Breast Implant and Augmentation Information

Why Breast Implants

The amount of breast development in an adult female varies considerably. Some women simply never develop a large amount of breast tissue. Others note that their breast tissue becomes noticeably less in amount following pregnancies. The majority of women seeking this surgery seek only to have normal size breasts that relates to their body proportions and they are not seeking to be exceptionally buxom.

Breast implants make small breast larger. They may, but do not necessarily, improve their shape. Breasts made larger by implants may have the same tendency to droop and sag as the same size breasts without implants might. Drooping and sagging breast sometimes, however, can be corrected partially with implants.

In the 1970s and 1980s, breast implant surgery was the most common cosmetic surgery in the United States. After the “silicone scare” of the 1990s, it is once again one of the most common cosmetic surgeries. Currently, over 100,000 such surgeries per year are now performed in America. At least 1.5 million women in this country have breast implants.

Type of Breast Implant

Before 1992 and the FDA scare, seven implant manufacturers existed. Today, only Allergan and Mentor survive. Saline implants produce a reduced incidence of capsular contracture, require smaller incisions, and they have an overall reputation of greater safety. Silicone gel is now available for first time augmentation and reconstruction surgery, should the patient choose it. The patient must be 22 years of age or older.

Different shapes and “projections” are available, and the saline “bag” surface can be textured or smooth. The literature regarding implants is massive and confusing, and different surgeons constantly debate which implant type and shape is the best. Most surgeons whom I respect and have worked with prefer the following implant characteristics for primary implantation:
• A smooth shell, without texturing, filled with saline or silicone
• Spherical (not “anatomic” or “teardrop”) shape
• High profile or moderate profile

Hospital, Surgical Center, or Office Surgery for your Breast Implants

Breast implant surgery can be safely and effectively performed in any of these settings. Surgical center and office settings are usually more convenient for all involved, are more confidential, have lower rates of infection, are less expensive, are often safer, and provide a more pleasant surgical experience.

Anesthesia Type: General, IV Sedation, or Local for Breast Implant Procedures

True local anesthetic is the safest, but is rarely adequate for breast implant surgery, except in very selective cases. IV sedation is also very safe, and is routinely performed in almost all ambulatory surgical centers. An example of this type of sedation is the IV sedation routinely given by oral surgeons (dentists with advance anesthetic and surgical training) for the extraction of wisdom teeth. General anesthesia involves intubation (a tube in your throat) and a breathing machine. In our facility a combination of a local anesthetic and IV sedation is used.

Placement & Position of Breast Augmentation Implants

The surgeon’s preferences and experience will almost always be the determining factor. This decision should be discussed with you in detail, because the position of the implant is critical to the final appearance and possible complications. Three types of placement are possible: Subglandular (under the breast, but over the muscle); Sub-pectoral (under the muscle); and Sub-fascial (under the breast, over the muscle, but under the very tough covering of the muscle, the fascia).

As you can see, each of the implant positions has its advantages and disadvantages. This is why discussion with your surgeon is critical.

Advantages of placing the implant under the muscular fascia include:
• Discomfort and operative injury are less
• Rippling of the implant under the skin is decreased
• Flattening and distortion of the inflated implant are less
• The implant “rides” in a lower, more natural looking position
• Surgery control is better, bleeding is reduced
• The breasts feel softer, and more natural
• Better results for mild to moderately sagging breast

Under Gland Under Muscle Under Fascia
Ease of surgery Equal Easiest Equal
Potential Surgical Bleeding Slightly higher Slightly less Slightly less
Discussed in literature Frequently Frequently Uncommonly
Popularity with patients Somewhat less Somewhat higher Somewhat higher
Done with TUBA incision Frequently Sometimes Never
Done with underarm incision Rarely Frequently Frequently
Done with sub mammary or areola incision Frequently Frequently Rarely
Chances of a “stuck on” or “softball” look Less More Less
Implants separated from breast tissue by muscle or fascial


No Yes Yes
Chance of nipple numbness  Slightly greater Slightly less Slightly less
Comfortable for serious amateur athletes or very active


More comfortable Less Comfortable More comfortable


What are my choices at Skinsational Liposculpture?

We can discuss any other options with you at anytime, other then the options below.
• Moderate or High profile Mentor implants.
• Sub-fascial placement position is preferred
• Axillary (underarm) incision (without incisions or scarring of the breast) is preferred
• Office local tumescent anesthesia, with or without IV sedation
These choices are made for maximum safety, minimal complications, shortest downtime, and the best looking, lasting cosmetic result possible.

Complications of Breast Augmentation surgery

These complications are aggregate (across the United States), and are for all surgeons, all implant types, all incisions, all placement positions, and all other variables. The incidence of some complications may be decreased by various factors, which will be discussed as you read on. At Skinsational Liposculpture, we believe that many of these numbers can be significantly reduced by experience, implant choice, implant placement, and incision type. Some of the complications require another surgery (sometimes within days, some after months or years).

Remember this: although some complications clearly must be corrected by further surgery, many complications will improve with time. Many are acceptable to the patients (and do not require further intervention), and some patients will not accept even the slightest abnormality.

If you don’t want to accept small, often temporary complications, do not have breast implant surgery. If you have perfect breasts, you shouldn’t be considering implant surgery. If you have imperfect breasts (almost all women) and you wish to improve their volume (and possibly equalize their size), do not expect implant surgery to correct nipple size and position or any other “pre-existing” breast abnormality.
In other words, your breasts will look very much like they did before the surgery, only larger and wider, possibly with mild enlargement of the areola.

Most Common Complications/Complaints with Breast Implants

Saline Silicone
Excessive Rippling   50        5%
Excessive Firmness (hard implants)  3-5 10-15%
Chronic, Long Term Deflation  100        0%
Palpability  100    100%
Noticeable Scars    50      50%
Problems with shape, position    10      10%
Asymmetry    10      20%
Numbness of breast or nipple    10 %      10%
Hematoma       1%        1%
Pneumothorax    0.1%     0.1%
Seroma    0.5%     0.5%
Infection    0.5     0.5%
Capsular contracture requiring re-operation    3-5% 10-15%

Possible Contraindications to Breast Augmentation Surgery

Poor Health: Bleeding tendencies, hypertension (high blood pressure), heart disease, chronic pulmonary (lung), renal (kidney), or hepatic (liver) disease can be contraindications. We will not perform surgery for patients with acute or chronic skin or periodontal infections.

Pendulous Breasts: Drooping or sagging breast (particularly larger breasts) are not always an “absolute” contraindication, but an adequate final result is more difficult to achieve with breasts that droop significantly.

Even though a drooping breast may be helped by implants, many patients with drooping breasts will eventually need a breast lift.

Gross Asymmetries: Pre-existing problems such as different size areola, nipples pointing in different directions, unequal infra-mammary folds, nipple inversion, or very unequal breasts will not be adequately corrected by implant surgery alone. The patient must be willing to accept that these problems will be present after implantation surgery. Other corrective surgeries can sometimes help these problems.

Lactating Breasts: Implants should not be placed until at least three months after breast-feeding and lactation have completely stopped. If even a few drops of milk can be expressed with mild pressure on the breast, lactation has not stopped. If implants are placed earlier, severe capsular contracture usually results.

Pregnancy: Obviously, implantation will not be done if you are pregnant. You have agreed not have sexual vaginal intercourse as of the first day of your menstrual period preceding your surgery date.

Mastopexy and Breast Lift

Dr. Luciano Sztulman does not perform conventional mastopexy or breast lift surgery during initial implant surgery. He does do an internal mastopexy on women who have had implants. This is done without the conventional scars usually associated with mastopexy.


Intravenous sedation for breast augmentation is very common, and generally there is little risk in the use of local anesthesia with sedation. However, in some cases, there can be a reaction. Implantation with only local anesthesia (for a patient who is awake) is impractical, and would be extremely unpleasant.

At Skinsational Liposculpture your surgery is possibly with intravenous sedation, or local anesthesia only. During surgery, you are breathing for yourself (without a tube in our throat). The surgery should take less than 1 hour. Following surgery, you awaken very quickly, and are able to leave after a recovery period of less than 45 minutes.

Breast Implant Recovery Period

For the first few days you must rest and relax. You will be wearing a bra without underwire, which will be provided for you at my office. You may sit, lie on you back or either side. You may be up to the bathroom and meals. There should be no strenuous housework at all for the first week. It is important to be cool and calm. Avoid overheating and excitement of any kind during this period of time to eliminate the possibility of accidental injury or bruising. You may raise your arms above the shoulders as needed after the third day. A shower can be taken on the second day. Passive sexual activity may resumed after 1 week but no vigorous activity for at least two weeks. You should wear the recommended bra all of the time in the first week. Sutures will be removed in 7-10 days.

Most of the discomfort will be over after the first two or three days; however, you may have some tenderness and soreness, which could last for a few weeks. After the first two days you may drive a car if not taking pain medication and do light housework such as washing dishes. You should avoid hot baths and vigorous activity for at least two weeks unless instructed otherwise. You should not participate in any sport such as jogging, swimming, bowling, tennis, etc. until after surgery is approximately four to six weeks old.

Return visits are the day after surgery, one week after surgery and one year after surgery, then on as needed basis. I will determine the time of the appointments after the first week and you must understand that these appointments must be kept. You will receive follow-up evaluation and instructions at no charge.

Breast Cancer Detection and Implants

Statistically, 1 of 8 women in North America will have breast cancer at some time during her lifetime. There has never been any evidence to suggest that women with implants have any higher rates of breast cancer. In fact, since the 1970s, the incidence of breast cancer has been slightly lower in women with implants.

For the purposes of breast augmentation surgery, we suggest that any woman over 39 years of age or with a family history of breast cancer have a mammogram before implant surgery.

Although mammography interpretation is somewhat more difficult with breast implants, this is very dependent upon the experience and skill of the radiologist, and the breast anatomy and size of the individual patient.
Breast lumps and abnormalities in women with implants are treated the same as they are for those women without breast implants.

Payment policy

• Payment can be made in cash, cashiers check, money order, credit cards (Credit card has to be in patients name)
• Financing is available through out-of-house financing companies. Please ask the front desk for more information.

What is not included in the fee at Skinsational Liposculpture?

• Mammogram
• Hotel, if out of town. You are required to stay at a local Hotel overnight if you come from out of town
• Antibiotics to be taken prior to surgery, and pain medications
• Antibacterial soap (Hibiclens) to be used prior to surgery.

Preoperative period

On the day of the operation, you should not have had anything to eat or drink for 8 hours prior to scheduled surgery. If you have anything to eat or drink during this time before surgery, you must tell the doctor and the operation may be cancelled. If you have taken aspirin or ibuprofen products recently the surgery will be cancelled.
An antibiotic will be taken prior to surgery and 7 days after.

Preoperative instructions and prescription for antibiotics will be given to you prior to your scheduled surgery. Any questions regarding these, please contact our office immediately. Try to arrive promptly. Think pleasant thoughts, since you will have no discomfort at all during surgery and will be given adequate pain medication afterwards.

Come see us
Providence, Rhode Island:
1 Randall Square, Suite 405
Providence, RI 02904
(401) 521-0303
Boston, Massachusetts:
One Boston Place, Ste. 2600
Boston, MA 02108
(617) 621-7144
Swansea, Massachusetts:
1010 GAR Hwy.
Swansea, MA 02777