The current lifetime risk of BIA-ALCL in the U.S. is unknown, but estimates have ranged between estimated to be between 1 in 70,000 to 1 in 500,000 women with breast implants according to MD Anderson.[73] Certain geographic locations have demonstrated variable risks. For instance, a December 2016 update from the Therapeutic Goods Administration of Australia and New Zealand reported a risk of 1:1,000 to 1:10,000 for textured implants.".[71] To date (2017), there has not been a case of BIAL reported where the patient had only implantation of smooth shell breast implants or a textured tissue expander that was exchanged for a smooth implant. The paucity of cases reported in Asian populations has raised the possibility that there may be a range of genetic susceptibility to the phenomena, or alternatively merely reflect differences in how cases are identified and reported.
When it comes to determining the prominence and size to utilize for the breast augmentation, the first step is to determine what are your goals/desires for the end result. Once you have decided on what you would like the final result to look like, the surgeon will make recommendations and suggestions based on your body type and build as to what they know will be able to achieve your goal, or get you as close to them as safely possible. An individual may want a specific size, but the surgeon will be able to tell if that is a realistic option for that individual or not. For example, if the patient’s chest is small and the breast tissue is tight, it will not be recommended to use a large implant as it will not fit. This is why a surgeon with clinical experience is beneficial, because they will be able to help you understand and guide you towards the best implant for your body. It is not uncommon for patients to become focused on details such as the actual volume of CC’s, however, you need to keep in mind that there are many varying factors that have to be considered by the surgeon when recommending the best implant for your body so try not to get too caught up in those details and trust your surgeon.
Of course, the breast reduction vs. breast lift question is not really cut and dry because every woman is unique. You may be unsure of what volume you would like with the breasts in a more favorable position. Breasts may be different sizes (asymmetric). The position of the nipple may be out of proportion to the amount of breast sag. Breasts may be ‘deflated’ after pregnancy. You may have heard that breast implants are the only reliable way to lift breasts. These questions can easily be addressed at the time of your consult.
It is certainly possible to lift a breast without changing the volume or removing any tissue, however, the breast will sometimes appear smaller after this procedure due to its position. It is also possible to reduce breast volume without lifting the tissue (usually via liposuction) but all reductions that are performed by making incisions will also include a lift.
Round breast implants with a smooth surface are currently used for the majority of breast augmentations in the United States and Canada. These implants tend to create a fuller appearance in the upper portion of the breasts and more distinct cleavage when placed over the muscle (subglandular implant placement). When placed under the muscle (subpectoral and submuscular implant placements), round implants create a very natural shape.
It is most common with saline breast implants for the implant to be placed beneath the muscle. When the implant is placed below the pictorial muscle it is technically only partially under the muscle. Generally, the top half of the implant is beneath the muscle, as the chest muscle does not extend down far enough to cover the entire implant. Therefore, it doesn’t cause any significant distinction for the patient. This method is more commonly used for the saline implants due to the fact that the saline implants have the tendency to wrinkle and become brittle more often than if you were to use a silicone gel implant. However, the wrinkling and rippling is not typically visible in the lower portion of the implant, so the fact that it is not completely covered by the chest muscle does not affect its aesthetic appearance. Even when wearing certain articles of clothing where the heel or the inner portion of the breast is exposed you will not see any wrinkling.
Breast reduction involves reducing the size of the breast. A breast lift involves lifting the nipple-areolar complex and reducing the excess skin of the breast. Breast reductions can involve just liposuction in patients who have more fatty tissue than glandular breast tissue. Liposuction alone indeed does reduce the volume of the breasts. However, sagging of the breast can result and liposuction alone is therefore performed usually in highly selected patients.
Adam R. Kolker, MD, explains: Although silicone breasts feel similar to real breasts, they are still man-made and don’t feel like natural breast tissue. You’ll be more likely to notice there’s an implant in a woman who began with little breast tissue than a woman who had more breast tissue to begin with. Smaller implants and those that are placed below the muscle are harder to detect.
She advises me that there are many conspiracies around botox- staying up right for more than two hours, is false for starters. ‘The solution takes 20 minutes to settle in your muscles, so I do advise you to stay upright for then, any longer wont make a difference’. She does however advise me not to undertake exercise that’s too strenuous or hot following the treatment (fine by me) and to carefully wash my face when I get home, not scrubbing or rubbing too hard.
You and your surgeon will decide together which incision choice is best for you: underarm incision, incision in the crease of the breast (inframammary fold), or through removal of the areola. Your doctor will take into consideration your beginning breast size and shape, breast tissue, and a number of other factors before recommending which options are best for you and your body.
The last thing and the most important decision you will have to make is selecting the right plastic surgeon to perform your breast augmentation surgery. It is critical that you choose somebody who not only has the experience in these types of surgical procedures but maybe more importantly, the credentials. Here in the United States, the best thing you can do is look for a board-certified plastic surgeon who is not only experienced and credentialed but also has the qualities and qualifications that make you feel confident in their abilities.
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Breast lift surgery is typically performed as an outpatient procedure using general anesthesia or local anesthesia + intravenous sedation. The procedure takes about 1-2 hours to perform, depending on the extent of surgery. You will be able to go home shortly after surgery to continue your recovery. Your breasts will be bandaged or placed in a surgical bra.
Hospitals are the most expensive choice of facility. In Manhattan, fees can reach $6,000 and beyond for a single procedure. Though it is the most costly option, a hospital is also the best equipped to facilitate surgery involving a patient who is prone to excessive bleeding, or has other conditions that increase the risk of complications. You can expect your doctor to closely examine your medical history to determine if surgery in a hospital is necessary.
Prepectoral or subcutaneous: in a breast reconstruction following a skin-sparing or skin- and nipple-sparing mastectomy, the implant is placed above the pectoralis major muscle without dissecting it so that the implant fills directly the volume of the mammary gland that has been removed. To avoid the issue of capsular contracture, the implant is often covered frontally or completely with a mesh in biomaterial, either biological or synthetic.
Complications after breast lifts are relatively rare. The main three are bleeding, infection, and scarring. Your surgeon will give you instructions for preparing that will help lower your risk of complications. Those instructions will include such things as not smoking, making sure you are off medications that may make bleeding more likely, and taking antibiotics if necessary.
The study Safety and Effectiveness of Mentor’s MemoryGel Implants at 6 Years (2009), which was a branch study of the U.S. FDA's core clinical trials for primary breast augmentation surgery patients, reported low device-rupture rates of 1.1 per cent at 6-years post-implantation.[49] The first series of MRI evaluations of the silicone breast implants with thick filler-gel reported a device-rupture rate of 1 percent, or less, at the median 6-year device-age.[50] Statistically, the manual examination (palpation) of the woman is inadequate for accurately evaluating if a breast implant has ruptured. The study, The Diagnosis of Silicone Breast implant Rupture: Clinical Findings Compared with Findings at Magnetic Resonance Imaging (2005), reported that, in asymptomatic patients, only 30 per cent of the ruptured breast implants are accurately palpated and detected by an experienced plastic surgeon, whereas MRI examinations accurately detected 86 per cent of breast implant ruptures.[51] Therefore, the U.S. FDA recommended scheduled MRI examinations, as silent-rupture screenings, beginning at the 3-year-mark post-implantation, and then every two years, thereafter.[22] Nonetheless, beyond the U.S., the medical establishments of other nations have not endorsed routine MRI screening, and, in its stead, proposed that such a radiologic examination be reserved for two purposes: (i) for the woman with a suspected breast implant rupture; and (ii) for the confirmation of mammographic and ultrasonic studies that indicate the presence of a ruptured breast implant.[52]
Body type is a major factor you need to consider before going for breast augmentation. The wrong size of breasts for a particular body type can create many complications like neck and back pain. If your body is small in size and your bone structure is thin, don’t go for huge sized implants. Opt for the size that will make your body look proportional. Similarly if you have a heavy body, you might have to go for larger breast implants.

Cosmetic surgeons may use the “crescent lift” technique for women who have a very small amount of sagging to correct. This involves a small incision running halfway around the top half of the edge of the areola. Usually, a crescent lift is only done when a patient is also having breast augmentation, and even in these cases the crescent incision type is less frequently used.
Functional breast-feeding difficulties arise if the surgeon cut the milk ducts or the major nerves innervating the breast, or if the milk glands were otherwise damaged. Milk duct and nerve damage are more common if the incisions cut tissue near the nipple. The milk glands are most likely to be affected by subglandular implants (under the gland), and by large-sized breast implants, which pinch the lactiferous ducts and impede milk flow. Small-sized breast implants, and submuscular implantation, cause fewer breast-function problems; however, it is impossible to predict whether a woman who undergoes breast augmentation will be able to successfully breast feed since some women are able to breast-feed after periareolar incisions and subglandular placement and some are not able to after augmentation using submuscular and other types of surgical incisions.[101]

2009 European Union International Committee for Quality Assurance, Medical Technologies & Devices in Plastic Surgery panel (IQUAM) The consensus statement of the Transatlantic Innovations conference (April 2009) indicated that additional medical studies demonstrated no association between silicone gel-filled breast implants and carcinoma, or any metabolic, immune, or allergic disorder.[38]

It is also possible for implants to rupture and leak. If saline implants rupture, the saline will be safely absorbed by the body. A silicone leak may stay inside the implant shell or leak outside of the shell. When a saline implant ruptures, it will deflate. But silicone breast implants may cause no obvious symptoms when they rupture. This is called silent rupture.


As with any medical/surgical treatment, individual results may vary. Only a surgeon/physician can determine whether reconstruction or augmentation>is an appropriate course of treatment. The following are general adverse events associated with breast implant surgery: Device Rupture, Capsular contracture, Infection, Hematoma/Seroma, Pain, Reoperation, Implant removal, changes in Nipple and Breast Sensation, unsatisfactory results, breast-feeding complications. Other reported conditions are listed in the Product Insert Data Sheet (PIDS). See full list in the PIDS for the product information. These potential adverse events, including contraindications, warnings, and precautions need to be discussed with your doctor prior to surgery.
Tip: Learn about the possible complications of breast augmentation, which include breast pain, changes in nipple sensation and hardening of the breast tissue around the implant. The FDA provides information on risks. Also, be aware that if you choose to have the implants removed, your breasts probably will not look the same as they did before surgery.
Submuscular: the breast implant is emplaced beneath the pectoralis major muscle, without releasing the inferior origin of the muscle proper. Total muscular coverage of the implant can be achieved by releasing the lateral muscles of the chest wall—either the serratus muscle or the pectoralis minor muscle, or both—and suturing it, or them, to the pectoralis major muscle. In breast reconstruction surgery, the submuscular implantation approach effects maximal coverage of the breast implants. This technique is rarely used in cosmetic surgery due to high risk of animation deformities.

A breast reduction typically includes a lift.  However, a lift does not necessarily require a reduction.  Both operations have similar incision patterns and resultant scars, but they have different indications.  One of the first questions I ask a patient who desires an improved appearance of her breasts is if she would like to be the same size, smaller, or larger.  The patient who wants to be the same size and is happy with her breasts when wearing a bra but unhappy with the amount of sagging without a bra is a candidate for a breast lift alone.  The patient who desires to be smaller or has one breast noticeably larger than the other, is a candidate for a breast reduction-lift combination.  Sometimes patients feel their breasts look smaller after removal of the excess skin with the lift even though no breast tissue was removed; the reason for this is that some of what fills your bra cup is excess skin.  The patient with sagging who desires to have larger breasts is a candidate for a breast lift with implants.
the first technological developments were a thinner-gauge device-shell, and a filler gel of low-cohesion silicone, which improved the functionality and the verisimilitude (size, appearance, and texture) of the silicone-gel breast implant. Yet, in clinical practice, second-generation breast implants proved fragile, and suffered greater incidences of shell rupture, and of filler leakage ("silicone-gel bleed") through the intact device shell. The consequent, increased incidence-rates of medical complications (e.g. capsular contracture) precipitated faulty-product, class action-lawsuits, by the U.S. government, against the Dow Corning Corporation, and other manufacturers of breast prostheses.

Healing from a breast implant surgery is not a set timeline. Each patient is different and their body heals at different rates. The actual incision made on the breast will typically heal in about 3-5 days. There will also be absorbable sutures that typically can be removed after 45 days. There will also be bruising present after the surgery, and it can take about one to two weeks to completely disappear. Most pain felt from this surgery is from the muscle being stretched. Generally the patient will be prescribed a pain medication, and depending on their situation their Doctor may also prescribe a muscle relaxant to help the muscle adapt to the new implant. Most patients have reported that after three to four days the pain has significantly subsided and they are able to resume normal activities, such as, driving. The Doctor will also be able to show you various exercises that will help the muscle stretch and assist the implants with settling not the new space more quickly.


Breast implants are not lifetime devices and breast implantation may not be a one-time surgery. The most common complications for breast augmentation and reconstruction with MemoryGel® Implants include any reoperation, capsular contracture, and implant removal with or without replacement. The most common complications with MemoryShape® Implants for breast augmentation include reoperation for any reason, implant removal with or without replacement, and ptosis. The most common complications with MemoryShape® Implants for breast reconstruction include reoperation for any reason, implant removal with or without replacement, and capsular contracture. A lower risk of complication is rupture. The health consequences of a ruptured silicone gel breast implant have not been fully established. MRI screenings are recommended three years after initial implant surgery and then every two years after to detect silent rupture. The most common complications with MENTOR® Saline-filled Implants include reoperation, implant removal, capsular contracture, breast pain, and implant deflation.
Surgery effects each person’s emotions differently. During the first week you can expect your energy level to be noticeably reduced. This will begin to improve the second week but it will take a full six weeks for you to have the same energy level you had before surgery. Many people say they want to sleep longer or more often. Normal hormone changes after surgery will also affect your emotions. Between 5 to 10 days most patients experience a period of doubt regarding their decision. They may feel down and sometimes cry. Remember, this is normal and will pass with time. If this depression is severe, contact us immediately so we can see you in our office.
Cosmetic surgeons may use the “crescent lift” technique for women who have a very small amount of sagging to correct. This involves a small incision running halfway around the top half of the edge of the areola. Usually, a crescent lift is only done when a patient is also having breast augmentation, and even in these cases the crescent incision type is less frequently used.

In 2000, the FDA approved saline breast implant Premarket Approval Applications (PMA) containing the type and rate data of the local medical complications experienced by the breast surgery patients.[116] "Despite complications experienced by some women, the majority of those women still in the Inamed Corporation and Mentor Corporation studies, after three years, reported being satisfied with their implants."[113] The premarket approvals were granted for breast augmentation, for women at least 18 years old, and for women requiring breast reconstruction.[117][118]
There’s saline, silicone, “gummy bear” (aka cohesive gel), and autologous fat, explains Dr. Rowe. For the latter, you’ll need around two to three pounds of fat to inject into the chest, and patients often need touch-ups to achieve symmetry. With saline, the implant ripples more, and some patients think that it feels heavier. If a saline implant ruptures, it’s absorbed into your body safely; however, the difference is very noticeable, so you’d likely want to see a doctor ASAP anyway, explains Dr. Doft. Silicone tends to feel more natural, hold its shape, and ripple less. Dr. Doft says the majority of her patients choose silicone.
If you’re considering breast lift surgery, choosing a cosmetic surgeon is the most important decision you’ll make. When you visit potential surgeons, ask how frequently he/she performs breast lift surgery and how many total procedures that surgeon has performed. View before and after photos, not just on a surgeon’s website but also during your consultation, paying close attention to the results of patients whose breasts before surgery look similar to yours—this will help you get a feel for a cosmetic surgeon’s aesthetic style.
When choosing a qualified rhinoplasty surgeon, make sure that he or she is a board-certified facial plastic surgeon. You should also consider a surgeon who has specialized in face procedures only. This level of specialization is important to consider since they are likely experts on facial features and shapes and should be able to produce better results.

Do not consume any alcoholic drinks (including beer and wine) for 48 hours after surgery. In addition, do not have any alcoholic drinks while you are taking the prescription pain pills. The alcohol can interact with these medicines and lead to serious health problems and death. Finally, drink alcohol in moderation for three weeks. Excessive consumption can lead to a fall that could ruin the results of the surgery.


All of us at the Bashioum Cosmetic Surgery Center are proud of the postoperative care of our patients. We want  you to have the very best surgical result possible! We are here for you. If you have any questions of any kind  at any time, please call us. It is our pleasure to help you through your convalescence. It is your responsibility  to follow these important instructions. They have been developed to reduce your risk of complications and  they will help with the postoperative healing. Working together we will succeed in our goal for you!  What you have accomplished is no small achievement. You have not only overcome a sensitivity you had with  your physical appearance but also you have overcome the fears of completing cosmetic surgery to correct this  problem. You are a person of courage and you can now demand great deeds of yourself.
Does the nipple/areola sit below the crease underneath my breast? One trait cosmetic surgeons frequently look for when evaluating a breast lift candidate is the position of the nipple/areola in relation to the inframammary fold, or crease beneath the breast. Try this test: slide a plain sheet of paper underneath your breast (no bra) so it sits against the breast crease. When looking in the mirror, do your nipples sit below the top edge of the paper? If so, this is a good indication that you have enough sagging to warrant a breast lift.
The breast implant has no clinical bearing upon lumpectomy breast-conservation surgery for women who developed breast cancer after the implantation procedure, nor does the breast implant interfere with external beam radiation treatments (XRT); moreover, the post-treatment incidence of breast-tissue fibrosis is common, and thus a consequent increased rate of capsular contracture.[108] The study Breast Cancer Detection and Survival among Women with Cosmetic Breast Implants: Systematic Review and Meta-analysis of Observational Studies, reported an average later stage in the diagnoses of women who developed breast cancer after undergoing breast augmentation, when compared to breast cancer patients who had not undergone breast augmentation, although this did not ultimately affect the patients prognosis. The use of implants for breast reconstruction after breast cancer mastectomy appears to have no negative effect upon the incidence of cancer-related death.[105][109]
Breast implants have gotten a bad reputation from the past and the fact that they had been known to rupture. The modern-day breast implants are very well made, and it’s almost impossible to cause them to rupture. This doesn’t mean that it can never happen, but it’s exceedingly rare. The rippling and wrinkling however, is a more difficult problem to address. This tends to me more common in the saline implants than with the silicone implants due to the filling. The saline implant is just water which is less dense then the silicone gel. The gel is denser and more closely resembles the actual breast tissue. Even when if the implant is placed below the muscle, it only covers about a half to two-thirds of the implant. Therefore, along the sides or underneath the implant you may see some wrinkling or rippling, however, depending on the size of implant used it may not even be noticeable. The larger the implant used the more visible any wrinkling or rippling could become. Typically, silicone implants are recommended because the risk of any wrinkling or rippling is lower and the implant feels more natural.
Body type is a major factor you need to consider before going for breast augmentation. The wrong size of breasts for a particular body type can create many complications like neck and back pain. If your body is small in size and your bone structure is thin, don’t go for huge sized implants. Opt for the size that will make your body look proportional. Similarly if you have a heavy body, you might have to go for larger breast implants.
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