Question:

hey dr garcia, i got some silicone implants last yr and have been working out at the gym and i feel like when i so arms/cheat machines it feels weird inthe breast area. will this cause harm to my implants?

Answer:

it might displace them down and outward if they are under the muscle in some cases, but should not cause injury to the implant itself. JG 10.4.13

Question:

Hello Dr and Happy Easter to you! I have been reading about a new technique of split muscle breast augmentation which is supposed to be ideal for skinny women and to avoid the tennis ball look. Do you have any opinions on this new method? Thank you

Answer:

It is really something that has been done for a long time and has resurfaced. The concern is that there is not complete muscle coverage of the implant. It is claimed to do so, but in reality, the muscle in certain areas, for example lower outer area, is quite thin and will usually tear and then not cover the implant. It does avoid the visibility of ripples in the upper inner part that can be seen in an evening gown, but the ripples can still be seen on the lower outer quadrant. The tennis ball look usually comes from either capsular contracture or an an inadequately dissected pocket. I hope that helps. JG 4.1.13

Question:

I had a latismus muscle done on one breast a couple of years ago which I regret immensely. It flattened the breast and made it look much bigger than the other one. The nerve was cut over a year ago, but it reconnected..Why is that, when my surgeon said that was impossible? Can the muscle be taken out and just gotten rid of since I do not miss it from the back?

Answer:

There can be multiple nerves in some patients or maybe the main nerve was missed and a smaller one cut. The nerve will not grow back together though. It can also be that the muscle has scarred down and has become stiff, causing the flattening of the mound. If that is the case cutting more nerves will not help and what needs to be done is some removal of scar tissue around the implant. That is much more common in breast reconstructions versus augmentations for cosmetic reasons. If the muscle were to be cut out it would leave very thin coverage over the implant and would almost certainly lead to capsular contracture of a severe nature or of the implant eroding through the skin. I wish you the best. JG 3.30.13

Question:

Hi Dr, What is realistically the recovery time to return back to work after breast augmentation (under the muscle) for a flight attendant, since a lot of lifting heavy objects is required? Thank you

Answer:

in my opinion, 4 weeks. JG 2.5.13

Question:

Hello, I had a breast implant exchange with pocket revision 10 days ago, went from saline to silicone for a more natural result without ripples. Look and feel great except for outside(armpit side) where it was anchored, after releasing sternum side, I am assuming from the internal sutures on that outside? How long for it all to settle in? Thank you! JR

Answer:

It can take anywhere from 6 weeks to a couple of months, depends on how you heal. JG 11.27.12

Question:

For breast implants, what is the difference between a round implant and a shaped round base implant? How does a shaped one differ?

Answer:

In the standing position, not much difference. JG 11.5.12

Question:

Hi Dr. Garcia! Hope all is well. I was going through some old files and came across photos of my silicone breast implants, ONE YR Post OP! It has been 5 years since. I did notice how gorgeous they once looked. What I mean is they were so full and fluffy and very BIGGER looking in diameter and nautural slope. Then I looked in the mirror 5 years later and was kind of shocked to NOW see they look s different. Even tho they are soft to the touch, somewhat pliable, they seem smaller in diameter, a bit shiny is some places and well more harder looking then the wonderful full look they once were! =( What happened?

Answer:

could be some element of capsular contracture along with stretching of the skin and loss of your own breast tissue, hard to say without examining you in person and seeing the old pictures. JG 11.4.12

Question:

What do you think of placing breast implants so they go a little on the side of body? I read that position might be good to balance broad shoulders if your do not have as wide a chest? Also, I read women can tell the difference between saline and silicone gel implants even if placed under the muscle- like it feels more part of tissue. Is this true?

Answer:

well, if you do that with an average size implant the nipple might not be in the center of the breast mound and will look funny. As to people feeling differences between silicone and saline, some certainly can, but not all, especially with average size implants below the muscle and if they stay under the muscle.The larger the implant is, no matter where it was placed originally, the easier it will be to tell the difference, especially in thin women with very little breast tissue. JG 10.12.12

Question:

I just had ba/bl 3 weeks ago. My PS said I would have 3 scars..one around the areola, one under the crease and one from areola down to crease. Woke up and just had under the crease and around areola. I got silicone under the muscle 400 cc. I started with a droopy/saggy 38C. I know I am early but my results are ugly. They still look the same as pre op, the only difference is a little fuller but not much at all. They are flat looking. Can I send you pics to get your opinion? Thank you so much. you question and answers are amazing and you are very appreciated and you can tell you know your stuff and you care.

Answer:

certainly, please send them to drgarcia@lvcosmeticsurgery.com

Question:

Okay, this is kinda hard to explain, but here goes! Had my breast implants for more than 4.5 years and not untill 10 months ago have they been noticeable in feeling in day to day activities! Not like in touch but like when I work out, get cold, or run and walk. It feels like there no longer apart of my body or in sync with my Body movements. If this makes sense? Like the other day I was doing A shoulder press and it feels like my implants are aggravated like shift up then go with my Body! This was never like this before! I always felt as they were apart of my Body but now not so much! I also get Little twinges! Can this be the scar tissue? If so what`s it doing? They don`t look distorted!

Answer:

it is likely very early scar tissue, enough to be tethering to the muscles but not enough to make the implants feel firm. It might stay that way for years and never get worse, but it also might slowly progress to the point that they do look and feel hard. For the time being I might suggest increasing your vitamin E intake to about 1,000iu per day and see how it responds. If it gets worse, then go back and see your surgeon. I wish you the best. JG 7.13.12

Question:

Dr. My silicone implants are 5 years old and this past few months my left implant feels to be looser and when working out or normal activities feels like its pulling to the left! Tho it looks normal it feels like its shifting Where my right is in tact! Whats doing on? Again it doesn`t look abnormal in my head it feels like its going to totally shift Down and or towards the armpit but isn`t! What after all these years makes this implant feel this way?

Answer:

it is likely more of an issue with the capsule surrounding the implant rather than the implant itself. The capsule might have partially torn and caused the difference.If you are concerned about the integrity of the implant itself, and MRI scan will yield the greatest amount of information.JG 7.9.12

Question:

Lol, next question Dr. Garcia. I have had TWO boob lifts/semi-reductions. I`m about a 38D/DD. My breasts are bottom heavy meaning all of that D cup is at the bottom, though my breasts do not sag. I`ve always hated the ugly scar so I really didn`t want another one. Is there any way to put BACK some volume (perhaps a small implant. Can`t believe I`m saying that after TWICE having a reduction) without any scar? Perhaps putting the implant in from the side and then filling it? I *think* I`ve seen that done? OR is there a better method of lifting and implanting without such a scar? THANK YOU SO MUCH DR. G!

Answer:

it would be difficult to place an implant that would correct just the upper part of the breast mound without it being a very large implant, thereby making you a lot bigger. The best thing is another lift but it appears to not last long in your case as your skin is likely stretched out and cannot support the breast in a higher position. I wish you the best. JG 7.6.12

Question:

For both saline and silicone gel implants, I might see or feel ripples on the side of the chest?

Answer:

Correct, slightly more with the saline, but both implants ripple. Some doctors downplay it, but all you have to do is ask them to show you an implant, and hold it ny its edge and you will see the ripples. JG 5.23.12

Question:

What are the shortcomings of both a saline breast implant and a silicone gel implant?

Answer:

the saline has more variety in end fill, requires a smaller incision to be placed, you need no special test to monitor for leaking as a leak will allow it to go flat as there can be no partial leaks,and it has more visible or palpable ripples. Silicone comes pre-filled so there can be no modifications during surgery, requires a larger incision to place, might feel more natural to many patients when placed above the muscle but also requires an MRI to detect a leak, and it will ripple about 60% less. Capsular contracture rates and leak rates are about the same. JG 5.21.12

Question:

What type of breast implants do you prefer to use? Do you think silicone gel looks and feels more natural than saline? Does it make a difference?

Answer:

I think that when placed above the muscle the silicone implant might feel more natural, but when placed below the muscle the difference is much less. As to my preference, I actually have the patients decide. I help them decide on a size, I give them the benefits and short comings of each implant and they decide. I would say that the choice ends up being about 50-50. JG 5.21.12

Question:

I had a procedure to minimize my breast implant scars above the folds of my breasts. If I get replacement breast implants, I was thinking of having them inserted through the armpit. Is one method easier or more effective than the other? Does it help that I originally had implants inserted through the breasts if I have them inserted through armpit next time ( I mean with placement of implants). Does the type of implant matter (saline or silicone gel) through the armpit?

Answer:

using the incision underneath the breast is the easiest of the three common incisions. The placement of the implant the second time around might be easier as the pocket has been created already and just might require a small degree of enlargement. There is likely a limit to what size silicone implant can be placed through an armpit incision but not with saline as it is filled in after the implant is inside your body whereas the silicone implants come pre-filled. JG 5.18.12

Question:

I want to have my 15-year-old saline implants replaced. Although I do not have any problems with them, I read you are supposed to get them replaced every 10-15 years or they will get hard and twisted or something like that? I thought if I get them replaced, i might as well get silicone gel so they feel more natural. Do you use silicone gel implants? Also, I do not recall how many CCs were used in each implant. One implant was filled a little more than other- perhaps 50cc, but I can`t recall. Is it really important to know the how much CCs were used when new implants are ordered whether saline or silicone gel?

Answer:

we do frequently use silicone implants. If you are not having any issues with the saline, there is no need for them to be changed out, the getting hard is the capsular contracture and that can happen with both silicone and saline and is not dependent on time. As to knowing the size, it is a good idea to get our records form the original surgeon so the appropriate size silicone implant can be available. The silicone ones cannot be adjusted during surgery like the saline ones can. Hope that helps. JG 5.11.12

Question:

Dr. Garcia, Can I email you some photos of my breasts? I want You to see something that I know isn`t right and it`s hard to explain? Do you have an email address I can send them? Very grateful!!`

Answer:

sure, send them to drgarcia@lvcosmeticsurgery.com

Question:

Hello Dr., I have a question regarding my silicone implants that I have had For 5 years/under muscle! My left implant seems to migrate over years down and to the side and Is very soft and wiggily! The right however, is dead bolted perfectly center and tho is soft to touch seems more round and in place! What is going on here and is this something I should fix? If u look in the mirror the two breasts Look different in shape! The looser implant that to left looks More of a slope ontop then the right one! Both are soft tho!

Answer:

I think you have some degree of mild capsular contracture on the right side. The left side might be moving too much, but it has less of a capsule limiting firmness. Fixing it can be attempted, one thing to do is to try to release the right side to allow it to not be bolted on. This will require a capsulotomy or capsulectomy. The left can be treated by trying to close the pocket a bit to limit its motion. I wish you the best. JG 4.24.12

Question:

Hello Dr. Garcia, If I went up 100cc in my implant size, is that enough To show a difference in size? I know I can add another 150cc but wanted to play it safe. Is it worth changing for the 100 or go 150 cc more! I just debating if it`s worth the surgery! I like what I have but want them a bit fuller!

Answer:

100cc is 3 ounces, so it depends on what size implant you have at present, the smaller your present implant is, the larger the 100cc increase would appear. I think you would likely see some difference, but it would not be huge. JG 4.14.12

Question:

Hi Dr. Garcia, How soon after breast augmentation do you tell yr patients they can go back to work? Thank you

Answer:

it all depends on their pain tolerance and what they do at work. I do not allow them to lift more than 20 pounds for two weeks after surgery and if they are taking pain medications I feel they should stay away from work. On average, the range to return to work is 5-14 days. JG 4.5.12

Question:

Good day! If you already have breast implants is there a way to tell if you can go bigger by looking at them for yourself? Is there a way you can tell the ons you have now are the limit by looking at your own anatomy? Any clues?

Answer:

it really would take a surgeon to do the measurements I am afraid, sorry. JG 1.27.12

Question:

Good day Doctor! I was wondering if one was going to replace there implant size for a different size and the pockets are already made, is there Less bleeding occurring during a swamp in size then the original surgery?

Answer:

Yes, unless you are going much bigger as the pocket needs to be made larger, but still likely less than the first time. JG 1.26.12

Question:

I am scheduled for surgery with you February 7th. In the event of a complication and/or emergency hospital admittance is required, how is that handled. Does your office have hospital admitting privileges ?

Answer:

yes, all true plastic surgeons that perform procedures in a surgicenter have admitting privileges at a local hospital, as I do. JG 1.15.12

Question:

Good Day Doctor! I need your opinion. I am a fitness girl and had my implants for more than 4 years, under the muscle. Genetically my breasts are low on my chest and I am big into intense weight training. I have not ever trained my chest since 2007 because when I had my first implants put in threw the armpit under the muscle my chest muscles, due to training were so tight on my rib cage the doctor had the worst time getting the implants under, but eventually did and it was a bad recovery....any ways years passed and I have been training and decided to try training just the UPPER part of my chest, the muscle from the shoulders across the upper chest NOT touching the pecs. I notice I DO NOT FEEL ANY movement of the implants which is good...BUT I DO NOTICE that when I lift I can feel the left implants unnoticeable but the right implants more stiff when I perform the exercise? Can this be Capsule on the right implant causing it to be stiffer? Also, should I NOT EVE N train my chest just in case I want to replace my implants? I don`t want to have the doctor have a hard time putting them in again if my chest muscle are well built! Thank you and I wish you the best 2012 EVER!! =D

Answer:

it is most likely a slight degree of capsule on the right that makes it feel tighter and does not allow it to move as much. I think since the pocket has already been made for the implants below the muscle, any further surgery on your breasts would be much easier if the same pocket is used. All the best. JG 12.30.11

Question:

Hope you had a wonderful Holiday!!! i have a question. My left breast implant feels looser than the right. I hate when I sleep and sleep on its side I feel it tug a little so I sleep on my right where this stays in place. Iam 5 years post op and they are under the muscle...probably not anymore but I wonder why this is? It also looks more natural than the right.... Thanks Doc..=)

Answer:

you might have some degree of capsular contracture that is causing one of the pockets to be smaller and not allow the implant to move as freely. A surgical removal of the scar tissue can be performed if desired. All the best and Happy New Year to you. JG 12.27.11

Question:

Dr. Garcia, This forum is the best. Thank you for your help. I have had my Silicone Breast Implants for almost 5 years. I noticed as time goes on they get more looser and lower on my chest then the first year. Is this possible or am I just used to them. They also seem more loose than tire and softer then they ever were 4 years post OP. Also, I kind of want to change my size but want to wait longer just because I dot want to be stupid and selfish if there aren`t anything wrong with the ones I have. What are the ODDS of replacing them and something bad happening? Your the best!

Answer:

It is common for the skin to stretch over time and the implants to move down and sag. The risks for something bad happening the second time are the same as the first. Going bigger might make you sag faster though due to more weight. All the best. JG 12.12.11

Question:

I had a latismus muscle done to my left breast several months ago which left me with a much wider and bigger looking breast than the other side. Also there was some dents in it afterwards. Now, two weeks ago, PS cut the nerve to the latismus muscle and put in a smaller diameter implant. It looks much better, but is still wider than the other one in spite of cutting the nerve and smaller diameter implant. Will that improve in time as the muscle atrophies now that the nerve is cut, or is the result that I see now the end result. If it will improve, how long are we thanks in advance.

Answer:

The muscke should weaken now that the nerve has been cut and will likely allow the implant to look more round in time. JG 11.6.11

Question:

Hi, Dr. Garcia. It has been a long time since I have seen you. My name is Lynette Ball. You did my breast augmentation a long time ago. We put Misty Gold in. One of my breasts broke in flight to Hawaii many years ago. I had Barry Markman fix it. I wish I had`nt. My right breast is gorgeous. My left breast is hard and the nipple looks off to the left. I can hardly stand the sight of it. I have the money right now for more surgery. I hate the thought and the expense. I take that bake. I welcome the thought and the expense. If you think you can help. Please! I look forward to looking forward again. lynekey@aol.com 702-450-4285

Answer:

give out office a call and we lsee you as soon as you are able to come in. JG 10.9.11

Question:

I just asked the question about the latismus muscle and more width to the breast. If surgeon cuts the nerve, will the muscle atrophy and lose the wide look and return more to previous look it had before the latismus? Also, can a portion of the muscle be cut so that it is not so binding and flattening? Thanks again

Answer:

the muscle will atrophy in time on its own without the nerve being cut, but cutting the nerve will allow it to happen faster. If the deformity you have now is due to the muscle being tight and causing the flattening, then relaxing the muscle will help achieve a more projected appearance. JG 9.23.11

Question:

I have natrelle implants style #20 475cc on both sides. These are smooth high profile silicone. I had infection which ended up with need for latismus muscle on one side. Since them the new implant on that side is flattened and has more width look than the other side. Also, some dents in bottom part of implant. Surgeon will fill out the dents with fat, but suggested changing the implant for a style 45 which is even higher profile and less width. Will I look uneven if the implants are not the same on both sides?In other words, because the diameter is l.2cm. less on the higher profile and projection 4mm. more, will the fullness look different from one side than the other.He will cut the nerve whicj he says will help alleviate the flatness a little bit..but, am confused as to whether I should agree to a different dimension on that side...Help..confused...

Answer:

well, they are uneven now and moving to that implant will certainly look different from the present state but might make you look closer to the other side. I think the differences in tissues from one side to the other along with the latissimus muscle has caused some differences that might benefit from asymmetric implant choices.Cutting the nerve might speed things along too. I wish you the best. JG 9.23.11

Question:

hello dr. garcia, i asked the previous question on breast implants during heart surgery. i meant is it safe to , do you know, to do full sternotomy on aortic valve with a patient who already has breast implants, and do you know or have you heard if the implants can be ruptured during the actual heart surgery?

Answer:

Sorry the sternotomy should not affect the implants, all the best. JG 7.4.11

Question:

Hi Dr G I would really like your professional opinion on Polyurethane implants,I`m aware that these were withdrawn from the Market in the US ,also the EU and Australia but have been reintroduced in Europe and the rest of the EU and Oz after there being extensive testing and them being given the all clear of the carcinogenic link. A number of surgeons past and present swear these give great longterm results with the added bonus of limiting CC to a tiny amount,also displacement Is virtually eradicated . Two things I have had trouble with. I`m very much drawn to these implants but do wonder why in the US they are still banned, do you know something we don`t,lol. I have done a fair amount of research on these and can`t find any patient testimonies to problems with them,only positives and I know that over in the US scilicone was removed from the Market also but we now know that these pose no significant link to breast cancer. would love to know your opinion or any info or experience you have with these implants.

Answer:

well, the issue with the polyurethane in the US years ago was that the polyurethane sheared off of the silicone bag, it caused a chronic inflammatory state and if that happened it would reduce the chance of mature scar tissue forming, which reduced the chances of capsular contracture. The issues with that were the polyurethane made it to the liver in rats and caused cancer, but just as bad was that the chronic inflamamtion was never know whether or not it would cause cancer in the capsular tissue. Chronic inflammation is never good as it is well known in humans that chronic inflammation will lead to cancers. I know of no implant makers that are trying to get it passed in the US, the cost would be prohibitive and long. I am unsure as to how expensive the clearance process is or expensive it is around the world, but it is likely less on both counts. I personally would not use them here until the long term safety issues are worked out. All the best. JG 7.3.11

Question:

Need clarification on more comment, please: The higher the profile of the implant, the more displacement will be caused by the muscle. What do you mean by displacement? Sag/drop/ball in sock effect? Thank you!

Answer:

That the muscle will try to push it out from below the muscle and it moves down and to the side. Not ball in sock. JG 5.22.11

Question:

Thanks so much for the quick reply. Thinking ahead and just curious... Which revision surgery causes more visible scarring....double bubble fix or bottom out fix?

Answer:

About the same and both likely with new scars. JG 5.22.11

Question:

Hi again. I asked a question before about cutting the latismus muscle under the arm.. You said the tendon could be cut, and my PS yesterday said the nerve could be cut. Which of the three is it.. the muscle, the tendon or the nerve, or are we basically all saying the same thing. Thanks again for your prompt answers.

Answer:

either one can be cut, might be hard to identify the nerve in many cases, but if the flap has healed in place for a few months, releasing the tendon will have no significant negative effect, and likely easier to perform. Either one can be performed. JG 5.13.11

Question:

Is my first time consulting for a breast augmentation? Do you change for the first visit, I would like to it as soon as possible but would like to consult various doctors before committing.

Answer:

we do charge for the consultation, it is booked with a credit card, if you end up having the surgery that fee is applied towards the surgical fee, and if you cancel the appointment within less than 48 hours of the appointment, the payment is kept as a credit on your account. If cancel more than 48 hours before, the fee would be refunded. JG 5.5.11

Question:

Thank you for answering my question previously. Now, my next question is. How hard is it to close the capsule under the arm since it seems that when I hold it with my hand like it was closed a little, the symetry improves a lot. It seems that even tho a high profile implant is in there, it is being held down by the latismus muscle ans squishing it and making it look larger. Would releasing {cutting} the muscle under the arm also help? But I also think the pocket is more open allowing it to relax more..Thanks again

Answer:

I think releasing the tendon in the armpit area could certainly weaken the muscle and allow a bit more roundness, less flattening. The pocket can be attempted to be reduced, but it is hard to close an area that has been previously larger if the implant wants to move into that space. JG 5.4.11

Question:

I had an infection last year at which time the implant was removed.This was the result of a breast reconstruction.My PS felt that I needed a muscle sparing latismus muscle done at the time of the expansion due to skin integrity because of the infection and thin skin. Now that I have had the exchange from the expander to the permanent implant, the breast appears flatter and wider than the other breast which has the same high profile implant. The muscle is only on the third bottom part of the breast, and not covering the whole thing.Why is the breast flatter and wider when the same size implant was used? And can anything be done to fix that? The fullness is all on the outer part of the implant under my arm.

Answer:

the difference in appearance is due to scar tissue and different tissues covering the similar implant. I cannot comment on what would be needed to achieve better symmetry without seeing you in person, but there is likely at least some things that can help. Perfect symmetry, never, but a closer approximation is likely. Sounds like at least a revision of the capsule is in order to attempt to push the implant towards the breast bone. All the best. JG 5.3.11

Question:

Hi Dr G:: I can`t find my question. Anyway I was wanting to reduce my implant size. I want to be a full B. My under bust measurement is 31 and my bust measurement is 36. I currently have 300cc (for two years). I feel they are too wide, like melons. what cc do you think I would need to drop to get a better result?

Answer:

I think 200-225 at most, all the best. JG 4.11.11

Question:

Hi Dr. Garcia, I had over the muscle breast implant and lift done to go smaller. I had a lot of my own tissue but it was pushed to the sides, i went from a 275 to 150 and now they are too small. The dr. did take away alot of my own tissue from the sides. So my question is will going from 150 cc to 220 make a difference? I was a very large C with 275cc, now at 150 I am a small B. I want to be a C cup a little full. I just had these done 2 mos ago, how long should I wait to swap to the bigger ones.

Answer:

I think you will need more than 70 cc to go from a B to a C cup, need to make up for the tissue that was removed. I think if the size implant is not the correct size, it can be switched out at any time. Best of luck. JG 3.14.11

Question:

Hello Dr. Garcia! I have a question. I have had implants for 4 years very active in fitness and running and am a perfection to body proportion especially when I compete in figure competitions. I`m not happy with my implants for my body structure. They maybe too narrow or big or something is not right with my pockets. My surgeon isn`t really good at fitting implants to ones body and wanted a second opinion. Is there a way I can email you photos for your advice on what they look like and if u think there wrong for my body as well as pocket issues?

Answer:

certainly, please send them to drgarcia@lvcosmeticsurgery.com and take straight on, full sides, 3/4 views and one with your arms at your sides but flex your pecs too. JG 3.7.11

Question:

My shape from breast implants is not as round as used to be. Why is this? I know the breat implants drop after 6 months to a year so they are not sticking up. But the shape was rounder after they dropped than the shape years later.

Answer:

might be from loss of your own breast tissue and also the weight of the breast stretching the skin out allowing a more tear drop shape to be visible. JG 10.18.10

Question:

Dr. Garcia, I want to get breast implants, and stopped breast feeding about 2 months ago, but not completely. I was still nursing baby once a day (about every 24 hrs), for the last two months. How long do I need to wait before getting breast implants?? thank you!!

Answer:

my preference is to have no milk coming out of the breast for three months to decrease infection rates. JG 10.11.10

Question:

hi Dr. Garcia, I would appreciate if you can let me know if Retinol is good for butt and breast augmentation. I`m in the process of getting this done but wanted to know if this is safe for the body. thank you for your answer.

Answer:

Retinol is a vitamin A derivative used for fine lines and pigment issues, never heard of it being used for augmenting anything, sorry.JG 9.22.10

Question:

Hi Dr. Garcia, About 3 years ago I had breast augmentation using Inamed/Allergan (?) 286 cc midrange style 15 profile implants. After, I had rippling in the cleavage area and a lot of muscle movement/distortion. I also felt that the implants were too big for me. A year later, I had those removed and replaced with 210 cc moderate (lower) profile (style 10) implants. The size is much better and the doctor released the muscle and the muscle movement is much improved. The rippling, however, is not. I figure it must be due to the scar capsule since it is in exactly the same place as it was with the original implants. It really only bothers me on my left side as I can see and feel the ripples (feels like something is bunched up in there). My doctor is suggesting that I do micro fat injections to cover the one or two ripples that are higher up in the cleavage area and very obvious even in tops that are not that low-cut. Have you had any experience with this? I am concerned about what negatives there may associated with fat injections. Might it turn out looking bumpy/lumpy where the fat is injected and, therefore, more noticeable than now? Is there a chance the implant can be punctured? Any other complications/concerns you know of? Or, is this a good option instead of doing another surgery to remove the capsule (which I hear may cause problems also) and start over. Thanks for your help!

Answer:

there are not alot of options for the ripples, silicone ripples less than saline, but both can ripple. I think the long term survival of the fat injections is fair at best, but with yoru case, it might be worth a try. Otherwise a piece of Alloderm can be placed below the skin to try to thicken it up and make the ripples, that are due to the shell of the implant and not the capsule, less visible. Injury to the implants and lumps are likely low risk. Best of luck. JG 9.18.10

Question:

thanks doc, ok are the risks of granulomas with breast implant types and macrolane the same? or similar?

Answer:

the percentage of granulomas with Macrolane is unknown at the present time, but capsular contracture rate of implants ia 20%. JG 8.24.10

Question:

I am the same person that asked the other night about an expander that looks too wide. I saw my PS yesterday, and he admitted that the expander is right in the mid line, in other words, if I had two expanders in, they would be touching each other.What does that mean when I get fills?Will they get even closer together, and can the adjustment be made at the exchange to put a little more space between, or should we put a smaller expander in now before expanding. Thanks again.

Answer:

as the expander stretches it will lift out and not push the expander to the center, it will pull it out to the side if anything. Minor adjustments are always part of the final exchange of the expander for the permanent prosthesis.Best of luck. JG 8.19.10

Question:

I had expander put in on Friday August 13th.It is the second one on this side since I had an infection after Christmas and had to get the implant removed.The right side is complete with high profile implant and looks great. But, now with this expander, it looks much wider than the implant side. Is it because it is still flat with 120cc of saline in it, or did he use something too wide. It seems to cross over the middle line in the cleavage area. Will that get taken care of at the exchange, or will he have to close the pocket in the middle? Before the surgery, he said that the pocket is already there, since I had an implant already and he will not open anything that isn`t already open.If that is the case, why does it look so much wider than the other side?Thanks for your input..

Answer:

correct, it is just because of the stage the expander is at presently. As the expander fills the dimensions will change, all the best. JG 8.16.10

Question:

I had silicone breast implants in April. They have bottomed out. My surgeon informs me that due the exceptionally strong pectoral muscles (even though I am thin) he will redo the surgery above the muscles rather than below the muscle. The surgery should take about 2 1/2 hours since he has to close the other pocket. Do you see any problem with this? he is a very reputable Plastic Surgeon. Thank you for your response

Answer:

it can happen for a variety of reasons and I think that is the best way to improve the problem, all the best. JG 8.15.10

Question:

I want to have breast enlargement but I am affraid of the complications...:(( really affraiiiiddd... How often will capsule contractions occur? and when it does will it need surgery? or are there other ways to treat them like pills or something.. coz i read you stated if surgery is performed then after that for it to occur is more likely... so it will just be surgery after surgery and it will just gradually get worse... that will be awful for a female... am I over worrying? Capsule contraction (a l

Answer:

on top of the muscle, after 5 years the risk is about 20-24%, under the muscle it is about 8%. Not all patients with capsular contracture need more surgery, all depends on how firm the capsule is and the patient`s desires. Once someone has a capsular contracture rate, the chances of recurrance at some time on the same breast is about 50%. I tell patients when they have a breast augmentation that there is a 20-24% chance that they will need a second surgery at some point in time. JG 8.6.10

Question:

Is it necessary to replace implants every 10 years? I have had mine since 1995, and have had no problems. Also, I have saline implants, are they still about the same or better today?

Answer:

saline implants have not changed to any significnat degree in that time and if it is not broken, don`t fix it, leave them alone until somethiing has to be done is my motto. JG 8.2.10

Question:

I am a 36b with moderate droop breastfed 2 kids and I am getting 440cc silicone textured implants under the muscle. I noticed you said you don`t put textured under the muscle and now you have me wondering why. My PS said to go with texture so they would stay in place better because of the droop. I don`t have a clue so please fill me in. Kinda nervous. Also what size do you think that will that make me? Thanks :)

Answer:

well firstly, your own breast tissue above the muscle will stil droop with time regardless of the implant, and if the texturing does in fact attach to the muscle, which it does not always do, it will not move as a natural implant would and also the leak rate is higher due to the folding in a repetitive fashion of the shell of the implant that is textured. I cannot comment on your eventual size as I cannot examine your own tissue and the shape of your ribcage, sorry. Best of luck. JG 8.1.10

Question:

I had a breast biopsy one week ago today. I had no discharge till monday, and wensday the steri strips came off, taking my skin with it. I had a huge spot without any skin covering and the discharge has been horrible. Lastnight finally stopped discharge and started to heal over the incision, but the skin covering incision is really black, and there is a big indent where biopsy was taken?

Answer:

might have developed a hematoma where the biospy was done, I suggest you see your surgeon as soon as you can. JG 7.29.10

Question:

Hello Dr. Garcia, I had a breast lift procedure and breast implant done along with a Mercator tummy tuck (Fleur de Lys style) done by a Dr. in Kirkland, WA. I am very satisfied with the results of the surgery other than a small difference in sizes between the two breasts. I had 430 cc implants put in (saline), but the right breast seems a little smaller, soft and more natural than the left. Could it be that the doctor left more tissue on the left side than the right when performing the breast lift? Or is there any possible way that he could have filled up one breast with saline solution more than the other? Thank you for your time..

Answer:

do not think there was an unequal fill so more likely is a difference in the breast tissue as you mentioned. JG 7.17.10

Question:

Dr. Garcia, If there is some bottoming out after breast augmentation is another surgery always necessary. Since this is not a health hazard, is it ok not to do anything. Thank you for your response.

Answer:

OK to leave it alone, but it can usually only be repaired with more surgery unless treated with suspension very very soon after surgery. JG 7.13.10

Question:

Thank you for your prompt response. It is is a case of bottoming out and new sutures have to be placed is that a big surgery? Also, it the bottoming out does not go below the suture line can it be left the way it is without surgery?

Answer:

yes, it is big surgery with significant downtime after the surgery and the results are fair, and many times it has to be done more than once. If you can live with it, it does not cause any health problems. JG 7.13.10

Question:

Dr.Garcia, Just had consultation with my PL and was told that one implant was possibly bottoming out. He suggested I wear a bra and if it stayed in this position it would be alright. I have thin breast tissue. Options are to put additional sutures in affected implant or if I so desire go to a smaller implant. I decided to take a wait and see attitude - what would you recommend?

Answer:

well, if the surgery was just a week or so ago, the bra, being worn all of the time, might cause enough scar tissue to form to hold it in place. If it is much longer than that, I am afraid it likely will not work and more surgery will be required, such as you described of placing sutures to elevate the capsule into a better position. All the best. JG 7.12.10

Question:

I underwent a breast mascectomy on 8-27-09. I was informed by my breast surgeon that I can got ahead for reconstructive surgery. Is this something you do? Are you a provider of UHC and Tricare? What are you outcomes? I would like the breast to look like the other breast as much as possible? Can I see you pictures of work done?

Answer:

I was a provider for UHC until the end of this month, unfortunately that was the only insurance we accepted and as of now, we are only doing it on a cash basis. sorry. JG 5.24.10

Question:

Dr. Garcia, Thank you for answering my questions. When I had my breast augmentation the Dr. told me at pre-op that he would use Allergan implants; however, after surgery he told me he used the Mentor. Is there a reason that would happen?

Answer:

he might not have had the size he needed of that brand the day of surgery, I do not think there is a large difference between them though, nothing I would worry about. JG 5.16.10

Question:

Dr. Garcia, I had breast augmentaton 1 month ago and am disappointed that the Mentor 550 ccs only brought me to a C cup is that possible? I am 5`5 and weight 105 lbs. and expected the 550 ccs to look much larger. Thank you

Answer:

there is no conversion chart of what cc implant will yield a certain end result as the ribcage shape has to be taken into consideration, sorry. JG 5.14.10

Question:

Dr. Garcia, I had many questions but after reading other posts I just have one left! I had a transumbilical breast augmentation surgery two weeks ago and yesterday I noticed one firm track mark running from my belly button to rib cage. The other side is completely soft and healed. At first I could not see it at all but now it is clearly visible in certain lightings and angles. Someone else had a similar problem and said she recieved steroid shots... What are these shots and should my plastic surgeon provide them for me? Is there ANYTHING else I can do, such as icing it or using lotion? Am I making it worse by rubbing and apply pressure to it? Will it continue to heal beyond two weeks? Could it get worse? My surgeon is five hours away (nearest doc who does TUBA) and will not give me advice until he can look at it.. post op appointment is in three weeks, I will go insane before then. Thank you for your support, this site has given me a lot of reassurance!

Answer:

in time it usually goes away with hot packs and massage, the shots are usually not needed. Not uncommon with a TUBA. Hang in there and just wait to see him in a couple of weeks. JG 5.11.10

Question:

hi there Dr. Garcia. I have PIP implants and I am going to have them replaced as I think one has ruptured. My question is, I am going to have Allergan Inspiras but I cannot decide between the Responsive or The Soft Touch. What in your opinion is the best to go for to avoid possible capsular contracture and/or rippling? I am having under the muscle. The clinic I am using has offered me a discount on the Resonsive, but I am trying not to be swayed by that. I didn`t want another operation, therefore I am looking at having the best I can as I don`t want to go through this again. I understand the science behind the names, ie that Responsive isn`t as cohesive as Soft Touch, would this make any difference to capsular contracture? What is your proffesional opinion? Many thanks.

Answer:

we do not have those implants here in the US, but as to capsular contracture rates, they are likely the same. You have to wonder why tehy are offering a discount on one of the types though. JG 4.14.10

Question:

hi doc do u think macrolane is good for breast to make large abit? i know it will need top ups but will it work?

Answer:

we cannot use it here in the US but I think it is likey very expensive for what length of time it will last as it is not permanent. JG 4.11.10

Question:

i had saline implants put in in 02 and now in 10 they seem smaller?? is this in my head or could it be??

Answer:

the skin might have stretched or you might have lost some of your own breast tissue is the most likely causes. JG 4.6.10

Question:

Dr. Garcia, A follow up to my earlier question today. Do you think Natrelle style 15 265cc will give me a natural upper pole fullness and cleavage? Thanks again

Answer:

less than the other sizes. Upper pole fullness is actually only natural in a pubescent breast, or a pregnant milk-engorged breast. As time goes on into the twenties, a full upper pole is not natural. That is not to say that women do not wish their breast`s upper poles to be full, therefore push up bras, or the use of overly large implants to acheive that appearance. The truth of the matter is that natural upper pole fullnes is an oxymoron after the age of about 22. Does not mean you cannot have it, just means it is not natural when not wearing a bra. JG 4.5.10

Question:

Hi Dr. Garcia, I would like to get your opinion on size. I currently wear 34b/ 32c. I have no upper pole fullness. My ribcage is 29 and my bwd is 12cm. I would like to be a small to mid c. I am 5`0 110# athletic build. I am also having a benelli lift. My ps recommended natrelle style 15 304cc. I feel that is going to be too large. I am trying to decide between 265cc and 286cc. What do you think will be the best size for me. Thank you so much for your help

Answer:

in general, the smaller the implant the less the complications, I think for your frame and measurements, either one is likely OK though, but when in doubt, I like to go smaller. You are talking less than one ounce difference. Best of luck. JG 4.5.10

Question:

Dr. G ...Can you give me some signs of Capsule contraction. Besides the obvious raised up distortion. Things to look for or feel? Is there pain?

Answer:

pain, muscle spasms, firmness, less implant mobility all are early signs. JG 3.29.10

Question:

Dr. Garcia. I have had my silicone breast implants for 2 years now all is fine...but them seem a bit stiffer than looser....like titer looking...NO they arent raising up or distored...but also when I press the inner curve pary by the inner cleavage...sometimes it hurts...just if I poke in a certain spot...a dull ach....any suggestions. Thanks =0)

Answer:

sounds like a mild case of capsular contracture, it might stay like that and it might get worse, no way to tell, sorry. JG 3.28.10

Question:

hi doc, ok I already explained to u that my body accept the breast implant and its removed because my body just wont accept it . you agreed for it to be removed... then i explained i have skin stretched and ugly results with no breast tissue left. u said i can get it lifted and take care of the result im left with. then i explained it looks grose! and i will go crazy if im left with theis result!!! i just will and i will hate it.... its really bad... and lastly to that you stated i can get a new implant.... but like i said my body wont accept the implant... wouldnt trying another one make the same problem as i already tried new ones before too.... im so depressed.or is there any implants for my condition????? or anything other stuff u can reccomend????

Answer:

there is nothing else I can suggest I am afraid, sorry.JG 3.23.10

Question:

what is are the chances of never having a problem with breast implants? percentage pls? thnxx

Answer:

20-24%. JG 3.15.10

Question:

Hi Dr. Garcia: My question is, have you heard of the Brava method for breast enlargement? What do you think of it for breast reconstruction? I lost an implant to infection, and can I expect a good result from it? I was looking at that method of fat grafting.. Is it promising?

Answer:

the efficacy of the fat grafting for breast reconstruction is still quite early one,with or without the Bravca method, the end result in terms of size and number of sessions of fat injections are still unpredictable and I am also not sure your insurance would cover it as they likely still consider itexperimental. Best of luck. JG 3.14.10

Question:

I had breast implants for 15 years. Will they likely last another 40 years? And do women often get bigger size breast implants when their breasts (with breast implants) starts to sag as they get older?

Answer:

the odds are that they will eventually leak and have to be replaced. Getting larger implants as your breast tissues age will only make them bigger, it will not lift the breast and the added weight will only make the sagging worse with time. JG 3.14.10

Question:

hi doc you said perfect c pills wont even work alittle for enlargement of breast. WHy? it explains it stimulates the tissues just a bit if no at all. wouldn`t it tiny tiny bit help at all?

Answer:

because they are lying. JG 3.12.10

Question:

Hello Dr. Garcia, I have left arm lymphedema, secondary due to a lump that removed from my left breast and the doctor decided since he was in the operating room to remove my lymphnodes w/o permission from under my armpit area just in case . I do have a stocking which I hardly wear, I mainly wear a glove, since the lymphedema is manageable. I would like to have breast implants but I am afraid that I am not a candiate . I am only 38 yrs old and have only 1 child, she is now 10yrs old and I will not be having anymore children. I hope this is enough information. Thanks for your advice, I know that it hard to tell without seeing me. Thanks again! Nicole

Answer:

well, it can be done,women that have had the operation you describe for cancer very commonly have their breast reconstructed with implants. I think you just need to understand that the swelling might take longer to resolve on that one side and you need to tell your surgeon the whole story so they know. All the best. JG 3.11.10

Question:

Hello Dr. Garcia: i had a macrolane filler in my breast, it was a small amount and i didn`t like it, after 4 months since i had the filler i feel multiple lumps in my breast, i had mammogram and ultra sound and they told me it`s from the filler, my question is how can i get rid of them? can i dissolve them? and if i leave them how long it will take them to be dissolved?Thank U

Answer:

might be able to dissolve it using hyaluronidase injections into the lumps. If you leave them alone it might take a year or more, if they do not develop granulomas which can last longer because it encases the product in scar tissue. JG 2.11.10

Question:

I have never had good self esteem given from many years in my childhood of severe sexual,physical, and emotional abuse. I purposely gained 188 pounds then lost it and have done the up and down . I am finally healthy. But My breasts never were youthful or perky, they look flat and it never full. I have bad credit and going to school. My husband approves but we don`t have any money. Is there any way to get it done on low low monthly payments or pro bono? I just want them filled out. It bothers me extremely emotionally so if you know of a way or place in town please let me know. Sincerely thank you.

Answer:

we do offer a company that helps with financing but we do not perform pro bon cosmetic surgery, sorry. JG 2.7.10

Question:

Hi again. Thanks for your response. Can you describe to me how an allergic reaction from alloderm would present itself? In other words, what would be the symptoms of an allergic reaction?I have one place on the outer side of the breast where my PS closed the pocket a little because it was going too much outward. That was done back in May. Since then, when I touch it there, there is a pinpoint area of sharp pain. I feel like there is something under there that is causing all this. He said he looked but could not see anything.Is there a test that could see if there a hidden stitch in that area that is the problem?

Answer:

it would be red and itchy, like a case of the hives.The pain on the lateral area may be from a stitch that was placed to close the pocket, a stitch placed there can commonly irritate nerves on the ribcage and cause the pain. I doubt that is the cause for all of the issues you have described though. JG 2.5.10

Question:

Hi again Dr. Garcia: I am the person that talked about infection in one breast. The area thinned, and was close to extrusion. January 5th, my surgeon put in a new implant with some alloderm in the thin area, and removed the skin that was thinned. Now, January 28th, I started feeling wetness on my nightgown in the night.I got up and looked, and there was a small slit opened up. As the day went on, it got worst and worst. By the next day, my breast was swollen almost it`s size with fluid dripping down to my legs. I went to ER They gave me a shot of antibiotic and an oral antibiotic called septra.The doctor also said that the implant needs to be removed. The infection improved on the antibiotic, but my PS had to remove it on Wednesday.I have to wait six months to start again. Could I be allergic to the alloderm?Why all the fluid? I am devastated, as it looked so good before all that started. Does it mean, that when I start over again, it will happen again. I had the implants in for 10 years with no problem. But a amall correction of some banding was done in May 2009, and since then, there has been 3 infections. The first one was 2 weeks after the revision and was very mild. Just a little bit of pinkness and warmth. Keflex took care of it, but only to return 7 months later in thr form of implant extrusion, and then the extreme swelling of fluids.Am I destined to be without a breast? Do you think the alloderm could have caused the problem this time? Thanks in advance.

Answer:

It is possible to be allergic to Alloderm, but what you are describing does not sound like an allergic reaction, it sounds like the tissues just are not strong and healthy enough to heal and that is what is happening, allowing bacteria from the skin to become a problem. Fluid comes from the normal swelling process after surgery and normally is absorbed by the body, but if there is a weak point in the skin, it likes to go the path of least resistance. There is a chance that it could happen again, but not high, although once you have had a problem such as that, risks of problems are certainly higher than the first time. I doubt the Alloderm caused the problem, it was there before the Alloderm was used. I wish you all the best. JG 2.5.10

Question:

Hi Dr. Garcia. I had a surgery on my breast on January 5th of this year because an infection had started. The doctor replaced the implant and put alloderm where the skin had thinned because of the infection. Also, the infection seemed to cause capsular contraction. He broke the encapsulation, but now I have a small bulge on the bottom part of my breast like the capsule split like a seam that gets undone. Is that possible, and what would be required to fix that. It is quite small, maybe the size of a dime, . Can it be opened up in that area, and the capsule sewn closed, or will I need an alloderm implant in that area also. The culture came back negative after being in lab being watched for several days. Hope this means the infection is gone never to return. What is your opinion. Thanks in advance.

Answer:

hard for me to say without seeing you, but if the capsule was scored and not removed, there can be weak areas like that where the implant will bulge through. In time they can tighten and become smaller, but that does not always occur. If it does not, Alloderm is certainly an option in that weak area too. Hope all gets better soon, and best of luck. JG 1.22.10

Question:

Thankyou for your prompt response.I see my doctor tomorrow,is it partially his fault that i am in the situation once again.What is the most dimplomatic way of letting him know he has not made me satisfied after 2nd surgery at full cost he did say 410 would be big on me.They look great i am just going through some emtions as i waited patiently for the 6 mths for the redo and could not wait to get that feeling of ahh this is what i wanted.This i am yet to experience.

Answer:

I really do not have any advice besides just being honest, these issues are much easier to deal with and decide before surgery and explain that not all that one wishes is possible.JG 1.21.10

Question:

Dr. Garcia i forgot to give you details my implants are textured gel under the muscle

Answer:

would not impact the size too greatly, I do not use textured implatns under the muscle myself. JG 1.21.10

Question:

I am 5ft 7` small frame 118 lbs 32 aa after breast feeding.6 months ago I did 260 ccs on doctors recommendation and was extremely disappointed did not make a difference in my clothes.I had a redo 1 week ago same doctor 410ccs which he said would be big on me.I am once again disappointed they look great but he gave me the impression they would be a bit bigger.I feel cheated and confused it seems to be a guessing system as to what you end up with.Can it be that my chest cavity is concave hence the reason 410 does not look as big as it should.It looks as if i will be a c not even full.What are the risks of a 3rd surgery.Should i just settle,i have spent so much and i feel cheated.your advice would be appreciated

Answer:

hard for me to advise in your scenario, most women, even those with very little breast tissue should have a fairly average size with a 410 cc implant, I will also say that not all people can have breasts as large as they wish due to anatomical limitations that thwir body controls. I think the risks of more surgey are higher capsular contractue rates, displacement of the large impalnt, visible and palpable ripples, but it is your decision to proceed, I cannot help you there. JG 1.21.10

Question:

Hi Dr. Garcia, Thanks for your response. In regards to getting a possible capsule 2 yrs post (3 previous surgeries within a yr due to pocket size and capsules), what kind of trauma would it take to cause a problem, for example, a direct injury to the breast or in my case my arm being pulled so hard that I felt the stress in my right breast? I`m a week out from my injury and I feel the most tenderness if I push on my nipple area in towards my chest? I`ve been trying to apply pressure to the area to loosen it up. You stated to avoid taking Vitamin E, what do you think about taking Singular? Thanks again.

Answer:

it can be a direct injury, or even an infection, such as a tooth abcess or a urinary tract infection that can seed the capsule formation. I know Singulair has been reported in the medical literature, but to be honest, the results are only so-so and you need to get blood tests as there are some toxic effects from that medication. Best of luck. JG 1.18.10

Question:

hi dr garcia, what do you think of stem cells for breast enlargement... is it like fat transfer? does this procedure work well for someone that wants to increase one cup size???? thank ya

Answer:

I think I would wait, although there are stem cells reportedly in the newer techniques, it is stil a fat injection that is being done with the hope that the stem cells might enhance the survivability of the injected fat. It is pricey and the end size prediction is not as accurate as an implant. JG 1.13.10

Question:

Hi Dr. Garcia, I`m coming up on being post 2 yrs from breast augmentation. I had 3 surgeries within a year due to undersized and oversized pockets and capsular contracture. My implants are under the muscle and are looking and feeling great. However yesterday, while walking my 75 pound dog he pulled me so hard that I felt immediate soreness on my right side and there is some discomfort. I`ve heard that if there is any internal bleeding or bruising that capsules can form. What are your thoughts? Should I be concered and go back to taking Vitamin E? Thanks....

Answer:

Vitmain E at this point can make the potential bleeding worse, so no to that. I suggest ice for 48 hours, then switch to warm heating pads, limit acitivity with that ar and see what happens. In most cases the amount of bleeding is quite small and should not cause any problems if indeed you had any bleeding. Best of luck. JG 1.12.10

Question:

i have brest implan 9 months ago. and 3 days ago my left brest got red and sensative . what should i do?

Answer:

call your surgeon and see them, in the meantime get started on some oral antibiotics. JG 1.4.10

Question:

happy new year dr. garcia can i ask you what your opinion is with doctors who advertise on billboards for instance, i saw a billboard get one breast augmentation and get the second one free. he also does lots of sales with buy one get one free with artfill and other fillers. how does one know if that is what you are really getting? any secrets to it? thanks so much

Answer:

if it sounds too good to be true, run away. JG 1.3.10

Question:

Hello Dr. Garcia. I had breast augmentation done in the Philippines almost 1 year ago. I had planned on going back after 6 months for a follow up but with the economy, money got tight and couldn`t go back. I haven`t had any problems with my breasts, except for my L breast, on the side of the scar I feel a small lump, like the suture didn`t dissolve all the way. Should I be alarmed? Also, do you recommend on going to a cosmetologist to get a follow up done?

Answer:

do not think you should be alarmed, and I guess you can see if a cosmetic surgeon here will see you, but many will not as you had surgery elsewhere. Best of luck. JG 1.3.10

Question:

I was wondering. My implants are almost 2 years. Silicone under. I am a lean tite athletic girl. I am also a runner. They still appear tite and NOT saggy. Tho they feel soft. I was wondering why mine looks titer than some girls whose look more natural or saggier?

Answer:

could be just you have healthy skin that has not sagged, also having them under the muscle helps keep them from sagging in most people. JG 12.28.09

Question:

hi dr. garcia, I been wanting a Breast Enlargement first thing my left breast is a full C cup and my right breast is a full B Cup it is really noticable that there uneven and on top of it I have givin birth to 4 children so there droopy I want to be a full D or DD Cup I`m 30yrs. old 145lbs. what is the best option and type of breast enlargement do you think for me?Please help...

Answer:

in most cases I would place it under the muslce, but you might need a breast lift along with the enlargement, possibly using different sizes to get them more balanced. JG 12.28.09

Question:

Hey Dr. Garcia, when oh when will I be able to take the fat from my butt and have it be placed in my breasts. Seriously, why can`t this happen? Does the fat just redistribute itself or what? Thank you, we all wonder about this you know ;-)

Answer:

they are working on it but there are some obstacles that still need to be worked out, at present it is unreliable. Merry Christmas, Happy Channukah and a Prosperous New Year. JG 12.19.09

Question:

I have had three breast surgeries on the same breast and had implants put in, three times.And it has gotten hard again. Is there a differnt kind of implant that I can get or anything different they can do surgically to keep this from happening again? I have saline implants now. It is embarressing and I dont feel very sexy with a rock hard breast. You know? I can`t understand why this happens to good people cancer is cruel.

Answer:

I am sorry but there is no implant that will eliminate that problem. That issue is much higher in breast cancer people due to less normal tisue between the skin and the implant, you might need to get an autologous breast reconstruction with your own tissues. All the best. Merry Christmas, Happy Channukah and Happy New Year. JG 12.18.09

Question:

Hi Dr. Garcia, I recently went in for a consultation for a BA. I am a small girl, 95lbs 5`3 and ribcage measured is 29in. I wear a 32AA and would like to have a full B by the end of healing. My doctor recommended Mentor saline 250cc high profile (because of my small frame) filled to 325cc. However, I came home and began researching online and it seems that many doctors have advised such small patients to not go over 300cc, especially using high profile. After looking at several pictures, it seems to me that filled to 260cc-280cc would be a more correct range? What I`m confused about is if he`s putting it under the muscle which will lose 50cc in looks, he says the implant filled to 325cc will actually be more like a 275cc implant that I tried on as a sizer at his office. What do you think?

Answer:

I am not a fan of high profile implants for augmentations as I feel they look too projected, I would go with the size you mention and use a Moderate Plus projection implant. Best of luck. Merry Christmas, Happy Channukah and Happy New Year. JG 12.17.09

Question:

Hi Dr. Garcia again: I was the last poster on this forum with the breast infection. I saw my surgeon yesterday. He says there is no stitch there. What I am seeing is a blackish area under the skin the size of less than a dime, and this is surrounded by a very red area the width and length of a small finger. He says the infection is localized and not systemic at this time, since I have no temperature and feel good.What he wants to do to try and save the implant is to see me next Tuesday, and if the infection is under control .he wants to do surgery on Wwdnesday. He wants to cut out the thin area and possibly put alloderm implant in there to strengthen the area. If the implant breaks thru the skin, then it will have to be removed and wait a period of six months for a new implant. I want to avoid this at all costs. Is he right in wanting to do a surgery even if there is still some infection there? Or am I asking for more trouble?He says the implant does not have to be replaced if he can save it with tsking out this thin area of skin. I am not sure what to do? What is your opinion? Thanks in advance.

Answer:

I think the thought process is correct. The implant might be saved if there is no infection and if it does not pop through the skin. I think having it repaired as soon is possible is the best idea. All the best. JG 12.16.09

Question:

Hi Dr.Garcia. I had breast cancer 10 years ago, with a double mastectomy performed. I later got breast reconstruction. I had a revision on the one implant 7 months ago, and resulted with an infection after about two weeks. The infection responded to Keflex, and all was well. However, it recurred now 7 months later.What does that mean? My little pomeranian jumped on me the other day, could it have busted the implant? It is silicone implant. I am now on keflex again. Will my implant have to be removed?If so, at what point does that decision have to be made, and how long a wait before another can be re-inserted? Will it look as good as it does now, or will I have ugly looking skin?

Answer:

no reason to think the implant is ruptured but the treatment with the oral antibiotic probably controlled it but did not eradicate it. It might be a matter of longer term antibiotics or finding a suture that can be removed that has caused the infection to recur. Your surgeon needs to see you to determine what is the cause. If the infection cannot be controlled with simple measures, then yes, the implant might need to be removed for a period of time. Usually after 6 months of infection free treatment, the implant can be reintroduced. It might require a short period of time with a tissue expander if the skin tried to shrink up, but in most cases it should be able to go just about to the previous appearance if all goes well. I wish you the best. JG 12.5.09

Question:

Dr. Garcia, Regarding that Beauty Queen that died after getting a Buttocks Agumentation. It was said, it could lead to a pulmonary embolism — a blood clot or other substance blocking the main artery in the lungs. Can that happen with Breast Agumentation? I had my breast done already and been under twice in my life. Do I have to worry about this for future surgeries in the breast? is there some way to prevent this..scares me

Answer:

possible, yes, but very very rare. There ae many precautions that can be taken to prevent a blood clot and that dimishes the risk sizable, not sure if they were used for Miss Argentina.JG 12.5.09

Question:

hey dr garcia, i have saline filled HP breast implants 400cc or 420 cc... i want to have these removed. im 23. can this be done? i saw some before and after pictures of explantations and also came across a girl who had 800 cc and after removal they had just shrunk back to how she was before. can i expect that as well? if not, anyway to go back to looking normal without any implants..

Answer:

as to shrinking back down, it all depends on how long they have been in and your skin elasticity, I cannot say 100% that you will shrink back down to your previous appearance though. JG 12.1.09

Question:

hi doc, Have you heard of the new technique for breast enlargement thats been just discovered where the fat cells grow in you breast region? it was on news here. It was discovered for the purpose of breast cancer patients. It stated it will be used for cosmetic reasons too. Will this be available soon? and will you be performing this?

Answer:

there are still many questions about the use of fat for breast enlargement as there is the potential for obscuring the detection of breast cancer secondary to the calcifications that can occur, although it is being done, I think it is still in the very early stages of acceptance by the medical community. I have looked at it for other areas of fat injections but am not planning on using it for breasts at the present time. JG 12.1.09

Question:

When you responded:Answer: in that amount of time it is more likely the skin has stretched and the increased looseness of the skin makes them look smaller. If scar tissue forms that can make them look smaller but they would then also feel firm or hard. JG 11.27.09 What makes the stretched skin appear smaller? Is it becase the mounds took shape and settled into the [ocket? or did they really get smaller?

Answer:

as the skin stretches the amount of skin is larger than it was so the breast size looks smaller as it is not as well supported. I seriously doubt you lost breast tissue in that time wihtout a large weight fluctuation. JG 11.27.09

Question:

Is it possible for my silicone impalnts to appear smaller after 15 months than after 9-10? I looked at photos from 10 months out and they seemed fuller and bigger and better. Now they seem just tite and a bit not as full but smaller...can this just be my imagination. Also, can or when the scar tissue forms as time goes on can be a cause of any impalknts to be smaller looking. By no means am I hard or not pliable..they just seem not AS FULL and LARGE as 10 months out as I do at 15?

Answer:

in that amount of time it is more likely the skin has stretched and the increased looseness of the skin makes them look smaller. If scar tissue forms that can make them look smaller but they would then also feel firm or hard. JG 11.27.09

Question:

hey dr garcia, i underwent a BA procedure about 3 years ago..420CC saline.. I was an A cup and now Im a full C small D.. I want to switch to silicones and much smaller ones (300-320) .. will that cause any problems?

Answer:

slightly less fullness up top most likely. Sorry I did not get back to you sooner as I was with family for dinner. JG 11.27.09

Question:

Hi Dr. Garcia, I`m 25, 5`5 and 125 lbs with a chest diameter of 12cm (this measurement was taken by a PS). Interested in silicones under muscle. 32B wanting very full C cup. What size silicone implant and profile do you reccomend for a 12cm chest?? I can`t decide between High Profile 400CC(11.9cm chest)-425CC(12.0cm chest) or a Mid Range Profile 339cc(12.4cm chest)-371cc(12.9cm chest). If I am a 12cm chest should I go with an implant that is more narrow like 11.7cm-11.9cm or should I stay in the 12.0cm-12.4cm?? Sorry for long question I`m just confused and would like your input. THANK YOU!

Answer:

well, assuming that by chest he meant breast diameter, I think one shoudl always stay at the diamter or less, if you go past that, it will show on the edges or give a double bubble. Also, most women`s breasts are wider than they are tall, the limiting dimension I find is the distance from the nipple to the crease of the breast, doubling that give me the maximum diameter more commonly than the horizontal width. I almost never use high profile implants for augmentations as I feel they look very artificial after they are placed. JG 11.24.09

Question:

Hey Dr Garcia, I had a BA procedure done about 3 years ago..I was 21 and went with saline 420 cc`s transumbilical. I am wantign to get smaller silicones. can you please advice if the removal of salines and replacement with silicones can be done thru the underarm as I dont want any scars on my breasts. will underarm incision be too big and do they heal ok on people. please advice. Thank you

Answer:

the scar length in the armpit will be determined by the size implant and it should be possible to do that, yes. JG 11.10.09

Question:

Hello Dr. G..I am 16 days postop and going thru those did I go big enough feelings..reading other posts it seems I just need to hold on and let the process continue because it could be months before I see the result I am expecting, my PS has had me wearing a compression band for 2 weeks now, what is this doing? how is this helping me? .. I am 5`8 , 140 lbs and preBA size was 34NB, and I had mod profile round smooth saline 300 implants overfilled to 330/340 cc`s placed under the muscle..I want to be a mid/full C when all said and done, does it seem I will be headed in that direction? It is just so hard for me to figure out this dropping/fluffing because the just seem realtively small to me :( Thanks for any advice!

Answer:

the compression helps relax the tissue and muscle. I think you just need to have a little patients, hang in there. JG 11.8.09

Question:

whats the biggest implant you would put in a girl with starting bary a cup, 5`00, small frame weight 115??

Answer:

it is a guess as I would need to knwo the dimensions of the actual breast, but maybe 270-300.JG 11.8.09

Question:

I am interested in 1st time breast augmentation under the muscle either silicone or saline. I am 23 yrs old, 5`6, 130lbs, 32B wanting to be a full C, maybe 300-330CC implant. What would this breast augmentation cost, even a ballpark figure would be helpful.

Answer:

the fees woudl vary from surgeon to surgeon but in our office it is about $7000. JG 11.7.09

Question:

Hello Dr. Garcia, I am interested in having my first breast augmentation surgery around April 2010. I would like to come in and have a consultation with you but I`m not sure if I should wait a few months (closer to april) or come to your office in November so I`m fully prepared well in advance. What do you reccomend?

Answer:

I suggest coming in at your earliest convenience so we can discuss things from an informational point of view, I find that prompts new questions that we can then discuss over the next few weeks to make sure you are ready. There is no need to book the surgery date now, it is just a fact finding tour so to speak. JG 11.3.09

Question:

I saw a new procedure on The Doctors television show for breast enlargements. I would like to know if it is available, what is the downtime for the procedures you recomend,are there age restrictions, the level of pain involved and cost. I am 66 years old and believe I have a A cup size and have always felt very inadequate about my size. Can you help me?

Answer:

I have never watched that show so I am unsure what reportedly new procedure you are referring to. JG 11.2.09

Question:

Hi Doctor - I just posted a question about breast enlargements stating that I was a A cup size - I would like to be a C - am 5 feet tall and weight 112 lbs. - I do have broad shoulders - do you think this is a reasonable size for me? Thank you for taking the time to answer me as I have been wanting to do this for so many years and know that you are one of the best surgeons.

Answer:

I need to know what the procedure you are referring to is. JG 11.2.09

Question:

Hi Dr. Garcia, I am hoping you can guide me here.. When I was 18 I had an implant placed in one breast because it never grew. The implant was placed to make my breasts even. Now that I am 32 had two children I am again, uneven as the real breast is sagging and almost a D, and the implant is not sagging and still almost a C. I just want to be even sized again. I was thinking about going to a full D size. Will I have to get a lift first and then implants? Please help.

Answer:

might be easier to do a small reduction and lift on the larger size. JG 10.26.09

Question:

hi dr garcia I was interested in breast englargement to be a b cup from AA. Im worried with the side effects and risks. What can be the lesser way of risk to have this result? and from your surgery of breast enlargement how many % have complications? and what complications do women face with this procedure? many thanks

Answer:

the risks are small in experienced hands, so I suggest a board certified plastic surgeon. Complications are rare and it is relatively safe procedure. The most common side effect, which is not truly a complication is capsular cpontracture, where the scar tissue makes the impalnts feel firm or hard. JG 10.25.09

Question:

In your experience, are buttock implants effective in most patients who have experienced a descent and atrophy of the tissues? My surgeon is recommending them in addition to the excision of a small amount of skin. What would you say are the chief problems/risks of buttock implants? Capsular contraction? Shifting of position? Extrusion? Are these rare or common problems? More or less common than with breast implants? Do you yourself ever place buttock implants? If not, why not? Thanks so much for your help, Dr. Garcia. You are so kind to offer your expertise to all of us in need of guidance!

Answer:

well, they have all of the risks of breast immplants but at much higher rates, infection rates are higher as well as malposition and extrusion is also more common. I did them for awhile but stopped due to the above stated problems.Best of luck. JG 10.4.09

Question:

Iam 1 year and a half post op from silicone under muscle implants. Tho they feel soft, i notice that my left looks sometimes smashed up on the top inner cleavege but evens or puffs out as theday goes on. Sometimes it looks not round but triangle sometimes its better? is this scar tissue or somethingwrong?

Answer:

if it changes thoughout the day it is more likely muscle contraction or spasms, nothing bad unless it stays that way. JG 9.29.09

Question:

I have smooth round silicone implants. I hear implants can shift, rotate and move inside ones pocket....how can you tell if they have done so? Do they look odd when they move?

Answer:

in most cases the normal rotation cannot be perceived nor is it a bad thing, they rarely flip over or anything that would likely change their appearance. It is actually good that the implants move because if they do not the rate of shell failure and leaking is greater. JG 9.29.09

Question:

I have implants for over a year, NOTHING bad is wrong with them but a little pocket work could be fixed and maybe VERY LITTLE scar tissue holding one up a bit! NOTHING that makes me cry or do anything about it. But I was wondering. I do want to change my size one day..I know I do. Should I do it in the next year or not even bother in the sense something can go wrong

Answer:

I would wait and do the pocket modification and implant exchange at the same time. JG 9.6.09

Question:

Just out of curiousity. If one was going to exchange her implants for a different size or profile what happens to the capsule? DOES HE REMOVE IT ENTIRELY or just cut some of it and leave it in when getting NEW IMPLANTS?

Answer:

in some cases the capsule is just cut, in others it is removed to make space for the different implant, it varies depending on what was in place and what is going to replace it. Sometimes part of the capsule is left untouched, yes. JG 9.6.09

Question:

Ive noticed that my left breast lower crease (underneith part) is not a nice round shape it is more uneven and triangular. Not like the round crescent lower fold like the right. More mis shaped. What can this be. Iam 15 month post op!

Answer:

can be either a small degree of car tissue or just that the pocket healed that way after the surgery. JG 9.3.09

Question:

I have decide I DONT LIKE my agumentation. I cant pin point why but they look so funny/wrong on my body. The sad thing is my ps doesnt EVER pick the size YOU DO! I have had 2 surgeries ....BOTH arent to my lieking. Im pretty much not careing at this point. I do have a question. I wonder the reason why im not liking them is because they look stagnet. I liked them when they were new.... I have smooth round silicone under the muscle. They feel firm but smooth but look sooooo not natural. Im wondering if cc is the cause....should i get a sec ps opinion. Im thinknig thats why. There is NO PAIN or TOTAL HARDENING just firm/soft.

Answer:

maybe going to a smaller size so they feel softer would help. JG 8.30.09

Question:

Soooo Ive seen some woman who have implants where the implant really moves around the pocket freely. Then there is MEEEEEE! They are soft to the touch but are limited to movement. like if i ran withoug a bra theyd move little but stay in place....is this because my implants are to big or the pocket is too small or just how my body is

Answer:

could be either one, also could be because they might be textured implants and the texturing works like velcro. JG 8.27.09

Question:

how long after pregnancy and breast feeding when you have implants does one size go back to normal?

Answer:

maybe 6 months, it varies from patient to patient. JG 8.24.09

Question:

I was looking at my implants today. Iam 1 year and a half post op..so all is what it will be as of now! Both soft to the touch---but the shape of the breasts dont look so perfectl;y round--kinda squished in shape--one looks more out to the side and off center on the chest with a triangular shape and the other is round and in the center--is this just how iam no matter what pocket or size i choose or have made

Answer:

hard to say without seeing your before pictures, but assuming they were even before the surgery, it might be a pocket issue that needs to be modified. JG 8.24.09

Question:

why do some people implants look like balls stuck to their chests....any way to prevent that look?

Answer:

the most common reason for that is a capsular contracture, and the second most common cause is too large of an implant placed for the patient`s anatomy. There is no way to 100% avoid capsular conracture but choosing an appropriate size implant can be done. JG 8.24.09

Question:

Iam a year and half post op! One of my boobs is more wider n rounder in appearance then my left which is more teardrop narrow! Both are soft n pliable! Silicone under muscle. Why is this? Thanks, you are the best!

Answer:

most likely either because you started off different, or because the pocket on one is bigger and does not fold the implant as much as the narrower side. JG 8.17.09

Question:

Dr. G, very recently I had a capsulectomy and during this surgery I went with a smaller inplant. After my firt ba I felt my breast size was too big and now that I have gone smaller I feel like they are too small. what do you think i should do?

Answer:

I suggest leaving them alone for at least 6 months and let everything heal in before you decide to do anything. JG 8.16.09

Question:

Thank you for your most recent reply. Is it unusual for scar tissue to cause this pain/discomfort, which began after replacement surgerys and pocket lowering began 3 years ago? Would that also explain cold causing more pain? In the 20+ years prior, I never had pain, only hardening, and did not know until surgery that the saline part of the double lumens used then had ruptured. Is there anything else it could be, since scans etc. did not show a problem? Should I be going to another PS for a second opinion?

Answer:

well, scar tissue can start to form at any time after the surgery, so it is not uncommon. When enough hardening occurs around a nerve it causes pain, I think you likely were lucky before that the hardening caused no pain. An MRI scan can look for other causes but in most cases it is a clinical diagnosis of exclusion and no test will tell you 100%, sorry. JG 8.14.09

Question:

Thank you for your last reply from 7/21. I did have the MRI done, and it confirmed that the right implant is over the breast now, even though it started out under. Everything else was okay, including showing that my left breast looks normal. Besides the scar showing now on the left, because of repeat surgery to lower the left, I also have constant discomfort on the left. It is no longer the pain that it was, thank goodness, but it makes it hard to move my left arm over my head. The position of getting the MRI a few weeks ago, has made the pain worse again. It is also worse with cold. It feels like the implant on that side is too big and any muscle movement causes it to swell and look even fuller on top. I really don`t want another surgery, but it is going on so long now, that I would even consider it if I knew it could be fixed with a smaller implant. My PS said it is no guarantee, and I am wondering if it is time to get another opinion. Any suggestions would be appreciated.

Answer:

I am sorry but I cannot say that a smaller implant will help the scenario, if the pain is due to scar tissue, it might persist even if you totally remove the implant. Wish I had more to offer. JG 8.12.09

Question:

Iam 14 months post-op! They are soft to touch, a bit stiff, but always been that way...they DO move. I noticed that one is shaped differntly. One is round and full the other seems to long oblong and point out to the side armpit more. They were always kinda different. Do you know why this is? Also the inner crease benieth seems to have a dent in it so the inner crease isnt as ROUND but it comes and goes...any suggestions? My impants are SILICONE under muslce

Answer:

seesm like a pocket issue where one side has a pocket that could be made larger. JG 8.10.09

Question:

My girlfriend got Silicone Breast Implants 8 months ago. Under the Muscle....They dont look too big butt seem soft and pliable but look FAKE like balls..I guess because she has NO fat on her and the tranisiton to the chest and breast are significant. Why is this? Ive seen ,amy woman with implants that look softer even with silicone where hers just look harsh on her? Im tiny alsop and looking to go into silicone but am afraid to look like her. Is there a reason why hers look so harsh on her thin frame? Any things I should be aware of in choosing to lookmore natural?

Answer:

could be the size of the pocket made, or the profile of the implant, and also could be due to too large a size being placed. The reasons they look like that has nothing to do with the silicone, if they were saline the potetnial reasons for looking that way would be the same. I think choosing an implant that fits your physical limitations is important. Best of luck. JG 8.3.09

Question:

its been 15 months after my BA...i have noticed my right boob is fuller and wider and the left is narrorwer and more tear drop. its noticeable in my bra...the left narrow one has a 1/2 gap in the cup to the center where the wider right goes over...is this just how my natural breasts were or a pocket issue? if so how can this be fixed

Answer:

hard to say without seeing what you looked like before the surgery. Assuming they were equal before, I would say that it appears to be a pocket issue with the left one being a little more narrow. After 15 months it will likely require repeat surgery to open the pocket further on the more narrow side. Best of luck JG 7.30.09

Question:

Since my Doctor doesnt measure my breast tissue and eyeball it Iam left all by thyself to pick the implant size myself then he will approve if its appropriate. SOOOOOO my question is this. HOw WIDE can I go in terms of a diameter? I have a 28 ribcage? If I use 500 mod plus thats 14 cent diameter....a 500 HP or CC put more projection is 13.2 cent...so I dont know what to do? Whats the safest?

Answer:

personally, I suggest you find a different doctor, that recommendation is ridiculous. JG 7.28.09

Question:

Why does Silicone Gel appear more natural than saline? I switched from saline to silicone and silicone has a natural slope as my saline had a hard edge ontop. Is this from the GEL of silicone migrateing down to the bottom of the bag?

Answer:

that has nothing to do with the filler, it is the pocket in which it sits, actually saline drops more to the bottom of an implant than silcone gel. JG 7.28.09

Question:

I haven`t written to you in a few years now, but I was having trouble with replacement 300cc silicone gel implants as one side kept rising too high. These were under the muscle(originals were overs and lasted 24 years). The side that was rising was lowered a 3rd time nearly 2 years ago, now, and the pocket was lowered at that time. It left a scar that now shows (and is not in the crease anymore), and that breast feels fuller and lower than the other, but it has remained soft. The other breast has hardened again on the top only, preventing me from being able to get a push back view on mammogram. I was also told now, by the radiologist, that the implant is not under the muscle on that side. How could that be if it was implanted under the muscle? My PS had told me it could not go back up over the muscle. Will the shape differences between the breasts now get worse with age?

Answer:

unable to say whether the differences will get worse, as to how can an implant placed under the muscle move to on top, in some cases, especially on repeat surgeries, the muscle might have been released medially to such a degree that the muscle pulled up like a windowshade and when that happened, since the tissues above the muscle had been prviously opened and weakened, the implant can move on top of the muscle again. As to the mammogram, might be better to skip it and just get an MRI with a breast coil to evaluate the breast tissue and the silicone impalnt at the same time. I wish there was something I could offer for the scar, but in order to displace it lower on the chestwall would require a smaller implant and pulling the skin down which could push the implant up again, sorry. Best of luck. JG 7.21.09

Question:

Iam 13 months post op! This morning my left breast felt like a tugging going left and down. I dont know if its just how i slept or that is it possible its moving and dropping in a diff place? I haver them under my muscle? if it is moving or what not is this not good and I should see my doctor?

Answer:

I think the pocket is fairly stable after 13 months so it is not the pocket, might be some muscle spasm though. I think seeing your doctor if it does not get better in a few days is always a good idea. JG 7.19.09

Question:

Is there REALLY a difference in a 500 HP vs 500 MOD PLUS is terms of visualness? Iam petite so im kinda in fear of a 14.1--mod plus diameter in a 28 inche ribcages body who is petite with a 29-30 hips....is that too wide? the 500 are 13.2 diamter..or shall i go smaller

Answer:

I feel there is, I think high profile implants look more artificial. I think you should go alot smaller. JG 7.13.09

Question:

Iam 13 months post OP silicone. One of my implants looks more dropped and fuller as well more natural. The other is more titer rounder and less fuller. BOTH ARE SOFT and MOVEABLE. You can see it if u look in reverse in the mirror better than taking a photo straight on. Can this be a pocket issue? Its always been like that even before when I had saline? Any suggestions? Basically the left is more natural looking and goes off to the left a lil where the Right stays put and is more WIDER and rounder. It looks like 2 different breasts. Again even when I had saline they looked this way! Can it be my breast shape or pocket

Answer:

it certainly sounds like a pocket issue and likely need more surgery. JG 7.13.09

Question:

I love your sight and I enjoy reading your answers to all the vaious questions. Thank you for taking the time to answer. Have a great day.

Answer:

many thanks and likewise on your day. JG 7.10.09

Question:

Won`t implants appear larger on a person if they lose weight, since the implants do not shrink but the person does?

Answer:

possibly, but they might also lose some breast tissue too so that might make them look smaller. JG 7.9.09

Question:

wierd question...does sleeping with or without a bra have more chance of breaking implant? and i got my implants in 02 how do i know when to replace them/

Answer:

no effect.If there is no problem with the implant, then it does not need to be replaced. JG 7.9.09

Question:

How much liquid is 100 vs 150 cc visually?

Answer:

between 3 and 5 ounces.JG 7.6.09

Question:

When u go with a larger diameter. Does it get bigger in terms of height on the chest. (*higher towards the collar bone) OR does it just get closer in the middle or outter but stays the same height and crease? Also is a 1 centimeter jump in diameter really going to effect this change? thanks Dr. =)

Answer:

usually higher to the collarbone and out more to the side. I think 1cm will affect it some, yes. JG 7.6.09

Question:

My PS doesnt measure ones breast tissue for appropriate implant sizes. This scares me. Do many doc do this? I mean what happens if he goes into surgery and cant fit it? Can doctors actually determine with the nakid eye what can or cannot fit and why do doctors not measure....

Answer:

I think many do, but not all, some think they can just tell with experience, I have always measured them. If you place an implant too big, then you can hang out too much on the side or get a double bubble. Happy Independence Day. JG 7.4.09

Question:

I was wondering when `I hear of peoples complications of an over disected pockets, lower, highering crease...pocket to small or large.....do these happen on the FIRST more? I mean, lets say someone had 2 BA`s and going in for a 3rd? do these problems are easier for the doctor to not make after the pocket has been made?

Answer:

It can happen on the first or any further surgeries. I think in general the risks increase the more surgeries you have had. Happy Independence Day. JG 7.4.09

Question:

Hi Dr. Garcia! I need an opinion. My current silicone implants I like BUT I want them a BIT FULLER...NOT A HUGE JUMP SIZE or Bra size. Just a lil bit bigger in a way they fill out more. Iam torn. Is 100 cc jump going to give me that fullness I want and worth doing it again or should I go 150 cc more just in case. Mind you iam a tiny petite girl so im afraid 150 mite make me WAY bigger then the lil fullness I want. What is your opinion on the matter of the diffent size jump for me need

Answer:

I am sorry but the answer to your quesion is almost impossible to give, there is no way to tell. I would always go for the smallest increase possible, but no way to predict whether it will make you happy, sorry. Happy Independence Day. JG 7.4.09

Question:

Is there MUCH visual difference in a diamter implant from 13.2 to 14.2? Would they be allot bigger where the eye can notice?

Answer:

they will look bigger, yes. JG 7.2.09

Question:

Dr. Garcia, Iam a narrow girl with a 27.5/28 inch ribcage. Tiny hips around 30 and waist is 24.5/25 inches~ My doctor said 500 cc....should i go with the HP or MOD PLUS silcione tho iam soo narrow....I may go smaller but was wondering if MOD PLUS in 500 is to wide being a 14.2 diameter comapired to a 13.2?

Answer:

I think it is pushing it and on your frmae I think those will not look too real. JG 7.2.09

Question:

iam 1 year post op! Things are soft and pliable. But i notice my left looks more natural in the pocket. down nice to the side. The right seems a bit higher up. you can tell from the side view it seems to be holding up more then lower with a nice slope. Pocket issue? or scar tissue issue? do u think it can be fixed or am i just being picky?

Answer:

hard to say wihtout seeing you in person, if it has been like that since the begining, then it is likely a pocket issue. If it was not there since the begining nad started later and slowly got worse, then it is a capsule issue. Either one can likely be remedied with a capsulotomy. JG 6.29.09

Question:

If you only have rippiling onthe inner-lower crease of the breast---does that mean the implant is too wide for ur breast width?

Answer:

possibly, or that the tissues are too thin and no matter what size you had placed, it was going to happen. JG 6.29.09

Question:

Is there a SET IMPLANT amount that is considered BAD for the sake of ones skin tissues? Meaning any implant above 400 can lead to great complications? Why do I see man ywoman going 600 to 700 CC? Are these implants gearing them for problems?

Answer:

no, it varies from patient to patient. But in general, the larger the implant, the greater the chances, I do think they ones getting those large implants are gearing up for problems later, yes. JG 6.25.09

Question:

WHAT IS THE BIGGEST IMPLANT CC YOU WOULD GIVE SOMEONE 5 FT 105 LBS, SMALL FRAME, BARELY THERE A?? WHAT SIZE DO YOU THINK KENDRA WILKINSON IS??

Answer:

cannot say about Kendra Wilkinson, and I would need to know at least the diameter of your breast tissue to tell. JG 6.9.09

Question:

Why in your opinion is the FIRST surgery the easiest one to operate then a person in their 2nd or 3rd?

Answer:

because the tissues are virgin, not scarred, have normal blood supply and are not tethered nor limited by any previuos scar tissue. The anatomy is more predictable and not distorted. JG 6.9.09

Question:

For a surgeon doing a BreastArgumentation. Is it HARDER for him to make the FIRST surgery making the pocket then it is to reoperate on someone hwo wnats NEW implants a second or third time around?

Answer:

the first surgery is the easiest one. JG 6.9.09

Question:

Regarding implant diameters. Iam already implanted. My PS doesnt measure the natural breast width so basically I picked my own. I look back and just want to know if I choose the right one. If its to small or to large for my body. I know u have to see me but my ribcage is 28 inches. Iam a narrow pettite girl and the implant width is 13.2....what can u guestemate? Also do u think i can reach a 14.o diameter?

Answer:

I think the 13.2 is already at the limit. JG 6.9.09

Question:

Hello. I had BA in march,500cc under muscle,silicone gel. I am looking at possibly going bigger but was wondering if i might be happy with saline instead of silicone. I have narrow and tubular breasts- do you recommend silicone or saline? Will saline give me more shape? The reason im asking is b/c when feeling the difference of the two the saline implant seemed to have a harder shell and more of a defined shape whereas the silicone was softer more squishier texture. Please advise and thank you.

Answer:

that is a personal choice, I do not think saline will make it look any better, though. JG 6.9.09

Question:

Okay so its 12 months-1-year since my SECOND BA! Silicone. Love them, but implants frustrate me. WHY? One week they look odd the next awesome. For instance. Early this week, at night they look lumpy and tite and smaller. Then in the morning or mid-day they are full and bigger. Like they keep changing shape and size on me, GRRR....Mine are under the muscle and iam athletic ...so i wonder if its just me or do they change like that. Some days i want to cahnge sizes other days i like

Answer:

it is because they are under the muscles and them move around and will change location to some extent within the pocket, not much that can be doen about it, what you are seeing will likely continue. JG 6.4.09

Question:

My left breast implant (under muscle) seems to pull to the side towards the armpit. NOW I have had 2 BA and they both have always been that way!!! Even when I stand straight it migrates to the left. The righty perfect centered. You can even see the implant in the inner crease wrinkle to the left. Is this just how my natural breast placement is or can this be fixed?

Answer:

hard to fix unless the location is changed to above the muscle because the tissues now are stretched out and will likely not heal into a smaller pocket. JG 5.31.09

Question:

Iam 11 month post OP. This is my second BA. I switched from saline to silicone. First off, Iam lean and athletic. Bodyfat? Where...lol Anyways my breasts seem stiff in movement. Not jiggily or bouncy. But they ARE SOFT to the touch. I was wondering if Iam tite due to my skin just tite genetically and I didnt have that much breast tissue! OR is it cc. Even tho they are soft? Or are my pockers just too tite

Answer:

likely due to tight skin and maybe a larger size implant, if they are soft, then it is not a capsular contracture, it migth also be that way if they are textured implants as textured implants do not feel as soft as they kind of velcro into place. JG 5.28.09

Question:

How much if any would 100cc effect my bra size? I was wondering beause if I do go up in that do I need to buy all new bras?

Answer:

would likley be able to weer most of your bras still. JG 5.26.09

Question:

Inoticed lil folds underneith inner crease by the cleavage in my silicone implants. You massage it it goes away or somedays its not there? What is this?

Answer:

might be the skin just not draping over the implants properly, hard to say. JG 5.26.09

Question:

Why do breast get a bit fuller during menstration? Is it water? I also noticed that my breast change in size or shape per month. Is ti caused by that?

Answer:

they are getting fuller due to the cells in the breast lobules enlarging in case you get pregnant. JG 5.26.09

Question:

What exactly is Symmastia? IS the cause an implant too wide for ur ribcage? Or a surgical error? How would u know if u can expect to get it

Answer:

both those things contribute to the elevation of the skin over the breastbone in between the breasts, it is not able to be predicted as it should not happen. JG 5.25.09

Question:

When one gets implants, what is the rate of replacement in a life time?

Answer:

20-24%.JG 5.25.09

Question:

Hi DR G:: Can you tell me what is the difference cutting around the top of the areola, and cutting around the bottom? when getting silicon implants. what is the best?

Answer:

usually the cut is done at the bottom to avoid the potential of the scar being more easilly seen. JG 5.21.09

Question:

Dr. Garcia. I know you always say a size is relative. But Iam 5 foot 4 110lbs athletic lean, and 28 ribcage--25 waiste--32 hips I started with a full A--got 500...I think afet 11 month I look small and want to go to 600 HP but my family thinks im big as is since im a petite gal. Do you think mayne they are right and im just self unaware. the 600 are 14 cent in diameter mine are 13.2 in diamerer now. I just want to see if iam just being self unaware...

Answer:

I would not have put the 500`s in for you as I think those are too big for the long term on your frame. JG 5.19.09

Question:

How can you tell if you have thin skin or thick skin? I hear many times some patients have thicker skin. Is there a way to tell

Answer:

no way to tell visually besides in experienced hands, but in general skin thins as it ages, males have thicker skin than females, the oilier your skin is in general, the thicker it is too. JG 5.14.09

Question:

I have a question regarding a maybe vidual complication. Iam 11 month post op and have silicone under the muscle implants. I have nipple placement that are naturally far apart. Well the left implants nipple got to be almost center and the left is not more outward still toward the armpit. It was like that after surgery but no as much since they dropped and fluffed! ALSO--that breast seems more wider and rounder NOT HARD but also the left one thats nipple is centered better is more natural and oblong looking. I wasa told that one of my natural breast cleveage is more rounder and the other has a flatter slope. Wondering if this is the reason. OR a pocket problem

Answer:

can be due to either a pocket issue or the shape of your own breast tissue and muscle to start off with. JG 5.13.09

Question:

Regarding the last question and you bet he put themover my muscle this time around! Is there a way to tell if they are overs? I know he told me along time ago that going over would be horrible on my body since there is no upper breast tissue. Also when its cold out and my chest muscle titens I can feel them press on my implants and it feels weird. Can this be a sign they are still under?

Answer:

well, here is the thing, if he could not put them under the muscle the first time and they were riding high and he kept them under the second time, how can that be. If you cannot place them under the muscle the first time the second time is not magic. If the tissue had softened enough to allow him to place it still below the muscle it would nnot be riding to ohigh. He likely made the pocket bigger, and the only way to make the pocket bigger is going down and to the side where there is no muscle, and when you do that the muscle pushes on the implant and pushes it out from below the muscle. It is hard if you are not experienced to tell the difference. JG 5.12.09

Question:

I have tite skin. My entire family even at the age of 80 have had great skin elasticicy, I have implant and wondered if that plays a role in my future of skin stretching over time with implants...or does that even matter

Answer:

to some degree it might help. JG 5.12.09

Question:

I have a question. Is it possible to get CC in a higher rate from the FIRST initial surgery than the Second by the fact the doctor has to rib the muscle from the ribcage and do more intense work on the body therefore more bleeding and brusing than the second? I remeber my poor doctor coulndt lift my chest musclke and get the implants he basically had to really use his strength to get them to place and couldnt lift them to fit. I was a mess. I was sooo bruised and I had a pain bump and he was so frustrated I remeber when my day of taking the bandages off he looked so upset cuz i was so tite and he couldnt get it rite. he told me he never seen anythinglikeit. OF COURSE hge couldnt make my pockets big enuff to fit the implant so as the year progressed the scar tissue formed allowing my implants no room to move and one eve rode up high. They were sooo horrible. I decided after a year to switch to silicone and this time around they are perfect soft and beautiful. Id never think theyd look so natural. Its been 1.3 years and are still great. I was just wondering if the first is more CapsuleCOntraction related themn the next?

Answer:

that all depends on what is done on the second opeation, more bleeding can lead to higher capsular contracture rate, but that can happen in some second surgeries more than the first. I would be willing to bet he put them on top of the muscle the second surgery. JG 5.12.09

Question:

Dr. Garcia, I wish to go a lil bit bigger. My Doc said no more than 100cc bigger can he fit. Even tho 100cc is around 3.2 oz...is it worth the size change?

Answer:

only you can decide if it is worth it, that is less than one cup size. JG 5.12.09

Question:

Dr. G~ Iam 10 month post op, Iam also have 10% body fat and an athlete. I did have a B cup before argumentation. My doctor said I have tite skin. Tho my implants on my body look nice and feel soft. They do look in an appearnce tite on me unlike womanly ladies with saggier skin and more fat. Is this jusat how iam and always will be or if I gained some dang weight...LOL i may have more cusion? I have silicone and they do look and feel better than my previous saline

Answer:

gaining weight cannot be directed to your chest so the appearance you have might be the way it is going to look due to your anatomical limitations. JG 5.8.09

Question:

Regarding muscle deformaty in lifting with implants ...I have 500 cc under...I DO NOT have this problem but a friend of mine has 300 and she cant even lift without them moving and you can see it.... Why do some people get that and some dont? Is that a surgical error?

Answer:

more likely than a surgical error is that yours are no longer under the muscle, have slipped down lower or elss the muscle was released properly and the size of your implant allowed the muscle to window shade upward after it was released and the muscle is not covering the implant any longer. If the implant is below the muscle there is almost always some animation upon muscle flexion,at least to some degree. JG 5.5.09

Question:

I have a question. Tho Iam already implanted and my PS never or even measures ones breast tissue for proper fit of an impant diameter. Is there a way for me to do this it see if the ones i have are fine or to wide or even can go wider? I dont know if this even matters butmy rib cage is 28 inches. I haad a mid/small B cub and have a 13.2 Diameter impant.

Answer:

your native breast measurements are difficult to obtain now, but if you can feel the edge of the implant now you likely cannot go any larger. By what you are telling me I think you are about at the limit. JG 5.5.09

Question:

HI DR G::: I was wondering is it ok to get lazer, ipl or the like on my chest area when I have implants?

Answer:

OK to do, yes. JG 5.3.09

Question:

Im a big fan of yours! Sorry I had to say that. Regarding my question on why one of my breast is fuller ontop and other teardrop and etc...you said probably the pockets are different one pocket is made bigger than the other. MY question is was this done on purpose? Also if I ever need to go under can the surgeon fix the titer size pocket or just not worth it or can be fixxed?

Answer:

no, not done on purpose, at times the tissue soften more on one side than another and at times some scar tissue can form that will reduce the size of the pocket, that is what capsular contracture is. If it is noticeable the likely best solution would require more surgery to enlarge the smaller pocket. JG 5.1.09

Question:

What causes even after a year, tho they both are soft, one breast is dropped and more teardop and the other seems dropped but more fuller on top and rounder then the other? i think the creases look the same butt off a tad? its been 10 monthS?

Answer:

could be a difference in the size of the pocket that the implant is sitting in, the fuller one likely has a smaller pocket so it pushes the implant up higher. JG 5.1.09

Question:

Hi Dr. Garcia...it`s me again, the girl that had BA on March 5 with 500 cc silicone under muscle. Quick question...how long will it take for me to get the final results of my BA? Its been 2 months already and the implants have dropped quite a bit....doesn`t look like there is room for them to drop more but maybe? Should I still be doing those muscle massages 3 times a day under the breast?

Answer:

maybe another 4 months or so to settle into position. Once the muscles have relaxed we stop the massages. JG 4.30.09

Question:

Hi Dr. Garcia. I posted a question earlier about having a BA on March 5...500 cc under the muscle with small improvement to cup size. The doctor said that my breasts were narrow and tubular and I thought that having the BA done (silicone gel implants) would give my breasts an overall better appearance. At times I look at my breasts and they are still somewhat pointy like a cone. They look really good when the nipples are erected but when not erected they look pointy. Why is this? Is it just my underlying anatomy? What if I decided to go bigger later in the future, say 700 cc. Would that help with the tubularness of the breast? Thank you again.

Answer:

in cases of tubular breasts, there usually needs to be something done to splay the tissues open, this even more so if the implant is placeed below the muscle rather than above it. Going larger without incising into the breast tissue will likely not help, sorry. JG 4.30.09

Question:

Hello Dr. Garcia. I had BA on march 5. I am almost 5`10 about 180 lbs and had 500 cc placed under the muscle. I was told that approx 200 cc was 1 cup size larger. I went from a b to a c only one cup size different. What happened? I was hoping for at least a d and may go under again to go bigger. The results are much better but was expecting a little bigger. Please advice as to why i only went up 1 cup size.

Answer:

well, statements that 200cc will give certain cup size are never accurate and are at best approximations, and going under the muscle tends to flatten the implant so, so that can contribute to it also. I doubt seriously that much of your implant will remain under the muscle and going larger will make them slip from below out even faster, the muscle will not be large enough to accomodate a larger implant. JG 4.30.09

Question:

Hi Dr G, I asked the question earlier about the 2 lumps & you said that it was probably a fold in the implant. Could this be caused by the fact that my PS downsized my implants by 100cc resulting in too much loose skin as he did not perform any breast lift at the same time. I had 2 previous BAs before. Thank you again for your kind advice.

Answer:

actually the opposite, it is more common to feel folds in cases where the pocket is too small for the implant. JG 4.29.09

Question:

I had 2 Ba`s one that was saline $6,300 and Silicone $7,500, same doctor. NOW--I have a friend who had a previous doctor but NOW wants to switch out her SILI and go with my DOC. So when I called and asked them about her and a price quote they quoted me $11,000 for a sili switch for her? UMM WHY SO MUCH? is it raised prices or cuz he has to touch another doctors original work?

Answer:

hard to say, they might be assuming a capsulectomy needs to be done on your friend which is more involved than a straight forward initial breast augmentation, and also you were likely given a discount by your surgeon on the second procedue he was performing for you. JG 4.29.09

Question:

I was wondering, since my PS isnt one to measure ones natural breast tissue if a 14 diameret implant size is tooo wide for me. As of now I have 13.2 diameter with a 28 inch ribcage with a 2.3 finger gap beteween breasts.

Answer:

it might not be possible to go to the larger size without having some degree of malposition. JG 4.29.09

Question:

I have over the muscle textured cohesive gel implants for 15 months. A few weeks ago, I could feel 2 lumps in the upper part of my right breast near the nipple. When I massage it, it seems to disappear, but after a while, it will pop up again. It is not visible but i can feel it under my skin. My PS says that it is just the implant & nothing more can be done. I am not happy with feeling them there. What do you think is causing it and what can be done about it? Thank you for your help.

Answer:

it is liklely the implant, a fold caused by the nature of the material,he is correct, there is likely not much that can be done to permanently eliminate it, sorry. JG 4.29.09

Question:

I reecntly got a new dog chihuahua mix that is about 6 pounds but while playing, his paw and body weight came down on my chest. it hurt kind of bad, even though he doesn`t weight much, it felt very heavy. the claws didnt get me, but i was wondering if the impact could cause implant rupture/deflate? I hope not...

Answer:

do not think so. JG 4.28.09

Question:

Hi DR G. Hey, can you give an idea (approx) of what size implant is the about the best size for someone who has a 29in rib cage? If the implant is moderate gel. At what point (cc) do you think the base diameter would be to wide. I am a small frame, 5`5 and 121lbs.

Answer:

well it is also controled by the diameter of yoru breast tissue you already have, but I think likely somewhere about 300cc or so. JG 4.25.09

Question:

Dr. G Iam 11 months post op...almost a year..YAY. I thought all my changes were done at 9 month. THIS is my SECOND BA so I was stretched skin before. Anyways....I noticed that my implants, which are silicone under the muscle have seemed to be fuller-wider-and more to the sides. Does this mean they dropped and fluffed and iam finally done with the changes. they seem wider where before more narror and a bit higher up?

Answer:

sounds like they have settled, yes. JG 4.23.09

Question:

I have noticed that one of my breast circumference is rounder/wider than the other. Almost different shapes. One is more round and has a nice inner slope. The other is round but there is NO inner slope, more flat on the inner breast than rounds out. No I have implants you can see one is natural and slopes down with a flatter look the other round and has a fuller inner curve. The result....one breast fills out the cup and the other is a 1/2 inch open space in the cup. Is there a way to fix it? I have 500 Sili so I know it is what it is. MAybe thats just how things are but was wondering if u can tell me anything that you think can or cant be fixed?

Answer:

impossible for me to tell without seeing you and the appearance of your breasts before the surgery. JG 4.9.09

Question:

I`ve heard that some women say that their breasts have gotten bigger, after their BA, after they have dropped and fluffed ? Why is this and have you seen this in any of your patients?

Answer:

I do not routinely see that, maybe because the base gets wider, or they gain weight, not sure what has occured in those cases without having more information. JG 4.9.09

Question:

How do you measure to see if you have a small, medium or large body frame?

Answer:

ther is no measurement that says that, it is relative. JG 4.9.09

Question:

How can u tell if your implant is too wide for your frame? I have a 13.2 cent diameer. Iam narrow but wanted to know if i can tell if i hit my max? My doctor doesnt measure your tissue he just looks and tells you what is good or not...

Answer:

well after it is placed, if it sticks out past the edge of yoru breast tissue, it was too big, as to before, your beast tissue is measured and then compared to the chart that lists the implant dimensions. JG 4.9.09

Question:

My PS is very realistic and very brutly honest. I do like that even tho m ost girls dont. Anyways my question is I always read on these Breast Agumentation forums about these woman who get 3 or 4 BA due to size and end up with 600-800 HP silicone implants and still think they are small....When i talk to by doctor mind you I have 500 its a big implant but i dont see how ones body can hold anything bigger and why these girls bodies can handel such large implants....what happens over time woth them also...is it possible for a 600 and up implant to actually keep from not haivng problems in an individual?

Answer:

I think the chances of bad thinsg happening goes up the larger the implant, I try to stay at 450 or smaller if at all possible. JG 4.7.09

Question:

Hi Dr. Garcia, I have had a problem with capsules in the past and recently had some involved dental work. I have read that there has been some correlation with capsules occurring after that kind of dental work. I took antibiotics twice before my recent work (new crowns and filings all within 2 months of each other). Since I unexpectedly needed another crown/possible root canal so quickly within the other work I didn`t take another antibiotic but have noticed tightness on my right side immediately after. Should I take an antibiotic now in case there is any infection going on? Do you think it will stop anything that may be progressing? Thanks for your help.

Answer:

for an infection to cause a capsular contracture would take weeks, so it happening right after is likely a coincidence. Taking it now might not help I am afraid. JG 4.7.09

Question:

Dr. G~ I have a question. I had a previous BA with saline and Iam very lean and athletic. They wer so hard and ball like and round. After a year I switched to Silicone. MUCH BETTER ID SAY.....Its been 9.5 months all is soft and nice but I have noticed they are dropped nicely appear smaller which is expected and well heres my question. Sometimes they look kind of lumpy. NOT ripples. But like where they dropped from a bit lumppy. Sometimes it goes away,. A fried of mine said its because the gel actually after time falls to the bottom part of the bag unlike saline which stays put. Do you find this to be true or is it something else. They are soft and look natural but some months they look lumpy...

Answer:

it is due to the edges of the implant and whatever the fill inside moving around, but saline stays put less than silicone, and they both are constantly moving around within the bag. Might be due to slight less swelling of your own breast tissue during your monthly cycle. JG 4.6.09

Question:

Hi DR G: I`m six weeks BA. My breasts are completely different shapes. Before the implants I could see that they were slightly different, but now it is really noticeable. When implants are settled and all healed to they even out the breast shape?

Answer:

in time they normally balance out more. JG 4.4.09

Question:

Dr.--Do you think. Besides the fact HP implants look fake that they also look smaller? For instance. Lets say a petite girl has 550 HP implants and the girl next to her same exact size with same amount of breast tissue BEFORE an agumentation had 350 MODS--do you think the 350 MODS will perspectivly look BIGGER than the 550 HP girl?

Answer:

they are narrower, that`s for sure with the HP, but size encompasses the volume, so the size is the same. Therefore the 500 will look bigger. JG 4.2.09

Question:

Hi DR G:: I am six weeks post BA. I have a couple of questions. When can I wear a normal bra with under wire? I hear the the under wire can cause permanent indents and deformities ... is this true? Also my nipples are always hard, so they are a little sore. How long before they are back to normal? Is it normal to have hard nipple all the time after a BA? Sorry for all the questions, hope you can help.

Answer:

we allow our patients to wear underwire bras for short periods of time after one month if they are under the muscle, if they are on top, then you can wear it as much as tolerated after 4-6 weeks. Nipple might ake a few more weeks to settle down. Everyone responds differently to the swelling and what you are having is not uncommon. JG 4.1.09

Question:

Dr. G, if my doctor decides I will need a capsulectomy, can I discuss reducing the size of my implants at this time? Would you recommend this for your patient? Thank You!

Answer:

if you desire a smaller size, that would be a good time to consider it being done. JG 4.1.09

Question:

What is considered a narrow chest/ribcage. and what is a large? Like if iam measueng myself what numbers would be considered narrow

Answer:

there are no measurements that determine that, it is all relative. JG 3.31.09

Question:

Why are HP implants considered FAKE looking compaired to MOD plus? what makes them look fake on woman? A petite girl i know has them nd they look nice....or maybe thats just me not knowing what a mod would be in real life

Answer:

because nature does not make a breasts that have that amount of volume with that narrow of a base. It also depends on one`s perception, one person might think they look fake and another might think they look fine, so there is no way to tell because it depends on your personal impression, but in my opinion, they look fake, at least I can usually spot them on a female relatively easily. JG 3.31.09

Question:

Hi Dr. Garcia. Have you ever had a patient go from textured anatomical implants to smooth round ones? I am petite, had no breast tissue and got textured anatomicals under the muscle. Do you think I would see or feel any improvements with smooth rounds - for example, more movement, softer feel, deeper cleavage with smooth silicone High Profiles maybe? Thank you so much!

Answer:

I have seen it and performed it many times, I think it will likely give you a better and more natural appearance. The cleveage will depend greatly on our muscles and the size of your breast bone too, no way to guarantee cleavage, especially if under the muscle. Also, in general, high profile implants I feel look pretty artificial. JG 3.31.09

Question:

Dr. Garcia....I have noticed that my left breast seems to go off to the left armpit OFF CENTER of my chest and my right stays perfectly centered. When I lie down and they flatten the right is perfect byt the left goes to the side off center too. I asked my PS about it and he said that its just how my body`s skin stretches. It is what is it. PLUS he had to center my implant around my nipple and my nipples are not centered the same on my breast. Thats why? What is your opinion on this matter and can this ever be fixed? Thanks Dr. G =)

Answer:

we do need to center the implant behind the nipple so the pocket created for your left implant sounds like it needed to be in a different location on your ribcage than the right. Also, if the tissue stretchs more on one side versus the other, that can also happen. JG 3.31.09

Question:

Dr. GArcia? How can you tell if your breasts are beginning to sag with implants? What are some good [pointers to look out for]..?

Answer:

look for how much of the mound of the implant is above or below the crease underneath the breast. JG 3.31.09

Question:

Dr. Garcia, Is there a way to tell if you have side boob? Mine are a 13.2 cent. diameter on a 28in ribcage. If I put my arms down or like when iam driving I can feel my sides of my breast in my inner bicep. Does this mean that I have a lil side boob? Like my iplnats may be to wide?

Answer:

sure sounds like it. JG 3.31.09

Question:

Is there a way I can stop the lactation? ~Thank you!

Answer:

the cause for the lactation has to be determined by your physician first. JG 316.09

Question:

Dr. Garcia, I posted my question last week regarding the CC that I am experiencing. There is one thing I did not include, from the breast that I am having issued with I noticed that I am lactating. I stopped nursing my son last July/August. Do you think this is a contributing factor to having CC?

Answer:

lactation carries with it more bacteria so it can be contributing to it, yes. JG 3.15.09

Question:

Hello again Dr, you said I will feel the result of Vit E in 2 months and if not then it is not working. My breast condition is firm and maybe just grade II of cc. Can this grade get worse or stay like the way it is? The only way if Vit E not work is to have another redo? is that corect?

Answer:

it can get worse and there are also cases where it will stay like that for long long periods of time, no way to tell. If the Vitamin E does not help I think the only thing is surgery, correct. JG 3.13.09

Question:

I have symmetry breast, right one in more lower by 2cm. I have done my BA. How can I fix this? the 1st before I do my BA my PS sugest me if she can cut and move it the hole thing but Im to scared I will lose the sensitivity of my nipple. Can you sugest what should I do? Thank you.

Answer:

impossible for me to tell without seeing you in person and a breast lift might be indicated, although loss of nipple sensation is rare, not in all cases. JG 3.13.09

Question:

HI DR G* I am three weeks post op BA. I was wondering... my breasts don`t look even at the natural crease line. The right crease line under my breast is lower than the left. I know that the implants drop but how can the crease line move? Also on the left breast, when I raise my arm, running vertical, its like thick tendon (about 5mm) or hard vein pops out across my crease line under my breast and is pulling which is a little painful. Is this normal? what is it? its like a hard piece of string constricting my movement. Could this be causing my left breast to sit higher?

Answer:

all normal, swelling will be different from one side to the other, give it some time and follow up at youe next scheduled appointment with your surgeon. Best of luck. JG 3.12.09

Question:

Thank you for your suggestion of taking the VitE. I hope it works! In the event I need to have surgery, what is the average cost of a capselectomy?

Answer:

you would need to see the surgeon you choose to do that as prices will vary, best of luck. JG 3.12.09

Question:

Hi Dr. Garcia.. I find some firming to hardening touch in my nipple area. This my 2nd BA and at 1st I have cc and I notice that the breast is not droping but it still moving around good just not soft enough. Should I be worry and since my PS didn`t say it is cc?? she only said it`s the musle? Thanks for your time GBU

Answer:

well, thre are degrees of capsular contracture, so it might just be a mild case so far. It can be the muscle too, so just give it some time and see what happens. JG 3.11.09

Question:

Thank`s to reply my question, You suggest that I take Vit E 1000 IU. The one I have /pil is 400 IU if I take it 3 times a day that make it 1200 IU it`s that ok? How long do you thing we can see the result? Have a good day!

Answer:

yes, OK to do. If it is going to work you should feel something after two months, if nothing by then, it will not work. JG 3.12.09

Question:

What would probably bring me to a dd with mod plus unders? My stats are 5`6, 130, ribcage 31, bwd 13, b/c cup. Thank you.

Answer:

hard for me to say without seeing you in person to see the size and pliability of your breast tissue.That is something your surgeon can help you with after an inperson consultation, having said that, it might never be possible without risky issues such as a double bubble, bottoming out, faster ptosis and palpable/visible ridges. JG 3.11.09

Question:

Dr. Garcia, I had a BA Oct `08 and starting experiencing CC in my left breat about 2 months ago. It is very painful and I hate looking at myself in the mirror bc of the visiual difference it has made in my breast. I have been to my PS and he recommends that I wait another month to see how things progress. Is there anything I can do in the interum to help my condition? Thank you for your time.

Answer:

massage and Vitamin E at 1000IU in three divided doses per day is about all. Best of luck. JG 3.10.09

Question:

Dr. G, THis is my second BA...I switched fromsaline to sili...so the sec time around was easier. Skin was already stretched and I was not tite or high in place. They seem to look good from the day the badages were remeoved. Anyways..Iam 8 month and 2 weeks post op. Am I looking at any more changes even tho the only ones I had was that they were more in the pockets and inplace? Alos when implants drop do they go into the pockets and to the sides more than when firts impanted?

Answer:

I think for the most part you are where you are going to be at this point, I would not anticipate more changes to any significant degree. When we say the implants drop, they are already in the pocket but the pocket and skin can stretch in time and give different look as time goes by after the surgery. As they drop they will usually move lower and to the sides, more so if they are under the muslce. JG 3.10.09

Question:

Dr. Garcia Iam a 500 Silicone. Low-mid D cup. If I went an 100 cc more...(which I wont) but just out of curiosity. Would that make me a FULL D or would that just go over the D. Which in that case would be just tooo big anyways. Thanks for everything!

Answer:

would likely be bigger but not more than a D cup. JG 3.10.09

Question:

Dr. Garcia, How much is 50cc relative to size in comparison. For example? A shot glass? 2 ketchup packets? I just want to see if i can visualize what it amounts to in solid gel form?

Answer:

almost two ounces. JG 3.10.09

Question:

Dr. Garcia. I know one cant guarentee any cup-sizes. Can you tell me from your experince the round about cup size you think i will achieve with 500cc Iam 5 foot4 110lbs 28inch ribcage petite gal. Iam starting with a very full A.

Answer:

c-d, maybe. JG 3.9.09

Question:

HI DR G::: I had breast enlargement surgery 2 and half weeks ago. When I massage one of my breast breasts it squeaks and makes a dull popping sound at times. It feels like it is rubbing on my chests bone? Anyway is this normal? will it go away? also that breast looks a little square - will the shape smooth out with massaging? please help.

Answer:

all normal and that all goes away over the first 4-6 weeks. The shape also takes time to settle in, just give it some more time. Massage is good. JG 3.7.09

Question:

My stats are 5`6 , 130, ribcage 31, bwd 13 , small c. About what size can I expect from having 475 filled to 520, mod plus implant unders?

Answer:

maybe a d cup. JG 3.6.09

Question:

Hallo again Doctor. I have my 1st BA on the 17 april 2008 and have hardening cc then I have my redo on the 7 nov 09, both my implants in smooth implants. Recently my lefty is become firmer and now is getting just a bit hard. My PS aks me to do ultrasound which I find out is not working. I believe I get cc again. I will see my PS next week. My question is do you think I shoud changes the implants with texture? and if my rib size is 28cm can I go over 430cc in medium profile? I like my size now but dont like from a side it doesnt look full, how can I get that look? thank you so much

Answer:

I am sorry but I do not thnk using textured implants will make much of a difference. JG 3.5.09

Question:

Hi I’m scheduled for breast augmentation this month. There is one thing though I can’t decide on a size. I’m 25 years old a little over 5`7 110 lbs and 34-a. I tried on 325cc with the doctor said would make me a 350cc total. Then I tried on a 350cc witch would make me a 375cc. right? Well I really like the bigger ones I’m really afraid that they will be too big. But I don’t want to have this all done and wish that they were bigger. What’s better for me? And my size?

Answer:

impossible for me to tell without seeing you and the other thing is that in order to minimize long term complications, you cannot always go as big as you want, the controling issue is the width of your breast. Having said that, 25 cc is a very small amount, less than one ounce, so I would not lose too much sleep between a 350 and a 375. JG 3.3.09

Question:

Hi Dr Garcia I am Scheduled to have an open capsulotomy on my left breast only what is the recovery time and when can I resume walking. I walk 5 days a week now?

Answer:

light duty typically in two weeks, full activity in 4-6, we allow walking in a jog bra after about 10 days or so. JG 3.3.09

Question:

Hello Dr. Garcia. About 3 weeks ago I had 400cc (hp-silicone) implant placed in the left breast and 375cc (hp-silicone gel) placed in my right breast. I barely filled a 34 A bra before and that was with my right breast. I just wanted to be a 34C cup and now I am deathly afraid that I`m going to be a D cup or larger. The doctor told me to wait 3 months before doing anything because I still have swelling (under the muscle placement). I feel huge but everyone says I look good not big at all-which makes me feel better. I want them to shrink even more. I am 5`7 120-125 pounds. I have become obsessed with them shrinking! Just wanted your expert opinion. Thank you!

Answer:

I still think you have lots of swelling at this point, give it some time. JG 3.2.09

Question:

hi dr. i had BA over a year ago, i noticed that one of my breasts feels so nautral but the other you can actually feel the implant bending while i bend i feel it right under my skin,feels like the skin is not thick enough to cover it.why is that and what can my doctor do?

Answer:

not much the doctor can do to thicken the skin, it might be aggravated due to some element of capsular contracture that is causing it to fold more. Might need the pocket made larger but that will not make it less palpable. JG 2.26.09

Question:

Dr., I am now 8 days post op from my BA surgery, my right side breast is swollen and my left side is not. It (the right side) looks like it is about 30% larger than the left. It has been the same size for about 4 days now. When should I expect the swelling to go down? I`m concerned because the left side has no swelling already but the right side is still swollen. It is not getting worst but it is not getting better. There is no pain but it feels tighter because of the swelling. I emailed my surgeon and he didn`t seem too concerned but I wanted to ask you Should I be worried? What can I do to help the swelling go down faster?

Answer:

should start seeing it go down starting the next few days. I do think you should see youe surgeon though. I suggest alternating some warm and then cold packs too. JG 2.25.09

Question:

I had surgery for breast agumentation approximately 10 days ago. As part of the surgery I had a slight nipple left to even out the position of my nipples. The doctor used dissovleable stiches, and covered the stiches with strips. It felt like the stiches on my nipple had dissolved so I started to peel away a little bit of the strip around my nipple. However, when I got to the area, I noticed that the skin hadn`t quite completely sealed. Only a little bit of blood escaped, so I doubt its somethine that requires stiches, but I`m concerned that my scaring will be worse because of this. What can I do? Should I go to my doctor?

Answer:

call the doctor and go see them so they can put some new steristrips on, in the meantime just cover it with Neosporin and a bandaid. JG 2.24.09

Question:

what is the reason my doctor says not to use an underwire bra for at least 6 months after my BA?

Answer:

to let the tissues relax and allow the impalnt to settle into proper position. JG 2.23.09

Question:

Hi Dr., I am 5 days post op from my second BA surgery. one of my breast is bigger than the other, could this still be swelling? How long before most of the swelling will be gone so i`ll know when to start worring that the one side is bigger

Answer:

could be swelling, but if the difference is getting bigger over time I suggest seeing your surgeon ASAP to make sure you do not have a hematoma that needs to be drained. JG 2.22.09

Question:

I was told that my breasts are very narrow and tubular and that it would be difficult, not impossible, to put a large implant in. Why would that be? I`m a small b cup and have had 2 children and have breastfed and pumped in the past so my breasts have stretched a little. The surgeon said he thinks he`ll be able to put in a max of 400 cc. What is your opinion on this? When i was being measured for size I liked the 500-600cc size mainly b/c I`m a big girl and I think I can handle a lot of volume. Thanks!

Answer:

it is because of the limitations of your underlying anatomy. If you put too large of an implant in, then the breast tissue you have will not properly drape over the implant and it will not look good. You cannot always get what you want I am afraid. JG 2.21.09

Question:

Hello Dr. Garcia. I am scheduled to have BA in a few weeks. My surgeon asked me if I wanted to get a pain pump. It sounded pretty appealing. He said I would go home with it and I would feel absolutely no pain b/c the meds are constantly being given into my body. However, he did tell me that maybe 1 out of 5 patients get it, it`s about $400 extra dollars and it is another outlet for infection. I don`t want to contribute to a possible infection but I also don`t wanna be in a lot of pain. What are your recommendations? He prescribed me oxycodone and propoxyphene. Do you think the oral meds will be enough to keep the pain down and to keep me comfy? Thank you!

Answer:

I have used them, they do help decrease the pain but it does not remove it all, but reduces it so you are more comfortable. In most cases the pain pills are enough though. JG 2.21.09

Question:

I just had my 3rd capsulectomy. I finally got new implants put in (rather than reusing the old ones) and switched from saline to silicone. I never had palpable or visible rippling with my saline. Now I have both with my silicone unders. It`s pretty bad as you can see the vertical lines of the implant folds when I stand naked and in the cleavage area there is a spot on each breast where the implant pokes through showing a bump. When I have on a bra pushing everything together it`s not noticable. Will this get better, I`m 2 weeks post.

Answer:

I am afriad not, it might get worse, unless you get a capsular contracture again and then that might hide the ripples. JG 2.20.09

Question:

So its been 8 month after my silicone BA. Right after the 6 month mark i totally forgot these were implants. Im amazed how they seem so real. Is it just because iam used to them or is it because they are settled now and conformed to me. IT amazes me....

Answer:

just normal healing, glad all is well. JG 2.20.09

Question:

TOPIC-large implants. I recently read on all these girl getting implants anywhere from 600-800 silicone. WHY? Why, does this seem so common. Even tho iam a petite girl I cant imagine how a large implant can effect ones body over time. Especially a runner of weight lifter. I myself have implants and well its been 2 years since mine and i have a relaitive big size not THAT BIG...but i wonder why a woman wants them. In your years of experience what have you seen in the effects of a larger implant over the years due to a woman. I mean a woman with lil no breast tissue with 600 and up? Also what is a large size implant in terms o consier. Like 400 and up?

Answer:

what is considered large is a relative term, as to larger implants, in my expereicne of over 21 years in the field, the larger the implants the higher the chance of problems. As to why they want them, that answer will vary from person to person too. JG 2.20.09

Question:

Dr. Garcia, Iam 110 lbs. 5 foot 4...31 inch hips 28in rib cage 24 inche waist. Im small boned athletic petite. I recieved 500 HP implants. Diameter 13.2 projection 5.3....I got Silicone due to low body fat and looks more natural than my previosu saline. Anyways...WHY DO I WANT TO GO BIGGER? Its driving me nuts. I mean they are considered a big size but to me they dont seem big at all. I see girls bigger boned than me taller wioder with smaller implants and they seem big. I even schedule an appointment with my PS to talk me on this. Do you feel my implants are large size for me and going bigger is just in my head? what advice would you tell me if i was your patient?

Answer:

if you were my patient I would not place any larger than what you already have in. I likely would have not even put in an implant as big as you have the first time around either. JG 2.11.09

Question:

I am 14 months post op. am very happy with BA. ocasionally i have sharp pains in either breast. my breasts are not hard. they are silicone, axillary, over the muscle, 400 and 425 cc. the pains will be moederatly painful coming and going for a day or two then go away right in the middle of my breast. PS is out of state and i have my 1 year check up next month, i am a little late. the pain got worse this weekend. is this normal so long post op ?

Answer:

still can be normal, usually it is just the tissue stretching. Cdeefox

Question:

Hello Dr. Garcia. I am seriously considering Breast Augmentation. As a matter of fact I had a consultation on Friday and was excited to get the ball rolling however, I am really afraid of the After surgery pain. I know that the meds they give me will help but for some reason that post surgery pain is all I can think of. I know you don`t personally know what the pain is like but from the patients you`ve done in the past, what have you noticed? I had jaw surgery several years ago where they broke my jaw in 4 places to reposition it and I figured that would probably be more painful than BA, right? At least with BA they aren`t breaking any bones. Is there anything you can tell me to make me feel more comfy with proceeding with BA? Thank you so much for all of your help!

Answer:

I think the breast augmentation pain will be less than your jaw surgery, in my experiences, even with patients with low pain tolerance the pain pills are good enough to control it. I have used pulsed magnets for post op pain along wiht pain pumps that infuse local anesthesia for a few days too, they also help. Best of luck. JG 2.9.08

Question:

I had my breast augmentation about 4 weeks ago....I had the crease incision...And my question is, Will the scar smooth out in time?? It is not noticebly thick, but when I feel it, it feels thick. I know it is the tissue that was cut. Just wondering will it always be thick like this? Or smmoth out in time?

Answer:

yes, you are just feeling the sutures that are below the skin that have yet to dissolve, but they will in time. JG 2.9.08

Question:

Iam 7.5 month post op! Everything seemed the same till this morning! I have silicone. All day yesterdaay I felt that my left breast the smaller one was loose and felt less high up! This morning I looked in the mirror and it changed! It`s loose softer fluffier full and BIGGER than my tight which was always the biggest! Now my question is why now after 7.5 months I see this dramastic change and will my right change too? They are both soft so no cc! I`m just in shock how that happened!

Answer:

hard to explain it from the surgery or the implants this far out, I suggest you see the surgeon for an inperson evalaution. JG 2.7.09

Question:

Regarding my loose feeling implant. I know you said things may be getting jsut softer or a break/leak in implant, Iam 8 months out from NEW silicone. So i cant beleive its be a rupture since they feel all nice. To me thee feeling is that the implant settled more into a pocket. Like it was higher up and now feels a bit lower. Can they drop and settle a lil more after 8 months....

Answer:

yes, it can happen in some cases. JG 2.6.09

Question:

Dr. This is driving me crazy. Some days my breast seem bigger and fuller some days tighter and appear smaller. Its been a year so no its not swelling. I do have them completly under my muscle...is there any explination for this? I know somedays my bra feels titer or looser...its insane

Answer:

hard for me to say, it should not be related to the implants this far out as surgical swelling should be all gone. JG 2.6.09

Question:

Dr. G--I love my BA but want to go a bit larger. Not to much maybe a 100cc just for fullness. Do you think i should wait a few years before really deciding. Again my instinct is to let it be (Iam 32) so i have a lifetime to change since if i decide to have kids i can do it after then. Do you feel iam on the right track?

Answer:

I woudl leave it alone. JG 2.6.09

Question:

Dr. G--My left implant feels very soft and loose. I cant really explain but it basically feels like a part of my skin like it meshes. It didnt feel like that 3 weeks ago. I freaked because i thought my implant wasnt there...lol. Why does my left one feel soooo loose and part of me suddenly? what happened?

Answer:

might just be that things got softer, it also could mean the implant ruptured if it is silicone, if it is saline you would know if it broke because you would slowly get smaller from your body absorbing the saline but the body does not absorb the silicone. JG 2.6.09

Question:

What changes if any, in appearance wise after 8 months will my silicone implants be? Now--this is not my first BA so I hardly had swelling or that drop n fluff for my pockets were already made and skin stretched. Iam 8 months next week. Would they get smaller or am I done? Thanks Dr. G!

Answer:

I think they might feel sofer, but size should not change much at this point. JG 2.6.09

Question:

Hello Dr, I have my 1st BA April 19th 2007 under mussle and had a capsular hardening on right one and slightly on the left too. So on Nov 7th 2008 I have redo capselotumy on both, everything was fine until around 2 weeks ago my lefty is bit firm, its still moving around ok as I use PIP smooth silicon but its firm, when I massage it is going soft then someime go back to firm again so I have to constanly massage it. What do you thing it is? another cc? I went to my surgeon to check up, she agree with me and reffer me to ulatrasound. Do you thing it could be just a spam muslle? how do I know if go back to cc again? Thanks Dr for your kind answer..

Answer:

well, it could be muscle spasms, but also it sounds like they used the same implant as the first time as PIP implants, at least here in the US, are no longer sold. Using a new implant when dooing a capsulectomy for capsular contratcure is a good idea to lessen the chances of the capsule coming back. I hope it is just muscle spasms in your case, otherwise it will be a recurrence of the capsule. JG 2.6.09

Question:

Hello Dr. Garcia. I am seriously considering breast augmentation. I have a friend that had BA several years ago and she says that she massages her breasts every night to keep them from getting hard and to keep them feeling natural. With Breast implants, is it necessary to massage them every night so they don`t get hard?

Answer:

that is somethng that was suggested to be done back in the 80`s, long term follow up has not shown to it make much of a difference past the first 6 weeks when the tissues need to heal in a larger pocket. I think your friend has not developed a capsule not because of the massage but just due to the way she reacts to the silicone envelope. After that, the massage likely does not affect the avoidance of capsular contracture. JG 2.5.09

Question:

I`m on the verge of having my 3rd BA surgery 18months. The 1st surgery 11/07 375 silicon high profile under the muscle I got a surgical infection in the right breast. One month later the breast was riding too high on my chest and was very hard. The left breast also started to get hard obviously a capsular contracture. On 7/08 implants removed w/capsulecotmy and replaced w/425 high profile silicon Two weeks after surgery i have a flat spot under the nipple of the right breast and a ball of scar tissue. I started the ultrasound on the right breast which did help the ball of scar tissue. The breast are getting hard again probably a baker grade III. Question is do I switch to saline, try a silicon textured,or try the alloderm placed over the implants. How expensive is alloderm

Answer:

well, the Alloderm I do not think will help anything that is going on, I do not think that recurrent capsular contracture will be different between silicone and saline implants. I am afriad you might be one of those small number of patients that cannot tolerate foreign materials and you might have to have the implant removed and left out. I am sorry. JG 2.4.09

Question:

Good morning Dr. Garcia: I had 450 cc Saline smooth round implanted on 1/29. From reading so much info online, it would seem I will lose 50 cc during the dropping phase. While looking at implants in the consultation, I was not the smallest D but the next to smallest which was a 450 cc implant. When asked what capacity the doctor filled to, I was told 450. Can you confirm based on my height 5`8, 155 pounds being a 36b barely , if I will be a 36C -full C, D or DD? Also feel zipping and zapping sensations mainly under nipple..what are those?? Incision was armpit..Seem to be recovering fine..tomorrow is 1 wk post op. Thanks for offering this service.

Answer:

predicting cup size is very difficult at is varies on your breast dimensions and also the manufacturer of the brasierre. The sensations under your nipple are also normal, they will get better in time. All the best. JG 2.3.09

Question:

hi Doc im 23 yrs old i hd breast feed for 7months so my breast sags and looks so ugly now and now i decided to hd breast augmentation i was scheduled on feb.9 2009 and my doctor advised me to hve periola incision at d same time he is going to do breast lift also but my worries is that im a keloid patient do u thnk if hell revise the scar and put steroid it will help?and for how long time before i see the best result or the normal result?any risks or side effect?and wht is better implant soft or smooth?thnks a lot

Answer:

well, keloids can happen, especially in lift scars, injections of steroids can help at times but do not work all of the time. Usually most of the healing is done 6 mnths after the surgery but subtle changes can occur for up to one year. I prefer smooth implants as I feel they leak less. Best of luck. JG 2.3.09

Question:

I am very fair skinned...I had breast enlargement 3 weeks ago...I love my breast!!But i am so embarrassed to show anyone cause the veins in my breast look like some one drew on me with a blue pen. They are very visible, and I do not tan. Is there any other way other than tanning to cover them OR a safe procedure i can have done to get rid of them??

Answer:

as the swelling goes down they should get better slowly. Tanning might help, yes. JG 2.2.09

Question:

I have a small problem...I had breast enlargement on the 8th, and on the 15th he took my stitches out and applied steri strips. He told me to wear them ttil they fell off. They are getting dingy and I am worried my incision may get infected. I cant find steri srips at any of our local store wal-mart or walgreens. Do suggest anything else I can put on my crease incision?? One is about to fall off and my incision is only half scabbed. Is it ok to go with nothing on the incision?? Thanks

Answer:

no worries, just remove them and if the area is tender, wear a little gauze on it under your bra. You can leave the incision dry at this time if you wish. JG 2.1.09

Question:

Hello...I had my Breast enlargement 23 days ago...I have been wearing a sports bra 24/7 except when showering. My doc said I could start wearing a bra if I wanted them to stay up with a little more cleavage..Or continue to wear the sports bra til my 6 weeks is up if I want them to look more natural...I dont mind wearing the sports bra, but when I go out I would like to wear a bra, cause the sports bra makes me look flat. Not sure what kind of bra is ok this early post op. Is underwire or no underwire best???push up or no push up...I Just want to wear a regular bra occasionally. I will cont. to wear my sports bra and sleep in it for the remainder of my 6 weeks...Thanks for any advise you have !

Answer:

well, that recommendation will vary from surgeon to surgeon, I think at this point if you wear a push up bra for a short period of time, it will likely not make a big difference though. JG 1.31.09

Question:

Hello Dr Garcia, i am new to this blog but happy I found it. I have some questions about my year old BA. I have been very happy with my results. My doctor was double board certified but retired right before my year check up. I am hoping everything is ok. Since the BA i have super sensation in my nipples which is fine because before i had little. I have saline implants under the muscle. I went from a barley A size to a BIG C size. Lately i have been having really bad back pain (i am 5`3 105 pounds) and my right breast seems to have sharp shooting pains periodically.If i hold my breast it seems to go away. I was scared maybe my husband popped them from laying on me but everything i have read says that if they had erupted then i would notice immediately. I was told that some weight was ok by my doctor so i am wondering if he hurt me or the implant. I hope you can help me by the description i have given you. Thanks so much. Amie

Answer:

I think the pain in your breast can be due to the nerves exiting from the ribcage that course through your breast being stretched and causing the pain, that is why when you support it, it feels better. I do not think you have popped anything. All the best. JG 1.30.09

Question:

Dr. Garcia. When I went to my 3 month follow up my doctor was VERY PLEASED with my results all were pefecto. He then said there was no more need to see me. Just come back in your year follow up all is great. Well according to his nurses I have a 6 month this month. Tho all to me is PERFECT...should I go ahead and see him for the 6month like it states in my contract with him> Im afraid he will get mad if I see him and he told me there was no need till my follow up in a year? Would you get mad at a patient if she came in for a check up?

Answer:

if all looks fine, I think I would just wait for your one year follow up. If you have any questions or concerns then I think it appropriate to see him sooner. JG 1.30.09

Question:

I had breast augmentation (crease incision) and the incision is underneath, and not visible when I look in the mirror.But it is not in the fold crease.As the breast drop will the incision move more toward the crease???How long do breast usually drop? I had my surgery 3 weeks ago. and my breast are still a little high and firm.

Answer:

as the breast drops, in fact the incision might appear higher up on the breast. JG 1.30.09

Question:

Hi Dr. Garcia, Thank you so much for your honest reply to my previous question. I just had my breast aug. revision last week. The surgeon opened me up under the breast and opened up the pocket on the outside of my breast. This was an attempt to get the implant to move out a bit (move towards the armpit). This was done because I had developed a small degree of synmastia. The nurse has suggested that I use a rolled up piece of gauze inbetween my breasts, for separation as well as to get the area of synmastia to heal itself. Is this REALLY going to work ? The surgeon did NOT do any internal suturing of this area. Not sure why he opted not to, when he had me opened up for my revision..... Please give me some guidance,as to what I can reasonably expect from the revision. And what ever other recommendation you can make regarding the synmastia. Thanks again. ~M.L.

Answer:

I think if the space that was opened near the breast bone is not closed with sutures tha the degree of the implant moving over to that area again will not change and the degree of synmastia you have will not change. That medial pocket needs to be sutured closed and the external pressure applied in conjunction, essentially nonstop for at least 6 weeks. Best of luck. JG 1.28.09

Question:

I had my surgery on the 8th, and I was wondering if it is too soon to get on my elliptical? If so, can i atleast go walking? i feel like I am gaining weight sitting around healing. I know the healing is very important, but is their anything I can do...Squats, flutter kicks, leg excercises, or sit up crunches??

Answer:

it depends on what surgery you had done, I think it best to ask your surgeon to be safe. They can tell you what you are able to do in their practice. JG 1.27.09

Question:

Hi again, thank you for answering my question yesterday about possible cc again in my left breast. I use smooth implant PIP and it seems to move around OK how could it be cc? what can I do if it is cc? because is so early can the ultrasound fix it? I dont want to go to another surgery again!

Answer:

well, if it is under the muscle it could also be just muscle spasm, very hard to say without knwoing all of the information and also examining you. I think the evidence for ultrasound treating capsular contracture is not well documented yet as to its effectiveness. I think it best to see your surgeon as they knwo your tissues best and see what they say. JG 1.27.09

Question:

Hi, Dr. Garcia. I had BA 25 years ago (I am now 49) that resulted in symastia. I am 5`2 and 101 lbs. If I remember correctly, I was told the implant was a bag of silicone encased by a second bag of saline and placed under the muscle. From what I`ve read and photos I`ve seen, mine is a milder case as my breasts look normal when standing with arms to the side,but they come together when I lean over or push my breasts together (low-cut is not an option for me). The implants also fall toward my armpits when I lie down. I would like to have a revision surgery but have heard that it is complicated, expensive, and the condition often recurs. Do you know the approximate cost of correcting this condition? Do you perform this surgery or is it very specialized? I`ve lived with this for a long time. Thanks in advance for your response.

Answer:

I do not perform that surgery any longer but can refer you to other surgeons in town that do perform it, prices are not cheap and the chances of it recurring are there, but as long as a reasonable size implant is chosen, it should be able to be controlled. JG 1.27.09

Question:

Hi Doctor, I have my cc redo about 9 weeks ago. My surgeon changes the both of implant. My lefty now is a bit firm than the other, it is soft but it`s not as soft than the right breast. I wonder why it doing this? I notice it become soft after I massage and lay on the floor. I have hardening on my right and slightly on the left too. Can you teel me what is the matter now..? is not cc right because is soft and look just normal like the right one. Thank you..

Answer:

well, capsualar contracture forms slowly, so if it is not muscle spasms, then it migtht be recurrent capsular contracture at least partially reforming. JG 1.26.09

Question:

The only way I can describe the feeling I am having on my breast is that, it kind of feels like it does when you have a sunburn...But I can asure you they are not sunburned...Is this normal after breast enlargement, maybe cause the skin is stretching? I have had them done 2 in a half weeks and they are just starting to feel this way...Thanks

Answer:

it is normal from the irritation of the nerves in the area. You might not have felt it before as the nerves were not working as well yet. Typically nothing to worry about. JG 1.26.09

Question:

HI Dr. Garcia! Have you ever heard of silicone implants causing breakout on the chest? if so what can help?

Answer:

have not seen that happen related to the silicone implants, no. JG 1.24.09

Question:

I had my breast enlargement surgery on the 8th...Then seven days after, I went back to have my stitches taken out, and the dr put on some surgery like tape over the incicion. He didnt tell me when to take it off. I have showered everyday, and it is still on. How long do I need to leave this on? My incisions kind of feel like scabs? I called and left this question on his voice mail, but have not heard back from him. Should I leave them on till they come off or take them off? they have been on for 11 days now....Thanks

Answer:

those are called steri strips and I suggest you leave them on until the fall off, all normal. JG 1.25.09

Question:

I had breast implants placed submuscular 2 weeks ago...I didnt seem as big as i was expecting. My PS says that as they drop, they will look fuller. Is that so? I have heard different things?????

Answer:

the muscles when tight can make them look flatter and as the muscle relaxes they obtain a rounder fuller shape. JG 1.24.09

Question:

hello Im a AA cup and like to get breast enlargement only to give it a nice shape. I want to get the smallest implant. What is the smallest implant? and are the complications less with smaller implants? my friends tell me its too expensive for the maintenance... is this true... i hear you need to change them every 7-8 years.... true? or false? and with the implants can i chose the shape...? teardrop...e.g what is the best shape for a small chested girl? and what implant is best and safe?

Answer:

I believe the smallest implant generally available is 180cc. There is no maintanence unless you get a silicone implant which is suggested to be checked with an MRI scan every three years. If they are not broken, there is no need to exchange them. I personally prefer the round implants as they look tear drop while standing and round while lying, which is the normal change. JG 1.24.09

Question:

HI DR, OK, THE DR I SAW TWO DAYS AGO GOT TO SPEAK TO MY DR IN MY FORMER LOCATION AND EXPLAINED TO HIM WHAT HE THOUGHT OF THE BUMP ON MY LEFT FOLD. I SPOKE TO MY DR TODAY AND HE WAS VERY CALM (ANNOYINGLY, BUT I THINK HE DOES IT SO I WILL NOT FREAK OUT)AND TOLD ME THAT I SHOULD NOT WORRY, BUT WAIT AND SEE WHAT HAPPENS, THAT THE BUMP WILL NOT COME DOWN,THAT MY HEALTH IS NOT IN DANGER, ETC.I KNOW I AM NOT IN DANGER, I JUST WANT TO KEEP LOOKING SYMETRICAL, NATURAL AND NICE. HE IS IN COLOMBIA AND KNOWS THAT I WILL BE VISITING MY FAMILY IN C.A. IN A COUPLE OF WEEKS. HE ASKED ME IF I COULD MAKE A DETOUR IN COLOMBIA SO HE COULD SEE ME. OF COURSE I WILL, I WOULD GO EVEN IF I HAD NOT PLANNED A TRIP. HE WILL BE GETTING MY PICTURES TODAY, BUT STILL WANTS TO SEE ME PERSONALLY. YOU SAID THAT DIASTOSIS DE LOS MUSCULOS WAS NOT BOTTOMING OUT. SHOULD I FEEL CALMER THAT APPARENTLY I HAVE THAT INSTEAD OF B.OUT..OR DOES THE FIRST LEAD TO THE SECOND? CAN YOU PLEASE EXPLAIN THE DIFFERENCE AND THE PROGNOSIS OR TREATMENT?

Answer:

I think you need to relax, wait until you see him and then decide in conjunction with him what is the best thing to do. If the muscles have weakened it is not always that you bottom out as that is more controlled by the skin. JG 1.24.09

Question:

HI DR. IF SILICONE IMPLANTS RUPTURE, WILL IT BE DIFFICULT TO REMOVE? IS SILICONE OR SALINE SOFTER WHEN YOU TOUCH THE BREAST? AND DOES SALINE RIPPLE MORE THAN SILICONE? THANK YOU.

Answer:

if it is still contained by the capsule that forms around the implant after the surgery it can be removed pretty well. Silicone does feel a little more natrual, more so when placed above the muscle, compared to saline, below the muscle the differences are small I feel. They both ripple but saline does ripple more than silicone. JG 1.23.09

Question:

Hi Dr., I am having a BA done in Feb. and I was all set to go with Silicone implants but yesterday I got some brochures and was reading it and it says I would need to get a MRI every year to make sure the implants aren’t leaking. My question is: if I know now that I won`t be able to afford MRI`s regularly in the future, is it still a good idea to use silicone? Also I read that if silicone leaks it can migrate to other parts of your body and even into your limp nodes. Is this a common occurrence? I still have maybe 50 years of life to go, with this amount of time is it inevitable that it will leak and migrate in my body someday (since I cant afford regular MRI`s)? Thank you for your time

Answer:

the MRI is accurate for silicone implant rupture but is recommended every three years. The only way the silicone can migrate is locally if the capsule is torn, it is not something that becomes clinically significant. JG 1.23.09

Question:

Is it common 15 days after breast enlargment surgery during the dropping process, for one to seem larger than the other? how long will they continue to drop?

Answer:

all normal, how long they drop depends on whether they are above or below the muscle and also on your skin tightness before the surgery and the size of the pocket made. They might continue to drop for months, although it will not progress quickly after 6 weeks, after that it will be slow. JG 1.23.09

Question:

Hi, I had a BA six weeks ago and all seems fine. I`m just wondering if there is anything to do to preserve them for as long as possible ie any exercises,moisturizers etc? Also do you think I should still wear a sports bra in bed? Ive just started to wear a normal bra during the day.

Answer:

I do not think there is anything external you can do to maintian them except avoid large weight fluctuations, try wearing a good support bra when jogging and no need to wear it at night either. JG 1.23.09

Question:

HI DR, WELL, I GOT TO SEE A DR. ABOUT THE BUBBLE ON MY LEFT FOLD. FIRST OF ALL HE TOLD ME THAT MY IMPLANTS LOOK AMAZING. WHEN I SHOWED HIM WHAT WORRIED ME, HE TOLD ME APPARENTLY THE IMPLANT HAD COME THROUGH THE TISSUE. I DO ALL MY RESEARCH IN ENGLISH (EVEN THOUGH SPANISH IS MY NATIVE TONGUE), SO I ASKED HIM IF IT SEEMED TO HIM LIKE IT WAS BOTTOMING OUT. HE DOES NOT KNOW THAT TERM IN ENGLISH, HE TOLD ME IT LOOKED LIKE DIASTOSIS DE LOS MUSCULOS . IS IT BOTTOMING OUT? HE TOLD ME THERE IS NO WAY TO KNOW HOW IT IS GOING TO BEHAVE, THAT I COULD WAIT IT OUT OR FIX IT, THAT HE DID NOT FEEL THAT PERMANENTLY WEARING A BRA WOULD FIX IT...STOP IT AT BEST. I TOLD HIM I HAD READ THAT IT IS FIXED THROUGH THE FOLD, BUT HE TOLD ME THAT WOULD LEAVE ANOTHER SCAR, THAT HE FAVORED GOING IN THROUGH THE AUREOLA, TAKING THE IMPLANT OUT, STITCHING AND PUTTING THE IMPLANT BACK. BUT I AM NOT READY TO DO ANYTHING YET. HE TOOK PICTURES WHICH HE WILL SEND TO MY SURGEON. I FEEL BUMMED OUT. I TOLD MY HUSBAND (HE HAS REALLY NOT NOTICED ANYTHING) AND HE ALSO FEELS BUMMED OUT. WHAT SHOULD I DOOOOOO?

Answer:

diastosis de los musculos is a splitting of the muscle, a weakness of the muscles that is allowing it to pooch through, it is not bottoming out though. I would just give it some time and see what happens and not do anything for now. JG 1.22.09

Question:

Dr. Garcia, I reas allot on forums about girls with BAD infections leading to implant removal or decaying tissue. I also read about bottoming out BAD symastia....or two different breast pockets making themnot right. Do you feel MOST of these are surgical error or just how ones body is?

Answer:

some of it is bad tissues, some of it is surgical misadventure, no 100% on that I am afraid. JG 1.22.09

Question:

HI DOCTOR, THERE IS A PROBLEM...I CANNOT GET TO THE MOST RECENT Q & A ABOUT BREAST AUG. I CLICK ON IT AND IT SHOWS ME ENTRIES UP TO THE 19...I COULD GET IN TODAY FOR A MOMENT AND SAW YOU HAD ANSWERED MY QUESTION YESTERDAY...BUT IT IS NOT WORKING ANYMORE

Answer:

not sure why , let me look into it. JG 1.22.09

Question:

HI DR,ABOUT THE BUBBLE/BUMP ON MY FOLD, WHICH IS DRIVING ME CRAZY WITH WORRY, I GET WHAT YOU SAID ABOUT THE BRA (A NON-SURGICAL,LET´S WAIT AND SEE OPTION),...I READ IT SHOULD ALSO BE PADDED...IS IT RIGHT? HOW LONG TILL IT IS KNOWN THAT IT HELPED AND I AM OUT OF THE WOODS? I WILL BE ABLE TO SEE A DR. TOMORROW...I HOPE I AM FINE BECAUSE I AM FAR AWAY FROM EVERYTHING FAMILIAR AND I DON´T WANT A ZILLION PEOPLE OPERATING ON ME AND MAKING THINGS WORSE. I´LL PRAY REALLY HARD SO IT IS NOT THE INNITIAL STAGE OF BOTTOMING OUT. THANKS FOR EVERYTHING...I´LL LET YOU KNOW WHAT THE DOCTOR´S ASSESSMENT IS.

Answer:

padding would be good and if it gets better with that, then after 6-8 weeks you should be out of the woods if you wear it that long. All the best. JG 1.22.09

Question:

Dr. Garcia, I had BA 10 months ago with silicone under the muscle through the armpit. My left breast feels fien,but my right one is a little hard from scar tissue. I really don`t want surgery unless have to. Will it get worse? Melissa

Answer:

if it is capsular contracture, it might get worse with time, if it is due to a pocket that is just not large enough, then no. Either one will need surgery to fix though. If it is muscle spasms, it might get softer over the next few months, might want to speak with your surgeon and see what is going on. JG 1.21.09

Question:

I am wondering about the use of Alloderm to re-enforce a persons skin and wheiter or not plastic surgeons could use it to help with rippling. I got 375cc mentor smooth round medium profile implants under the muscle for my re-do and have visible rippling in the left crease . I have a little in the right crease but it can only be felt, not seen. I find my implants quite large but went this size at my doctors recomendation. Started with a very small A-cup with hardly any breast tissue and very light, thin skin. So I wonder if it is possible to use Alloderm to cover the implants more fully and reduce the visible rippling. Thank you

Answer:

it has been used and reported on, initially it looks quite good, but long term results show little improvements, so after 6-12 months you are back to where you were. JG 1.21.09

Question:

I had my surgery about 13 days ago.And My breast have dropped a little and look awesome when I am undressed...But in clothes I cant really tell,they look like they did before with a padded bra on...Is this cause of the sports bra that I am having to wear maybe? Once they drop completly and I can wear normal bras will they look fuller and better in clothes. I went from a very flat small b to a full c. Silicone, submuscular placement, if that helps any.......

Answer:

yes, that is because of the bra and also, you might now look like you did in a padded bra before, but now, if you wear a padded bra again, you would look alot bigger. The muscle tends to flatten them out for awhile and in time they will look rounder, fuller and have more projection. JG 1.21.09

Question:

HI DOCTOR! COULD YOU TELL ME WHAT CAUSES RIPPLING? IS IT ONE SPECIFIC SIUATION OR DOES IT JUST OCCUR AT RANDOM?

Answer:

all breast implants ripple, it is seen in patients with thinner skin more than on patients with thicker skin and more fat and tissue below the skin. It happens because of the structure of the implant and how it is filled. JG 1.21.09

Question:

I had breast enlargement done...Placed partial under the muscle...He told me to do these exercises for 15 minutes~3 times per day...Like drawing circles with my elbows...Do you have your patients do these exercises? Can it help prevent capsule contracture? Or is it just to help open the pocket ? It seems to make me kind of sore after doing the excersices, is that common? Thank you!

Answer:

we do direct pressure on the implants but there are lots of ways to get the muscles to relax and allow the implant to settle into position. I think it will not do anything long term to prevent capsular contracture though. It is to keep the pocket open for the first 6 weeks or so is all. JG 1.20.09

Question:

ok...I am probably driving you crazy with questions...I had my breast enlargement on the 8th~(12 days ago). And my breast are tender to the touch, firm, and numb...Is this normal after 12 days? How long can these symptoms last? I am terrified of getting capsule contracture...I know these are signs of that...Is it too soon to worry? thanks!

Answer:

all normal at this point, yes. Capsules biologically cannot form for about 6 weeks, so that is not the problem. All normal healing.Hang in there. JG 1.20.09

Question:

HI DOCTOR, ABOUT THE LITTLE BUBBLE/BUMPO ON THE FOLD OF MY BREAST, I HAVE MADE AN APPOINTMENT IN MY NEW LOCATION FOR A DOCTOR TO EVALUATE ME IN A WEEK. YOUR SUGGESTION ABOUT AN UNDERWIRE BRA (I AM WILLING TO DO IT 24/7!IF IT IS EFFECTIVE!)TO MAKE SCAR TISSUE AROUND THE WEAKNESS, DOES IT REALLY WORK...OR IS IT ONE OF THOSE LAST NOT-SO-SUCCESSFUL TRIES TO SOLVE AN UNSOLVABLE PROBLEM? I REALLY LIKE THE WAY MY SURGERY TURNED OUT, I JUST WANT THAT BUMP GONE! PLEASE BE HONEST!!!! AS ALWAYS, THANKS A MILLION....IF I LIVED CLOSE TO VEGAS, YOU WOULD SOOO BE MY SURGEON....BUT I AM SOOOOO FAR AWAY, A CONTINENT AWAY!!!!!

Answer:

it might help, no way to tell, but it is at least something that might help with no surgery. Best of luck and keep me posted. JG 1.20.09

Question:

I had breast enlargement this month...and now that I am a full c, my veins are very visible, like blue lines all over both breasts...Is this just because I am swollen and they have not dropped yet? They were placed submuscular. Also I am fair skinned, could that be why? will this get better in time? is there anything that can help?

Answer:

it is part of the swelling and in most cases they go away with time, but it might take months. Fair skinned people see the blue veins easier, yes. JG 1.19.09

Question:

Greetings from Canada Dr. Garcia! Prior to my BA I was a deflated A cup. At my consultation I told my PS that all I wanted was a conservative B cup - to replace what I lost in pregnancy/breastfeeding. We settled on the Inamed Style 410 implants, 280grams - 12cm width, 11.7 height and 4.4cm projection. I am now measuring a D cup (way too big for me) and I also find them to be too firm. I believe that it is the somewhat higher overall profile of these implants that give more bang for the buck with these implants. For my downsize re-do, we have settled on the Mentor Round Moderate Profile Silicone implants - 200ccs, 11.7 diameter with 2.5cm projection. Although I`m only going down 80ccs/grams, will the difference in projection give me a the noticeable/visible decrease in size that I`m hoping for? Also, will these Mentor Round Silicones be softer than the Gummy Anatomicals? Thanks in Advance.

Answer:

I think what you have chosen will give you a more natural appearance and they will feel much softer than the gummy bears, yes. All the best. JG 1.18.09

Question:

is it normal for my breast to feel numb(the only way to describe it)I had my breast enlargement surgery 7 days ago...will this get better in time?

Answer:

yes, normal and will get better in time. JG 1.16.09

Question:

Is it common for breast to feel kind of numb...will this get better in time? I had my surgery 7 days ago and am just wondering...

Answer:

all normal and will get bettter with time, yes. JG 1.16.09

Question:

I had my breast enlargement surgery 7 days ago, on Jan 8th...I was suppose to start my period on that day,which the dr said would be no problem..But I have still not started. Is it possible that the surgery could cause me to get a little off track with my menstral. Or should I see a obgyn asap, or give it some time??I also was under alot of stress before my surgery...Thank you for your input.

Answer:

actually, very common, the sterss and the medications can cause that. I would wait until next month, and on the outside chance, might want to get a pregnancy test although it is doubtful as most surgicenters check that prior to surgery. JG 1.15.09

Question:

If ones ribcage is 28 inches what diameter is too big..as a rule a thumb? like is 14cm to big. even tho i do know that u have to go with the size of ur natural breast tissue

Answer:

yes, I would likely stay with about a 12 cm diamter implant. JG 1.11.09

Question:

Yes, it would be a 100c in a different Silicone implant..not in Saline but in a Siliocne bag. How come you said it will visually see a difference in size but not in cup? Would they just look fuller in my bra but i willstill be the same size with 100cc? Also after 7 months do ones Breast implants change much? This isnt my first BA btw, so my skin and pockets were made

Answer:

might look a little fuller, all depends on how much breast tissue you have and the size of the implants now. The changes after 7 months are small I feel. I personally would try to talk you out of the exchange to try to limit future problems with sagging or ripples. JG 1.11.09

Question:

HI, DOCTOR! I HAVE A QUESTION: IT´S BEEN ALMOST 3 MONTHS SINCE MY BREAST AUGMENTATION AND THE LITTLE BUBBLE I FELT ON MY LEFT BREAST (ON THE FOLD, ON THE OUTER SIDE) IS NOT GONE. IF I STAND UP REALLY STRAIGHT IT SEEMS LIKE MY LEFT BREAST IS A LITTLE LOWER ON THAT AREA. IF I RUN MY FINGER LIGHTLY UNDER MY RIGHT BREAST, IT FEELS EVEN AND ROUND FROM CORNER TO CORNER. IF I DO IT ON THE LEFT ONE, A LITTLE BUMP CAN BE FELT ON THAT AREA. THE TRUTH IS IT REALLY NOT NOTICEABLE TO UNLESS YOU SCRUTINIZE BOTH BREAST,BUT I NOTICE IT. I KNOW IT IS THE IMPLANT BECAUSE I CAN FEEL IT. I ASKED YOU ABOUT THIS WEEKS AGO BEACAUSE I WAS WORRIED ABOUT BOTTOMING OUT. YOU SAID THAT IT WOULD LIKELY NOT BE ON ONLY THAT AREA, BUT THE WHOLE BOTTOM OF THE BREAST. THEN WHY DOES THAT HAPPEN? SHOULD I JUST GET USED TO IT? WILL IT GO AWAY? WILL IT GET WORSE? IT DOES NOT SEEM TO BE GOING AWAY.

Answer:

if it is a small area and the rest of the tissue is not doing the same thing then the implant should not bottom out. I suggest wearing an underwire bra as much as possible at this point and hopefully the small area of tissue weakness you feel where the implant bubbles through will scar in and make it less palpable. Best of luck. JG 1.10.09

Question:

Would you do surgery on a patient that is on their menstral??I am about to start my period any day now, and my breast are very sore as usual around this time. And my surgery is tomorrow. Do you think it is safe to still have the surgery during my menstral cycle?

Answer:

some doctors feel patients bleed more easily when on their cycle and try not to operate at that time but I have never found it to be any differEnce myself. I thiNk it is likely safe, yes. JG 1.7.09

Question:

I have 2 questions....First, Am I going to risk infection in my breast everytime I get sick, even with colds???Also is capsule contracture only fixed with surgery, or can it be dealt with other ways???

Answer:

no, colds are usually a virus and they will not infect the breast implant. In my experience the only way to reliably treat the capsule is with surgery. JG 1.7.09

Question:

Hi Dr G, I have my redo capsuletomy about 8 weeks ago. At the moment in my right breast around the cleavege is feeling a bit sore after massage, I ask my surgeon about that and she said is because the mussle around it has been lift. I was having hardening and the look on my right breast is not nice at all. What do you thing about that Dr G? Cheers..

Answer:

I think it is to soon to tell, and without knowing exactly what was done during the surgery, I cannot tell much. I think at this point things are stil helaing though and I suggest giving it some time to let it heal and soften so more. Best of luck. JG 1.7.09

Question:

Thank you...Well, I dont have an antibiotic now..But I start one right after my surgery and they give antibiotic during surgery...How long should i wait after surgery to get the tooth pulled? Do I have to wait 6 weeks? Or can I do it as soon as I am feeling ok? I will be starting an antibiotic with my surgery..Is that ok? Or what should I do...I only have 2 days?

Answer:

Ideally 6 weeks if possible. As long as the tooth is not infected you can start the antibiotics at the time of surgery. JG 1.5.09

Question:

Dr. G....Some girl told me silicone looks smaller than saline once implanted. MEaning if I had 400 cc saline and wanted to switch to silicone id have to get 450-500 to make them look similar. My suregeon kinda said the same thing. Whats your take?

Answer:

if the shape and dimension of the bag is the same, then it will make no difference. JG 1.6.09

Question:

I am having breast augmentation on Thursday...2 days away!! And all of a sudden one of my wisdom teeth on the bottom is trying to come through AGAIN..I dont want to put my surgery off. I would like to go ahead with my surgery and then get my tooth pulled. My dentist can cut it out without putting me to sleep...What is your opinion, and how long after my surgery could I have my dental work done???I would really like to know your opinion...Thanks so much!!And I wish you a blessed New Year!

Answer:

well, as long as you are on antibiotics starting now and until the tooth is removed and for at least one day after, it is likely OK, the risk would be infection. Best of luck. JG 1.6.09

Question:

Hi, happy new years. 2 1/2 months ago I had TUBA navel breast augmentation surgery to avoid scarring. Am very dissapointed to realize that I ended up with not only visible track marks, but very hard internal tissue scaring. I honestly don`t mind the hardness of the internal tissue, my dilemma is the visible v track mark. They are giving me pinches of steroid shots that after talking to my primary doctor says pinches of steroids is okay, I know it`s to diminish or lessen the harden tissue of my TUBA surgery. Now my main concern is the visible v track marks, they tell me it will go away, is this true? as mentioned it`s been 2 1/2 months and they have only gave me those steroid pinch shot twice in the v track tissue marks, but is the visibility of the v track going to go away? Am assuming my PS didn`t go deep enough of my skin layer to do this incision, but now this would contradict my decision to have a navel breast implant surgery since I got it so they would be NO visible scarring, so again will my v track marks go away externally?

Answer:

in most cases the V tracks get better but they do not always go away. It can take months for them to get better, even with the shots. The navel approach has as many problems as all other techniques, as to the hardness, it most likely is due to an inadequate size pocket being made at the time if surgery by the surgoen, that might need surgery in the future to correct. The navel technique also invalidates the warranty the companies offer if the implant were to leak, sorry to tell you all that. JG 1.4.09

Question:

Dr. Garcia, Thanks soo much for having a site like this. You are a gem to help everyone of us. I have a question, I have had 2 BA thus far. Iam now 6.5 months out frommy second...switched from saline to silicone and noticed the same problem (if it is a problem) as my previous set and wondered if my surgeon didnt see it before it must just be the way my body is and live with it. One breast is fuller and more up and out and the other is a bit natural looking and has a more natural slope and basically looks like a different size boob. I do not have CC cuz they are soft as butter and bounce. But i do know it is either just how my two boobs are naturally are mis shapped or maybe a pocket? either way should i bring it to his attentions?

Answer:

It is likely the difference in the pockets, the more natrual one having a larger pocket, your surgeon should be able to see that. Might just need the one pocket made larger. JG 1.4.09

Question:

What kind of implants are used to add more at bottom of breast. I know some doctors of porn stars have put a regular round implant along with a second half circle shaped implant at bottom of breast to make it fuller there. I know doctors are not supposed to do that. So, what kind of implant do you suggest to add more volume at bottom of breast?

Answer:

might use an anatomical shaped textured implant. JG 1.2.09

Question:

Not sure if it went threw.. # Dr. G, I need some advice since you see many woman for breast agumentation. Okay...so I had 2! First one was saline and my body is just soo lean and athletic ..(fitness competitor) my PS suggested Silicone but at the time was scared went with saline. BAD choice a year later we switched to SILICONE....GOOD choice...but the size is just god not flattering to my body. its 500 HIGH PROFILE...I feel too narrow. Iam petite tho. So here it goes....I want to redo it...YES AGAIN...tho I will wait another year because i just want to be sure. Im thinking Moderate plus or moderate 400 or 450..because it seems the HP is just tooo there on my bony chest. As a surgeon would you think this patient is just plain crazy for these redos. Or can you understand her goal isnt met in what she wants. I feel bad keep redoing them but its a big learning experiance. Do you feel its something thats wise to do or just leave it as is and learn that a BA isnt ever going to be what you want and be happy with what you have...?

Answer:

well, I think the regular profile will be the most natural option, and if you are not happy with the appearance and there is something that can be done, then I think it is reasonable to do it. Not sure why they went with a 500 high profile to begin with.JG 1.2.09

Question:

I think the reason he went with the 500 HP! Is because i wanted to go bigger and iam soo narrow the only way id see a cahnge in appearance is to go up 150 in what i had....so he felt that left me with 500 and im a tiny girl he said HP! But they look fine in clothing just odd because i dont have fatty chest tissue to make it look good. Id rather go smaller and in mod plus or mod..why do surgeons hate HP? ODo you ever use them/?

Answer:

I never use them, they look too fake for my liking. JG 1.2.09

Question:

Dr. G, I need some advice since you see many woman for breast agumentation. Okay...so I had 2! First one was saline and my body is just soo lean and athletic ..(fitness competitor) my PS suggested Silicone but at the time was scared went with saline. BAD choice a year later we switched to SILICONE....GOOD choice...but the size is just god not flattering to my body. its 500 HIGH PROFILE...I feel too narrow. Iam petite tho. So here it goes....I want to redo it...YES AGAIN...tho I will wait another year because i just want to be sure. Im thinking Moderate plus or moderate 400 or 450..because it seems the HP is just tooo there on my bony chest. As a surgeon would you think this patient is just plain crazy for these redos. Or can you understand her goal isnt met in what she wants. I feel bad keep redoing them but its a big learning experiance. Do you feel its something thats wise to do or just leave it as is and learn that a BA isnt ever going to be what you want and be happy with what you have...?

Answer:

would go with the regular profile for the most natural appearance. JG 1.2.09

Question:

Is is normal for my nipples to be still sensitive after 6 months I had the BAM (enlarged)

Answer:

can happen, not usual, but can happen. JG 12.31.08

Question:

not sure if my questiom posted...I have never tried a ask question site???Is it possoble to get a 400cc silicone gel implant into a small incision in the areola? I am a 34b and wanting a full c/small d...Just nervous the thought of a large implant going through such a small incision.How do yall do that? thanks

Answer:

yes, usually is possible. The silicone implant is compressable. JG 12.30.08

Question:

I am having my surgery very soon and I am still not sure of the incision that I want...The dr recommended areola...But my worry is, How is he going to get about 400cc silicone gel implants into that little incision..I dont want to ask him or him to think I doubt his recommendation...How does that work? Putting such a large implant into such a small incision? thank you!

Answer:

the silicone implants are compressable and can fit though normal sized incisions. JG 12.30.08

Question:

Is there a way to tell if your implants are toooo narrow? Mine are 13.2 cent. My ribcage is 28? I guess i just think they are but is taht considered a narrow implant ?

Answer:

I am afraid narrow is a relative term. JG 12.30.08

Question:

I have had multiple redo`s on my L. breast for various reasons. Each time the incision was made through the nipple. I think I have scar tissue as a result. My nipple on the bottom part seems to `indent`, and there is also an indentation that runs slightly into part of the breast. The breast overall is very soft, but this area (the size of a quarter) is tight and slightly hard. I am not going through with another surgery to repair this. What are the best options for treating scar tissue in other ways? (Massage/ultrasound etc)

Answer:

I think both massage and ultrasound will help if relatively recent, but if time has passed it might not help much, would not hurt to try it though. JG 12.30.08

Question:

HI DR GARCIA! NO QUESTIONS THIS TIME....I JUST WANT TO WISH YOU THE BEST IN YOUR JOB, HEALTH AND FAMILY LIFE FOR THE NEW YEAR. AS ALWAYS ,THANKS FOR TAKING THE TIME TO ANSWER ALL OUR QUESTIONS!!!

Answer:

it is my pleasure and the best to you for the New Year. JG 12.30.08

Question:

Oh, one more thing. Do you think its worth (If can be doone) To fix the lil off center nipple and diff size breasts even tho everything is perfect as in complocations and softnesss? Or suck it up and live with it.

Answer:

I would leave it alone, the scars around the areola will likely not be worth the surgery. Merry Christmas and Happy New Year. JG 12.27.08

Question:

I have a question. Iam on my 2nd ba. Switched to Silicone. Much better on my lean body. Everything is great its been 6 months. I tend not to look at them tooooo much because i dont want to find any problems that really arent there and become tooo critical. But I did. Just like my first with saline. I noticed symmetry issues. NOW i know my doctor doesnt fix that he jsut puts in a size and makes you a bigger you. Unless your sizes are way of and diformed. Mine maybe one is way fuller and fills out one cup and other noticablre smaller. Is there a way one can have this fixed? Even if my docotor doesnt fix that? Also I know one centers the implant around the nipple but mine were never centered more to the sides. Once implanted one is more centered and the other is off to my armpit and if i literaalt push my breast to center it it looks good. Can this be fixed and how? I konw my docotr told me the only way is to remove my nipple and recenter it? ummmm I rather keep my nipples off center then. Just curious on your take on my off--symmetry with silicone and the nipple issue. They both look like TWO different sizes in a bra and mirror.... Happy New Year Dr. G

Answer:

not sure, might need different size implants to correct that problem. Closing the pocket that was made and getting it to stay closed can be very difficult. Hard to comment more without seeing you in person. Merry Christmas and Happy New Year. JG 12.27.08

Question:

what can cause a low-grade fever that can cause cc?

Answer:

resolving accumulation of blood or a low grade infection. Merry Christmas and Happy New Year. JG 12.27.08

Question:

Is it common to have a breast augmentation scar one and half inches above the breast fold line? Or are most incisions right on the fold line? Did the doctor mess up if it is not on the fold line?

Answer:

usually the incison is placed in the fold and in some cases with downward migration of the implant the scar appears like they rose up. Its is not the doctor`s fault, it is the way the implant settled. Merry Christmas and Happy New Year. JG 12.27.08

Question:

Dr. G if one doesnt have Capsular contraction and gets a redo to go BIGGER can she make her risks higher to get it? Someone told me the FIRST sugery is where its most high due to bleeding and if you get a redo and just switch out implants and make the pocket to fit its not as bad a the first? is this true regarding CC...or is it just a catch 22?

Answer:

well, if you are going larger the risks are the same because the pocket has to be made larger, if it just an exchange and no treatment of the capsule, it might be a little smaller but it is a low grade infection and not bleeding that is the major cause of capsular contracture and that can happen years later. Merry Christmas and Happy New Year. JG 12.27.08

Question:

I have a question that Iam tring to be logical about. I wanted to go bigger in my BA! Iam 31 years old no children yet but do you think i should wait till AFTER I HAVE kids to go under to go bigger or doesnt that matter? Im, not going to breast feed for personal reasons but would haviong kids change my tissue and should wait till iam threw?

Answer:

yes, without a doubt, wait until you are done having all of the children. Merry Christmas and Happy New Year. JG 12.27.08

Question:

HELLO DR! I HAD BREAST SURGERY NINE WEEKS AGO. ABOUT FIVE DAYS AGO I NOTICED THAT WHEN I TENSE MY PECTORAL MUSCLES THE INCISION SIGHT ON THE THE BOTTOM MY RIGHT AUREOLA TAKES ON A WEIRD SHAPE,IT KIND OF CAVES IN A LITTLE, LIKE IF SOMETHING IS PULLING IT FROM INSIDE. THE OTHER SIDE DOES NOT DO THAT, IT MOVES UP, STAYS ROUND, AND MOVES DOWN. WHAT CAN THIS BE? DWHAT CAN BE DONE TO SOLVE IT?

Answer:

it is just scar tissue that is adherent and massage and time should make it all get better. Merry Christmas and Happy New Year. JG 12.27.08

Question:

My wife had Mentor saline implants used for her breast implants and they came out incredible and we have had no problems. Now my daughter is getting saline breast implants as well but the same Dr. is now using Natrelle brand implants. Are these as good as Mentor brand? Do I have any concerns?

Answer:

no concerns, they are good implants made by Allergan. JG 12.23.08

Question:

what exactly is side boob? What does it look like n how do I know if I do or do not have it?

Answer:

it is when an implant that is too large is placed and the impalnt hangs out past the side of the ribcage. If you look at yourself in the mirror with your hands slightly away from your body and the mound of the implant goes out past the ribcage, or if from the same pose someone can see the implants when looking at you from behind, they are hanging out. JG 12.18.08

Question:

I was wondering! Since my PS doesnt measure ones breast tissue to find a perfect diameter for ones body if u could help since I`m doing this solo. i have a 28 inch ribcage with a natural inch space between by breasts! I don`t have breasts close together nor far apart, so just inbetween. I`m a narrow gal, petite! Small hips like. 29-30 inch hips. Is a implant 14 cm toooo wide for me?

Answer:

I think so, more like 12.5 to 13. JG 12.18.08

Question:

hola dr.garcia mi nombre es maybel garcia tengo 22 anos me gustaria saver cuanto me puede costar un levantamiento del vusto

Answer:

aproximada $7500. JG 12.16.08

Question:

Dr. Garcia, I was reading some post omn a girl who kept getting infections and her crease incision would never heal or close and always get infected... is that a wrong doing of a surgeon? Or is that just the breaks some people can gentically get. It sounded really scary. Ive had 2 BA`s and healed AMAZINGLY....Can this happen to me even tho I was fine the last two times. It just was sooo scary...

Answer:

well, in most cases it is due to an infection around the implant that will not allow the incision to heal and it will likely require the implant to be removed for a period of a few months and then replaced for it to heal and close. It can happen anytime you have another surgery, but it is rare. JG 12.12.08

Question:

Hi Dr, I have 430cc in each breast but why is it the left breast seem to be fuller thatn the right? but if you look it from the photo`s I take the right one is the one look bigger..is that because the way I breast feeding always dominan the left one?

Answer:

it can be due to the amount of breast tissue you had to start with, it can be due to some element of scar tissue pushing and shaping the implant differently, it can be due to the pocket that was created at the time of surgery being uneven, or healing unevenly. JG 12.11.08

Question:

HELLO DR, I UNDERSTAND WHAT YOU EXPLAINED ABOUT REMOVING THE INTERNAL STITCHES TRHOUGH A NICK. YESTERDAY I SPOKE TO MY SURGEON AND HE TOLD ME THEY ARE NOT PERMANENT, THAT I SHOULD WAIT (IT HAS BEEN 6 WEEKS)TILL THEY DISSOLVE OR COME OUT, THAT I SHOULD NOT WORRY. TODAY I PULLED OUT OF BOTH BREAST A TINY, TINY PIECE OF SUTURE. IT WAS REALLY WEIRD KNOWING THAT COTTON-LIKE THREAD WAS INSIDE OF ME! ANYWAY, IT WAS TOO TINY...SHOULD I EXPECT MORE TO COME OUT OF THE SAME PLACE OR FOR THEM TO SURFACE SOMEWHERE ELSE? WILL THE TINY HOLES THEY CAME OUT OF CLOSE TOTALLY?

Answer:

likely more will pop through on their own in time. The tiny holes will close on their own. JG 12.10.08

Question:

thank you for your reply regarding the 2 weeks post op symmastia repair. How would you know you have torn a stitch? As I am not starting to use my arms to reach slightly. As I was reaching for somthing yesterday I felt a slight tingle in my left breast where the symmastia was repaired. As I still have some swelling and discomfort. How would one know if a stitch has been torn or just the muscles healing? Thanks !

Answer:

there is no good way to tell, until and unless the repair fails and the implants move back to the undesired position. Sorry. JG 12.10.08

Question:

HI DR, ABOUT THAT NICK YOU SAY IS A SMALL INCISION.....IS IT UNDER SOME KIND OF ANESTHESIA? DOES THE DR WHO CARRIES IT OUT CLOSE IT WITH STITCHES?

Answer:

can be done under local anesthesia and usually a small suture is placed to close the skin JG 12.8.08

Question:

HI DR, ABOUT INTERNAL SUTURES AROUND THE AREOLA, HOW LONG DOES ONE HAVE TO WAIT TILL THEY DISSOLVE? A COUPLE OF MONTHS....MORE? WHAT IF 3 OR 4 MONTHS GO BY AND THEY CAN STILL BE FELT AND DID NOT COME TO THE SURFACE?

Answer:

how long they take to dissolve depends on what type of sutures the surgeon used, could be weeks to months, and at times they use permanent ones. If they begin to bother you they can always be cut out with a small nick over the bump. JG 12.8.08

Question:

HI DR, ABOUT INTERNAL SUTURES, YOU SAID SOMETHING ABOUT PERMANENT SUTURES...DOES THAT MEAN THEY DO NOT DISSOLVE? THEY JUST STAY THERE? IT´S BEEN 6 WEEKS SINCE MY SURGERY AND I CAN STILL FEEL LIKE A ROPE ALONG THE INCISION SIGHT AND IN ONE SIDE AVEN A LITTLE BUMP. SINCE I CANNOT GO TO MY SURGEON BECAUSE I MOVED, WHAT SHOULD I DO? SHOULD I GO SEE A SURGEON TO HAVE HIM EVALUATE MY PROGRESS SOON OR SHOULD I GIVE MY BODY MORE TIME TO DO ITS THING? AND.....WHEN YOU MENTIONED REMOVING THEM THROUGH A NICK ....WHAT DOES THAT MEAN?

Answer:

permanent sutures do not dissolve, correct. I think requesting your records from the original surgeon and going to see a surgoen in your new location would be the thing to do. Making a nick is a very small cut and then removing the knot and the suture. JG 12.8.08

Question:

HELLO DR. GARCIA, HOW LONG DO WOMEN HAVE TO WAIT TO SLEEP ON THEIR SIDE AND FACE DOWN AFTER BREAST IMPLANT SURGERY?

Answer:

on their side about 2 weeks, and face down about 1 month. JG 12.8.08

Question:

Dr. Garcia, Why do internal sutures around the areola become hard after breast implant surgery. Is it common? What can be done to soften them? Or is it just a matter of time until the skin becomes soft to the touch again?

Answer:

it is common becasue the tissue is quite thin so they are easy to feel. Usually they dissolve or come to the surface and can be removed. JG 12.8.08

Question:

JG 12.7.08Dear Doctor I have my capsuletomy about 4 weeks ago in my right breast. Today I felt pain in my lower part of that breast, it`s kind of sore and sharp pain. I have 2 younger kids and I start picking them up gently about 3 weeks as my PS told me I can start lifting them up during that time. What do you thing the pain from..? It`s felt good tho when I massage it but I`m worry it could be something else? My husband tell me to take a mussle recovery because he thing is the mussle. Can you help me with that one please..? The breast it`s very soft tho.. thank you so much..

Answer:

I think the pain is just stretching of the tissues as they are stil tight. I do not think it is anything to worry about, all part of the normal healing process. JG 12.7.08

Question:

Question, Okay, Im going to try to explain what I need help with. I have noticed that my inner LOWER crease on my left breat where it hits the middle sternum is not curved like the other. Meaning instead of a nice SWOOSH in the inner lower crease the silicone implant seems to indent in so it looks more tirnagular? Is this because my docter didnt or couldnt lift my chest muscle any closer so basically stuffed it in?

Answer:

it most likely is due to the way the pocket that was opened healed and closed off. JG 12.4.08

Question:

Either My imgaination and this is all in my head, but do Breast change from month to month...maybe its the womans cycle, maybe its water retention. But iam 5.5 months after my SECOND BA..which there wasnt that much swelling andno dropping....I feel that some weeks my breasts are full and bigger and some days they seem smaller? Is this possible. Even the shape changes as in rounder and fluffier to titer and more un rounder....but then it goes back to fluffy..etc...i have under the muscle by the way and am an avid weight lifter....

Answer:

bereast size and turgor can change with menstrual cycles, yes. JG 12.1.08

Question:

HELLO, DR. GARCIA. I UNDERSTAND THAT AFTER BREAST AUG SURGERY, AT TIMES NIPPLE SENSATION TAKES A FEW WEEKS OR MONTHS TO RETURN. IN WHAT PERCENTAGE OF CASES IS IT PERMANENTLY LOST?

Answer:

can vary from 1-5%. JG 11.26.08

Question:

Hello, doctor. I am a little confused about the type of bra one should use 4 or 5 weeks after augmentation surgery. Should it be a normal bra (not the sports kind? Can it have an underwire? I ask this because information varies...some say you can´t wear underwires until 3 months post op, others say it is fine after 4 or 6 weeks.

Answer:

at that point in time we allow a normal bra, we allow an underwire bra for a few hours but not for extended periods of time, especially if the implants were placed below the muscle. JG 11.25.08

Question:

Hi Doctor Garcia, sorry to bother you again, but I really did´t understand your answer to my question about bottoming out. You explained the initial signs and the only thing I see in me is that tiny bubble still in the same place..not bigger or smaller...nothing matches the description of the symptoms. So my question was, do you think I can rule out bottoming out?

Answer:

yes, I think you can, it would not happen in one small area like that, it would be the whole width of the implant from side to side. JG 11.25.08

Question:

Hi Dr. Garcia. More or less how long after breast implant surgery does one know there will be no cc, rippling...or any other complication?

Answer:

well as to infection, usually a few weeks, but as to rippling and capsular contracture, I am afraid never. JG 11.25.08

Question:

HI Dr. Garcia. Thanks so mucho for your prompt response. I asked you a couple of days ago about a tini buble I have noticed since the third week after my surgery. It is located on the fold of my left breast. You told me it would get better with time, but I was just afraid it could be bottoming out. Now I see that what you explaines about the initial stages is not the way my body is behaving. Do you think I can rule out bottoming out?

Answer:

I honestly doubt it. JG 11.25.08

Question:

Hi Dr. Garcia, I received implants nine months ago and my PS has a revision policy that provides I am responsible for the OR and the anesthesiologist within the first year....which is totally fine. I called the PS at two monts post op with complaint about asymmetry and wierd cleavage and they told me I needed to wait at least six months to see how they settle. Now at nine months, they are still recognizably different sizes and the cleavage is still wierd . I also feel that the size I look like is very different than the pictures I showed the PS given that my frame is different than the models (larger) and feel he should have advised me larger given this. I want to go back in and get them enlarged more, have the asymmetry corrected as well as the cleavage issue. My PS is wanting to charge me almost double the amount I paid for my first BA, citing that revisions are only performed at the rates in my contract if medically necessary. It does not stipulate any medical necessity in my contracts only that revisions may need to be done to obtain optimal results and will be performed as needed. What are my rights here? I feel they should be charging me the revision fees and not almost double what I initally paid. Please help with your advice. Thank you!

Answer:

well, there are no rules on this issue, it is between your surgoen and you, the revision might be covered if it is only the cleavage issue and you forgo the size change. JG 11.25.08

Question:

Hello Dr. Garcia. How commong is bottoming out and what are the inicial signs patients should look for?

Answer:

it is not common, more common in thin skinned patients with large implants, especially ones that are very active like running. The first thing you usually see is that the skin between the nipple and the inframammary crease starts to stretch out. JG 11.24.08

Question:

Hi, Dr. Garcia. Aproximately how long does it take periaureolar breast augmentation scars to become softer to the touch?

Answer:

6 weeks to 6 months, it varies widely. JG 11.24.08

Question:

Hi, Dr. Garcia. Aproximately how long does it take periaureolar breast augmentation scars to become softer to the touch?

Answer:

6 weeks to 6 months, it will vary widely. JG 11.24.08

Question:

I am going to have to have a third redo for capsular contracture. I have always used the same saline implants and will now try brand NEW silicone implants with a capsulectomy again. My PS wants to use textured as theoretically they are better for CC. Personally I don`t think the research is strong enough and it seems textured have more complications. Do you find textured implants ARE better for CC? What negatives do textured have that smooth don`t? Any info. appreciated. Thank you

Answer:

I think the scientific proof for less capsular contacture with textured implants is almost non-existent but I will say that a new set is certainly a much better idea than using the same ones due to the potential development of an infected biofilm around the old implants that can contribute to the recurrence. I also think textured implants leak more as they fold repetitively again and again in the same area if the texturing really does adhere. Best of luck. JG 11.23.08

Question:

Hi Doctor G, I have my redo on the Nov 7 because of cc hardening when my scar tissue push implants up and make funny shape in the cleavege area(they kind of square instead of normal shape) the op went well only o the day 5 I start having tinggling pain in the cleavege area and now at day 15 it start to become slightly square again. My PC not just clean the hole scar, she make my poket bigger too this time. I`am so affraid that I have develope cc again.. what do you thing Doc..? Thank you so much..

Answer:

well, if the capsule was entirely removed or at least aggressively removed, it is early for scar tissue capsular contracture to form again, I would give it some time and not get too worried just yet. JG 11.22.08

Question:

Hello Dr. Garcia, I need your best educated guess if you will share it with me. I am going for my first BA and have decided I want a nice D cup. My current bra size is 36B. I am 5`8 and weigh 165 lbs. my ribcage is 33 and my breast width is 5 each. My doctor recommends a 575cc moderate silicone implant under the muscle. Does this sound too big or do you think I will be in a nice D cup without overflowing. My fear is going too big and looking too fake and I definitely dont want bigger than a D cup. Thanks for any input.

Answer:

I do not think the footprint of the implant chosen will be properly covered by the footprint of your native breast tissue, and it might hang out and give you visible ripples or a possible double bubble issue, I would likely not go that large. JG 11.20.08

Question:

Hallo Doctor, I have a question: How many time a day you will advise your patient to massage they breast after OP?

Answer:

once or twice per day for the fisrt 4-6 weeks is enough if it is needed. JG 11.20.08

Question:

HELLO DR! 25 DAYS AGO I GOT MY 340 GRAM HIGH PROFILE SILICONE IMPLANTS REPLACED FOR 500 GRAM MEDIUM PROFILE IMPLANTS. TWO WEEKS AFTER MY SURGERY I MOVED TO ANOTHER COUNTRY AND HAVE BEEN IN CONTACT VIA PHONE WITH MY SURGEON.I LOVE THE WAY MY BREASTS LOOK, ROUNDER, BUT NOT A LOT BIGGER. HOWEVER I HAVE TWO CONCERNS: 1.I CAN FEEL A LITTLE BALL ALONG THE INCISION. CAN IT BE THE INNER-LAYER STITCHES? MY DR SAYS IT WILL GO AWAY OR MY BODY WILL EXPELL THEM THROUGH A ZIT-LIKE FORMATION AND THEN I WILL HEAL. IS THIS CONSIDERED A COMPLICATION OR JUST SOMETHING THAT SOMETIMES HAPPENS? 2. SINCE 14 DAYS AFTER MY SURGERY I CAN FEEL A SMALL BUBBLE NEAR THE FOLD OF MY LEFT BREAST. IS THIS THE IMPLANT? IS IT SWOLLEN MUSCLE? WATER? CAN I EXPECT IT TO GO AWAY? EVEN THOUGH IT IS TINY, I DON´T WANT IT TO STAY!

Answer:

I think the balll is likely just the internal sutures, yes. It usually just dissolves in time. Not uncommon and usually not dangerous. I think the bubble is also not something to worry about and will also get better in time. Best of luck. JG 11.18.08

Question:

Well yes he does have an open door policy for visits. Its just he contradicted himself and said...more of the matter. YOU ARE DOING GREAT and look good no worries for me to have to worry of you. Do you suggest I just go for my 6 month anyways? I plan on going to my 1 year anyways. I just want to be sure on YOU AS A DOCTER`s perdeption if you get sick and tired of seeing the same patient..HAAA

Answer:

well if you feel fine and there is nothing going on that you see or feel, then wait for the one year, if you have any concerns, then you should see him at least at the 6 month or sooner if something perceptible is happening. JG 11.17.08

Question:

Sooo...I have an odd question. Iam on my second BA! Swapped Saline to Sili. TOTAL DIFFERENCE...Its been 5 month and it odd....NOW THEY FEEL...*(FEEL AS IN HOW IT FEELS IN MY BODY --NOT TOUCH), They feel a bit like my muscles contract over them and twitch. Like before the implants seem to mesh with my muscles or body but 5 montrh later they seem to feel seperate from my bod like my muscle will clamp down and hit it and it will just be in its place where before it seemed to NOT HAVE THAT! I know its hard to describe. They are soft to the tocuh tho..i just dont get why they feel inside my body a bit FOREIGN then a month or two ago

Answer:

might just have some fluid or swelling around the implant that makes them move like that, if it is that it will get better in time. JG 11.10.08

Question:

Hi Dr. Garcia, Just had my BA on 11/3/08. Follow-up appt.is this Wed. I had 400cc of saline (smooth-mid profile). I can hear the swoosh of the saline in my left breast & not the right. I am doing what I can to massage (thru the muscular pain I still have). Is the swooshing sound normal?Will it go away? Entry was thru nipple, my right breast (under nipple) is sore and more bruised/lots of broken blood vessels. Normal? I know it`s only 1-wk post-op, but I just have so many questions....Thanks!

Answer:

swish is normal and will all go away over the next few weeks. Hang in there. JG 11.10.08

Question:

I posted above about the Gummies. I know they are not yet approved but am hoping they will be in next couple years

Answer:

could be in the next year we hope. JG 11.8.08

Question:

I have had 3 BAs, first in 1986, silicone overs, had had 2 pregnancies. Had them replace with saline 18 years later, silicone not yet approved and my PS wasnt in the study, so even tho i had had sillies before, he wouldnt/couldnt do them. I went bigger, as he said it might help fill up slight slack, since i had had 2 more pregnancies and nurse both babies for a year each. So i went from 300cc sil overs to 550 cc saline unders. Big mistake, literally. Too big for my frame, one was sore and tight for whole year, had them replace again since they both bottomed out and looked ugly, wnt smaller, about 425 was smallest he(dif PS) could go, he did sort of an internal lift, have about a 5 inch crease incision(completely faded to thin white, even better than first 2 scars) Again, this last time, i just missed the silicone approval. Ideally, some day, (Tho hubby probably wont let me, why fix if it aint broke) i would like to go back to silicone overs, ideally, the gummy bear semi solid ones. Do you think it would be possible to go back to overs, since i probably have even less natural breast tissue?Even tho my current salines are under, they still ripple when i lean over, sillie overs never did, they were virtually undetectable. I also feel like i had more cleavage with sillie overs. is this generally the case?

Answer:

yes, I think your desires are possible, juts wait until the gummy bears are released. JG 11.8.08

Question:

Hi, can you tell me what the pro`s and con`s are for saline vs. silicone implants? which do you think is best? also, I am doing a redo on my implants, no problems with the first except size, is there a higher chance for capsulary construction doing a redo or is it the same as the first time? thank you so much for your time.

Answer:

pro`s for saline are smaller incision and if it leaks you know because it goes flat, pros for silicone are slightly more natural feel, slightly less ripples, cons for saline, slightly more ripples, slightly less natural feel, cons for silicone are larger incisions needed for palcement and if they rupture you need an MRI for $1000 to diagnose it. If there is no capsule problem at present then the risk of capsules after the redo is the same. JG 11.7.08

Question:

Hi Dr Garcia, I am trying to decide between saline or silicone for my breast augmentation. I`ve read that the cons of having silicone is that it ruptures easier than saline implants and that there`s a higher chance of getting capsular construction with silicone. Is this true and if so how much higher is my risk of these things.

Answer:

the rupture rates are the same and the capsular contracture rates are also the same. JG 11.7.08

Question:

Hi Dr. Garcia! I was at my ps yesterday and I do have symmastia. He said he would go in and suture down the tissue or muscle (not sure exactly how this works) to my sternum and he would take out about 50 cc`s from each implant down to 350ccs, and he may also make the pocket a little wider out towards my sides. He said he will not charge me for this. I will need to wear a thong bra after and no heavy lifting for 4-6 weeks. My question is how likely is it that this will work long term and how can I improve my chances? I have asked my ps and his staff all this but I got different answers from all of them, I am just concerned that if I do this I will end up worse than I already am. Thank you so much!!

Answer:

in most cases that all should work, but there are no guarantees, I would do that, and maybe even remove a little more from the implant if possible, best of luck. JG 11.7.08

Question:

REgarding my question about being not Satisfied the sec time around. Do you think I should bring up to my docter switching to Mod or Mod PLUS from my HP! If I switched from the size in HP to Mod Plus do you feel that my restlessness in what Iam feeling as to not looking right may help? Im just saying...going from a HP to a Mod or Mod plus what look do i expect from what i had? more fullness? Less fullness? wider? smaller? Or is it best DONT touch whats not broken and be grateful Thanks Doc G...

Answer:

I think you shoudl tell the surgeon what it is that you do not like and let him, with his experience, decide about implant shape. I cannot decide for you whether you should have more surgery or not though. Best of luck. JG 11.7.08

Question:

i have had saline breast implant, under the muscle, for about 4 years. I just notice i can feel what i think is the valve? just to the left of my left nipple. it is about the size and shape of a dime. i get regular mammograms and my ob has never said anything about it and i just noticed it myself in the shower. is it unusual to feel it????

Answer:

no, not really. JG 11.7.08

Question:

How soft are implants usually normally? Also how pliable!

Answer:

should be very soft and pliable as long as there is no capsular contracture. JG 11.5.08

Question:

Firstable I want to say thank you so much to answering my question, there is no website better than this when you can get all you straight answer! My redo is in 3 days, I`m having problem with my breathing, I have mild asthma and ventolin wont do me much. I`m going to see my GP tomorrow to get stronger ventolin. My question is would my asthma will affect me during surgery? My PS will put me on antibiotic straight away, will that affect my ventolin? by having implants 65cc more in each breast will that be affect my breathing too? Thank you again..

Answer:

I think since it is elective surgery you should postpone it until your medical condition is optmized, best of luck. JG 11.3.08

Question:

Hi, What would make an implant that was placed under the muscle slip out?

Answer:

the pressure of the muscle, it is made more common wth implants that are too large for the pateint`s frame and also if the tissues of the chest are not too strong and give way to the pressure. JG 11.2.08

Question:

I`m sorry I forgot to mention that the breast still itch inside as well-13 months later.

Answer:

that is irritation of the nerves in scar tissue. JG 11.2.08

Question:

Hello, I had a BA 13 months ago, aereola incision. The lower part of my breast are still numb but for about 9 months now my nipples have become very painful--extremely painful. Please tell me this pain isn`t going to last forever.

Answer:

it should get better as the scar tissue heals and softens. JG 11.2.08

Question:

Hi Dr. Garcia! I hope you can help provide some clarity regarding some issues that I am having with my right breast, since having augmentation. First, my left nipple hurts, it has the sensation of being traumatized, almost bruised. It has now been a year since having my aug. What is the problem ? Second, my incision was made in the fold of my breast, it now looks like it is riding up and has also changed the position of my nipple. The nipple looks too high and too far to the left (towards my armpit) How can this be fixed. Last, I look as though I also have some degree of symastia. My breast are very close together, my cleavage is crooked and has the appearance of a bubble crossing over my natural center. How can this be properly be fixed ? I am 5-2 , 115 lbs, 550cc silicone implants, placed under the muscle. I am really looking for a second opinion, because this is now my second BA with now needing a third surgery to correct these problems. PLEASE HELP! ~Michele

Answer:

the pain in the left nipple is due to the nerves being trapped in scar tissue or that they have been stretched, some oral medications might help but not much can be done surgically. The placement of the incision and therby the nipple might be able to be improved with an opening of the pocket to a greater degree and some creation of adherence of the incision to the ribs to avoid it from recurring. The synmastia might need some sutures to be placed to reattach the skin and going to a smaller implant will help too. All the best. JG 11.1.08

Question:

Hi Dr. Garcia (again)!! I wrote about a week ago about my fears about symmastia. (29 years old, 5`7 , 125lbs, 400cc mentor moderate profile & under muscle) I have been taking daily pictures and I am noticing that one of my implants seems to be moving in past the middle line of my chest. I can still flex my muscles and get it to move to where I feel it should be and the skin does go pretty flat. I have an appt. set up but I am scared that he will not want to admit that it may be. Also his nurse told me that if it is they would just put a couple stitches on the outside to hold it down. Everything I have read says it needs to be corrected from the inside with permanent sutures. Also if I were to get them taken out would it heal itself and I could get implants again later or not? How about smaller implants or ones that are less wide? Sorry about all the questions, you are the only person I can find to get straight answers from!!

Answer:

I do not think external sutures alone will do the repair, I think removing them and then replacing them after a few months is an option and the tissues due heal. Smaller implants would help down the road if more surgery is done, yes. Best of luck. JG 10.31.08

Question:

How come they say...implant appear smaller in a body in terms of a size than a naturally breast? For instance a D cup size appears as a C then a reall D cup breast?

Answer:

I am not sure why anyone would say that. JG 10.31.08

Question:

Thank you to answer my question 27/10/08 I felt much better now. But I do have another question, my PS say she will make my pocket bigger to put 430cc moderate profile, I`am now 365cc low profile. What did that mean? And which one redo surgery will do better capsulotomy or capsulectomy? I read that capsulectomy can make your skin tissue thinner is that right? Thank you Doctor.

Answer:

the pocket needs to be adjusted to accomodate the diameter of the new implant is all. As to what is better, a capsulectomy or otomy depends on what is needed, if there is restriction of the implant then removing the caspule through a capsulectomy would be better. Removing the capsule can thin the covering, that is true. JG 10.30.08

Question:

Hey Dr. Garcia, I am re-doing my BA to go smaller (I mainly want less projection and to be not so `round` on top). Currently, I have Inamed Silicone 286 vol mid-profile (style 15) implants (11.7 cm diam, 3.8 cm proj) under the muscle. The width is o.k. but I feel they `stick out` too far for me and are not `natural` looking on top due to the roundness. I am considering going to Inamed`s lower-profile style 10 Silicone implant in either the 210 vol (11.2 cm diam, 3.0 cm proj) or the 240 vol (11.7 cm diam, 3.2 vol) in hopes of less projection and more of a slope on top. My questions are: 1) will I actually see a difference in size with either of these, and 2) since the volume is less, will that potentially cause rippling or too much movement of the `bag` inside the pocket since the pocket was originally `made` for the higher volume implants? My PS is concerned that the decrease in volume may lead to visible rippling even under the muscle. Thanks for your help!

Answer:

I think the difference with the 240 will be very small, might want to go to the smaller if you want more of a slope. As long as they are under the muscle I think the rippling issue is a small concern. I do not see how a smaller size would lead to more rippling if you do not have it now, unless you have rippling now that is concealed by scar tissue. Best of luck. JG 10.29.08

Question:

Hello from Australia,I`m having my redo on the nov 7 due to capsular hardening on right breast and slightly on the left. Im a 169cm and 60kg, my diameter size is 14 and 28 in frame. I have cohesive gel implant 365cc now and would like to change with more bigger and more volume. My PS gave me the size of 430cc moderate profile of cohesive gel too. The diameter of both implants is different by 1mm and I cant go lower because it be look to narrow. My question is will the size fit me? is it to big? if so what should I do.. go low profile with more big diameter? Im so confiused... please help.. thank you

Answer:

it likley will be OK, but I would certainly go no bigger than that. The limiting factor is the diameter so if you go to a low profile the size will be smaller for the same diameter, also realize that you might not be able to get to the size you desire without increasing future risks.JG 10.29.08

Question:

Hi Dr. Garcia! Thank you so much for taking time to answer questions! I had my ba done 6 weeks ago and I am very concerned that I may have symmastia. I am 5`7 125 pounds and got Mentor moderate profile 400cc`s under the muscle. There is a cushion like feeling between my breasts although they definitely look separate. When I flex my muscles they separate and there is a good space between them and the skin lays pretty flat, also when I bend over the cushion seems to almost disappear but they are very close together. My ps said it was swelling and scheduled me back in another month. Do think this is symmastia and will it get worse if it is? Thanks again!!

Answer:

I think it is likely swelling, if you can try placing a rolled up small towel inbetween your breast in yoru bra to apply some pressure and get the swelling to decrease, best of luck. JG 10.25.08

Question:

hi dr. garcia, my name is donald and i just got pectorial implants.there is a problem with one of the implants. on the top of one the implant isn`t sitting flush and pertruding a bit. what can be done to it to make it look better? it bother me because it looks like an implant my surgeon said the implant didn`t want to lay flat. he mentioned about fillers to correct it. what do you think about that.I`m not happy about it. could you be so kind to suggest what to do doctor. thank you for your time. donald correira 415 626 8996 +email dcorreira@hotmail.com many many thanks again. have a wonderful day!

Answer:

it will require surgery in order to make the pocket larger and let the implant lay flat. I do not think fillers are going to help much and will not help long term. Best of luck. JG 10.21.08

Question:

Dr.Garcia-I had saline implants twenty-three years ago under the muscle. My question is now I am feeling some pain at the infarmamary fold, it hurts when I reach or bend I am begining to think it could be a hernia of the muscle holding the implant. Is this a possiblity? Who should I seek help from? Will have a mamogram in a few months(dec)and see my Gyn at that time.

Answer:

more likely scar tissue, there is no true herniation of the implant that would cause that. I think it best to see the surgeon that operated on you or another plastic surgoen if the original one is not around, a mammogram will give some information but not much in this case. JG 10.20.08

Question:

Hello Dr. Garcia. I am a 30 yr old mother of two. I had mt BA in 4/01. Over the years i have noticed the right one decrease considerably in sz. It is so bad now it does not even fill out that side of the bra. I am getting them re done in Feb. 09, but I have very severe rippling in the right some in the left. I have noticed also in the right that I can see a perfect round circle just below and to the right of my right nipple looking almost as an oversized coke bottle cap, as if it were the underneath circle ridged part that is on the imlants. The right one def is drooping also more outward than has ever. So with this being said my question is that... does it sound like a rupture or slow leak. My dr. is in NC. and Im in KY so they have not seen me to examine it, but over the phone they just keep putting it off as if it is normal and all about asymetry. I call bluff but would really like to know your opinion

Answer:

I doubt it is a slow leak and the bottle cap you are feeling is probably the disc on the implant which has likely flipped over, it also sonds like your tissues have stretched over time you have lost some breast tissue and this has added to the difference in appearance and size. If that is the case, going to larger implants will accelerate the problem, and even if you change to silicone the ripples will presist, albeit it decreased, but not zero. JG 10.19.08

Question:

My biggest concern regarding breast augmentation is having an augmented look afterward. I want larger breasts, but want to avoid some of the tale tale signs of an augmentation, specifically, the breast appearing to sit or begin too high on the chest wall. I actually want them to droop a little, like a natural breast. Would using an implant with a smaller diameter vs wider diameter be one solution?..like the high profiles? If so, do the high profiles create more upper pole fullness or less? To achieve this look, I need less upper pole fullness, right?

Answer:

breast are normally not high in profile so a low profile implant will yield a more natural resutl and also it should not extend past the width of the native breast tissue to allow adequate coverage. JG 10.16.08

Question:

Hi Dr. Garcia, I have 475 cc mentor mod salines under the muscle and will be switching them out for 420 filled to 490 cc mentor HP salines under the muscle. The reason for the redo is because right now my implants are too close together causing tenting. My doctor said that he will use local anesthesia and he would not need to do any pocket work. Why is that? I would think he would need to do pocket work because the new HP implants are about 2.4 cm less in diameter but 2.5 cm more in projection. Does he take the added projection into account when making the pocket? Without the pocket work wouldn`t the HP implants sit too low on my chest wall? Thank you for your time..

Answer:

I think the exchange will most likely not fix the problem, yes they are narrrower but the higher projection will raise the skin off the chest wall as much if not more. The best way to fix that problem is to either change the site, moving them into a different plane, they are under now so move them above into a totally new pocket, or take them out, wait 6 months for the pocket to close off and try to go back in and not open the pocket as much, that is hard to do, tough problem. Best of luck. JG 10.13.08

Question:

How can you tell if your surgeon made ones pockets to small for ones implants?

Answer:

by how much the implants move around after the surgery. JG 10.13.08

Question:

they say in ur intitial BA it takes a certain amount of time for ones pockets to close! If u have a pocket already made, get new implantsnlarger with a bigger pocket does that rule apply also? how long then dies it take foe the pockets to heal?

Answer:

to a certain degree yes because you are opening the old pocket to make it bigger to accept the larger implant that likely would not fit correctly in the older smaller pocket. Healing will be a little shorter than the first one but not by much. JG 10.10.08

Question:

I have 500 hp silicone under my muscle! 5 foot 4 -111 pounds and very petite and athletic! there pretty and wanted to Go to 600-650 hp! I really believe don`t fix unless broken! But wanted ur opinion on larger implants in HP, I know doc said I can go bigger on high profiles only but I`m so petite I`d look funny! I have a 28 ribcage by implants diameter is 13.2 cc

Answer:

I would have tried to talk you out of the ones you have now and tried to go smaller. JG 10.10.08

Question:

Is it true that implants don`t change the shape of your breast just it enhances the size of what u naturally have

Answer:

correct. JG 10.10.08

Question:

HELLO AGAIN, DR. GARCIA....I AM THE 36-YEAR OLD DISSATISFIED WITH HER NOW 16 DAY OLD IMPLANTS. YOU TOLD ME THAT FROM THE ANESTHETIC POINT OF VIEW IT WOULD BE SAFE TO UPGRADE MY IMPLANTS...WHAT ABOUT FROM THE HEALING OR SCARRING PROCESS POINT OF VIEW? I KEEP HEARING FROM PEOPLE THAT 3 MONTHS HAVE TO GO BY BEFORE CHANGING IMPLANTS. IS THIS TRUE? I HAVE AN APPOINTMENT WITH MY DOCTOR THIS WEEK AND WOULD LIKE TO KNOW THIS BEFORE BROACHING THE SUBJECT OF CHANGING MY IMPLANTS.

Answer:

well, I also prefer to wait 3-6 months but there is certainly nothing wrong with doing it sooner. If it is merely a size change for somethng larger, as there is likely swelling at this point, going to a smaller implant is better to wait as the swelling might be contributing to the too large effect. JG 10.7.08

Question:

Prior to breast augmentation, would it be beneficial to stop lifting weights that target the chest muscles? I`m wondering if it could possibly shorten the amount of time it takes the muscles to release and accept the implants thus allowing the implants to drop faster if the chest muscles weren`t as developed. Also, what is your long term recommendation regarding exercising the chest muscles after breast augmentation? Of course this is all in the interest of having the most natural breast appearance after augmentation.

Answer:

sorry, it will not make any difference. I usually let patients resume normal activity after one month and I suggest trying to minimize direct pectoral muscle exercises forever after a submuscular breast augmentation. JG 10.6.08

Question:

You stated the size of your breast implants you can get depends on the diameter of your breast tissue. I have seen photos of breast reconstructions on one breast. Women who had a breast removed had it match the size of the other breast even if it was D or bigger size. Women who have a breast removed have no breast tissue so how can they get a bigger size? I know they might use tissue expanders. Would tissue expanders also work in women who did not have abreast removed, but want a bigger size than the diameter of their breast tissue?

Answer:

the limitations posed by the breast tissue is because a crease can result where the breast tissue ends and the implants extend past that crease. In breast reconstruction, all the breast tissue has been removed so there is no limitation of base diameter, but serious other limitations exist. JG 10.5.8

Question:

Dr. Garcia, I am not sure if you will be able to answer my question this way but.. I am 20 years old and about a 34 AA. About how much would it cost to go to around a full size B?

Answer:

there is no cost by implant size, you need to see a physician, decide on which one you like and then get the fee as the fees vary greatly from doctor to doctor. JG 10.5.8

Question:

Hi Dr. Garcia. I`ve had breast implants for eight years, and I think they may be the cause of my chronic fatigue and weakness. I`ve had every test known to man, and the doctors have come up with nothing. I`ve been researching online and alot of women with this problem felt better after having their implants removed. I`ve had fatigue problems for two years now, and now that I think about it, I remember tasting a kind of metalic taste, or a saline taste in my mouth just out of the blue, I thought maybe I was imagining things. My breast do appear smaller, but I have had a child since the augmentation and I thought maybe that was why. They do not appear to be deflating. I have saline filled implants. I know I have to have them replaced, but will that just continue the problem, or will new ones help?

Answer:

I doubt the implants are causing your probelms and if they are not hardened or deflated I see no need to change them. JG 10.4.08

Question:

Hello again , Dr. Garcia, I ´m the 36-year-old dissatisfied with the size of her 12 day implants. I am sure my body could take more, as a matter of fact we had decided on 380 grams, but I kind of chickened out at the last minute because I did not want to look like a cheap stripper with two basketballs on her chest. And I had enough breast tissue, since I was not small-chested before. So, taking into consideration that I won´t stick around this city for long and am moving far away, WOULD IT BE POSSIBLE TO CHANGE MY IMPLANTS TO 380 OR 400 ONE MONTH POST-OP? And, by the way, I think it is absolutely great that you give this space to mere mortals so we can clear out our doubts.

Answer:

that decision is entrely between your surgeon and you, it can be done safely from the anesthetic point of view if that is your question. All the best, thnalks for the kind words but we are all mortals here I hope and have a safe trip. JG 10.3.08

Question:

Hi Dr. Garcia: I had silicon under the muscle 2 months ago and am unhappy with the position and size (too low and too small). Can you please let me know the following: (1) when is the earliest that it is safe to have them exchanged out for larger size; (2) is it possible to make the pocket and nipple higher as they are too low; (3) is it possible to get a larger implant diameter wise as I want them to be higher up now that skin has stretched; (4) the maker of the ones I have even with changing the type only goes up another 1.3cm in projection which will only yield me 1/2 inch in projection although it is 150ccs difference and I don`t see how that will get me where I want to be. I should have gone with different manufacturer as the similar diameter would yield me 2.2 more cm in projection. Will that work? Also, at 2 months, I am concerned about exercising where I lift the weight of my body - can pocket open up? Thanks so much for answering all my concerns!!!!!

Answer:

I would wait 6 months so the lowest part of the capsule is well formed and then you could exchange the implant for a larger size with less risk of further dropping. The only way to lift the nipple is to cut around it and move it, if the lowest part of the pocket is not opened further and only the top is opened, it might give the appearance of a better position. The breast tissue diameter is what controls the potential safe implant size, not the skin itself. I think at two months you can work out, as to the dimensions it is difficult for me to say without having seen you before the surgery and getting your measurements, sorry. JG 10.2.08.

Question:

For those who can;t handle big implants= is it that your skin just needs to stretch with the implants you get and then in a year or so you can get bigger implants?

Answer:

no, it is the base diameter of your own breast tissue and that usually will not change much. JG 10.2.08

Question:

Hello Dr. Garcia, I´m 36 yrs old, no children. I weigh 112 pounds, my height is 5,6. My frame is rather small. I used to wear a 34b bra, but over the years my breasts sagged a little, lost volume and tone. Ten days ago (Seopt 22) I got 340 grams silicone Allergan round implants and a crescent lift of my aureola. The initial swelling has subsided some and the shape and placement of my nipples look really nice, but I keep being told that they will decrease in volume...and the volume I have now is a little smaller than what I had hoped. I told my dr. that I am not entirely satisfied with the size, he placed an elastic band over the top of my breast so the implants would drop and will see me in two weeks( Sept 15). This is my question: IF I AM STILL DISSATISFIED WITH SIZE IN TWO WEEKS, CAN HE CHANGE THEM FOR LARGER ONES THEN(ONE MONTH POST OP?)I AM MOVING TO ANOTHER COUNTRY NEXT MONTH AND CANNOT COME BACK FOR THE REVISION SURGERY IN TRHEE MONTHS!!!! I SOOO HOPE YOUR ANSWER IS AFFIRMATIVE!!!!!!!!!!!!!!!!!11

Answer:

well I would wait a few months to change them and also, not everyone can take all sizes of implants, it is determined but your tissues, so it might be the case that you cannot have a larger implant, I cannot tell without having seen you before the surgery. It can certainly be done sooner though if those circumstances exist. JG 10.2.08

Question:

Why do docters put you on Singular for 3 months? Why is it so magical for 3 months NOT 2 NOT 1...but 3? Its an allergy medicine...Is it because of healing in the foirst 3 months is crucial?

Answer:

a small number of doctors believe that Sngulair can decrease the chances of capsular contracture, it is not a reliable method of doing so,is an off label use of the drug. I have tried it with no improvement, and it can cause liver damage, so blood tests need to be done to make sure all is OK while on the medication. It is an attempt to modify the inflammatory process that is common between a capsular contracture and allergies to lessen the inflammation and attempt to therefore decrease the formation of scar tissue. JG 10.1.08

Question:

MY DOCTOR TOLD ME EVERY 200CC MADE A CUP..UHHHHHH...... SO IF I WANT A FULL D AND IM A FULL B HOW DOES HE KNOW HOW MANY CC TO GIVE ME?? HE TOLD ME THE MAX HE WILL DO IS 400 OR 375.

Answer:

well, the truth is he does not know, if he is so sure, pose this question to him, if he puts in what he thinks is correct and your bra size is not the desired cup after the swelling goes down, will he re-do the operation at no cost? Your tissue might never be able to give you a D cup, unless illadvised sizes are used. JG 9.29.08

Question:

how many cc make a cup????

Answer:

there is no such translation, sorry. JG 9.29.08

Question:

if a girl wanted to go bigger is she better going with a 100 cc jump or 150cc to makena differeence?

Answer:

well, the larger the jump the greater the difference but it all depends on whether her tissues can take the jump in size. JG 9.27.08

Question:

I just recently had a breast revision due to capsular contracture. This is my 4th revision surgery. I have very little breast tissue. I choose a 270cc moderate plus. I want a smaller implant either a 225 cc moderate or 250cc. If I exchange these out within the next two months, will my skin be saggy or will it go back in place? I want an implant with less projection. I started with a AA cup. I know it may seem silly, but have never been over 240cc moderate. And that has been very comfortable for me.

Answer:

it will likely be a little saggy as you have had so many surgeries already. JG 9.27.08

Question:

i had a ba one week ago with 220cc unders, i previously had 340cc overs and at a large c small d that was too big for my slender frame. i am happy with the size that i am at the moment, how much swelling do i have to allow for and how much smaller will they go, as i love them the size there are now.

Answer:

hard to say but a guess would be 10-20% decrease. Best of luck. JG 9.27.08

Question:

hello, im 34b and i want to be a full d my doctor told me to get 350 or 375. but i kown when u get ur boobs first u r bigger than what u r going to be, so i was thinking that 400cc will give me a full d..........what do u think???????

Answer:

three is no way to tell you what cup you will end up after an augmentation, you will be bigger, but there is no 100% accurate way to determine the cup result. As to the difference between a 350 and a 400cc implant, the 50cc will not make you a cup larger. JG 9.25.08

Question:

hello again, im going to poss nude so im looking for more of a play boy look. im getting silicone under the muscles do u think that wil give me the look i want or should i get it on top of the muscles????????

Answer:

there will be more motion and potential distortion of the implant under the muscle when you are holding certain poses. JG 9.25.08

Question:

Thanks for your previous answer (I`m 5`0, 400cc now 325 silicone). I feel great to walk and if I start stationary biking now (48 hours post op)will that make my implants `drop` more? They`re already low enough and I don`t want to ruin where the surgeon put them. Elyptical machine, same question. Is 48 hours or 72 hours or 1 week best? Also should I keep a too-tight or perfectly fit sports bra on 24/7 for the next week or two?

Answer:

unles the pocket was made larger, they will not drop any more and that will not help swelling either. If no work was done on the pocket, you can probabaly do all of that without much concern after 2-3 weeks, just not heavy lifting for the first month. We limit activity for the first two weeks to avoid delayed bleeding. JG 9.24.08

Question:

I`m 5`0 and 13 years ago had 400cc saline, just 2 days ago replaced with 325cc silicone, both under muscle - professional surgeon. Questions - I was hoping they`d be smaller but they seem too big... could it be swelling? There`s no pain or bruising, and I can reach my arms over my head. How many days after surgery can I see my `real` breast size to buy a bra? Also do I not need to `massage` them like saline I used to?

Answer:

At this point there is likely lots of swelling, too early to determine end size. For the most part you should be about there in 4-6 weeks if there was not extensive capsule work done as that adds time to the resolution and to the amount of swelling in general. Since the pocket was made long ago, we usually do not have the patient massage at this time in cases similar to yours. JG 9.24.08

Question:

i have just had my 2nd ba with high profile unders at 220cc i was orginally 340cc and my dr wanted me to have 240cc but as i have lost alot of weight and had rippling wanted the smaller implant. is there a great amount of difference between a 220cc and 240cc implants. have made a mistake by choosing the smaller of the two.

Answer:

20 cc is not enough to worry about. JG 9.24.08

Question:

whats a good cardio excercise for women with larger implants, other than jogging or stationary bike. Any helpful thoughts....?

Answer:

stationary bike is the best, after that would be the elliptical trainer, but that is less effective. I think jogging has its negative effects due to the bouncing and stretch induced by the implants on the skin. JG 9.24.08

Question:

will sleeping with a victoria secret push up bra harm your implants, or cause premature problems, at all?

Answer:

no, but it will not do anything helpful either. JG 9.23.08

Question:

Hi, I see my PS next week about my CC that has come back. But, since making the appointment one breast has gotten much worse in just a couple days. It is swelling, very sore and even that shoulder and shoulder tip hurt and it radiates down my arm. Could this just be the CC or could there be something else going on like infection. I have no fever or anything. I can`t see him sooner due to work.

Answer:

might be an infection or a fluid collection of some sort. Asking him for some anitbiotics is a good safeguard just in case. JG 9.18.08

Question:

Me and my girlfriend BOTH are of the same size and staure...small petite girls both started out wil lil breast tissue around a 34 full A. She got 400 Moderate and I got 500 HP..hers look so huge and full mine look so tiny. I know we arent suposed to compare but is this just me or why is that someone with less can appear larger than a person with more cc

Answer:

I think it is a shape thing and a perception thing, yours are more narrow and might be contributing to that look, but 500cc is always larger, at least in size, to 400cc. JG 9.17.08

Question:

I was a small, slightly saggy/empty C cup after nursing all my children. I got 510 saline implants and have had them almost 3 years and had two capsular contracture redos in that time. If I got explanted would I have less tissue than I started with because of the capsulotomy and capsulectomy? If I got a peri-areolar lift at the same time would that help in looking decent? I`m debating whether to try one more time with new implants or to explant as I have CC once again.

Answer:

I think you would be smaller yes. I cannot say without seeing you to what degree a periareolar lift will help, I do not peform them very commonly due to the potential for stretched out scars and flattening of the breast mound. I think two failed attempts within that time frame, assuming new implants were used each time, would point me to not trying implants again. JG 9.16.08

Question:

Hi, I have had two redos due to CC. First was a capsulotomy which only lasted 2 weeks before coming back. This time I had a capsulectomy and put my overs to unders as well. They stayed really good until about 7 months post and all of a sudden it started coming back again. They don`t look as bad yet but look round and unnatural and are firm and stiff again. I notice when I do deep massaging they soften up a bit, but I don`t think I`ll ever be able to get them to where they were! I was considering explanting but decided to give it ONE more shot. I will probably switch to silicone this time as I`ve used my same saline implants for all my redos. Do you have any advice to help keep CC away next time? Should I stay with unders as well? Thank you!

Answer:

well, I will will say that exchanging the implants to new ones should help as at times small microscopic amounts of bacteria can settle on the shell of the implant creating something called biofilm and can contribute to recurrence of the capsular contracture. Best of luck. JG 9.12.08

Question:

I had a breast augmentation five years ago. they are 500 cc supposed to be placed under the muscle. my implants have stayed pretty hard but did drop. i have never been able to lay on them to sleep very long because they get sore. a couple of months ago i was having pain in my left breast and felt a pea sized knot on the top left side. i initially had and ultrasound and then a 3-D MRI. They showed a hardening of the implant and the doctor said nothing that needed to be attended to right away. My question is that the ultra sound and the MRI both state that the implants are subglandular. Is it possible for them to move from under the muscle and if not how can I tell if they were ever placed under the muscle? Could the tests be wrong about them being subglandular. I have not spoke with my surgeon about this yet. All my test were done by my obgyn. Thanks!

Answer:

it is very common for implants of that size to not stay under the muscle, yes, the muscle will try to push something that size out from below it. I seriously doubt the tests are wrong. JG 9.11.08

Question:

would working out w/ 3-5 lbs shorten life of an implant? also if i was a barely there a before 500 cc implants would working out bring them any smaller like a small c (hopefully not possible...

Answer:

no, it should not shorten it. I do not think working out will alter their size. JG 9.11.08

Question:

Is a 28 inch rib cage considered a narrow ribcage to the point I cant go to wide? Also, is there any dropping and fluffing degree on a second BA? Or is there not due to the fact the pocket is already there and skin is stretched?

Answer:

yes, I feel it is narrow. As to a secondary breast aug and the post operative course, it all depends on what it is being done for, the more surgery involved the onger it will take to settle. No way for me to tell without more information on what is being done. JG 9.10.08

Question:

Im sorry, I should of been more specific regarding swelling. This isnt my first BA...I had 360 cc and YES it took about 5 months for the swelling to go down. But my second BA was just a littl eimplant switch to 500 Siliocne . There wasnt THAT much swelling and by week 3 it seemed to have gonr. Iam 3 months now and was wondering it my swelling is done with. I think so because they feel apart of me and not sooo foreign as they did when swollen. I guess what iam asking is that is it likely for the swelling to have gone down FASTER with my 2nd BA since he didnt have to make a pocket? ALSO THEY ARE UNDER MY MUSCLE

Answer:

in that case it is almost all gone by now I would say. Placing it into the same position does reduce swelling, yes. JG 9.8.08

Question:

Is there a way ti tell when the swelling is done or overwith and you are at your normal size after your BA?

Answer:

usually takes about 3 months, a little longer if under the muscle. JG 9.5.08

Question:

Dr. Garcia, How come plastic surgeons recommend Singular after a BA. After my second BA my docter had to score my capsular and insert new implants due to the fact on went up in size. Anyways he put me on Singular for 3 months. WHY do they do that? How does an ALLERGY MEDICINE coinside with Capsular Contraction? Also why only 3 months? Do you feel it is neccisary to take it loner or your view?

Answer:

It is an attempt to diminish the chances of a capsular contracture but the success of the medication is small and unpredicatable and has side effects on your liver. The allergy medicine is trying to reduce the inflammation that can cause the scar tissue is the theory. There is little evidence it works and none that taking it longer than three months is better. JG 9.5.08

Question:

if a saline implant were to ruputure, how long before I knew. Like say your boyfriend hugged you in s rough way and from the pressure?

Answer:

it can becoma obvious in as little as 4 hours, the larger the hole where it is leaking from the faster it goes flat, if the hole is small it can take a couple of weeks too. JG 9.2.08

Question:

Hi Doctor Garcia, Following my breast augmentation in thailand 4 weeks ago now. one of my breast is alot more sensitive than the other. i think that one has dropped before the other it is alot lower than the other one and softer. is this possible? and more or less is this normal?

Answer:

all possible, not necessarily abnormal, I think you need to give it some time though and see what happens. JG 8.31.08

Question:

Hi Dr. Garcia! I am about 2 weeks out of surgery with under the muscle silicone implants. How much more time until all my swelling is gone and how much smaller size wise will my implants ultimately become? Or is it more about my breast shape changing significantly? I do not want to lose anymore size wise or want them to change shape all that much. Should I be buying regular bra now or will I need a smaller size when swelling is over? How long till I can exercise and be in the sun? Thanks!!!

Answer:

that is quite variable from patient to patient, should see size differences in about 6 weeks. If you are 2 weeks out you will lose some visible size I feel. I would wait on buying bras for 6 weeks. We allow our patients to exercise in 3-4 weeks and go out in the sun then. These are really questions your surgeon should have gone over with you before surgery though. JG 8.25.08

Question:

Dr. Garcia, I had breast enlargement surgery in 1990. Lately, I have had pain in the right breast and the breast has hardened. What do you recommend or what are my options to correct the situation? Thank you.

Answer:

the only real option is to go in and have the capsule cut out, but there is likey about a 50% chnace of it coming back in time. JG 8.25.08

Question:

will a mamaogram break your implants? how can i do a self check?

Answer:

there is a potential for rupture of the implant and the self exam will never give as much information as a mammogram. JG 8.25.08

Question:

Is there a chance they will drop on their own this far out post op - that way I do not have to have another surgery? Is there anything that I can do to help them do so?

Answer:

yes, there is, but if they drop, they likely will no longer be under the muscle, it can take up to one year in some patients. Not much you can do at this point except wait. Sorry. JG 8.22.08

Question:

I had breast implants about 7 months ago (under the muscle/400 CC/smooth moderate mentor). I have lost 130 pounds in the past three years. I was 5`7 and weighed 128 at the time of surgery and breasts or should I say lack of breast were a size b. At my peak weight when pregnant my breasts were a very large double d. The dr did not cut my muscles or did not want to go bigger because he was afraid that my lack of breast tissue would not hold a bigger implant. My implants now refuse to drop. They sit up very perky and high but my nipples and saggy skin hand below the implant. the dr is telling me that i need to wait until a year post op to see if they will drop. is this common. he said he might have to go in and cut the muscle. Im afraid the implants will not fill the pocket. would larger implants work, will the cutting the muscle work or will i need a lift

Answer:

cutting the muscle will likely allow the implant to slip out from below the muscle, and a larger implant might do the same thing. I think with your degree of weigth loss and likely loose skin and breast ptosis, you more appropriately need a breast lift to position the nipple better and remove the excess skin. JG 8.22.08

Question:

This is in regards to my last post (re: orig sx 10/31 with revision 7/11). Placement was under muscle, there was capsule formation and he used prev implants. Do you recommend saline if I have to have another revision? Could the silicone possibly be the reason the capsule is forming? I see my PS on Monday. Thank you again for your response.

Answer:

I do not think the saline or silcone will differ much as the outer cover is the same and the incidence of capsule formation is equal, best of luck. JG 8.22.08

Question:

Hi Dr Garcia, I have BA with 350cc Silicone Oct 31, 07. Finally July 11, my PS agreed to a capsule release on the right and a vertical lift on both. I had the crescent lift done initially. It`s been 6 weeks now since revision and the right is still higher and firm. Is this normal? I had a lot of fluid around the implant immediately after the procedure and was told this was normal. Any insight would be appreciated. Thanks

Answer:

well, no, it should be softer, hard for me to say more without knowing what exactly was done, where the implants were positioned, whether there was a capsule formation after the initial surgery or just an inadequate pocket, whether the implants were exchanged the second go round. Might need another surgery I am afraid to say. JG 8.21.08

Question:

How come after surgery about 3 weeks my breasts felt heavy n bounced around when walking to the point I was babying them. Now there light as a feather n feels like there apart of me? did my body just yet used to them

Answer:

just swelling mostly. JG 8.21.08

Question:

Hi Dr. Garcia, After my breast augmentation nearly 3 weeks ago I have noticed my left breast is softer than my left and more sensitive to pain. I feel a burning feeling from my armpit to my nipple which really hurts sometimes. And i noticed my right one is higher than my left. is this just the healing process? and my left is moving around alot (can i send you a picture for your opinion) when i lie down i have to wear a sports bra cause it hurts when it rolls around. Is this normal?

Answer:

at this point all is stil healing, all that you are seeing and feeling can still be normal, I would take it easy and follow your doctor`s instructions and see him in the next week or so to make sure all is progressing well from this point on. JG 8.19.08

Question:

what do you mean by, You feel very little muscle is covered anymore, if any by the implant due to many capsule scorrings ...Where did the muscle go? Does all the tissue get taking out or dies off?

Answer:

as the caspules are cut, it is not uncommon for the muscle to retract superiorly and then cover less and less of the implant. The fat and breast tissue that is around the implant when a capsulotomy or capsulectomy is done can get thiner due to injury to the blood vessels and subsequent atrophy of the tissues. JG 8.19.08

Question:

Regarding the less healthy tissue with reaccuring redos of a BA, so what tissues die off or get ruined during a BA over time? Especilly if under ones muscles

Answer:

breast tissue and fat that provide a covering for the implant. I would venture to say that in your case that very little if any of your implant is still under the muscles after repeated capsulotomies. JG 8.19.08

Question:

when a docter scores your capsule where does it go? does he take it out inpieces? Also what tool does he use to score it?

Answer:

when a capsule is scored, it is just cut and allowed to stretch in-between the cuts, there is nothing removed, that is why it very commonly comes right back. They use a cautery unit or a scalpel to score it. JG 8.19.08

Question:

I know one cannot predict a bra size. But ian a small girl. I have 28 in ribcage and was a full a cup prior to implan ts I got 500 hp sili under my muscle. Iam 2 month post op and measure a full c cup! How can that be if lots of woman who started smaller got a D cup a d look larger ablns I`m a short petite gal? do u think i will change as my tissue stretches?

Answer:

because using a HP profile only fills the top of the cup, an augmentation, regardless of the shape of the implant, does not necessarily enlarge the cup you wear. In many cases just fills the top making you look rounder or fuller. One cannot compare one person`s results to another due to anatomica differences. JG 8.18.08

Question:

Hi Dr. Garcia, I am 3 1/2 weeks post BA, these past 2 days I have been overwhelmed with weeping....emotional over everything, can depression set in for a short time after surgery...can`t explain this train wreck. Thank you.

Answer:

not uncommon, surgery has lots of stresses and getting emotional is actually not uncommon, hang in there it will get better, just think about how good you are going to look. JG 8.16.08

Question:

I have developed capsular contracture and would like to try the new ultrasound therapy. Do you offer it, or know of anyone who does (in Las Vegas)?

Answer:

sorry but we do not offer it and not sure who does. JG 8.15.08

Question:

Hi Dr Garcia - F/U clarification to my question below. I wanted to clarify that my RC is more like 35 and I never could get a straight answer from this dr as to what it was. Thanks!

Answer:

your ribcage does not change with surgery, ribs are ribs and the implants are on top, yes, but it can be measured below the implant to see what it is. JG 8.13.08

Question:

Hi Dr. Garcia! I started with a small 36B and made it perfectly clear that I wanted to be a 36 D to DD. I am 5` 7 , 135 lbs, and RC of 32. I had silicone mentor mod plus of 550 cc`s 5 days ago. I am no larger than a C and was told that I could not take a 600 mod plus implant by this doctor. I should have gone with HPs 650 - 700 to match diameter of mod plus as I did not want narrow implants and wanted a full D -DD cup. I am swimming in D bras and can actually fit into some of my B bras - absolutely a C. I am aghast. When my implants drop will I become a D cup or am I screwed into finding another doctor who knows how to place the right implants in to achieve the size that I want. I am no small girl so I cannot imagine how all I see are women with much smaller frames holding larger implants. Mine have been swallowed up. Is there a different implant maker that I should have used as this doctor only uses Mentor. Should I have them replaced NOW before capsule forms or what? Please help. Thank you.

Answer:

I cannot say that your cup size will change dramatically to a larger size when the implants drop, size and projection will likely not change that much. I do not think the company that makes the implants will create any difference, and with the ribcage dimensions you have, and with you saying you did not want narrow implants, there will be limitations and you might never be able to achieve what you have in mind. It is impossible for me to say more without seeing you in person, but you need to understand that you might not be able to get what you desire with your anatomical limitations, no matter what is done, at least if you want to look anywere natural. JG 8.13.08

Question:

on someone that is flat as a board, with almost absolutely no breast tissue get to a full c or small d size? what would 330cc filled to 360 give. about what size. this is on a 95 pound 5`3inch body.

Answer:

maybe a C. JG 8.13.08

Question:

Hi Doctor Garcia, i had a breast augmentation in thailand two weeks ago. My scar under my armpit has healed but i noticed a small bump i thought it might have been an ingrown hair so i tried to exract it. I removed a bit of hard skin to find a clear/ white stitch underneath. i think my skin grew over the stitches. is this bad? isnt the stitch supposed to fall out? also my right breast doesnt look as smooth and round as the left one. its a bit lumpy underneath. is this normal? is it normal for the my breasts to feel itchy on the inside? HELP! Should i go to a GP?

Answer:

no, those stitches were likely meant to dissolve and just had not done so yet, not a problem. Hard to say what the lumpyness can be, could be swelling and could be the edge of the implant too. I think a GP will not be able to help, I think a plastic surgeon is what you need but it might be difficult to get one to see you if they did not do your surgery. JG 8.13.08

Question:

will the suzanne sommers torso track distort or cause damage to implant or pocket. I ask because you are really strecting out your chest and torso.

Answer:

I do not believe it would. JG 8.13.08

Question:

What is (inches) considered a small ribcage? what about large?

Answer:

32 would be considered small and then large above that, maybe 38-40. It is measured around the ribs at the level of the crease of the breast. JG 8.13.08

Question:

Hi and thank you for all of us for taking your time to answer our questions. I have saline brest implants in 2002 but it seems like my breast now look shagy and i can see the bag and i can feel the bags evry where i touch my breast they not look natural no more and they getting smaller and smaller i was size 34dd since i put them but a year ago i been wearing sdmaller bras now i`m size 34c why is this, i`m getting tons of strech marks ion the top since five month ago. what can i do?. also is any type of ingectable substance to disolve cellulite from your body such legs, hips or but.?

Answer:

you have lost lots of your own tissue and due to the implant size the skin has stretched and gotten thiner. I think the only thing that might help is a breast lift with the permanet scars and the improvement that will not last forever. There are no injections to dissolve cellulite that work. JG 8.12.08

Question:

This is a question regarding the width-diameter of an implant. Some surgeons have you pick your own and some are strict in what can fit! I have a 13.2 Diamter implant and a 28 ribcage. I KONW its all about your breast tissue. But heres ,my question...I have about 2 lil fingers put together width between my cleavage normally wihtout a bra.. Is there a way i can go with a wider bag like 14 or is this close enuff..NO MORE! Again if i put my middle finger and pointer finger together this is the space i have before the two breasts touch! Is this too close or fine

Answer:

if your breast diameter is 13.2, that is all I would personally put in. JG 8.12.08

Question:

My docter told me when we switch out my implants for a bigger size he DOES NOT OPEN the pockets on the sides just in the inner crease to fit the bag. Is this normally what surgeons do when one goes bigger? If lets say one goes bigger the thirs time...does he still open the inner and not touch the side? Reason being he said he wont touch the side of the breast pocket towards the armpit because it will cause it to go into it....

Answer:

well, it normally varies from patient to patient. If your present implant is centered over your nipple and you replace it with a larger and wider implant and open the capsule only medially, then your nipples will look like they are pointing out to the side. JG 8.12.08

Question:

One more thing! Which implant style VISUALLY looks larger a High Profile or Moderate?

Answer:

high profile looks more fake, normal breast do not have those dimensisons. JG 8.12.08

Question:

HI Dr. Garcia I am a little spooked. For the past few days I have noticed my left breast looks larger than my right or my right smaller than left. I have BA for 4 years 600cc. Anyways I thought it was my eyes playing tricks on me cuz its not very much on difference but 2nite I got a better look at my breasts>> seems to me that my right breast is lower than the other therefore it sags more and does not look as round and large as usual. I have saline implants what might be your take on this since I have 2 wait to see my PS. Im nervous. I mean is it leaking? or did my pocket drop? something please. Thanks!

Answer:

could be a leak of the saline and as the saline is absorbed the breast shrinks and can look like it is sagging. JG 8.10.08

Question:

Thanks again for your answer on stretch marks between the 2 sizes. What would you say the percentage chance is on getting stretch marks using either the 325`s or 350`s based on my daughters variables I mentioned previously?Thanks again.

Answer:

I have only seen it happen in patients that had not had children and I have only seen it happen once or twice in over 1000 cases. JG 8.8.08

Question:

Thanks so much for the answer to my earlier question-her Dr. is saying 325`s also possibly 350`plus overfill of about 30cc so your response helps confirm what we are hearing.One more question--How much more likely is it to get stretch marks if my daughter goes with 350 mentor moderate round profile implants instead of 325`s. ( I will repeat her variables-Her skin looseness is rated moderate,she is 5`4,125lbs,20 years old base width is 12.9,areola to inframatory fold is 7.5,sternal noth to nipple 21.5,nipple to midline 9.5) Thanks again for your help!

Answer:

I think that small of a change will not influence the risk of stretch marks much. Hope all this helps. JG 8.7.08

Question:

I have 425cc (filled to 440)mentor moderate round profile saline implants. I`m 5` 6 ,135lbs, 40 yrs old, my base width is 15.2, my areola to inframmatory fold is 9 , my sternal noth to nipple is 22, nipple to midline is 10.5. I`m really happy with my size and my daughter wants a similar look. She is 5`4 , 125lbs, 20 yrs old, her base width is 12.9, aerola to inframmatory fold is 7.5, her sternal noth to nipple is 21.5, and her nipple to midline is 9.5. What size implant would you suggest to give a similar look?

Answer:

might get a similar look but it will not be close to the same size, maybe somewhere around 325-340 or so, hard to say as the tissue pliabilty has to come into play and that cannot be determined on you versus her. JG 8.5.08

Question:

what do you recommed for contracture than since manual breakup seems bad? Iv had 2 surgeries do to contracture, and now with these and a new surgeon doing manual brekaup they have stayed soft for 6 years? how do you deal with it if it keeps reacurring? ive had pain while its being done but never after..

Answer:

in most cases it would involve repeat surgery. JG 8.5.08

Question:

I have a question regarding pregnancy and breasts. What happens to a breast after pregnancy? Does it get smaller or stay large? Also..if one has implants under the muscle what happens to them then? Do they need or can they be affected?

Answer:

it is variable, no way to 100% tell what will happen. The implants under the muscle should not be affected but your own breast tissue might sag over them. JG 8.5.08

Question:

OH I KNOW. I JUST THOUGH MAYBE YOU COULD HELP SINCE I THOUGHT MAYBE I COULD HAVE HEMATOMA FROM MANUAL BREAKUP OF SCARTISSUE. SORRY.

Answer:

a hematoma from a break up of a capsular contracture done by external pressure will cause discomfort, not from the hematoma but from the tearing of the scar tissue. Warm packs and massage might help it get better slowly but in most cases where a hematoma occurs, the capsular contracture will return in time too. JG 8.5.08

Question:

Well I ve been having chest pain that led to panic attacks. Could that pain be a hematoma. I have had 2 xrays, and EKG, and a eckocardiogram. Would that show it? They cant find anything and are just telling me i have anxety. please give me any other symptoms....

Answer:

this in not the appropriate site to ask those types of questions, this is a plastic surgery site and if yo have those concerns you need to see your doctr or go to the emergency room. JG 8.5.08

Question:

OK so excercise, sun, jogging; nothing like that will dissolve filler faster? Can I did from a hematoma, and would I know if I have on. Symptoms?

Answer:

correct. A hematoma, unless around the heart or in your head, will not kill you. JG 8.4.08

Question:

OK so excercise, sun, jogging; nothing like that will dissolve filler faster? Can I did from a hematoma, and would I know if I have on. Symptoms?

Answer:

the symptoms of a hematoma are that of a bruise, if it is around your heart or in your head you would have other medical problems. You need to be specific about where this hematoma you are concerned about is. JG 8.4.08

Question:

what is a hematoma?

Answer:

a blood collection. JG 8.4.08

Question:

My girlfriend got 700 HP silicone implants. She is tiny around 5 feet with a 29 inch ribcage....how is the world does a docter make that fit? Will she have problems down the road. They look great tho? Makes m ewant to switch out my 500 HP for a 600 or 650 HP...but i remeber what you said about long term risks...

Answer:

tissues and skin stretch, without seeing her, it is difficult for me to say, my guess though is if she had wanted that I would likely not have doen it for her and sent her elsewhere. JG 8.4.08

Question:

I know this sounds silly. But regarding my jogging bra question below. Its not harmful to squish my breasts in place when runni ng? It wont hurt them will it? Im just not used to my boobs squished down thinking it will ruin my pockets...am i being silly?

Answer:

no, it will not. JG 8.4.08

Question:

I`m 5 weeks post op of my second ba, I`m running again and wondered if its ok to wear a very secure sports bra that is squishing them down in place

Answer:

we have our patients wear jogging bras all of the time when they run. JG 8.4.08

Question:

Hi Dr. Garcia, I went to see my ps to discuss the capsule on my right breast and he suggested replacing my current gel implants with textured ones. Do you think the use of textured implants works that significantly? Would it be worth the risk of new implants to end up with the same result. Could my problem be that the pocket is just too small and that`s why the scar tissue is forming because it has no where else to go? I`m am very thin and had very little tissue previously. I also understand that there is a chance of rippling with the textured implants. Does that occur even under the muscle? Thank you!

Answer:

sorry but I do not think it will make any difference, short or long term. The pocket was likely made larger but it continues to scar down causing it to become smaller with time, that is how capsular contracture works. Rippling will still occur under the muscle out to the side and when placed under the muscle the texturing at times does not even work the way they wanted it to as the muscle motion can at times prevent it from adhering to the implant. JG 8.1.08

Question:

Dr. Garcia, Iam one month post op on my second BA! Ive noticed that when I wake up my implants seem tite & more firm and as the day goes on loosen up and seem to be more fluffy. Is this possible? Also some days they look bigger and sometimes smaller is this also possible? this possible?

Answer:

can be due to muscles being tight, not uncommon. As to size fluctuations that can be due to swelling too. JG 7.31.08

Question:

I came in for a consultation today for a tummy tuck and liposuction on my flank area. I am now also considering having a breast augmentation. Can these be done at the same time?

Answer:

if one is healthy, it can be yes, but there will be more downtime and the time period you will need assiatance for will be greater. JG 7.31.08

Question:

Hi Dr. Garcia, In regards to Singular or Accolate for capsular treatment what is the concern with toxic levels? How long would you recommend to take this medication before causing any harm? Should I request a blood test? Thanks as always.

Answer:

it can affect yuur liver so blood tests should be done to see where your liver enzymes are before you start and then likely tested once per month, the medication when used for capsular contracture is used for three months. JG 7.28.08

Question:

Hi Dr. Garcia, Had my last revision in March (3rd w/in a year). I started taking Singular for my right breast which feels very uncomfortable and I believe is starting to rise. I stopped it recently because I was concerned that my left breast was getting lower (the last revision repaired a over dissected pocket on my left breast as well as fixed a capsule on the right). I just started taking the Singular 10mg. along with Vitamin E 1200mg again because of the discomfort of my right breast. Can you tell me if there are any other options to treat this capsule? What are your thoughs on ultrasound? Have you ever recommended it and had any success? My ps recommended 10mg. however I thought 20mg. was the normal dosage for this problem. What do you usually prescribe and for how long? Thanks so much.

Answer:

I have not seen ultrasound make any differnce in the long term, it might help a small amount in the short term but the evidence is very anecdotal. I have not used Singuair, but have used Accolate at a twice daily dose, and have drawn blood tests once a month to monitor for toxic effects,the results have been disappointing though. All the best. JG 7.28.08

Question:

Dr. Garcia, I asked a question last week and it ws not really answered even though I was told it could be found in the question and answer section which it wasn`t. So I will try again. What is the age limit for having Breast Enlargement or a Breast Lift? Thank You Carol Everett Wa

Answer:

there is no upper limit for that, sorry it was lost somehow. Having said there is no age limit, the older one is the less time it will last. As to the youngest, legally, a breast lift can be done on anyone over 18, just like saline implants but for silcone you have to be 22. JG 7.22.08

Question:

Oh, one more thing... Silly question...but Iam 3 weeks of my sec BA and I didnt have much swelling...I was wondering as time goes on do the implants get smaller even tho iam 22 days after my BA or do they stay the same size? Reason being i love them and for some reason think theyll shrink one day...dont ask! It must be because my first ba was a nightmare with impants settling and all that...this time it was a br4eeze.. Thanks for all your help threwout my processes this past year you were a godsent!

Answer:

not much, not as much as with the first surgery because that one created more swelling than this one. JG 7.22.08

Question:

Dr. Garcia....After a Breast Agumentation and all is said and done and down the road...is one supposed to sleep in a certain bra so the pockets dont get screwed up or to prevent sagging or shifting? Or is it once all is healed and set it doenst matter? What bra is one suposed to sleep in if any. Some girls say a snug one some say none some say a surgical or sports bra...any suggestions to keep things in placce?

Answer:

after about 6 weeks one can likley sleep without a bra with little worry about pocket shift.JG 7.22.08

Question:

i have a wierd and stupid question. i had a small size a before having implants of 500cc which made me a c. if i were to work out my arms just to tone them with dumbbells could i possibly shrink my own breast tissue and make my size smaller...i know this is wierd

Answer:

I do not think that would happen. JG 7.19.08

Question:

With crease incisions...i have been wearing a surgical bra for 2 weeks...i asked the nurse if i caan AFTER 2 weeks wear a WIRE FREE smooth soft cup bra for support..she said it was fine...do you agree? Also when is it safe to wear a regular any kind of bra after a BA crease incison surgery? Is it possible to mess up ones pockets if you wear a bra too early or late?

Answer:

yes, I agree. We let people wear a normal bra after one month, if placed under he muscle we ask them to limit the underwires bras to 4-6 hours at a time for the fisrt 3 months or so. If the bra worn is too tight it can push the implant up and close off the pocket that was opened for it to lie in. JG 7.18.08

Question:

Thanks doc for your reply regarding the breast implants. Can you tell me is it normal or better if the muscle is released from the bone a little and then the implant placed under the muscle? Does it help in reducing the implants puling apart?

Answer:

adequate release of the muscle from the ribs and breast bone can assist in having the implants stay in a more centralized location, yes. JG 7.17.08

Question:

Dr. Garcia I was in for a consult recently and was more than impressed with how you explained the procedure and the problems that came with it. I`ve had two other consults since and neither of the doctors showed the same concern for my longterm consequences. But I have given alot of thought to the size you`ve recommended and was hoping you would consider doing my procedure even though I would like to go with the 380cc implants. I`m fully aware and prepared to handle the reprocutions of my decision to do this. My biggest worry is that you won`t perform the surgery because of what I`m asking. If there is any way you would consider this it would mean alot because I would not be happy with anyone else. Thank you for your time.

Answer:

I think the best thing would be to come in in person and re-consult I will say that numbers are arbitrary, and at times peopel are fixated on a certain cc volume, but at times, even with that, it will not give them the appearance they desire. As to going against my instincts and your anatomical measurements, there wil be a limit that I wil do. You might have to have a high profile implant placed if you desire that size, but as I explained to you, it might leave you looking artificial due to the narrow yet highly projected shape. The hardest part about being a doctor is telling a patient that what they want is not possible or should to be done, not a fun scenario, but although a patient says they are willing to take the risks of a less than perfect result, the degree of deformity has not been seen or felt by you but has been by me, and I am also aware of the large number of patients that claim that certain things will not bother them until they get it and then they are distraught.Lot sto think about, but al the office nad coem back in so we can talk more at length. JG 7.17.08

Question:

Hi Dr J. ..... I went for a consult for breast implants and the doctor told me that he takes about 3 hours to perform the surgery as spends time separating one of the muscles from the breast bone which reduces the chance of the implants pulling apart and gives a more natural results. He said most surgeons take about one hour as thats how long it takes to create the pocket (the easy part) the harder part is taking the time to release the muscle. WHAT DO YOU THINK? IS THIS RIGHT?

Answer:

nope, most surgeons I know that lecture on a national basis regarding breast augmentation routinely do a breast augmentation under the muscle in 1 to 1 1/2 hours. JG 7.16.08

Question:

One more thing, People always say a 500cc implant is a big implant. I have recently recieved them and to be honest i went from a 300 to a 500 and its not that BIG...is it becauseIam just used to seeing an implant on me and its just the trick of my eye. Basically the term SELF-UNAWARE comes to mind....

Answer:

it is a big implant, it is likely your definition of big is different from most. JG 7.16.08

Question:

Dr. Garcia... I have a 500 HP Siliocne Gel implant. I was going to pick a 550 HP Siliocne but opted for the smaller size. If I did go for the 550..would it made that much of a visual or cup size difference?

Answer:

it will likely not hange your cup sze at all, it will look narrower and it will have slightly more projection, so the shape will change but not the size to any appreciable amount. JG 7.16.08

Question:

I had my original augmentation (overs/areola incision) over 2 years ago. I also required two additional surgeries after that. 1)capsulotomy/same incision and 2)capsulectomy/same incision. They are now under the muscle as well. I`d like to know if it`s possible for me to breastfeed if I have another baby. I remember being told after my original surgery that I would be able to. I have nursed all my children successfully in the past before implants. After 3 breast surgeries though should I forget the idea of being able to breast feed or is it possible? Thank you

Answer:

should still be able to do so, but the incision around the nipple might have cut some but not all of the ducts, so impossible to say 100%. JG 7.15.08

Question:

whats the bestsurgeryunder breast or neval do you have the gummy bears and how much

Answer:

I feel between the crease of the breast and the navel, the crease is a better incision and the gummy bear implants are not availabe efor general use in the US yet. JG 7.10.08

Question:

Dr. Garcia is it possiable to fix the hieght of a nipple one of my nipples is about a half inch higher than the other one. It really bothers me went I wear a bathing suit or a sports bra because it is very noticable. Is this fixalbe and if so how is it done? Thanks

Answer:

areolas can be moved, and nipples themselves can be shortened or reduced, but there is some scarring and there can be loss of sensation. JG 7.8.08

Question:

Dr. Garcia, My 22 year old daughter has deep stretch marks on her breasts. She would like to have a breaste enlargement some day but she is worried about her stretch marks. What should she do? Is there a way to get rid of stretch marks?

Answer:

I am afraid there is nothing she can do to rmove or improve the stretch marks, lasers might help fade the redness is about all, sorry. JG 7.4.08

Question:

Dr. Garcia. Excuse me, I would also like to know if breast enlargement would make stretch marks wider or more visible

Answer:

if the size of the implant used makes the skin stretch, they can get worse or develop new ones, if it is within the size of the skin at present, there should be no more. JG 7.4.08

Question:

Hola Dr. Garcia. Hace un año me sometí a una mamoplastía. Hace unos días,aparecieron unos pequeños bultos bajo mi seno que fueron corriendo hacia el ombligo, somo si una plastilina dura pasara por un conducto. Eran firmes y un poco dolorosos al tacto. Fueron bajando y haciendose mas pequeños hasta desaparecer. Mi medico dijo que era una vena infartada, me dio aspirina y dijo que no habia problema. Tambien dijo que no tenía relacion con mis prótesis mamarias (yo pensé incluso, que podía ser una fuga de las prótesis)Realmente debo olvidarme de este evento?

Answer:

si, olvidate de todo eso, estoy deacuerdo con tu medico. JG 7.4.08

Question:

Dr. Garcia, Iam going in for my dsecond BA....same position under the muscle. What is the rule of thumb for activities as in exercise again? Iam an athlete, runner, lifter and exreme sport girl. Is it like 10 days you cant get your heart rate up. 3 weeks to lift and how long to run again? I remeber my first BA i was doing situps 3 days after and trained with lower half of my body 2 weeks out and was fine. is it the same or can I heal better faster the sec time around to resume these?

Answer:

cannot do any of that for one month. 2 weeks keep heart rate low. You might heal faster but the restrictions are to avoid post-operative bleeding and those risks are the same the second time around. JG 7.1.08

Question:

I read question below about changing diameter projection size. My surgeon never discussed that with me meaning I thought there was just one size implant you stuck in (eith A, B, C or D etc). Please explain the choices of diameter projection and what it does. How can find out what prjection I have (if any)?

Answer:

implants do not come in cup sizes, in order to minimize long term problems it is best to use an impalnt of the base diameter of your native breast, different projections can lead to slightly larger size between them once chosen. The projection described is not of your breast but of the implant when filled. JG 6.30.08

Question:

One more thing, Iam scheduled for surgery next Wed at 8am from saline to silicone. I just read an article on an athlete who just got the NEW sili gels and in 5 weeks she got ill and had them removed and is now forever sick. Tho it didnt rupture she was going on about even SALINE how the shell thats silicone substance is very TOXIN and has hidden chemicals that os horrible for your body and rapidly or slowly kills your body. I was very upset hearing and am about to cancel my surgery or keep what I have. Any help to sooth me?

Answer:

I think the patient is looking for something to blame, but I seriously doubt her new implants caused anything. If she had taken a blood test before the surgery she would have found that she has silicone in her body before the surgery. That is because silicone is everywhere around us, in OTC pills, in deodorant, hair and skin products,in many things we eat, even in our water. I think she is incorrect is her statement.JG 6.26.08

Question:

To my prvious question of me switching to silicone. You said my ripples will be less but my hardness will be the same? How can that be since docters aer saying that silicone resembles natural breast tissue and is more real in feel. My docter is also performing a Capselotomy due to the fact my skin never stretched to accomidate my implant so the scar tissue just held it in place. So if he scoresit i should be able to feelk the softer implant dont you agree? Im confused with your statement when you said siicone still will feel hard?

Answer:

what I mean to say is the chances of you getting a capsular contracture or a firm breast in the future is the same with a silicone versus a saline implant. If the capsule is scored, that will allow a large impalnt to be placed and might make it feel softer, but there is no guarantee it will stay that way and could contract to a firm feeling in time. JG 6.24.08

Question:

Dr. Garcia! Iam switching to Siliocne Gel! YAY from saline for i had hard breasts and rippling due to my athletic 7% bodyfat! My question is this my doc wants me to go 100-150 more cc...because saline looks bigger than when silicone is in. Why is Siicone look smaller on a person? and will t hey sag more?

Answer:

I have honestly never heard that saline looks bigger than silicone, and I am afraid your chances of hardness will be the same and the ripples will lessen but not be totally eliminated too. JG 6.24.08

Question:

Hi Dr. Garcia! I am considering getting breast implants but I have a few questions. I`ve heard that an armpit incision is a new way of putting a breast implant in. Is is anymore dangerous that the incision underneath the breat? Also, can implants affect breast feeding because I have no had children yet. I know it`s usually good to wait until after I have children but I am so uncomfortable with the way mine look. Will I still be able to breast feed or is there usually complications?

Answer:

the armpit incision has been around for almost thirty years, certainly not new. It is used for placing implants under the muscle, it is difficult to place them above the muscle from that approach. It is not any more dangerous and has all of the same risks as the other incisions. Implants have about a 1-2% chance of altering nipple sensation, no matter which incision but should not preclude you from breast feeding in the future if done through the armpit incision. JG 6.10.08

Question:

Oh, is it the 1600 in the Mentor 1600 Round which controls the diameter? What higher sizes are there in the Mentor Round to get a C or D size?

Answer:

no, that is just once of the styles, there are many diferent base diameters in that model. JG 6.5.08

Question:

If a female was a size A cup, and got a 325cc size implant with it overflowed to 360cc, what cup size would she be?

Answer:

no way to tell I am afraid, but somewhere between a large B and a C cup. JG 6.5.08

Question:

Would a 325 cc implant be the diameter size (325cc)? What data determines the diameter or the implant? I have a 325 cc implant which seems to have a smaller diameter. What I mean is the diameter of my breast shape is almost the same as before I got implants, but ti is just higher up in inches to increas cup size. However, I want the diameter (circle) larger and I don`t know what you need to ask for so the diameter will be increased.

Answer:

it is the actual base width of the implant, that is the diamter, it is not the volume of the implant. What you have is what a properly done breast implant should do, it should not go beyond the diameter of your breast. JG 6.5.08

Question:

Dr. Garcia: What is the better of Silicon gel vs Saline implants. Which is the best of these 3 incision: armpits, creasefold, or areola? Do many doctors still use endoscope if going thru armpits or I was lied to? I`m prone to scarring but would like a silicone gel.Where would the best area for incisions? would that cut my muslces? Would that make me more incline to having CC? thank you for your time.

Answer:

I think they both have their good and their bad points, I do not think there is one better than the other in generla though. I think the best incision will depend on the individual patient, there is no one incsion that is best for all people. I do not think the endoscope is used much anymore, it was more of a marketing thing as the armpit approach was used for many years with great success without the endoscope. I think the quality of the scars will likely be similar in all of the locations, the inframammary might have a sligtly higher risk of being a little thicker. The muscles are only cut if the implant is placed below the muscle, and it is only a partial muscle transection. Going under the muscle I feel lowers the risk of capsular contracture. JG 6.3.08

Question:

I just had a breast augmentation on March 19, both of my breast round out on the sides farther than my actual body does. Is this normal, or were they placed too far out? Also when I lay down they both slide to the sides, and are rounded out almost completely into my armpit. I called and told them I was having problems and made an appointment, I just want to know if my concerns are justified.

Answer:

it can be becasue the muscle is pushing them out, or the pocket was made too far to the side, or from choosing too large of an implant to place. I think you are justified and going and asking them what they think is going on. JG 6.3.08

Question:

Sorry one more thing, My breast shapes isnt right. One looks like round but the edges point out so its a TRIANGLE SHAPE to the armpit. NOW i know this isnt GRADE 4 CC. Cuz the breast really isnt scary distorted but the TWO SHAPES ARE DIFFERENT. The left is more to the side and pokes out so its like a triankle and the right looks OBLONG sideways....its hard to explain...why

Answer:

sounds like a pocket dissection issue. JG 6.2.08

Question:

Dr. Garcia, I have implants already in and my surgeon blindly let me pick the size. I unfortuatly learned ALOT more about sizeing after a year of havingh these. He never measured my breast tissues to tell me the upmost diameter that would be safe for me. Is there a way he can determine that now that iam implanted? How can he do this since iam implanted?

Answer:

well, it can be done in some cases when you can see or feel where your own tissue ends and the implants starts, mostly near the edges. JG 6.3.08

Question:

dr. i had my ba 5 days ago and i am doing great! but how lond does it take for them to drop? i fell like i have long flat breasts. and also how long till i can swim?thank you so much.

Answer:

it wil take weeks, and if under the muscle it will take longer. JG 6.2.08

Question:

Hi Dr. Garcia, I am 46, 5`4 112 lbs, petite and jog, 9 months post-op with my first surgery, had 325 saline filled to 340 under the muscle, went from a b to a d or dd, wanted to just go to small c, two questions: the saline in the cold is stiff, but in the heat is soft, does silicone respond the same way, the cold feels rather uncomfortable, 2nd question, I am too big for my lifestyle and frame and considering a re-do because I am gynormous that time of the month, (not by vegas standards!!), but for me, what would your opinion be about 275 or 300, silicone or saline? And the recovery time comparted to before. My breasts now look heavy around the base and sides, so my petiteness is gone...don`t know if it is worth it, but I do find myself hiding behind my clothes because no one knows and I want to keep it that way? Thank you so very much!

Answer:

I think the size reduction you are thinking about will reduce them by about 1/2 cup, and the same sensations can happen with the silicone. JG 6.2.08

Question:

With breast implants, I am not sure what difference is betwene high profile and other implants. The surgeon never gave me a choice? Which kind of implant do you think is best to use? What do you recommend for most women? In addition to high profile, like textured or untextured, etc?

Answer:

there is no best implant for all patients, there are personal variations that make one better in some people than in others, I very rarely use high profile implants and I never use textured implants. JG 5.30.08

Question:

I don`t know if anyone has ever asked you this before, but I hope you can answer. I think you measure your breast cup size by inches or every 1 inch is equal to one cup. In other words if you breast mound is 3 inches in height, it would be a size C cup. Now, I would like to measure the lenght of a B, C or D cup from top to bottom instead of from side to side (across) the breast. How many inches measuring from top to bottom of your breast would a size B, size C or size D cup be? It would be like measuring the size of your hand from wrist to tip of finger. If you do not know exact inches, an estimation is good.

Answer:

you would need a large caliper to get that measurement, it cannot be done with a tape measure, but it is the same dimension. JG 5.30.08

Question:

How can you tell if an implant under the muscle is migrating to the armpit! How can you tell? Can this also be fixed and how? Also I noticed my left breast after a year seems to feel like its tugging something like that? IS this possible?

Answer:

well, if you lay down on your back and it moves to the armpit, you have your answer. The only way to attempt to fix it is to try to close off the pocket in that area, it does not always work though. The tugging is likely some scar tissue is all, not dangerous. JG 5.28.08

Question:

I wanted to go a silicone this time around but the MRI upkeep is something I can`t see me doing . Is this a factor in which I just answered my own question to keep saline? also is silicone really than amazing on a person where there is a great outcome

Answer:

sounds like saline it is, the silicoen has some issues where it feels somewhat more natural, btu it is not night and day. JG 5.27.08

Question:

Regarding SILICONE! Why do these ripple kess? I wa told by a woman who had them in the first run that the Silicone Cohesive gel over time actually droops to the bottom of its bag from gravity and the life of it and doesnt hold its shape like SALINE! So basically if you like round and full Silicone over time wont have this effect. Do you agree?

Answer:

they ripple less than saline, but they still ripple. I think actually silicone will hold its shape more so that saline though. Over time the tissue stretchs on the lower pole of the breast and that round full look will not stay, no matter what implant is used. JG 5.27.08

Question:

Is there anyway post op you can do to prevent CC. Even tho its up to the body but activities to avoid so u wont further get it worse

Answer:

no 100% way to prevent it. Activity level will not influence it. JG 5.27.08

Question:

Dr. Garcia. Iam 11 months post op. Both of my breasts look different and actually havent really changed threwpout the 11 months. I have noticed that both are soft on the sides but on the inner parts they are very firm...can CC just be on the inside? Also I notice bothe breasts are different shapes. The softer one triangler and the harder a circle.... What can be done to fix this? Also would it be best to just do everything over with newer implants since i dont like the size? or just keep the sizes and what process can be done to fix it?

Answer:

I do not think capsules form in just one area but it sounds like you will need more surgery to correct all of that. JG 5.27.08

Question:

Hi Dr. Garcia, Thank you for answering my other question. I have had a hard time posting this question, so I hope you don`t get three of basically the same. I had BA 9 weeks ago for the first time and everything is going well. I went to a very reputable plastic surgeon, and breasts look great. However, I do have some ripples -- I guess they are called -- or maybe it is traction , only in the cleavage area right close to chest that I feel and do not see unless I use chest muscle, the muscle contracts or I move awkwardly. they are textured round saline 360cc filled to 390 cc under the muscle. Apparently the textured are all doc uses. 4 questions: (1) In regard to rippling, if all saline implants ripple to some extent and is normal , to what extent is it normal at which to feel the rippling and when is it not normal? My doc says this is normal. Is it?? I am 5`1 and 107 lbs. (2) What is the visual difference between rippling and traction?, Or is it the edge of the implants I feel? -- implants have not dropped fully yet.(3) also what is the main reason for the weight restricton of 5 lbs? I have followed ALL directions per doc`s orders, however I do have a toddler -who I have NOT picked up in 9 weeks, but at times have strained myself maybe too much trying to control her. I ponder the thought-- could I have caused this rippling myself?? I feel as though everything I do could jeoperdize my final result. Thank you for your valuable time!!!

Answer:

well, I have to say , all implants sold now ripple, saline ripples more, but whereeer the tissue is thin, the ripples will be usually at least felt if not seen. I will also say that textured implants show more ripples due to the traction effect you mention. In cases where you see it by the center of the breast bone, even if under the muscle, it is because the muscle is thin and cannot hide them. There is essentially not much visible or practical difference between just plain ripples or traction folds. The ripples are all on the surface or edge of the implant. The weight restrictions are to avoid popping a little blood clot off of a blood vessels and getting excessive bleeding that can result in a return to the operating room. Our weight restrictions are lifted completely after 4 weeks though. The ripples have nothing to do with anything you did, it is just thin tissue. Best of luck. JG 5.23.08

Question:

Dr. Garcia. What are the risk with BA thru areola? will there be nipple insensitivity afterwards? How can a surgeon be so sure as to not cut any muscle when he lifted the muscle to create the pocket when he did not use an endoscope during this process? What is the difference between High profile and Moderate Profile Saline? Also, does capsule contracture always developed in everyone since it is a foreign object for the body. It is only a matter of degree for each person 1-4? Thank you for your patience.

Answer:

the risks are all the same as the other incisions, even as far as loss of nipple sensation using an incision through the areola. As to being sure how not to cut the muslce, it is done under direct vision so they can see it. The difference between the high and moderate profile implant is the height or prjection of the implant off of the chest wall.As to the capsular contracture, all peopel get scar tissue, but a percentage, roughly 20-24% wil get stiffness of that scar tissue as it contacts.Best of luck. JG 5.23.08

Question:

Hi Dr. Garcia, How long does it usually take to feel a difference after taking Vitamin E for a capsule? For example is a week or two weeks enough? Or does it takes months. Also, can the capsule continue to get worse while taking the Vitamin E? Thanks so much.

Answer:

weeks to months if it is going to help at all, it might not help the capsular contracture. The capsule, if it is not going to repsond to the Vitamin E might continue to get worse while on the vitamin too. JG 5.22.08

Question:

Dr. Garcia. Questions on BA via armpits incisions: How are the pockets created? Is tissue expander being used? Why not? -Will the PS cut through some muscle and nerve when he is creating the pockets? - When they say Suture, do they mean the suture on the armpits or inside my body to hold the implants in place? - Will there be drainage on my armpits? Why not? - Where would the bruising be? What do I do with these bruises? Thank you very much for your kindness. I wish I live in Las Vegas so I could go see you instead.

Answer:

the pocket is created using instruments to lift the muscle off of the ribcage, a tissue expander is used by a small percentage of surgeons to assist them in opening the pocket at times. The muslce is pulled off of the ribs but not cut. The sutures only close the skin, they do not attach to the implant. There might be some oozing at the incision but we do not routinely use drain tubes as the amount of fluid is very small. The bruising should be small and gone within 7-10 days. Best of luck. JG 5.22.08

Question:

Dr.Garcia, what is the difference between a plastic surgeon and a cosmetic surgeon? I am considering a Breast Augmentation procedure. Also, pls tell me the Pro and Con of the TUBA method versus via incison thru armpit. Many thanks. God Bless.

Answer:

well, I think the doctor has confused you, a TUBA is an augmentation done through the belly button and it invalidates the company warranty on the saline implant, the arm pit ncison can also be used and some doctors use an endoscope to perform the procedure but it is not needed. As t the difference between a cosmetic surgeon and a plastic surgoen, cosmetic surgeons are doctors from other fields like gynecology or family practice and even dentists who never did a board certified training period in an accredited plastic surgery university based program and have decided that rather than practice what they were trained to do, they take week long or weekend course to learn how to peform certain cosmetic surgery procedures as they are a cash basis and present better return than insurnace reimbursement from the type of medicine they were formally trained to do. JG 5.22.08

Question:

I was wondering. I have implants under the muscle. Iam going for a redo for a larger size. During recovery time. Is it still a rule to NOT LIFT OVER 5 pounds and such? Or is it relatively not that bad comapiared to the first. DO I also have to wait the same amount a time to run and lift. How long to you advise to continue with running after the second as well as lifting?

Answer:

yes, the restrictions are the same to avoid bleeding and tearing the incision open. I would also suggest waiting the sae alloted time before physical activity. I would not run for 3-4 weeks, you can walk on an incline treadmill with no bouncing after 2 weeks in our practice. JG 5.21.08

Question:

If a woman does not have enough breast tissue to be a size C, so she get s a size B breast implant= can she eventually increase to size C or D over time? Is it what tissue she has needs to strecth more before a bigger implant can be inserted?

Answer:

possibly, if the native breast tissue widens afer the implant. JG 5.20.08

Question:

What size cup would would you recommend for a person who has 34 inch chest, 5`8 and weighs 125 lbs? (small, medium or full cup A, B, C or D)?

Answer:

there are anatomical limitations on what can be placed, these are the size of your native breast tissue, location of your nipples and shape of your rib cage that will influence that, so no way I can tell. JG 5.19.08

Question:

Is is true that if you choose saline implants you do not need to have any additional tests such as an MRI every few years? Would you recommend a mammogram every year if after the age of 40 to check for breast cancer as in someone without implants? Thanks so much for your advice.

Answer:

no, the need for MRI scans every 2-3 years applies for silicone implants only. Mammograms are still needed, no matter what type of implants are placed, for cancer monitoring, yes. JG 5.17.08

Question:

Hi Dr. Garcia. I had a breast lift/augmentation (Saline/sround smooth implants used)a year ago in NY. My doctor gave me Accolade for capsule scarring, but it`s been a year my right breat is a slight bit higher than the left. As well as firmer than the right. I was told it was a capsule, my question is at this point is there anything that can be done to correct this (involving surgery or not). I initially went to my dr. 4 months after the procedure with these concerns and he told me to give it a year to improve, but a year later not much has changed at all. What do you think my best options are? Thank you in advance for your time.

Answer:

I think the only thing would be a capsulotomy or capsulectomy to alleviate the contracture, but there is a high recurrance rate. JG 5.16.08

Question:

Dr. Garcia, What are your thoughts on taking Accolate for a capsule? Thanks.

Answer:

works in a very small number of cases, even less if not combined with surgery. JG 5.16.08

Question:

Hi Dr. Garcia, I had one more question that I forget to mention regarding the start of a capsule at 8 wks post (3rd surgery w/in a year.) 1st revision for implants not dropping & left capsule, 2nd revision for left over-dissection of pocket & right start of capsule). You suggested taking 3000 mg of vitamin e for a month and then decreasing from there. Would you still recommend that high dosage for someone who had a bottoming revision? My last surgery was for a bottoming out on my left breast. The tightness that I`m feeling in on the right side. At 8- 10 weeks post does the high amount of vitamin e jeopardize the bottoming out repair? Thanks again. You are so helpful.

Answer:

well, I think the Vitamin E softens scar tissue and if it is going to work on the capsule, it coudl also work on the bottoming out repair in a negative fashion I guess, tough call.I have never had to use the Vitmain E at the time of repairing two opposing issues I am afraid. JG 5.15.08

Question:

I am considering having a breast augmentation but after reading negative information on the internet it is sounding like it is surgery that is eventually damaging and unhealthy on the body because of the likely risks of leakage etc. I have no family history of breast cancer, am 39 years old and for years have had one breast that causes me a bit of pain on and off and down that arm. I have been told that this breast has a lot more tissue than the other and have been sent for a couple of ultrasounds over the last 10 yrs which were normal. Do you think even though nothing shows up as a reason for the pain it is reason enough that I shouldn`t comtemplate implants? Thank you so much for any advice.

Answer:

I am not sure what is causing the pain but I do not think it will get any better or worse with an implant being placed. I think when you go to the web to find information you typcally get a distorted view as happy patients to not get on message boards or blogs, so it sounds more negative than it really is in real life. There are risks, but they are small. JG 5.15.08

Question:

Which type of breast implant is less likely to show ripples on skin= textured or nontextured. I think I got the kind which was less likely to show ripples.

Answer:

I believe smooth show less ripples. JG 5.14.08

Question:

Is 300 or 320 cc considered a large textured implant? Also, I was wondering how many years you keep patients records? I do not know if my doctor would still have the information after 15 years since I have not been in his office since? Would Mentor have the information on my implants if I gave them my name (and would they know the amoutn of CCs of saline)?

Answer:

the definition of large is not the number, but how it compares to the breast tissue and anatomy you have, a 300 could be small on a large framed person and too large for a small frame, no way to tell without seeing you in person. The docotr might have the information, and Mentor might also. JG 5.14.08

Question:

Now that I think I am not sure if I chose nontextured or textured implant. i think I chose whichever one had less chance of breakage. Which one would that be? If I had textured implants inserted, would that cause triangular shape?

Answer:

if it is a textured anatomical shaped implant, then changing it to a smooth round implant might alleviate the issue because anatomical textured implants can look triangular in some women when the implant chosen is large. JG 5.14.08

Question:

Hi Dr. Garcia, Thanks for your response regarding the start of a capsule at 8 wks post. You suggested taking 3000 units for a month and then decreasing down to a 1/3. How long would you recommend continuing on the 1000 units thereafter?

Answer:

2 months, if it is no better by then you can stop the extra Vitamin E. JG 5.14.08

Question:

In regards to question below about traingular shape to breasts, I had a mentor implant put in. The surgeon only gave e tow choice textured or nontextured, which I chose nontextured. What kind of implant should I ask for?

Answer:

well, if you have a non-textured implant, then the triangular shape is not due to the implant, it is either some degree of capsular contracture or inadequate pocket dissection. You will need more surgery but changing the implant will not affect it. JG 5.14.08

Question:

I have read that after a breast augmentation with silicon implants you need to have regular mri`s to make sure it has not leaked? Is this true and is it better to have a breast ultrasound than a mammogram due to the risk of them rupturing with a mammogram? Thank you!

Answer:

it is true, mammograms are not adequate to detect leaking in silicone implants, ultrasounds are not as good at picking up small tumors as a mammogram is. JG 5.14.08

Question:

I am 52 yrs. old, in good health, 95 lbs. 5`0. Is it too late to have a breast augmentation? I want to have a cup full C.

Answer:

I do not think it is too late but I cannot say what size you could be, it depends on your anatomy. JG 5.14.08

Question:

Hi Dr. Garcia, I had my 2nd revision and 3rd third surgery (breast augmentation under the muscle) within a year. I am 2 months post my last revision and have noticed that my right breast is feeling tight. I`ve had slight capsules before. The first time was on my left and the last time was on my right. My PS doesn`t think that either was a true case of a capsule but a combination of things, ie. the pockets not being large enough. Can you tell me if it is the start of a capsule could it begin 8 weeks post surgery? Also would you recommend taking vitamin e and at what amount?

Answer:

at 8 weeks a capsuln can start, yes. If you are going to take Vitamin E, I usually start at 3000 units per day in three divided doses for one month and then decrease by 1/3, it will thin your blood though. JG 5.13.08

Question:

Dr. Garcia my ps says he can replace my 360MP implants with my origional 330MP implants like it was no proble. Is this pretty ease to do and what has to be done to do this?

Answer:

pretty straightforward, just open the incision and the capsule and remove one and replace it with the other. JG 5.10.08

Question:

I had a BA done almost seven weeks ago. I had 68MP 330, the left filled to 350 and the right filled to 370, placed under the muscle. I started out with very little breast tissue. On the second day after surgery, the left implant popped up to around my collar bone. The PS had to grab it and yank it back down into place. From there, I wore a strap for three weeks. My right breast has turned out beautifully. The left, however, after that trauma, is still fairly red in color. The skin tone to the breast and the nipple have not gone back to normal. It is not bright red, though, just discolored somewhat. As time goes on, and the discoloration gets better, I am beginning to see areas of some type of bruising that look like hickies. The implant is sitting higher than the normal side by a little bit. The nipple is sitting lower, which I assume is because the implant is riding higher. On that same traumatized side, I have a dent on the cleavage side. It almost feels like there is no muscle attached in that little 1/2-inch spot, which is causing the dent. My sternum is very sore right there. First, what would cause the implant to have popped up like it did? Second, could my muscle have been cut by the middle of the sternum while creating the pocket, allowing this dent? If so, can that be fixed? Thirdly, how long will discoloration and healing generally take after trauma like having to yank the implant back down into place? Thank you so much for your time.

Answer:

sounds like with all that you are describing you had a hematoma develop from probably a partial tear of the pectoralis muscle off of the breastbone and that has caused all of what is going on. If there is a hematoma the best thing is to drain it so that will let the implant settle into place and also help reduce the risk of capsular contracture down the road. The strap and massaging might help but it can literally take months to settle down in some cases. JG 5.10.08

Question:

Dr. Garcia. Why or how come saline ripples dont show up at all then after like 10 months it can show? For instance my left breast which is smaller than my right has absolutly no ripples but my larger breast on the inside you can see the ripple on the edge. Mind you they both are the same fill 360 max. NO under or or fill! And do you sincerly beleive silicone wont have this problem?

Answer:

it is due to the swelling going down and also something called a piston effect where the implant bounces and puts strain or traction on the skin to make it slightly thinner thereby allowing the ripples to be more easily seen. The smaller breast can also have some element of capsular contracture that may hide some of the ripples. Silicone lessens but never eliminates the ripples, at least with the silicone implants sold now in the US. JG 5.8.08

Question:

My right breast seems to be harder then my soft left. It sometimes has a sting/pinch dull titening pinch! Nothing major it just feels like a knotted muscle. Can this be the scar tissue closing in. This breast also has a firm feel with a lil ripple. My left ne is perfect with no visula or felt problems. Mind you the problem right one has alwaus been the faker looking one from day one. iam 11 month post op. now!

Answer:

it might be scar tissue, yes. I suggest seeing your surgeon for a check up. JG 5.8.08

Question:

Dr. Garcia, I had a baby six months ago and have since stopped breast feeding. I am really surprised by the loss of fullness in my breasts now...I had a breast aug. 12 years ago, saline above the muscle 500cc, and while they are now a full D(go figure) they are not as firm as before the pregnancy. What is the best option for getting the fullness back...I do not want a lift because the scar is too visible. Thank you for your time.

Answer:

not much that can be done besides the lift, a larger implant I think would not fix that issue. JG 5.8.08

Question:

Hi Dr.Garcia, do women get breast augmentation in their 40`s? I had to have my silicone implants removed due to rupture, after 17 years. I`m now 46 and I miss looking good. If so, would you recommend saline or silicone again?

Answer:

I think either silicone or saline can be done, the silicone might feel a little more natural, and yes, many women in the 40`s have them placed, even for the first time. JG 5.8.08

Question:

Dr. Garcia my left breast is slopping out to my armpit and making a crease on the side as it settles and the nipple is off copared to my right breast which lloks perfect. Why is this? And can this be fixed? My PS made a mistake in surgery when he went threw the fold on the right and then relized he was supposed to go threw the areola. Insead of going threw the fold on the left he went ahead and went threw the areola on that one which is the one that does not look right. Nobody told me what had happen then when my husband was aloud to come back and see me he surprised me with the bad news on the mistake. Then from listening to my husband he tells me what the doctor had told him and I was pleasantly surprised to find out he hates going threw the areola he perfures to go threw the fold. Why would`nt a doctor tell you that before you went under the knife with him. Is this just a pocket ajustment I need to correct the problem. And letting him go threw the fold on this would that make a big difference if thats the way he perfures to use?

Answer:

it is likely to to the pocket size and when implants are placed under the muscle that can happen from the pressure of the muscle pushing on the implant. It can be attempted to be fixed by closing the pocket, but it is not a guaranteed result as it depends greatly on how the tissues heal. As to why the doctor did not discuss that all with you before, that is really up to him, but it is usually discussed at length prior to surgery. I think the revision surgery can be done through either approach so I suggest letting him use the incision he prefers. Best of luck. JG 5.8.08

Question:

I had small D implants put in 17 years ago, but since then have put on a little weight and I am now a DD. Can I have them redone to a size C? I hate them this big! If so, how long do you think I would be out of work? I`m a flight attendant. Thanks.........

Answer:

yes, but the degree of size reduction required will need to be discussed with the surgoen and they will likely need to know the size implant originally used to make that determination. JG 5.8.08

Question:

Regarding my nipple placement. He suggested the only way to center my nipple on the implant is to remove my nipples and replace them in the center? Ummm...thats like an entirely different surgery PLUS IMPLANTS! Is he nuts? I never heard of this before. I wish i can send you photos. Also....I notcied my left one falls more to the armpit and the right is dead center and not so pliable. You rhink this is CC? I really dont mind having a redo. I just wnat to make sure im not going nuts...

Answer:

that is absurd, I think you need to seek out another surgeon. The right side might have some capsular contracture or just a larger pocket, hard to say. I think pictures help some but in your case it would require a physical examination as the implant needs to be moved to see what can be accomplished, sorry. JG 5.7.08

Question:

May I ask you how would a surgeon go about fixing my nipples so they are more centered than all over the place! So much for the Harvard/Yale plastic surgeon of mine!

Answer:

well, in most cases it is due to improper pocket location for the implant. JG 5.7.08

Question:

My docter tends to play it safe! He places his implants far apart to be safe! Mine are 360 11.2 diameter and so far apart there is at least a 3.5 inch gap. What can I do to fix this? also being small- low b cup prw ba, my nipples were naturally far apart! Now ones centered and the other is literally under the other and far to my armpit! Its ridiculous n hideous! Can this be helped? Is my docter just not good?

Answer:

to be honest, I am not sure how that makes it safe, it might avoid one problem, synmastia, but the issue is the implant needs to be centered behind the nipple evenly, that might require an adjustment on the size though. I think you need another surgery and possibly different implants and a pocket adjustment, sorry. JG 5.6.08

Question:

Me again-gummy bears in Costa Rica. Thank you for the answers. One more-what about the pain in my nipples? It hurts to touch them even when my clothes touch them, when the shower water hits them. What is the cause of this? Will I live w/ this pain forever?

Answer:

could be a neuroma formed on the nerve, and yes, it might be there forever. That is a very rare problem. JG 5.6.08

Question:

I had gummy bear implants (costa rica) 7 months ago under the muscle. The bottom of my breast are completely numb and the nipples hurt. I had an areola incision. My doctor suggested an MRI to look for left over sutures but like I told him it`s not the incision site, it`s the tip of the nipples that hurt. In addition, this week I noticed one of the breast starting to sit lower. Is it too late for the numbess to go away? Why do my nipples hurt and why is one sitting lower now?

Answer:

sutures would no cause that and an MRI will not show much I am afraid, sounds like the nerves were injured during the placement of the implant. Although there can be improvements in the sensation occuring for 12 months, most of it should be normal by now. I am afraad there is not much I can offer for now. The implant can be sitting too low due to the muscle pushing the implant lower over time from the pocket being made slighty larger at the time of the surgery. JG 5.4.08

Question:

Hi Dr.Garcia. I am about 8 Months posts Breast Aug. I had zero breast tissue to start with, and now have textured anatomical silicone co-gels 375 gram. Is it possible for the textured surface to cause the skin between my breasts to pull away - almost like tenting? My breasts are separate so no symmastia. The tenting is worsened by bras that push them together. I also have very little movement, I guess from the textured surface, like when I lay on my back they do not move at all. A bra does not push them much closer either, they just really stay where they were placed no matter what. If I were to switch to smooth round silicones, do you think some of the problems may be resolved? Could I expect more movement in the pocket? Do you think the skin between my breasts might lay more flat? Thanks so much for your time, have a great weekend!

Answer:

I think what mmight be happening is that the implants are attached to the tissue and when in the bra it pulls on the skin. I do think a smooth walled implant would solve some of the issues. The tenting will not get better if the implant is too large though. JG 5.3.08

Question:

I have a question. Iam about a year POST OP--YAY! And I have noticed...this was always this way That me left breast actually slopes down and nicely and the right one seems more ROUNDER and sticks out. Likeits holding itsself in place in an upright posiion. YOU CAN especially see it when you turn to the side. The left looks dropped and natural the right is more higher up .. Basically..is this just a pocket thing or scar tissue just is holdoing it thast way?

Answer:

if it has been there from the begging it is a pocket thing, if it looked sloped first nd then got rounder, it is scar tissue. JG 5.3.08

Question:

Dr. Garcia. I have had an armpit incision my first time around. This time around the Doc wants to go threw my breast fold to place a bigger new saline implant in. I was wondering what the procedure is like. Does he first cut an incision then does he lift the muscle up or does he cut the muscle from that position and then what? Does he pop the saline out or cut the scar tissue ? Like whats the procedure. he said hed do a Capseulotomy to fit the implant in. Is this a bloody mess? Am I cut from a different muscle area than the armpit? I still dont understand how the implant wont fall out threw the insciion.

Answer:

the muscle is lifted, the capsule is opened and the implant removed intact and then the capsule cut to allow it to open enough to accept the larger implant. The muscles will not need to be cut anymore than they were the first time, it should not be a bloody mess. The implant is wider than the incision and will not fall out becasue it will heal and the tissue will be strong enough to suoport it. JG 5.3.08

Question:

Dr. Garcia! Thanks soo much for helping all of us with any of our concerns. YOu have been a GODSEND! I was wondering...I bag jump in diameter from 11.2 to 12.4... Is that really a wider bag visually or not that noticeable?

Answer:

about one half inch so it will be visible. JG 5.3.08

Question:

Hi Dr Garcia, I asked you if breast implants can cause cysts and you said they cant but the removal of the old implants can cause fluid like collections that look like cysts. My question is what exactly causes this collection of fluid and would it be better if i had them removed en bloc then replaced? I would also like to know what is the best way to deal with them. The doc aspirated mine but told me it will probably fill up again. As my breast looked very deformed before as the lump was very big I am worried it will come back if it does what can be done?

Answer:

collections of fluid after surgery are from blood or serum accumulating in the open space created by the surgery or the removal of something during the surgery. At times placing a drain tube at the time of surgery will help decrease that risk, but it is not 100%. Even if you removed the implants en bloc, the cavity it was removed from can create a fluid collection, it is not a case of implants being removed in pieces that causes it. If repeat aspirations are needed, it might warrant the placement of a drain tube to control it. JG 4.30.08

Question:

Dr. Garcia: I had Memme implants twenty years ago. THey were placed above the muscle. (The surgeon who replaced them thought that they may have been subpectoral by my description.) My chest was FLAT for the first few days after surgery. Later, they were spectacular. My OB/GYN did not know I had been altered. My implant could move up/down as much as a natural breast. If you will note your patients prior to surgery, their natural breast fades all the way to the clavicle. It does not stop half way up her chest. My revision was done with smooth implants. I have capsular contracture and will replace these with a textured implant. Are there any surgeons who are as artistic/innovative as my first (now retired) PS? If not, why not? My last surgeon will not be getting my business again. He was competant, but did not listen and would not answer my questions. Thank you

Answer:

well, there are no new developments in terms of avoiding capsular contracture I am afraid, your initial resutl was to a great deal due to the Meme implants and they are no longer available. There are surgeons that do only breast urgery but without the Meme implants, results will likely not be as good and also your tissues have degraded due to time. Wish I had suggestions for you. JG 4.30.08

Question:

How do you know if a saline implant is leaking...they seem so less firm and less projection. I got them in 2002, is it time to replace?

Answer:

there is no slow leak with saline, if they leak, you go flat, the longest it would tkae to go flat would be about one month. If they are not broken they do not need to be replaced unless there is something else going on. JG 4.28.08

Question:

Dr. Garcia, I have extra skin on my stomach from having kids, if i get my implants in any way will it pull up my skin ( i only have a litte)from my stomach? i am not even an A now, i am 5`2 and amd 115 pounds and im thinking about 325 cc what do you think?

Answer:

sorry,but it won`t do that. JG 4.28.08

Question:

Dr.Garcia, Regarding my question about a BIGGER implant in the 480 range youd GUARENNTEE will not be covered much by thy muscle. Where does it go if it isnt covered? Out to the sides? Also what can happen when it isnt covered by muscle all the way? Can you determine what size range one can max out before it exceeds the muscle coverage? Mine are 360? what about 450?

Answer:

it goes out to the side and down and will be covered by breast tissue if there is enough, otherwise it will be covered by skin only. The biggest thing when not covered by the muscle is being able to see and feel ripples. I cannot tell you what the max size would be without examining you, sorry. JG 4.28.08

Question:

When one has a second BA, do u still have a hard time lifting ur hands over ur head with that muscle soarness as well as the difficulties with chest muscle movement like the first one? or is it easier just tighter? ( both under muscle)

Answer:

there is still soreness, but less than the first in most cases. JG 4.27.08

Question:

how do u find ones BWD if her ribcage is 28 inches ?

Answer:

the native breast tissues needs to be measured to determine BWD, not the ribcage. JG 4.27.08

Question:

Hi Dr Garcia, I have had my silicone breast implants removed after a long time. Immediatley after surgery I noticed a hard lump which was still there months later. I had an ultra sound and I was told it was a cyst which the doc aspirated with a needle. My question is can implants cause cysts this was a very large cyst and deformed my breast It definatley was not ther before.

Answer:

implants do not cause cysts, but during the removal of the implants there cna be fuid collections that develop that look like cysts. JG 4.27.08

Question:

I have a question regarding ones skin elasticity and tissues! I keep hearing girls talking about THIN TISSUE or THIN SKIN and they need LOW PROFILE implants because of this. How can you tell if your tissue is think or you have thin skin for a certain size of implant? Also, Iam a very fit and tite skinned lady. Basically my natural size WAS a really small B but my tissue of breast was dense and harder bnecaue iam so lean and muscular that my skin is very tite. I got 360 cc put in and my poor docter had one heck of a time gettiny my skin to stretch as well as lifting my chest muscle up because they were so tite and developed. Tho iam 11 months post op...they have finally let loose and droped. My question is this ...if I were to go to 480 or 510 cc. Will my skin/tissues be able to handle this. AGAIN THEY ARE UNER MY MUSCLE....

Answer:

the thiness does nothing to do with the profile, it is the width of their tissue that it will influence it. I think a bigger implant in a thin person with low body fat will likely show rippples due to thin skin. I can guarantee you an implant in the 480 range or higher will only have a small portion below the muscle. JG 4.27.08

Question:

sorry. i previously asked you about my 650cc implants being enlarged to 800cc and asked if it would make much difference. when i said do i get 50cc more i was meaning should i get 850cc instead

Answer:

I do not think it will make much visible difference. JG 4.23.08

Question:

hi dr garcia. i previously had a size 34a/b and had 650cc implants put in abroad. i`m getting them enlarged in about a week but am worried there won`t be a noticeable size difference and don`t want to have to have them redone a third time. do you think there will be much difference or do i get an extra 50cc

Answer:

50cc on top of 650cc will not make much difference. JG 4.23.08

Question:

I was wondering i am on birth control and all of a sudden my breast get sore and a little bigger, but only while on the birth control patch should i stop that particular birth control or will i just be a little more sore, after my procedure.

Answer:

no need to stop, the discomfort will likely be no different. JG 4.24.08

Question:

Dr. Garcia how do you ask a ps that one breast looks great but i really don`t care for how the other breast turned out with offending him?

Answer:

well, it is one of those honesty is the best policy, tell him how happy you are with ehe one side first and then ask if the other one can be improved to look like the nice one. JG 4.21.08

Question:

Dr. Garcia...How soft or pliable are implants that are saline are SUPOSSED to be? Like when you move them how pliable are they suposed to move. REason I ask is because after 1 year mine feel like NOT HARD but feel like a plasric rubber ball that if you try to move them together one actually can move in about 1/2 inch the other DOESNT. Is this something that is normal. Agian no pain...but they just dont feel right. I wouldnt know how THEY are suposed to be since I never had implants before

Answer:

it depends on how much the were filled, they should be pretty pliable in general though. What you are describing sounds more like a small amount of capsular contracture.JG 4.18.08

Question:

Dr. Garcia, How can you FOR SURE tell if the surgeon you are using is THE BEST for you and is ACTUALLY A GOOD HONEST surgeon! Im going for a redo because the man I once had faith in is giving me doubts because when I go to tell him why or whats wrong with my implants evertime its a different story and he never can look at me in the eyes. Is this an honest surgeon? THo he has amazing credentials I just get frustrated tring to have a conversation with him

Answer:

I am afriad there is no 100% way, I suggest talking to previous patients and other doctors. Credentials do nto give honesty per se, sorry. JG 4.18.08

Question:

Dr. Garcia How full would you fill a 68MP 360 breast implant if i ask to have them filled to the fullest you could fill them? I know you can`t really say without seeing the me. Just wondering how full a doctor could accually fill them if the patient request the max. fill and the doctor was ok with it. Thank you for your time.

Answer:

I likely would not fill them past 400-410 in most cases. JG 4.18.08

Question:

Dr. Garcia I have to choose between Saline 480cc MODERATE PLUS (12.3 in diameter and 5.4 projection) To 510 MOD PLUSS cc (12.5 to 5.5) i know there is No big difference...but what should i choose to be more happy with between those 2? Shall i go for the bigger or the smaller?

Answer:

I am sorry but that is not a professional decision, it is a personal choice. JG 4.15.08

Question:

Dr. Garcia, When an individual comes in for a redo for a larger implant does the DOCTER LEAVE the scar capsule surrounding the previous implant in or cut away at it to make room for the bigger implant to lay? Basically my doc wants me to have a capsulotomy to make sure the new implant lays. Is this ALWAYS the case in going larger? If so or NOT so what is the reason? HOw would one go larger with the same capsule inside? Wouldnt it get in the way of the new implant if it isnt cut or released?

Answer:

usually the capsule is either cut and allowed to expand to allow the newer implant to be placed, in a small number of cases the capsule is entirely removed. It is almost unheard of for a larger implant to be placed without something being done to the capsue unless it was a very large pocket to begin with. JG 4.14.08

Question:

Hello, Dr. Garcia. I had a revision a little over 3 weeks ago. Switched over muscle saline for under muscle silicone. Dr. said going under muscle would make them sit a little farther apart (which I needed) and there would be no ripples...if any, just underneath where the muscle wasn`t covering them. Between the time of consult and procedure, I`m wondering if he forgot what we talked about. I know he said during surgery the one capsule was difficult because of scarring. Here`s my question. I have a feeling he did not go under the muscle. I had no pain from surgery, they were not high and needing to drop like most under muscle, they are where they were the first day and I have far more rippling in cleavage than the saline that were over the muscle. In addition, they are no farther apart, if anything..closer together, almost symastia. When I showed him the rippling, he said my previous surgeon probably broke through muscle in the middle. I reminded him I had overs and he got a funny look on his face. I fear he forgot and during surgery, just cleaned out pockets and stuck new ones in. Is there any way for me to know for sure if they are under the muscle before I accuse him of a mistake?

Answer:

I think you can certainly ask him for a copy of your operative record, or get it from the surgery center and read it there. JG 4.13.08

Question:

question, I have 500 cc implants and a tiny frame so I buy these tank tops with a elastic bra in it but they have to be size small to fit my frame but there TIGHT on implants, will that eventually lead to loss of fullness or distortion to implant, if bra is too tight?

Answer:

no, it should not. JG 4.10.08

Question:

If many woman seem to want bigger implants and it may be tooo big of an implant for their tissue or body..how come a surgeon cant say no? Or can he...or does the surgeon just wnat to make a perosn happy regardless

Answer:

he can say no, I do it all the time. Not all surgeons say no though. I think you need to ask the surgeon their motivations for doing it as larger implants might end up not giving the patient what they want long term. JG 4.10.08

Question:

Hi Dr. Garcia, I know this is hard without pictures/seeing me in person, but..I am 7 months post op Breast Aug with full unders. When I am standing up straight, the skin over my sternum/cleavage has a sort of cushiony feel to it, but my breasts are definitely separate. When I lean over, however, I get a tenting effect, the skin sort of lifts off and my cleavage does not look normal, it is very rounded. Would you consider this mild or borderline symmastia? I do not know what else it could be. Is tenting still tenting if it`s mostly noticeable leaning over? It also is worsened when I wear a push-up bra. Thank you so much!! Have a good week.

Answer:

borderline I would say. Tenting is stil tenting, yes. It worsens with the push up bra because the implant lifts the skin off your breastbone. JG 4.10.08

Question:

Hello Dr Pirece Dr Garcia I hope you can answer a few of my questions Cuz im sort of freaking out. I have had 2 mammograms done one at 32 and another at 35. MY last one had 10 views (due to implants) we were ruling out cancer of course> which yes all is fine. (I had felt something by my armpit) turned out to be muscle. Ok so my panic is from what I have read lots of articles.... I have increased my risk by 2-4% from the radiation over NOTHING? What is your opinion on this matter? I really really am freaking out? Also are MRIs safer?

Answer:

I think mammograms are worth the trade off for the radiation. MRI is better if you have silicone implants though. JG 4.10.08

Question:

I have a question. I have been reading som eposts on here an I read about some of these girls with sooo many surgical problems. Creases being lopsided, pockets not right...all these revisions. How does this happen? Is the surgeon not skilled properly? Also..my docter is amazing and did wonderful placement and symmetry and all... My question is tis..can all these problems happen to an individual when she goes larger even tho the original pocket is perfect from before? Or is this just what can happen no matter what?

Answer:

it can happen from wanting too large of an implant, from the surgeon opening the pcket to a certain degree, to the quality of their tissues and degree of support it can sustain, to previous pregnanacies, to many issues. I think the biggest contributor is an implant that is too large for the anatomy of the patient. JG 4.10.08

Question:

I wrote you a few times--you have a great service for us!! I had multiple revisions on my L breast over an 18 month period due to failure of the implant to drop. It is now very soft, looks very natural. In fact, it is slightly different in shape than the R (more projected, slightly narrower base etc.) I also had a rev. abd done 2 years ago that resulted in a wide scar which sits lower than I wanted, ultimately pulling down my breast creases, creating a flattening look of the underside of my breasts. I have a decision to make: my PS wants to do a capsulotomy on the R breast because he agrees it is stage 2 cc, tight and different shape than the L. He also wants to redefine the L breast crease, since it has been `pulled down` over the last year. THe R breast crease seems to be more intact because I guess the slight CC has keep it from dropping loose into the crease? (the L breast has a natural, slope shape and the R breast looks like a tighter, round breast). Finally, he wants to do a full rev. abd scar revision to give me a prettier, thinner scar. He feels confident that he can do all of it in one surgery. I am scared of doing so much at one time. I feel that if he does the capsulotomy on the R breast, we need to see how it looks after compared to the L and then after a few months, see if hte L breast crease needs to be done only, or if the R breast crease will also need done; together with a rev. abd. scar revision. He wants to use my rev. abd scar as an entry point for the R capsulotomy, leaving the nipple incision alone. I know he can do all of this in 1 surgery, but I have been through 6 procedures in 18 months and I need to make sure that it is a success. I am desperate for two breasts that finally `match` in shape and feel. I don`t want the rev. abd scar revision to pull down on a freshly corrected R breast. Any advice knowing that I need the following: R breast capsulotomy, redefinition of L breast crease (possibly R in future) and complete Rev. abd scar revision? Sorry so long!!

Answer:

I think it is safe to do it all at one time but if there is not enough loose skin to revise the reverse abdominoplasty scar, the scar will eventually end up looking the same. JG 4.9.08

Question:

Im going threw with a redo to go 100 cc bigger. My doc told me a year ago I`d end up doing it over becuse the size I choose was very small. Let`s face it I was scared. Anyways the first surgery was a success now what are the odds something bad can happen the sec time around? He went via armpit first time. Now he is going threw the fold of my breast because it wants to release the scar tissue capule so a bigger implant can lay better. Can something bad happen a this for any retreats to do this?

Answer:

I think the risks are almost the same as the first one. JG 4.8.08

Question:

Dr.Garcia just wondering why you would use the same amount of cc with a 360 implant as to the 330 implant. If looking for the almost same result the 330 were overfilled 25cc more on the left and 70cc on the right. So if my doctor used 360 can`t he overfill them to a total of 405cc on the left and 430cc on the right. Before they were 375 on left and 400 on right with the 330 implants and they were tight and full but they did loosen up and become nice and soft. I just fill these are underfilled compared to last time exspecial on the left they only have 15cc overfill and i can fill and see rippleing on the left lower bottom side and when i massage them you can fill the implant fills to empty and has that wrinkling popping filling. I just don`t understand why us the same cc if the implant is bigger. Or is that what you meant us the same amount of overfill cc as before? Thank you so much for answering all my questions.

Answer:

I would use the same cc, yes. Overfilling is up to the surgeon in terms of amount. The implant has an amount it can be filled to, overfilling it will make it feel firm as it is past the recommended amount and can also lead to more leaking. JG 4.8.08

Question:

Hi Dr Garcia, I had silicone implants for 10 years and had them replaced 6 wks ago. I had 350 cc in and my right breast was slightly bigger than my left.The doc said he would try and make them even. I was a 34d and wanted to be a 34dd he said he would have a couple of sizes available and see which was best. When I woke up my right implant was noticeably smaller with a lump on the side. The doc said wait till the swelling goes down which I have and it is still smaller and the lump is much bigger, a hard moveable lump. I did not have this lump before, and i had mir scan before and nothing showed up. What do you think it is? I think maybe he has took too much breast tissue from the right and the lump maybe scar tissue but im not sure. Also the doc said he put 605cc in but i am still a 34d (no difference in size) just slightly fuller why do you think this is?

Answer:

well there is no breast tissue that woudl need to be removed. Not knowing why you had the surgery, but if you had ruptured silicone implants it could be scar tissue from the silicone that could not be removed and 6 weeks is way too early to determine symmetry of size after your surgery, 6 months is more like it. As to size, I have found there is no way to guarantee size of cup after a breast surgery, all we can do is make you larger and certainly you have had a significant increase in the volume of the implant, I would say t give it some time for some healing to occur. JG 4.8.08

Question:

Dr. Garcia my next question then is if you were to us an implant size 360 on me and I wanted them overfilled to get more projection with the best results how much would you overfill them for the closes look I`m looking for.

Answer:

to the amount you previously had. JG 4.8.08

Question:

Dr. Garcia one more question i don`t know if you can answer this question or not but just an opinion whould help. Why would a doctor use a 360 verses a 330 when I wanted the same results as i had. He did tell me there is not that big of a difference in the diameter or width and he would prefer to use 360. What would be the reason for that you think? Thanks again

Answer:

I really can`t say, I would have used the same size if possible, maybe he had the 360 and did not want to order another one. JG 4.8.08

Question:

Dr.Garcia Sorry for so many entries last question for tonight anyway. Would I also get better clevage with this implant size if overfilled? Thanks

Answer:

not necessarily so, especially when in a bra. JG 4.8.08

Question:

Dr.Garcia I forgot to ask this with my last question does overfilling also give you a more outward look as to more fullness and less apperence with rippleing.

Answer:

yes, but if overfilled enough you will get scalloping, which makes it look like those mylar balloons at the mall that have firm ridged edges. JG 4.7.08

Question:

Dr. Garcia If iI had 330 moderate profile implants overfilled to 375 and 400cc my first time around and now I have 360 moderate profile implants how much would you overfill them to get the same results as before. Thanks for answering all my questions.

Answer:

well, the real answer is that you cannot, The reason is, in a smaller diameter implant, overfilling it will achieve a certain amount of projection. If you use a larger implant the next time with a wider base, then overfilling it will give you more projection but also a wider base, so they will never be the same. The closest you can get in terms of size is to use the same volume, but then the projection will be less than the first time. If you use more volume to get the same projection, in truth they will have to be bigger. JG 4.7.08

Question:

So Iam getting a redo... And I have Saline. My docter is SOOO PUSHING silicone. telling me it will look soo much better on my fit tiny body! Is there REALLY a HUGE differenc If i went to Silicone? Like REALLY, in all honesty..I understand everyone tring to get these tihngs back on themarket. But in pure honesty is Silicone THE END ALL OF BE ALL on the GREATES looking BA? Or should i just keep my saline. Which BTW i think would keep its FORM MORE and I feel Silicone would not

Answer:

well, let me say I already disagree, saline and silicone do not look very different, maybe in a person with very low body fat in certain positions you might see more ripples on the lateral chest with saline over silicone but they both ripple. Silicone feels better, but is more expensive to follow up for ruptures as you need a $1000 MRI to evaluate it. JG 4.7.08

Question:

when someone has a Capsulotmy done with a scoreing of the scar tissue, ( submuscular implant), does any muscle or skin or breast tissue get lost or damaged during this? also what is scoring process like?

Answer:

there should be none. JG 4.4.08

Question:

One more thing, I remeber after my surgery..my neck and back and chest BROKE out..it itched and was just a great big breakout. Was this from my skin stretching or a reaction to the anestia coming out of ones body?

Answer:

most likley a response to one of the medications. JG 4.3.08

Question:

Is there any way to actually prevent an infection to happen after a BA. Also, how long are you at risk for a infection before your free of the risk after the surgery. My first surgery, I had an armpit incision. I was so tite and red for 1.5 months. NO FEVER..NO SICKNESS...my docter thought I had an infection because i was soo red..turned out it was just my very sensitve fair skin and my titeness..and how my body own skin reacted to stretching.

Answer:

nothing is 100%. You are actually at risk for capsular contracture which most likely comes from subclinical infection, but in terms of regular infection, I would say that after 30 days you are out of the woods. JG 4.3.08

Question:

DR. GARCIA, IS THERE ANY DOWNSIDES OR NEGATIVES IN HAVING A BREAST AGUMENTATION REDO. WHAT I MEAN IS JUST RE-OPERATING ON A PERSON IN GENERAL. THEN WHAT HAPPENS TO AN IMPLANT. BASICALLY, IS IT WRONG FOR ONE TO REDO A BRAST AGUMENTATION JUST BECAUSE SHE IS UNHAPPY WITH HER SIZE? ID RATHER BE UNHAPPY AND SAFE THEN HAPPY WITH MY SIZE AND MEDICALLY SOMETHING GOES WRONG... *SORRY MY CAPS LOCK IS ON

Answer:

well, it is just that if not needed for a medical reason, the risks you take, like infection that would require the implant be removed for 6 months and scar tissue are somethig that needs to be balanced out. No easy answer. JG 4.3.08

Question:

I am considering having a breast implant what`sthe difference between silicone and saline. which would you recommend? also over the muscles or under. Please help.

Answer:

we usually do under the muscle and silicone might fell a little more natural but requires an MRI scan to check for leaks every 2-3 years, and that test costs $1000. JG 4.2.08

Question:

Dr. Garcia How long does it take for your breast to drop and fluff. And if had 330 size implants filled to 375 on left and 400on right the first time around and then went with 360 implants filled to 405 on left and 430 to 440 on right will i get the same fullness as i did before. Right now I am 4 weeks out and have 360 size implants filled to 375 on left and 400 on right and they don`t fill as big outward as before. And my left breast is tilted to my arm pit giving me a much fuller look out to my armpit then my right one. And my nipples are at different levels so when i wear a sports bra and my nipples are hard you can tell there off and i did not have that before. Is this fixable and does this sound like my left breast neens a revision surgery done. Please give me any answers that you can. Thank again

Answer:

I think they will be nearly the same size and fullness in time, as to if it is fixable, it is impossible for me to say without knowing what you had done, the reason for the repeat surgery and seeing you, sorry. JG 4.1.08

Question:

Dr. Garcia... When an individual has a REDO to go 100cc bigger. Is there REALLY much of a difference in look. I mean is it REALLY worth that...if say your docter says 100 cc no more you can fit. Would that size jump be really worth the size? Is that a 1./2 bra size bigger?

Answer:

in most peopele that is less than a cup difference, but in some women, that is enough. JG 3.31.08

Question:

Why does saline have ripples that you can feel on the edges and Siliocne doesnt? If the Slaine is MAX filled or overfilled how can you still feel a ripple...what causes this? Silcione, well if its jsut as is id think youd still be able to feel the bag?

Answer:

they both have ripples, it is just the silicone ripples less, but it ripples also. If you over fill a saline implant what you feel is called scalloping, not ripples,like those mylar ballons sold at the mall that are overinflated and have ridges. JG 3.31.08

Question:

Hello Dr. Garcia, I had surgery last week, silicone under muscle. I had no pain afterwards, everyone told me my pecs would be screaming. Is it normal to have 0 pain or do you think he did not go under the muscle? (He told me he did). Also, I had lower blephs done, no skin removal, just fat removed. Is it normal to have swelling in upper lids? The swelling is pretty much gone on lowers but the area along my brow is drooping over my upper lids a little. Looks weird, he didn`t even do surgery there. ????

Answer:

some people are just more tough than others. As to the eyes, there can be swelling on the upper lids too even if they did not have surgery. All will get better in time. JG 3.28.08

Question:

Dr. Garcia, I have a delimma. I have had saline implants for less than year now. Was considering redoing them because I just dont like them. Iam basically a VERY lean athletic girl with a great amount of muscle tone. And well to be honest these impalnts just dont seem to fit thy body. For one, they are very firm and dont even mover they just sit there. My shoulders are very broud and wide and my MODERATE PLUS 360 cc`s seem to BE to NARROW and it just doesnt look right. I tried to like them but i just try to basically IGNORE them and go on with life. It doesnt ADD a thing to balence my physique. I know your not a psycologist but heres my dellima. Iam considering just taking them out and have NO implants in. Or do you think if I went with *(GULP) Silicone implants they will be MUCH better to my liking. If i DO go with Silicone I know I will not do any MRI follow up in life because I DONT LIKE MRI`s at all... BAsically there is not much i feel i can do... any advice would be great since you see soo many patients and their outcomes..

Answer:

silicone implants will not change your concerns, they can likely look just like the saline ones if the same size and shape is used. If you are that unhappy I think removing them is the best. JG 3.28.08

Question:

Hello, Dr. Garcia. Thank you for taking time to answer our questions. I had revision BA one week ago today. Switched from over muscle saline, for under muscle silicone. Today, I noticed on my left breast in the cleavage area there are large ripple like waves that have appeared. I was told silicone doesn`t do that, especially under the muscle. Do you think that weird part will fill in or is this what I`m stuck with? Thanks.

Answer:

I am afraid you are likely stuck until the true cohesive gel implants become available. The silicone implants for sale now do ripple, they just ripple less than saline, so I am not sure why they told you that. JG 3.27.08

Question:

Hello, again. In regards to my previous question about silicone under muscle should not ripple. I`m confused because my saline overs did not ripple there. They said going under the muscle with saline wouldn`t ripple in cleaveage, only underneath and possibly on sides; but definitely no rippling with silicone especially under the muscle. Why would I ripple with silicone UNDER the muscle when I didn`t with saline over?

Answer:

well, it is likley that the muscle was released to aggressively and the muscle has pulled away and no longer covers the muscle, or the muscle is very thing. If you had some capsule there that was thick before it could have hidden the ripples too. JG 3.27.08

Question:

Dr. Garcia I had a BA done three weeks ago with 360 moderate profile with 375cc on left and 400cc on the right. My first BA I had 330 moderate profile filled to 375cc on left and 400cc on the right. I had them removed but was not happy with the end results so seven months later I had them put back in witch is the 360 moderat profiles filled to 375 left and 400 right. They don`t look as big as before I mean out ward. I don`t know why he choose 360 size when I had 330 and was pleased with the size of them filled to 375 and 400. Don`t get me wrong the 360 look good but not has full outward like before. If I had them overfilled like before would that help and how much can they overfill a 360 to get the results of a 330 overfilled to 375 and 400cc. And how long should I wait to go back under and do you think a doctor would be ok with going back in to overfill if the patient wanted a fuller look. Thank you for taking the time to answer my questions.

Answer:

I think overfilling can be done, but they will feel more firm and the leak rate is higher when overfilled, I think the difference will be small though. I think if you want it done, and the surgeon is agreeable, the sooner the better. JG 3.27.08

Question:

Why is going larger in an implant make it have more complications? Is it the fact its heavier and ones tissues can fail? I have a nice size considered small or nice in the 300`s...but i dont want to have complications if i go to 450...even tho my docter says no problem...do you think this will be a bad choice. what are some risks besides rippleing can one except from a size up? Can it just ripp threw your tissues as time goes on?

Answer:

more visible rippling, greater chance of double bubble problem, greater degree of sagging. I think if they look fine I would leave them alone. JG 3.27.08

Question:

Dr. Garcia, Why do some surgeons doing breast agumentation during anesicia use the tube down the throat and soe do not. My docter DID NOT he used just an oxygen mask! Do you know why the tube may be used in some ba surgeies and not others...

Answer:

if you had local anesthesia with sedation, there is no need for a tube down the throat, that is only for general anesthesia. JG 3.27.08

Question:

Dr. Garcia, Why in most cases Docters PREFER a more conservative implant size like 300-400 in most patients..but going any where 450-500`s they tend to be a bit complacent. I have 300 filled to 360 giving me a nice small D but full C and lil ol me wanted to go bigger and my docter told me you can easily go to 450....which is fine but is there REALLY a bigger size differnece for me to see from 100cc? If so how much more you think?

Answer:

100cc is a significant increase but the larger you go the greater the long term complications from the implant. JG 3.27.08

Question:

Dr. Garcia.... I read an article of a girl who died from breast aguementation due to anesthesia. My question is this... If I had a previosu surgery with NO MEDICAL complications to the anesthesia not even naueseia or anything...will I be okay the second time around..or is there ALWAYS a risk? Also, can one die from a BA proceedure duurnig healing?

Answer:

there are always risks but in trained hands the risks are small, and that young girl died due to complications from the anesthesia, not the surgery, full details have not be released so I cannot comment on the cause any further. I think if you follow all of the doctor`s advice after the surgery the chances of death are extremely small. JG 3.26.08

Question:

I had breast aug revision last week. Went from over to under muscle. I literally had no pain except at incision site and took no pain meds. I was surprised, I thought my pecs would be screaming. I`m 38, 5`2 , 96 lbs. I can`t tell how much swelling there is. What percentage is typical for swelling and how long does it last? I know it can last several weeks, but would you say most of the swelling would be down after a week or two?

Answer:

most cases the sweling at this point will make it go about 10-15% smaller and it might take 6 weeks for most of it to go down. JG 3.25.08

Question:

Hello, Dr. Thank you for donating you time to help us! I had my 2nd revision surgery 6 days ago. I went from over to under muscle. My ribcage is 26 and I have 450 silicone implants. They are touching in the middle and when I push, my finger goes a centimeter or 2 before I feel my breast bone. I asked the Dr. about symmastia but he said he did not dissect towards the middle at all and it shouldn`t happen without surgeon error. Do you think this is just swelling? Or can symmastia happen without dissecting the muscle?

Answer:

it is most likely swelling, but it can happen even without the surgeon lifting the muscle as the muscle can tear from a large implant applying pressure medially. Hang in there and give it some time. JG 3.25.08

Question:

Thank you for your quick response. One other thing regarding my fear of symmastia 6 days post-op. When I lay on my back, my skin lays flat against sternum. Does this mean I don`t have symmastia or not necessarily? Thanks again.

Answer:

not necessarily as the implants wil pull the skin down and back due to their weight. JG 3.25.08

Question:

Hi Dr. Garcia. I am 6 months post op a breast augmentation with crease incisions. I am using ScarGuard, but my scars still feel lumpy, the surface is smooth, but it is like there are lumps underneath. What is this, scar tissue? What can be done for this? Thank you so much!!

Answer:

I would just give it time, I do not think the ScarGuard will help anything below the surface, might be small sutures that still need to dissolve. JG 3.24.08

Question:

Dr. Garcia, Is ones second BA allot of bloodiness? Basically for an implant size switch does one have to worry about blood clots? What about with a Capselotomy?

Answer:

bleeding increases with anything done to the capsule, if an exchange is done to go smaller, then the risk of bleeding is small, but if a larger impalnt is placed, opening of the capsule needs to be done and that increases bleeding, but certainly no higher than the original surgery. JG 3.24.08

Question:

is a doctor who is in the AACS licensed to do breast implants, lipo, facelifts, ect?

Answer:

that license is granted by the state and that is still not a guaratee the doctor is propery trained. JG 3.24.08

Question:

Dr. Garcia, Can thin girls with tite skin ever EVER have sagging breasts.....with implants in? Even if she hardlyhas breast tissue to begin with? Also, My saline implants are firm...NOT pliable....kinda just there... Iam 9 months out. Tho if you push on them they ares softer to touch but you really cant squeeze them. Anways..my docter wanted to do a CASLEOTOMY to remove some of the scar tissue NOT ALL to free the impant to be softer ...with a size exchange. My question is this worth doing or should i keep my firm NON pliable breasts?

Answer:

yes, they can, the skin might be tight to begin with but in many cases with time and bouncing the skin will relax. As to whether surgery is needed, if they do not hurt and you can live with them I would leave them alone, with little breast tissue the chances of it recurring exactly the same is high so I would reserve surgery until really needed. JG 3.23.08

Question:

Dr. Garcia! I was wondering what this could be. Im about 9 months post op. SOmetimes when i reach behind to fix my bra hooks or bra strap..I always hear this POP ...Its kinda funny..I was wondering why my chest was poping? No pain but its like a POP...Also, when I sleep I feel this one/two blood veins across my breast area pulse... Kinda like the one in your wrist when your runnig..butt sometimes my vein over my agumentated breast tissue pulses or you can see it thump? What causes these TWO things? Odd i know! THankx...

Answer:

the pop might just be the implants shifting position and the veins will swell and subside with activity and position. JG 3.23.08

Question:

Hi Dr Garcia, Sorry this is a bit long. About two months ago, I had unders switched to overs due to muscle distortion & double bubble. The DB is gone now and so has most of the muscle distortion. However, my left breast is still not 100% yet. Like when I have to use my left pec muscle, doing simple things like pressing down on a soap dispenser bottle with my left hand makes my left breast feel strange, like the muscle is moving the implant or something. I use to have this problem before the repair. It is not visible - I can only feel it which I hate. Is this cos the muscle has not healed fully or will this problem stay with me? Does the surgeon normally have to stitch the muscle together again when switching to overs, or will the muscle just readhere on its own? Thanks.

Answer:

it might be aggravated because the muscle was previously lifted but there will be motion of the implant with motion of the pectoral muslce even if there was no previous under the muscle palcement as they are adjacent and as the capsule moves with the muscle the implant will move, that is normal. JG 3.23.08

Question:

I had my first breast enlargemtent in 2000, in 2005 i had my second surgery because my right implant deflated, i had no trauma to it or anything, now i`m gonna have to have surgery again because of the same issue on the same side. how rare is it to have a deflation on the same side? and what could cause it to happen?

Answer:

it can happen, it happens more in textured implants, but they are man made and they do fail in time, your scenario is unusual though. It might be a flaw in the implant or a small injury at the time of surgery when placing the implant that weakens the wall of the implant. JG 3.22.08

Question:

Dr. Garcia, I had a breast lift and saline tear drop implants 9 yrs ago. I have never been satisfied with the results. When I went for a mammogram I was questioned about what I had done to my breasts as she had never come across that type of implant before. My breast have square edges along the underside of the breast and I can feel(through the skin) a small hard round area. I presume where they were filled. They are also heavy and sagging! At times they just feel uncomfortable. I want to have breast revision done with a different type of implant. Do you think I will have to have another lift or will a PS be able to exchange the implant? And...can you let me know the cost of breast revision in the Las Vegas area. Thank you!

Answer:

I think in some cases the implant alone can be exchanged as long as the breast tissue and nipple location are in good position. The costs will vary from surgeon to surgeon and you need to decide on your surgoen and then ask. Best of luck. JG 3.20.08

Question:

Hello> I have 2 questions for you please. 1st> please will you tell me your professional and personal opinion about silcone implants versus saline> I know silicone will feel and look more natural but what about the saftey issues? 2nd> Please, I am confused about facial regimens. Can I just stack 4-5 different creams and spot treatments like... retin-a, clindamycin,hydrquinone, etc on top of each other or do I need to wait a certain amount of time> so each will penetrate and give me benefits? Thank you for you time

Answer:

I think silicone implants are safe. As to the skin, as long as you allow 10-15 minutes between the apllication of each, it is OK to use them all. JG 3.20.08

Question:

Hi Dr. Garcia, Just had my third surgery ( 2nd breast revision) two weeks ago. I had my left breast repaired from a bottoming out and my right pocket enlarged. My right was 2cms higher than my left. My PS has my left breast (the bottomed out side)higher than my right. He says that the left side will definitely drop and that`s why he lifted that side higher. Does a bottomed out breast always fall a little and settle? How long does it usually take for scar tissue to form? Thanks so much.

Answer:

yes, that is the way it is usually done and it can take 4-12 weeks to settle in. JG 3.19.08

Question:

I would really would like to know what is considered strong reasons for a re-do and what are not? SInce my L revision a couple of months ago (it has been revised 3 times) it finally looks soft, feels amazing. But, it is now wider from armpit to sternum and less projection than the R (originally done in 05/06, never needed revision). THe R one is harder (the surface is soft to the touch but I can feel a `hard ball` sensation when I do my massage. The R one is also slightly narrower from armpit to sternum. With bra and clothes on, I don`t think it`s really noticeable. But, naked I can definitely see the difference. The L one also has a slightly lower crease because I think now that the implant has finally dropped, it is filling that area in nicely, but the creases are about 1` off now. The R one is somewhat painful when I lay on it to do hamstring curls. The nipple and central portion of the R breast seem to be tender to the touch after I`ve been on my tummy. What are realistic expectations of how breasts should look after augmentation? DOes what I describe sound realistic for him to open up te pocket more on the R? He doesn`t feel there is much CC going on, maybe a level 1, he said. I truly feel like the R pocket is too small, because the R implant feels and kind of looks like a round ball and certainly doesn`t move that well.

Answer:

sounds like a grade 2 capsule on the right and the symmetry would be better possibly with a capsulectomy of the rigth side now. JG 3.19.08

Question:

I am considering an implant exchange for a smaller size. What size do you think it will take for me to go down two cup sizes smaller?? I was a 34B prior to SX and with 250/275 silicone moderate unders, I am in 32DDD. Also - You mentioned that C cup has about 300-350cc in it. How much does a B cup have?

Answer:

no real way to tell for the B cup, but a guess would be about 200-225. I think you might need to get the implants taken out and left out to go down two sizes. JG 3.10.08

Question:

I have had the gastric bypass done several years ago in california and am very intrested in getting a brest enlargemnet...my question is do you work with insurance companies to get this procedure covered? The reason why I ask this is because I have alot of extra skin that get irratated by my bar due to the weight loss. In California they were going to get it covered under the insurance due to it being considered medically necessary

Answer:

insurance typically will not pay for a cosmetic procedure like that. Sorry. JG 3.10.08

Question:

For breast enlargements...what is the general price range?

Answer:

in Las Vegas $4000-$7900. JG 3.8.08

Question:

How long before breast implants need to be replaced? In other words, is it necessary to have new ones if the old ones are fine after 10 years or so?

Answer:

if they are doing fine there is no need to replace them. JG 3.8.08

Question:

I had breast augmentation 14 months ago. Since then I have had my L breast revised twice (would not drop). One month ago, he revisd the L breast again and it now looks beautiful. It is now soft, round and I cannot even feel the implant-amazing! The problem is that now the R breast feels so much harder than the left. THe R one is a pretty nice shape but now the slight hardness bothers me. When I lay on my tummy, it feels hard on the R (even slightly painful). The breasts are pretty symmetrical, my middle cleavage is great, my nipples are pretty even. WHen I look at them naked, I can see that the new Left one is fuller and has a slightly wider diameter (from midline to armpit). THe Right one is slightly narrower, slighter more projection and not as rounded or full on the armpit side. (My breasts were the same size pre-surgery and we used 375 silicones on both sides.) I can even feel the implant on the armpit side of the R breast. With a bra on and clothes on , you can`t notice the difference. Is it worth messing with the right one for these differences? Or, should I have him do the `release` of the pocket on the right in order to loosen it like on the left? Yesterday my PS said that the R one is slightly harder but suggested I don`t change anything. Are there more risks in trying to fix this problem than just leaving it alone?

Answer:

I strongly believe you should leave it as is and not do anything else for now. JG 3.6.08

Question:

Hello, I have recently had breast augmentation (4 weeks ago). The swelling has gone down but I have several ripples over the top and at the sides. Can you advise on how long does it take for them to disapear and if they are permanent, what surgical procedures are there to remove the ripples. I have my follow up consultation in 5 weeks, but would like some information before then to put my mind at rest. Best regards

Answer:

if they are ripples in the implant that are showing through due to low body fat and not much breast tissue over the implant, they wil be permanent. There is no surgical procedure that will reliably fix it, fat injections have bee tried but the improvement is variable and not predictable.Best of luck. JG 3.6.08

Question:

So after month of debating. I decided on a BA redo. So in my last attempt at deciding between silicone and saline. *(I have saline...btw) They are very firm not at all squishy, nor are they pliable. I want your HONEST opinion on which you think is theee best, I dont want to go in again and have any regrets..that would be devistating... Iam 5 foot 4 and 110 pounds low body fat 9% very musclular and athletic.

Answer:

well, they have the same incidence of scar tissue which is what the problem is now apparently, so both could potentially feel the way they do now in time. If they remin soft, then the silicone one might have less ripples, but will still have some ripples. JG 3.5.08

Question:

Hi Dr. Garcia. I have a question regarding numbness after a breast augmentation. I heard that by tracing your fingertips over the numb areas, you can retrain the nerves and gain feeling back? Is this true, or is there any other way (besides time) to stimulate nerves? Thanks so much for all of your time and help.

Answer:

nope, it will track the return but will not cause any nerves to grow back.Sorry. JG 3.5.08

Question:

So after month of debating. I decided on a BA redo. So in my last attempt at deciding between silicone and saline. *(I have saline...btw) They are very firm not at all squishy, nor are they pliable. I want your HONEST opinion on which you think is theee best, I dont want to go in again and have any regrets..that would be devistating... Iam 5 foot 4 and 110 pounds low body fat 9% very musclular and athletic.

Answer:

how they feel now is a reflection of caspular contracture most likley and can happen at the same rate for both silicone and saline implants. I think silicone will have less visible ripples, but it is less, not none. JG 3.6.08

Question:

Dr. Garcia, What makes some girls skin to be so tight months after surgery opposed to others. For instance, My docter says I still look like 2 weeks after surgery even tho its been 8 months...lol He said I just have such tite skin it holds them... Is this just a genetic thing? Or is it my chest muscles..Just to let you know I had these UNBELEIVEABLE PEC muscles that HE-Man woulda loved to have prior to surgery...

Answer:

it is mostly genetic, in terms of the strength of your tissues. JG 3.5.08

Question:

I wwrote you about having an `indented` look to my lower areolar area with a hardened area underneath (where the incision was made for my recent breast revision)--3rd one). You mentioned it could be scar tissue. Won`t further intervention with a new incision just create further scar tissue? How can it be cleaned up and prevented in the future?

Answer:

yes, but if they lift the areola and pull the tissue below up to fill in the depressed area, that should correct it, at least partially. Just cutting and sewing wihtout transposition of tissue will not work. JG 3.4.08

Question:

I just had a breast pocket revision last week. I am also an avid runner and work out with weights 4-5 days/week. When is it okay to start running and when is it okay to start lifting weights again? How tight should my sports bra be when I am running? What do I need to be careful of in the future in terms of exercising?

Answer:

since it is a revision of the pocket, and since both of those activities place a larger stress on the repair of the pocket, I would say at least 4-6 weeks, after three weeks you could walk on an incline or ride a stationary bike in a jog bra at all times when do it too. JG 3.4.08

Question:

Hi Dr. Garcia, I had silicone implants 4 days ago 605cc these were replacements of old implants. Before the op the doc said my right one was slightly larger than my left. After the op i have noticed my left one is noticeably bigger although the doc said the implants are the same size.Is there another expanation for this? Also I am slim build 5ft 4ins and 112 1bs yetmy 605cc implants dont look that big any idea why?

Answer:

could be how they are sitting in the pocket and also due to swelling still there. As to 650 being big or not big, I guess it is all a matter of opinion, considering that a C cup, including breast tissue and implant, is about 300-350cc. JG 3.4.08

Question:

I had breast augmentation (375 CC, silicone gel, under muscle) over 18 months ago. Within that period I have had 3 revisions on the left breast due to failure of the implant to properly drop (causing a high L breast). Each time the incision was made in the nipple. This last surgery (Jan.25, 08)was a success. My implant dropped, it is very soft and looks great. However, on the bottom portion of my nipple where the incision was made, it seems to `indent` slightly into my breast tissue creasting a slight puckering. I do feel a small dime-sized hardness near the incision. Is this normal? The rest of the breast is very soft and supple. What do you think? I am taking Vitamin E and performing daily massage.

Answer:

most likely scar tissue, it might be abe to be revised under local anesthesia without going too deep. Not uncommon from repeat opening of the incision like that. JG 3.4.08

Question:

Hi Dr. Garcia, Is it dangerous or harmful to be put under general anesthesia three times within a year? I`m about to have my 2nd revision (3rd breast surgery) in less than a yr. The first was last April, then September and now March. I`m concerned about going under so many times. Also, I`m having a bottoming out repair and am concerned about damage to my lungs. I`ve read where sometimes the lung can be perforated or punctured. I understand you are more at risk if you are thin. Is this a rare or common occurrence. Thanks.

Answer:

nowadays, general anesthesia is much safer and there should not be any long term negative effects from three anesthetics in one year. I think the risk of a lung injury would be very small, it is very rare, all the best. JG 3.3.08

Question:

Hi Dr Garcia, I have just had silicone implants replaced with new ones 4 days ago. I have had 605 cc put in both sides apparently but the left one seems bigger and firmer, before my op the doc told me my right one looks slightly bigger. I have asked him if he put a large one in the left but he says he has`nt. Is there any other reason for this cos I cant see it just being swllling. Also for 605cc they do not look that big but i know i had lost quite a lot of breast tissue so im assuming its just filled out the loose skin. What do you think the reason for the difference in sizes is ?

Answer:

I think it could be from swelling or from the implant laying differenty in the pocket and both of those issues will change substantially in the next few weeks, you need to give it time for the swelling and the implnat to settle into its place. Hang in there. JG 3.4.08

Question:

Dr. Can you explain the procedure difference that goes on between a CAPSULOTOMY vs. a CASPULECTOMY? And what is the pain difference between having that...

Answer:

pain is greater with a capsulectomy and the capsulectomy is the removal of the scar tissue where the capsulotomy is just the cutting and weakening of the scar tissue without removal. JG 3.3.08

Question:

I am 10 mo po and have almost totally numb nipples. I had 350cc`s saline under the muscle with the areola incision. With both nipples being numb I almost think it is the fault of my ps. What do you think, and is there still time for the feeling to come back? Thanks

Answer:

there is still a small chance, but it is small. JG 3.3.08

Question:

Hello Dr. Garcia,2 years ago I had breat implants saline 350cc thru nipple incision.They are both fine and natural but the left arm sometimes has very reduced feeling and goes numb temporarily. Also the breast is not similar in color especially the right nipple. Overall the left implant scar has not healed as well as the right scar.Will the feeling in the left arm and nipple ever come back to pre surgery. Thank you Dr Garcia

Answer:

I think at this point in time if the sensation issue is due to your surgery, it will stay that way. All the best. JG 3.3.08

Question:

Hello Dr. Garcia,2 years ago I had breat implants saline 350cc thru nipple incision.They are both fine and natural but the left arm sometimes has very reduced feeling and goes numb temporarily. Also the breast is not similar in color especially the right nipple. Overall the left implant scar has not healed as well as the right scar.Will the feeling in the left arm and nipple ever come back to pre surgery. Thank you Dr Garcia

Answer:

after this much time, if the sensation issue is due to the surgery, it will not change, all the best. JG 3.3.08

Question:

Hi Dr. Garcia. I am 5.5 months post op a breast aug, under the muscle, very tight muscles and no breast tissue to start with. Both of my breasts are equally soft, but the right one seems to be slightly smaller and higher. When I take front view photos of myself, it has that curved C- shape in the cleavage area, while the left one falls more naturally and has no curve or hump. What could be keeping the right one up like this, besides capsular contracture because I really do not think that is it? Is it possible to take this long to settle? Thank you!

Answer:

the only other thing would be that the pocket opened at the time of the surgery was not large enough or that the muscle of the right side is tighter and stronger and did not relax as much as the left during the first couple of months and allowed everything to heal up higher on your chest. Under the muscle can at times take 8 months or longer to settle in, hang in there. JG 2.29.08

Question:

What causes the muscle spasm? And what concern should I worry about for me to see the docter if this occurs again? Why would this be a concern

Answer:

if it is a muscle spasm, there is not much to do or worry about, but I cannot diagnose it long distance so if it persists you need to be examined in person to make sure it is nothing else. JG 2.28.08

Question:

DR. Garcia..Today for the first time I was sitting in the office and felt these lil pelpatations in my chest muscle over my left breast. I have impants under the muscle. So I ran in the mirror and you can see this lil BUMPS pop up n down where the pelpatation started and then it stoped when it stoped. I was like WOW my implant must be dropping weee THen i was like wAIT its 8 months post op...they should be done...it was like a muscle spasm? waht causes this i NEVER HAD THIS b4? any concern?

Answer:

sounds like a small muscle spasm, should be OK but if it occurs again I think you should see your doctor. JG 2.28.08

Question:

Dr. Garcia, can you explain when a surgeon does the incision UNDER the breast fold ...to put an implant already palced under the muscle ...what EXACTLY is he cutting threw or is he cutting the skin and just lifting? Also with an ARMPIT inscision...what is he cutting to go threw or get threw? Like after he cuts the skin....it cant be hollow?

Answer:

he is cutting through the skin and lifting the edge of the breast until he gets to the edge of the muscle and then he goes below that leaving the breast tissue attached to the anterior surface of the muscle. As to the armpit, there is very loose tissue below the skin that is very thin and almostimmediately he can gain access to the edge of the muscle and then go below it. JG 2.27.08

Question:

Dr. In all honesty is there REALLY a big size differnece in lets say someone going from 480 cc saline to 510 cc saline? I mean whats an ounce? Or is that noticable then expected? Also why is it said SILICONE sags more then saline being BAM right on and projects out? is this true?

Answer:

well, it is less than 10% of a differecne, I would not do surgery for that small of a change. I see no reason why silicone would sag more, that has not been my experience with them, the weight of a 300cc implant with silicone or saline is the same. JG 2.27.08

Question:

Dr. Garcia, in all honesty. What REALLY is the differance in siliocne vs. saline. I have saline so I know how those are. Now if I SWITCHED to silicone will I be like, WOW WHAT A COMPLETE DIFFERANCE

Answer:

well, the differences are small, there are advantages and disadvantages to both, if they are under the muscle I will tell you the diference is quite small, on top of the muscle, there is maybe less rippling with silicone and they might feel a litle more like Jello, but the temperature changes are slower with silicone so they are not your body temperature as fast when you change locations. Scar tissue and leak rates are about the same. If you are not having any problems I would leave them alone, no need to change them unless there is an issue. JG 2.26.08

Question:

One more thing..I asked my docter this but he wont give me a quote till Im ready to make my decision. On a round about price. What do m ost surgeons charge for a saline implant exchange with a capsultomy?

Answer:

the prices will vary from surgeon to surgeon, no way to tell, but the original surgeon usually wil give a discount since you are already a patient. JG 2.25.08

Question:

Dr. Garcia. When a woman has level 1 or 2 Grade cc. How can you tell if it is getting worse. Reason being...Sometimes, lately I feel very stiff or a lil pinching or flexation on my chest muscles. Iam very firm with hardly any movement. Does it mean the tissue is growing? Also....It doesnt pinch it is like a stiff musccle feeling and once in a blue moon i get a pinch nothing distracting. Im wondering If i should go threw wth the CApsultomy now...

Answer:

I think capsular contracture can get worse but it does not go hard and soft back and forth, once it gets worse it does not get better on its own. I suggest getting it treated once it causes you serious concern or pain. JG 2.25.08

Question:

Dr. after my visit with the docter *(7 months post op) He wants me to think a couple of months before I deicde on a re do. Now...I wanted a redo to go a bit bigger, which we said ok, BUT here is the thing ...My implants are saline under and ARE VERY FIRM..he does not beleive in the massage technique at all. I mean they dont move that much docter. They are basically sort of bolted in place firm like day one BUT are soft in skin ..THEY dont hurt at all. Anyways...I went threw the armpit and he will have to go under the breast fold to remove the some (NOT ALL ) scar tissue to relase the impalnt to soften and drop. UGh..I want to get new implants but now the thoguht of going under my breast fold leaves me wanting to keep my firm breast. Can I ask you how in the world does the implant not fall threw the crease under the breast fold after surger. What hodl it in place? Also because this is my second surgery (OR WOULD BE if i do this) HOw long do I have to wait to RUN and LIFT again. Im afraid if I run it will fall threw the crease incision =(

Answer:

the implant does not fall through that incison because only the tissues above the incision are weakened, and not below, you could also go through an incision around the areola. The getting back to running and lifting will be the same amount of time as the first go round I am afraid. Best of luck. JG 2.24.08

Question:

Thanks for answearing my inquery on my recent question. Even tho the docter wants to remove my scar tissue so my new implant moves freely to get rid of the stifness, I was wondering this also: If I just left what i have smoth saline under and dont go in to get a redo to go nigger or release the scar tissue so the firmness will go away..(Iam 7 months post op..btw..) Is that okay to do or do you think I WILL HAVE TO do something about this sooner or later. What im asking is, is THIS A SURGERY I HAVE TO HAVE. Also...I told him I dont have that muscle implant flexation problem. Like i can do pushups/pullups and everything with no implant moving or getting in the way. He told me THIS IS CUZ THE SCAR TISSUE is holding the implant in place, making not to move so thats why.. So my positive tihnknig of weee I dont have any movement getting in my way with the implant and ,muscle is mainily cuz the scar tissue is not allowing the implant to move freely. THus my question, Is it safe to leave it or better to release the scar tissue...what is your view.. YOU ARE THEE BEST

Answer:

I do not think it is a surgery you need to have until the scar tissue starts to cause you pain. I think it best to leave it be if you can deal with the size. JG 2.22.08

Question:

Hi Dr. Garcia, I am getting ready to have my 2nd revision (3rd surgery) within a year. I have under the muscle hp gel implants and have two issues that need to be repaired. My left pocket was over di-sected and needs to be lifted. My right implant is too high and needs to be lowered. I also believe that the right breast is forming a capsule (the implant has risen and is tight). My PS does not believe that it is a true capsule but that the pocket on the right side is not big enough for the implant (350 hp). If it is a capsule, is it totally obvious to you that there is scar tissue that needs to be removed when you take out the implant? I`m concerned that he will only open the pocket and not get rid of the scar tissue. Can you tell me which breast you would adjust first? My PS is saying that he will most likely lift the left over di-sected pocket higher than the right knowing that it will settle. Do you agree with this? I`m concerned that I will end up just as lopsided as I currently am but reverse. Do you believe it`s possible to get the desired results when you are having to tweak both breasts at the same time? Thank you.

Answer:

removing the scar tissue is difficult when it is below the muscle for fear of damaging the muscle so only a partial capsule removal is usually done. Overcorrection of the lower side is the usual thing to. It is not uncommon to have to revise both breast, best of luck. JG 2.19.08

Question:

I was reading th epost below about the owman with the implants that appeared smaller after 6 years. You said it may be also a loss of breast tissue. How does the body loose breast tissue with impants? Does it just disinagrate? Or is it just stretched so is thinner? Also, I WAS considering exchanging my implants for either a different profile or lil bigger to fill up some space. I have had these for 9 months. DO you think itsbest I just wait 5 years till something goes wrong? As odd as it seems Im afraid of ruining my body with playing with impalnt sizes. Or is a redo not someting I should worry so much about?

Answer:

normally women lose breast tissue as they age, but the implant, since it causes some stretching of the skin, can also stretch it so it looks looser. I think changing them after 9 months unless something needs to be done is a little too soon. I think a redo should only be done if really needed. JG 2.18.08

Question:

If a woman came to you after a year of having a breast aguemntation and her left breast looked entirely different than her right. *(Meaning one is a 1/2 cup size smaller than the other) Can this be fixable or would you tell her to leave it because there really is nothing one can do. Also if one is relaxing off to the side and is more pliable and the other is centered and stiff can this be fixed? and why is this? THanks Dr. Garcia...=)

Answer:

well, hard to say without seeing before and after pictures and reading the operative report, at times there can be things done to get a little more symmmetry but perfect symmetry is never possible. JG 2.18.08

Question:

I had mentor high profile breast implants 500 cc left, 515 right, put in 2002. Now 6 years later I sware they look less full, smaller and less projeection...am I crazy or can this happen without having a breakage?

Answer:

could be just the loss of your own breast tissue and the skin relaxing so they do not feel as firm. JG 2.13.08

Question:

Hi Dr. Garcia. You`ve mentioned `winking` in relation to muscle flex distortion. What exactly do you mean by `winking`? Thanks again!!

Answer:

when the muscle flexes the implant folds in half and it looks like the fold appears like the mound is winking or creasing. JG 2.12.08

Question:

Dr. Garcia, In your opinion and years of practice, do you fell/seen that there is a less complications with a smaller implant size inserted than a medium or little larger size (NOT TOO BIG)... or is it just a catch-22....Size isnt the matter its jsut how your body is able to be

Answer:

I totally believe that a smaller implant has less long term complications, without a doubt. JG 2.12.08

Question:

One more thing, Is it true that If I have a redo after 9 or 10 months it is a bad thing for your body? Or should I wait it out? Also if there a chance after having a redo to go bigger a chance for my CC rate to go higher or does it stay the same. What are the negatives for a redo if there isnt any problems that are major? If it is a higher negative than a positive maybe its just not worth a redo

Answer:

it is not a bad thing to do if the redo is going to help. The chances for the capsular contracture rate is the same but the possibility of more visible and palpable edges and riples goes up. There might nto be anything you can do due to the anatomical limitations you had to start with. JG 2.11.08

Question:

Hi Dr. Garcia! I have a question. The other day I was getiing myself PROFESSIONALY MEASURED at a bridal shop for theee perfect bra size iam. Now I have had breast agumentation 7 months ago. The lady measured each breast in width. My lrft was 10 inches (Side and Volume) the other was 9 inches..WOW! So wonder I have been moaning and complaining about my BA all this time. Is there a way to correct this in the future redo? They both are Max filled to 360 cc....My docter WILL ONLY MAX FILL..wont under fill or go over the max limit... Im going to talk with him next week. How do I appraoch this matter with him in an apprpriate way? Or is this jus thow it is and I should accept it!

Answer:

well, the width is partially due to the implant and also partially due to the native breast tissue you have, going to a wider implant might make your base width wider but can also leave you with an edge laterally or near the inferior part of your breast where it is visible and palable to where the breast tissue ends and the implants starts. There are anatomical differences that make perfect symmetry impossible at times. JG 2.11.08

Question:

Hey! It`s me again, with the symmastia questions! Thanks for answering my prior question:) In your opinion, do you think I should wait a full 6 months before I possibly have another repair or take them out? Also, do you think I should still wear the thong bra on a day to day basis as well as when I work out? My PS said it wasn`t necessary, only when I work out. Also, I had to have them done over the muscle and would really prefer they go back under. Is that possible within a certain amount of time and how long? I had to have them placed over due to my muscle being cut and it had to be sewn back down. How long do I have to let that heal before I go back under if that`s what I decide to do and could this interfere with my symmastia repair? Thanks again!

Answer:

if you are content with how it is, then wait, if it is not the way you can deal with it if it were to be permanent, then take them out. I think a good support jog bra is all that is needed at this point when working out. Going back under the muscle is possible, yes and should limit the chances of it getting synmastia all over again. I would leave them out for at least 6 months. Best of luck. JG 2.10.08

Question:

Hi, Dr. Garcia! I had a symmastia repair almost 4 months ago and wore the thong bra for a full 3 months. I do have a better space than I did, but not a huge difference. I went to a high profile implant but I still feel as though the skin isn`t quite attached to the breast bone. My PS still wants me to wear the thong bra while I work out, run on the treadmill, etc..at least for 6 more weeks. I thought after 3 months it either fixed the problem or it didn`t? I guess my question is...should the skin still look slightly lifted, will it take at least 6 mos for it to really attach? Or will it always look the way it does now? Would a second repair surgery need to be done and have you ever had to repair the same symmastia patient more than once? Thanks for your help!

Answer:

it might be imporved but it appears that not totaly, I think wearing the thong bra at this time will probably help it from lifting off the sternum any more but will not make it stick back down. It might stay that way without more repair. It might require significant more intervention, potentially even including removing the implants for 6 months and starting over again after the tissues have readhered I am afraid. Synmastia can be difficult to repair without concessions. High profile helps to some degree as it is narrower, but at times a significant size reduction is also needed along with the higher profile implant. JG 2.10.08

Question:

Hi doc... thank you for your imformative website! I just got explanted 13 days ago after having implants in 3 years. I am only 5`2 and going small D-cups was too big for my frame plus I missed my natural Bs. I went to a cocktail events for 4-5 hours in which I took off my sports bra for the evening last weekend 8 days post-op in which I wore a full Victoria Secret Body bra which was push up and softly wired. Now, three days later I felt slight tugging on my left breast. Seems like a very faint `tugging` and I`m worried that I caused scar tissue to for by not sticking to the sports bra 24/7. It happens when I lift myself off the floor with my left arm but it happens only some of the times. The is no visible distortion. What does this mean? Can I reverse this pulling by beginning to massage the area?

Answer:

I do not think you did anyting bad by wearing the other bra, it would have happend with the sports bra too, it is just the tissues trying to heal together, massage might help, but in time those tissues want to readhere to one another. JG 2.6.08

Question:

Hi doc... thank you for your imformative website! I just got explanted 13 days ago after having implants in 3 years. I am only 5`2 and going small D-cups was too big for my frame plus I missed my natural Bs. I went to a cocktail event for 4-5 hours in which I took off my sports bra for the evening last weekend 8 days post-op in which I wore a full Victoria Secret Body bra which was push up and softly wired. Now, three days later I felt slight tugging on my left breast. Seems like a very faint `tugging` and I`m worried that I caused scar tissue to form by not sticking to the sports bra 24/7. It happens when I lift myself off the floor with my left arm but it happens only some of the times. The is no visible distortion. What does this mean? Can I reverse this pulling by beginning to massage the area?

Answer:

no harm done, just the tissues trying to heal, a little massage might help it feel better. JG 2.6.08

Question:

Hi Dr. Garcia, Do you charge more for a breast implant re-do (first done by another doctor) than you do for first-time implant patients? Also, is it possible to go from under the muscle to over the muscle? What happens to the pocket under the muscle after the implants are removed? Does it re-heal together or do you need to sew it closed?

Answer:

at present we are not accepting patients for repeat breast surgery done elsewhere due to our schedule but when we did the fees did not always go up, it depended on what needed to be done. It is possible to go from unders to overs, yes. The old pocket usually shrinks and heals flat. JG 2.5.08

Question:

i was just curious on this situation. i currently have breast implants and looking into the future when they have to be removed. will i still have breasts like my natural ones. i really didn`t go that big. so when the times comes for them to be removed will i have some breasts left. i went from a 34 B to a 34 D.

Answer:

you will only need the lift if they sag over the next few years. JG 2.5.08

Question:

THANK YOU! Also how long is a FULL CASELOTOMY and IMPALNT exchange take? If he deflates the implant does the scar tissue go with the implant or does he scrap it from my insides =*( Your soo nice and detailed in your answears. My docter just says it so cold and blank... =)

Answer:

it varies but about 1 1/2 hours or so for that surgery in most cases. The scar tissue is never attached to the implant so it is gently peeled off of the normal surrounding tissues, best of luck. JG 1.30.08

Question:

Okay, SOOOOO after talking to my doc. I told him about my EVER SO un matching boobs. Where one goes to the left and one stays nice and centered. Tho Iam 6 months..I was talking to him about ONE: WHY they both look DIFFERENT TWO: I wanted a size exchange anyways.. He said if I decided to go with a larger implat hed have to do a CAPSELUTOMY! Ummmmmmmm...In your opinion..WHY..? I mean i have no REAL HARDNESS, Iam 6 months out..and does this ALWAYS HAVE TO BE WITH AN IMPALNT exchange. Also, what is the pain invoved in that and whats invovled with that procedure..i have saline and hed deflate the implant if i go bigger?

Answer:

the capsulectomy for large implants is a good option in order to avoid any potential limitation from the previous capsule not allowing the implants to lie in the best position. The pain is no larger than the original surgery. JG 1.30.08

Question:

QUESTION ABOUT BREAST IMPLANT DEFLATION. WILL WEARING TOO TIGHT OF SHIRTS OR BRAS, WHICH KIND OF PRESS DOWN ON BREAST CAUSE THEM TO DEFLATE? SHOULD A BRA EVEN BE WORN? OR WILL NOT WEARING A BRA MAKE THE IMPLANTS SAG OVER TIME? ALSO WHAT ABOUT SLEEPING ON STOMACH SIDE? THANK YOU

Answer:

I do not think wearing tight clothing will cause a deflation. Not wearing a bra might allow the eventual sagging to go faster, as will the added weight of the implant. I think sleeping position will have little effect. JG 1.30.08

Question:

I spoke with my Dr. about fat injections and he said its possible to be able to fix double bubble this way. What is the risks of this?

Answer:

the biggest isk is that the fat doesn`t survive and you end up looking the same. JG 1.29.08

Question:

When u take implants out and put new ones in, will the new ones fall right into previous pocket or will u have to wait weeks for them to fall, like in the first BA?

Answer:

they will settle pretty quickly unless the pocket had to be enlarged, but it will still take less time than the first time. JG 1.29.08

Question:

So ur shape will not be the same from what it is now if you upgrade to a 120cc bag?Thanks

Answer:

if you enlarge it by 120cc it will likely look different. JG 1.29.08

Question:

Regarding the phrase; Tissues NOT holding the implant in place ... What causes that to happen on only ONE side than the other? And, can this be fixed? All I know is I had before surgery very STRONG AND TAUNT chest muscle. Like those male bodybuilders. Because I worked allot of my chest muscle for years. Tho he said I was very tite and hard to get the implant under the muscles, the thought of tissues making one side look different than the other confuse me =*( Any great thoughts... Thanks Dr. Garcia!

Answer:

it can be from the degree of lifting or stretching, in some cases it can be if the skin started off less strong, for example in areas with large amounts of stretch marks, placement over or under the muscle will also affect the pressure applied to the implant and therefore the tissues also. The stronger the muscles the greater the chance of the muscles causing the problem as when they flex the muscles flattten and that tends to push the implant down and out more. JG 1.29.08

Question:

When you take them out from under and put them over (implants)are they garenteed to project more? Also, if they are somehwhat close together while under, how will this effect them when over?

Answer:

to some degreee yes because the muscle is not there to cause the mild flattening that it usually does, but if the same implant is used it will likely not be very noticable. The placement towards the center will totally depend on how wide the pocket is opened during the exchange. JG 1.29.08

Question:

Dr. Garcia, before I go in and yell at my docter. I want an opinion. Is it POSSIBLE that event ho he has THEE HIGHEST CREDENTIALS and UPMOST PRESTIGE in COsmetic SURGERY..can he by anyway anychance screw up my pockets? IS this possible for an upscale well knowledge surgeon to do? I swear number ONE my left is smaller than my right..ALSO my left is not even ROUND its more triangle or uneven... ALSO you can see the center of my chest strum perfectly and the left one is soo off center from there or lower than my right? Why is the right perfectly centered and close to the center and the left SOO OFF and no even cnetered or round? Im thinknig he screwed up...Iam 7 months post op! WEEE fun...=*( I also want to thank you for being so accomidating to the public with your help and knowledge it truely is a blessing for all of us!

Answer:

well, different pocket sizes in breast augmentations can happen either from unequal pocket dissectiosn at the time of surgery or the tissues not holding up. Just because a surgeon is highly qualified and well trained is no guarantee that there will not be things that happen that might result in your scenario. No surgeon is perfect all of the time. I think speaking frankly with him and telling him what you see and that you would like it fixed is the best approach. I wish you the best. JG 1.29.08

Question:

One more thing. Why is it that another docter wont touch you when you have surgery done else where?

Answer:

revision surgey is much more complicated than the first surgery and if the second surgeon tries to fix it and cannot, then, in many cases the patients will hold the second surgoen responsible and not the first. JG 1.29.08

Question:

Hi Doctor,can you tell me a bit about some of the products claiming to increase breast size by one or 2 cups, supposed to be completely natural and affordable and have loads of testaments from top models in europe in every magazine that they are advertised in, i dont know what they are called in the states but here in ireland there is a product called natures gain amongst other better known brands, thank you

Answer:

they do not work. The models are paid endorsers that will say whatever they need to say to get paid. JG 1.29.08

Question:

My Dr. says over the muscle has many issues. How do u avoid them? Also, I heard going over helps with double bubble, if its semi. Is that true? My Dr. says that my shape will be the same if I go larger, but fuller? True?

Answer:

no way to avoid them I am afraid, but under the muscle limits projection and size. I think the above or below isses does not affect the double bubble, I have seen it happen in both sites. As to your shape, I respectfully disagree with him. JG 1.28.08

Question:

Thanks for the reply. Fat injections, are they from your body fat or not?

Answer:

yes, correct. JG 1.28.08

Question:

How do u get the look of the adult entertainment women as in, the large amount of width on sides on implants. I like the look that looks like alot of curve on sides and all sides to that fact. They all look like they are big and perfectly shaped. Do u go with a much bigger implant or go over the muscle?So if I am 375 filled to 440 and I want that look, would I go to 550 or 600 bag?

Answer:

over the muscle is needed and size will depend on yout anatomy. JG 1.28.08

Question:

Hi Dr. Garcia, I have had my first BA in June/06. I am happy with my results for the most part but, have had 2 additional sugeries to (1)try to fix a slight double bubble and (2) fill up 50 more cc`s. I have 375 mentor smooth round moderate profile,Under muscle, over filled to r/440 L/425. My dr. had to drop my crease a lot to achieve a full C cup. I began with 34a/b. I now have a slight indent from where my real breast and implant meet but do not smooth one another out, on R only. I want to fix this problem and also would like a fuller all around bigger implant that projects more. They are wide in diameter but do not project enough to match the width. My Dr. has recommeded I go to 500 either moderate plus or high profile,he says this might help push out the indent and give me a fuller D cup breast. I`m 5`2 117 lbs, athletic shape. What I want is more on all sides, indent unnoticable and maybe a little of the fake look. Will this do exactly what my Dr. says? Also, what if I went over muscle, will that fix indent and overall satisfaction?Thanx.

Answer:

could consider fat injections to smooth out the double bubble but I think going larger will potentially make all of your problems worse. You might not be able to get the size and projection you desire. JG 1.28.08

Question:

Hi Dr. Garcia again, I have written you before and appreciate all of your advice. It has now been 8 weeks since I received my moderate plus profile saline implants. I am trying to become happy with my implants, but I struggle with the fact that I feel they are not full enough when looking at my side profile. Also, I was hoping to have more cleavage. I go back in a couple of weeks to the doctor for my final visit. T Inamed style 68 saline implants 450-480, filled to a 500,he implant placed in me has a D = 13.7 and P = 4.6. I then went to Mentors website and found the comparable one to my style 50-2550 550+110 cc mininium range 14.0 cm 5.3 cm and maximum range 13.7 cm 6.1 cm. First, why does mentor have min. and max. range and Inamed does not? Next, if the range on the mentor site is 13.7 matching my Inamed implants, would that have been a comparable implant? Last, if it is comparable would it have given me a greater projection at 6.1, with the fullness I desire? Finally, is there a big difference in both companies? Sorry, so long I am just at a lost....

Answer:

all saline implnats have ranges in the sense that it is up to the doctr to fill it in, it is impopssible to tell if a higher profile will give you the fullness you desire as fullness is a genral volume, not a specific dimension, sorry, wish I could make it easier for you. The truth is that the picture you have in your head of what you want your breasts to look like might never be possible with man made breast implants due to your own anatomical limitations. JG 1.25.08

Question:

Dr. Garcia...I need an opinion. I have waited 15 years to get implants and decided on a size and profile thats toooo tiny for my borad shoulders.... SO i waited and waited in hopeing id like them....6.5 months have passed and Iam still unhappy with the way they fit my body..its jsut doenst look right. I se other girls with implants that im like DAM why are they happy and im miserable. Does this justify my WANTING TO HAVE A REDO? I guess i feel bad and selfish for tring to find a perfect fit for my body...but at the same time iam NOT SATISFIED

Answer:

well if you are not happy I think a redo is about all you can do, you have waited and things have not changed so I think it is OK to think about moving forward. JG 1.22.08

Question:

I have an odd question. I have my implants over the muscle. I was wondering, when one has a redo to go bigger and exchange the implant. Does this (besides the fact become bigger,)Does the breast shape of WHAT WE HAD BEFORE on the original smaller argumentation stay the same..like the roundness and shape that we have had. Or does excahanging an implant destry your indistincitve shape... Also, what do people mean when they say you loose breast tissue in a BA? How does this hapen? Especially if one has it under the muscle no where near the breast tissue?

Answer:

the larger you go, the greater the chance of destroying the original shape, yes. As to losing breast tissue during an augmentation, it is not a true phenomenon, it is an illusion to a certain degree. The weight of the implant, especially when placed above the muscle, though will over time act like a piston to stretch the skin envelope out and as the skin stretches and the amount of original breast tissue stays the same, the breast looks smaller as it is in a larger skin envelope. Along with that, as one ages, most women loose fat in the breast leading to a smaller breast. JG 1.21.08

Question:

Sorry, I HAVE BREAST implant UNDER not over..the muscle...regarding the previosu question...

Answer:

it wil apply to both but more obvious when above the muscle. JG 1.21.0l8

Question:

I have a question. Iam 6 month post op... My left breast seems to lean to the left armpit and OFF CENTER to my chest wall!! What causes this? Can I fix it with a tite bra? Or does the DOC need to redo the pocket? Or would a bigger implant fix this..since the left is a lil smaller than the right which is perfect =)

Answer:

could be the tissues relaxing on the lateral aspect of the chest wall and now allows the implant to move that way, it can be very difficult, if not impossible to correct, without new incisions.JG 1.15.08

Question:

Is it normal to feel the implant under the breast at the imframmory fold? Would this lead to bottoming out? I have silicone partial unders 250/275cc - 34B to 32DD. My crease was lowered slightly under the smaller breast and I can feel the implant more there.

Answer:

it is common if the amount of breast tissue is small. It does not always lead to bottoming out though, that depends on many other factors. JG 1.15.08

Question:

I had my BA via TUBA surgery about 2 weeks ago. Although I am feeling a lot better, I am still having a shooting pain in my left breast if I move my arm a certain way, it hurts really bad on the bottom of my breast, and in my nipple. Is this something to worry about or is the implant just laying on a nerve? Sometimes it is really painful and Im hoping it isnt anything serious. Do you have any suggestions? Thanks.

Answer:

I think it is just the swelling on the nerves from opening the pocket to place the implant. Doubt it would be anything serious though. JG 1.13.08

Question:

I HAD BA IN MAY OF 2007. I AM DISSATISFIED WITH MY SIZE AS I FEEL THEY ARE TOO SMALL. MY PS SAID HE CAN ADD MORE SALINE. I HAVE 68-360 INAMED IMPLANTS FILLED TO 360. HOW MUCH CAN BE ADDED AND WILL THIS MAKE A VISIBLE DIFFERENCE TO MY BREAST?

Answer:

that implant can only be filled in another 50 cc so that is about 1 1/2 ounce.JG 1.13.08

Question:

Hi Doctor Garcia, Thanks for answering my past questions regarding muscle flex/shape distortion. I have been doing some research and have read about an implant placement method called “split subpectoral/subfasial” where the upper portion of the implant is underneath the muscle for coverage while the lower portion of the implant is on top of the muscle and under the fascia. Supposedly this placement 1) reduces the up-and-out movement of the implant upon muscle flexion and 2) eliminates shape distortion. Seems like this could help me since I don’t have the option to go over the muscle but I am wondering if there are any downsides to this technique? So, I guess my questions are: 1) Do you have any opinion regarding this placement (pros/cons, does it really work), and 2) Do you know of any doctors on the East Coast who use this technique? (From my searches, I can only find names of two doctors who perform this placement (one on the West Coast and one in Europe). Thanks again for your help!!

Answer:

sorry, but that claim has been made but is absolutely no different than the partial submuscular and then not submuscular. Lots of hype that in time shows no difference, sorry. JG 1.12.08

Question:

Regarding my question on emailing you my photos for guidance. My DOCTER NEVER EVER VER measured my chest. He just felt to see how much tissue was over to determine to go under or over so I HAD TO PICK which was 360 cc... SO NO HE NEVER MEASURED me... He still is like GUESS_timateing me...thats why i wanted your opinino before i go under again

Answer:

the diameter of your original breast is what ultimately wil determine what size implant can be plaed without potetnial long term repercussions, I would need to see yo in person then I am afriad. JG 1.11.08

Question:

I just got results from an MRI, saying I have a gel bleed on right breast. It has been incapsulated for sometime and is getting harder all the time. Had silicone implants put in 19 years ago. Do you suggest replacing them and if so how much? As been as I have MRI results now, maybe it would be less. What is a gel bleed? Thank You

Answer:

gel bleed is a leak and I suggest you have them replaced, yes. At present, unless you are a previous patient of ours, we are not accepting patients operated on elsewhere due to our schedule, the fees will vary from surgeon to surgeon though. JG 1.11.08

Question:

Hello Dr., I had BA 2 years ago...Approx. 300cc saline under muscle...Went from A/B cup to full C...The problem is my left breast is wider and goes into my armpit area more...Also it hangs a little lower..I inquired about it being fixed 6 mos after, but my surgeon said that you never mess with the original mammary fold because the implants could drop substantially...He also said he could not tack up the breast because I would lose the nice contour..So now I have one slightly larger & lower breast, which is not noticeable in a bra, but is without...Should he have made the fold lines symmetrical? Did he over-dissect the pocket on side? I thought a plastic surgeon could also fix flaws in the process, not just exxagerate them. Have any advice?

Answer:

we certainly try the make the folds even, at times the pressure from the implants can stretch the fold out allowing the implant to drop lower, yielding what you have. The larger the implant the greater the chance of that happening, especially when placed under the muscle It can be attempted to be repaired but resuturing the crease higher. That should not make you lose the round contour that you have. Best of luck. JG 1.11.08

Question:

Dr. Garcia.... I need some advice. I got a BA 8 months ago and at first I didnt like them. I got 300 bag MODERATE PLUS max filled to 360cc. NOw that they settled and look very natural. I want to go a bit bigger. But im afraid I may screw something up. The docter did wonderful placement and no complication. But the more I think one side of me goes..If it were a bit bigger ID BE ESTACTICLLU HAPPY..but another part of me is like well keep what you have at least you got something and next time u have to go under to replace go bigger... any suggestions...the more i think the more i contimplate..

Answer:

well, there are limits as to what your body can cover in terms of size and diameter of the implant and going bigger is often desired but can be problematic, depending on the size increase. I think you need to discuss this all with your surgoen and get their advice. JG 1.9.08

Question:

I am still having problems with muscle spasms/ and or the pocket not relaxing and it is 6 months after surgery. When I saw my ps a month ago, he said I have no sign of cc(it is very soft) and he doesn` t think scar tissue is the problem. He agreed that I try muscle relaxants as you had suggested before, and I think they have helped lessen the severity and frequency, but they are not gone, especially after going off the meds a few days. This problem is on one side after a pocket revision, and replacement- so that side has had 3 surgeries in less than a year, and he thinks that is why it is taking so long. I also stopped doing the upper body exercise I had started after a few months, as that made it worse. Does that make sense to you? Have you ever heard of it taking so long for these very uncomfortable spasms to stop? I don`t want to stay on the meds unless it really is helping me get past this, or will they stop eventually on their own?

Answer:

unusual for muscle spasms to last that long but since you have had so many surgeries in a relatively short period of time, it can happen. I think in time with massage and stretching, the muscle should go away, but the medicine might keep you comfortable until they do. JG 1.8.08

Question:

Hello again, Ok Dr G. I had a BA done 2 years ago. 680cc. I really like the size exceot my left side on a profile looks distorted the shape like not round or oval but kind of flat and round>> this is hard to explain. But I want to fix for sure. What would need to be done considering you understand what I have said. What is an approx charge for this procedure in your office? Thanx again.

Answer:

it sounds like you need a capsulectomy to remove scar tissue. At present we are not accepting patients that have had surgery done elswhere due to our schedule being booked, you might want to contact the local medical society for a referral. Best of luck. JG 1.6.08

Question:

HELLO, ONCE AGAIN THANK YOU FOR YOUR TIME AND DEDICATION TO THIS WEB SITE. 8 MONTHS AGO 525CC SALINE REMOVED, A LOLLIPOP LIFT AND 425CC MODERATE PROFILE SALINE IMPLANTS FILLED TO 510. UNFORTUNATLY I AM NOT HAPPY, I WANTED TO BE SMALLER, D TO C. ALSO THE IMPLANTS ARE TOO CLOSE TOGETHER. I AM GOING BACK TO HAVE THE IMPLANTS SWITCHED TO REGULAR PROFILE. HOW MANY CC`S WOULD YOU RECOMMEND FOR A C? ALSO, WHAT CAN BE DONE REGARDING TOO MUCH CLEAVAGE? THANK YOU!

Answer:

need to drop by about 150 cc and as to the cleavage that will lessen with the smaller implants, best of luck. JG 1.5.08

Question:

I am 1 month post op from switching over to under. About 2 weeks post op I developed a swollen circular patch in my cleavage area of one breast. It hasn`t gotten better or worse. PS says it`s not a hematoma, seroma or infection but probably something to do with where the muscle was seperated. He didn`t know for sure but said it would go away. It is still there, no better, no worse. It`s ugly and you can see it when I have a bra on or in lower cut shirts. It`s a puffed out circular patch. What could it be?? Will it really go away on its own?

Answer:

never seen anything like that, hard for me to tell without seeing you I am afraid. JG 1.5.08

Question:

i just had an implant revision and it was one week ago they said i have breast implant infection, and i am on 3 differant antibiotics and a cream is this serious

Answer:

it might be and it might require the implants being removed in order to fight the infection. JG 1.4.08

Question:

Dr. Garcia: You said saline implants cost between $4500-7000. How much would replacing saline with silicone implants under the breast crease cost?

Answer:

about $6000 if the capsules do not have to be removed or revised. JG 1.3.08

Question:

In response to the moving implants--I had the gummy implants overseas. Should I be concerned that they move? However, it takes a lot of force to move them, they do not move on their own or out of the cavity.

Answer:

well, the implants can move but the silicone inside of the implant shoudl not move in a gummy bear implant, maybe I misunderstood your previous question. If they are textured implants and if the texturing allowed tissue ingrowth, then they will not move, but in cases of smooth walled implants, they will move within the pocket, all normal, no problem with that. JG 1.2.08

Question:

Hello. I had gummy bear implants 3 months ago. Yesterday, while pushing on them to see if they were hard the silicone moved. I now notice that I can move the silicone in both breast from side to side. The breast don`t move just the siicone inside. Is this normal?

Answer:

well, in a true gummy bear implant that shouldnto happen, the gummy bear implants are not sold in the US yet, unless you are part of a study, so if you are not part of a study and live in the US, then you have the regular non-gummy bear implant which has silicone that will move. JG 1.2.08

Question:

sorry for asking again,for someone who was an 32A cup,how many cc`s is a full B cup,and a full C cup, approximatley? thanx

Answer:

ther is no chart where that can be figured out, but a general guess would be 300 for the B and then 400-450 for the C, but again that is a guesstimate. JG 12.28.07

Question:

what projection do you preer to use for under the muscle (mentor) silicone implants?high or moderate?thanx

Answer:

at most, the Moderate Plus from Mentor, I feel the High Profiles look artificial in most cases. JG 12.28.07

Question:

hi dr.garcia,can i change my implant from 225 to 300cc,and get married 10 days after that?will there be lots of swelling like when i first had the operation?will the stitches fade by then?and what about avoiding direct pressure. plz help

Answer:

the level of swelling will be less this go round but your activity level will be reduced and you will not be able to enjoy your honeymoon, that size change will be less than a cup in either regard. I would avoid direct pressure for at least 2-4 weeks and the sutures will be out but the incision will still be pink and not too strong. JG 12.28.07

Question:

hi dr. sorry for asking again, what kind of complications could i face if i wanted to change my breast implant to a bigger size from 225 to 300cc.is cutting on the same scar around the nipple twice going to make the scar more visible?thank you

Answer:

the scar should not change, as to the size change, if it is wider than the native breast tissue you might see and feel more ripples , that is the most common problem. JG 12.27.07

Question:

hi dr. garcia,i had a breast augmentation 3 months ago through the nipple,one breast looks great and the scar is not visible at all,the scar on the other breast on the other hand is visible and much wider,probably the doctor didnt stitch the skin close enough,or maybe i slept on that side right after surgery and caused that.is there any procedure that i can have done to make the scar a thin clean line like my other breast?i dont mind going under the knife again.and will i need full anestesia?and how much will it cost approximatley?thanx

Answer:

I think a minor scar revision under local anesthesia in the office is likely warranted, the surgeon who did your surgery will most likely do it for you at little to no cost. JG 12.27.07

Question:

dr. im worried my doctor damaged nerves around my nipple when giving me a breast augmentation through the nipple,i have no feelings there and its been almost 4 months, does it usually take that much time?thank you

Answer:

in some cases it can take as long as one year for the sensation to return. If the nerve was cut out on the side of the breast near the ribcage where it emerges from the ribs it might never come back though, that is a known risk of the surgery, and the chances of that are the same for all incisions. JG 12.27.07

Question:

hi dr. is it true that after marriage and giving birth.your breast gets bigger cause of hormones?..im having regrets,after my breast augmentation im wishing i chose a bigger size instead of just 225 cc..i wish i got atleast a 300 cc.

Answer:

the reaction of the breast tissue to pregnancy is quite variable, in my experience, most women actually lose breast tissue so they end up smaller than they were prior to the babies. JG 12.27.07

Question:

I have had a breast augmentation done 3 weeks ago and although it has all gone well I feel they are just to big for me and know I want them reduced. Could you possibly give me some information on How soon can I have this done and what the implications would be. At the moment I am devasted as the surgeon has done a good job but they are just to big for me Hope you can help

Answer:

well if you are firmly convinced you want them smaller, then the sooner the better, but there is likey some visible swelling in most cases for 6 weeks and residual small swelling for 3-6 months at times. JG 12.24.07

Question:

Hi, please help me! I`m am very scared right now. I had a capsulectomy and switch to unders 2 weeks ago. Everything has gone perfectly. I had a large bruise on the left side that slowly went completely away. In the last couple days I`ve noticed a 1 inch by 1 inch circular area that is slightly puffy in that same spot where the bruise used to be and it is a bit sore. Is this a hematoma? I had drains for 5 days and have had no issues. I`m scared I`ll get CC again because of it. I want to massage but now don`t want to because I may damage the hematoma area that has a clear outline. Will this go away on its own? Will I need more surgery? Is there anything I can take to help it? Thank you!

Answer:

if it is a small hematoma it should dissolve on its own with little problems, maybe some warm packs until you can see the surgeon for an in-person examination. I would not worry too much though. JG 12.22.07

Question:

hello Dr. Garcia, I am interested in re-sizing my breast implants. I had 360cc and 390cc, saline solution about three years ago. It is small D right now, but I never like to have this big. Is it really hard to go down full B with silicon gell? I heard there is silicon that they are safe and not liquid.. amy

Answer:

yes, there are silicone implants but the ones available in the US, although thicker in consistency than many years ago, can still leak, the semi-solid gummy bear implants are not widely available in the US yet. JG 12.18.07

Question:

I know that you will not encourage my choice here but I thought that I`d ask for specific help in any case. I presently have McGhan 410FX 775cc`s but I am going to go larger. BTW I went in for a bra fitting and I`m 34F. I asked the saleswomen what size they sell most often and it is 36F, so I`m so average. My breasts seriously do not look huge, I`ve seen women with 500cc that are much larger than mine. I`m not overweight either, just average height and weight but I do have broad shoulders. Anyways, I love the feel and look of the cohesive gel anatomicals but Inamed does not make any larger in this model. I`ve searched high & low for silicone anatomicals (I got mine in Costa Rica and I`m willing to travel to South America or Europe if I have to) that are larger volume (900cc or more) anatomicals and have at least the amount of projection I currently have with these which is 7.1 cm. However, I`m wondering if you have had any experience with either the Becker or Inamed combination saline inner & silicone outer expandable & adjustable implants and if perhaps these implants might help me reach my goal, since I might find the outer silicone filler comparable to my gummy bears. I`m looking for a surgeon who has lots of experience with these and I have no idea where to start looking. Doctors do not advertise which manufacturer they use on their websites, and I am suspecting these types of implants are more often used for reconstruction not cosmetic? Any leads for my search would be so helpful thank you.

Answer:

well, the Becker implants have a leak rate higher than the regular implants and I am not sure it will give you the anatomical shape you desire. You are correct, the vast majority of the time those implants are used for reconstructive cases. I really do not have any leads on where you can find a surgeon willing to do that for you. Sorry. JG 12.16.07

Question:

I have another question. When my drains were removed the first time with the weaker sutures per the dcotor. The nurse used something to clean around the area or to get the tape off. The liquid went into the hole where the drain was and it burned, but this only happened on the breast I`m now having trouble with. Could this have affected the sutures or them weakening faster which caused my incision to re-open. They never used sterie strips to close the holes the drains came out of either....your thoughts?

Answer:

I doubt that is the culprit. I also never use steri-strips on the drains, I prefer to allow it to close on its own over a day or so. JG 12.16.07

Question:

I had a breast aug. in October 2007. My right breast incision opened and I could see the implant. My doctor said this was due to him using new sutures that were weaker. He re-opened the incision site cleaned it and re-sutured and stiched it- also adding a drain. This was a week ago. He also put me on 5oomg of Cipro and I`m still on Accolate since my surgery. My breast now feels a bit hard and is sometimes painful. My drainage has decreased but changed to a darker and bit purplish red color and is thicker than before the re-incision closure. Could this just be an infection or is cc staring? Do I need a stronger script? I appreciate your insight thanks.

Answer:

I think it can be the begining of a capsular contracture and what was attempted to be done to salvage the implant might not work and you might need to have it removed for a few months and then replaced. JG 12.16.07

Question:

i had breast augmentation 1 and a half weeks ago with over the muscle saline 300cc. when should i be measuring for my final bra size? they still seeem a little big.. and do you think its possible that i still have inflamation? do youthink the y will become a little smaller soon? thank you

Answer:

I would wait 4-6 weeks at least. JG 12.16.07

Question:

Hi Dr. Garcia. I am 17 days post op from a breast lift and silicone implants. I am 5`6, 128 pounds. I got 397 on the left side and 457 on the right side under the muscle. I am concerned about swelling in between my breast. It is on the right side towards the bottom middle of breast. I am so concerned with symmastia. Should I be concerned now? Would it show up this soon or could it still be swelling? Thank you, Susan

Answer:

well it can show up at this point, maybe place a wrapped up towel over the breat bone in your bra until you can see your surgeon. JG 12.16.07

Question:

Is there ever a point in time after a Breast Aug. that a woman would know she is `in the clear` from symmastia? I know when due to surgeon error it appears quickly, but can it happen at anytime after implants are put in?

Answer:

I think after 6 months you are likely in the clear, maybe a little sooner. JG 12.13.07

Question:

Hi Doctor, I have a question about fixing muscle flex distortion. Mine is significant. I don’t mind the movement that much but the shape distortion really bothers me. When my chest muscles engage even slightly, a long dent occurs in both breasts just under the nipple area. It looks as if each breast is being separated into two parts which is noticeable under semi-tight and tight clothing and is becoming embarrassing. I have silicone implants partially under the muscle. I don’t think I have the option of moving the placement to over the muscle because I am thin and have very little natural breast tissue to cover the implants. Is there a standard procedure that can reliably eliminate or reduce this distortion? (I don’t want to go through another surgery if there isn’t a high probability of it helping or if it may make the distortion worse.) And, how long after the initial surgery do you recommend I wait to have this corrected, if possible? Thank you so much for your help!!

Answer:

well, not much surgically that can be doen besides moving them on top of the muscle. Some physicians have tried injecting Botox in a relativley large dose to weaken the muscle but it can get pricey and it is temporary, if it works. JG 12.12.07

Question:

hi dr. is it okay to sleep every nite on my stomach after 3months from having a breast augmentation(silicone gel).i can only sleep on my stomache but im afraid in the long run the implant might get damaged?thank you

Answer:

should be OK at that point in time. JG 12.12.07

Question:

hello .. I had a BA on thursday (last) i had chronic vomiting 3 days later.. no vomiting before that. and today which is wed. im still feeling dazed and groggy.. is this normal of anesthesia? thes e long lasting effects? thankyou

Answer:

could be from the anesthesia or the pain pills, breast surgery can cause lots of nausea, but nothing permanent. JG 12.12.07

Question:

I had the capsulectomy and changed pockets. I have drains so it`s been 4 days now with them. I have less drainage, but still a consistent amount. How long is ok to leave them in? Does risk of infection go up the longer you keep them in? Is it ok to still have some drainage when they are taken out or will that contribute to CC? Thank you!!!

Answer:

they can stay in for a week or more in some cases. Infection is rare, but I keep the patient on antibiotics while the drain is in place. Cutting down on the blood left there will hopefully decrease the capsular contracture recurrance rate. JG 12.11.07

Question:

Hi, it`s been 4 days since my capsulectomy and switching to under the muscle. I`m happy that they are very soft and natural looking which is a big change from when I had CC. My worry is that in the morning when I stretch or do shoulder circles I can hear crackling noises like when I had CC. Is this normal or is the CC starting up already again? IS it too early to start massaging?

Answer:

nope, just fluid from the surgery causing the sound, it is way too early for capsular contracture to form, that would take at least 6 weeks or more to form. JG 12.11.07

Question:

When can one usually start to do upper-body workouts again (excluding chest exercises but including back,biceps,triceps) after a breast augmentation under the muscle? Thank you!!

Answer:

I suggest 4 weeks. JG 12.9.07

Question:

Hi Dr. Garcia.Thanks so much for this Q&A segment.Sorry this is so long,but I want to give you my history.I had BA in May 2007.Inamed 68-MP;right side 450 filled to 510,left 450 filled to 480,under the muscle.I had assymetry.My right side never moved since the day of the surgery.I developed CC,had a capsuleotomy in Sept.2007,and right breast finally did move down noticeably.In Nov.2007,I noticed my right breast (the side that was smaller to begin with) rising up again,made an appointment with my PS,and he had me start taking accolate.He told me at the appointment if it wasn`t better by Dec.13,2007,he would schedule a capsulectomy.Being that my implant is already behind the muscle-1.Do you think once this surgery is over,how likely is it that the capsule will harden and be a problem again?2.When he does the surgery,should he replace the implant with a new one?I appreciate all your expertise.

Answer:

I think the best option is to change location and change implant both, so new implant and over the muscle. It needs a new plane for it to have a chance, best of luck. JG 12.8.07

Question:

Dr.Garcia I had asked you about CC before and I just had my implants removed for the second time. I just wanted to know if there is anything i can do or surgery that can get me back to the way I was before. I lost a lot of breast tissue and have a lot of scars, I am very small and have no fat, what can I do?

Answer:

very hard for me to say without seeing you I am afraid. JG 12.8.07

Question:

I had a capsulectomy on Friday and the drains are to come out on Monday. I had drains last time and it took them 2 seconds to take them out. I`m wondering if I could save myself a 4 hour drive and take them out myself at home. It would be one stitch and just pull them out and put on a sterile dressing. Do you think this would be okay if I`m fine otherwise?

Answer:

I think you need to ask the surgoen to make sure it is OK with him. JG 12.8.07

Question:

What is the price range of the saline breast implants?

Answer:

depends n the surgoen, but about $4500-$7000. Depends on how it is done and whether it is above or below the muscle. JG 12.8.07

Question:

Hi Dr Garcia, I had breast augmentation revision 5 months ago, i went from 220cc hp silicone over the muscle to 240cc silicone moderate profile under the muscle with a binelli lift. This was due to cc and some loss of breast tissue due to 2 pregnancies. Basically the ps over dissected my muscle and i have implants that are so close they are practically touching. If I push down on the sides of the implants the skin does raise. A few ps`s have said I do have symmastia. I have some rippling in my clevage now and am in a much worse position than i was originally. Could you advise on the best form of action? would an explant be the best option??? thanks

Answer:

I would apply some pressure on a constant basis over the breast bone to try to get the skin to re-attach, hopefully it will and you can avoid a repeat surgery to correct the synmastia. Best of luck. JG 12.7.07

Question:

I am approximately 7 weeks post a breast augmentation revision. My right breast feels firm but my ps does not believe it is the start of a capsule. I had one on the left hand side previously. He believes that the firmness is in line with the timeframe of the surgery. Does the breast soften as times goes on? I need another revision on the left hand side to fix a bottoming out. Do you usually repair with multiple rows of sutures? He is suggesting (9 month dissolvable sutures) and placing a few select permanent sutures. He also mentioned cauterizing in a few areas to aggrevate the skin to heal. Do you agree with that? Lastly, what is your experience with the repair of bottoming out not working? I`m concerned if it doesn`t hold that I`ll need another surgery. Thank you.

Answer:

the breast does soften with time from surgery in most cases, yes. It depends greatly on what was done during the revision too. I usually do a double layer of permanent sutures and many times will use a non-absorbable mesh too. I am not quite sure what he means by cauterizing the skin to get it to heal, all that will do is stop bleeding or it might close a pocket off if he is talking about cauterizing the capsule to get it to shrink or close down and limit the motion. Best of luck. JG 12.6.07

Question:

Recently (4 weeks), I recently had a Breast Enlargement. My weight is 124, height 5`4, diameter 13 -14, and cup 34 B. I wanted to be a a round D cup. I had under the muscle, moderate profile, inamed smooth round 68 saline implants, size 450-480 cc. This was recommended by the doctor. Well, I was sized with a silcone 493 filled to a 503 and told that the 450-80 saline would be comparible. The doctor stated I would be a D cup, but as I look in the mirror it looks like a C cup. I am happy with the surgeon, but feel they are too small. When I asked prior to surgery to go with a bigger one - two cc`s up, I was told it would cause rippling. Is this true? Also, is MP the best? When I went in I wanted HP? Will I be the round D cup I desire? What happens when I go back if they are too small to me? Thank you for advise.

Answer:

well, if you go to a larger size, then the diameter of the implant is wider so on the side it might show more ripples, that is true. Moderate plus profile will give you more projection but likley not a different cup, just fuller or rounder. High profile even more so. As to the surgeon going back and going larger, that is possible but you need to balance it out with the potential down sides. The first thing you need to understand is that achieving a desired cup size is not only difficult, but it can also demand that you accept some negative side effects like rippling in the short term and also long term issues like double bubble problems, earlier bottoming out or ptosis. So in short, you cannot always get what you want, there are your own physical limitations that can hold your desires back. JG 12.6.07

Question:

ihad breast implant exchange this AM (saline) over muscle. I went from 550 ccs both breasts, to 300 and 325. they still look alittle large, is this due to inflammation>.. and am sure when they drop will they look smaller? how long will it take to see or know the true size? im trying to achieve a large B size. thankyu

Answer:

yes, all due to swelling at this point. It will take a while to see the final result. All depends on if the removed the capsule or not as to how long it takes.JG 12.6.07

Question:

I just posted asking if you think I could have necrosis or an infection and forgot to mention I have Saline implants.

Answer:

saline or silicone will not make any difference with what needs to be done. JG 12.6.07

Question:

Thanks for such a swift reply from earlier I,m the lady with the big bleed 3 weeks after augmentation Do you know what could have caused it to happen I have rested and worn all the right support,as I said I have had a buning sensation in the bottom of this breast since the opp but not in the other one. As of now my breast has gone right down I would say it is a third bigger now than the right one in 4 days and is now soft to touch with no pain. I have to see the surgeon on Monday my GP doubts now as it has gone down so much he will want to open it back up.With the CC in mind would you think I should insist on this? My sugeon said if he did open me up and clean out the cavity I risk infection and also the bleed could happen again....But I don;t want the increased chance of CC in a few months and have to have it done then.

Answer:

most likely a small clot on the blood vessels fell off from stretching or pulling, or even coughing, it happens. If it has gone down a lot it might be OK to wait it out. JG 12.6.07

Question:

I has a breast augmentation On October 4th with under the breast incision. I quit smoking since the January before and followed all doctors orders strickly. My left breast has healed nicely, but my right has not. 2 weeks ago a small hole open back up on the right side and white puss looking stuff was visable. I was told by the nurse this is normal and part of the healing process and not to worry. I continued to keep the area covered/clean and I have been experiencing leakage that is a light yellow color. The incision looks purple now and it seems that skin is weakening-another small hole onthe other end is starting to open. I can also see the implant covering the larger hole area and can touch it. My doctor is suppose to see me today. I was wondering why this happened and what you think is wrong? Could is be Necrosis or an infection?

Answer:

I do not think it was due to smoking as you had stopped so long before, I think the incision needs to be opened, cleaned and reclosed, it is certainly not a common thing but does happen rarely.I think trying to let it close on its own if the implant is visible is likely not to happen, and if it does the chances of capsular contracture is quite high. Best of luck. JG 12.6.07

Question:

Dr. Garcia, My BA was 15 months ago, I am 48. I had 350 saline partial unders-areola incision. I went from a B to a full C. I have tried to speak to my ps concerning this, bu each time I have had an appointment with him I feel rushed in and out of his office. In fact he will be walking out the door as I am trying to ask him a question, he answers in the door way. Anyway, I still feel aches and pains, mainly on the left side, the lower portion of the breast,the pain will radiate laterly to my side. My left shoulder and between my shoulder blades hurts every day. I am in menopause, and at least monthly my breasts hurt so bad. When I was younger and when I was still having a period, my breasts never hurt as much as they do now. I am on bio identical hormone replacement, and have been over the past 3-4 years. With all that being said, I am wondering is this all normal, and is this how it is going to stay? Thank you in advance for taking the time to read my e-mail, and respond.

Answer:

well it is quite along time for the pain to be due to muscle stretching but it can be stiff scar tissue. With the added issue of hormonal changes, I will say that breast pain from benign breast fibrocystic disease does get worse as one ages, bio-identical hormones do help and you might want to speak to your gynecologist about possibly checking your levels to see if you need to get the hormones bumped up a bit. As you age the breast ducts sclerose or close off and that can cause more pain. Wish I had more to offer you. JG 12.6.07

Question:

Hi Dr. Garcia, I just sent my question to you, however I said I had 350 saline partial unders. I am not sure what I was thinking, but I have 350 silicone partial unders with an areola incision.

Answer:

no difference there. JG 12.6.07

Question:

I had breast augmentation 3 weeks ago,two day ago after experiencing a burning sensation at the bottom of my left hand breast somtimes when I moved,I had a massive bleed in the breast in the chest pocket,my implants are behind the muscle. my breast swelled up about three times the size of the other one was rock hard and excrutiatingly painful I rushed to see my surgeon that night he said he could either open me up then take it out and drain it or better than this if i could stand the pain for me to let it be reabsorbed by my body. It has gone down now 4 days later by 50% but is going black underneath and is still big and heavy though not painful. Do you think I should have surgically had it drained? Will it be reabsorbed by my body? Could it lead to CC ? Would having it drained within 24hr have reduced further complications ? ie breast sagging, CC ,Or the implant moving? My GP thinks it was the right decisition to let it setlle on its own but i,m having my doubts. Thanks for your time Kindest regards Tania

Answer:

I think it is best if the size difference is that high, to have it surgically drained because the chances of capsular contracture are much higher if the body absorbs it as it does cause inflammation. I think the chances of sagging due to the hematoma are not a high probability. JG 12.6.07

Question:

Why do some woman get BAD scar tissue around the implant and some dont? Is it just the way ones body is? And is it true the second surgery you have to les say go bigger or smaller will MAKE you get more scar tissue? Or is that false...

Answer:

different immune system from one person to another is the most likely reason. The size change for the second surgery will likely not have any major effect on the capsular contracure if the scar tissue is all removed. JG 12.5.07

Question:

Dr. I wanted to know why is the 400 Moderate Plus implant BAG smaller than DIAMTER than the 400 Moderate (Reg)? Is it because it Projects more? Are they the same size in cc`s to one another its just the shape of the bag due to the FLATTER (MODS) than the PLUS? If iam wanting to go bigger but have a narrower ribcage im guessing the plus is the way to go?

Answer:

yes, it is due to greater projection. Both have the same volume, but different shape. JG 12.5.07

Question:

One more thing. Iam 4 months post op! The Docter was saying iam still VERY TITE (skin) is also taunt. But he noticed the left one (skin) is looser and more elastic than my right. Because of this the left implant is actually pulling far to the armpit then staying in the center like the right is dead bolted perfect placed..so i have to wear a push up pad in the left to make the cleavage equal. Do u agree on this..or is it something different as to why one iplant seems to be going to the armpit and is looser and the right is dead center and perfect and firm?

Answer:

asounds like possible capsular contracture or a pocket that is not relaxing, hard to say. JG 12.5.07

Question:

Hi Dr Garcia,I had a BA & mastopexy(Donut) on 11/14/2007 5`1 117lbs,36B...275cc filled to (Rt)305 (Lt)300..my righty is swollen & sore still..lefty is feeling great and smaller???I measured my self tonight..Lt is a small C my Rt is a B cup?? I`m very upset.someone told me,my breast will go thru more changes, when your implant softens up..FLUFFING??

Answer:

you likely still have a good amount of swelling and I think things will change over time,give it a bit and talk with your surgeon on your next visit and ask what their his is. JG 12.3.07

Question:

Hello Dr. Garcia. I am curious, since it`s not a good idea to go into breast augmentation surgery with any kind of infection (I had to take an infected piercing out and let it heal), what happens if I get an infection that like again at any point post-Op(I am almost 3 months Post-Op)? I was wondering about infected piercings, infections from ingrown toenails, sinus infections...Would I just let it clear up/use antibiotics as I would do normally without implants? Thank you so much for you help! Have a great holiday.

Answer:

well, any infection can seed the blood and potentially cause problems, not so much an infection around the breast implant, but a microscopic infection can lead to scar tissue or capsular contracture around the implant, so when in doubt, if breast implants are in place it is best to aggressively treat the infection with antibiotics and draining the infection if appropriate. Best of the season to you too. JG 12.3.07

Question:

Hi iam from india and and my age is 19 years old and i have a very common problem that is my breast is very small and there is no growth i feel embarrased comparing it to others so can you please advise me what can be done in order to increase my breast size or else are there any creams available in the market which can be used to increase my breast size ,please let me know what can be done for this preoblem

Answer:

I am sorry but it will require breast surgery to change their size, no creams will do that. JG 11.30.07

Question:

I am getting breast augmentation, but I am conflicted about how many cc`s to get. I am 37yrs old, 4 11 and extremely petite. My bra size is 32AA. I was thinking about getting 300cc, but will this be enough of a change? My goal is to be a FULL B. My current doctor cautions me against referring to bra sizes when we talk about how many cc`s I should get. Any adivce is appreciated!! Shellyk

Answer:

I think that should be more than enough, good luck with everything. JG 11.29.07

Question:

Thank you for your quick reply regarding muscle spasms. I do have an appt. to see my surgeon again in 2 weeks (5 months). When I called a few weeks ago, I was told that massage might help(it hasn`t). Is there an over the counter muscle relaxant that could help? I hate to start with a prescription unless this is short term. Is this a problem that you have seen happen this long after surgery? Will it eventually go away, and should I continue to use that arm as little as possible again to help it heal or is it better to lift light weights and resume stretching using the band. Even lifting my arm up over my head is a problem. Thanks again.

Answer:

if it is spasms it will go away on its own, no real OTC pills for that though. I think stretching is OK but I would refrain from lifting. JG 11.29.07

Question:

I had a pocket revision done 4 and a half months ago. It was done to lower the pocket after a previous exchange surgery to under the muscle cohesive gels, because the left side rode up after a few months, possibly due to severe muscle spasms. The breast looks great, feels soft, has stayed down, and is mobile. The problem is that about 3 weeks ago, after doing more stretching and light weights as I was instructed to gradually get my range of motion and strength back in my left arm, I started getting severe muscle spasms. I am feeling pain and discomfort on that side with even the slightest use of my pectoral muscle. I cut back again on doing anything, but the discomfort has not gone away. It seems the implant is interfering with the muscle as before, even though it hasn`t pushed it up. I have gone back to wearing the band when I can which helps with the spasms, but they are back as soon as I take it off. Am I doomed to a life of pain from this implant, or will the spasms go away even though they didn`t start until I was nearly 4 months after surgery? Going back to over the muscle is not an option for me. Any suggestions are appreciated. Thank you.

Answer:

may want to see your surgeon and get some muscle relaxant to assist in getting things to relax. JG 11.28.07

Question:

Dr.Garcia I had asked several questions before, thank you for responding. This has been very helpful. I just had my incision revised and now I have a hole that I noticed at the bottem of my incision under the breast and I see the inplant. So what is going to happen now? there is no leakage just a hole and it is painful. Thank You

Answer:

if you can see the implant it wil likely need to be re-closed to avoid the implant getting infected, you need to call your surgeon when possible. JG 11.25.07

Question:

Is it possible to have swelling 2.5 months post-op? My breasts are definitely separated, but the skin in between them does not feel like it is sitting perfectly against my sternum. I`m very thin but can pinch the skin there, and when I bend over, the cleavage area is just very rounded. It`s hard to explain, I know I`d need an exam, just wondering what you think! How does someone know when the skin is tenting ? Thanks so much!

Answer:

there can stil be swelling after 2.5 months, yes. In cases of a synmastia repair one would hope that the skin over the breast bone after the repair would be tight, as it will likely loosen over time. I woudl suggest not pinching and pulling on the skin too to let it heal in position. JG 11.25.07

Question:

Hi Dr. Garcia, First let me say that I am impressed with your website and happy to have found you! I am 1 month postop of having a BA. I am 40 years old, 5`7, weigh 140 and have broad shoulders/athletic build. I took my surgeon several pictures in hopes to have a full C after my augmentation. My surgeon chose Mentor silicone implants 350cc, unders.....I do not have the fullness that I expected. And I have a follow up visit next Thursday and will be requesting a redo. I am barely a full B, small C. I have read so many articles after the fact of women that do not achieve what they expected to get. Do you have any advice for me on which implant size to go with to achieve my goal?

Answer:

welll, the honest truth is that when done properly, your own anatomy limits the size implant you can have if you are going to minimize long term complications so the desired cup might not be achievable in all cases, typically you need to limit the implant to the width of your own breast tissue and that will limit the size implant I am afraid. JG 11.24.07

Question:

Dr. Garcia, I forgot to list what type of Mentor silicone implants my surgeon chose...they were high profiles. I am the 40 year old that just asked a question regarding feeling dissappointed with my results after my BA. Is this a typical scenario for surgeons to make errors or miscalculate what their patient should look like afterwards?

Answer:

high profile implants give more projection but they do not guarantee a cup size. JG 11.24.07

Question:

I am scheduled for my redo surgery (capsulectomy and switching to under the muscle due to CC) in two weeks. I currently have bronchitis I got from a bad cold, it`s getting better yet really dragging out but I am trying to avoid antibiotics before surgery so I can have a stronger immune system. Should I go ahead and see about antibiotics or recover without them? I`m currently taking vitamin C and a probiotic.

Answer:

I woudld start the antibiotics to control the lung issues or that might delay the surgery. JG 11.23.07

Question:

I had symmastia for 8 years before recently having it corrected. Not sure if it was right but it has been 5 weeks and the thong bra I wear works but the skin in the cleavage area keeps reverting back to an stretched out look. In other words it is not flat against the breast bone. Will it eventually go all of the way down or is this something I will have to live with? Thank you

Answer:

most likely either live with it or have more surgery. JG 11.21.07

Question:

Regarding my previous question... Even tho I have had these slaines for 4 month..Is it possible to leak this far out in the process? How can that happen? Also...how long do you think it will tkae for it to be completly deflated? =/

Answer:

yes,it can happen at any time. It might take a few weeks to totally deflate. JG 11.21.07

Question:

HELP ME...I swear i MUST HAVE A LEAK in my left implant! I looked in the mirror this morning and the implant is NOT FULL Like the other and WAY FLATTER then the other..SIGNIFICANTLY....I took a mirror to the thing and its nice and full on the bottom but the right one is PERFECT IN VOLUME and projection and fill my right chest nicely and the other deflated one is so flat on the upper pole and inner part and covers 3/4 of the left chest wall..the two look completly different.. EITHER I HAVE CC on the right and the left is HOW IT SHOULD look Or i havre two completly different BREAST sizes and now the swelling is gone u can see it more..(Iam 4 months post op) WHAT DO I DO...its thanksgiving weekend...should i just let it be....Im really mad than upset..like i had enough and just wnat to take them out and forget about implants all together because this has been more frustrating than NOT having them. My docter in my previosu follow up visits doesnt help me with my goals i just dont know what to do anymore

Answer:

sounds like a leak as capsular contracture does not develop overnight, will need to have it replaced and the manufacturer should warranty it, hang in there. JG 11.21.07

Question:

Dr. Garcia, I asked you a question earlier, but I thought of another. Do women who have CC ever get sraight or do they usually have to have a lot of surgery to correct the condition and loss of tissue? This is my second surgery and I want to get on with my life and be healthy. Thanks a lot!

Answer:

I have to say that once CC happens, it is usually the start of a long road most of the time. At times one gets lucky, but the more times you have to operate due to the capsular contracture, the more tissue is lost and the greater the recurrence of the CC. Changing the location of the implant from below to above or from below to above is almost always needed along with an new implant.I wish you the best. JG 11.18.07

Question:

Hi again Dr. Garcia - about the possible bottoming out of my left implant (375 gram, silicone, textured, anatomical, complete under) If it is 10 weeks Post Op that this is starting to occur, is it likely that it was the surgeon`s error with the pocket, or just the weight of the implant since I had a severe lack of breast tissue/fat? I trust my surgeon but I just want to know what you think about this, thank you so much for all of your time and help!

Answer:

well, I think it is likley the size of pocket dissected by the surgeon or because of the poor elasticiy of the skin, which is not under his control, I can tell you that they are not completely under if this is happening. JG 11.18.07

Question:

Dr. I had a CC a year ago and had the implants removed. Recently 3 weeks ago had them replaced with gel high profile 300cc`s. I beleive I have a CC again in the right side just as before, I have been taking singular and V-E but I dont feel any improvment yet. Should I wait for 6 months or can my doctor do and open capsulotomy just on that side to correct it. Thanks

Answer:

well, I would give it at least three months to let the tissues soften up. JG 11.18.07

Question:

Hi Dr! I had breast aug approx 1 and 1/2 years ago. (mentor,smooth round mod gel 375cc silicon) I am happy with my results with ONE troubling issues. Due to the increase in breast fullness, the veins around my breasts are very blue and prominant. In low cut dresses, tops they travel up near my cleavage and I can cover them with makeup or self tanners. My question is if I could have someone touch up these veins by doing the same treatment as done on blue viens for legs? Sclerotherapy? My concern being possible injury to the implant. I had them behind the chest muscle, but still not sure if the possibilty of puncture is a concern? Thanks for your time. PS. Would lasers work for this issue, and if so- safe for implants?

Answer:

do not think you will harm the implants but I am unsure how effective the sclerotherapy will be and I would avoid lasers for that area. JG 11.18.07

Question:

Hi Dr. Garcia. I am almost 2 months and 1 week Post Op my breast augmentation. I am very thin, no breast tissue to start with, had 375 gram silicone complete unders. I think my left may be bottoming out (I will see my surgeon next week). The nipple is even with the right one, but is sitting higher on the breast since the left one has dropped. The left nipple is also pointing upwards. If I am bottoming out, it is not very severe (yet anyway). Just wondering, can it only get worse, or can it stay the same? Should I expect the right one to bottom out as well? Is revision only performed if it is severe, and are results usually permanent, successful? I was wondering if a smaller, less heavy, implant is ever needed. Sorry for so many questions, thank you so much for your time!

Answer:

I am afraid it can get worse in time if it is fact occuring. The right one migth never bottom out. Usually the results from the revision are good and long lasting, best of luck. JG 11.18.07

Question:

I am scheduled for BA in four weeks, I am a little concerned with the size I chose.....my PS was helpfull but not helpfull enough. I currently live in a very small town, which means I have to commute almost 2 1/2 hours to see my PS. I chose to get 420 ccs, I am currectly a C cup but somewhat saggy due to having my son. I am hoping to upgrade to a big D or small DD. I want my breast to look as natural as possible, I don`t want them to look like two huge rocks. When I met my PS, he was the type that wouldn`t tell me what was good for me, he wanted me to tell him what I wanted. After I measured some implants, I decided on the 420 ccs and THEN he proceeded to tell me that it would be under the muscle and that I was getting high profile Mentor implants. I was able to choose between saline and silicone but other then that he did the rest. What I am confused about is that like I said, I want them to look natural. Will saline, Mentor high profile implants under the muscle make my breast look like rocks? I`ve seen alot of before & after pictures and I don`t like the rock look. What do you recommend for the more natural look?

Answer:

well it is hard to say without seeing you, but in my opinion high profile implants can look a little too narrow and artifical and placing them under the muscles will not lift your breast so your own breast tisuse is likley not going to be centered over the implant if you have any significant degree of sagging. Might want to take a drive and talk with him again. JG 11.17.07

Question:

The previous question has me wondering about my own BA. I had assymetrical breasts, with one crease much higher and the breast smaller. My BWD was 12.5 L and 13.5 R. The L was also the smaller cup size. My PS used 275 silicone Mod (13.2BWD)on the L and also lowered the crease a bit. He used 250 on the R with a Benelli Lift. My concern is about the L side. I was advised to wear underwires. 1) Is the underwire requirement done to avoid the complications you mentioned in the earlier question? 2) How will I drop & fluff if I am always to wear the underwires? At the 4 wk followup - he told me to wear an ace bandage across the top at night as they were sitting very high.

Answer:

the underwire can help avoid, but not totally the bottoming out, but not always the double bubble. The underwires are essentially speed bumps,they will slow it down but never totally prevent it even if you wore them 24/7. The bandage up top is to get them to drop or for the skin on the lower part of your breast to expand and allow the more natural look. I will say that breast asymmetry is diffcult to totally correct, I always tell patients it will be improved but never equal due to nature`s imposed limitations. JG 11.16.07

Question:

Edit for question on the underwires earlier. My BWD on the L is 12.5 (not 13.2) 13.2 is the BWD of the R

Answer:

even more difficult to get them to match. JG 11.16.07

Question:

If someone picks a larger size implant that is LARGER that ones natural breast diameter...What can go wrong? Why do some surgeons dont care as long as it firs in your chest? Also, I think I can get a bigger bag than what i have because i see my natural breast tissue NOT FILLED or PLUMPED up compaired to where the implant is placed? Can this be that I NEED a bigger implant to fill out my natural breast tissue more? And how will I know how bigger to go from that?

Answer:

it can hang out on the side, increase the chances of seeing and feeling ripples, increase the chances of developing a double bubble phenomenon, increase risk of bottoming out and the implant dropping down excessively. Hard for me to advise you more than that without physically examining you, sorry. JG 11.16.07

Question:

I had breast augmentation 7 months ago: Mentor Smooth Moderate Profile, under muscle, crease incision, 250cc in each. (I didn`t want to go too big, as I am only 5`2 & 99 lbs.) Both breasts were symmetrical pre-BA, although the right one was very slightly larger, almost imperceptible. The PS was aware of this but opted to fill both implants the same CCs, which I was ok with. Post-BA, the right one sat much higher, & over time, did not settle. My PS said part of the problem was that my right pec muscle is more developed. So 7 months post-BA, he did a right-breast pocket revision in which he lowered the crease. The revision was 20 days ago. A few hours later, the right had already lowered slightly. My PS advised me to wear the strap at night, which I am doing. I haven`t noticed any further lowering/settling, although he said it would continue to do so. I`m wondering why he didn`t go ahead & place the implant in the correct position during the revision, & why I need to wait for it to catch up to the left one. Could this be because the left has had 7 months to settle, & the right hasn`t yet? Also, I have numbness in the right breast near the incision (which is larger than before). Can I expect the numbness to diminish with time? Thank you.

Answer:

the numbness will get better over a few months. When we open and revise the pocket the tissues have to stretch and relax over time, if it looks perfect at the end of surgery, it might then lead to too low of a position once the tissue relax, that is why you need to wear the strp, to stretch the tissues and let it all heal, hang in there. JG 11.14.07

Question:

Hi Doctor Garcia! Before i begin i would like to say that this has been one of the most helpful websites for breast augmentation. Especially the question part. Im exactly 8 weeks post op from breast augmentation under the muscle i just started a seasonal waitressing job for some extra cash. Im concerned is it safe for me to be carrying drink trays and plates? Can this cause any damage or complicate things for me?

Answer:

you are OK to proceed and resume normal activity at this point, best of luck! JG 11.14.07

Question:

Hi Dr. Garcia, Thank you for making yourself available for questions. What a wonderful service you are offering to women. I`m 5`2`` and about 115 lbs after 2 kids. I am now a small 34B and when I was 15 (I`m now 37) I had a breast reduction (I was a 36D). I`ve got a naturally muscular build (especially my arms)- I`m having silicone implants in a couple of weeks - either 286 cc`s or 305 cc`s because I`m tired of wearing padded push up bras, etc. I want to look sexy, but I just can`t seem to get perspective on which would be better for me. Would you suggest one size over the other for me? THANK YOU!

Answer:

to be very honest I do not think the difference between those two is large enough to make a visible difference, it more relates to the width or the base measurement of your breast, you want to not go larger in terms of the implant compared to the width of your own breast. I think you need to ask your surgeon about those measurement so you can decide. JG 11.12.07

Question:

Dr. Garcia, If a pocket has been over dissected and you need to do a revision to raise the implant and crease. Do you use multiple rows of permanent sutures? My ps suggested a few dissolvable sutures. He said it was a quick 5 minute surgery? Do you agree? I understand this is the most challenging breast revision surgery. How long do you think this sort of repair would take? Thanks so much.

Answer:

I always use permanent sutures to make sure they last long enough for the scar tissue to form and hold. As to the time involved, I have to say that it depends greatly on how much needs to be done but I have never done one that took me less than 30 minutes. JG 11.12.07

Question:

Hi Docter =) I have decided on a REDO because I choose WAY to small of a diamter implant size for my width of my chest. It looks BAD. Because of this I want a redo TO GET THE PERFECT DIAMETER implant size for my body. How can I pick the size/diameter implant that will fit MY BODY perfectly? Is there a way to calcualte what diameter of an implant size WILL FIT ones body..Iam choosing MODERATE PLUS SALINE .... i have a 28 inch ribcage...NOW have 300 bag filled to 360 cc Moderate plus... Thanks

Answer:

the best diameter for the implant is the diameter of your own breast tissue. JG 11.12.07

Question:

Hi Dr. Garcia, I am the person who posted the question about using Botox as an option for muscle flex distortion and movement. Thanks so much for answering so quickly! I want to make sure that I clearly understand your answer. One, you say that “both options are good ones.” Do you mean Botox and/or muscle relaxers, OR Botox or surgery to release the muscles? Two, when you say “that all gets better in time too,” do you mean the muscle distortion/movement may lessen with time on its own, OR after using Botox for awhile? Three, will it take 50 units of Botox on each side or 25 on each side (For a total of 50)? And finally, do you know of any negative side effects of ‘Botoxing’ chest muscles? Have I hit my question limit yet? :o) Thanks again for your help!!!

Answer:

well surgery might not help, in time as the muscle heal they relax and loosen up. When I inject I usually use 50 units per side, correct. No negative side effects I have seen. JG 11.12.07

Question:

Hi Dr. Garcia, I am about 6 weeks post op from breast augmentation. I have, what I think, is very strong muscle flex distortion and movement. It is very uncomfortable, happens even with the slightest engagement of my chest muscles, such as when I open or close a drawer or am writing/erasing. The movement is very noticeable under clothing and above the neckline of tops that aren`t even that low. I am wondering if you know of any research studies that use Botox to lessen the muscle distortion and movement and what the negative side effects of trying this may be (e.g. bottoming out, other implant shifting, etc.). Also, do you think muscle relaxers may help or is surgery to release the muscle my only option (I hear that it can sometimes be worse after a second surgery). Thanks for taking the time to help. Elisabeth

Answer:

I think both options are good ones, the Botox might require 50 units and is injectd diffusely into the muslce. That all gets better in time on its own too. Best of luck. JG 11.12.07

Question:

Dr. Garcia - I had a BA 1 year ago 420 MP overfilled to 450 under muscle. Rippling starting occuring 2 months ago and it is getting more noticeable. Would HP 560 implant help with some of the rippling? I am trying to stay close to the same diameter. I assume that I will become 1 cup larger with more upper fullness. Will the HP Implant make me look much larger? 5`5 130 started out 34aa, current 34 small D or large C. approx 28` ripcage, 26 waist and 36 hips Thank you in advance for your answers. Very much appreciated.

Answer:

mayeb 20% or so with the exchange, not much more than that, there will still be ripples I am afraid. The high profile implants at times look unatural due to the narrow base and exaggerated projection. JG 11.9.07

Question:

Dr. Garcia...Im considering a re-do after my first BA. I was wondering a couple of things... ONE~ Is the pain as bad as the first TWO~ What is different (POST OP) in the second surgery comapired to the firts THIRD~ Even tho Im going bigger will my BREAST SHAPE ALTER or be the same as they are now only bigger? =) Also...is it dangerous to have a redo even tho the first was a success without any complications

Answer:

the pain will depend greatly on what is planned. The post op should be pretty similar though, going bigger can alter the shape of your breast because you are only changing the size of the implant and not of your breast tissue. I do not think a redo is dangerous but there are risks in every surgery so they have to be weighed with the possible benefits of going larger. JG 11.9.07

Question:

Hi, I had gummy bear implants 5 weeks ago overseas. They look beautiful. My question is my PS told me there is no need to massage them so I am concerned about them staying hard. Have you heard this. Also, they are warm to the touch. Is this normal on BA?

Answer:

I do not think massage will do much and the silicone does not change temperature very quickly so at times they will feel warm, no problem with that. JG 11.7.07

Question:

I`m having a capsulectomy next month and switching to under the muscle due to recurring CC. My PS doesn`t want me to get silicone as he says it has a higher risk of CC, is this correct? Also, do you believe in any homeopathic or other medication to help with CC and scar tissue? Thanks!

Answer:

there is absolutely no evidence that silicone has a higer risk of capsular contracture. I do not think homeopathic products help prevent scar tissue but they do help with bruising. JG 11.6.07

Question:

Hello Dr. Garcia. I`ve had saline implants under the muscle for 14 yrs with no problems. Due to my weightloss and age (42 no kids, tissue still the same)I will be seeing my surgeon to see if I should change them in January. I just feel they need to be adjusted to a few more cc`s. When I saw my surgeon after having the implants for only about 8 yrs, he told me that he`d rather not touch them. If he revises them they will either be too high or too low and heavy. He said he`d revise them if I wish but didn`t want to due to the risks. Why was he concerned with bleeding and infection and whatever other risks there are with a revision? Why did he say they might be too high or too heavy and low? Does he not know how they will turn out unless he attempts the revision? I think he might be concerned that I don`t have that much tissue to make a noticeable visual difference. I was wondering what your thoughts were on the way he was thinking. Thanks so much !

Answer:

I think if they are doing OK I would leave them alone. JG 11.6.07

Question:

Dr. Garcia..Im considering a redo in March of 08. And my docter is push..push PUSHING SILICONE on me even tho I have saline. I know Iam a slender fit gal and my saline is fine...but he seems to be like I TOLD YOU U SHOULD GO WITH SILICONE because he feels its look better on a thin girl. BUT i dont want another scar in a different place nor the thought if something is leaking will drive me looney....At the same time Im afraid he will be mad at me if i dont....I just feel a bit pressured and if I do go redo them I dot want to make a mistake either.. Any suggestions...

Answer:

well, I guess you need to ask him why he feels the silicone will be better, if you are not displeased with the ripples and you do not want to spend $1000 every 2-3 years for an MRI to investigate the silicone for rupture, which is what the FDA and the companies suggest at the present time, then stick with the saline. You are the pateint and you are the one who should decide that issue. JG 11.5.07

Question:

I had bilat subcutaneous mastectomy Oct 2006. Had 500cc silicone implants placed and then couple months later had them replaced with 800cc. Since I have no breast tissue it was an adequate size but the skin between my breast isn`t flush w/my sternum so it seems like i have no cleavage. Should i have smaller implants placed (700cc)? Also, since implants are under muscle my left breast has indention couple inches above nipple which seems like muscle is contracting at all times. What do I do about this?

Answer:

not much you can do about the dimpling/mucle winking and I think a smaller implant might help some of the lifting occuring over your breastbone, it might also need to be stitched down to reattach it better as it has been lifted. JG 11.4.07

Question:

Hello! I am new to your site and if I may, very impressive! I have a quick questions...,I am having surgery in a bout one month, I am getting breast augmentation with breast lift and a tummy tuck. My mind is going crazy, I can`t seem to make up my mind. I went to see my surgeon last week. I am 5`7 , 160 lbs. with saggy C cup boobs. With my body frame, I believe I can handle a DD cup size. I tried on different sizes at the office and I chose the 420 cc`s implant/saline. He told me I would most likely upgrade 2 to 2 1/2 sizes. This is what is freaking me out, he said with the 420 cc`s, under the muscle, he would have to fill the implant to 550 cc`s. Is that possible or normal? and will that be too much? I can handle the DD cup size, but I will be completely misserable if I go to an E cup size. What are you thoughts........Thank You!

Answer:

well I think the two cup increase is about right but the saline implants have about a 50cc window to expand and filling them up 130 over their intended size will make them feel firm so I would not do that. Every cup increase in general terms is between 100-150 cc. Best of luck. JG 11.3.07

Question:

Sorry, I should have been clear that during my capsulotomy revision I had my pockets increased on both sides with larger implants. So in this situation, would you have cut the capsule on the right side too? My ps said my scar tissue was about the same on both sides. Thanks

Answer:

well, it depends on how much of an increas was made with the implants, in certain scenarios, if the pocket has been established and has enough space for a larger implant then I do not do anytything to the capsule, but if the pocket of the capsule on the softer side is not large enough to accomodate the new larger implant then I will do a capsulotomy on the soft side also to allow the implant to be placed. If the scar tissue was the same, then the implants should have felt the same before the recent surgery. JG 11.2.07

Question:

Hi Dr. Garcia, If a patient has a capsule on one side and you perform a capsulotomy, do you typically release the scar tissue on the other side so they both match? My ps only did it on the left side and now the left breast is much more pliable and significantly lower than the right side. The crease on the left side is not defined at all and it looks like I have two different breasts on my chest. Thanks.

Answer:

no, I only do surgery on one side if the other side is fine becasue you might take a situation where it was OK and have a complication like an infection and then need to remove the implant. JG 11.2.07

Question:

Hi Dr. Garcia, I am getting breast implants on Nov 7..I am 5`11 145 lbs. I am smaller frame and currently I am 34A. I am getting low profile 360 cc saline implants. I believe my diameter is 13.5 and this was what was recommended to me by my plastic surgeon to look enhanced while maintaing a more model like portfolio. I just dont wan to be too busty? do you think this is a good fit and what cup size do you think it will end up being?

Answer:

I think that is a reasonable size and I would guess at about a small C cup, depends on if it is above or below the muscle too, below will lose a little size. JG 11.1.07

Question:

I had a very slight case of symmastia and just had it repaired. My doctor said that only one side was in need which was correct but I am wondering if both sides should have been sutured? He also says I do not need to wear a thong bra because it is corrected. Is this right? Last question is how long does it take for the cleavage area swelling to go down it is still raised somewhat 10 days after surgery. Thanks

Answer:

well, synmastia affects both breasts by definition so typically both sides need to be done and I use a Thong bra to get the skin to re-adhere even if it is sutured down, just to be safer. It will take at least 2-6 weeks for the swelling to go down, got to give it some time. JG 11.1.07

Question:

Hello... I`m very interested in the gummi bear implants that are currently being tested by the FDA, and I`m wondering when they are going to (feasibly) be on the market. I was hoping maybe this summer? Also, will the price be considerably more, or will the implants be relatively the same price as the traditional saline implant? (Gotta save my pennies!) Thanks in advance...

Answer:

hard to say, maybe one year, hopefully. I think the price will be higher than the silcone under present release, yes, price still to be determined. Guess would be about $2000 for the implants alone. JG 10.31.07

Question:

How long should I wait after having breast augmentation (500g silicon)to visit Disney World? Would 2 1/2 months be too soon? Sincerely Simone.

Answer:

should be plenty. JG 10.31.07

Question:

I had 23 year old silicone implants removed 2 1/2 weeks a go. One was seeping. I have kept a sleep bra on during the night all this time. I started using a regular bra, no underwires last week. Four days ago my right incision became very sore and the left one slightly. For two days I have gone without anything at night and worn the sleep bra during the day. Yesterday there was a big improvement, but this morning the soreness is back in the right one a bit. There is no sign of redness in either incision. Is this something that happens as the implants settle in? Or could that bra have irritated the incision? Is letting them go unsupported at night better or not? I never had a moment`s problem all those years with my old implants. And that`s with a mammogram every year too. I hated to lose them.

Answer:

I think it might be irritation from the bra, might want to try a jogging bra instead. Best of luck. JG 10.31.07

Question:

I wonder if this is possible....I am a lil fitness figure athlete who weight trains. Before my BA I had a really tuff and hars thick built up chest muscles. Well as the healing is on its way 4 months i swear the implants seem to be wider and pushing towards my armpits..not that noticeable but it seems wider than before...can theyjust migrate that way from under the muscle. NOW I GAVE UP TRAINING CHEST after my BA because it is known to push the implants outward....Even tho this is NOT my case they seem to be wider..can this be just happening by itself?

Answer:

your pec muscles will casue the displacement,the stronger the muscles are the more they move, but they will move even in non-weight lifters if the tissues have been loosened to place the implant there. JG 10.30.07

Question:

Why are my breasts bolted to my chest and WILL NOT move hardly even after 4 months after my BA? Are they always like this? Or going ot be like this? I feel I just have to rocks in there. My docter doesnt make the pocket big for it to move around he makes it fit the implant size thus NOT havibg to massage it but the muscle above the implant will do it naturally with movement. Im wndering this is why? Also how come some girls implants move about? Is it because iam lean? I did have a nice amount of tissue before....Im confused =*(

Answer:

sounds like capsular contracture or an inadequate pocket dissection. The implant needs to move to feel and stay soft. JG 10.30.07

Question:

Hi Dr. Garcia, Do you charge if someone comes to see you for a second opinion? I called a doctor`s office and they do free consults but charge for second opinions. I need a revision but want the view of another doctor first. Thanks.

Answer:

we did charge when we still did them but we are at present not accepting patients that have had surgery elsewhere. JG 10.30.07

Question:

Hi Dr. Garcia, I am 6wks post a breast augmentation revision. My first surgery was in April. I had a revision in September for a capsulotomy on the left breast and to increase both the left and right pockets. Now my left breast is lower than the right and the crease is not defined. My PS says that he does not believe that it is a true case of bottoming out as my nipples are both even. He is suggesting a 2nd revision to add some dissolvable sutures to form a tighter crease. He says that the implant only needs to be lifted about a 1/4 inch. Do you agree that the dissovable stitches will hold the implant or should he be using permanent? Is there any risk difference with using one over the other. Will repairing this left breast interfere with the capsulotomy repair that he did just recently? Thanks so much.

Answer:

I use permanent sutures and the nipples being even does not rule out bottmoning out. JG 10.29.07

Question:

Im REALLY CONSIDERING A RE-do and its only been less than 4 months after my very first BA. Iam not happy at all with my resluts. How long should I wait to make that decision to redo. Im hoping one day Ill wake up and like them...But everyday isnt even near that day. Also, do many clients of yours ahve re-dos to go bigge ror change a profile? Also..I have Moderate Plus and because i have such a small implant size the width is horrible. You can literally see that more can fill up that pocket. Waht iam saying is do you think MODERATE will be better than a MODERATE PLUS or no difference. I DO LIKE THE PROJECTION THO... Thanks Doc =)

Answer:

well, the re-do whether or not to do is really a matter of why you are considering a re-do, some things get better in time and others do not. I wil say that there are certain anatomical dimensions of yuor breast and ribcage that may limit the size implant that can be placed in orer to limit late complications, so it is not just a matter of getting more because you want more. Larger may not be a viable option without increasing long term problems. Moderate will lose projection when compared to Moderate plus too. JG 10.29.07

Question:

I choose a really small implant because I was scared to go too big my first time. Plus Iam an athlete with low bodyfat so I wanted to ease into the size because I was unsure how I would turn out with my leaness and muscle. Anyways..my size I DONT LIKE..too small. Because they are such a small bag size they are literally a pop can diameter size apart...adn i know i can see there is room between to fill more of an bigger impant.... Is this worht fixing or should I just let it go....

Answer:

a larger implant is wider at the base so it will spread out both to the center and to the side of your chest, both. JG 10.23.07

Question:

Hello again! You answered a previous question and have another concern you can hopefully help me with. I had uneven breasts to begin with...my left was smaller than my right and also the left crease was higher. He did lower my left crease but used the same implant size in both breasts so i still have the assymetry problem. I can`t understand why he didn`t put more cc`s in my left breast unless because i have a small built he felt that breast couldn`t handle a bigger implant. I`m very disappointed and already want a re-do but i am not quite two weeks post op. Do you think there is any chance they will even out or i am doomed? Thanks!

Answer:

I would give it at least 6 months and let the tissues relax, in many cases the tissue will loosen and the size difference will not be as visible. JG 10.23.07

Question:

In Nov. 2005, I had reconstructive surgery with fillable implants (Mentor, Smooth Becker) inserted. Approx. 8 months into it, I developed a cc in my left breast. My doctor added saline to the right breast to compensate for the difference in size and prescribed Singulair. Ten months later, the scar tissue doesn`t seem to have changed. We are nearing the time to make a decision (actually past, since Mentor recommends valves be replaced w/in 6 mos.) to remove the valves however, I`m wondering if anyone else has had any success with scar tissue actually going away/dissolving?? Since there is more volume in the right breast (615cc) than the left breast (500cc) however, if the valves are removed, AND the scar tissue dissolves, I will be uneven! Would you recommend removing the valves with the current size (same in physical appearance but different in actual volume) and take the change that the scar tissue won`t go away, AND discontinue taking the Singulair? Or, adjust before removing the valves? Additonally, have you ever heard of attempts to overfill an implant to try and break up the scar tissue? Thank you for your opinion. Signed, Wishing to Make an Informed Decission.

Answer:

I do not think the Singulair will help if it has not at this point, I am also unimpressed with the ability of over-inflation of an implant loosening a capsular contracture once it has formed, but I will say that deflating the side that has contracted will make it look softer and hopefully the capsule will stay larger and leave you with a softer feel. I will say that capsular conracture rates in reconstructive cases is much higher than in cosmetic cases so one cannot compare the two to one another. Capsules never go away, at best they stabilize and do not get tighter. I think deflating the expanders some, removing the injection ports and stopping the Singulair are the option now. Hope that helps. JG 10.23.07

Question:

Hi Dr. Garcia, I am 6 months post-op from a breast augmentation with 350CC moderate profile smooth round saline implants places submuscularly. I went from a small B to a full D. I had a descent amount of breast tissue to begin with, but I did not have a very definitive crease. I just got back from my PS office today because I felt my breasts had dropped too low. Unfortunately the PS stated that the implants had dropped below the crease...which constitutes as bottoming out I believe. My doctor wants to correct my crease using dissolvable sutures. I`m very nervous about going for additional revisions. All the articles I`ve read say permanent sutures are used for this correction, but my PS doesnt feel they are neccessary. What are the pro`s and con`s between permanent and dissolvable sutures? And what course of action would you take in such a scenario?

Answer:

I also use permanent sutures to avoid it from happening again. JG 10.23.07

Question:

Hello Dr.Garcia. I just had breast surgery about 6 months ago. Im very happy with them but I may want to get them bigger someday. How long would I have to wait before I can have a second surgery?

Answer:

I like to wait one year if possible to let the tissue soften and relax. JG 10.23.07

Question:

I have a question regarding size. With someone with a 28 inch rib cage what is the MAX implant size in width (Diameter) can a girl max at withoout risking symmastia? Thanks Docter =)

Answer:

well, I think there are other parameters to look at to answer that question, like whether it will be placed above or below the muscle and also the diameter of your own breast. The diameter of your own breast is really the greatest limitation, the implant base should not be wider than that to avoid a double bubble. JG 10.21.07

Question:

is it true that saline implants loose volume over time? also how long do they typically last before u have to replace them?

Answer:

I do not feel that is true. JG 10.21.07

Question:

Hello Dr. Garcia! I am only 10 days post op from breast augmentation and worried that I didn`t go big enough. I am 5`3, 110 lbs, 32 a cup pre op and recieved 300 cc`s silicone unders...was wondering what size you think i will end up. Was hoping for at least a C but not sure if i`ll make it past a B cup. I know it`s still early in the game but will my breasts get a little bigger as the muscle stretches? Thanks for you time.

Answer:

hard to say but somewhere in the large B to small C cup most likely. The appearance will look bigger as the muscle relaxes, yes. JG 10.21.07

Question:

Hi Dr. Garcia! I have a slight case of symastia, there is a visible dent in my right breast where the muscle has been cut, so the two PS I have spoken with have told me that the only way to repair this is to go in front of the muscle, so that way they would be dealing with new tissue. I was concerned, because I am an avid marathoner and I didn`t want them moving around all over the place...but he said he would be using new tissue and creating a pocket so he could make it to where they didn`t move around as much as they do now. My prior surgeon made my pocket too large which caused the partial symastia. Do you think that is my only option, going in front of the muscle?

Answer:

well, tough call, I think the skin over the breast bone has been lifted and although going on top is a new pocket, the only way to avoid it from connecting to the area where the skin has already been lifted would be for the pocket to be made quite laterally, it might be an option but there is no guarantee it will not go into the same thin skin area already lifted the first time. Could consider removing the implants and leaving them out for a period of 6 months or more and then trying agian in a new area, might be safer that way. JG 10.20.07

Question:

hi Doctor, I had breast augmented 2 month ago, my question is? is normal to feel hard on the area of the incision, after 2 month? the inflamation it completle gone but I,m concern it will go away?

Answer:

all normal can at times take 3-6 months in some cases. It will all get better. JG 10.8.07

Question:

I need your advice... My rib cage under my breast fold is 28 inches. Now...im loking into MODERATE PLUS SALINE..in MENTORS MEASUREMENTS...these are my 2 sizes in Diameter.. (400+80 cc) MAX FILL--(Diameter)12.3 cm (Project)5.5 cm (425+85 cc) MAX FILL--(Diameter) 12.5 cm (Project)5.6 cm Are these too big for my frame iam five foot 3 112lbs..small boned..butlong and lean

Answer:

I think even the 400 might be too much if you go to far above that, certainly not another 80cc. JG 10.18.07

Question:

I`m worried about double bubble. Who gets this, how and why? I am getting unders and am saggy/loose skin and PS doesn`t want to do a lift now. I`m worried I`ll have a high implant and saggy breast underneath (double bubble). He isn`t concerned. Should I be worried or not? Thanks

Answer:

it happens when the implant sticks out wider than the native breast tissue, it happens when the tissues cannot support an implant or if too large of an implant was used. A high implant and saggy breast that is lower below the implant is not a double bubble, in that case you need to have your breast tissue lifted. JG 10.17.07

Question:

How come some skinny small girls have these 600 cc implants and seem to get away with it... If your surgeon doesnt give you a SIZE limit for your frame and seems to let U choose.... How can one tell for herself when chooasing a size THE BIGGEST she can go without a problem?

Answer:

well, getting away with it is temporary, trust me, they will all in time have major problems that will not be easy to fix. The easiest way I can tell you is to measure the diameter of your own breast tissue and then that is the limit of the implant that should be placed. JG 10.16.07

Question:

What are possible complications with getting partial unders when you are saggy pre-ba? I am quite saggy but my nipples are not too low (deflated from nursing). My PS wants to do unders with no type of lift at all. I am worried my own tissue will be hanging under the high implant.

Answer:

well, the worst that can happen is that you do the breast augmentation and then 6-12 months later have a limited breast lift, not a bad choice and if it does not look bad you can put it off for a few years. JG 10.15.07

Question:

i will be going for this surgery on end of oct 07 and the doc gave me 250cc for both breasts. i requested for a C-cup n the most he up me will be 275cc. what cup size will 275cc be? i find 275cc small. i`m 50kg n is a AA cup now. is 275cc enough for me or i`m able to increase more. thks

Answer:

very difficult for me to say without seeing you, you might be a C cup with that but realize also that there are limits to what size can be placed and those limtis are due to your anatomy, placing larger implants might create new problems that can be difficult to correct, such as a double bubble. JG 10.13.07

Question:

WHAT EXACTLY is the process of an implant bottoming out and why? And what makes some implants ripple and some not? Would ones docter know how to prevent htis BEFOR Eplaceing any implant...especially with bottoming out

Answer:

bottoming out is where the implant is inferiorly displaced below the desired crease when the tissue or skin have stretched and cannot support it in the proper postion. All implants ripple, in terms of saline if they are over-filled they will ripple less but they will feel firmer. There is no way to prevent ripples if the tissue will not cover the implant and as to bottoming out, if it is due to over aggressive dissection, it can be limited by trying to avoid that, but at times it is just the tissues that cannot hold up and there is no way to tell that. JG 10.12.07

Question:

Hi Dr. Garcia, If your implants need to be lowered due to them not dropping and your pockets need to be increased do you use the same implants after they`ve been removed to do the revision? Or do you have to replace with new sterile ones? Also, if you need to replace do you charge for the new implants? I`ve had the first revision done, and now noticed that the left implant is really low and the right implant is higher (and looks smaller because of this). I`m afraid that either the left side is bottoming out (the left side has a lot of breast underneath the nipple whereas before I didn`t have enough)or that the right will not drop to the same amount as the other side. I had a capusulomoty done on the left side and am 4 wks post now. I`m afraid that I`ll need another revision and am concerned if the ps didn`t get it done correctly this 2nd time. Thanks so much.

Answer:

usually stay with the same ones, if they need to be replaced for some reason I usaully do charge but if it is just a pocket modification that should not be needed, unless it is for capsular contracture. Sounds more like the left is bottoming out and to fix that should not require an implant exchange. JG 10.12.07

Question:

Hi, when you do a capsulectomy do you replace the implants or use the same ones? I want to use my same one but people keep saying I`ll get the CC back if I use the same ones. Is there any truth to this?

Answer:

it depends on how long they have been in, if they are older I like to replace them if the patient will allow us to. I will say that there is some evidence that there is less recurrence if new ones are placed, yes. JG 10.12.07

Question:

How come some surgeons correct symmetry and balance of the breasts and some just leave it and put the implants in without correcting that?

Answer:

I cannot say, I think if there is some asymmetry that needs to be discussed and addressed before any surgey is performed. JG 10.12.07

Question:

Dr. Garcia, I have a few more questions in regards to the 2nd post below this one. Thanks for the quick response. If I do the replacement surgery, I`m sure my doctor will inform me as to what is best for me. Is it possible to have implants put over the muscle after having them under the muscle for 14 yrs? Has that ever been done and were most women happy with the results? In that case it would probably create more cleavage? If re-done under the muscle, my pocket would be ok, so they wouldn`t have to create a pocket which would result in less bleeding? is that correct? You`re the best, I cannot believe you respond on a daily basis, that`s awesome. Thx again

Answer:

yes, they can be repositioned from below the muscle to above. It is done frequently but there migth be ripples and also a higher chance of capsular contracture too. It can increase cleavage though. Placing it in the same pocket will likely have less bleeding, correct. All the best. JG 10.11.07

Question:

In your opinion, why is it when I ask my Docter his opinion on what is right for me or what he would do if he were me or what is BEST FOR MY BODY...he just goes blank and says whatever makes you happy? Well....Its been 3 months since my BA...tho iam not THRILLED with my results..for I feel they are TOO FAR apart..(You can put my WRIST between by breast and there is a lil more space) Why is this? Also, my mother told me to not even think of a redo because i should be lucky to have what i have. Should i just leave it even tho im like HO-hum...or sohuld i get it re-done to have it the way that makes me HAPPY...or am i being unrealsitic? Thanks for taking the time....

Answer:

if they are under the muscle it could be because the muscles are pushing the implants laterally. As to having a re-do, it depends, some things might not be able to be made better, hard for me to say without an examination. JG 10.10.07

Question:

I`m 42, 5`5, 135 lbs, I had a ba 14 yrs ago. They were put under the muscle. I had no brusing and my doctor told me if all his patients turned out as well as mine he`d be a rich man. My question, they still look great, I`ve had no problems whatsoever. I`ve since lost 25 lbs and I`ve noticed the skin is looser on the sides and I can feel rippling on the sides which I could definately not feel before. I feel I`ve lost my cleavage and they definately feel smaller, I guess due to the weight loss and my age. My body is in great condition, however, I had an allergy to an antibiotic 2 yrs ago in which I`m still getting hives and it lowered my ammune system, which created food allergies. I know this is a lot of info, however, I`m wondering, if I re-do them to a larger size (which I really want to do) do you think my body will react in some way with the new implants being replaced? Will I have a lot of bleeding? Is it risky to take out the old and put in the new? I`m overly senstive to things now and I`m a bit scared. I have had other surgeries since the allergy and I`ve been fine with the meds and being put out. I just don`t want to open a can of worms if I can do with what I have now. I`m just hoping the surgery is less painful and will you see more rippling if the implant is bigger and my body is smaller now with the weight loss? Thanks for your input. Sorry this is so long. :)

Answer:

no way to say that the bleeding issue will be the same, actually proabably not. I think going larger will have its limits in terms of cleavage since yours are under the muscle and that limits the amount of cleavage gotten. I also think going larger will not correct the ripples as there will still be lack of tissue over the implant and that is what was causing the ripples not to be seen and felt. Also gaining weight will likely not go where you want it to go either. I think it might be a difficult choice becasue if you do not heal as well and if most or all of your concerns are not made better by going bigger you might not be happy that you chose to do it. JG 10.10.07

Question:

Hi Dr. Garcia - i know this is not legal in the US yet...what are your feelings on the technique where fat is liposuctioned out, something is done with stem cells and it is injected into women`s breasts, so that they grow their own breasts? is this safe, permanent?

Answer:

well, it is nto legal in the US and it is not legal in any conutry that I am aware of. I think the risks have to be worked out in terms of the potential of injecting cells that could turn into cancer at an earlier age. What is injected at present is just fat cells and they are hoping there are stem cells in it that will turn into something else lots of hoping. JG 10.9.07

Question:

So I went for my 3 month follow up appointment and asked my docter I wanted to go BIGGER.... Iam 5 foot 4...28 inch rib cage ..very petite..around 108lbs and 30 inch hips 24 inche waist.... He told me wht ever size I wanted.....IM LIKE...WELL DONT I HAVE A CERTAIN LIMIT to go so I wont run into issues like Double-Bubble or Rippleing..SAGGING...etc... He looked at me BLANK!!!! And said no...no ..For one not matter what you will NEVER HAVE SAGGING BOOBS for your skin is so tite and hes like you would carry 500 fine anything up would throw your body proptions off... UMmm...is this a correct answear because im now looking to go to 480 or 510 cc moderate plus..but i swear is something goes wrong im going to feel mis-guided... any thoughts

Answer:

I do not agree with him personally. Sorry. JG 10.9.07

Question:

Dr. Garcia....You know how originally before a BA ones breast are ALWAYS different...Well my left one is a tiny bit smaller but flatter on top and in the crease by the cleavage and my right is perfect in volume when its upper pole and a beautiful curve by the clevage. THEN after my BA well..the docter just put in my implants so that they are bigger with the same SYMMETRY problem. What iam asking you is that WAS MY DOCETR suposed to originally see this and correct it in surgery to even out my breasts? Or is this not fixable? Also should I have a redo to fix this because it bothers me or just learn to live with it and mabe realize that everything is not perfecr and at least i have two breasts =**(

Answer:

well, if it bothers you and can be fixed, then have it fixed. Having said that, the implants will make the breast larger so any asymmetry due to size will get better but it does not ever change the shape of the breast which you were born with so most asymmetries will never be corrected. JG 10.8.07

Question:

Dr. Garcia, I had a BA 5/23/07 for symmetry reasons. I had Mentor Moderate Silcone implants 400L/300R over muscle. In September, my right breast became hard. Start of CC? PS prescribed Accolate. I`ve seen your post where it may work for some...my question is, if I take the Accolate for 3 months and it doesn`t work, does my PS just go in and what cut the scar tissue? I don`t want this to be a long drawn out ordeal...I`d just rather have them removed and call it day if that is the case.

Answer:

that is the best option if it has not worked by three months and if it is cut out I would continue the Accolate for an additional three months too. Best of luck. JG 10.8.07

Question:

Hi Dr Garcia, Had my consult w/ PS, he recommended 275cc Mentor moderate Rt filled to 305 Lt filled 310-315? I`m 5`1 120lbs 36B now Rib cage 32..hopeing to be C cup, OH and I`m having a donut type lift...I`m short...so I want to look portioned, not top heavy..is this a conservative size? Thanks for your opinion Seacane

Answer:

I think it is a reasonable choice for your desires but now way to predict cup size I am afraid. JG 10.7.07

Question:

Hi Dr. Garcia...I am having a ba done oct.10.I am 49,5`3 ,138 lbs. 36 C.Having 400cc,high profile,over,mentor cohesive solid gel implants. What size will I be afterwards?Will I be able to use my arms at all for the first couple of days?As in drinking a cup of tea, pouring a kettle, etc.Also, having a full tummy tuck done at the same time..

Answer:

I think arm movement should be minimized for the first few days, but the small things you suggest are OK. Hard to say what size you will be but likely fairly large, likely over a D-DD cup. JG 10.7.07

Question:

Hi, I have saline overs now. I was a deflated and saggy small C cup to start. But, my nipples were still high and I liked the shape and droop look of my breasts, they were just deflated from nursing so long. The overs worked fine without a lift. But, I will be going with unders now due to my CC and I know my PS will suggest a lift. I really don`t want a full lift or lollipop lift with scars on my breasts. I want a benelli/donut lift & areola reduction as I only want enough loose skin off without actually lifting too much to make unders work well. I hate perky breasts. Anyway, do you think I could get away with just the benelli?? Also, do you charge a lot more to do an areola reduction when you`re doing a benelli lift? Thank you

Answer:

hard to say without seing you but the scar from the Bennelli lift I feel are not good scars and the amount of lift is limited and it tends to flatten the breast. I am not sure it is a good option for you. JG 10.6.07

Question:

I love this Q&A section.... Is it right for my docter to get angry or argumentatively at me when I ask him a question regarding his way in what I choose in size to what he gave me? Basically he got angry with me when I questioned him about the size I choose and wasnt happy with the results and why I felt mislead? I wasnt argiuing with him I think I offended him..I just felt awkward he got mad...Is this right? Did I do something wrong? Anyways....one more thing....what exactly is the differance between Moderate and Moderate Plus..*(besides projection). In terms of width on the chest. I love Moderate Plus but want more width with it..I have 300+60 cc already...am going to exchange the size to get more width across my chest for this what size in this saline implant should i get?

Answer:

well, I do not think it is right to get angry, I do not choose sizes for my patients, I have them choose. I really cannot say what size to go with as I have not seen your anantomy. Also understand that there are physical limitations as to the size that can be placed without incurring other problems like a double bubble so you might not be able to get what you want. JG 10.5.07

Question:

i always lay on my back when sleeping because i dont want to put pressure on implants. do you think by sleeping on stomach, it would cause implants to deflate slowly?

Answer:

no, it will not. JG 10.5.07

Question:

What really is the difference in all honesty with Silicon vs. Saline. Is it best for a thin woman to have Silicon. I heard Silicon looks smaller in the body tan Saline? Why is that. My docter told me Id LOVE Silicon for its natural feel and look. I have Saline now and dont mind it at all...but in all honesty for me redo Iam kinda perplexed on what to choose. A down side is that hed go underneith my breast fold..and I already have a scar in my armpit and really am discouraged about that!! ADvice woulde be great =) Thanks Dr.

Answer:

when looking at the same size per cc, there is no difference in size, just another of the many wives tales out there by people. As to Silicone and Saline, there are many differences, feel, bounce, opacity on mammaogram and on detection of leak rates, there is a trade off for each and advantages for each. I think under the muscle blunts many of the probelms, I think if you are happy with saline stay with them, and if you are happy, why are you thinking about changing? JG 10.4.07

Question:

I have a question... Is it not really healthy to subject ones body to re-doing a breast agumentation over unless needed? I mean just for the sake of going bigger or different profile. Also, my docter said a redo can be done at any time...be it 2 months or 1 month after the VERY FIRST ONE... But is it safe to keep opening up ones body unless needed for a BA if the original one is fine?

Answer:

well, I think doing surgery only when needed is best, as to redoing surgery, it can be redone at almost anytime but one likes to wait to see if things are going to change so the repeat surgery is not needed, to let swelling go down if that is affecting the appearance, and also to let the tissues soften and become more pliable if things are going to have to be shifted. JG 10.4.07

Question:

Hi Dr. Garcia, I had a revision done on both sides to lower the pockets. I also had a capsulotomy done on only one breast. Can you tell me if after the capsulotomy if that breast is immediatly in it`s settled place? My PS said that with a revision your breasts are pretty much where they`ll be. However the capsulomoty side is definitely more pliable and lower than the other at 2 weeks post. Thanks so much for your feedback.

Answer:

not right away, it will take a little time, at least a few weeks and maybe more if they were below the muscle. JG 10.4.07

Question:

Dr. Garcia, Iam 5 foot 4 and 108lbs with 8-10% Bodyfat. Iam an athlete..runner....Broad shoulders...no to small hips and long legs. I got a BA..Before I fit into a very small B...but not FULL..So I got 360 c.c. Moderate Plus. There cute...but I wanted more fullness....should I go bigger? If so what size would be good to go to see more fullness? Would 460 cc. Moderate plus be good..or too big... I do know 500 and up would make me look like Dolly..=*( If I do have a redo..I want to make the right choice for meeee Thanks soooo

Answer:

well, breast augmentation is not just a matter of dialing in a larger size, there are restraants imposed by your anatomy and your tissue may not support something too big, there are limitations. Going bigger can make ripples more obvious, can accelerate the sagging that your active lifestyle will speeed up and there is also the chances of the implant hanging out on the side or getting a double bubble so your surgeon needs to tell you what the limitations in your case would be. Uusually a size increase will require 50-75cc to see a visible difference, Wish I had more to offer but without examining you, not much more I can guess at. JG 10.3.07

Question:

Hi Dr. Garcia, How long do you recommend wearing a surgical bra after ba?

Answer:

at least one month. JG 10.3.07

Question:

Dr. Garcia, I am 6 days post-op from a skin-sparing bilateral mastectomy with 34 lymph nodes removed. I am now ready to take a look at my options for reconstruction, since the pathology indicates that no radiation or chemotherapy will be needed for me. What types of reconstruction options do you offer for bi-lat patients? Do you perform free flap reconstructions?

Answer:

I do nto offer any free flaps, I do offer pedicled latissimus dorsi flaps which require implants, I offer pedicled TRAM flaps if indicated and also tissue expanders. Glad all the nodes are negative. JG 10.3.07

Question:

This is be long. I had a BA 3 months ago and BOTH breast are sunburn/red...still! My docter at first thought I had an infection but I had no fever...no hardening...no swelling...STILL RED... Not only that I have 360 cc Moderate Plus which puts me to a 36 c--34 D I am a figure competitior -- weight lifter -- and befor esurgery my chest muscle were tighter than anything and the docter had one rough time lifting those chest muscles to get them under into the pocket... Anyways....I also have one boob completly full and round the other is flatter my the top and full on the bottom wit a huge GAP and ABSOLUTLY NO CLEAVAGE... why is this happening? =*(

Answer:

I cannot say about the redness but I would expect cleavage to be limited if placed under the muscle, the pockets being dissected differently can contribute to what is happening too. The rounder one likely had a more aggressive muscle dissection and the muscle has probably slipped up and it not covering as much of the implant now. JG 10.3.07

Question:

Hi Dr. Garcia I am a 46 year old woman who had a revision in 2004 ,I had previous silicone implants from 1986 and chose to have silicone again , in the first year they were great , now they have gotten firm again ,the Dr. who did my first surgery would perform a closed C/C on me and they would soften up again , well I don`t think they do this anymore , even though the implants were intact when they took them out for replacement, the Dr. that did this has since long since retired .If bacteria is a cause of C/C why don`t they wash out the pocket with a antibacterial solution ? I have also been on antibiotics for years for acne , so why won`t this kill the bacteria ? I have tried many different things , like massaging and pressing my breast against the wall but I`m afraid this is going to hurt the breast tissue or cause cancer or something,I would appreciate any suggestions . Thank you

Answer:

well, they do but the breast ducts have bacteria constantly and other causes will allow the breast implant to be re-exposed to the bacteria over time. I do not think what you are describing will cause cancer though. As to oral antibiotics, the issues is that once the implant gets exposed to the bacteria it attached to the foreign material and will not come off, it is called bio-film. You might need a repeat surgery to remove and replace them again, sorry. JG 10.2.07

Question:

I have Mentor moderate plus 425 filled to 510. This is the maximum fill. If I remove some saline they should project less and be less firm. How much saline could I remove before rippling sets in? I have no rippling now but would like to remove some saline if possible. Thanks!

Answer:

yes, less projection and less firm. I think going to 475 should look OK and as you go down from there it will increase. JG 10.2.07

Question:

Hi Dr Garcia, I had breast augmentation on Thurs,(overs, l 295. r 315) and since my left breast has been more swollen than the right. I had a larger implant in the left so I dont understand it. I feel like I need to support it with my hand when moving about, the wound underneath the breast feels really sore. Could this just be the pressure of the swelling? Is it normal to have this? Also, I am currently in a D cup and can also fit in a DD cup due to the swelling of the left breast! What is the average swelling after surgery, is it possible I will remain a D cup or could I go down to a C cup in a few months?? Thank you for taking the time to answer my questions. :-)

Answer:

all normal and most likely the swelling, the amount of swelling is never the same from one side to another. There is no average swelling after surgery as there are too many variables that affect that. Hang in there, it will get better. JG 10.2.07

Question:

Hi Dr. Garcia, I am two weeks post a breast augmentation revision where the dr. had to increase the pockets for the implants to drop. My one breast is clearly lower than the other side. Is it possible to bottom out immediately or just over disection? Thanks so much.

Answer:

well bottoming out can be from the tissues stretching excessively after the surgery or from an over-dissection, so it can be both in a way. JG 10.1.07

Question:

Hi Dr. García: I am considering breast augmentation. I recently had mammogram in which a benign small cluster of microcalcificacions came up. You think this issue should be a deterent into considering the surgery. I am 38 years old, no family history of breast cancer. Thanks for your advice.

Answer:

no, but I think since it is there a biopsy at the time of the augmentation would be nice for your peace of mind. Most likely at your age a calcified lymph node or calcified breast cyst. JG 10.1.07

Question:

Hello Dr. Garcia, I was wondering what the procedure was to correct inverted nipples? Is it an expensive and difficult/painful procedure? It has never really bothered me but I read recently that it can get in the way of breast feeding. Someone also suggested to me that using a breast pump at times helps.

Answer:

it likely will not affect breast feeding and breast pumps in many cases do help to evert them and avoid the surgery. The surgery is not too painful but in some cases can make breast feeding difficult because in some individuals the ducts have to be partially cut to release the inversion so that would make breast feeding more difficult but maybe not impossible. I would certainly try the breast pump first, at least a couple of times per day for a few weeks. JG 10.1.07

Question:

Dr. Garcia, Thank you so much for your response. One additional question for you. I should have mentioned that my PS performed a capsulotomy on the left breast. He only went in an snipped the capsule (which he said was only slightly thicker than the usual scar tissue). Can you tell me if the tissue is cut at the top or bottom of the implant? Wouldn`t most of my swelling be at the top rather than the bottom of the implant?

Answer:

usually if the implant was sitting too high it is cut at the bottom. The swelling typically will go to the bottom due to gravity since it is a liquid.JG 10.1.07

Question:

Hi Dr. Garcia, I am post 2 weeks for a breast augmentation revision. Five months ago I had silicon breast augmentation (submuscularly) and had developed a Grade II Baker capsule on the left side. In addition, my PS confirmed that my implant placement on both breasts were too high and that the pocket needed to be enlarged. At that time of the revision I decided to increase my implant size from a 275 high profile to 350 high profile. I just had my sutures removed today and have noticed (which I had also noticed the first day of my surgery revision) that my left breast is lower than the right? My PS stated that it could be swelling since there was more work done on the left side because of the capsule. Can you tell me what your thoughts are on this? Could it be swelling, or could it be that my PS increased the left pocket too much? Can I expect changes within the next few weeks? Also, my PS is not putting me on Vitamin E at this time. He believes that my implants are soft and will place me on the Vitamin E if we notice any changes down the road. What do you think? Thanks so much for your feedback.

Answer:

I agree, it can be swelling at this point in time, and if different things were done to the sides then there will be differences in the healing and swelling. I think the next 4 weeks will tell you much more. I avoid Vitmain E for at least two weeks after surgery but I think after that if you are going to use it, it is best to start before any firmness begins, but it is not a 100% solution to capsular contracture. JG 10.1.07

Question:

Hi, when a capsulectomy is done and placed from overs to unders do you take out the saline implant whole or deflate and reinflate it? Also, if you stay as overs during the capsulectomy do you take out the implant at all or can you remove the capsule and scar tissue with it in place? Thank you

Answer:

I usually take it out and leave it inflated. I think the implant is best to be removed while doing the capsulectomy to avoid injury to the breast implant. JG 10.1.07

Question:

I am doing research before going to my consult. I am 5`7 145lbs (med. boned) I currently wear a size 36C bra but my breasts ar saggy from having two children. I know I need a lift, but not sure what size implant to get. I want fullness, & dont want the slope breast. I want more of a rounded look and fuller on the top of my breasts. Would I go with smooth round silicone implants over the muscle? & what is the difference between `high profile` `mod. profile, & low profile implants? Also, If I want 700cc would a lift be neccesary?..becuause I would be filling out the skin.. Thank you for taking the time to answer my questions!

Answer:

the difference between the profiles is the footprint and the smaller the foot print the more projection, so a high profile implant will have the most projection. As to fuller up top, I think both over and under the muscle can accomplish that but I need to tell you that in time the fullness up top will go away and the slope will come, and that will happen faster with them above the muscle. Also breast lifts do not last forever, you are looking at 5-10 years before you will need a lift again and the more your breast and implant weigh together the shorter period of time it will last, therfore the 700cc implant will shorten it significantly. I think the first thing you will hear is that your desires might be achievable, but only in the short term and not in the long term. Not all your wishes I feel will likely be met safely and without secondary issues happening. JG 9.30.07

Question:

Thank you so much, Dr. Garcia, for your quick response to my previous question regarding cohesive gel implants. Do you have any idea when the FDA is planning to allow these these implants to be used and do these cohesive gel implants truly not ripple at all?

Answer:

the FDA has not released any suggested release date yet, sorry. JG 9.30.07

Question:

Hi Dr.Garcia I wanted to know your opinion. Do you think for a girl that is 5`6, 138lbs, 34A cup size, 375cc`s silicone moderate plus profile under the muscle is a conservative size?

Answer:

a reasonable choice, yes.JG 9.28.07

Question:

hi Dr. Garcia.. i guess my first post didn`t go through because i don`t see it on the list... but my question and concern is that I had a BA 3 1/2 weeks ago and everything was fine post op... I noticed that the swelling from both breasts had gone down by the third week.. but just recently (yesterday) I noticed and felt that my left breast had gotten slightly bigger than my right (my right one was slightly bigger before)and it seemed like it had gotten swollen again... I was also doing my routine manipulation this morning and felt a moderate pain on one area on the side of my left breast, right next to my armpit, but it only hurts when I touch it.I was just a little concern because I don`t understand how the swelling had gone down, then gets swollen again.. is this something to be worried about, or is this normal?.. thank you so much for your time!

Answer:

could be a delayed hematoma from delayed bleeding, you should go see your surgeon to make sure all is OK. In the meantime do not take any aspirin or Motrin, only tylenol just in case. JG 9.26.07

Question:

Hi Dr.Garcia i have a couple of questions its been 3 weeks since I had my breast augmentation im 5`4 about 110 pounds and before the surgery i wore a size 32AA and know have 330 saline HP filled up to 395 on left and 400 right (under the muscle) on the the feel very firm, and whats worst is that i feel very tired all the time and sometimes have problems breathing i cant even keep a long conversation w/o feeling out of breath. Does this mean that i will have to get them removed and how much will this cost me. I had very little breast tissue would my breast get soft at all being that they were overfilled soo much? Thank you very much youre web site has been soo informative..

Answer:

all normal this far from surgery, the muscles are really tight but they will loosen and all will get better, the fatigue can be from the medications and anesthesia too, just hang in there for a bit. Those are relatively large implants for your frame so it will take some time. JG 9.25.07

Question:

I am 5`3 and weigh 113 pounds. My current bra size is 34A. I want to be a 34B+. I have one doctor suggesting 300cc`s and another 375cc`s. How many cc`s you think will make me more likely a 34B+?

Answer:

likely the 300. JG 9.25.07

Question:

I have a doctor that claims that making the insicion site periaereolar leaves more scar tissue inside the breast, because he has to make a tunnel through the breast tissue to get behind the muscle. This scar tissue can come up in future mammograms, and interfere with acurately reading the results. He prefers making the insicion inframmamary thus reducing the inside scar tissue left behind. What do you think about this claim?

Answer:

I disagree, the scar tissue he claimes is formed I have never seen on a mammogram and if you desire, surgeons are taught to make the peri-areolar incision and not cut through the breast but dissect down to the crease and then go below the breast tissue. I will say the breast crease incision is easier for the surgeon though JG 9.25.07

Question:

Hey Dr.Garcia, i want to get a breast augmentation done i want to be ad cup but my bf thinks thats too big but i`m a 32 b and i was just wondering what you thought would a d cup be a good size for me i`m 5 ft tall and 120 lbs. ever waiting your reply. Ageless Forever

Answer:

pretty big I think. JG 9.24.07

Question:

Hi Dr. Garcia, I am having ba in 3 days. I am a small 34B and would like to be a full C. I am 5`1 and 100lbs. My surgeon suggested either 325cc or 350cc mentor moderate plus implants. Do feel this is correct? Which size do you recommend? Thank you.

Answer:

sounds good to me, best of luck. JG 9.24.07

Question:

Hi Dr. Garcia, I am having ba in 3 days. I am a small 34B and would like to be a full C. I am 5`1 and 100lbs. My surgeon suggested either 325cc or 350cc mentor moderate plus implants placed under the muscle. Do feel this is correct? Which size do you recommend? Thank you.

Answer:

I agree with that size choice, best of luck. JG 9.24.07

Question:

Hi, do you normally prefer overs or unders and why? Do you get less cleavage with unders? Do all girls get ugly distortion/are some at higher risk? Which do you believe gives a more natural/sloped look? One more...do unders feel firmer since a thick muscle is on top of the implant? Thanks so much!

Answer:

my preference if possible is under the muscle, as to cleavage, it is greater with over the muscle.I think both can look natural when the muscle is properly released and the implant chosen is reasonable in size. The firmness of under the muslces is not felt because of the muscle, it is not that thick of a muscle in most women. JG 9.24.07

Question:

My breasts seem a little smaller than whe I first got implants. I implants seemed to be bigger for a few years after the surgery, but now they seem smaller. Do implants gradually leak over time?

Answer:

the cannot leak small amounts, it likely is your breast tissue varying in size. JG 9.23.07

Question:

With silicone breast implants, is there volume/size lost when going completely under the muscle? I keep hearing there is 15% lost and that when trying on sizers, you will look that much smaller if you go under the muscle. Thank you so much!

Answer:

yes, between 10-15%.JG 9.23.07

Question:

I will have breast augemtation towards the end of this year and I was just concerned of the size my doctor has chosen for me. I am a small 34B and he has advised me to get the 365cc. They are the teardrop cohesive type which are available here and I was wondering what would be my size cup after the surgery.

Answer:

hard to say but a guess would be about a mid to large C cup. JG 9.23.07

Question:

I have had two breast augmentations, the first was with saline and I ended up with severe rippling, including along my cleavage. To try and correct the problem I had a second surgery in October of last year and switched to silicone. However, this did not correct the problem. Since then the cohesive gel implants have become available and my question is if rippling is still possible with these implants as well. I know that rippling is not common with silicone, however, it still occurs in my case which leads me to believe mine is severe. I desperately want to correct this problem and think that the cohesive gel would be my best option, is riipling still possible?

Answer:

well let me say that the silicoen implants you received are exactly the same ones that are generally available in the US, the true cohesive gel implants referred to as gummy bear implants are not for sale in the US yet, one of the implant companies has used the word cohesive in their marketing to take advantage of it, and in truth it is more cohesive than it was in the early 90`s but it is not the gummy bears, I think silicone available now will at most reduce the rippling by 50% or so, and in thin people that is not much. I think your best bet is to hang in there until the FDA aproves the gummy bear implants and then have an exchange. JG 9.22.07

Question:

I am 140, 5`7-36C currently have 450cc under the muscle and am going to 700 silicone full profile. I do not look like I have implants now. I like the fake look and want some projection. Will full profile or high profile be better? Thanks

Answer:

If you want fake then go for the high profile. JG 9.21.07

Question:

Hi Dr. Garcia, I have CC again after my capsulotomy. My PS says there are other things we could try such as a complete capsulectomy, going under the muscle/changing pockets, changing implants, etc. What do you believe would give me the best chance of not getting CC again? I currently have over the muscle saline and would like to switch to silicone when I get this done as well. I`m scared of under the muscle as I`d hate to have distortion. I`m also scared of capsulectomy as I have a lot of my own tissue (was a full B before) and don`t want to lose it all and have less natural coverage over my implants. What do you think? Thank you!

Answer:

honestly I think even with all of that it will likely be about 35-50%. There will be some loss of tissues with a capsulectomy, tough choice to be honest. JG 9.21.07

Question:

Hi, on the Mentor site the memory gel implants come in Moderate, moderate plus and high profile. Only on the moderate plus profile does it say it has Aggressive Fill What does this mean and why don`t the other profiles have it? Thank you

Answer:

the best way I can explain it is that the aggressive fill is what resulted in a slightly higher projection with a slightly smaller foorprint whiel using a mioderate profiel implant, where the high profile is a totally redesigned implant. JG 9.21.07

Question:

I had pocket revision surgery 11 weeks ago and the pocket was lowered. It was done because my replacement surgery(under the muscle, 320cc silicone gel) ended up with that implant rising on the one side. PS said that my rib cage assymetry may have caused it, and after 2 attempts, the only other choice was to lower the pocket. That side seems to be staying down, although it is still fuller overall. Do you think the size can still be going down? Also, I am not happy that the incision scar that used to be in my crease, is now nearly an inch higher, and very visible . Is that what happens by lowering the pocket? Thank you.

Answer:

scar migration does happen with the lowering of the pocket and as to the fulness, I can`t say much, might be that the ribcage difference neede a smaller implantr. JG 9.19.07

Question:

Dr. Garcia, I had two children before I had a breast augmentation, which was about four years ago. I am going to have another baby in a month or so(my last). I know at some point I will have to have a redo. However for right now, I am wondering if nursing or pumping will have a more negative impact on me than not nursing at all? I am trying to lessen the impact that this will have on the breasts and implants. Also, in regards to pumping and nursing which is harder on your breasts and implants? Thanks!

Answer:

should not be a problem, best of luck. JG 9.19.07

Question:

I am the 45 yr BA from yesterday, thank you so much for your response. I guess the real question is...If I really think I am too big, is it best to fix it 1 week post-op or to wait. Is it better for the body to wait or not? I have been wearing a padded b cup and I think I really wanted to fill a b cup, not be a c cup. I am really stretched at a 325cc implant. I am a modest person, and the last person anyone would expect to get a BA! You are very kind to help...thanks again.

Answer:

I think waiting at least 3-6 months is best to make sure the issue is not swelling. JG 9.17.07

Question:

Dr. Garcia: I am 1 week post-op for my BA, where I got Mentor saline 325cc unders. I was a 34b, active 45 year old, small person, 5`4, 115...I am so afraid that they are too big...I think 300cc would have been better...I am doing the bandau thing to bring them down...I only wanted to restore the youthfulness, not bring attention to my breasts..question is, can they let some of the saline out now? I don`t know if that is possible? Or in your opinion, once they soften and drop, will they significantly improve? I am a jogger and this info was clear to my surgeon...She didn`t appear too shocked today when I saw her, but I am miserable. I also understand that patients can feel regretful in the first two weeks and that`s normal. But, I feel more panicked then sad...thanks so much!

Answer:

at this point in time there is considerable swelling and I would advise waiting as removing 25cc is less than an ounce and would be almost imperceptible, give it time and as the swelling goes down I think it will all look much better, hang in there. JG 9.17.07

Question:

sorry my question came out round. I mean, would a person with 600 cc high profile implants look bigger than they would if they had 600 cc low profile implants. What would be the difference in appearance between the two different implants?

Answer:

yes, they would look bigger due to more projection. JG 9.17.07

Question:

hi, I have a question which may sound stupid but what is the difference between high profile and low profile and what `effect` do they both give. I.e would the same person with 360 cc low profile implants look the same with 600 cc high profile except a cup size and a half difference.

Answer:

the high profile has a smaller base, or a smaller foot print for the same volume so it looks like it projects more. It would be hard to answer your second question I am afriad. JG 9.17.07

Question:

I want to get implants and i dont want to miss alot of time away from work. How much pain will I have after surgery. Do I get pain killer`s. Also do you do implants trough the belly button.

Answer:

I do not do implants through the belly button, pain killers are prescribed after surgery and how long it takes for people to recover varies on each patient and how they have the implants placed. Would likely miss one to two weeks of work. JG 9.16.07

Question:

hi there? around what size is 600 cc as a cupsize? Also, is going from 360 cc to 600 cc a very big difference or is it only a cupsize and a half bigger?

Answer:

that is a big difference and no way to tell the end cup size without seeing you and the amount of breast tissue you have to start with, I think that change should give you between one to two cup increase though. JG 9.16.07

Question:

Hi Dr. Garcia, I asked months ago about my breast creating liquid after a mammogram hurting it. You said it could be from trauma, and it was. After testing the liquid, it was not sylicone, and this doctor removed the liquid with a syringe during several visits. My question now is, that happened last year to my right breast, but now I am noticing my left breast enlarged and in similar condition as the other last year. How can this happened without me having hurt my breast this time. The only change I have had this year is visits to a Curves gym place about three times a week. Not very strenous workout, but otherwise no injuries. My right breast has been normal for the past 9 months now. I really appreciate any information you can give me. Thanks so much

Answer:

yes, it can happen without any trauma too, can be cased by hormones too. JG 9.16.07

Question:

I had BA surgery in April 07 and everything looked great at first, then the right breast did not drop, and the left one dropped too much. I went into my 5 week checkup and I was told I did not develop scar tissue to hold up my implant on the left side, and my Dr would have to go in and remove the implants. Also I asked for full C`s and they ended up being small C`s, that is why he is removing them,(and putting in larger inplants) instead of just going into to fix them. Also I went with a girlfriend on the same day and she got a lift and implants and hers were perfect and I had 3 other girlfriends who went there and everything went great. I just want to know if this happens a lot and what you normally do to fix it, and why I can`t find any informaiton on the web? What is this called? Thanks Jen

Answer:

it does not happen alot and what is done to correct it varies from patient to patient, going bigger can make some of the issues easier and some harder to deal with though. There are many names for what has occured on the lower side, no one name for it. JG 9.16.07

Question:

Wow. Thanks for the quick reply. Can you please tell me if there is anything I can use right after surgery as the creams you suggested (mederma and scarguard) are to be used once the scar is healed? Maybe some sort of strip or bandage. Other questions.. My Dr recommended me to wear a wireless bra right after surgery to help prevent bottoming out again, I however feel I need more support from a wired bra to keep me up. What do you suggest? Will the wired bra do damage to my scar? And will a wireless bra be sufficient support? Thanks again. Anh

Answer:

we use either one after the sutures are out. After a bottoming out repair we use an underwire bra for support. JG 9.16.07

Question:

Hello from Sydney. Just came across your extremely helpful site. I`ve had a BA 9 months ago and the scar (under the breast) is still quiet visible. It`s not raised or textured, just light brown in colour. I`m asian and tend to get brown scars easily elsewhere on my body when scratched or cut. Does this mean scarring of the incision (I`m about to have a revision op. to fix bottoming out) is bound to happen or is there something I can do to prevent scarring or to quicken the fading? Thanks for you time Doc! Anh

Answer:

after the next surgey I would consideer using some Mederma or Scarguard at least, the ScarGuard has a bleaching cream formula, or else use hydrooquinone cream on it once the sutures are out. Best of luck. JG 9.7.07

Question:

If I have to fet an implant replaced-what is the waiting period after my first surgery?

Answer:

if it is ruptured, the sooner the better. JG 9.7.07

Question:

I had a BA on 7/25/07. I got 400 cc saline-under the muscle. My left implant dropped within one week, my right was still very high and hard. I returned to the dr and was told it was normal. Now six weeks later, my left is real jelly like and a lot smaller. I love my right side. I was told to return to the dr-the left may be leaking. If it is leaking what can they do?

Answer:

if it is leaking they will need to replace the implant with a new one. JG 9.7.07

Question:

How long do I have to wait after my first surgery to have a second? Do dr`s usually charge full price for replacements?

Answer:

if it is a leak the implant manufacuturer will usually cover the cost of the new implant and most companies sell a warranty that pays for most of it for ten years, if not then different doctors charge differently, so I cannot say. JG 9.7.07

Question:

Hi Dr. Garcia I am two months PO. I had saline implants placed under the muscle. Is it normal to feel the implant? When I bend over it`s almost like I can feel my left side shift. More presure than the right side. This isn`t a sign of CC is it. The implants and my breasts are soft. I do have rippling under both breasts but nothing that can be seen by the eye. I`m just concerned because if I press on them I can feel the implant surrounding my breasts. I just want to make sure all this is normal. Especially the part about feeling the left implant shift if I lean over. Any insite you have would be great. I appriciate your site. It is very informative. Thanks again!

Answer:

yes, it is very normal to feel the implants. It is not a sign of capsular contracture, no. All OK, best of luck and thanks for visiting. JG 9.6.07

Question:

hello dr.garcia, im a full b cup & i was woundering if 550 cc under the breast is ok. Im a 5`2 134lb girl what do u think.

Answer:

personally sounds a little large to me. JG 9.5.07

Question:

im just learing how to use my computer.didnt realize you answered my questions earlier.im soooo sorry.one more question.Do you have pictures of a full b cup to a 500-550 ccs?

Answer:

a 550 cc implant in one patient will not look the same as it in another patient due to anatomy and breast tissue dimensions and the laxity of the tissues. JG 9.5.07

Question:

I have had saline implants over the muscle for over 6 years and would like to have them replaced with silicone. Would it be possible to place them under the muscle at this time? I am very active and have a physically demanding job, would that be a problem? I must be able to do push-ups, bench press, etc and not lose any strength. Is this a problem with under the muscle? What type of lift may be needed to address any loose skin? Do you think it would be better to stay with over? Thank you.

Answer:

the exhange in position might need a removal of skin at the same tiem as the skin over the muscle will have been stretched and will not redrape in the position an under the muscle implant will likely occupy. The lentgh of those scars will be determined by the amount of skin that is required to be removed, the more skin removed, the longer the incisions.Going under the muscle will involve some element of loss of strength too. The percentage is unable to be predicted. JG 9.3.07

Question:

dr. plz do u know the brand name of the true gummy bears?there is alot out there called new silicone cohessive gel, and they are under many brand names,can u give me the brand name of the true gummy bears implants im very confussed?is it silimed?

Answer:

none of the silicone implants for sale in the US at present are the true gummy bear implants, when they are approved by the FDA there will be both brands, Inamed and Mentor. To the best of my knowledge all Silimed implants are under investigation in the US, not for sale yet. JG 9.2.07

Question:

Hello Dr. Garcia, Thank You for providing this very valuable information source. I hope you will be able to give me some insight. I had Mastopexy with HP 400cc silicone under muscle implants on May 15th of 2007. Immediately after I developed synmastia. I am a post Gastric Bypass patient (09/05) who has lost 157 lbs. I am now 5`3 and 140lbs. I am very thin on top with no breast tissue to speak of. I had a revision with my original plastic surgeon on 08/29/07. She had a great deal of trouble because of my tissue condition . She had to take me apart and put me back together 4 times before she decided that it was acceptable. She warned me I may have external bolster stitches and I do. Three right down the midline. She is taking those out on 09/04/07 because she does not want to run the risk of scarring my midline too badly. I have to say that for the first time since this all began my breasts actually feel like they are mine and not some alien bubbles in my chest. I feel as thought for the most part the revision is working but the main concern is the skin re-attachment in the middle of my breasts. The implants look to be in perfect position and while swollen they feel somewhat soft. I am wearing the thong bra constantly and not lifting more than 5 lbs. What are the chances that with continuous use of the the thong bra for a period of 6 to 8 weeks(or more), the skin in the middle of my breasts will re-attach itself? My PS has not done many of these surgeries, none of the PS in the area have. Are there any suggestion I can make to her to ensure a better outcome for me and anybody else like me?

Answer:

I think the reverse thong bra where it puts pressure on the breast bone area probably should continue for three months at least during the day, I think at nightime it can be removed after 2 months, hopefully if the weight of the implants is not to great, the amount of pulling on the tissues will not allow it to recur but I will say that the larger the implants in combination with weak tissues, the greater the potential recurrance. Best of luck. JG 9.2.07

Question:

Hi Dr. Garcia, a few questions... I am getting a BA. I have little to no breast tissue (probably a AA cup). My waist is 24 inches, my butt 34 in. I am getting Mc Ghan 410 cohesive gel implants. Since they measure in grams, I was told mine will be abut 375 ccs. I am worried this will be too big since I am so petite and I don`t want them to overpower me or look unnatural. I want to be a full B, can you guess what cup size this will be? Also, which Mc Ghan implants are these (in grams?) Will going the next size down make a difference? Thanks so much.

Answer:

I think that will likely make you closer to a middle C cup, might want to discuss it with your surgeon if you are concerned. it is very difficult to predict cup size after the surgery though. JG 9.2.07

Question:

Hi Dr.Garcia, I have had a consultation and am due to have breast enlargment at the end of the month. The Surgeon said I am to have overs with 315cc in the right and 275cc in the left. I felt happy with the sizing when trying on a bra with the implants inside at the consultation but have read up on implant sizing and now feel confused. I am a 34b with not alot of breast tissue, really wanting to be a D or at least a substantial amount larger. (without looking out of proportion) Obviously hard without seeing me but do you think this is about the right size for me? Or will I need bigger implants?

Answer:

I think those implants might not get you to a D cup if you have very little breast tissue but you are also limited by the dimensions of your own breast tissues in terms of what can be placed and also avoid a double bubble. You might not be able to get the size you want, it is not possible in all cases. JG 8.31.07

Question:

Hello Dr. Garcia, How traumatic to the breast is a capsulectomy for a submuscular implant? Is it a procedure that has a high risk of damaging the surrounding breast tissue? Also, is it possible to do such a capsulectomy through a previous transaxillary scar? Thank you so much for your time!

Answer:

it wil not damamge breast tissue but it cna tear the muscle and casue a hamtoma and can rupture the implant in rare cases, very difficult to do for implants below the muscle I must say. Not able to be done through a transaxillary incision either. JG 8.31.07

Question:

hi there. I had breast augmentation about a year ago but was not that happy about the results as they werent as big as I wanted. They were 360 CCs. Now the surgeon has said that to be a cup size bigger, 500, 550 cc should be fine to create the look I am going for. Bigger but not huge. Is going from 360 cc to 550 cc a huge contrast or does this sound about right as I want to be a cup size and a half bigger.

Answer:

that I would guesstimate would be about 1 1/2 cup larger. JG 8.31.07

Question:

Hi Dr. Garcia I would like to know if I have a revision done and take out my 375cc implants and go with 300cc implants will I need a breast reduction.

Answer:

you will be a little looser and maybe saggier but it might not be worth the scars from a breast lift. JG 8.31.07

Question:

hi dr.Garcia, My question is i am a 24 year old female who is 134 lbs. at 5`2 im in the process of loosing 15 lbs.Im a b cup can i go double d or even an e cup? i want to go big & beautiful.

Answer:

that all depends on the dimensions of your breast, it might and it might not be possible, I would need to see you in person. JG 8.31.07

Question:

hi dr. garcia,can i go from a b cup to a double d or even an e cup if im 134 lbs at 5`2 without looking freakish or even a large cleavege?