In breast augmentation surgery, it is possible to eliminate some risk factors in order to achieve predictably good results and avoid short- and long-term complications. For this reason, any prudent plastic surgeon will always require his patients to quit smoking at least three weeks prior to surgery.
But for extra conservative doctors, patients are even advised to avoid tobacco products for several months. The idea is to wait for the body to flush out the toxins known to impede healing and increase risk of complications.
Upland plastic surgery expert Dr. Tarick Smaili explains the four main reasons to quit smoking before breast augmentation, or better yet, to kick the nicotine habit for good.
1. Accelerated aging of the breast. Several studies have already proven the detrimental effects of smoking to skin, particularly how it breaks down collagen and leads to dry, sagging skin. For this reason, heavy smokers are more prone to breast ptosis or drooping even after factoring in other variables.
If sagging occurs after augmentation, the breast will look pendulous and unattractive. While breast lift can give some improvement, the poor skin quality of smokers could impede them to achieve optimal results.
The leading breast augmentation surgeon believes that there is no point of improving one’s appearance through surgery if she is unwilling to kick the nicotine habit or poor lifestyle known to accelerate aging.
2. Increased risk of infection and capsular contracture. Smoking can significantly increase the risk of general complications and less than optimal results.
Infection is particularly detrimental because it could trigger capsular contracture in which a thin, transparent scar tissue that normally forms around an implanted device becomes too thick. Eventually, the affected breast becomes painful and distorted, thus warranting a revision surgery.
Smokers are also prone to internal bleeding, coughing episodes (which is rather inconvenient during breast augmentation recovery), anesthetic-related complications such as pneumonia, and blood clots.
3. High incidence of reoperation. Of course, with increased risk of complications comes another problem—i.e., high incidence of reoperation which means additional expenses, emotional distress, and possibly less than optimal results.
4. Longer recovery. Cigarettes and other tobacco products are considered vasoconstrictors, meaning they cause blood vessels to tighten up, affecting the way the body recovers from surgical trauma.
Usually, quitting smoking just three weeks is enough to reverse most of its detrimental effects, although some patients who are heavy smokers are required to wait a little longer “to be on a safer side.”
Breast augmentation surgery is not just about placing implants in the “pocket” to increase your bust size. A more important goal is to create pleasing results, which is possible by first acknowledging all the anatomies, and of course, their limits.
Celebrity Beverly Hills plastic surgeon Dr. Tarick Smaili says the most commonly used technique involves the inframammary fold. With a 2-2.5 cm incision inside the crease, it allows direct implant positioning, easy pocket dissection, and resulting scar that is hidden from sight, he adds.
But if your inframammary folds are quite deep, you are particularly at an advantage because of the well-hidden scars. The same is true if you have a slightly sagging breast, which further minimizes the risk of visible scarring.
Nevertheless, excessive ptosis or breast sagging is a contraindication to breast augmentation unless the surgery is performed alongside mastopexy, or more commonly referred to as breast lift. Take note that without treating the drooping appearance, implants can aggravate your problem.
The postop appearance of your inframammary fold matters a lot because even the slightest “deviation” could give an impression that an implant is beneath the skin. The general rule of thumb, as suggested by Dr. Smaili, is to create a 4.5-5 cm distance between the breast crease and the bottom part of the nipple-areola complex.
However, a 6 cm distance might be ideal after a significant amount of augmentation, explains the celebrity plastic surgeon.
To achieve the right balance, you might need your inframammary fold to be slightly lowered to encourage the implants to lie approximately in the center of the breast mound, behind the areola.
But lowering or creating a new inframammary fold could lead to old crease becoming visible in the lower half, although a “seasoned” plastic surgeon can minimize the risk.
If the old crease remains persistent, postop massage or simply waiting for the tissue to “relax” might help diminish its appearance.
For some patients, they may have to use acellular dermal matrix (grafts that can thicken their breast tissue) to achieve a nice looking inframammary fold. This adjunct procedure is not uncommon in breast reconstruction following cancer surgery.
Meanwhile, Dr. Smaili warns that one of the most common errors of inexperienced surgeons is inadequate release of the muscle just above the inframammary fold, leading to high-riding implants that give an illusion of excessive upper cleavage. Simply put, the preoperative crease should always be taken into consideration if the goal is to preserve the natural projection and shape.
A recent survey has shown that a growing number of breast augmentation surgeries used implants that were not bigger than 400 cc. By choosing a conservative size, it is much easier to achieve natural-looking results and minimize risk of complications such as bottoming-out, palpability, and rippling.
Nevertheless, a small breast implant may not be able to deliver the desired amount of augmentation. To avoid less-than-optimal results, your cosmetic goals and underlying anatomy and its limitations should all “meet in the middle.”
For some women, this could be interpreted as getting the “biggest” implants their body can accommodate without having to worry about significant risk of sagging, skin thinning, and short- and long-term complications.; and choosing the “smallest” possible implants that can still meet their cosmetic goals and make them happy.
But what makes a breast implant size small or conservative?
While most Los Angeles plastic surgeons define small breast implants as not larger than 400-500 cc, take note that each patient is different. For instance, a 5’11” woman may not see significant improvements with a 350 cc implant, which for someone who is petite may be enough to deliver the desired results.
Aside from your existing breast tissue or “coverage,” another factor that determines the ideal and comfortable implant size is your breast base diameter. If, for example, yours is 12 cm then a prudent surgeon will recommend a prosthesis that has almost the same measurement.
On the other hand, using implants whose base diameter is way bigger than your breast and chest measurement will lead to a significant risk of rippling, palpability, unnatural breast contour, skin thinning, and other telltale signs of breast augmentation surgery.
Choosing the ideal breast implant volume is much the same as shopping for your shoes. Take note that no woman in her right mind would choose a shoe size 10 if hers is 7 or 12, which could lead to a significant amount of discomfort and even injuries.
The same thing happens if you choose a breast implant size that is too big for your body; not only it leads to poor cosmetic results, but also to discomfort due to the extra weight you need to carry around. In fact, you have to be extra conservative when you have an active lifestyle.
Smaller or conservative-sized breast implants are less obtrusive than bigger implants that could alter your daily activities and level of comfort when exercising or doing a physically demanding task.
The “actual” cost of breast implants depends on their filler material. Saline implants are typically priced at $1,000 for a pair, standard silicone implants at $2,000, and gummy bear or fifth generation silicone implants at $3,000. However, you should also take into consideration other factors such as your doctor and anesthesiologist’s fee, facility fee, and medical supplies.
The total cost of breast augmentation surgery, according to celebrity Beverly Hills plastic surgeon Dr. Tarick Smaili, greatly varies although the average falls between $6,500 and $9,500.
The variables that could spike up the price of your surgery include the location and doctor’s fee. Take note that you have to pay “premium” if you live in a place where the demand for plastic surgery is high, and your surgeon has impressive qualifications and extensive experience that can minimize risk of complications.
While it might be tempting to choose a surgeon based on the one who gives the biggest discount, a surgery that is performed by a non-specialist has a higher incidence of reoperation to correct botched results, which of course leads to more expenses.
Lowering the price to a significant degree means that “something has to give,” i.e., your doctor might choose a non-accredited facility and/or using shoddy implants, which of course will jeopardize not just your cosmetic results but also your health.
Also, bear in mind that breast augmentation surgery is not a one-time cost. While today’s implants are notably strong, there is no really no guaranty that they can last a lifetime, with studies suggesting that their average lifespan is 10 to 15 years.
Choosing silicone breast implants also entail regular MRI screening to detect asymptomatic leak, a recommendation coming from the FDA. For this reason, be prepared to shell out at least $2,000 every two years for this breast exam, although it might be covered if you have your implants as part of your breast reconstruction following cancer surgery.
Meanwhile, saline implants do not require regular MRI breast exam because in the event of leak, the affected breast will immediately appear smaller than the other one.
Fortunately, US breast implant manufacturers have started offering lifetime warranties on their products, meaning these will be replaced for free in the event of rupture. Nevertheless, you will still have to pay for other costs such as facility, anesthesiologist, and plastic surgeon’s fee.
When it comes to health insurance, your policy might also change after getting breast implants. In general, issuers will not pay for your revisions, MRI scan, and surgeries to address implant-related complications.
Because you’re made aware of the ramifications of going “too big,” such as risk of rippling and systemic discomfort, you chose a breast implant size that was within the boundaries of your body. That’s why you are baffled by the back pain you have been experiencing right after the surgery.
Leading LA plastic surgeon Dr. Tarick Smaili says back pain right after breast augmentation surgery is not uncommon, although it generally dissipates on its own without medical intervention.
Take note that upper back pain is quite common for patients whose breast implants are positioned underneath the pectoralis muscle (submuscular placement), which is connected to the back muscle. And due to some stretching and distortion caused by the surgery, it leads to temporary discomfort, explains Dr. Smaili.
Some patients might also experience lower back pain, which Dr. Smaili says is more likely caused by changes in the sleeping position or incorrect posture.
Another culprit is the postop pain in the chest muscle, prompting some patients to use their back, abdomen, and/or arms differently without them even knowing it, he adds.
Any form of back pain caused by surgery is usually gone within six weeks postop, assuming that your implants are not too big relative to your underlying anatomy such as body frame, amount of natural breast tissue, chest measurement, breast dimension, just to name a few.
Simply put, there is nothing to worry about since your body will eventually adjust to the implants.
Nevertheless, you don’t have to suffer from back pain during your entire breast augmentation recovery. Taking a low dose of muscle relaxer, such as Valium, can relieve muscle tension and spasm.
When using muscle relaxants and narcotics, which are both helpful in controlling postop pain and discomfort, it is important that you avoid driving or any task that requires high level of mental alertness because these medications can lead to poor coordination, lethargy, and confusion.
In the rare event that back pain persists for more than six weeks, you might want to consider low-impact physical therapy and exercise such as rowing and biking. The idea is to improve your core muscle [strength], which includes your abdominal muscles, back muscles, and muscles around your pelvis.
But before doing any strenuous exercise, or any activity that could elevate your blood pressure and heart rate, you should get a clearance from your doctor to avoid injuries. The celebrity LA plastic surgeon says the general rule of thumb is to wait at least three weeks after surgery.