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Thinking about getting that breast augmentation? Maybe you’ve always thought about breast implants. Or maybe you finished [breastfeeding](https://aedit.com/aedition/how-pregnancy-and-breastfeeding-impact-breast-implants) and your family is complete. Perhaps you’ve been doing your research and came upon something called capsular contracture. While [breast augmentation with implants](https://aedit.com/procedure/breast-augmentation-with-implants) is consistently among the most popular cosmetic surgeries – and the procedure is generally considered safe and effective – no surgery is without risk. In the case of breast implants, [capsular contracture](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518817/#:~:text=Capsular%20contracture%20is%20a%20common,into%20account%20to%20avoid%20recurrence.) is a complication that prospective patients should be aware of. For this article, we tapped top plastic surgeons to learn more about what capsular contracture is, what causes it, how it should be treated, and what you can do to prevent it. 

## **What Is Capsular Contracture?** 
When a foreign object like a breast implant (or any kind of medical implant) is placed in the body, a ‘capsule’ of scar tissue forms. This is a natural part of the healing process. “When our body encounters a foreign object, it naturally forms a scar around it,” says [Elise Min, MD](https://www.drcassileth.com/surgeons/dr-elise-min.html), a board certified plastic and reconstructive surgeon at Cassileth Plastic Surgery in Beverly Hills. It’s what happens to that scar tissue over time that takes it from normal or complicated. “In some patients, this scar can thicken over time and can distort the breast shape and even cause discomfort,” Dr. Min shares.
 
As such, “a capsular contracture is when the capsule or scar tissue around a breast implant becomes unusually hard and contracts around the implant,” explains [Jules Walters III, MD](https://aedit.com/provider/jules-walters-md-34662), a board certified plastic and reconstructive surgeon and founder of [The Modern Plastic Surgery and Medspa](https://drjuleswalters.com/) in Metairie, LA. This tightening can have several effects. “A tight capsule can cause the implant to feel firmer, ride higher, or become painful,” says [Anna Steve, MD](https://www.instagram.com/annakstevemd/?hl=en), a plastic surgeon at [Neinstein Plastic Surgery](https://neinsteinplasticsurgery.com/) in New York City.
 
So, just how common is it? “Capsular contracture rates range among different publications, but the average is around 10 percent,” says [Melissa Doft, MD](https://doftplasticsurgery.com/), a double board certified plastic and reconstructive surgeon in NYC. “It should be noted that 75 percent of capsular contractures occur in the first two years after surgery, but they can occur much later.” 

There are ‘grades’ of the condition, which means it doesn’t present the same for everyone. Symptoms include firmness, distortion to the shape of the breast, and, sometimes, pain. “The first symptom is a hardening of the implant,” Dr. Doft shares. “The implant does not feel as soft as it once did.” That can lead to aesthetic impacts. “In more significant capsular contracture, the breast may appear distorted – lifted or the nipple is no longer in the center,” she explains.  

## **Why Does Capsular Contracture Happen?** 
There are several theories as to why capsular contracture occurs — and it most likely varies from patient to patient and is multifactorial. “Some causes include ruptured implants, hematoma, and a ‘biofilm’ layer, which is a thin layer of bacteria that leads to a chronic, low-grade infection,” Dr. Min says. Those who tend to develop thick scars may also have a genetic predisposition. “All of these factors can lead to more aggressive fibrous scar tissue around the implant leading to capsular contracture,” she notes. 
 
Capsular contracture is more common in women who receive breast implants [after breast cancer](https://aedit.com/aedition/comprehensive-guide-to-breast-reconstruction-nipple-reconstruction-after-breast-cancer) and need radiation therapy, Dr. Steve notes. And then there is technique. “Placing implants in front of the muscle or through incisions in the armpit or around the nipple also increases the risk of capsular contracture,” she shares. [Data indicates](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4579163/) that placing implants under the chest muscles can lower the chance of capsular contracture from about 12 to 18 percent lifetime risk for over-the-muscle cases to 4 to 8 percent.

## **How Should You Treat Capsular Contracture?**
Here’s the interesting thing about capsular contracture, it’s not a ‘dangerous’ [complication](https://aedit.com/aedition/guide-to-cosmetic-surgery-complications). “It does not necessarily pose a health risk to the patient,” Dr. Walters says. “But capsular contractures can become painful and can cause [asymmetry](https://aedit.com/aedition/cosmetic-procedures-for-body-asymmetries) to the breasts.” Needless to say, this can have a big impact on the patient. As he explains, it often leaves them “feeling insecure about the appearance of their breasts.”
 
The reason why capsular contracture is treated is not because it’s life-threatening, but rather because of its quality of life implications. “It's important to know that it's usually not dangerous to one's health,” Dr. Min shares. “However, in the context of breast implants, it often alters the appearance of the breasts — which is why it is frequently treated.” Just as there are different grades of capsular contracture, there are different ways to treat it.
 
If you think you have capsular contracture, Dr. Steve recommends returning to your plastic surgeon. “In most cases, a small surgery to release the tight capsule will be performed,” she says. In other cases, [replacing the implants](https://aedit.com/aedition/guide-to-replacing-breast-implants) may be necessary. “If your implants are in front of the muscle, having your implants placed under the muscle can help decrease the risk of the capsule becoming tight again,” Dr. Steve shares. In such situations, the existing implants and thick capsules are removed and replaced with new implants. Our experts share that adding a dermal matrix can also help lower the risk of recurrence.

It should also be noted that manufacturers may cover some or all of the cost of revision. “The implant companies have created warranties to help pay for corrective surgery after capsular contracture,” Dr. Doft says. For example, the [Sientra](https://sientra.com/breast-augmentation/warranty-details/) warranty stipulates that patients are entitled to “free implant replacement for complications of capsular contracture (Baker Grade III/IV), late forming seroma, double capsule, and BIA-ALCL” for 20 years and “up to $2,000 for uncovered fees and costs due to capsular contracture (Baker Grade III/IV), late forming seroma, and double capsule” for two years.

## **Can You Prevent Capsular Contracture?**
The short answer is yes, Dr. Doft says. Limiting the handling of the breast implants during surgery decreases the risk of capsular contracture. “Most board certified plastic surgeons follow the [14 Point Plan](https://saferbreastimplants.org/about/the-14-point-plan/), which is designed to minimize the number of bacteria that can contaminate breast implants at the time of surgery,” Dr. Walters explains. [Choosing the right implant](https://aedit.com/aedition/guide-to-breast-implants) size, type, and placement for your aesthetic goals and needs is also important. “Having your implants placed under the muscle – through an incision under the breast – and choosing the right size of implant for you decreases the risk,” Dr. Steve adds. 

Additionally, don’t underestimate the importance of pre- and post-op planning. Dr. Min says that it's important to have a preoperative discussion with your surgeon about reducing the risks of possible bleeding. This includes certain medication use, foods, genetic propensity, and smoking. Post-surgery, Dr. Min notes that there is some [evidence](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5327859/#:~:text) to suggest leukotriene inhibitors could reduce the risk of developing capsular contracture. Finally, “some plastic surgeons believe that massaging the implants when they are first placed can help prevent capsular contracture,” Dr. Doft shares. 

As with any surgery or procedure, following your surgeon's recommendations pre- and post-op can go a long way towards a favorable outcome.

Aesthetics

The complication isn’t necessarily dangerous but it can have quality of life impacts. Here, top plastic surgeons weigh in.

Capsular Contracture And Breast Implants: Causes, Symptoms, Treatments

What To Know About Capsular Contracture And Breast Implants

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Starting your aesthetic journey is a learning process that requires a lot of research. Not only do you need to narrow down your provider options, but you also have to think about what type of procedure will provide the outcome you desire. Take, for instance, augmentation mammaplasty (a.k.a. [breast augmentation](https://aedit.com/procedure/breast-augmentation-solutions)). Generally speaking, there are three types of breast augmentation: breast implants, [fat transfer](https://aedit.com/procedure/breast-augmentation-with-fat-transfer), and a combination of the two. 

If you are interested in [breast implants](https://aedit.com/procedure/breast-augmentation-with-implants) or [hybrid breast augmentation](https://aedit.com/procedure/hybrid-breast-augmentation) (which combines implants with fat transfer), part of your consultation and pre-op process will involve [deciding on what type of implant](https://aedit.com/aedition/how-to-choose-the-right-breast-implants) is best for you. It’s not just about size — you and your plastic surgeon will also discuss material, shape, and texture. 

The vocabulary can be confusing, but you don’t need a medical degree to sort it all out. To break down the terminology and what should factor into your decision-making process, we tapped the man who quite literally wrote the book on implants, [Gregory Buford, MD](https://aedit.com/provider/gregory-buford-md-1015), a Colorado-based board certified plastic and reconstructive surgeon and author of *[The Boob Job Bible: Your Ultimate Guide To Breast Surgery](https://www.beautybybuford.com/the-boob-job-bible-guide-breast-enhancement/)*. Read on for a masterclass on breast implants. 

<BeforeAfterModule
  title={Before & Afters: Breast Implants}
  procedureId={1013}
/>

## **Types of Breast Implants**
Once you’ve established that you are a candidate for breast implants, the next step is choose the material from which the implant is made. “The two main types of breast implants currently available in the United States are those filled with saline and those filled with silicone gel,” Dr. Buford notes. Here’s how they differ:

### **Silicone Gel Breast Implants**
- **What**: A silicone outer shell that is filled with silicone gel.   
- **Pros**: Used in both primary and secondary (read: [revision](https://aedit.com/aedition/guide-to-replacing-breast-implants)) breast augmentation and [reconstructive](https://aedit.com/aedition/comprehensive-guide-to-breast-reconstruction-nipple-reconstruction-after-breast-cancer) surgeries, Dr. Buford says silicone breast implants are the most popular in the U.S. “They not only look and feel more natural, but they also move more naturally, giving a far more optimal appearance,” he explains. At his practice, he specifically uses Allergan’s Natrelle INSPIRA™ implants because he likes the “individual styles, sizes, and gel structure that Allergan has.” 
- **Cons**: Dr. Buford notes that saline implants are not approved by the U.S. Food and Drug Administration (FDA) for people under the age of 22, and they can be more expensive. In the event of a rupture, the danger of silicone implants is that they do not reabsorb into the body. The so-called ‘silent rupture’ requires an MRI scan to diagnose. Additionally, inserting this type of implant requires a larger [incision](https://aedit.com/aedition/minimizing-scars-after-surgery), which may factor into the decision-making process for some. 

### **Saline Breast Implants**
- **What**: A silicone outer shell that is filled with saline (i.e. saltwater).
- **Pros**: Unlike silicone gel implants, saline-filled implants are FDA-approved for patients 18 and older. Another advantage? “They can be preferentially filled with a range of fluid (saltwater), which allows better customization of size,” Dr. Buford adds. Because they aren’t pre-filled, a smaller incision is needed. “This allows them to be rolled (like a cigar) into a much smaller profile and inserted through a much smaller incision,” he notes. If saline implants rupture, the saltwater is harmless and reabsorbed by the body.
- **Cons**: Rupturing is a big concern for many breast implant patients, and, if a saline implant ruptures, Dr. Buford says it will leave you “with what we lovingly refer to as the ‘flat tire’ look.” The breast will have a visible deflated appearance that requires surgery to correct. Additionally, saline implants can have a wrinkled or rippled appearance under thinner skin.

## **Breast Implant Shape**
Now that you know the difference between silicone- and saline-filled implants, it’s time to talk about shape. “There are really only two different shapes of implants: round and anatomic (a.k.a. teardrop),” Dr. Buford says. This impacts the profile of the breast once the implant is inserted.

### **Round Breast Implants**
- **What**: Round implants are circular and have a uniform circumference.
- **Pros**: In the event of a rotation, the round shape does not appear to have moved the same way a teardrop might. Round implants can be filled with silicone or saline and housed in a textured or smooth casing. 
- **Cons**: There are few notable cons to round-shaped breast implants. Depending on their aesthetic goals, some patients may express dissatisfaction based on individual preference. 

### **Teardrop Breast Implants**
- **What**: Anatomic or teardrop breast implants have more volume at the bottom.
- **Pros**: Because teardrop breast implants are tapered, they theoretically better mimic the shape of a natural breast. To minimize the risk of rotation and asymmetry, they have a textured exterior (more on that below).
- **Cons**: “The early buzz of anatomic implants was that they would give a more natural result,” Dr. Buford recalls. The theory, however, did not bear out. “When blinded observers compared results, this was not the case,” he says. Instead, “the big disadvantage of the teardrop-shaped implants is their ability to rotate,” Dr. Buford notes. In order to maintain the shape, teardrop implants can only be saline-filled.

## **Breast Implant Texture**
As we started to discuss above, the texture of the implant also matters. Implant texture refers to how the outer shell feels (think: smooth or textured). There are pros and cons to both:

### **Smooth Breast Implants**
- **What**: The exterior of the implant has no texture. 
- **Pros**: Without any texture to the shell, the implant may have a softer look. Without the texture to lock it in, smooth implants can move around more freely, which allows it to feel more natural. 
- **Cons**: This style can be more prone to inflammation around the implant and may not be the right fit depending on your medical history. Additionally, there is more of a chance of rotation, though it’s not usually very noticeable in round-shaped implants.

### **Textured Breast Implants**
- **What**: The shell has a rough exterior that is comparable to sandpaper. 
- **Pros**: “Texturing is thought to potentially reduce the risk for capsular contracture, but it is also used when the implant is shaped — instead of round — to avoid rotation,” Dr. Buford explains.
- **Cons**: For the implant to have a textured exterior, it requires a thicker shell that may lead to a less [natural-looking](https://aedit.com/aedition/how-to-get-the-most-natural-looking-breast-implants) appearance. Additionally, you may [remember the recall](https://aedit.com/aedition/heres-what-you-need-to-know-about-the-allergan-breast-implant-recall) involving textured implants from a couple years ago. “These implants have been tied to the risk for a very rare cancer called anaplastic large cell lymphoma (ALCL) — a form of Non-Hodgkin's Lymphoma,” Dr. Buford notes. For these reasons, he prefers smooth implants.

## **Additional Factors**
So, you’ve got a good sense of breast implant filling, shape, and texture. Here are the remaining factors for you to think about:

### **1. Sizing**
Cubic centimeters (a.k.a. CC) is the sizing system for implant volume. Implants usually begin at 100 CC and can go up to 800 CC, depending on the manufacturer. To help you visualize this, it is estimated that 150 CC to 200 CC equals a full cup size — though it is important to remember that the way an implant looks ultimately depends on the patient’s measurements. This is why surgeons tend to [focus less on specific sizes](https://aedit.com/aedition/why-women-are-getting-smaller-breast-implants) and more on look and feel. Because no two breasts are the same (think of them as sisters, not twins), implant sizes can be mixed and matched to create a more [symmetrical appearance](https://aedit.com/aedition/cosmetic-procedures-for-body-asymmetries). 

### **2. Profile**
Not to be confused with size, the profile or dimension of the implant will dictate the protrusion of the breast. “Given the same amount of volume, we have implants that are wider and flatter and we have implants that are narrower and more projectes,” Dr. Buford explains. “[This allows] for even further [customization](https://aedit.com/aedition/combining-breast-augmentation-with-breast-lift) of a specific look for your patients.” A lower profile implant, for example, will only protrude a little, whereas the high profile option will appear fuller. While that’s the general rule, the exact outcome depends on the individual's anatomy — meaning the size and shape of the chest wall and breast envelope.

### **3. Incisions**
“Most plastic surgeons these days are placing implants through either a periareolar or an inframammary approach incision,” Dr. Buford explains. The former involves incisions around the areola, while the latter goes through the base of the breast. The size and nature of the incisions will depend on the type of implant used. Silicone gel implants tend to require larger incisions than their saline counterparts because they are pre-filled. Regardless, good [scar care](https://aedit.com/aedition/scar-minimizing-skincare-to-use-after-surgery) should minimize the appearance of postoperative marks.

### **4. Shelf Life** 
What does Dr. Buford believe is the biggest misconception about breast implants for patients and providers alike? “That you need to change out all breast implants every 10 years,” he says. While observing the implants for possible rupture is part of long-term post-op maintenance, [implant replacement](https://aedit.com/procedure/breast-implant-removal) does not happen on one set timeline. “At 10 years, there is an increased risk for complications associated with implants,” he admits. “But, if it ain't broke, don't fix it.”

## **The Takeaway** 
All plastic surgery is personal, and [breast augmentation with implants](https://aedit.com/aedition/breast-augmentation-recovery-healing-process) is no exception. As Dr. Buford explains, your ‘after’ will be more impacted by your ‘before’ than by the implant itself. “Your tissue quality, degree of symmetry (or lack thereof), and the overall appearance of your breasts are far more important than the specific style of implant used,” he shares. Consider that all the more reason to ensure you [find a plastic surgeon](https://aedit.com/aedition/finding-the-right-plastic-surgeon-dermatologist-or-cosmetic-dentist) who understands your aesthetic goals.

You’re curious about breast augmentation with implants but don’t know the difference between silicone or saline, round or teardrop, textured or smooth. We’re here to help. 

Guide To Breast Implant Type, Shape, Texture, Size, And More

Breast Implants 101: Your Guide To Type, Shape, Texture, And More

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When it comes to cosmetic breast surgeries, there are three main types of procedures: [breast augmentation](https://aedit.com/procedure/breast-augmentation-solutions), [breast reduction](https://aedit.com/procedure/breast-reduction-and-revision-solutions), and [breast lift](https://aedit.com/procedure/breast-lift-solutions). The first two deal with size. We probably don’t need to tell you that breast augmentation increases the size of the breasts, while a breast reduction reduces it. A breast lift, meanwhile, specifically addresses breast ptosis (or sagging), and it can be performed alone or as a complement to other breast surgeries.

During the COVID-19 pandemic, [doubling up on procedures](https://aedit.com/aedition/best-aesthetic-procedures-to-combine-to-maximize-appointments) offered a way to maximize time. But, in the case of many combos, the coupling also maximizes results. Exhibit A: [breasts](https://aedit.com/concern/breast-shape-and-size). “Breast reshaping has become more and more popular with refinements in technique, technology, and pain control limiting downtime and improving patient experience,” says [Ryan Neinstein, MD](https://neinsteinplasticsurgery.com/?gclid=Cj0KCQjw7MGJBhD-ARIsAMZ0eesF9voc8ntXcgbrEdZLeY6NKANEycl3vnMjnkdwPlKYwA3PZc-uTCkaAhgdEALw_wcB), a board certified plastic and reconstructive surgeon in New York City. 

For some women, combining a breast augmentation and breast lift is the best way to achieve their aesthetic goals. So, what makes someone a candidate for the duo and how does the combined procedure and recovery differ from solo surgeries? We asked the experts.

## **Breast Augmentation vs. Breast Lift: What’s the Difference?**
Before you can understand the benefits of pairing them, you first need to understand what makes each procedure unique. Also known as augmentation mammoplasty, breast augmentation refers to surgery that increases the size of the breast. There are three ways to do so:

1. Breast Implants
2. Fat Transfer
3. A hybrid of the two

Most commonly, breast augmentation involves placing [silicone or saline breast implants](https://aedit.com/procedure/breast-augmentation-with-implants) under the breast tissue or pectoral muscle. In a [breast augmentation with fat transfer](https://aedit.com/procedure/breast-augmentation-with-fat-transfer), fat is liposuctioned from one part of the body (think: the abdomen or thighs), purified, and then injected into the breast to add volume. It is considered a natural alternative to implants, though only patients with enough body fat qualify. Lastly, a [hybrid breast augmentation](https://aedit.com/procedure/hybrid-breast-augmentation) uses fat injections to smooth and perfect the appearance of implants for a more natural effect.

A mastopexy (a.k.a. breast lift) is a procedure that addresses breast ptosis (read: drooping or sagging). Depending on the degree of ptosis, a non-surgical, [radiofrequency (RF) breast lift](https://aedit.com/procedure/radiofrequency-assisted-breast-lift) may be enough to restore a perkier contour. For more advanced cases, there are an array of surgical techniques to lift the breasts. During a [surgical breast lift](https://aedit.com/procedure/breast-lift), one or more incisions are made to remove excess breast skin and breast tissue and shift the areola and nipple into a higher position. Deep tissue sutures are then used to support the new breast positioning.

## **The Ideal Candidate for a Breast Augmentation + Breast Lift**
For the most part, any healthy individual who is interested in a [breast augmentation](https://aedit.com/aedition/breast-implants-during-covid-19-pandemic) is generally a candidate for it. The parameters for a breast lift are a little more specific. To determine if you are a good fit, a plastic surgeon will examine the shape of the breast and the position of the nipple and areola relative to the inframammary fold, or the lower part of the breast where it meets the chest. The degree of breast ptosis (as classified on a three-grade scale) is determined based on where the nipple sits relative to the fold.

This combination of surgeries tends to be best for patients who have lost volume *and* have saggy skin, says [Lisa Cassileth, MD](https://www.drcassileth.com/), a board certified plastic and reconstructive surgeon in Beverly Hills. As Dr. Neinstein explains, it’s not uncommon for women to seek to address these concerns simultaneously — especially at certain times in their life. “[After breastfeeding and pregnancy](https://aedit.com/aedition/mastopexy-breast-lift-after-pregnancy-breastfeeding), many women will feel as though their breasts are deflated and lack a youthful look and feel,” he says. “For others, weight loss or genetics may be the driving force behind their breast changes that drive them to seek enhancement.”

### **Who Isn’t a Candidate for Combining These Procedures?** 
While it can be transformative for some patients, it’s not a given that a breast lift needs to be combined with a breast augmentation (or vice versa). “It isn’t necessary to do a breast augmentation to get a lift,” Dr. Cassileth notes. “So, this is only for patients that want more volume.”

Breast surgery — make that *any* surgery — can be overwhelming, and patients who are not physically and/or emotionally prepared should defer. “Patients with unrealistic expectations whereby they are hoping either a lift or augmentation alone will completely attain their desired goals should not seek surgery,” Dr. Neinstein says. Additionally, depending on the breast lift technique employed, [visible scarring](https://aedit.com/aedition/minimizing-scars-after-surgery) is possible. “Lifts entail scarring, which will have a different psychological burden on different people,” he adds.  

To ensure the most desirable outcome, it’s important for providers and patients to be on the same page. “It is essential to develop a therapeutic alliance with the surgeon in order to completely grasp all the risks, benefits, and alternatives to the desired procedure,” Dr. Neinstein shares.

## **How to Prep for a Breast Augmentation + Breast Lift**
The lead-up to a combined breast augmentation and breast lift procedure is not unlike most other cosmetic surgeries. “Typically, the patient must avoid aspirin, ibuprofen and other blood-thinning medication for one to two weeks prior to surgery,” Dr. Cassileth says. “All [herbals](https://aedit.com/aedition/vitamins-supplements-to-avoid-before-cosmetic-surgery) that may thin the blood, like ginger and ginkgo, must be stopped as well.” In addition, alcohol should be avoided for one week prior to surgery.

Typically, after thorough evaluation and consultation, the patient can proceed to surgery, Dr. Neinstein adds. Patients over 40 will obtain a baseline mammogram, along with standard pre-operative assessment. That includes discussing the patient’s aesthetic goals, so that an [implant can be chosen](https://aedit.com/aedition/how-to-choose-the-right-breast-implants). “A size, based on patient individual characteristics and desires, will be chosen preoperatively,” he adds. 

## **The Breast Augmentation + Breast Lift Procedure Process**
As Dr. Neinstein explains, the surgery will begin with the augmentation. In the majority of patients, he places smooth, round silicone gel implants under the pec muscle. Alternatively, saline implants or the patient’s own fat can be used to augment the breasts.

After the breast augmentation is completed, the lift is performed. “While surgeons will perform [preoperative markings](https://aedit.com/aedition/purpose-of-a-plastic-surgeons-markup-pen-during-cosmetic-surgery), the dynamics of the patient will change in surgery and the surgical plan must be re-evaluated,” Dr. Neinstein says. Most likely, either a lollipop or anchor-pattern lift will be performed. “The lollipop lift is typically used for shorter distance lifts compared to the anchor pattern, which allows greater movement and reshaping,” he explains. The nipple and areola are typically pivoted up, “dissolving sutures are placed, and long-acting numbing is strategically placed to enhance the healing process,” Dr. Neinstein adds. 

## **Recovering from a Breast Augmentation + Breast Lift** 
Adding a lift to augmentation tends to extend the healing time that each individual procedure would take. “This is because the procedure is longer and, therefore, the inflammation and stretch on the tissues is increased,” Dr. Neinstein explains. “Combining procedures, however, allows patients to meet multiple objectives within one procedure and limits the overall downtime and psychological burden associated with surgery.” Dr. Cassileth agrees. “Recovery is similar for both procedures, so we always perform them together in our practice,” she shares.

One thing to keep in mind? “If done together, extra care is taken to make sure to supply the nipple with continued good blood flow, as the mastopexy and the augmentation both can decrease blood flow to the nipple,” Dr. Cassileth cautions. Otherwise, the [recovery process](https://aedit.com/aedition/breast-augmentation-recovery-healing-process) tends to mimic those of the solo surgeries.

When recovering from a combined breast augmentation and breast lift, patients can usually expect to be sore for a week, but they should be off all [pain medication](https://aedit.com/aedition/opioid-crisis-plastic-surgery-recovery-pain-management) — except the occasional acetaminophen (Tylenol) and ibuprofen (Motrin) — by the second week, Dr. Cassileth says. An ointment is used on the incisions for about 14 days, before being swapped out for a special [scar cream](https://aedit.com/aedition/scar-minimizing-skincare-to-use-after-surgery) to minimize the appearance of post-op marks. Most patients will wear a [soft sports bra](https://aedit.com/aedition/benefits-of-compression-garments-after-cosmetic-surgery) for the first three weeks, Dr. Neinstein adds.

Patients can return to work after three or four days and do light activities in three weeks, Dr. Neinstein notes. [Normal exercise](https://aedit.com/aedition/when-to-start-exercising-again-after-cosmetic-surgery-procedures) can usually be resumed four to six weeks post-op. Results are immediate — save for post-op swelling — with full healing three to six months after surgery.

Alone, breast augmentations and breast lifts have a transformative effect. But, for some, pairing these popular procedures only enhances the results. Here’s how to tell if you are a candidate for the combo.

The Benefits Of Combining A Breast Augmentation With A Breast Lift

The Benefits Of Combining A Breast Augmentation And Breast Lift

shutterstock 1312702532

If you're thinking about having a [breast augmentation](https://aedit.com/procedure/breast-augmentation-solutions) or [breast reconstruction](https://aedit.com/aedition/comprehensive-guide-to-breast-reconstruction-nipple-reconstruction-after-breast-cancer) surgery with implants, there's bound to be a never ending stream of questions going around in your mind. One of the most essential to answer when it comes to [breast implants](https://aedit.com/procedure/breast-augmentation-with-implants), in particular, is which one is right for you. Whether you already have a cup size in mind or you're looking for guidance, a board certified plastic surgeon is the best placed to advise on which implants will be best. To better understand how they go about figuring out the ideal implant and sizing for each patient, we spoke to three top plastic surgeons. 

## **Factors to Consider When Choosing Breast Implants** 
From size and shape to look and feel, there are a number of factors that help determine which implant is right for you. Three of the most important:

### **Sizing**
Chances are, if you're considering having a breast augmentation, you already have an idea of the cup size you'd like to be after surgery. "Most women have this ‘American ideal’ in mind,” says [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), a board certified plastic and reconstructive surgeon in Nashville. What is that perceived ‘ideal’ you may ask? “Most everyone — regardless of their height, shape, size, or actual desires — will say ‘full C,’” he shares.  

If you’ve ever been bra shopping, you know the issue with cup sizes is that they are rarely created equal. To avoid confusion, it may be better to bring visual inspiration. After all, a picture is worth a thousand words. “What is more effective is having patients bring in photos of their desired result and working with them to select an implant that will help them achieve their desired result,” notes [Umbareen Mahmood, MD](https://aedit.com/provider/umbareen-mahmood-md-23), a board certified plastic and reconstructive surgeon in New York City. She calls these images “wish pics” and suggests all patients bring them to their consultation. 

While conversations about aesthetic goals will begin during your initial office visit, some surgeons prefer to leave the nitty gritty of sizing to future appointments. “I currently do sizing as a separate office visit where the patient brings a bra and top that they would like to ‘fill out’ and we try inserting different volumes of sample breast implants until we are happy with the look we achieve,” says [Lauren Chmielewski, MD](https://aedit.com/provider/lauren-chmielewski-md-143), a board certified plastic and reconstructive surgeon in NYC. As she explains, there are many methods surgeons use when working with patients to choose the “most flattering implant size.” Those include the so-called ‘rice test’ (“using a bag of rice to experiment with different implant volumes,” she says), the ‘high five’ calculation (“a specially formulated set of measurements,” she notes), and 3D modeling to name a few.

### **Proportion**
As one beauty editor who underwent a breast augmentation procedure during the COVID-19 pandemic [wrote of her experience](https://aedit.com/aedition/breast-implants-during-covid-19-pandemic), finding the right implants was less about size and more about look, feel, and, yes, proportion. After trying on an array of implants, she determined 250-ish CCs looked most proportional to her body. Her surgeon took note of her preference, but he would ultimately decide during surgery what worked best. Finding the right implants for patients is part of the art of aesthetic medicine. 

Each surgeon has their preferred method of determining the best implant, but proportion is primordial. “One of the most important factors in implant selection is the base width of the patient’s breast compared to the base width of possible implants,” Dr. Mahmood explains. If you’re curious, she says the base width of the breast is the “width of the chest wall from the cleavage to the outermost edge of the breast.” 

In addition to base width, Dr. Mahmood also takes the volume of the implant and its projection into account. “For patients with narrow base widths who desire larger implants, high profile implants are a good option,” she says. “They maintain a smaller width but contain more volume by having an increased projection.”

Similarly, Dr. Unger seeks to balance biology with patient intention. “I determine implant size based primarily on their anatomy, meaning the size and shape of the chest wall and breast envelope,” he shares. “Then, of course, that is influenced by the patient's individual desire.” As he explains, some women “want to be more full” and some women “want to be [more subtle or natural-appearing](https://aedit.com/aedition/how-to-get-the-most-natural-looking-breast-implants).” Understanding a patient’s preference allows him to “use the more full or less full sizes in the range that will fit their chest,” he adds.

### **Texture & Feel**
It’s one thing to think about what your new breasts will look like, but equally important is how they will feel. “A breast augmentation consultation is not complete without the patient being able to observe, hold, and ‘squish’ each style of implant that I use,” Dr. Chmielewski says. “This helps guide the patient to a feel, shape, and texture that best achieves their goals.” 

How your chest feels post-surgery mostly comes down to the type of implant you go for. In Dr. Chmielewski’s opinion, “silicone implants still trump saline” in terms of feel. Dr. Mahmood’s preference for silicone implants comes down to longevity. “They do not need to be [replaced every 10 years](https://aedit.com/aedition/guide-to-replacing-breast-implants), as the older generation of silicone implants with thinner shells did, which makes them a more desirable option,” she explains. Another benefit? “There is less risk of implant rippling with silicone implants than with saline implants,” Dr. Mahmood says.

It’s also important to take the patient’s natural breast tissue into account. “I consider each patient's breast tissue firmness or softness when choosing the gel subtype we use,” Dr. Unger notes. A firmer gel, he says, is “more consistent with a more youthful, firm breast,” while a softer gel will feel more natural in a more mature or postpartum breast where “there is more fatty tissue creating softer tissue.” In either case, the goal is to “help [the breast] feel more uniform,” Dr. Unger shares.

<BeforeAfterModule
  title={Before & Afters: Breast Augmentation}
  procedureId={1013}
/>

## **Questions to Ask During a Breast Implant Consultation**
While the overview above should give you a good sense of the main factors to keep in mind when discussing implant options with your surgeon, we understand that [plastic surgery consultations](https://aedit.com/aedition/questions-to-ask-your-doctor-during-plastic-surgery-consultation) can be overwhelming. Coming ready with a list of questions is a failsafe way to ensure you get the information you will ultimately need to make an educated decision. A few questions you should consider asking about breast implants include:

### **1. Which type of implants do you usually use and why?**
This inquiry will kick start a conversation about the material used to make the implant, the look and feel, the longevity, and more. You can use this opportunity to share more about your lifestyle and your personal aesthetic goals, both of which will factor into your final choice. At this point, you will likely also be able to hold a few different types, so you can start to — quite literally — get a feel for the implants. “There are pros and cons to each type of implant,” Dr. Chmielewski says. “I discuss each with my patients, and we arrive at a decision that works for them.”

### **2. What size implant would you recommend for my body?**
This question gives you the chance to start discussing what is possible from a size perspective taking your preferences and anatomy into account. “I do a breast exam where I take careful measurements of all breast dimensions and note asymmetries,” Dr. Mahmood explains. From there, she reviews the three implant-based factors — shape, projection, and volume — with her patients. “Based on their breast measurements as well as their desired result, the patient and I work together to select the best implant for them,” she shares. 

On the topic of symmetry, Dr. Mahmood is quick to note that body asymmetries are the rule, not the exception. “I always tell patients: Breasts are sisters, not twins,” she says. “Asymmetry is common.” So while breast implants can help to [address asymmetry](https://aedit.com/aedition/cosmetic-procedures-for-body-asymmetries), the purpose of the procedure is not to make your breasts identical.

### **3. Should I expect to have any revision surgeries in the future?**
While modern silicone breast implants may not need to be replaced at the same rate as older models, [breast augmentation](https://aedit.com/aedition/breast-augmentation-recovery-healing-process) is still not a one-and-done procedure. There are, however, steps that can be taken to prolong the life of the implant. “I believe that getting the desired result with the [least amount of volume possible](https://aedit.com/aedition/why-women-are-getting-smaller-breast-implants) is always the goal,” Dr. Unger shares. “This allows you to have long-lasting, stable, and beautiful results.” 

This also means not placing implants beyond the boundaries of the anatomy.  For example, consider patients who get, in Dr. Unger’s words, very large implants placed into very small chests. “It might give them the fuller look they want,” he says. “[But] the problem is that, over time, it places excessive amounts of tension and stress on the breast and causes tissue to stretch more quickly.” This can lead to a “droopy or ptotic shape much more quickly,” he adds.

## **The Takeaway**
Choosing breast implants is a hugely important (and personal!) step in the process of preparing for a breast augmentation. Your plastic surgeon will be there to guide you through the decision and offer a range of methods to figure out the right solution for your needs. It should come as no surprise then that many patients find the key to a successful outcome is [finding a plastic surgeon](https://aedit.com/aedition/how-i-found-my-plastic-surgeon-trust-your-gut) who truly understands the results they’re seeking and how to achieve them in a safe and natural-looking way.

Expert Opinion

You’ve decided you want breast implants. Now what? Top plastic surgeons weigh in on exactly how they help patients choose the ideal implant.

How To Choose The Right Breast Implants For You

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*Since 1985, October has served as Breast Cancer Awareness (BCA) Month — a period devoted to educating the public on the disease that, [according to the Centers for Disease Control and Prevention (CDC)](https://www.cdc.gov/cancer/breast/statistics/index.htm), is the second most common form of cancer in women, regardless of race or ethnicity. Men can also be diagnosed with breast cancer (albeit at a much lower rate), and The AEDITION is devoting much of its coverage this month to [BCA](https://aedit.com/aedition/category/breast-cancer-awareness), from expert guides to mastectomies and reconstructive breast surgery to powerful patient perspectives and roundups of products that give back.*

The physical and emotional toll a breast cancer diagnosis takes is considerable. In addition to the fear and confusion often associated with various treatment options, breast cancer patients  must also consider the [breast reconstruction process](https://aedit.com/aedition/post-mastectomy-breast-reconstruction-process-breast-cancer) and how that might impact their overall health and sense of identity. Fortunately, breast reconstruction techniques have come a long way in recent years, and one such example is the rising popularity of one-stage breast reconstruction. Here, we’re breaking down everything you need to know about the singular surgery — from who’s a candidate to what’s involved — with one its pioneers. 

## **What Is One-Stage Breast Reconstruction?**
Also known as direct-to-implant (DTI) breast reconstruction, [one-stage breast reconstruction](https://aedit.com/aedition/comprehensive-guide-to-breast-reconstruction-nipple-reconstruction-after-breast-cancer) refers to when a plastic surgeon places implants at the time of a mastectomy. “This is in contrast to tissue expander reconstruction, which is more commonly performed, where a special expansion device is put in the breast at the time of mastectomy,” explains  Lisa Cassileth, MD, a board certified plastic and reconstructive surgeon and founder of [Cassileth Plastic Surgery](https://www.drcassileth.com/surgeons/dr-lisa-cassileth.html) in Beverly Hills.

For women who are interested in breast implants [after a mastectomy](https://aedit.com/aedition/mastectomy-breast-cancer-experience-from-patient-perspective), the standard has long been to schedule a delayed breast reconstruction. Instead of putting the implants in during the mastectomy surgery, the patient would have tissue expanders sutured into the breast pocket. In the weeks and months that follow, the expanders are gradually inflated in a plastic surgeon’s office using air or saline. Once they reach the appropriate size, the expanders are swapped out for implants. 

The expansion process can be painful, but some surgeons believe it is a necessary evil. Dr. Cassileth and her team, however, have been refining what they consider to be a more desirable alternative. Back in 2012, Dr. Cassileth’s [original research](https://pubmed.ncbi.nlm.nih.gov/21734545/) on one-stage reconstructive surgery was published in the *Annals of Plastic Surgery*. The study found the procedure to have lower risks compared to traditional two-stage tissue expander reconstruction and highly satisfactory outcomes. The technique has only improved from there.

## **Ideal Candidates for One-Stage Breast Reconstruction** 
For many years, it was thought that only women with smaller, non-droopy breasts could be candidates for DTI, but that is no longer the case. “DTI is good for women who qualify for [nipple-sparing mastectomy](https://aedit.com/aedition/what-to-expect-before-during-after-mastectomy-breast-cancer), since no skin will be cut away during the mastectomy and the lost volume of the breast can immediately be replaced without worrying about skin tension,” Dr. Cassileth says. With that said, patients with cancers that grow into the skin and must have skin removed may not qualify.

## **How One-Stage Breast Reconstruction Works** 
At Cassileth Plastic Surgery, DTI is performed over the muscle for the most natural-looking results. “This is in contrast to the under-the-muscle procedure, which was pretty standard years ago and now is more rarely performed because it cuts the pectoralis muscle,” Dr. Cassileth notes. When the breast implant is placed above the pectoralis major muscle, you avoid the so-called ‘pec flex’ deformity some sub-pectoral implant patients see and also experience a less painful recovery because the muscle remains intact.

Rather than simply wrap the implant in an acellular dermal matrix and place it in the mastectomy flap, Dr. Cassileth creates an internal bra structure to support it. By using a dermal matrix to bridge the gap between the implant and the chest wall, she prevents drooping at the bottom of the breast pocket, softens the contour of the implant, and decreases the need for [fat grafting](https://aedit.com/procedure/breast-augmentation-with-fat-transfer). Additionally, Dr. Cassileth performs a nerve graft at the same time as the reconstruction to restore sensation to the breast. Sensation improves as you heal.

It is important to note that the success and safety of a DTI breast reconstruction is not just in the hands of the plastic surgeon. One-stage reconstruction should only be performed when a mastectomy surgeon has a low rate of flap necrosis. Dr. Cassileth says that the rate should be less than one percent or else it is not safe to go direct-to-implant because the breast skin may not survive.

Following a mastectomy and one-stage breast reconstruction, patients stay in aftercare for two to three days. Drains are typically removed one to two weeks after surgery. “They can have normal day-to-day activities, like driving, after two weeks, and are allowed to lift heavy objects and [exercise](https://aedit.com/aedition/when-to-start-exercising-again-after-cosmetic-surgery-procedures) after one month,” Dr. Cassileth says. 

## **A Non-Implant Alternative...**
For women who do not wish to have implants or are not a candidate for them, there is another innovative option to consider. Developed by Dr. Cassileth and mastectomy surgeon [Heather Richardson, MD](https://www.bedfordbreastcenter.com/mastectomy-surgeon-heather-richardson-md/), of the Bedford Breast Center in Beverly Hills, [SWIM breast reconstruction](https://aedit.com/aedition/swim-breast-reconstruction-for-breast-cancer-mastectomy-patients) combines a nipple-sparing mastectomy with a breast reduction (SWIM stands for skin-sparing wise-pattern internal mammary perforator). 

In this procedure, the mammary tissue is removed during the mastectomy portion of the surgery, but the skin and subcutaneous fat are preserved. During reconstruction, the extra fat is folded and placed to create the breast shape. Unlike traditional TRAM and DIEP flap surgeries, no muscle is sacrificed and no abdominal, back, or buttocks tissue is transferred. This provides an alternative for women who want to avoid the extensive surgery, incisions, and long recovery period involved with other flap procedures.

Breast reconstruction techniques have come a long way in recent years, and one such example is the rising popularity of direct-to-implant surgery. Here’s what you need to know.

One-Stage Direct-to-Implant Breast Reconstruction For Breast Cancer Patients

What To Know About One-Stage Breast Reconstruction

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To be honest, I never really thought much about my breasts — until I started to lose them. They were always on the smaller side of average, yet, due to my height (I’m 5’9”), I believed they looked even smaller and flatter than they actually were. I felt like my shoulders and the flatness of my torso made my upper half just look… long. But, once I started to run marathons, the volume loss and deflation became a serious insecurity for me.

## **The Decision-Making Process**
As much as I told myself that there was something impossibly chic about having tiny breasts (I mean, it’s good enough for Kate Moss!), I couldn’t stop myself from obsessing over my chest after every single run. I even bought a seamstress-style tape measure. And then a second one. I was certain the first was wrong — there's just *no way* that my A-cup bra could be baggy. It must be the tape.

It was a rude lesson to learn that losing weight is the same as gaining it. We can’t choose the body area where it comes and goes, and that deflation from volume loss is *real* (I still don’t know why I thought they would stay perky if they were flat as a pancake). But it wasn't until one Saturday, about six miles into a long run, that I realized I wasn't wearing a sports bra (or any bra for that matter) and I hadn't even noticed. At that moment, I began to seriously consider medical intervention in the form of [breast augmentation with implants](https://aedit.com/procedure/breast-augmentation-with-implants).

Then the [COVID-19 pandemic](https://aedit.com/aedition/plastic-surgery-dermatology-cosmetic-dentistry-practices-reopening-during-covid-19) happened. I certainly couldn’t stop running now — it was my only activity! But, as it did for many, the pandemic certainly put things in perspective. I always expected to get a ‘[mommy makeover](https://aedit.com/concern/mommy-makeover)’ after I had children, with a breast procedure or two on the list. But, over the last year, my perspective evolved into: What the heck am I waiting for?

## **The Consultation**
“How much volume did you lose?” my plastic surgeon, [Adam Kolker, MD](https://www.drkolker.com/), immediately asked when I began our [breast augmentation](https://aedit.com/procedure/breast-augmentation-solutions) consultation by blaming marathons for my newfound insecurity. *“How did he know?”* I thought, as we sat socially distanced with me in a chair on one side of the office, Dr. Kolker on the opposite side, and his right-hand RN, Ashley, standing against the wall between us. All of us were masked, temperature-checked upon arrival, and sanitizing our hands like crazy. Although we were all vaccinated, both rising cases and the chaotic Delta variant were increasingly worrisome. 

During the examination portion of our consult, Dr. Kolker and Ashley measured my breasts in a few different ways (think: the collarbone to nipple, nipple to base, and width, among others). We discussed my goals — “natural but juicy,” I told him — but my main concern was balancing out my tall silhouette with implants that look like they belonged on my body’s shape. Then they took the ‘before’ photos and opened a briefcase of implants to try on and take for a test drive. Dr. Kolker recommended I ignore the [measurements on the implants](https://aedit.com/aedition/how-to-get-the-most-natural-looking-breast-implants) and decide what I liked based on the look and feel, not the number of CCs. 

Left alone, I tried on every single one, starting with the largest. I placed each set of implants in my bra and modeled from every angle. I felt like Goldilocks, and giving the different sizes a test run was immensely helpful for me to determine just how large I wanted to go. When Dr. Kolker returned to wrap up our conversation about size goals, I told him that I thought 250-ish CCs looked the most proportional to my body. He noted my preference and explained that the final decision on CC amount is decided in the OR, based on several factors that are revealed only once the incision is made. We also went over his instructions for pre-surgery care. As I was heading out, Ashley asked me to send a photo of my COVID-19 vaccination card before the big day. 

## **The Surgery**
On the day of the surgery, I arrived alone — no companions allowed — and went over what to expect before and after the surgery with Kat, the recovery room nurse. Dr. Kolker then came in to review our surgery goals once again, take a few more photos, and finally — the dramatic moment I was waiting for — [draw on my body with a Sharpie](https://aedit.com/aedition/purpose-of-a-plastic-surgeons-markup-pen-during-cosmetic-surgery) just like they do in movies. At that moment, it all felt very real. I thought to myself, *“I have Sharpie on my body, it’s REALLY happening!”*

In the last, and less dramatic, step before walking to the OR, I had a tête-à-tête with the [anesthesiologist](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia) to align on our sedation plan. I asked him what the likelihood of accidentally waking up mid-surgery (a new-found fear), and he said he was zero for 60,000-plus, meaning that he’s managed more than 60,000 surgeries and zero patients have woken up before they were meant to. I felt very safe and that weird new fear became a memory as we walked to the [operating room](https://aedit.com/aedition/unexpected-things-to-know-about-the-plastic-surgery-operating-room) to meet Ashley and Dr. Kolker.

I was very impressed with the OR — all of my information was splashed up on a wall-mounted TV across from Dr. Kolker, music was playing, the temperature was chilly (my favorite), and Ashley put a pillow under my knees for extra circulation. It felt kind of like a spa, until the anesthesiologist attached the needle. 

Next thing I know, I woke up in the recovery room with Kat, who told me that my friend was on her way to the office to pick me up. Three juice boxes later, I was cleared to go home and hopped in an Uber.

It was all very efficient and speedy: neither Dr. Kolker nor his nurses overstayed or lingered. They came in, got down to business, answered my questions with care and compassion, and left because, after all, we were still indoors, in small treatment rooms, during a pandemic.

## **Post-Op**
Happily, the [breast implant recovery process](https://aedit.com/aedition/breast-augmentation-recovery-healing-process) wasn’t as intense as I predicted. Pain was manageable, and I only took prescription pain killers for the first two days and then just Tylenol after that. The first few days post-op were mostly just uncomfortable. My chest felt pressure but rarely pain unless I forgot I just had surgery and tried to open our heavy fridge door. [Sleeping](https://aedit.com/aedition/sleeping-better-after-cosmetic-surgery-aesthetic-procedures), however, was nearly impossible for the first week. Imagine trying to sleep sitting up straight — and I mean stiff-as-a-board-straight — with a [pillow fort](https://aedit.com/aedition/best-pillows-for-plastic-sugery-recovery-healing) all around so you are immobile. 

Dr. Kolker called me the day after surgery to check in, and I went back into the office on day seven for my first post-op appointment. On my post-care sheet, Dr. Kolker recommended a few [specific options for sports bras](https://aedit.com/aedition/benefits-of-compression-garments-after-cosmetic-surgery) to wear at one-week post-op, and I brought them along. I was temperature checked, masked, and ushered into a treatment room, where Dr. Kolker inspected [swelling](https://aedit.com/aedition/how-to-treat-minimize-swelling-after-cosmetic-surgery), the incisions, and the implants, followed by taking a set of photos. I was instructed to wear a heavy-duty sports bra 24/7, along with a white strap that sat right above the implant to help with settling.

Two days later, I had a mini freakout that my sports bra was compressing my implant too much and called the office. Rather than have me come by (which I suspect they would have had me done in ‘Normal Times’), Dr. Kolker hopped on FaceTime to visually inspect my compression concerns and reassure me.

On day 14, I began a set of three implant displacement ‘massages,’ which are very much not massages but rather awkward-feeling push and pull movements to encourage the implant to move, reducing the risk of capsular contracture. I was cleared by Dr. Kolker to take long walks and even a quick dip in the pool, but I still had to wear the sports bra and strap for most of the day. 

At my week four in-office post-op appointment, Dr. Kolker evaluated my healing progress and took another round of ‘after’ photos. I couldn’t stop gushing about how happy I was with the size and the totally manageable recovery. Somewhere around week three, I stopped feeling discomfort when lying down and sleeping became fun again. At the one-month mark, I was allowed to start wearing regular bras during the day, and I raced home to online shop — adding only the sexiest and laciest push-up bras to my cart.

## **My Takeaway** 
This past year, I’ve lost any sense of being able to evaluate what is weird. I may be in the minority, but I don’t think that my experience of getting breast implants during a pandemic deviated *that* much from what the surgery would have looked like in pre-COVID times. Aside from the masking, sanitizing, and temperature checking, it seemed business as usual. All of my post-op visits, just like my [consult](https://aedit.com/aedition/questions-to-ask-your-doctor-during-plastic-surgery-consultation), were very efficiently managed but never rushed, just the good sense to discourage anyone to linger in tight spaces unnecessarily. 

I couldn’t be more thrilled with my results. My body finally looks proportional and natural, which I always kind of thought was just a thing you say to be nice — but they *actually* look natural! Hands down, I’m happy that I didn’t wait. Pandemic or not, I’d do the surgery again.

Patient Perspective

It was weird, but definitely not as weird as I was expecting.

What It's Like To Get Breast Implants During The COVID-19 Pandemic

What It’s Really Like To Get Breast Implants During A Pandemic

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There’s a new breast rejuvenation option that’ll soon be popping up in doctors offices: [InMode’s BreastTite](https://inmodemd.com/physician-treatments/minimally-invasive-body-contouring/), a procedure that uses radiofrequency (RF) energy and fractional technology to lift the breast (think: millimeters to centimeters) with minimal downtime. While not a one-to-one swap for a [traditional breast lift](https://aedit.com/procedure/breast-lift-solutions), it can be an alternative for women in search of a quick and subtle firming solution for breast sagging — sans the scars that come with surgery. In fact, [Jacob Unger, MD](https://aedit.com/provider/jacob-unger-md-2649), a board certified plastic and reconstructive surgeon in Nashville, TN, who recently performed the procedure on [Paula Abdul](https://www.instagram.com/tv/CPRuNoEjok9/?utm_medium=copy_link), calls it “the Botox® of the breast.” Here’s what to know before you book your appointment. 

## **What Is BreastTite?**
Much like leveraging [Thermage®](https://www.thermage.com/) (RF) and [Ultherapy®](https://aedit.com/procedure/ultrasound-skin-tighteningultherapy) (ultrasound) for the chest, BreastTite is a minimally invasive breast rejuvenation procedure that employs radiofrequency technology to remodel and tighten the skin envelope to lift the entire breast. And since it usually only requires three small incisions per boob, it does so without leaving behind [noticeable scars](https://aedit.com/aedition/minimizing-scars-after-surgery). 
 
“Typically, this is a fairly quick procedure that involves utilizing standard tumescent solution (which is used for [liposuction](https://aedit.com/procedure/tumescent-liposuction)) and then using the [BodyTite](https://inmodemd.com/technologies/technologies-bodytite/) cannula to import the energy to the breast,” Dr. Unger explains. “The next step is a small amount of liposuction to remove any excess fluid.” The third and final step: A round of [Morpheus8](https://inmodemd.com/technologies/full-body-fractionated-anti-aging-morpheus8-technology/), InMode’s [microneedling with radiofrequency](http://radiofrequency) treatment.
 
## **Frequently Asked Questions: BreastTite Edition**
Now that you have a better sense of how it works, it’s time to get into the nitty gritty. From ideal candidates and cost to recovery and results, we’re breaking down everything you need to know about BreastTite.
 
### **Who Is an Ideal Candidate for BreastTite?**
Folks with good quality skin (i.e. decent elasticity and not too much [sun damage](https://aedit.com/aedition/cosmetic-procedures-treatments-to-correct-sun-damage)) who want a slight lift are the ideal candidate for BreastTite. “I think the best patients for this technology are those that are young with minimal ptosis — or drooping — of the breasts and whose breast size is a C-cup or below,” explains [Kelly Killeen, MD](https://www.drcassileth.com/surgeons/dr-kelly-killeen.html), a double board certified plastic and reconstructive surgeon at Cassileth Plastic Surgery in Beverly Hills. “These patients would not be good candidates for surgery, so it's a nice option in this situation.” Other patients BreastTite can benefit? Those seeking more symmetry between the [nipples](https://aedit.com/procedure/nipple-correction-solutions), Dr. Unger shares.
 
### **What Is the BreastTite Procedure Like?**
If you are getting BreastTite alone, the procedure can be performed awake with [local anesthesia](https://aedit.com/aedition/everything-you-need-to-know-about-anesthesia). “The patient will feel a small amount of discomfort from the injection of the numbing medicine before making the small incisions to add the numbing fluid,” Dr. Unger says. The sensation is best likened to increased pressure, and it dissipates quickly. From there, the procedure takes about an hour. 
 
### **How Long Does It Take to Recover from BreastTite?**
One of the biggest selling points of a [radiofrequency-assisted breast lift](https://aedit.com/procedure/radiofrequency-assisted-breast-lift) is the minimal downtime associated with it. The average recovery time is seven to 10 days, with patients generally experiencing a bit of soreness and [bruising](https://aedit.com/aedition/how-to-treat-prevent-bruising-after-lasers-filler-botox). “Many women feel they can return to work in one or two days,” Dr. Unger says. 
 
### **What Are the Results of BreastTite?**
Perhaps the most important thing to consider before opting for BreastTite is whether or not the subtlety of the results will satisfy your aesthetic goals. The results don’t tend to be dramatic, which means it doesn’t take the place of a surgical breast lift for women with larger breasts who are looking for significant elevation. Dr. Killeen says benefits tap out at about a 20 percent improvement on the high end, so she doesn’t consider it a go-to option for many of her patients. 

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/3hKB7YN3X7vZqsLuYKBqTq/1f06b011177ebebf814b156768bc65d9/BreastTite1-DrGuillermoBlugerman.jpg}>
  A before-and-after look at a BreastTite patient treated by Guillermo Blugerman, MD (courtesy of InMode).
</CaptionImg>

That being said, Dr. Killeen does recommend it in certain cases — specifically to women with smaller breasts that want a bit of lift. Another candidate? “I also think it's a nice adjunct for women undergoing liposuction [breast reduction](https://aedit.com/procedure/breast-reduction-and-revision-solutions) to help tighten the skin as much as possible,” she adds. While some report that results of an RF breast lift last for years, Dr. Killeen finds her patients need to repeat the protocol every 18 to 24 months to maintain the effect. 

Similarly, Dr. Unger says it's important to [manage expectations](https://aedit.com/aedition/how-plastic-surgeons-balance-patients-cosmetic-surgery-desires-and-safety). “While it does not have the power of a surgical intervention that can completely reshape the entirety of the breast, it does create this subjective sense of a more youthful and tighter overall breast,” he explains. For patients, that often manifests as an increased comfort level with the perkiness of the chest. “Women typically describe for me that they feel much more comfortable lying in bed and not wearing a bra in general after this treatment,” he says.

<CaptionImg url={https://images.ctfassets.net/zw35sfestf1t/71H1ijumvD2Qi09ur3zJoZ/953d7054e7fc900fa46ae7121320717e/BreastTite2-DrMarkCraig.jpg}>
  A before-and-after look at a patient treated by Mark Craig, MD, with BodyTite and Morpheus8 (courtesy of InMode).
</CaptionImg>

One of the big benefits of the BreastTite results? You don’t have to worry about ending up with an uneven outcome. “Since the two breasts typically have very similar skin quality, I would expect a similar response to the technology in both breasts,” Dr. Unger explains. 
 
### **How Much Does BreastTite Cost?** 
Depending on the patient, provider, and location of the procedure, BreastTite procedures usually start around $7,000 and can run upwards of $12,000. You can learn more about the price of invasive and non-invasive breast lift procedures in our [guide to breast lift cost](https://aedit.com/procedure/breast-lift-mastopexy/cost).

## **The Takeaway**
For the right candidate, BreastTite can offer a natural-looking lift and firmness without the same incisions or recovery time associated with more [traditional mastopexy](https://aedit.com/procedure/breast-lift). Consulting with a board certified plastic surgeon can help to ensure you receive the best treatment protocol for your anatomy and aesthetic goals.

BreastTite employs radiofrequency energy to lift the breasts, and it may be an ideal alternative for women looking for a little boost.

BreastTite Radiofrequency-Assisted Breast Lift: Benefits, Candidates, Results, Cost

Is This New Breast-Lifting Procedure Right For You?

ivan-stern-k lzqO Yl4Y-unsplash

For the last several decades, [breast augmentation with implants](https://aedit.com/procedure/breast-augmentation-with-implants) has consistently been one of the top-performed aesthetic procedures in the United States. The U.S. Food and Drug Administration (FDA) has [approved](https://www.fda.gov/consumers/consumer-updates/what-know-about-breast-implants) two types of breast implants — saline-filled and silicone gel-filled — for increasing breast size in women, for reconstruction after breast cancer or trauma, to correct developmental defects, and to improve the result of a previous surgery.

While breast augmentation surgery with a board certified plastic and reconstructive surgeon has long been considered generally safe and effective and FDA-approved implants undergo extensive testing prior to hitting the market, there are potential risks associated with breast implants once they are placed in the body. Rupture, infection, capsular contracture (scar tissue squeezing the implant), pain, and the need for replacement and revision procedures are all possibilities, as is the chance for systemic symptoms that have come to be known as breast implant illness (BII).

Over the last few years, there has been a rise in women with breast implants reporting the unexpected onset of a cocktail of symptoms ranging from fatigue and brain fog to muscle weakness and respiratory issues. Celebrities like Chrissy Tiegen, [Ashley Tisdale](https://www.instagram.com/p/CD_qbPDlajA/?utm_source=ig_embed&utm_campaign=loading), and Hayley Hubbard have recently opened up about the physical and psychological impacts their breast implants have had on them. Despite the growing chorus of anecdotal evidence, what makes BII so evasive is the lack of research surrounding it, the confusion over the root of the problem, and the difficulty in pinpointing a diagnosis. 

To learn more about breast implant illness, what may cause it, how it can affect your health, and treatment options, The AEDITION spoke with [Nima Naghshineh, MD](https://aedit.com/provider/nima-naghshineh-md-600), a board certified cosmetic surgeon and founder of Dr. Nima Plastic Surgery based in Pasadena, California. 

## **What Is Breast Implant Illness?**
“Breast implant illness or silicone implant illness, often does not refer to a specific disease or problem and has not been formally categorized or defined by the medical community,” Dr. Nima explains. Because there is no distinct set of symptoms but rather an assortment of indicators that the body is negatively impacted by the implant, it’s hard to explain what the illness is in specific terms. “BII is more like an all-encompassing category of issues/symptoms that some women with implants have described,” he continues. 

What’s more? There seems to be no rhyme or reason for when it arises. According to Dr. Nima, BII symptoms may present at any time. “There are several individual theories about what causes BII, but most hinge on the idea that there is some degree of interaction between the implant, a pro-inflammatory presence (typically bacteria or fungus), and the body’s exaggerated response to all of this,” Dr. Nima shares. It should be noted that the type of implant is not considered a specific root of the condition. “Though [textured breast implants](https://aedit.com/aedition/heres-what-you-need-to-know-about-the-allergan-breast-implant-recall) — as opposed to the more common smooth — have been implicated in breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), there is no clear association between implant type, model, or manufacturer with BII,” he adds. 

So, it is not necessarily the body rejecting the implant but rather issues during the surgery that leads to infection. “It has been shown that a large percentage of capsules (greater than 40 percent) removed at the time of implantation had bacterial colonization,” Dr. Nima explains. As such, improving implantation techniques could, theoretically, help prevent complications. “Employing sterile ‘no-touch’ techniques when placing the implants could reduce the risk of bacterial contamination and subsequent inflammation and BII as a result,” he says. 

## **Diagnosing Breast Implant Illness**
“If you believe that you may have symptoms related to BII, it is important to seek a [board certified](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) plastic surgeon who specializes in breast-related issues and reconstruction,” Dr. Nima emphasizes. “Your surgeon will examine you and may suggest follow-up with your PCP and other specialists such as a rheumatologist.” Patients may undergo a blood test, MRI, and/or ultrasound to test for iron levels, autoimmune disease, liver function, blood count, and more.

One of the things that makes BII so difficult to conclusively diagnose is the fact that the symptoms often point to other conditions. “Because the symptoms associated with BII can overlap with existing known diseases, such as autoimmune diseases, it is important to rule out these known diseases at the same time as exploring the possibility of BII,” Dr. Nima says. 

Even so, medical advancements are leading to broader consensus on the illness. “Simply put, doctors are also scientists. Many make their decisions based on the evidence in the medical literature,” he explains. “As we get more data on BII, we will find less disagreement and a more unified approach to this issue,”

## **Symptoms of Breast Implant Illness** 
As we’ve established, there is no one set of symptoms for breast implant illness, and the effects aren’t always just physical. Dr. Nima says women who have experienced BII often put symptoms into the following categories:  

- **Physical**: Hair loss, dry skin, and rashes are some of the most prevalent physical indicators of BII. These are surface-level and can be seen rather than felt. 
- **Central Nervous**: This includes brain fog, memory loss, vertigo, headaches, migraines, and tinnitus (ringing in ears).
- **Cardiorespiratory**:  Dr. Nima says “shortness of breath, heart palpitations, arrhythmia, heart pain, cough, and throat clearing,” are potential issues that may arise. 
- **GI & Genitourinary**: “Frequent urination, liver and kidney problems, reduced libido, UTI, reflux, gastritis, weight loss/gain, sudden dehydration, liver dysfunction, leaky gut, IBS, metallic tastes, choking, difficulty swallowing, pancreatitis, [and] gallbladder disease” may also accompany BII, Dr. Nima explains.
- **Musculoskeletal**: Some women report muscle or joint pain, numbness or tingling in the upper and lower limbs, fibromyalgia, neuralgia/burning pain, discoloration of hands/feet, and slow muscle recovery after activity.  
- **Immune**: As we’ve mentioned, BII can present like an autoimmune disease. It may lead to “Raynaud's, Hashimoto’s, RA, scleroderma, SLE, Sjogren’s, MCTD, MS, recurrent infections, toxic shock, fevers night sweats, slow healing and easy bruising, chronic fatigue, persistent infections, sudden food intolerance, allergies, and tender lymph nodes,” Dr. Nima says. 
- **Psychological**: And it’s not just physical symptoms — BII can manifest in “anxiety, depression, panic attacks, and the feeling of impending death,” he notes. 

Breast implant illness is not life-threatening, but the symptoms can certainly be strong enough to affect a person's quality of life. Depending on the severity, it may lead to additional medical expenses and impact both physical and emotional wellbeing.  

## **Treating Breast Implant Illness**
Because women experience BII symptoms at different points in time, it may go undiagnosed, untreated, or be perceived as another ailment, which is why it’s so important for those with breast implants to be vigilant and work with a board certified provider. The reality is that treating individual symptoms may not be sufficient. The biggest source of improvement is often [breast implant removal](https://aedit.com/procedure/breast-implant-removal) — but it’s not that simple. Dr. Nima explains that “whether it’s for BII, breast implant-associated lymphoma, or severe capsular contracture with pain,” removing the implant “is not enough.” 

The explant will require the removal of the capsule surrounding the implant as well. “We know that, for many of these problems, the issue is the capsule,” Dr. Nima notes. “Therefore, when possible, an en bloc total capsulectomy is recommended.” The capsule can then be sent to a pathologist and examined. “Any fluid around the implant, as well as a piece of that capsule, should also be sent for microbiology testing which will look at whether there are any organisms, like bacteria, colonized in the capsule,” he adds.

For patients whose symptoms cannot be attributed to another condition (think: rheumatic or autoimmune), “[they] are likely to have an improvement in physical symptoms as well as psychological well-being” after breast implant removal, Dr. Nima says.

## **Patient Perspective**
*After years of weight fluctuation, Maddi, 27, decided to get tear-drop silicone breast implants in 2018 to help restore volume in her breasts. Shortly after, the Las Vegas resident started noticing symptoms of breast implant illness.* 

<Dialogue>
  <Question party={The AEDITION}>
    Why did you want to get breast implants?
  </Question>
  <Response party={Maddi}>
    My weight was often fluctuating and my breasts started to sag. I wanted a permanent solution, which is why I went with a tear-drop implant. I wanted the natural look in case my weight continued to change.
  </Response>
  <Question party={The AEDITION}>
    When did you start noticing symptoms of BII?
  </Question>
  <Response party={Maddi}>
    It started fairly early, and I had symptoms of fatigue, chronic pain, muscle aches, and overall exhaustion. I didn’t have issues like this prior to the implants and knew that it must have something to do with my augmentation. It impacted my life to the point that I had an accident at work. I dropped a tray after feeling pain in my dominant arm. After that, I had a fever and needed to go to the emergency room. Luckily, I caught it early and was able to get medical treatment to help with the symptoms, but they didn’t stop.
  </Response>
  <Question party={The AEDITION}>
    When did you get the breast implants removed?
  </Question>
  <Response party={Maddi}>
    After I visited my doctor, I knew I wanted to have them removed. Due to the high cost of the procedure and all the medical bills, I had to wait two years to finally have my operation. I decided to change my implants for a non-textured implant, which I felt would allow me to keep the shape I wanted since I had a lot of loose skin due the original implant being a bigger size than I originally asked for.
  </Response>
  <Question party={The AEDITION}>
    What did you experience after the implant replacement?
  </Question>
  <Response party={Maddi}>
    After getting my implants replaced, I had the exact same symptoms and had to go to the doctor again. The entire process has left me with a lot of scarring, but I am focusing on my health at the moment to ensure I can be healthy for when I am able to have it taken care of.
  </Response>
  <Question party={The AEDITION}>
    What would you recommend for women wanting to get breast implants?
  </Question>
  <Response party={Maddi}>
    If you want breast augmentation, go with a fat transfer instead of implants. If I could do it over, I wouldn’t get breast implants again. This has been a learning experience that has left me unhappy with the overall results, and it will take time to get it fixed.
  </Response>
</Dialogue>

## **The Takeaway** 
Not every woman who has breast implants experiences breast implant illness, but, if you are concerned it may develop, Dr. Nima says “the most effective way of reducing your risk of BII is to remove and replace [the implants] with your own fat and to have a complete removal of the capsule or scar tissue surrounding the implants.” [Breast augmentation via fat transfer](https://aedit.com/procedure/breast-augmentation-with-fat-transfer) offers a natural way to address any excess skin, volume loss, or dissatisfaction with shape that accompany the [implant removal](https://aedit.com/aedition/what-happens-when-you-have-breast-implants-removed). “When using one’s fat, you can restore a significant amount of volume in just one procedure at the time of explant,” Dr. Nima says. 

If you have breast implants and are experiencing any of the symptoms outlined above, it is important to consult with your plastic surgeon to determine the best course of treatment. 

Wellness

Breast implants are one of the most popular cosmetic surgeries in the U.S., but some patients experience post-op complications that seriously impact quality of life. Here’s what you need to know about BII.

Breast Implant Illness: Causes, Symptoms, Treatment, Recovery

Understanding Breast Implant Illness

implant removal

It is recommended that [breast implants be replaced](https://aedit.com/aedition/guide-to-replacing-breast-implants) every 10 years or so, but what if you no longer want your implants? That’s where [breast implant removal](https://aedit.com/procedure/breast-implant-removal) comes in. 

Generally speaking, there are a few reasons women who undergo [breast augmentation](https://aedit.com/procedure/breast-augmentation-with-implants) or [breast reconstruction](https://aedit.com/aedition/comprehensive-guide-to-breast-reconstruction-nipple-reconstruction-after-breast-cancer) with implants later wish to have them removed, says [Melissa Doft, MD](https://aedit.com/provider/melissa-doft-md-63), a double board certified plastic and reconstructive surgeon and founder of Doft Plastic Surgery in New York City: 

- **Capsular Contracture**: The most common reason for removal, according to Dr. Doft, the condition occurs when the capsule that forms around the implant hardens, distorting the implant and potentially causing pain.
- **Patient Preference**: Some women decide they simply no longer want to have implants. “They may have had them placed 20 years ago and find that the size no longer fits their body,” Dr. Doft says.
- **Breast Implant Illness (BII) Symptoms**: Breast implant patients sometimes describe symptoms like fatigue, chronic pain, hair loss, headaches, photosensitivity, sleep disturbance, and depression (to name a few) that may be attributed to the implants. “It is unclear if BII is a real disease, as removing the implant often does not improve symptoms,” Dr. Doft explains.

Just this week, Chrissy Teigen shared on social media that she is planning to have her implants removed “soon” because they no longer serve her. “I’m getting my boobs out! They’ve been great to me for many years but I’m just over it,” [she wrote, in part, on Instagram](https://www.instagram.com/p/CAqylh4pjZ-/). “I’d like to be able to zip a dress in my size, lay on my belly with pure comfort! No biggie! So don’t worry about me!”

Whether your preferences have changed like Teigen or you are experiencing complications from breast augmentation, anyone considering breast implant removal likely has a lot of questions: *What does the breast implant removal surgery entail?* *What will my breasts look like afterwards?* *Are additional procedures required?* Here, we break down everything you need to know about the process. 

## **The Breast Implant Removal Process**
Women considering breast implant removal should first consult with a [board certified](https://aedit.com/aedition/medical-board-certification-in-plastic-surgery-cosmetic-dermatology) plastic surgeon to assess the state of their implants and discuss their aesthetic goals and/or concerns. In many cases, the explant is a fairly straightforward cosmetic procedure during which the surgeon will remove the implant from the breast capsule (i.e. the pocket the body forms around the foreign substance). In some cases, conditions like capsular contraction, deflation, or rupture  may make the removal surgery more complex, but desired results can still be achieved. 

Similar to how breast implants are placed, breast implant removal surgery requires an incision to be made along the lower fold of the breast (i.e. the inframammary fold) or around the areola. From there, surgeons will remove the implant and, in most cases, the breast capsule as well.

## **How Breasts Look After Implant Removal**
As Dr. Doft explains, the shape and condition of the breasts after implants are removed depends on three factors:

1. The size of your breasts before implants
2. The size of the implants placed
3. Body changes while having implants (think: weight loss or gain, pregnancy, menopause) 

It should come as no surprise that larger implants will have a larger effect on the natural breast than smaller ones. “Larger implants will lead to more distortion of the breasts — saggy skin and deflation,” Dr. Doft says. “A smaller implant will have less effect on the skin.” As such, removing small implants often results in what she describes as a “very natural,” “slightly ptotic” (read: saggy) breast.  

Similarly, women who naturally had smaller breasts pre-implants will see less of an effect post-implants. “If you had very small breasts before the implants, there is less of a change than if you had larger breasts as there is less skin and breast tissue to sag,” she explains. “Hormonal and weight changes will often make your breasts saggier, and, without the extra volume of the implant, your breasts will look more deflated and ptotic.”

Age also plays a role in how the breasts recover from implant removal. “Small breasts in young women may contract back to close to where they were,” Dr. Doft notes. “Older patients have less elastin and collagen in their skin and are less likely to revert back.” 

## **Achieving the Best Breast Implant Removal Results**
If someone truly wishes to have their breast implants removed, Dr. Doft always recommends a “complete removal.” But, to ensure patients are happy with their breasts post-op, she may suggest coupling it with additional procedures. “If the implant is large, they have loose skin, or they wish to have the best possible breast shape with their natural tissue, I often recommend a [breast lift](https://aedit.com/procedure/breast-lift) at the same time as the implant removal,” she says.  

And it’s not just additional breast surgeries that patients may add onto a breast implant removal. “Often, women who are removing breast implants are at the ‘next stage’ of life — meaning that they had implants placed in their twenties or early thirties and now it is 20 years later,” Dr. Doft shares. “They may want to have their eyes done, a [facelift](https://aedit.com/aedition/popularity-of-facelift-cosmetic-surgery-for-aging-sagging-neck), or a body contouring procedure, like a [tummy tuck](https://aedit.com/procedure/abdominoplasty) or [liposuction](https://aedit.com/procedure/tumescent-liposuction).” 

Assuming the patient is a candidate for such procedures, [doubling (or tripling) up](https://aedit.com/aedition/when-is-it-safe-to-combine-plastic-surgery-procedures) can be more economical for two reasons: “The cost of surgery is often less when multiple procedures are added together and the cost of downtime — time off from work, increased babysitting, vacation days — are less,” she says. 

## **The Takeaway**
Whether a patient is dealing with complications from breast implants or simply no longer wishes to have them, breast implant removal is often the best solution. Depending on factors like the size of the implants, the size of natural breasts, and the age of patient, breast sagging and deflation can occur post-op. In those cases, procedures like mastopexy (a.k.a. breast lift) can be performed in conjunction with the removal procedure to improve results. It should also be noted that, if a patient is simply interested in downsizing their current implants, a breast implant replacement — using a smaller size — is an option. Consulting with a board certified plastic surgeon will ensure patients get the best treatment for their needs.

If you, like Chrissy Teigen, are considering removing your breast implants, you likely have a lot of questions. Here, The AEDITION breaks down everything you need to know about the process.