How Long Do The Results of a Breast Augmentation Last?

It is a common myth that breast implants need to be replaced every 10 years.  This is not true.  Spontaneous implant failure rate does increase by about 1% per year, after 10 years.  How long exactly implants will last is unknown and varies from person to person.  The expected range is between 10 and 25 years. If your breast aesthetic has changed because of aging, breastfeeding, pregnancy, or a change in personal desires, then it may be a good idea to perform revisional surgery and use the opportunity to replace the implants.  In the absence of any issues, recommendations may be made for implant exchange, including any urgency and optimal timing.  Each of the 3 FDA-approved implant manufacturers offers some degree of warranty against implant rupture. Providing your implant card will allow an inquiry about the warranty on your behalf.

What Factors Can Affect the Results of the Surgery?

Most American plastic surgeons prefer smooth, round, silicone implants.  Silicone implants look better, feel better, and last longer.  Silicone implants are made from a highly cohesive gel, often called “gummy bear” implants, and maintain their form even in the event of micro-rupture.  The only benefits of saline implants are they are cheaper, rupture is immediately detected as saline is absorbed by the body in a matter of hours and the breast goes flat, and they can be placed via smaller incisions as they come deflated out of the box.  However, silicone implants provide the most natural breast augmentation results.

In general, placement of breast implants below the muscle is my preferred method.  Under the muscle (sub-pectoral) breast implant placement provides a more natural look, more subtle transition in the superior pole of the breast, lower rates of capsular contracture (scar tissue formation around the implant), lower tendency to drop with time, and provides less distortion of the breast tissue for purposes of routine breast cancer monitoring with mammography.

Above the muscle (pre-pectoral) breast implant placement is technically easier, and causes less pain, BUT looks and feels significantly less natural.  In my opinion, the only indication for pre-pectoral placement of implants is in patients who are professional weightlifters or professional athletes who are unwilling to sacrifice any pectoralis muscle strength, albeit how minor it might be.  In non-professional athletes and non-body builders, the resultant decrease in strength from lifting the muscle to place the implants is indetectable.

A “dual-plane” approach places the top 80-90% of the implant below the muscle, and the bottom 10-20% of the implant directly below the breast tissue.  This is achieved by allowing the pectoralis muscle to “window-shade” up.  A dual-plane approach imparts the benefits of both pre-pectoral and sub-pectoral implant placement.  All the benefits of sub-pectoral implant placement are achieved, plus, the ability for an implant to drop as the breast ages, providing for a longer, more natural-looking result.

Breast crease incision (inframammary fold crease incision) – The breast augmentation incision is hidden underneath the breast fold.  Most patients are best suited for this incision.  In women who have a natural breast crease, this is often the most hidden incision.  Additionally, the breast crease incision provides the best visualization for the surgeon, the best control over symmetry and implant position, and carries the lowest risk of capsular contracture.

Nipple areolar incision (periareolar incision) – an incision is made along the bottom edge of the areola.  This incision provides an excellent ability to hide the incision in women who have a poorly defined breast fold and are, therefore, not great candidates for a breast crease incision.  Women with a well-defined areolar border are better candidates as opposed to those with watershed pigmentation where a fine-lined incision would be more obvious.  Due to proximity to the nipple, a periareolar approach can affect nipple sensation

Post-Surgery Lifestyle & Health

Breast augmentation recovery is usually less significant than anticipated.  Patients can return to work in 2-3 days, as long as activity restrictions are respected.  You can expect to feel chest pressure and tightness for several days, but NO sharp chest pain.  Pain medications are provided and should be used as needed during the immediate post-operative period.

Most patients will feel almost entirely back to normal after 1 week.  I usually need to remind patients to respect the recommended activity restrictions as to not risk bleeding or implant shifting.  Although the term “rapid-recovery” is often associated with breast augmentation, it is important to remember that there are activity restrictions in place to ensure that you heal perfectly.

Lower body exercises such as spinning and speed walking can be resumed after 1 to 2 weeks.  Use of the upper body, pectoralis muscles, and core training can be resumed at 4 to 6 weeks.  No heavy lifting (greater than 10 lbs.) for 6 weeks.

Most women will have absolutely no change in nipple sensation.  However, a nipple/areolar incision does have a higher likelihood of causing some changes in nipple sensation called “paresthesia”.  Still, more than 90% of women who opt for a peri areolar incision will regain full nipple sensation.  Paresthesia, if it occurs, can be temporary, involve only one side or both, and in a very rare circumstance, cause a permanent reduction in nipple sensation.  A breast crease incision, due to its distance from the nipple-areolar complex, has NO permanent effect on nipple sensation.  In women where nipple sensation is an important part of their sexuality, a breast crease/fold incision might be a better choice for surgical insertion of implants.

Breast implants, regardless of sub-glandular or submuscular position, do not affect your ability to breastfeed.  A nipple/areolar incision has a higher likelihood of disrupting some of the milk ducts and can slightly affect the transfer of milk to the main nipple duct.  This will be discussed in detail during your consultation.

Scheduling a Consultation with Dr. Maman

The first step to schedule a consultation would be doing thorough research. There are many ways to find a plastic surgeon. Arguably the best way would be to receive a referral from another physician, such as primary care, dermatologist, or OB-GYN. These providers often see multiple patients with good results and can attest to those by referring their patients somewhere. Friends are a secondarily good referral source, especially if they are patients themselves. When it comes to advertising, the most essential consideration is the plastic surgeon’s education, board certification ONLY by the American Board of Plastic Surgery, and before/after gallery. If those components match your desired outcome, then they would be a good source of information to seek in consultation. You will often come across taglines such as “no downtime surgery” or “no anesthesia required”. If it seems too good to be true, it probably is. There are no shortcuts to SAFE plastic surgery.

The next step would be to contact the office of a board-certified plastic surgeon to find a time to meet them. First impressions last a lifetime, so pay attention when speaking to the receptionist upon calling. Should you decide to have surgery, this is the team you will be dealing with multiple times per month for at least a year. The administrative team directly reflects the surgeon’s ways of working. Another thing to clarify would be a potential timeline for surgery. This is sometimes best done before reaching out to qualified providers because they are booked one to six months out, on average. Knowing well enough in advance will give you adequate time to interview surgeons, get any preoperative lab work done, and feel confident moving forward with your scheduled procedure.