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Breast Augmentation (enlargement using implants): enhances shape and size of breasts, by inserting implants under existing breast tissue. The result is fuller, larger and shapelier breasts.


Frequently Asked Questions:

Q: What type implant do you use?

A: We use both saline filled and silicone gel filled implants in different situations for different patients. As will be repeated often in this section, there is not just one implant that will do for all individuals needs. We use both high profile and medium profile round implants; occasionally a teardrop shaped implant; and even, occasionally a custom made implant, sometimes with a smooth surface and sometimes with a textured surface, but always individualized for the patient's exact needs.


Q: What about the silicone controversy?

A: In 1991 a huge controversy arose regarding the use of silicone, not just in breast implants, but also other medical devices. We feel that this was a controversy created by plaintiffs' attorneys and the news media in the name of greed and in the absence of facts. While the older implants were far from perfect, no one to this day has proven any cause and effect relationship between silicone and any disease process.


Q: Are there different brands of implants?

A: Yes, there are two major manufacturers in the United States, as well as several overseas. We use implants from Inamed McGhan, as well as those from Mentor, depending on a patient's exact needs.


Q: I have heard that the FDA has now approved silicon gel implants? Is that correct?

A: Yes, in November 2006 gel implants were approved for most uses in patients over 22 years old. While there remains a few regulations on the matter most patients have this option now. This is of greatest advantage to patients wanting very large implants or those with very thin tissue. In particular, breast reconstruction after mastectomy is almost always better done with a gel implant.


Q: Do you go on top of the muscle or underneath? I have heard that one or the other is best?

A: As stated, earlier, no one key fits every lock. Certain patients need the implant on top of the muscle, usually to maximize lift action, while many patients are better suited to have the implant under the muscle to provide additional cover for the implant or possibly a more natural look in some individuals.


Q: What about mammograms? Can or should I still have them?

A: Absolutely. Breasts implants should have no affect on scheduling your mammograms. Most people agree that women should have a baseline mammogram at age 35, then again at age 40, and yearly thereafter until approximately age 65, at which time they are done every 2 years. These recommendations change and vary also depending possibly on your family history and other medical factors.


Q: What about breast feeding?

A: The presence or absence of implants should have no bearing on breast feeding.


Q: What about scars?

A: We use the incision in the axilla (armpit) in over 75% of our cases. Not everyone can have the operation done this way because of individual circumstances. This scar heals almost imperceptibly in the fine lines that already exist in the skin in the armpit. For others, we use the around-the-nipple or in-the-crease incision, depending on a patient's preferences and once again on the exact details of their anatomical situation.


Q: Can I have a breast augmentation and liposuction or rhinoplasty at the same time?

A: Generally speaking, it is perfectly acceptable to combine a breast augmentation and one or two other cosmetic procedures, such as liposuction, a rhinoplasty, an eyelid tuck, or some such procedure. There is a slight increased risk associated with the lengthened anesthesia time; however, that is probably no greater than having the operation sequentially at different times, at least in the case of the healthy patients that we normally are taking care of. You should discuss this with Dr. Wallace if it pertains to you, but in most cases this can be arranged.


Q: Will it hurt more if I have two or three operations at the same time?

A: Naturally, there will be some increase in discomfort. However, normally, most patients experience the discomfort of one operation or the other the most and somewhat forget about the other operations that they have had. This is one of the reasons that many patients opt for combined procedures.


Q: How much does it hurt to have a breast augmentation?

A: This varies widely between patients from hardly any at all to those who find it to be fairly uncomfortable. A lot of that has to do with how an individual perceives and reacts to pain and not so much on the operation itself. Almost everyone is back to work in a few days and back to all their regular activities in a week or two. We have recently started giving all our patients a powerful anti-inflammatory medicine (Celebrex) preoperatively and found that this cuts pain dramatically in almost everyone, especially Breast Augmentation, Body Contouring and Facial procedures.


Q. I have heard some doctors advertise a "painless" breast augmentation. What is that all about?

A: Some physicians are always looking for some sort of gimmick to boost their practices. Clearly, it is impossible to promise someone a painless breast augmentation and irresponsible to suggest that they can be out shopping, drinking or dancing on the night of the surgery. While some of our patients experience just such a course, I would not think it responsible to advertise such a thing.


Q: You seem to be a real advocate of the endoscopic approach. Why is that?

A: I prefer to use the endoscopic approach through the axilla (armpit approach) anytime it is feasible, simply because it leaves no scar on the breast. I cannot tell that it leads to a quicker recovery, a better shaped result, or any other particular advantage except for the very simple fact that there is no scar on the breast.


Q: How do you figure out what size implant to use?

A: I use a method of sizing that involves looking through a variety of pictures, both patient pictures, as well as pictures of models, to get an idea of what size, proportion and balance an individual patient is looking for. This avoids all the confusion about exactly what size bra translates into what size and complicated mathematical formulas and the inexactitudes of measuring the breasts. This results in about a 99% satisfaction rate with the size that we choose, it is relatively simple, and easy for everyone to understand.


Q: Do you use the teardrop implant?

A: The teardrop implant is a good implant in some patients. We do not use it routinely, as it is more expensive, can rotate into undesirable positions, and at least in the experience of some, it has a slightly higher rupture rate than round implants. Additionally, round implants take on a teardrop shape when one is in the vertical position anyway. Nonetheless, in some patients the teardrop implant offers some advantages and in that situation we are happy to use it.


Q: I have heard about soybean / peanut oil implants. Do you use those?

A: Those are experimental implants that have been abandoned because of problems when they rupture. I never was involved in either of these studies, as I did not see that they offered any legitimate advantage over silicone and saline implants.


Q: What is capsular contracture or hardening of the scar tissue?

A: This is a condition that occurs when the scar tissue that normally forms around every implant, whether it is a breast implant, heart pacemaker, hip joint, or any other medical device, becomes tight or thick around the implant in an abnormal way. This can occur for a variety of reasons, but it usually has to do with a leaking gel implant, a very mild, usually unnoticed infection, or other unexplained causes. With modern implants, this occurs well under 2% of the time and with old implants it can usually be taken care of by implant removal, removal of the scar tissue and replacement with modern implants.


Q: How often do implants rupture?

A: Modern implants are very durable. In fact, we demonstrated the durability by placing a towel in the parking lot, placing an implant on the towel and then covering the implant over with the towel and running it over with a pickup truck several times. The implant did not break after three passes. Nonetheless, implants do break on occasion. A good rule of thumb is that implants should last on the order of 10 years. Occasionally, they do not last that long for unknown reasons and require replacement. This happens something along the line of 1% breakage of implants per year.


Q: What type of anesthesia do you use for breast augmentation surgery?

A: Ordinarily we use a heavy sedation that is supplemented with local anesthesia. Occasionally, in conjunction with the anesthetist, it will be determined that it is better to do a full general anesthetic, but that is not ordinarily the case.


Q: When can I workout after surgery?

A: We allow patients to resume their ordinary activities as they feel like it. However, I do discourage vigorous weight lifting and running until 3 weeks.


Q: What complications should I worry about?

A: All surgery can have the usual complications of bleeding, infection and anesthetic problems, but in my experience this occurs less than 1% of the time. Occasionally, one implant or the other will be too high or too low and will require some sort of adjustment. In our practice, that occurs in about 1 in 50 patients and, of course, we work considerably to avoid this.


Q: I saw a web site that shows all kinds of pictures of women with all sorts of different implants. What do you think of that?

A: There are several web sites that patients bring pictures from illustrating what kind of implant they want. This is similar to the process that we go through in the office when we discuss the size that the patient particularly wants to be. These can be useful, but are not necessary, given the way we do our size discussion.


Q: I saw a web site that gave a lot of reasons to not have an implant put in. What do you think about that?

A: People have brought me all sorts of negative publicity surrounding implants. Many of these appear to be written by angry individuals who ostensibly thrive on negativism. Breast augmentation is an operation that people undertake for personal betterment and there will always be people and groups who, rather than thriving on the positive aspects of life, feel the need to dwell on negativism. Indeed, I somewhat feel sorry for people who live their life this way, but more importantly I wish they would not try to drive other people to the same sort of unhappiness they obviously feel.


Q: Would you allow your wife, sister, or daughter to have implants?

A: Well, my wife has implants, I don't have a sister, and my daughter is in the eleventh grade. However, if she makes that decision, I will be happy to stand by her.


Q: My husband / boyfriend wants me to get a particular size implant. What do you think about that?

A: It is very important that you arrive at a size agreement with Dr. Wallace based on what you want, not on what someone else wants. No more than you should have the surgery to begin with because of a husband's or boyfriend's wishes, the size is something that you must be comfortable with. While you may want to take their opinion into consideration, you absolutely must be personally comfortable with the final decision.


Q: Can you fix sagginess with implants?

A: In many cases, ptosis (sagginess) of the breast can be fixed with implants alone. In more severe cases, this will require an implant as well as the removal of excess skin that results of course in some form of a scar. That is a subject and separate discussion under Mastopexy-Breast Lift.


Q: How will my breasts feel with implants?

A: Ordinarily after implants there is a full, firm, pleasant feel to the breasts. In women who have considerable breast tissue to begin with, the implant may not be palpable. In those without much breast tissue, the edges of the implant may be perceptible, but should not be considered objectionable.


Q: What about sloshing? I have heard that some women can hear their implants sloshing around.

A: With modern implants, this should not occur except perhaps in the first few weeks after the surgery when tiny air bubbles inside the pocket are still being absorbed.


Q: What about numbness after the surgery?

A: It is normal for patients to have a little bit of numbness for a few days or weeks after the surgery. However, this ordinarily resolves and does not cause any problems. Rarely this can take longer to recover, total numbness after augmentation is unspeakably rare in my experience.


Q: Have you had any patients who want their implants out?

A: As of the time of this writing, I have done over 2000 breast augmentation operations. We have removed and left out fewer than 10 patients' implants out of that number. Several of those patients came back and wanted implants put back in. All but two of these patients were in the middle 90's during the height of the implant controversy and hysteria.


Q: What if I want them bigger or smaller after the operation?

A: Generally, this requires a second operation and replacement of your implants. Occasionally an adjustment can be made by adding or removing saline from one or both implants to accommodate a slight size difference from side to side or personal wishes. With our method of selecting the implant size and using the discussion of photos mentioned above, accuracy in selecting the implant and accuracy in defining the patient's goals is achieved in well over 97% of patients.


Q: I am going on a diet to lose 15-20 pounds. Should I wait to have the surgery?

A: Patients who are in the middle of a weight loss program may want to postpone their surgery until they are within 10-15 pounds of their goal to be more certain of their results. It is important to be reasonably stable at a weight that you can live with and not something that you transiently achieve no matter what sort of surgery you are considering undertaking.


Q: What about ripple / wrinkle problems?

A: Our experience has been that this exists mainly in people who lose considerable weight and have textured saline implants. The problem usually can be resolved by either changing to smooth implants or in some cases, silicone gel implants.


Q: Do you have your patients wear special bras?

A: We have most patients wear a sport type elastic bra for the first couple of weeks and then can transition to whatever they find comfortable as long as it doesn't gouge or pinch in an untoward way.


Q: I heard you could go to Mexico, Costa Rica or ... and get the surgery for less. Why does it cost so much here?

A: It is true that you can go to a variety of foreign countries and have the operation done for less. However, we have seen a number of people come back from these clinics with infections, dissatisfaction with the size, terrible scars, or other problems. It indeed seems like a rather illogical way to try to save money, as obviously, at least in our patient population, their complication rate is much higher and there have been a number of well publicized disasters in such circumstances where safety is not a paramount concern.