Breast Augmentation Q&A - Dr. Hayes answers 10 of the most popular realself breast augmentation questions.

Breast augmentation is one of the most popular cosmetic procedures. Learn more about the surgery, recovery and results, by checking out Dr. Hayes' answers to common questions.

1. Breast Augmentation Recovery: What Can I Expect?
Breast augmentation surgery recovery is better than most women expect. The old way of doing breast augmentation caused a lot of swelling and bruising. New techniques help minimize swelling and pain. Most women are back to their day-to-day activities within 24 hours. No strong narcotics are typically required and many patients just take ibuprofen. Norco (hydrocodone/acetaminophen) can be used as needed. My patients take a warm shower and start doing arm raises, to stretch their chest, starting several hours after surgery. They also go out of the house for a walk, or dinner, on the night of surgery.
Most women are back to work in 5-7 days. Cardio exercise can be restarted at 4 weeks. Chest exercises can be restarted at six weeks.

2. When Does Swelling After Breast Augmentation Begin to Subside?
The swelling after breast augmentation typically takes around four weeks to go down, but the implants take several months to settle. The implants will descend ("drop and fluff") over the course of 3-6 months. As the implants settle, the bottom of the breast appears more round and full.

3. How Do You Massage Breasts After Breast Augmentation?
In my office women start massaging their implants one week after surgery. Breast implant massage takes about two minutes and is performed twice per day. It's important to understand that only smooth round implants are massaged. Textured, or shaped, cohesive gel implants are not massaged during the healing process.

To massage the implant, use the heel of your hand to push the implant "in" for 10 seconds. Push the implant "up", and hold for 10 seconds. Lastly, push the implant "out" (away from the midline) and hold for 10 seconds. In my office, I typically don't have women push the implant down. I want to give the tissues, that support the breast crease, time to heal before pushing the implant down. I find that most implants settle on their own, with no extra help. After the implant massage it's good to squeeze the skin and breast tissue all around the breast. This helps decrease sensitivity and keeps the breast capsule soft.

Breast implant massage is performed for six weeks after surgery. Squeezing the breasts is done daily as long as the implants are in place.

4. What are the signs of capsular contracture after breast augmentation?
The body naturally forms a capsule around all breast implants. In some women this capsule becomes thickened and can tighten. This can cause the breast to feel firm, look abnormal, or even become painful. It is thought that the presence of bacteria, or blood, within the breast pocket can cause a abnormally thick capsule to form.
There are four grades of capsular contracture (Baker Scale).

Grade I — the breast is normally soft and appears natural in size and shape.
Grade II — the breast is a slightly more firm, but has a normal appearance.
Grade III — the breast is firm and appears distorted.
Grade IV — the breast is hard, painful, and appears abnormal.

After breast augmentation, a small group of patients will notice that one or both sides begin to harden. It's possible to determine if you have a capsular contracture by consulting with your surgeon, who will examine you to see if one side feels more firm than the other.

I ALWAYS take precautionary steps in the operating room to address the causes of capsular contracture. This includes keeping the pocket dry by using meticulous hemostasis. Covering each nipple with a waterproof dressing (Tegaderm) and using a "no touch" technique when handling the implant. This involves using a Keller funnel. A Keller funnel allows the surgeon to place the implant inside the breast without touching it. The implant is also rinsed in antibiotic solution before it is placed (bacitracin, cefazolin, gentamicin). With all of these precautions the capsular contracture rate is less than 5%.

5. Advice for Exercise After Breast Augmentation?
After breast augmentation most women are back to their everyday activities after 24 hours. For the first two weeks after surgery I recommend that patients only do light cardio activities, like walking or taking a gentle hike. It’s important to avoid activities that raise your heart rate or blood pressure during this time. After four weeks you can resume lower body workouts and full cardio, but should avoid any workouts that work the chest (planks, yoga, spinning, and presses). It takes six weeks until women can do full chest workouts and any activity without restriction.

6. How Long Do I Have to Sleep on my Back After Breast Augmentation?
It typically takes six weeks to heal completely from a breast augmentation surgery. I ask my patients to avoid sleeping on their back, if possible, for six weeks after surgery. If they can't sleep on their back, then they'll typically side-sleep. Being careful, even while you're sleeping, allows a stable capsule to form around the implant, so that the implants are held in place by the fully healed tissue.

7. What size implants should I choose?
The most important factor when sizing implants, is working closely with your surgeon in-person to find the implant size that gives you the look that you desire. Careful measurements of your breast and chest wall will help determine which size implants will fit within your natural breast foundation. Taking into account your desired look ("natural" vs "augmented"), and your measurements, an implant is chosen that specifically fits your body.

Unfortunately, online recommendations are not that helpful. Make sure that you have a good relationship with your plastic surgeon, so that you can work together to find the right size.

In my office, patients try on implants in a bra and clothing. There able to see how they look in the mirror, and in photographs. Women are also encouraged to bring in wish pictures, so that I can get a sense of the look that they would like to achieve.

8. At what point do you know if you need a breast lift vs breast implants (or both)?
It’s very common to see woman who are wondering about this exact question. There are important questions to ask yourself when determining which procedure, or combination of procedures, will give you the look that you want.

A breast lift changes the shape of the breast. A lift gives the breast a more youthful look by moving the nipple higher and reshaping the breast by removing excess skin. The incisions vary from a donut (around the areola), to a lollipop (around the areola and down to the crease below the breast), or an anchor (adds a third incision within the breast crease). The number of incisions depends on the amount of sagging of the breasts (degree of ptosis), and therefore the amount of lift that's needed. 

Drooping of the breasts (ptosis) is graded by measuring where the nipple lies in relation to the crease below the breast. As women age the nipple and bulk of the breast descends. This descent can also be accompanied by loss of breast volume. When determining whether you need a lift, the question to ask is, do I like the position of my nipple and the shape of my breast?

When determining whether to do a breast augmentation, it’s helpful to know whether you're happy with your breast size when wearing a bra. If not, then some volume will need to be added by using an implant. Using a breast implant in a woman with mild ptosis can often correct the ptosis such that a separate breast lift may not need to be performed. Careful measurements in the office help decide whether I add a lift to a breast augmentation procedure. 

Consultation with your plastic surgeon will help you decide which procedure is right for you.

9. Should I Wear Surgical Bra After Breast Augmentation?
The only dressing after breast augmentation surgery is a waterproof Band-Aid (Active-Flex). My patients take a shower on the day of surgery. I want them to be as comfortable as possible, so I don't require that they wear a bra. However I asked them to purchase a surgical bra so that they have one available if they find it more comfortable. Since I don't recommend that they wear an underwire bra for the first six weeks, though typically wear the surgical bra, or a comfortable band-bra, until they're ready for their new bra fitting. Because implants settle dramatically in the first several months after surgery, I asked him to wait two months before having a bra fitting.

10. How to Bring the Natural Breasts Closer Together?
Unfortunately there is no surgical or medicinal way to create cleavage. The breast has a natural foot, like the foundation of a house. Even after breast augmentation, the implant sits within this natural footprint. A breast augmentation makes the breast larger, but does not bring them closer together. The only way to create cleavage is to wear a push-up bra that pushes your breasts higher and closer together.

**How much does breast augmentation surgery cost?**
See our price list for fee estimates

Austin Hayes, MD

Portland plastic surgeon, Dr. Hayes specializes in cosmetic surgery of the face, breasts and body. He has offices in Portland, Seattle, and Hood River.