For patients who will undergo breast surgery via areola incision, they should ask their doctors if they will receive a pedicle technique in which the nipples and areolas are relocated but not completely severed from the wedge of tissue that contains the milk glands and primary nerves.

The pedicle technique has become a standard in breast reduction surgery in an effort to preserve the nipple sensation, although this is not used in treating excessively large breasts as it can limit the amount of excess tissues, fats, and skin a surgeon can remove during an operation.

For women who want to undergo breast implant surgery but are concerned with the risk of permanent numbness in the nipple, most doctors would probably recommend the underarm incision in which they will stretch the tissue rather than cut it to place the device inside the breast pocket.

If the nerves are only stretched, the sensation usually returns sooner unlike if they are cut or cauterized (burned).  But regardless of the incision site, there is always the risk of partial or complete loss of sensation after a breast augmentation surgery.

Another way to reduce the risk of permanent numbness is to avoid using an implant which has a diameter larger than the base of the breast.  For example, a patient who chooses a 12 cm diameter implant even if her breast’s diameter is only 10 cm is more likely to experience this problem than a woman who “considers” her anatomy.

Some plastic surgeons also claim that placing the implants under the muscle can lower the rate of nipple numbness than if the devices are placed behind the tissue or partially under the muscle.

In case that nipple numbness occurs after a breast surgery, it may take up to two years before the sensation will return.  Meanwhile, research has shown that most women can increased their ability to breastfeed five years after the procedure because the damaged nerves and glands can repair themselves over time.

Experts suggest that massaging the nipples and breast skin regularly may encourage a complete or sooner return of sensation by reinforcing neural pathways in the brain; this is done by lightly touching the area with fingers for a few minutes several times each day.

To guide you during your recovery after surgery, the California Surgical Institute has provided a list of answers to the most frequently asked questions about what you should do and expect during the healing time:

1.  Question:  Should I assign someone who will care for me during my recovery?

Answer:  Yes.  Assign a capable adult who will tend to your needs for at least three days following your surgery.  But in case that your procedure is an extensive one, it is best that you opt for an overnight stay at a hospital.

2.  Q:  How long is my recovery?

A:  The length of your recovery will largely depend on the treated area, extensiveness of the procedure, type of plastic surgery, and your body’s healing capability.

These are the most common cosmetic procedures and their estimated recovery time:

• breast augmentation – three to 12 months
• eyelid surgery – eight weeks to seven months
• tummy tuck – eight weeks to nine months
• traditional liposuction – eight weeks to 12 months
• facelift – eight weeks to 10 months

3.  Q:  When can I resume my work and normal activities?

A:  Most patients can return to normal activities (excluding strenuous exercises) and “quiet” work” 10 days after their surgery.  But to be on the safe side, you should always ask your doctors on when you can safely resume your daily life activities.

4.  Q:  Why is it dangerous to remain sedentary or bed-ridden for a long period of time after my surgery?

A:  If you remain in bed for a long period of time, you are at risk of developing blood clots in your legs and lungs and other serious complications.  Ideally, you should take a short, gentle walk as soon as you can in order to promote a good blood circulation.

5.  Q:  What are the most common postoperative symptoms should I expect?

A:  It is most likely that you will experience swelling, bruising, tenderness, soreness, pain and discomfort, temporary numbness in the treated area, and nausea as the anesthesia wears off.

But a week after your surgery, most of these symptoms will become less pronounced.

In case that there is no improvement within a week, you should immediately visit your plastic surgeon to determine if you are experiencing delayed healing and other complications.

6.  Q:  How can I minimize the swelling?

A:  Swelling is more common after a facelift, eyelid, rhinoplasty or nose surgery, otoplasty or ear tucking, neck lift, and tummy tuck.  To minimize this symptom, you should elevate your head and shoulder with pillows within seven to 10 days following your surgery.

Ice packs can also be helpful in minimizing the swelling and bruising.

7.  Q:  Why should I avoid aspirin and anti-inflammatory medications during my recovery?

A:  These drugs, which are sometimes called as blood-thinners, can increase bleeding during surgery and recovery and can also inhibit the body’s healing ability.  Herbal supplements and vitamins, particularly those containing green tea, vitamin E, ginseng, and ginkgo biloba have also been found to increase bleeding.

Just to be on the safe side, you should tell your surgeon all the current medications you are taking.

8.  Q:  Why is it important that I avoid smoking and second-hand smoke before my surgery and during the recovery period?

A:  The nicotine can inhibit normal blood circulation, thus significantly increasingly your risk of developing skin necrosis or death of skin tissue, a complication that often leads to delayed healing and unnecessary scarring.

9.  Q:  What is the most ideal diet during my recovery after plastic surgery?

A:  Because your body will need to repair itself after a surgical procedure, your diet should be high in protein.  However, you should watch your sodium intake since too much of this may aggravate swelling.

10.  Q:  Why is it important to wear compression garments particularly during the first few days of my surgery?

A: If you undergo breast augmentation, breast lift, breast reduction, liposuction, facelift, body lift, and tummy tuck, your doctor will require you to wear a compression garment for a certain period of time in order to prevent sagging, provide support to the new contour, and minimize swelling.

11.  Q:  What are the tell-tale signs of complications related with surgery?

A:  You should immediately seek medical attention if you experience any of the following: abnormal heart rate, swelling and bruising which do not subside after a week, delayed healing, and other conditions which are “out of ordinary.”

12.  Q:  How can I avoid or at least minimize the appearance of scars?

A:  Never expose the incision sites to direct sunlight for six to 12 months in order to avoid dark pigmentation.  You can also use petroleum jelly or special creams, ointments, and lotions especially those containing vitamin E and C, glycolic acid, onion extract, Retin-A, and emu oil.  However, you should only apply these creams after the surgical wound is completely closed (to be on the safe side, you should ask your doctor).

13.  Q:  Aside from using creams and lotions, what are the other ways to remove or minimize the appearance of scars?

A:  Scar revision procedures may include laser resurfacing, anti-inflammatory agents to flatten and/or soften the scar tissue, and medical tattooing to camouflage the dark pigments.

14.  Q:  Is the result of plastic surgery supposed to last a lifetime?

A:  It will depend on the type of procedure.  For example, the result of tummy tuck, body lift, breast reduction, and liposuction can last a lifetime as long as you will maintain a stable, normal weight and avoid future pregnancy.

Rhinonoplaty or nose-reshaping surgery is also supposed to last a lifetime unless you experience unexpected nasal growth.  For this reason, most doctors require their patients to be at least 15 years old to make sure that their nose is fully developed.

But if you will undergo a breast augmentation, expect that you will have a revision surgery at some point in your life since breast implants are not designed to last forever.

For women who want to achieve a more natural appearance, most plastic surgeons recommend the silicone implants which are filled with a cohesive gel material noted for simulating the “feel” and “bounce” of a real breast tissue.  This may not be the case for saline implant which feels like a water-balloon, according to some patients’ description.

In general, the silicone implants provide a slightly better result compared to the saline version, although the outcome may still depend on the amount of skin and tissue, surgeon’s skills, and other factors.

Petite women who usually have limited amount of breast tissue and skin are usually advised to have silicone-filled implants which are less likely to ripple than the saline version.  To further reduce the risk of rippling to this type of patients, plastic surgeons place the implants under the chest muscles rather than over them so that more amounts of skin and tissue can cover the shell and provide a reliable “bra-like” support.

Because the silicone implants are less likely to ripple, many experts also believe that these materials have a lower chance of leaking.  (Rippling may affect the durability of the shell which may result to breakage.)

Another advantage of using silicone implants is that women can maintain their breast volume unless if there is a leak.  This is not the case for patients with saline implants which have a natural deflation rate—due to evaporation and other factors—of 1 percent every year.

During the previous years, there were claims that silicone breast implant can increase a patient’s risk of autoimmune and connective tissue diseases.  However, extensive studies did not find a strong link between this type of implant and the risk of developing such conditions.

Despite the advantages of silicone implants, some plastic surgeons warn that these biocompatible materials still have some downsides.  For example, women with this type of breast implant are required to undergo a regular MRI screening—ideally every two years—to detect any possible leak.  (Because a silicone leak just stays around the tissue, the condition may sometimes go undetected for months or even years.)

In contrast, this is not a requirement for patients with saline implants.  This is because the saltwater filling is immediately absorbed by the surrounding tissues in case of a leak, and as a result, the breasts will appear deflated just four hours after the shell breaks.

Implant-related problems such as rupture in the shell are the most common reasons why doctors perform revision breast implant plastic surgery.  Fortunately, most US manufacturers provide lifetime warranty on their products and may even offer some form of coverage to other expenses related to surgery.

To detect leaks in silicone-filled implants, doctors recommend MRI screening three years after breast augmentation and subsequently every two years.  However, this is not a requirement for patients with saline implants which can immediately inflate within four hours after the shell breaks.

Aside from rupture in the shell, another common implant-related problem is wrinkling in which patients with limited amount of breast skin and tissue are at higher risk compared to large-framed women who usually have a thicker glandular tissue.

It is interesting to note that the chance of implant wrinkling can be easily reduced by placing the material under the breast muscles instead of behind the tissue.  This is why most board-certified plastic surgeons recommend and use this implant placement technique which is also noted for giving a natural result and preventing sagginess in later years.

Meanwhile, revision breast implant surgery usually involves replacing it with a new one.  This is because removing the implants without replacing them may result to unnatural appearance since the tissue have already been stretched, although this approach may be the best option for women who want to permanently remove the synthetic materials due to medical or personal reasons.

For patients who do not want to replace their implants, plastic surgeons will most likely perform a more extensive procedure in order to address the overstretched tissue.

Many plastic surgery experts believe that removing the implants “en bloc” is the most ideal approach.  This means that the entire material and the scar tissue capsule around it are removed together; in this way, doctors can make sure that any silicone that may have leaked from a rupture shell is removed.

However, this approach is more difficult than removing just the breast implants.

It is important to note that removing the implants is more complicated than putting them, especially if there is a leak in the shell.  For this reason, patients should consult with plastic surgeons who have an extensive experience in performing not just “implantation” but also “extraction.”

According to plastic surgery specialists, a good doctor will not push the limit of the body by introducing sizes that are too large in relation with the amount of tissue and anatomical frame of a person.

Because the breast tissue and skin of petite women are not that thick, thus making them prone to wrinkling and rippling, most plastic surgeons believe that extremely large implants are usually not a good idea for them.

Patients with a limited amount of tissue and skin are also at higher risk of bottoming out if they choose a bigger size.  This is because the weight of larger implants may not receive enough support, thus resulting to premature sagging.

Also, their small body frame may look “heavy on top” and appear unnatural if they will choose implants that are too large.

And lastly, petite women with larger implants are at higher risk of developing back problems since the weight may be too much for their small structure to accommodate (because it pulls the body forward, also leading to poor body posture).

On the other hand, large-framed patients who generally have a thicker tissue and skin on their breast can accommodate bigger implants compared to petite individuals without exposing themselves to higher risk of complications.

But aside from the body frame, the breast implant size should also depend on a patient’s lifestyle.  For instance, professional athletes and individuals engaged in sports are not advised by plastic surgeons to have larger sizes which may affect or interfere with their performance.

Another important consideration when it comes to choosing the implant size is the goal of each patient.  Does she want to have the natural appearance or the large, round look?  Whatever is her choice, the result should provide her satisfaction rather than regret for going too big or too small.

Women who are considering larger implants should also realize that these usually result to more post-operative pain and discomfort compared to having smaller ones because the skin and tissue will be more stretched in order to accommodate the biocompatible materials.

To be on the safe side, patients should only consult with a board-certified plastic surgery doctor who can guide them in choosing the sizes that will provide the most desired result without exposing them to certain risks.

To provide the most desired results, breast implants come in different profile (projection from the chest wall), shapes, fillings, shell texture, and of course, sizes.

Although breast implants are used to increase the bust size, plastic surgeons agree that some patients cannot accommodate larger sizes because they have limited breast tissue and skin or they have smaller body frame.  It is important to note that pushing the body’s limit by introducing bigger implants may result to higher risk of wrinkling and back pain, difficulty to move, and more post-operative pain and discomfort.

Aside from the body frame, plastic surgery specialists also believe that the lifestyle of patients can also determine if they can have larger implants.  For example, professional athletes and women who lead an active life are not a good candidate for bigger sizes which may affect their performance, balance, and movements.

On the other hand, large-framed women who usually have more breast tissue and skin than petite individuals may accommodate larger sizes.  And besides, bigger implants will most likely appear natural for them because of their body structure.

While patients with thicker tissue and skin are less likely to experience implant rippling compared to petite women, most plastic surgeons still prefer placing the implants under the chest muscle (rather than behind the tissue) so that more amounts of tissue and skin will serve as a “padding” which in turn can provide a more natural result.

It is very important for patients to discuss their goals and expectations to their plastic surgeons, especially when it comes to breast size.  This is because many women who had asked for a revision plastic surgery regretted for going too small or too large.

During the consultation, patients should be as accurate as possible in telling the breast size they want to achieve after their surgery, and in turn, doctors will determine if the size is feasible to their body frame.  By having an open discussion, both patients and surgeons can come up with the most appropriate size.

For women who are interested in just a small enhancement (less than a cup size), breast augmentation through fat grafting may be a better option than using implants.  In this plastic surgery procedure, doctors collect fats from the thighs or tummy, purify them to separate the tissue and blood, and re-inject them to the bust.

Many patients who had this plastic surgery said that the recovery period is the most challenging for them rather than the procedure itself.  This is because they had to endure pain and discomfort, nausea, swelling, and bruising especially within the first few days of their operation.

Despite the discomfort, most plastic surgeons require their patients to start walking as soon as possible to promote better blood flow and faster healing, and prevent excessive swelling and blood clotting.  Meanwhile, people should not lie down all the time as doing so can aggravate swelling, slow down their metabolism, and predispose them to risk of blood clotting in the legs, lungs, and other vital organs.  (See picture below.)

In some cases, plastic surgeons also require their patients to perform breast massage and compression exercises that involve pushing the implants to the outermost corners of the pockets.  If performed correctly, this post-operative care can provide a more natural appearance by promoting the synthetic materials to “settle” down to their proper position.

Aside from providing a better result, breast massage has also been said to reduce the risk of capsular contracture, a painful condition in which the scar tissue attaches itself around the implants, resulting to a ball-shaped bust.

However, not all plastic surgery specialists recommend this exercise especially for women with textured or teardrop-shaped implants.  To be on the safe side, patients should ask their doctors if it is safe to perform breast massage and what is the proper way to do this procedure.

Meanwhile, mammograms (breast X-rays) and examinations are also an important part of implant maintenance program.  According to plastic surgeons, women with silicone-filled implants should undergo MRI screening three years following their plastic surgery and then every two years to detect if there is any leak or rupture in the shell.

For women with saline-filled implants, MRI screening is not a requirement since an implant leak will always have “visible manifestations” such as asymmetrical or deflated-looking breasts.

But to be on the safe side, women older than 40 should undergo an annual clinical breast exam while those who are in their 20s and 30s should at least have this procedure every three years.

Women with implants should also inform their doctors, including their dentists, that they had breast augmentation procedure.  In this way, they may be advised to pre-medicate with antibiotics before they will have surgery or dental work.

It is also important that the patients are not smoking or not exposed to second-hand smoke since the nicotine, carbon monoxide, and other chemicals found in the cigarettes can delay the body’s healing ability by interfering with oxygen absorption and diminishing the blood supply from the incision site.  In most cases, delayed healing results to risks of skin necrosis (death of skin tissue that results to unnecessary scarring) and also infection.  (See picture below.)

To reduce the risk of skin necrosis and other complications associated with smoking, most plastic surgeons ask their patients to stop the habit several months before and after the surgery.  Following such advise is critical since a recent study shows that smokers are 1,500 more likely to develop skin necrosis compared to individuals who are not smoking.

Because of the risk of smoking, majority of plastic surgeons are now refusing to operate on smokers, especially those who seek breast surgery, facelift, tummy tuck, and other procedures that require skin to be shifted, unless they are willing to quit the habit well in advance of their plastic surgery.

Aside from being physically fit, a good candidate for breast augmentation surgery should have realistic goals and expectations which can have a significant impact on the satisfaction of patients after the surgery.  It is important to note that with realistic and attainable expectations, this plastic surgery can improve a person’s confidence and body image.

Meanwhile, breast augmentation is usually performed with the use of silicone or saline implants, although fat grafting (using a patient’s own fats to augment the bust) is increasingly becoming a popular alternative for women who want to slightly increase their size (this approach can only increase the bust with less than a “cup”).

With this consideration, breast implant surgery is usually recommended on patients with smaller breasts who want to significantly increase their size.  However, petite women who usually have limited breast tissue and skin may not accommodate larger implants because they are at higher risk of rippling and wrinkling.

While more commonly used to increase the bust size, plastic surgeons also perform breast implant surgery to address asymmetrical appearance (one breast is smaller or sags more than the other), make the breast appear fuller again after weight loss or pregnancy, and reconstruct the breast of post-cancer patients.

Since this plastic surgery procedure cannot change the size of the breasts, some women ask for complementary surgeries such as breast augmentation (through the use of implants) to make their bust appear fuller or breast reduction to decrease the size of an enlarged breast.

In general, women who have any of these conditions may consider breast lift surgery: 1.) Have nipples pointing downward or falling below the breast crease.  2.) Have one breast sagging more than the other resulting to asymmetrical appearance.  3.) Have stretched skin and enlarged areolas.  4.) Have elongated, pendulous breasts.

As with any plastic surgery, breast lift involves potential risks such as excessive bleeding, unnecessary scarring, delayed healing, skin necrosis, and infection.  For these reasons, a good candidate for this procedure should be physically fit and non-smoker.  It is also important that she has a positive outlook in life and has realistic goals and expectations.

Although breast lift can be performed at any age, most plastic surgeons require their patients to wait until their breasts have stopped developing and they are no longer considering having babies.  This is because the procedure may have unpredictable effects on the function, size, and shape of the breasts.

To reduce the risk of complications, plastic surgeons require their patients to have pre-operative lab tests to determine their health status.  In some cases, doctors also require women to stop taking certain medications several weeks before the surgery that may affect the body’s healing ability and predispose them to bleeding and infection.  Examples of these drugs include anti-inflammatory medications, aspirin, and certain herbal supplements.

Because the breast size differs from patients to patients, there are several techniques used in breast lift.  The most common approach is the anchor-shaped incision that involves a cut around the circumference of the areola, a vertical incision that starts from the areola to the crease, and a cut across the breast fold.

In some cases, the anchor-shaped incision is too invasive for a patient.  With this, plastic surgery specialists may resort to a technique called lollipop incision in which they remove the horizontal cut across the breast crease, resulting to a shorter downtime and one less scar.

Most of the symptoms of capsular contracture begin several months after the breast surgery, although this may occur at any time.  But in most cases or about 75 percent of capsules appear within the first two years of breast augmentation surgery, with many of the reported incidents occurring on patients with silicone implants rather than those with saline version.

Perhaps the most widely accepted cause of this complication is a low-grade infection, although some doctors also associate this with the use of radiation therapy, severe breast trauma, seroma or collection of fluids underneath the skin, hematoma or broken blood vessels under the skin, use of inordinately large implants to patients with limited breast skin and tissue, and autoimmune disorders.

Meanwhile, plastic surgeons have found several ways to avoid capsular contracture.  One of these techniques include submuscular implant placement in which they put the synthetic materials under the chest muscle instead behind the tissue.  The theory is that the constant massage from the pectoral muscles will inhibit the growth of scar tissue around the shell.

Some specialists in LA plastic surgery also recommend taking antibiotics before and sometimes after breast augmentation which is said to prevent bacterial infection that may lead to capsular contracture, while others promote breast massage and compression exercises after the procedure which are believed to prevent the tissue from hardening and to encourage the implants to settle to their proper place.

In case the symptoms of capsular contracture have already occurred, most plastic surgeons believe that implant removal (including the scar tissue around it) is the only treatment that guarantees success.  Meanwhile, patients may ask for another set of implants or permanent removal, although the latter option may leave them with sagging breasts that usually require suturing methods to correct the stretched tissue.

However, some doctors in LA plastic surgery claim that there are non-surgical treatments for this complication, although the effectiveness of such approach is only based on anecdotal evidence.  Examples of these procedures include the use of sound waves to soften the breast tissue, certain anti-inflammatory medications, and oral vitamin E.