Let’s face it: we live in a world of fake boobs and plastic surgery. Between social media stars, celebrities and a billion reality shows devoted to plastic surgery, a breast augmentation (aka a boob job) has become a pretty common surgery! According to the American Society of Plastic Surgeons, the number one cosmetic surgical procedure in 2017 was breast augmentation, with a staggering 300,000 procedures performed in the last year. As for the most popular implant material, silicone was used 87% of the time while saline implants were only used 13%, but more on which is better, later.
Deciding whether or not to get a breast augmentation (or lift) is a very personal matter, and you should choose what you feel is right for your body. Factors like self-confidence, wardrobe issues, health concerns or pain (relating to lifts) all come into play when making this decision – everyone has their reason for wanting a boob job, and we’re here to give you all the facts on the procedure so that you can make an informed decision. But there are also serval other things to keep in mind before you make what is a very permanent decision (especially in the case of a lift), like scarring, risks, placement of the implant, cost, and the biggie (no pun intended): how large or small should you go?
“There is not a one size fits all situation,” says Gerald Imber M.D., world-renowned Plastic Surgeon and Director of NYC’s Youth Corridor Clinic. “Each situation should be discussed with one’s surgeon.”
Considering Dr. Imber has performed more than 1,000 breast augmentations and 500 lifts and reductions in his career, he’s the perfect doc to answer all of our burning questions on the matter, which he happily did, below.
When it comes to implants, there are different kinds, different ways of inserting them, and it can all be a bit confusing. Can you break down the options?
All breast implants have an outer shell of soft silicone sheeting, and the filling can be saline or silicone gel. By far the most natural results are achieved with silicone gel, which has been proven to have greater longevity without sacrificing safety. An exceedingly small incidence of lymphoma has been identified primarily with textured surface implants, so most surgeons have chosen to avoid their use in favor of smooth surface, gel-filled implants.
The natural breast is under the skin and subcutaneous fat of the chest, on top of the pectoral muscles. In the best of all possible worlds, the implant should be placed under the breast, on top of the muscle.
Some years ago, when there were incidents of implants hardening due to excess scar tissue, surgeons began to place the implants beneath the pectoral muscle to disguise the firmness, but this often results in an unnatural appearance, with the implant moving up when the arms are raised. There’s also a configuration lacking in the natural flow of breasts. Hardening (or contracture) is seen much less frequently with newer implants, and my choice is to place the implant beneath the breast, but ON TOP of the muscle.
What’s the difference between an augmentation and a lift?
A breast augmentation involves the use of implants placed beneath the breast to increase breast size. The implants push the natural breast forward and enlarge its projection and width. This can be achieved by placing the implant on top of the pectoralis muscles, in a natural plane just beneath the breast, or under the pectoralis muscles themselves. Incisions can be placed under the breast, near the inframammary fold, around the areola, or under the arm. Usually, the inframammary incision offers the best access and is best tolerated. As for breast lifts, these are performed using the same incisions as breast reductions, and excess skin is removed, but not breast tissue. In essence, this operation creates a tighter, higher skin brassiere. When there is less dramatic sagging of the breasts, smaller incisions will often suffice, sometimes only around the areola, where scarring is minimal.
What precautions should I take before surgery?
Know all possible complications. Be sure the surgeon is experienced and well thought of in the community and someone with whom you have a good rapport. A breast lift surgery usually requires fairly extensive incisions. The resulting shape is good, and the scars virtually disappear.
Speaking of complications, what are the risks involved?
Excessive scarring is the biggest risk. Shape and height are easy to achieve, but the incisions under the breasts should not extend beyond the breast overhang whenever possible. Significant complications are rare.
Can I still breastfeed post breast surgery?
It should not affect breastfeeding. Occasionally, breast reduction surgery may result in cyst production with lactation, however.
What about the cost?
Costs vary with location and individual surgeons, but usually, a lift/reduction is most costly as it requires more time to perform. Fees for breast augmentation vary between $7,500 and $20,000.
What’s the biggest mistake you’ve seen women make, when it comes to augmentations and lifts?
Breast augmentation patients often stress about wanting to be natural and “not too big.” Often, they underestimate what they want, so size discussions are crucial. The reverse is true of reductions. Many women are tired of lugging around huge breasts and want them reduced too radically.
How long do breast implants usually last before you need a little “top up” or need to think about replacements?
Implants need to be exchanged when there is a problem, but often this takes decades. Some people believe implants should be changed every ten years. There is no scientific basis for this, but implants do continue to improve.
If you can’t decide between a lift and an augmentation, what would your advice be?
If the breasts are only slightly sagging, adding implants fills out the skin and gives the illusion of a lift. Once the breasts sag significantly, a lift plus implant may be the answer — particularly when substance is lost after breastfeeding. If sagging is significant (enough for the nipples to point downward), the only answer is a lift.
Still have more questions? Send Dr. Imber a DM at @youthcorridor! If you’ve always wondered about breast reduction surgery, check out the experts’ tips for everything you need to know about a boob reduction here.