Pink Prescriptions - February 2019

Your Treasured Chest: Expert Knowledge About Breast Augmentation & reduction


February 2019 Issue

Bigger? Smaller? Implants? Uplift? Safe? Sorry? Scary? Sigh. Should we or shouldn’t we tamper with our ta-tas? These are the February Pink Prescriptions questions all about breast augmentation, and our medical professionals—all board certified plastic surgeons—are here with the answers.

Rx Weniger

Dr. Frederick G. Weniger, Weniger Plastic Surgery

Explain the different options of augmentation and how long they last?

Modern breast augmentation options these days include implants, or YOUR OWN FAT! I remember laughing with a patient more than 10 years ago when she suggested that we just take fat from her hips and put it in her breasts! We had a good laugh because, as I told her, we couldn’t really do that. But now we can, and we do—a lot.

This new “natural” option in breast augmentation is almost a too-good-to-be-true way to repurpose unwanted bulges into a dream-come-true. Still, the vast majority of breast augmentations we do are with implants. Of those implants, some are saline and some are silicone. Some are shaped (anatomical/teardrop) and some are round. Some are smooth and some are textured. There are even options these days for implants with different firmness and perkiness characteristics! Why are there so many choices?  

Let’s start with implants. Breast implants have been used since the 1970s.  Saline implants then became the rule in the 1990s. Silicone implants then became commonly available again in 2006 once the safety of these devices was proven and the implication that implants caused diseases was conclusively disproven. Silicone implants generally feel more natural, but have a higher chance of getting hard scar tissue around them. Saline implants are less expensive, but are more likely to rupture. Round implants can be chosen with varying amounts of fullness/roundness for a push-up look at the top of the breast, or shaped implants can be used to give a more subtle, natural slope. All implants have a chance of rupturing, and because of this and changes in shape, aging, symmetry, and scar tissue, patients should expect to need future surgeries on their breasts to maintain the best aesthetics.

Using a patient’s own fat, on the other hand, has some advantages of its own. First, if you are getting liposuction anyway, why throw the fat out if you want larger breasts? Grafting the fat into the breasts with liposuction cannulas is inexpensive if we already have the fat. Also, there is no way to get a more natural feel or look than with your own tissue, right?  Additionally, you can’t get scar tissue and firmness around your implants, rupture your implants, or have malposition of your implants if you don’t have implants! BUT, fat grafting has some big limitations. Most patients can only increase one or one and a half cup sizes with fat grafting. If a patient wants more than that, she will need more grafting sessions. Also, fat grafting can’t give the same round push-up look that implants can. Nonetheless, the fat that survives the transfer procedure is permanent (just like when you couldn’t get rid of it).

Will insurance cover these procedures and, if so, under what circumstances?

Regardless of the type of breast augmentation, these procedures are essentially only covered by insurance in cases of breast cancer reconstruction.  Cosmetic procedures are not covered.
What is the ONE thing you would tell any woman who is considering breast augmentation?
If a woman is considering a breast augmentation, she needs to go to a board-certified plastic surgeon. Ideally, she should find a surgeon dedicated to cosmetic procedures who has experience with ALL types of augmentation.  You need to make your surgery decisions together after discussing all of the options and their subtleties. Patients and their goals are all different, so make sure your surgeon can offer you the customized approach you deserve!

Board Certified, Frederick G. Weniger, M.D., F.A.C.S. has 19 years of experience providing cosmetic plastic surgery and is a member of American Society for Aesthetic Plastic Surgery, American Society of Plastic Surgeons and Fellow of the American College of Surgeons. Author of Facial Rejuvenation: Surgical and Non-Surgical Procedures for a Younger-Looking You.


Rx Finger

Dr. E. Ronald Finger, Finger & Associates

What are the risks/side effects associated with augmentation?
Breast augmentations with silicone implants began in 1962. Before that there were sponges and other materials used—unsuccessfully. Since the introduction of silicone implants, breast augmentations have been among the most popular cosmetic procedure performed by plastic surgeons.

Typical questions include:

At what age do women have breast implants? The ages have varied from 16 (with parent’s consent) to 60 and older.  

How do you determine size? Sizers (special implants that mimic real implants in the body) are placed in a bra with and without a T-shirt in front of a full-length mirror. Another method we use is Crisalix, which is 3-D imaging. One can see how each size looks from different angles.

What choices are available for implants? Implants can be memory silicone gel implants or saline (salt water). The large majority prefer silicone because of the natural feel, and saline implants tend to wrinkle causing some deformity. Memory silicone means that if the silicone capsule ruptures, the gel will not leak out. Implants increase in size by 25 milliliters, e.g. 300 ml, 325ml, 350 ml, etc. up to 750 ml. Shapes vary also from round to contoured. Studies show that there is no difference in the final result regarding shape. However, the width and height of each implant does make a difference and this should be determined by chest shape and size.

Should implants be placed above or under the muscle? Studies show that under the muscle has a lower encapsulation rate. Encapsulation means that scar tissue forms around the implants causing them to feel hard and look deformed, according to the degree of encapsulation. This is the most common complication of breast implants. Most often, if it occurs, non-surgical measures can be done to make the implants feel more natural. Occasionally they must be removed and replaced. Every effort is made to avoid encapsulation.

How is encapsulation avoided? Implants behind the muscle, antibiotics placed around the implants and special massaging exercises post-operatively.

Recovery is now much shorter with the rapid recovery technique discomfort is much less. Normal activities can usually be resumed the next day or so, with the exception of exercising. Many patients state that discomfort is minimal.

Please discuss augmentation as it relates to: mammograms, nipple sensation, breast cancer, and breast feeding.
Loss of nipple sensation can occur, but it is rare. Huge implants require huge pockets, so with these extreme sizes the risk of numbness increases. As with any surgery, one can get an infection, have excessive bleeding, or a reaction to the closing sutures. Complications are uncommon with this procedure when performed skillfully.

One can still breast feed after breast implant surgery. The implants should not be placed within the breasts, but behind them. Mammograms can still be performed after implants. There is a special technique radiologists use for taking these x-rays, however. They can be more easily read with implants placed behind the muscles. Studies have not demonstrated any increase risk of breast cancer. However, textured implants (with a surface like a gum drop) do have a very rare cancer risk of a type of lymphoma.

What is the one thing you would tell any woman who is considering breast augmentation?
Assessing a patient for implants involves an examination to determine if implants alone can meet their goals, or if uplift is also necessary. The patient needs to understand what to expect and the limitations, if any. This way there are no surprises, and patients are more likely to be happy with their results.

E. Ronald Finger, MD, FACS Owner of Finger and Associates Plastic Surgery Center is certified by the American Board of Plastic Surgeons and is available for surgical and non-surgical services in Savannah Georgia as well as Bluffton South Carolina. Dr. Finger was voted one of the Top Doctors on RealSelfCom and is dedicated to outstanding patient care.

Rx Reid

Dr. David Reid, Hilton Head Plastic Surgery

Is there a minimum or maximum age for augmentation or reduction?
Typically, the minimum age for either augmentation or reduction is 18. The exception would be implants for a congenital condition called Poland’s Syndrome. Breast reduction is best if the patient has finished having children, but extreme back and/or neck pain warrants a reduction until other “life goals” are met.

Should I be having routine checkups if I already have implants?
Yes, routine checkups are advised for implant patients on an annual basis, which patients should be having anyway. Many physicians offer free routine checkups for their augmentation patients. Be sure to ask what follow-up protocol your physician offers.

What is the ONE thing you would tell any woman who is considering breast augmentation?
Look for a Board Certified Plastic Surgeon with experience!

Dr. David Reid has 26 years of experience as a practicing plastic surgeon and has been board certified for 23. He attended medical school at the Bowman Gray School of Medicine at Wake Forest University. Dr. Reid served 27 years in the US Navy and has been the Assistant Professor in Surgery at two medical schools. He's been in private practice for 17 years and was delighted when he and his lovely wife, Kathy, had the opportunity to make the permanent move to Hilton Head to provide the best in plastic surgery care to the residents of the Lowcountry. The Reids have three children, the oldest of which is a medical resident in the Southeast.

Rx Klenke

Dr. Audrey A. Klenke, Pinnacle Plastic Surgery

Should I have implants or a lift?
This is one of the questions I’m asked most often. If you want more volume globally, or if you want fullness in what’s called the “upper pole” of the breast, which extends beyond your natural breast position on your chest wall, you need an implant. If you like the volume of breast tissue you have when you wear your favorite bra, but you don’t like the sagging of your breasts when you see them in the mirror after your shower, then you may just need a lift. If you are concerned about both volume loss and sagging sometimes the answer is you need both!

Do implants help change the shape of your breasts
from their natural shape?
Breast implants have made leaps and bounds in terms of the available styles, shapes, volumes, and improved safety profiles. There are teardrop shaped implants, round implants, silicone implants and now, the Ideal Implantâ is a new saline implant that feels and looks more like silicone. Not all surgeons offer this, so be sure to do your research. The different styles of implants allow patients to decide if they want to maintain their natural breast shape or maybe change it up a bit. And then there’s the dreaded bra roll. “Dr. Klenke, what can we do about THIS thing?” I’m asked as my patients point to that little fluffy bulge where the underarm and breast meet that gets squished out of the side of your brassiere. I have a few options in my bag of tricks including UltraShape Power (a non-surgical, painless, in-office permanent fat destruction procedure), Kybella (a non-surgical injectable medicine to melt fat), and liposuction. I also love to borrow a little fat from the tummy and add it to the dip between the “bra roll” and the breast in a procedure called fat grafting, which helps smooth and contour this area. Bra roll be gone!

What is the one thing you would tell any woman who is considering breast augmentation?
The most important thing about breast surgery is to feel comfortable with your board-certified plastic surgeon. I like to spend time understanding what exactly it is my patients are trying to achieve and to have an honest conversation about their procedure.

Dr. Audrey A. Klenke, owner of Pinnacle Plastic Surgery and Pure Medical Spa, is a board-certified plastic surgeon. She is on staff at the Bluffton-Okatie Outpatient Center, Hilton Head Hospital, and Beaufort Memorial Hospital. For more information go to:

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