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What to Know Before You Change Your Breast Size. By Juno DeMelo

What to Know Before You Change Your Breast Size. By Juno DeMelo
  • July 07 2017

You’d like to go up or down a cup size -- or more. You want implants for more curves, or to take some of the pressure off your back with breast reduction surgery.

It sounds great. But you’ll want to know what to expect, including how those changes will hold up over time.

“Breast augmentation can be life-changing for a lot of women,” says Juliana Hansen, MD, a professor and chief of plastic and reconstructive surgery at Oregon Health & Science University. “But you need to make an informed decision about the long-term consequences.”

1. Implants don’t last forever.

Breast augmentation isn’t once-and-done. It’s the first thing that plastic surgeon Nolan S. Karp, MD, tells women who come to him for implants.

“Most companies guarantee their implants for 10 years, though they hardly ever need to be replaced that often,” Karp says. “I tell my patients that implants usually last at least 15 years. So depending on your age, you usually have to anticipate a couple more surgeries.”

Plan to schedule a yearly exam with your plastic surgeon to make sure your implants are strong and intact.

2. But breast reduction usually does last.

How long your results hold up depends on your breasts.

There are three types of breast tissue: fatty, fibrous, and glandular. It’s really unlikely that you would develop more fibrous or glandular tissue after surgery.

“I’ve probably done more than 2,000 breast-reduction surgeries, and 99% of the time, the tissue doesn’t grow back,” Karp says.

There’s a big exception. If you gain weight after the surgery, you could develop more fatty tissue in your breasts. That’s why it’s ideal to get breast reduction surgery when your weight is steady, Hansen says.

3. There are different types of breast implants.

Some women still get saline ones, which your surgeon puts into your breast empty and then fills with sterile saltwater. But many others now get silicone implants, which come prefilled with silicone gel.

There are also different types of silicone implants. Some are soft. Others are “form-stable.” Some people call those “gummy bear” implants because they keep their shape even if the shell is broken. Form-stable implants are fuller at the bottom, which may look more natural. But unlike round ones, they can distort the breast’s natural shape if they rotate.

Which type should you choose? “Your surgeon will look at your anatomy and help you decide which type is right for you,” Karp says.

4. There are different techniques.

To insert the implant, your surgeon will make a single cut in one of three places:

  1. In the crease under your breast
  2. Under your arm
  3. Around your nipple

The type of cut you choose depends on the type of implant you get, your anatomy, and your personal preference. Afterward, the surgeon will close the cut with stitches and bandage it.

“You’ll have scarring with all three incisions, but we try to hide the scars underneath the breast, in the fold of the armpit, or right where the dark-colored skin around your nipple meets the skin of your breast [the areola] so it won’t be as visible,” Karp says.  

With breast reduction, the surgeon usually makes a cut around the areola in a circular, keyhole, or upside-down T-shaped pattern. Though the cut lines are permanent, they’ll fade over time.

5. Qualifications count.

“It’s really important that your surgeon is board-certified in plastic surgery,” Hansen says. “A lot of doctors want to get into breast surgery even though that’s not their specialty.”

If you decide to set up a consultation, ask the doctor if they're certified by the American Board of Plastic Surgery. That requires at least 5 years of training as a surgeon, including at least 3 years devoted to plastic surgery specifically.

Also ask how many years of plastic surgery training the surgeon has gotten.

6. Your life should go back to normal pretty quickly.

If you get breast augmentation, you can usually go home the same day. 

“It’s really rare for an implant procedure done for cosmetic purposes to require an overnight stay,” Hansen says.

Plan ahead for someone to drive you home after the operation and stay with you for at least 1 night. Your breasts might feel stiff or sore for up to 5 days, and you should skip physical activity for a few weeks.

After breast reduction surgery, your doctor may ask you to wear an elastic bandage or special bra to minimize swelling. She may also place a temporary tube under your skin to drain blood or fluid.

Should you choose to breastfeed after breast enlargement surgery, “there’s no reason why you couldn’t,” Hansen says. But breast reduction may affect your ability to breastfeed, so talk to your doctor if you plan to nurse.

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