What is the recovery time after breast augmentation surgery  is a question frequently asked by patients.  To answer  that question  each patient has to be define what they mean by “recovery”. Do you mean “when can I return to work” or “when can I return to unrestricted  physical activity” or does recovery refer to the time period until final results are obtained.

As far as return to work is concerned,   most of my patients can return to work within 48-72 hours of their surgery, provided of course they are not involved in some type of  job in which physical labor is involved (such as overhead use of the arms as in warehouse workers or construction work. Seriously, I have had  patients  who work on road crews and in the construction industry). I tell my patients that as soon as they no longer require narcotic pain medications there is no reason why they can not return to work.  9 out of 10  of my patients use over the counter Tylenol and Motrin  after the first post operative day to control post operative discomfort and use narcotics only at night before bedtime.  I utilize long acting local anesthetics in the operating room so that each patient is pain free upon  completion of their surgery.  This technique  in conjunction with a comprehensive post operative recovery  regime  minimizes  pain  management .  I discuss what all this entails with my patients at their initial consult. I used the “pain pump” after surgeries when they were first brought out on the market years ago, but after extensive experience with both the pain pump and my own post operative pain management regime, my regime is vastly superior to the pain pump. Hundreds of patients can attest to that. In fact I still have several unused, unopened pain pumps in my inventory at my surgical facility.  If a patient is some how sold on the idea of a pain pump after their surgery  I can provide that option.

Regarding return to unrestricted physical activity, the time frame for this  is generally 3 – 6 weeks depending on whether the implant was placed above the muscle or below the muscle. Anything which will elevated the blood pressure or heart rate after surgery will increase blood flow through the area which is trying to heal. This will induce more swelling. More swelling is counter productive to  long term outcome. This is especially true if the implant is placed under the muscle. The muscle swells quite a bit after surgery on its own just by the nature of the procedure;  patients shouldn’t do anything which amplifies this response.  I will allow patients to resume light activity after the second week and see how each patient responds. After three weeks I generally allow for any type of physical activity for submammary augmentation patients and six weeks for submuscular. Also, by six weeks the muscle has healed to the point that strenuous  physical activity can not cause any injury to the muscle which could cause internal bleeding and produce a hematoma (blood collection) around the implant.  Physical intimacy can be resumed as soon as the individual feels comfortable doing so. ( But no “rough stuff” for a couple of weeks! ).  I am perhaps slightly more conservative than some surgeons, but I feel my extremely low re-operation/complication rate speaks for itself.

The last aspect of the recovery phase is how long until the final  results. By final results I mean complete healing and also the appearance of the breast contour. Let me address breast contour first.  Once again this time frame is shorter for submammary augmentation patients than for submuscular because the role the pectoral muscle plays in the post operative breast shape. In both types of surgery patients will experience what is known as “upper pole ” swelling or fullness. ( upper pole  refers to the region of the breast above the nipple areolar complex, the inferior pole is the area below).  The breast tissue itself recovers relatively quickly and it is not uncommon for my submammary breast augmentation patients to have their final shape within  two or three weeks of their surgery. This time frame is longer in those patients who started off with tighter breast tissue and experience what is known as “soft tissue” stretch due to the implant. The more the soft tissue has to stretch to accommodate the implant, the more swelling there may be, hence a slightly longer recovery period. (this is one reason why it is not a good idea to have  an implant which is too larger for your individual breast characteristics. This should be determined and thoroughly discussed with each patient  when  deciding implant shape and size).  The inferior pole often times has to expand somewhat in order to accommodate the implant and this can take a couple of weeks as well. This response to the surgery and placement of the implant is amplified when the implant is placed under the muscle. For submuscular augmentation patients it maybe as long as two or three months before the upper pole swelling resolves completely and the breasts accommodates to  the implant. By six weeks most of the swelling has resolved and the great majority of patients do not appreciate any residual swelling and are extremely happy with their new size and shape. It is when you look at side by side comparisons of pictures taken at 6 weeks versus 12 weeks when these subtle nuances can be seen. And for the most part the differences are quite subtle.

The other aspect of final healing is how long until the numbness from the surgery resolves and the scars fade.  Sensation returns somewhat in the first or second post operative week  and  returns completely by six to twelve weeks. The more soft tissue stretch the longer this may take. Residual numbness can take as long as a year to completely resolve but this is very unusual. Scars tend to be red for  a couple of  months and gradually fade over a year or so. The  blonde,  blue eyed patients tend to have redder scars initially but also tend to fade to the whitest given time. Darker colored individuals tend to develop darker scars which take a year or so to completely fade. Thick or raised/wide scars  are exceedingly rare in my practice for several reasons which I discuss with each patient during their consult.  There are several post operative scar management regimes I discuss with each patient throughout their recovery based on their needs which will maximize the quality of their scars and minimize the visibility. Remember: there is no such thing as a “scarless scar” in the adult patient.  But by and large the long term scars from breast augmentation surgery heal very nicely and inconspicuously.

The last aspect regarding recovery from breast augmentation surgery which I stress with each patient is the need to be vigilant about good support garments to maintain the newly acquired breast contour and the need for pocket exercises to keep  the breasts soft and feeling natural.  If patients are committed to these post operative breast augmentation recommendations they can expect to  achieve the best possible long term outcome  and avoid problems.

The typical cost of breast augmentation surgery, including implants can vary from low of $5800.00 for saline implants to a high of more than $8500.00 for silicone implants.  In some parts of the country ( like New York City for example), breast augmentation surgery can be $10,00 or more. Fortunately in the MidWest the costs are more reasonable. My practice charges $5900 for saline and $7000 for silicone. From time to time we will run specials and these prices can drop  significantly. Of course these prices can increase depending on the costs of the implants, supplies,  medications and anesthesia related expenses used  to perform the surgery.  So why such a disparity in costs?  It is because there are several factors which make up the entire cost, and each of these  factors can vary considerably thereby affecting the bottom line. So by knowing only what the surgeon charges or how much a particular set of implants cost, will be only  part of the picture. That is why it is important to get the entire cost.

First there is the surgeon’s fee. Each surgeon’s fee will be   different  and this may be based on his or her experience ,  the time involved and how the followup visits are handled.  The number of follow up visits and for how long (how many weeks or months) vary from surgeon to surgeon as does who actually sees the follow up patients.  Sometimes the doctor spends only  a few minutes with a patient in follow up and delegates most of the follow up visit responsibilities to  his or her nurses. Also the surgeon’s  technique is an important consideration. A transaxillary endoscopic breast augmentation takes more time  because the equipment set up time is much more involved, and it is technically more involved than other techniques.  Expect to pay a  more for this particular technique.  The facility may also ask for slightly more if this technique is used because of the expense  of the equipment and the time and effort involved with the cleaning and care of this equipment.. At my facility the additional cost is usually on the order of an additional $1000.That covers all additional expenses for transaxillary endoscopic breast augmentation. For patients who are adamant about  having no scarring on the breast, this is worth the premium cost.

Next is the  Facility /Operating Room (OR) fees  and anesthesia services  which are another major cost  factor. Facility fees and anesthesia services are generally separate fees incurred by the patient, but every once in awhile they are rolled into a single  “facility” fee.  These fees can vary  between facilities as to how they charge for their time and services.  Generally hospitals are more expensive than free standing  ambulatory surgery facilities and office based  surgical facility being the least expensive, but  this may not always be the case. Many facilities charge a basic rate for  breast augmentation surgery, say for an hour or so of O.R. time  with  the recovery room being included.  Same is usually true for anesthesia services.  Anesthesia services may be slightly more if you undergo a general anesthesia versus local with IV sedation. However, if your surgeon goes over  the allotted block of time he or she has set aside for you or you are slow to recover from the anesthesia , then the patient is frequently made responsible for these  additional charge. So beware of this  “add-on” cost which you, the patient can get stuck with. Often times I hear patients tell me how they are told  by other physician’s office staff  “not to worry”, “that hardly ever happens” etc.  The fact is that  these “overage” fees can AND do occur.

In fact my own patients have had this unpleasant experience before I built my own facility. This scenario absolutely never occurs at my facility;  I guarantee it , so there are no surprises when it comes to  the  facility  and/or anesthesia costs. Surgery is stressful enough for the patient,  so there will be NO  stressing over this issue.

The last cost factor are the implants themselves. Depending on what type of implant the patient selects (silicone or saline) the cost of the implants can vary from around $1000.00 for saline and about twice that for silicone.  Implant manufacturers have  their own  costs as well, so not all saline  or silicone implants will be identical in cost. I do not not charge a premium for silicone augmentation surgery above the actual costs I incur by the manufacturers for the implants themselves. Some practices do charge more for silicone augmentation surgery because of the additional time and effort to close the slightly longer incisions utilized for the silicone implants.

One thing which I stress to patients who are considering breast augmentation, or any type of cosmetic surgery for that matter is that while cost is an important consideration, it should be about the last thing on your list when choosing who performs your surgery  or  where. The most important consideration is whether or not your surgery will be done #1 safely, and #2 effectively. Then you must have a good overall feel for the surgeon and his staff. Are they highly experienced, do you share them same sense of aesthetics regarding size and shape, do you like the results  this particular surgeon obtains, are you comfortable in the presence of the surgeon and staff. All these factors should come into play when making your choice.  Whether  or not you got your surgery for a discount or for ” a really good deal” will mean nothing if you are not happy  and  healthy  afterwards….food for thought.

A breast augmentation patient inquired yesterday as to whether it is better to place the implant above or below the muscle. The answer to this question depends very much on the individuals characteristics of the patient and the patient’s  desires. The simple answer from your potential surgeon of “that is the way I do all my breast augmentation surgeries” is not good enough reason to choose one route over another.

Generally the most important consideration in deciding if a breast implant should be placed above the muscle, referred to as a submammary breast augmentation,              ( click here or click here to view before/after submammary breast augmentation) or under/below the muscle,  referred to as a submuscular or subpectoralpectoral breast augmenatation  (click here to view before/after submuscular breast augmentation) is how much breast tissue is present and the quality of the that breast tissue. The only accurate method of determining the quality and quantity of each patient’s breast tissue  as it relates to  optimal implant position is by a thorough physical examination.  Pictures can not convey these important  physical characteristics.

Another factor in determining  optimal implant position is the activity or lifestyle of each patient. Sometimes compromises must be made in order to meet an individual patient’s needs. For example, placing an implant above the muscle in a female bodybuilder may lead to more implant visibility post operatively, but that may be less important than not having the implant move with muscle contraction as would be the case if the implant was under the muscle.

If there is not much  breast tissue present ,  an implant placed on top of the muscle has a  greater tendency to be visible. Being able to see the edge  of a breast implant is not a natural look .  Some patients actually want to have the pronounced appearance of the implant, the so called ” Pamela Lee Anderson” or ” Victoria Secret” model look. This generally refers to the roundness of the upper portion of the breast, but it the visibility of the edge of the implant which imparts this look. Also, sometimes an implant can wrinkle at some  point post operatively, usually months after the surgery. Placing the implant under the muscle allows for an extra layer of soft tissue coverage in order to  hide the implant  and therefore lessen the chance of visible wrinkling.  If the implant is placed under the muscle a slightly larger implant  may be utilized all other factors being equal. This is because along the medial border of the breast  (medial border being over the breast bone side versus the lateral border which is the arm pit side of the breast) there is considerably  less tissue.   Placing the implant  under the muscle  provides additional soft tissue coverage over the medial aspect of the breast and this can lessen the  chance of implant visibility post op.

An implant placed under the muscle may move with muscle contraction. There are  implant selection considerations and surgical techniques which can lessen the tendency for this to occur, but there is no getting around the fact that a submuscular implant may be prone to movement with muscle contraction.  If this does occur post operatively it is   generally minimal and well tolerated in most patients.

Also, if the patients tissue characteristics are poor (a lot of stretch marks, laxity of the skin) an implant placed on top of the muscle may not have the support as if it was placed under the muscle. In the long term , the skin can stretch and the implant drops significantly. This is known as a “ball in sock deformity”.  Imagine placing a cue ball in a tube sock…not a very pleasant visual; and very difficult to correct. Best to avoid this complication.

Also, in selected patients who need a breast lift with breast augmentation, placing the implant under the muscle can be safer in that the blood supply to the nipple area is preserved. If a more extensive mastopexy (breast lift)  procedure needs to be done to produce the most aesthetically pleasing outcome, this is an important consideration in order to avoid the potential complication of skin loss around the nipple region of the breast. Click here to view before/after mastopexy breast augmentation.

Placing the breast implant underneath the muscle also affords slightly more visualization of the breast tissue during mammogragphy. This might be a consideration in those patients who have a family history of breast cancer.

Are there down sides to having a subpectoral breast augmentation which have not been discussed?? of course…there is no free lunch so to speak.  Some of the other  downsides of having subpectoral breast augmentation include the following :  generally somewhat more painful post operatively, requires more time of restricted activity to allow for healing,  has  more swelling and  takes longer to achieve the end results of a naturally appearing breast than a submammary augmentation. All of the “down sides” are well worth it if the patient’s individual characteristic require subpectoral implant placement to avoid complications and undesirable outcomes.

So how do you know whether you should have your breast augmentation surgery utilizing the submammary or the subpectoral route? Start with a thorough examination and consultation by a qualified plastic surgeon who has extensive training and experience in breast augmentation surgery who understands  your needs and desires for breast augmentation which will maximize  your  individual  outcome.  Hope this has shed some light on submammary versus subpectoral breast augmentation. In the end,  the best route for breast augmentation is the one that will maximize your outcome.