More or less: everything you need to know about cosmetic breast surgery

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What is the main reason that women choose to have breast augmentation or lift surgery?
Women between the ages of 18 and 35 want larger breasts to feel more feminine.  Perky, full but not overly large breasts provide them with the ability to fill out a dress or a bikini, which increases their self-confidence.

Starting in their mid to late 30s, women notice that their once-perky breasts have drooped with age, often times after having children. Their breasts also may lose fullness, as a result of post-pregnancy changes.

Starting in their 50s, women will often notice a change in breast size compared to their younger years.  This is due to age and gravity as well as to changes associated with menopause.  Much of the elasticity has been lost and the breasts don’t have the fullness or bounce they once had.

Are more FOF women having breast surgery? If so, why?
Yes, noticeably more, perhaps in the neighborhood of a 20 percent increase.  Breast enhancement surgery is not just for the rich and famous, actresses or models.  It can benefit women of all backgrounds and at different stages of life.  Competition, the economic downturn and financing plans have made plastic surgery of the breast much more affordable to women of almost all income levels.

How does a woman decide whether she should explore her options?
If a woman would rather have the lights off than on when she is topless, it may be time to consider a consultation with a plastic surgeon.

How do you perform lift surgery?
Breast lifts are performed on women of all ages.  The incision may be made just around the areola, around the areola and down the center of the bottom part of the breast (a “lollipop lift”) or around the areola, down the center and at the infra-mammary crease (where an underwire would sit).  The incisions used will depend on the amount tissue that needs to be lifted and/or removed.

And what happens with implant surgery?
A breast implant can be placed in front of or behind the muscle.  It can be placed through an incision around the areola, under the breast (in the infra-mammary crease), or under the armpit (trans-axillary).  If a breast lift is being performed at the same time, there is no need for any additional incisions beyond those being used for the lift itself.  The surgery is performed on an outpatient basis in an accredited facility.

What are implants made of?
Breast implants have a silicone shell which is filled with sterile salt water (saline) or a silicone gel.  In the United States, three companies manufacture both types of breast implants: Allergan, Mentor (a division of Johnson & Johnson) and Sientra, whose implants recently received FDA approval

What’s the difference?
Silicone gel implants feel, look and behave more like a natural breasts than saline implants.  In general, silicone gel implants also are more durable than saline implants.

What’s happened with the silicone safety issue since 1992, when it was thought leaks from these implants could lead to cancer and they were pulled off the market?
Breast implants are safe and approved by the FDA.  However, saline or silicone gel breast implants can develop leaks.  The odds of rupture are 1 percent per year per implant.  In most cases, it is best to place breast implants under the muscle, which protects and camouflages them better and minimizes any interference with a mammogram.

What if you’re one of the unlucky women?
If a woman has a ruptured breast implant, the implant should be removed promptly.  It may be replaced with a new implant.  If a woman desires, she may use this opportunity to select a new implant type or size compared to the one that ruptured.  To the best of our knowledge, there is a very little chance that a woman’s health will be affected by a leaking implant.


A ruptured saline breast implant.

How can someone tell if her implants are leaking?
The breast will decrease in size if a saline implant has ruptured. It may be more difficult to detect a rupture with a silicone gel implant.  Whether or not a woman has implants, she should perform monthly self breast examinations to detect cancer, as well as have her breasts examined by her doctor at least once a year.  If there is any concern that a silicone gel breast implant has ruptured, a woman should see her plastic surgeon.

How does a woman decide what size implant is ideal for her?
Implant size is a personal choice.  To start, a woman can put on an unpadded bra and a tight T-shirt.  We then insert breast implant sizers to determine what looks and feels best for her. Breast and chest measurements are taken to ensure the implants are within an appropriate range for that patient.

How does a woman decide which surgeon to use?
Make sure the plastic surgeon has completed an accredited plastic surgery residency.  It’s a bonus if he or she has completed additional training, known as a fellowship. Check that the surgeon has hospital privileges for plastic surgery.  If the doctor is operating outside of the hospital, make sure the facility is accredited.  Ask to see before and after photos as well as to speak or meet with patients who have undergone surgery like the one you are considering.

I am a member of the medical staff at Lenox Hill Hospital, Manhattan Eye, Ear & Throat Hospital, and the New York Eye and Ear Infirmary.  I also operate at the Center for Specialty Care as well as in our accredited outpatient surgery center located in our office.  Besides completing a plastic surgery residency, I have completed two fellowships:  one at Georgetown University Hospital in aesthetic and breast plastic surgery, the other affiliated with Stanford in advanced facial plastic surgery.

Is the surgery dangerous?
Plastic surgery that is performed in an accredited facility is generally ve safe.  I work with an experienced team that includes board certified anesthesiologists, which enables me to perform Rapid Recovery Breast Augmentation under intravenous sedation, not general anesthesia.  This means less risk and faster recovery for my patients.  Women walk out of the office a few hours after surgery feeling like they have a little pressure on their chest.

The best question for last.  What is the cost?
The cost for a breast augmentation starts around $5,000.  The cost of the breast lift varies and depends on the amount of work that needs to be done.  A breast lift starts around $7,500.  A breast lift with an augmentation costs around $10,000.

Why is this surgery so costly?
You have to consider all the costs, including the anesthesiologist, the operating room, the implants, the staff, and the surgeon’s fee.

(Editor’s note: A good paint job on a modest size New York apartment costs well over $7,000, so this is pretty good price to give your breasts a fresh new look.)

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Dr. Adam Schaffner

Plastic Surgery Institute
60 East 56th Street, 2nd floor
NYC, NY 10022

Tel:  (212) 688-5882

www.drschaffner.com

Click here to view Dr. Schaffner’s patient before and after.

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6 Responses to “More or less: everything you need to know about cosmetic breast surgery”

  1. Sara says:

    I was also hoping to read about breast reduction in this piece. For women who suffer from overly large breasts, the self-esteem issues are equal to those with overly small breasts, but there are also physical challenges, including pain. And talk about not being able to find clothes that fit! The headline “more or less” was a bit misleading in that this piece only covers the “more” side of the equation.

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  2. Kim Meadows says:

    Hope to get feedback on this too. I am going to have a reduction soon but need to get my BMI under 30 before my surgeon will do the op. A friend Of mine has had 3 caesareans and a breast lift/reduction. She says that the op isnt as bad as caesareans are. I have told my doctor I would like to be loaded up with pain killer after the op and he has told me that usually Panadol Forte is enough…

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  3. Norma Byrd says:

    I looked like a pre-bust-twelve-year-old until I was in my thirties and decided ENOUGH! I wanted clothes to fit without wearing industrial-strength padding in my bras. I wanted my husband to see a pretty figure when I undressed. I wanted to look in the mirror and feel like I looked like other adult females. Vanity? Oh sure. (Isn’t that part of having pride in how we look? Doesn’t that drive what clothes we choose to put on in the morning and how we do our hair as attractively as possible?) So was my decision justified? You bet! I told the surgeon I didn’t want to be Dolly Parton huge, he laughed and said he couldn’t make me that way if I wanted it because there just wasn’t enough skin to stretch that much! And how I loved the results!!

    Twenty years later I grew concerned with all the hoopla about leakage and implant failure and returned to him. He agreed to replacement just to be on the safe side, and by-the-way, if I wanted to increase by one size we could now do that. YES! (He found that the original implants were perfectly intact, but there was no way to have been sure of that prior to surgery, and besides, there was a lot of scar tissue build-up that made them feel hard. That hasn’t been a problem with the newer implants.)

    If you long to be curvy and beautiful and can afford breast surgery, I don’t care if you’re 95, go for it! It sounds like a lot of risk has been removed and your doctor will advise the best approach. And you will love it too!

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    • Becky Beer says:

      O.K. , I also was an “A” cup when I got my gel implants, 23+ years ago. I really don’t think they have leaked ;but I do worry about them ‘getting old’ . I’m almost 53 years old now, need a lift,and have gained weight since my late 20’s. I went from A to B ,and now with the weight I’m a C. The implants are under my breast tissue. …..Advise PLEASE!! Thank you, Becky

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  4. Sally Alexander says:

    What about women with a strong family history of breast cancer? (In my case, my mom, my aunt and my grandmother.) Would this be a contraindication for breast augmentation? Could a lump still be detected during self-examination with implants in place?

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  5. Mara Kaplan says:

    What is breast reduction surgery like? Yes they sag, but they are also too big.

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