Statistics from the American Society of Plastic Surgeons show that breast augmentations were the most popular cosmetic surgical procedure in 2018 and have been for the past few years. Here, some expert plastic surgeons share what you should keep in mind before getting breast surgery.
1. It’s rare for insurance to cover breast surgery for purely cosmetic reasons.
According to Melissa Doft, MD, FACS, surgery will sometimes be covered when correcting severe asymmetry due to developmental deformity or reconstruction after mastectomy or lumpectomy. For breast reductions, Rady Rahban, MD, FACS, adds that insurance will sometimes pay if the breasts are so large they create symptoms of back pain, neck pain, or rashes under the breast or if surgery is otherwise medically necessary.
2. Beware of “nonsurgical breast augmentation” procedures.
Procedures that advertise using fat from liposuction and re-injecting it into the breast, also called fat grafts, are still considered surgical procedures, explains Dr. Doft. While it might be tempting to consider because it seems less invasive than a traditional boob job, the results are also harder to predict. Dr. Doft says: “Thirty to 50 percent of the fat will not survive. It is also not possible to know which fat will and will not survive, which may alter your results.
Constance Chen, MD, board-certified plastic surgeon and breast reconstruction specialist, adds that the FDA is currently looking into fat grafting to see if there’s a risk of breast cancer associated with it. Other nonsurgical augmentations with saline or injectable fillers are extremely dangerous and not recommended, says Lara Devgan, MD, board-certified plastic surgeon and RealSelf Chief Medical Officer. “We do not understand how injectable fillers interact with breast tissue in the long run,” she explains.
3. Your body type will help decide what kind of incision your doctors use.
If you have very small areola, that might make areola incision more difficult, says Dr. Doft. Scarring is also something to consider talking to your doctor about. Dr. Norman Rowe, MD, says that for some women who want to go topless, they’d prefer to use the areola incision method, while others want to use the underarm incision so they can wear tank tops freely.
4. Looking into your doctor’s social media presence can be very telling.
Nowadays, it’s not uncommon for patients to find doctors via social media like Instagram and Snapchat. These platforms, when used appropriately, can be a good indicator of the kind of doctor you’re getting, says Dr. Rahban. You can get a sense of the doctor’s personality and the kinds of surgeries they do, but “that being said,” he adds, “when a doctor utilizes it as an entertainer or for shock factor, it tells a lot about [their] professionalism.”
5. It’s probably best to err on the side of more conservative when it comes to sizing.
Dr. Rahban estimates that 30 percent of the errors made in breast augmentation come down to incorrect size selection. “The most important thing with breast augmentation is to make sure that the implant you select is conservative and not too large for the size of your anatomy.” It’s a red flag if your doctor doesn’t seem concerned with advising you about the maximum size you can reach before developing medical complications.
6. Certain types of breast implants are associated with a kind of cancer called ALCL(anaplastic large cell lymphoma).
“At this point, they are unsure as to what causes it but believe it is somehow related to the texturing of the implant surface,” explains Dr. Rahban. It also seems that removing the implant along with any scar tissue can be curative. So far, statistics are rare, with 626 cases and 17 deaths reported worldwide. If you’ve gotten implants in the past, don’t freak out yet. “It is something to be aware of. While I don’t think it’s super alarming, it’s good to know what is on the horizon,” says Dr. Rahban.
7. You have a choice of different kinds of implant materials.
There’s saline, silicone, “gummy bear” (aka cohesive gel), and autologous fat, explains Dr. Rowe. For the latter, you’ll need around two to three pounds of fat to inject into the chest, and patients often need touch-ups to achieve symmetry. With saline, the implant ripples more, and some patients think that it feels heavier. If a saline implant ruptures, it’s absorbed into your body safely; however, the difference is very noticeable, so you’d likely want to see a doctor ASAP anyway, explains Dr. Doft. Silicone tends to feel more natural, hold its shape, and ripple less. Dr. Doft says the majority of her patients choose silicone.
8. Your first breast surgery probably won’t be your last.
Twenty-five percent of women will need another surgery after 10 years because implants don’t last forever. The implant could begin to leak over time or a “scar shell” could develop around it, warping the shape and causing a need for new implants. Weight loss, pregnancy, and change in preference are other factors that could lead the patient to having another surgery after a few years.
9. It will cost you around $3,719.
This average total, according to the 2016 statistics from the American Society of Plastic Surgeons, is based on the surgeon’s fee only and does not include the cost of anesthesia, facilities, and materials (stitches, bandages, drapes, etc.). The price will also depend on doctor, patient, and region. The cost of reduction, though, varies greatly patient to patient. A reduction procedure could take three to four times longer than an augmentation, and the cost would reflect that.
10. Generally, patients will only have to take five to seven days off work for a breast augmentation and about the same for a reduction.
You won’t be feeling 100 percent after that week, but you’ll be in good-enough shape to head back to the office if your job doesn’t require manual labor. However, if the implant is placed behind the muscle instead of on top (many women choose to do this for a more realistic look and less chance of a scar shell forming around the implant), recovery will be a little harder and you might be sore longer.
11. Breasts with implants feel different to the touch than real breasts.
Adam R. Kolker, MD, explains: Although silicone breasts feel similar to real breasts, they are still man-made and don’t feel like natural breast tissue. You’ll be more likely to notice there’s an implant in a woman who began with little breast tissue than a woman who had more breast tissue to begin with. Smaller implants and those that are placed below the muscle are harder to detect.
12. You can try on different boob sizes before deciding on one.
Using “sizers,” a bead-filled neoprene sack, you can stuff your bra to give you an idea of the size you might like.
13. You can’t go from small to huge all at once.
If you’re starting with a small A cup, don’t expect to go up to a DD cup in one procedure. It’s important to set realistic goals. Your body and skin need time to adjust to drastic changes, so a surgeon will likely suggest going up only a couple cup sizes at first, then increasing the implant size over the course of a few years.
14. Breast augmentations and reductions could possibly affect your ability to breastfeed in the future.
Women who have implants oftentimes choose not to breastfeed, so the data sets on these women are unclear. However, if you have an areola incision, there’s a small risk you could damage minor ducts and disconnect the areola complex with the main portion of the gland, hindering your ability to breastfeed. Women who have underarm incisions or incisions in the crease of the breast should not have a problem.
15. You might lose feeling in your nipples after a breast augmentation or reduction.
Loss of sensation in the nipples can occur whenever there is surgery to the breasts. This depends on a number of factors, including breast shape and surgery type. Even if you lose sensation in your nipples, they will still respond to cold and stimulation (aka they will still be able to get hard even if you can’t feel it).
16. You’re not a great candidate for a breast augmentation if you have a very strong family history of breast cancer, are obese, or smoke.
All these factors increase risks and complications during and after surgery. If you have any significant medical issues, you need to be evaluated and cleared before surgery.
17. Not all “plastic surgeons” are board-certified and trustworthy.
Thoroughly research surgeons who meet certain criteria before settling on one. First, make sure the surgeon is certified from the American Board of Plastic Surgery. Be wary of other “boards” that are not legitimate. Your doctor should also be a member of the American Society of Plastic Surgeons and American Society for Aesthetic Plastic Surgery, both of which have a very high standard of criteria and maintenance. Then make sure that the surgeon has experience in the type of surgery you’re wanting. Ask to see a body of their work and before-and-after photos. Speak to other patients. Schedule a consultation and get a feel for the surgeon’s approach.
18. You can get an areola reduction.
This is also called a mastopexy. Oftentimes women who get a reduction will also have an areola reduction so the areola is proportional to the new size of the breast. The area around the nipple is very forgiving with scarring.
19. You can’t walk in to a consultation and say you want X implant type through X incision location.
You and your surgeon will decide together which incision choice is best for you: underarm incision, incision in the crease of the breast (inframammary fold), or through removal of the areola. Your doctor will take into consideration your beginning breast size and shape, breast tissue, and a number of other factors before recommending which options are best for you and your body.
20. Any breast surgery can have a small effect on breast cancer screening in the future.
Breast health is important. Before the surgery, have a proper breast exam with your gynecologist. If you’re of age, get a mammogram. Most mammographers don’t have an issue if the implant is placed behind the muscle, but it is important to discuss with your surgeon.
21. Exercise, especially cardio that involves bouncing, is restricted after surgery.
Although you can start doing light cardio again after a week, most women will need to limit their exercise for up to 12 weeks.
22. Implants are more comfortable if the procedure is done postpartum rather than before the patient has kids.
But any implant placed under the muscle will increase the discomfort levels.
23. Augmented breasts will affect your posture just like the weight of natural breasts would.
The weight difference between equal volumes of saline, silicone, and breast tissue is slim to none, so a natural C cup and an augmented C cup are very similar in weight, says Dr. Kolker. If you choose an implant size proportional to your frame, you will see little effect on your posture. However, if you choose large implants, you will feel the effects.
24. Your boobs do not need to be a minimum size for a reduction.
This is all based on personal preference. Think of boob size in terms of a scale from small to large. Based on breast size before the procedure and desired breast size afterward, there are a number of incision options for a reduction for a huge range of results. You can even choose to get a reduction and an implant to replace some of the volume you’ve lost over time.
25. It is possible that your boobs can grow back after a reduction.
However, Dr. Kolker explains that if the procedure is done after pregnancy and your weight stays consistent, your breast size is unlikely to change.
26. Ask yourself the following questions and be comfortable with your answers before going through with the surgery:
- How much does my current situation bother me?
- Why do I want this procedure?
- How excited am I to go through with this?
- Can I handle the time off from work and exercise?
- How much am I willing to expose myself to certain risks?