What To Know Before Getting A Boob Job

So, you’re thinking of having your boobs done. But, like buying your first apartment or searching for a new job, any type of breast surgery requires careful consideration, research, and a basic understanding of what’s involved — even before booking your first appointment with your surgeon. For example, what’s the difference between a breast augmentation (“boob job”) and a lift? What does a reduction entail? How do you go about finding the right doctor for you? To answer all of your burning questions, we consulted four surgeons who practice in different areas of the country for their insider, on-the-ground, and no-BS advice on what to know before even thinking about doing anything to your boobs.
Illustrated by Anna Sudit.
First things first: Do a little homework.
While an indiscriminate Google search on boob jobs, lifts, or reductions will probably take you down a rabbit hole of overwhelming (and sometimes dubious) information, focused initial research is crucial. The two most comprehensive and, more importantly, plastic-surgeon vetted and recommended sites are the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery. Both these resources break down the different types of breast surgeries available and procedure details, provide info on FDA-approved implants, explain the costs, and give crucial updates on the latest related news and technologies. “Any woman thinking about breast augmentation, or any cosmetic breast work, should look at both of those sites,” says Julius Few, MD, founder of The Few Institute of Aesthetic Plastic Surgery, which has locations in Chicago and New York. The institute offers listings of plastic surgeons in your area who specialize in breast-related procedures. Shop around: Find the right doctor.
Selecting the right surgeon is the most important part of this process. First, you need to make sure your doctor is legit, i.e. certified by the American Board of Plastic Surgery. Don't be confused by a certification from the American Board of Cosmetic Surgery, which, per Los Angeles surgeon Chia Chi Kao, MD, is “not plastic surgery.” Larry Fan, MD, founder of 77 Plastic Surgery in San Francisco, agrees by pointing out that plastic surgeons are specifically educated, trained, and certified to perform both cosmetic and reconstructive surgeries of the entire face and body. Also, beware of any other official-sounding, but totally sketchy “board” or “association.” It’s actually legal for other types of surgeons, and even non-surgeons — ear, nose, and throat doctors; Ob/Gyns; physical therapists; and dermatologists — to perform cosmetic surgery on your breasts, even though it’s not their specialty. Dr. Fan strongly suggests verifying a doctor’s plastic surgery board certification with the American Board of Medical Specialties at Certification Matters. And, make sure to ask how many years of training and practice the doctor lists on his or her résumé. It’s also a good idea to verify the surgeon’s hospital privileges, and make sure the surgical facility and office are accredited by a national- or state-recognized agency. Once you feel safe and secure with your decision, make sure you connect with your doctor. “It’s important to try to get a sense of whether or not your aesthetic sense is aligned with the surgeon’s,” says Mia Talmor, MD, plastic surgeon at New York-Presbyterian Hospital (and the first female surgeon appointed to the full-time faculty of the Division of Plastic Surgery at the hospital: respect). Referrals from a trusted friend are great, too. Sometimes, Dr. Talmor will have her prospective patients meet with current ones to feel more at ease with their decision. The surgeon should also schedule two consultation appointments with you prior to the surgery — the first to talk things out, and the second to go over preoperative decisions — and maintain regular follow-ups after your procedure. Ask to see as many photos of their work as possible.
Photos — or “aesthetic ideals,” in Dr. Kao's fancy surgical terminology — not only help you determine if your visions match, but also to convey to your doctor what size and shape you want your boobs to end up. All the doctors we spoke with say that the way bra sizes, cup sizes, and implant volumes look on each individual's body differs. Even a 3-D camera, while hi-tech and cool-looking, won’t always be accurate. Dr. Few uses one for research, but thinks the digital generation sets up “unrealistic expectations.” He has patients look at up to 50 photos — specific sizes, shapes, and skin tones — of “befores” similar to the patient and preferred “afters” to best represent end goals. Also, crucial: Pictures provide the opportunity to assess the doctor’s surgical skill when it comes to post-surgery scars. Because, there will be scarring (much more on that below), so you need to meticulously assess and compare as many photos of the surgeon’s handiwork as possible. “You want to see 10, 20, 30, 40 really, really good [examples of] work,” Dr. Kao emphasizes.

Make sure they're FDA-approved (duh).
You may have come across miraculous-sounding, en vogue implants like B-Lite from Britain. But, it's safest to stick with ones approved by the FDA. Dr. Talmor says that there are only three FDA-approved implant-manufacturing companies in the U.S.: Mentor, Allergan, and Sientra. “The FDA process here is pretty stringent,” she says. “ all the data from the implant companies to determine if the implant is safe for use, so it’s a pretty good idea to use one of those three approved manufacturers.”
Illustrated by Anna Sudit.
Understand the different types of implants.
Once you decide on your aesthetic goal, your surgeon will work with you to decide what implants will help you achieve it. Here’s a primer on the terminology you’ll be hearing: You may have heard of saline implants, which are filled with sterile salt water (and are FDA-approved for those 18 and up) and silicone implants, which are filled with silicone gel (and are approved for ages 22 and older). Dr. Few says that silicone implants are the most common type in the U.S. and internationally, because they’re softer and give a more natural look — plus they’re less likely to break. Dr. Kao, who hasn’t done a saline implant in 12 years, agrees, and points out that the saline kind can create an awkward rippling effect under the skin. Know that implants come in different profiles (i.e., heights) and in round or teardrop shapes, and can be smooth or textured. Talk to your doctor about what you want your breasts to look and feel like.

Understand the different incision sites for implant insertion.

The surgeon has to create a pocket — either over or under your pectoral muscle — to insert the implant. There are three common areas for making the incision (and where you could have scars). The surgeon’s recommended approach depends on the size of the implant and your own anatomy. So, definitely ask your doctor about what type of scar will result after your augmentation, reduction, and/or lift. It can also depend on your skin quality: For example, stretch-marked or less elastic skin is more scar-prone. One approach is the periareolar way, which means the incision goes around the lower half of the nipple. Dr. Kao prefers this method because the eventual scar can blend in with the nipple. Plus, he says the nipple is “usually covered up” (although tell that to #freethenipple supporters). There’s the inframammary incision, which goes under the crease of the breast. Dr. Few says this technique is favored for women who tend to sag more in the lower half of the breast, so the scar is completely hidden. There’s also the transaxillary incision, which is in the armpit. This approach appeals to women with small areolas and not enough breast tissue to hide an inframammary scar. Dr. Fan specializes in this technique, which is typically more difficult to perform, by using an endoscope for more precise implant placement. There’s also a fourth approach called TUBA (short for transumbilical breast augmentation), which goes in through the bellybutton and is for saline implants only. While some surgeons do specialize in TUBA, it’s not as popular. Dr. Fan says there’s a higher risk of mispositioning of the implants and excessive scar-tissue forming (a.k.a. capsular contracture).

And, about that fat-transfer boob job.

A fat-transfer breast augmentation entails liposuctioning fat out of one part of the body and injecting it into the breasts. The doctors we talked to are divided on the topic. First off, it really only gives a moderate increase in breast size. But also, the patient needs to have enough fat to remove. Dr. Kao says that 90% of his breast work involves some form of fat transfer, and he uses a process called centrifugation to “purify” the fat. He points out that he needs to remove about three times as much fat as he needs to inject. “[Fat transfer] is still considered somewhat investigational, particularly in the setting of breast augmentation without the use of an implant,” says Dr. Talmor. She only uses fat transfer to support breast reconstruction surgery along with an implant, not for cosmetic augmentation. Dr. Few acknowledges that the process is still “controversial,” and he does not perform it because he’s waiting for more data on its long-term impact. He says that while the procedure is natural because it uses your own body’s fat and fluids sans synthetic foreign bodies, there are a few caveats. The first is aesthetic: Without an actual solid implant, fat itself can’t do any “lifting” to help sagging. Also, “there is a real chance of a significant portion of the fat transfer being absorbed by the body,” which can make the results look non-ideal.

What to know before having a reduction.

Candidates for a reduction usually have breasts that are so large and heavy that they cause pain to the neck and/or back, skin irritation on the undercrease, and/or extreme discomfort from bra straps digging into the skin. Also, unwieldy breast size can make it hard to exercise or engage in other physical activity — plus, there’s the underlying emotional toll and self-consciousness. Know that with a reduction, a permanent scar will result, so you should discuss the incision site and your scar potential with your doctor. There are three ways the surgeon would make the incision: around the areola, a “keyhole” or “racquet” shape around and under it, or an inverted T-shape around and above it (there are good pictures here). Then, the surgeon will remove excess glandular tissue, fat, and skin, and, if necessary, remove and reposition the nipple and areola afterward. Younger ladies, listen up: It’s recommended to have a reduction when breasts are at the fully developed stage. Also, be aware that post-reduction breast shape may change later in life, especially if you get pregnant or experience drastic weight changes. A primer on breast lifts.
Also called mastopexies, lifts tend to be favored by women who are experiencing sagging, drooping, enlarged areolas, and/or loss of skin elasticity. A lift involves raising the breasts by removing excess skin and tightening and shaping the breast tissue. The nipple will also be removed and repositioned, and, if applicable, the surgeon might take off skin around the perimeter of the areola. A lift won’t make your boobs bigger, though. Know that there will be visible scarring where the incision is made. The surgeon will make the incision around the nipple and along a line from the nipple to the base of the breast. “It looks like a lollipop pattern,” says Dr. Talmor.
Illustrated by Anna Sudit.
Sometimes, a lift and augmentation will create your desired results.
Technically referred to as an “augmentation mastopexy,” this procedure both lifts and reshapes the boobs. Dr. Fan says that the combination of procedures will give more fullness in the upper part of the breast, something a lift itself can’t accomplish. Again, talk with your doctor. “Not every boob job is the same,” says Dr. Talmor. “It’s very dependent on the anatomy of the patient and what their hopes are for the outcome.”

Get the go-ahead from your regular doctor before you go in for breast surgery.

Dr. Kao’s practice actually requires clearance from a patient’s primary-care doctor before he’ll perform any type of breast surgery. Dr. Few likes his patients to ask their regular doctors for input “to support that decision.” Also, important: Dr. Talmor suggests screening for breast cancer before getting the surgery, just in case. If you have issues with wound healing, scarring, or abnormal bleeding; and/or have diabetes, cardiovascular disease, breast disease, are immunosuppressed, or are obese — all could be problems for having breast surgery. Also, if you’re a smoker, quit. “Smoking impairs the blood supply (i.e. circulation) to the breast and nipple, which interferes with wound healing and increases the risk of tissue loss, nipple loss, and delayed healing,” warns Dr. Fan. And, if you’re suffering from body dysmorphia or are going through intense emotional stress, talk to a specialist before pursuing any type of cosmetic surgery.

There are complications to be aware of.

Discuss any complications or risks with your surgeon. The two major issues doctors are on the lookout for are bleeding and infection. With implants, there’s also the risk of rupture in the future. There may also be changes in the nipple and/or breast sensation after surgery. Also, know that you could have difficulty breast-feeding in the future.

How you’ll recover.

Augmentations, lifts, and reductions are all outpatient surgeries. Make sure you have a trusted friend or family member who can take you home after. Also, talk to your surgeon for recommendations on taking care of your breasts during the recovery stages, as each doctor has his or her own individual way of doing things. “Everyone is different,” says Dr. Fan, about how long it takes to feel normal again. “Some people are rabbits, some people are turtles, and most people are in-between.” As a general guideline, he suggests taking three to 10 days off work following an augmentation or a lift. Patients should expect to feel mild to moderate pain and experience bruising, swelling, numbness, and tingling. Same goes for a reduction, but he usually suggests taking two to three weeks off work for that. With augmentation, know that your boobs won’t look the way you want them to for awhile. “It’s really important to know that the implants settle a lot in the first six months after surgery,” Dr. Talmor says about the post-surgery swelling. “So, if they feel a little bit too big in the beginning that’s intentional.”

How much it’ll cost you.

It depends on what the surgery entails, the surgeon, and the city where you’re having it done. According to 2013 statistics from the American Society of Plastic Surgeons, the average cost is $3,678 for an augmentation and $4,207 for a lift. Both surgeries are considered cosmetic and elective, so the costs are out-of-pocket. (Although, reconstructive breast surgery following a mastectomy could be covered by insurance.) The price of a breast reduction can “vary widely,” according to the ASPS, but Dr. Fan estimates that it can run between $6,000 and $12,000. A breast reduction may also count as medically necessary, so speak with your doctor’s office and check your insurance coverage for your options.

Final word: You will also feel things.

Understand what you want and why you’re doing this. “I think the motivation for doing it is really important,” says Dr. Talmor. “I’m always a little bit nervous if someone comes in and their boyfriend or husband is doing most of the talking. You feel like they’re being a bit unduly influenced, and I think that it’s a very individual and independent decision that has to be made without too much external influence.” Know, especially if you’re on the younger side, that permanent scars could affect you emotionally. “It’s very hard from an emotional standpoint to understand the impact that having scars on your breasts will have on your future, on your sex life,” Dr. Talmor says. “You have to be really comfortable, not only with the scars, but with the change — and embrace that change.” Dr. Few says it’s natural for patients to feel “a little bit of regret, especially during the first two to six weeks” following breast surgery. If you have a boob job at a younger age, it might not be a one-time procedure — you may have to go back in for more surgeries. “As you go through life, your body will continue to change,” Dr. Fan says. “As you get older, if you have kids, you breast-feed, you gain and lose weight, your breasts and the quality of your natural breast tissue will change.” So, have an emotional understanding of that before you go in. And, at the end of the day, it's important to have a support system. “I think it’s critically important to have the support of close friends and family,” says Dr. Few. “So they can be along for the journey.”

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