Turn Back the Clock

I am interested in breast augmentation, but I heard that breast implants need to be changed every ten years. Is this true?

Not really. This common misconception is really based on previous studies performed with much older implants. Today, implants from the leading manufacturers are made with very highly-cohesive silicone. This silicone is either the very soft and natural consistency of gel, or in a semisolid configuration that allows the implant to form an anatomical tear-dropped shape (i.e. “gummy-bear implants”). Although there is not 50 years’ worth of data to support the long-term effects of new generation implants yet, it is possible that they may last a very long time without any need for revision. It is not typically recommended to change the implant unless there is a problem with it. Several potential problems may include malpositioning of the implant, scarring or hardening of the implant, rupture or infection. We must also keep in mind that the longer the breast implant is in place, the more likely the need for a revisional procedure. For example, a woman who has had implants for 30 years most likely has a greater chance of needing a revisional procedure than a woman who has had breast implants for 3 years. If you do experience any issues with your breast implant, a consultation with Dr. Pacella instead can be very helpful to guide you through your decision-making.

I have had very small breasts my entire life. I have made the decision to undergo breast augmentation and I want to increase my breast size very significantly. How big can I go?

In general, this depends on a number of factors. Your board-certified plastic surgeon should assess several characteristics to assist you in determining your optimal and desired breast size. For example, one of the baseline characteristics that is very important to determine is your breast “base width”. If you have a very small base width (i.e. 9-10 cm) and choose a very large implant that has a larger base width (i.e. 12-14 cm), then the implant may appear out of place. The cleavage area may deform or the implant may project too far onto the arm. Other important characteristics to measure are the position of your chest muscles, the position of the inframammary fold in relation to your nipple, the existing breast tissue you have and the thickness of your skin. If you desire a larger breast size and have a smaller base width, you may want to choose a rounder implant that is more projected (i.e. as a higher profile vs. a low or moderate profile). It is important to realize that choosing a breast implant size is often not as simple as going from a “B cup to a D cup”. When choosing a desired breast size, many patients bring in example photographs or images that they feel are representative of the breast appearance that they would like. This can be very helpful for you and your surgeon to discuss your optimal breast sizing and what may be possible with your particular body frame. Determining your breast size is one of the most important processes during your evaluation for breast augmentation, thus this should be discussed extensively with your surgeon and their team.

I stopped breastfeeding my child a year ago. I was always a C size cup but now I think I am closer to a B. I hate the shape of my breasts and my nipples are pointing downward. I think I need a breast lift. Why would a breast implant be needed? Can’t my breasts be lifted to a higher position without a breast implant?

This is a very good question. Breastfeeding, age and gravity have very specific effects on breast tissue. When milk is produced in the breast, it causes a very rapid expansion of its natural architecture . When breastfeeding is discontinued, this architecture is stretched. As the size of the breast decreases, this can cause a very predictable appearance. The breast often loses its volume and most of the time this is noticeable toward the upper half of the breast. The breast can sag, which worsens the appearance of its top half. While performing a breast lift can reposition the nipple and usually create a very nice shape for the bottom half of the breast, oftentimes restoring the upper half is more challenging. Depending on your body type, the condition of your breast and your desired breast size, a breast implant can often be utilized with a breast lift to reshape the upper half of the breast. Not every woman that desires a breast lift needs a breast implant. During your consultation, Dr. Pacella can assist you in choosing the optimal approach to restoring your breasts to your desired appearance.

I have recently been diagnosed with breast cancer and I’m feeling overwhelmed. My doctor told me that I may require radiation after my mastectomy. The thought of living without a breast, even for a short period of time scares me. Are there options for breast reconstruction even when radiation is recommended?

Absolutely. There are many options. While radiation can be very effective in controlling the spread of breast cancershould be discussed extensively with your surgeon, it is very important to understand what effect radiation will have on the appearance of your breast reconstruction. Knowing these effects ahead of time, your plastic surgeon can anticipate some of the changes and plan the strategy of your reconstruction accordingly. For example, we know that radiation after immediate breast reconstruction will cause the skin to contract and sometimes make the breast position itself higher on the chest wall. In light of this, the expander can be positioned slightly lower or be slightly over-expanded to anticipate and counter-effect these changes. The choice of reconstruction method is also very important to plan ahead of time. For instance, breast reconstructions designed using your own fat (i.e. TRAM or DIEP flaps) tend to do very poorly if exposed to radiation. Reconstructions made from muscle (i.e. latissimus flap) can withstand radiation quite well. In light of your situation, Dr. Pacella can determine which choice for reconstruction is best for your situation.

Several years ago, I underwent a lumpectomy for left-sided breast cancer. Radiation was also performed. Since the treatment, my left breast has a noticeable divot and its size is much smaller than the opposite breast. The deformity is very noticeable, even when I wear clothes. Are there any options for correcting this?

Yes, there are options. Radiation can cause lasting effects on breast tissue. Although the damage from radiation cannot be reversed, there are options available to attempt to restore symmetry to your breasts. If the overall size of the radiated breast is smaller, oftentimes a small, lower profile implant can be inserted to add breast volume or projection. If there are specific divots or deformities, fat can often be transferred from another part of your body to fill in this deformity. If the opposite breast is positioned lower or is too large, a breast lift or breast reduction can be performed to match the size of the affected breast. Treating deformities after radiation can be a very challenging procedure in plastic surgery, but many options exist to improve the appearance of your breasts after breast cancer and can be evaluated during a consultation with Dr. Pacella.

To schedule your appointment, please call (858) 554-9930.

The questions above are represented for informational purposes only. They do not constitute actual medical advice. Dr. Pacella is pleased to discuss your unique personal circumstances at your consultation.