. The best practice is always for the physician to discuss with each patient the known risks and potential complications associated with any procedure. It is important for the patient and her doctor to frankly discuss all options available, and the risks involved. 

Every plastic surgeon offers patients options regarding breast implants in terms of sizing, shape, and surface. Depending on a particular patient’s needs, a textured implant may be preferable. The plastic surgeon must provide a frank and transparent discussion regarding the benefits and risks of implants, both smooth and textured. The patient must then make an informed decision, based upon her own assessment of her needs and the risks involved. 

Every plastic surgeon needs to help each individual patient make her own decision about which implant she prefers in a fully transparent manner. This involves weighing any possible increased risks against the advantages offered by a particular type of implant. It is critical that the patient makes a fully informed decision following a full discussion of the risks and benefits. 

Q. What is the recommended clinical response to a patient presenting with symptoms that could be attributable to ALCL? 

A. Detailed information can be found on the ASAPS website at: 

http://www.surgery.org/professionals 

Q: Where can I find more information on BIA-ALCL? 

A: Additional information and resources on BIA-ALCL are available online at https://www.surgery.org/media/resources 

Q: Is there any assistance available to the patient? 

A: The Mollenkopf Aesthetic Breast Reconstruction Fund and the BIA-ALCL Patient Assistance Fund can offer financial assistance to patients. Additionally, Sientra offers to cover lab testing for any seromas associated with their implants. 

The Mollenkopf Aesthetic Breast Reconstruction Fund: http://www.aserf.org/attachments/223_mollenkopf-grant-request-form.pdf 

The Mollenkopf Aesthetic Breast Reconstruction Fund The Aesthetic Surgery Education and Research Foundation (ASERF) is pleased to announce available funding for breast reconstruction patients. The Mollenkopf Aesthetic Breast Reconstruction Fund provides grants to ASERF/ASAPS member surgeons, to financially assist patients in completing their aesthetic breast reconstruction journeys. These funds are intended to help underinsured or uninsured patients nationwide cover the associated costs with breast reconstruction. The goal of this fund is to provide women with limited financial means the opportunity to achieve the best possible aesthetic breast reconstruction result. In particular, the grant is focused on women who need a final surgery or revisional surgery to complete their aesthetic reconstruction. The goal is for ASERF/ASAPS members to help women feel good about themselves after their reconstruction and aid them in returning “back to me.” 

The BIA-ALCL Patient Assistance Fund: http://www.aserf.org/images/documents/bia-alcl-patient-fund-grant-request-form.pdf 

The American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS), in conjunction with the Aesthetic Surgery Education and Research Foundation (ASERF) and the Plastic Surgery Foundation (PSF), are pleased to announce funding for patients diagnosed with breast implant associated anaplastic large cell lymphoma (BIA-ALCL). These funds are intended to help underinsured or uninsured patients who are seeking surgical treatment of BIA-ALCL, total capsulectomy and explantation, and excision of associated mass with biopsy of suspicious node(s) and implant-based reconstruction, if indicated. The goal of this Fund is for ASAPS, ASPS, ASERF, and PSF members to help patients obtain treatment when insurance limitations would have otherwise restricted their ability to do so. The Fund is made possible by generous contributions from Allergan, Mentor Worldwide, LLC and Sientra, Inc. 

Sientra: http://sientra.com/Content/pdfs/LGL-0006%20R2-Sientra%20Warranty%20Terms%20and%20Conditions.pdf 

The Sientra Platinum20™ Product Replacement and Limited Warranty Program for Sientra Opus™ Silicone Gel Breast Implants (Smooth and Textured Surface) offers assistance with patients presenting with late-forming seromas. 

Q: What research is being conducted? 

A: ASERF is currently funding two BIA-ALCL studies on the Pathogenesis of BIA-ALCL and Genomic Profiling to Understand the Pathogenesis of BIA-ALCL. 

ASERF is sponsoring leading, cutting edge research on BIA-ALCL to better define the disease and improve diagnosis and outcome. More information can be found on the ASERF website: www.aserf.org 

if you haven’t donated to ASERF, here’s the link: http://www.aserf.org/donor-benefits/make-a-difference http://www.aserf.org/donor-benefits/make-a-difference 

Breast Implant Massage Las Vegas

Beginning with your second post-operative breast augmentation visit with Dr. Michael Edwards, Dr. Terry Higgins, or Dr, Andrew Silver, your breast massage regimen will be started (typically 1 week post-op) to aid in obtaining and maintaining a naturally soft breast. The softness of the breast after surgery is dependent on the pocket (also called the capsule), which heals around the implant, being slightly larger or looser than the implant. Our plastic surgeons recommend these breast implant massage exercises for their Las Vegas patients to foil the body’s natural healing process, which may contract the size of the pocket/capsule yielding a firm feeling breast.

IMPLANT ROLL (after you have been instructed in the office)

With your bra off, press your open palm against the breast directly under the nipple. The palm should be rolled up tightly against the chest wall causing the implant to rise upwards. This is not a pushing up move, the push is in. Repeat this on each breast for 10 repetitions 3 times a day holding for 10 seconds. It is not uncommon to hear the implant slide against the chest wall early on. Watch for the implant to slide up as in the middle photograph. The third photograph illustrates the downward displacement of the implant for 10 seconds which is equally as important. It helps to look in the mirror as you push both breasts in on your breast to make sure they are at the same level as when they were initially positioned. The downward massage can be diminished in frequency as the implant settles over the weeks after surgery.

MIDLINE MASSAGE

This exercise is to allow further refinement in the medial and lateral (the sides) position of the implants. Your chest muscles (if your implants are under the muscle) do hold the implants back and this massage will encourage it to relax in an effort to be able to develop cleavage. The massage to the sides (far right hand photo) should be done carefully because we do not want your implant to displace too far to the side.

TOWEL ROLL EXERCISE (do this only if your surgeon instructs you to)

Dr. Edwards or Dr. Higgins may ask you to take a rolled bath towel, place it across the top or you breasts, and lay on a firm surface. This exercise may involve one or both breasts. If done properly you should feel pressure on the lower breasts but not severe discomfort. If you feel severe discomfort, re-position the towel higher on your breast to exert less pressure. Do this exercise only as long as Dr. Edwards or Dr. Higgins has instructed you to because there is a risk that you can cause the implant to slide down too far.

How do I choose the right implants for me?

Today’s breast augmentationpatients are fortunate in that they have seemingly endless combinations of options from which to choose. Although the ultimate decision is up to you, Dr. Edwards, Dr. Higgins, or Dr. Silver will help you determine the best fit based on your body and your desired results. Here are just a few of the factors you’ll need to consider, as well as some advantages of each option:

  • Implant material: Saline implants are filled with a sterile saltwater solution which is just like the saltwater in your tissues and blood vessels. Because they are inserted into the body empty and only filled once they’re in place, they require slightly smaller incisions. Silicone implants are filled with a cohesive silicone gel, which most people agree feels and looks more natural than a saline implant. Silicone gel-filled implants are often appropriate for women with less natural breast tissue, because they pose less risk of a complication called rippling, which occurs when the edges of the implant can be seen or felt.
  • Implant size: The size of implants chosen for you is mostly a matter of personal preference, as well as what is appropriate based upon what your surgeon determines during your examination. You may have a bra cup size in mind that you’d like to reach, which is helpful in planning, but we actually measure implants in cubic centimeters, or cc, because cup sizes vary among bra manufacturers. You can try on different “sizers” under a sizing bra to see how you might look with different options. You may also be a candidate for 3D imaging, where different implants can be simulated for you to view.
  • Implant shape: Round implants can be smooth or textured, saline or silicone, and can yield a very natural result. Shaped implants are contoured to try to mimic the look of a natural breast shape. They have more volume toward the bottom in an effort to try to also provide a natural result. Dr. Edwards, Dr. Higgins , or Dr. Silver will review these options with you to help you decide which implant is most appropriate for you.

Which incision is best?

Depending on your personal preferences and choice of implants, you may choose from 2 incision options, both which create discreet scars:

  • The most popular incision is the inframammaryincision. If you choose this incision, Dr. Edwards, Dr. Higgins, or Dr. Silver will trace the position of the fold beneath your breast where it meets your body, called the inframammary fold. The incision will be placed on this line and allows the surgeon control during surgery and precision for predictable results that are as symmetrical as possible with your anatomy. Once healed, the resulting scar can be concealed beneath clothing, lingerie, and swimwear.
  • The second incision option is the periareolarincision, which runs along the lower border of the areola, or the area of dark skin surrounding the nipple. This incision may be more appropriate for women who have naturally large areolas. These incisions generally heal well, as the resulting scars blend with the natural color delineation between the areola and the breast skin.
Inframammary and Periareolar incision graphic

How long does the surgery take?

The exact duration of your surgery depends on a few different factors, including whether you’ve chosen to undergo a breast liftwith your breast augmentation. Breast augmentation on its own generally takes about one hour, but every patient is told the operation will take as long as it takes to safely provide the best result we can. During your consultation, Dr. Edwards, Dr. Higgins or Dr. Silver will give you a better idea of how long you can expect your procedure to last.

How long does implant ‘settling’ take?

“Settling” refers to the process of breast implants dropping and softening after surgery, or assuming their final, or natural, position. Immediately after breast augmentation, it is common for the breasts to sit higher on the chest and feel and appear swollen and firm. Over the weeks following surgery, your breast implants will gradually descend to a more natural-looking position with the assistance of breast implant massage, which our staff will teach you. As the tissue around them relaxes, the breasts also become softer. The process of dropping can take weeks to a few months.

How can I improve my recovery?

We do our best to make sure your recuperation period is smooth and stress-free, and there are ways you can help in that effort, as well. We review all of your pre and post-operative instructions during your clinic and at your pre-operative consult. For instance, we recommend you sleep on your back for some time after surgery in order to give your implants the opportunity to heal properly. This can be tricky if you are used to sleeping on your side or stomach, but doing so for a relatively short time will help in your recovery. Our surgeons suggest sleeping with pillows at your sides to keep you from rolling over in the night. That’s just one of many tips we provide after your surgery. The most significant thing you can do to speed your recovery is to follow all of our instructions, regarding everything from medications to activity restrictions to follow-up appointments. We will give you detailed guidelines and are glad to take questions at any time. Patients who follow these instructions tend to find the process goes by quickly and easily.

Which is better: augmentation with implants or fat transfer?

The option that’s best for you generally has a lot to do with the type of results you want. Fat transfer is an exciting option for many women because it creates results that look and feel quite natural. However, it’s not a good match for patients in search of a significant increase in volume, as fat transfer can’t add more than a cup size or so. If you’re unsure of the procedure that would work best for you, Dr. Edwards, Dr. Higgins, or Dr. Silver can help you decide.

If I need to replace my implants in the future, can the same incisions be used?

Even though the majority of breast augmentation patients are satisfied with the results of the primary procedure, breast implant revisionsurgery is a possibility at some point. Some women get revision surgery to change the size or type of implants. Our experienced plastic surgeons specialize in implant revision procedures and often perform them for patients who were unhappy with results they got from other practices. They use existing incisions whenever possible. It is very common if a patient had implants originally inserted through inframammary incisions that the same incisions can be used. Incisions at the base of the areola can also usually be used again.

Can breast augmentation be combined with other procedures?

Yes, combining breast augmentation with complementary procedures is common, safe, and an excellent choice for some patients. The most common combined procedure is having a breast lift and getting breast implants during the same operation. Women who have lost a significant amount of weight or had children may get a tummy tuckand liposuctionalong with cosmetic breast enhancement — a procedure that is often called a “mommy makeover.” The best way to determine if you’re a candidate for combining breast augmentation with other procedures is to consult with either Dr. Edwards, Dr. Higgins, or Dr. Silver.