When choosing a surgeon who is experienced with breast implantation, we recommend that you find out the answers to the following questions:

• In which states is he/she licensed to practice surgery? Note that some state medical licencing boards provide information on disciplinary action and malpractice claims/settlements to prospective patients either by request or on the internet.

• Is he/she board certified, and if so, with which board?

• How many breast augmentation, reconstruction, or revision surgeries does he/she perform per year?

• How many years has he/she performed breast implantation surgeries?

• What are the most common complications he/she encounters with patients after breast implantation?

• What is his/her reoperation rate with breast implants and what is the most common type of reoperation he/she performs?

When you have answers to these questions, you will have a better idea of the technical qualifications of your surgeon.

You should consider the following when you and your surgeon are discussing implant options.

Implant Status – Whether or not an implant is PMA-approved or investigational (not PMA-approved) should be something you consider (see the Status/Availability section for details). An implant that is investigational means you will need to be part of a clinical study to get these implants. In addition, the surgeon of your choice may work with only specific breast implants.

Shape and Size - Depending on the desired shape and size you wish to achieve, you and your surgeon may choose a round or contoured implant shape of appropriate size (volume). You should be aware that contoured implants that are placed submuscular (under the pectoralis major muscle) may assume a round shape after implantation. Your surgeon will also evaluate your existing tissue to determine if you have enough to cover the breast implant.

Implant Surface - Textured surface implants were designed to reduce the chance of capsular contracture. Some studies with small numbers of women suggest that surface texturing reduces the chance of severe capsular contracture. However, other studies of a large number of women with saline-filled implants show no difference in the likelihood of developing capsular contracture with textured implants when compared to smooth-surfaced implants.

Implant Palpability/Visibility - The following may cause implants to be more palpable (more easily felt) or more visible: textured implants; larger implants; subglandular placement; and smaller amount of skin/tissue available to cover the implant.

You should discuss the pros and cons for each incision site you are considering with your surgeon. Your surgeon may recommend an incision site for you depending on whether you will be having augmentation or reconstruction.

Augmentation Incision Sites – The three common incision sites are under the arm (transaxillary), around the nipple (periareolar), or within the breast fold (inframammary). The sketch below shows each of these incisions sites.⁶⁵

• Transaxillary – This incision is less concealed than periareolar but associated with less difficulty than the periareolar incision site when breast feeding.

• Periareolar – This incision is most concealed but is associated with a higher likelihood of inability to successfully breast feed, as compared to the other incision sites.

• Inframammary – This incision is less concealed than periareolar but associated with less difficulty with breast feeding than the periareolar incision site.

The umbilical/endoscopic incision site is not recommended by companies.

Breast implant surgery can be performed on an outpatient (not in the hospital) basis or in a hospital. It can be done under local anesthesia (only the breast area is numbed) or under general anesthesia (put to sleep or not aware of having surgery).

Breast implant surgery can last from one to several hours depending on your particular case (your condition, implant choice, incision site, implant placement, etc.).

If the surgery is done in a hospital, the length of the hospital stay will vary according to the type of surgery, the development of any postoperative (after surgery) complications, and your general health. The length of the hospital stay may also depend on the type of coverage your insurance provides.

Before surgery, your doctor should discuss with you the extent of surgery, the estimated time it will take, and the choice of treatment for pain and nausea.

Your doctor should describe the usual postoperative recovery process, the possible complications that can arise, and the expected recovery period. Following the operation, as with any surgery, you can expect some pain, swelling, bruising, and tenderness. These complications may last for a month or longer, but they should disappear with time. In addition, scarring is a natural outcome of surgery. Ask your doctor to describe the location, size, and appearance of the scars you can expect to have. For most women, scars will fade over time to thin lines, although the darker your skin, the more prominent the scars are likely to be.

Your doctor may prescribe medications for pain and nausea. Some women may experience bleeding and some may experience fever, warmth, or redness of the breast, or other symptoms of infection. You should report these symptoms immediately to your doctor. Your doctor should tell you about wound healing and how to care for your wound. Drains may be used for a few days.

You may need a post-operative bra, compression bandage, or jog bra for extra support and positioning while you heal. At your doctor’s recommendation, you will most likely be able to return to work within a few days, although you should avoid any strenuous activities that could raise your pulse and blood pressure for at least a couple of weeks. Your doctor may also recommend breast massage exercises.

Ask your doctor about a schedule of follow-up examinations, limits on your activities, precautions you should take, and when you can return to your normal routine, including exercising. (If you are enrolled in a clinical study, your doctor should give you a schedule for follow-up examinations set by the study plan.)