Breast Augmentation

Individual recovery experiences can vary depending on the patient, the implant placement, what type of implant is used, and a number of other factors. Rapid recovery techniques allow a very quick return to normal activities. Dr. Sorokin does not want patients to stay in bed after breast augmentation. Rather, light activity is encouraged immediately. Arm exercises are prescribed to start on the day of surgery. Dr. Sorokin encourages patients to be up and about the very next day. A prescription for pain medication will be provided, but most patients are able to switch to over-the-counter drugs within a few days. Women who work office jobs usually feel well enough to return to work after 3 or 4 days. For jobs such as hair stylist or nurse, he recommends taking off about a week. Light exercise at the gym is allowed as early as 10 days after Dr. Sorokin clears each patient’s healing progress.

Dr. Sorokin uses rapid recovery techniques for women receiving breast implants at his New Jersey practice. Using specialized equipment and techniques, he’s able to reduce pain and downtime. Dr. Sorokin acknowledges that different people have different pain tolerances, and while 95% of his patients recover quickly, some people take a little bit longer.

We give clear written instructions to all of our patients, and it’s a good idea to plan ahead and review these instructions. Stocking your refrigerator with some ready-to-eat meals and arranging for help with kids, chores, and pets is a great idea! Specialized bras, implant positioning straps, special breast implant pillows and other ideas described on various websites on the Internet are not advised and, in fact, can hurt recovery more than help. Before following recommendations of unknown websites, please discuss with our office.

Dr. Sorokin’s breast augmentation patients consistently tell us how much easier their recovery was than they expected it to be.

All surgery carries some degree of risk. Though they are minimal, surgical risks include infection, bleeding, and excessive scarring. Risks that are specific to breast augmentation include:

• Capsular contracture

This occurs when scar tissue develops around the implant, causing the breasts to feel hard and uncomfortable.

• Deflation

No implant is a life-long device. These devices are manmade and may leak. If one lives long enough with the implant, the implant may need to be replaced.

• Rippling

More often seen in subglandular (over-the-muscle) placement, rippling occurs when the outline of the implant is visible through the breast skin, causing a rippled appearance.

• “Bottoming out”

This term refers to what happens when the implant migrates lower than its original placement, gradually falling beneath the breast crease.

• Asymmetry

No woman has two identical breasts. Dr. Sorokin tells patients that they are “more like sisters than twins.” During different times of the month and throughout the years, breasts change size and shape. Dr. Sorokin guarantees all patients that some degree of asymmetry will exist and that a small amount of asymmetry is normal and expected. Larger degrees of asymmetry occasionally do occur during the healing process and could require revision.

• Breast Implant Illness

This is a relatively new term that has been fueled more by social media than by scientific research. In fact there is no medical disease called Breast Implant Illness (BII) and yet as plastic surgeons we have seen women who come in with vague systemic complaints such as fatigue, rashes, hair loss, brain fog, muscle pains among other complaints. Indeed there are groups of women who believe their implants may be creating these symptoms and decide to get their implants removed. Dr. Sorokin believes that indeed some patients may not tolerate implants of any sort, be it a breast implant or a knee replacement and believes women should be aware of this phenomenon and if vague symptoms begin they should come in for an evaluation.

• Lymphoma

A rare breast implant associated lymphoma, known as Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) has been associated with the capsule (scar tissue) around the implant.  In August of 2020, the FDA noted 733 worldwide confirmed cases of BIA-ALCL and 36 known deaths. Thus, this is a serious, but rare side effect. The implant most often associated with this disease has been removed from the market. It was a textured breast implant. Nearly all implants used in the United States at this time are smooth walled implants.

• Black Box Warning

A Black Box Warning (a very strong warning that the FDA issues) explains to all patients and prospective patients:

• Breast Implants are not considered lifetime devices;
• The chance of developing complications increases over time;
• Some complications will require more surgery;
• Breast implants have been associated with the development of a cancer of the immune system called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)

Not necessarily. Though it’s no secret that pregnancy and childbirth can alter a woman’s body, the results of a breast augmentation are not usually affected by the process. If you’re considering breast enlargement in New Jersey and you’d like to breastfeed in the future, be sure to discuss your plans with Dr. Sorokin prior to your surgery. He will customize your procedure to maximize the possibility of future breastfeeding. The presence of implants will not affect the safety or quality of the milk you produce.

Yes. If you’re considering a breast augmentation and another procedure, such as a tummy tuck, it might be prudent to combine the procedures into a single surgery. Combining surgeries saves you time in the long run and maximizes results. Consult with Dr. Sorokin to decide whether a combinational procedure is right for you. Also, you can learn more about your options by visiting Dr. Sorokin’s main site or liposuction specialty site.

This is an impossible question to answer. Scarring is a normal result of injury to the skin. Dr. Sorokin uses the techniques of plastic surgery to minimize scarring. In addition, he recommends scar-care products in order to optimize the results of the scar as it matures during the year after surgery. Unfortunately every person scars differently and some people scar worse than others. The scar is a tradeoff for the improvement in size and shape of the breast. Following aftercare instructions and keeping the incision clean and dry during recovery will also help to minimize scarring. Read more about incisions on our surgical technique page.

Yes. Most women have breasts that are naturally asymmetrical, although the degree can vary. Severe cases of asymmetry can be improved with breast implants. Some breasts are not only asymmetrical in size but also asymmetrical in shape and will require a breast lift in order to obtain better symmetry. Depending on the patient’s needs and wishes, Dr. Sorokin can insert different sizes of implants and possibly combine this with a breast lift to ensure that both the size and shape of the breasts match up after surgery.

Size can be a difficult thing to decide upon. Many women know they want to be “larger” but are unsure as to how large they want to be. Dr. Sorokin is often told to “make me proportional” or “just a little bigger,” however these are vague descriptions and more precise understanding is essential prior to surgery. Throughout the U.S. one of the most common regrets is “I wish I had gone bigger.” Dr. Sorokin suggests several methods to determine what size implant you will get:

• Sizers: We have a system of sizer implants which simulates in a bra what different sized implants will look like.
• Photos: Dr. Sorokin recommends that patients find some photographs of breasts that they love. This can come from our photo gallery or it can come from a magazine such as Playboy™. The adage “a picture is worth a thousand words” is true here as showing Dr. Sorokin a photo of breasts you like helps him understand your goals. He can never replicate any given photograph in terms of size or shape, but it certainly helps guide him through the implant selection process.
• Computer Simulation Imaging – Dr. Sorokin used computer imaging to simulate results for many years. It always bothered him that the software carried a disclaimer on the printouts that said “not intended to simulate results.” If it wasn’t intended to simulate results, what was the point? The problem is that these simulations are notoriously inaccurate and Dr. Sorokin does not feel comfortable with patients relying on these simulations. Thus, he no longer offers this.

Cost is an important consideration and we like to present a clear explanation of all costs and fees to our patients. Our package costs for breast implants is around $7,500. We may not be the lowest price in the area, but we certainly aren’t the highest either. We do however believe we offer a great value. For instance, all blood work and testing is done in house to save you not only extra cost, but extra time! Costs included in the package price that we will give each patient include:

• Surgeon’s fee (based on what needs to be done and how long it will take)
• Anesthesia fee (based on amount of time)
• Facility fee (operating room, nurses, sterile and non-sterile supplies)
• Implants (price varies for saline versus silicone)
• Preoperative labs and testing
• Postoperative bras and dressings

Additional costs include the cost of postoperative prescriptions, medical clearance if needed, mammograms if needed, and pathology testing of any breast tissue sent to an outside pathologist for testing if needed.

While we can give you an estimation on the telephone of what average procedure costs are, it is much better to meet with you so that after consultation and examination exact costs can be determined. We can then discuss options including financing and answer any questions that you may have.

Dr. Sorokin explains that for ladies who do not need a lift (mastopexy) that the crease incision under the breast (also known as inframammary) incision is the best incision for several reasons. It offers the quickest recovery with the least chance of potential complications. It provides a discrete, hidden scar for most patients. Other incisions such as around the base of the areola have higher rates of complications and axillary (armpit) incisions have a significantly more painful recovery. Thus for most patients who do not need a lift Dr. Sorokin recommends the crease incision under the breast.

This depends on your goals! Most of Dr. Sorokin’s patients want to look natural and he strives to deliver a natural result.  Some patients desire a more round fake appearance and he can also deliver a more fake appearing result if this is your goal! It is always best to explain during consultation exactly what you would like to achieve and then Dr. Sorokin can best explain your options based on your natural shape and starting point.

This is a complicated decision that is best made after discussing pros and cons of all pocket locations with your surgeon.  Dr. Sorokin places most implants under the muscle as they tend to look more natural, have less rippling and importantly mammograms are easier when the implants are under the muscle. For some patients this is not the best location. For instance, in a bodybuilder or patient who does extreme exercise an implant under the muscle may migrate laterally and have more animation when flexing. For a patient who would like to have more cleavage or look more round an implant under the muscle may not be the right choice. Subfascial is a technique that Dr. Sorokin uses instead of placing the implant purely above the muscle the fibrous layer of tissue on the upper surface of the muscle is lifted to create a pocket above the muscle but still with a layer of tissue separating the implant from the breast gland itself. Dr. Sorokin speaks to every patient in consultation about their goals and after an examination is able to make best recommendations for individualized, optimized results.

There is not a direct correlation between cc’s of volume and final breast size. Final breast size is based on many factors including how much breast tissue the patient naturally starts with as well as her overall chest width, height, weight, and tissue elasticity. If an implant is placed under the muscle it tends to look slightly smaller than above the muscle. Thus ultimate size is based on many factors besides just the implant size itself.

Breast implants are available in different shapes and sizes. Commercially available implants from 120cc to 800cc are available and they come in different profiles (or projections.). The more narrow width implants deliver their volume outwards from the chest and are considered high profile implants. The wider implants fill a wider chest wall and do not project as much. The proper implant choice is based on how wide a patient’s breast and chest wall is to start and how large she would like to be. We have multiple breast implant samples available to show patients during consultation and can explain best options after listening to your goals as well as performing a physical exam.

This really depends on how sagging they are. If they have simply lost volume in the upper portion of the breast an implant can fill this area. Sagging breasts which plastic surgeons refer to as “ptotic” breasts where the nipple droops below the lower crease of the breast will need a breast lift known as a “mastopexy” to reshape and remove loose skin. A lift is a larger operation with larger incisions used to reshape and reposition the natural breast tissue. Often a lift can be combined with a breast implant.

This is a controversial subject amongst plastic surgeons. Some surgeons tell their patients to change them every 10 years. Dr. Sorokin does not believe that asymptomatic patients with a perfectly good implant need to have surgery at 10 years but as the implants age the risk of them leaking becomes higher. Implants last a different length of time in every patient and 15 to 20 years is a good estimate. Thus it is important that patients go back to see their plastic surgeon as time passes for follow up appointments and to discuss best options for each individual.

Breast implants can and do leak over time. Every implant manufacturer’s FDA approval studies list rupture and leak as something that can happen. Dr. Sorokin explains to all patients that breast implants are man made devices and not designed to last forever. Most patients, especially younger patients, will eventually need to replace their implants. Dr. Sorokin recommends getting ultrasounds starting at 5 years and then every 2 to 3 years afterwards to monitor for leaks. Implant package labeling recommends an MRI at 3 years and then every other year and while we are happy to give you a prescription to have this done most insurance carriers do not cover this and Dr. Sorokin has found over the years that most patients do not actually get this done. Ultrasounds are a quick and reliable way to screen for leaks and we believe this should be the first step done by any patient with a leak as otherwise leaks can go unnoticed. If the ultrasound is unable to determine implant integrity then an MRI is the next step.

While it is not an emergency to urgently remove and replace a leaking silicone breast implant it is something that should be done within a few months after diagnosis of the leak.  Leaking silicone can cause inflammation and hardening of the breast implant capsule.  This in turn leads to a more complicated revision surgery so the earlier the leak is treated the better.

Breast implants can become surrounded by thick scar tissue and develop what is known as capsular contracture. This scar tissue can make the breast harder than desired and even change the shape of the breast implant or become painful. To decrease the risk of capsular contracture, Dr. Sorokin follows the 14 point plan developed by Dr. Adams https://sientra.com/wp-content/uploads/2020/08/EXT-0029-R2-14-Point-Plan.pdf, a surgeon Dr. Sorokin trained under at University of Texas Southwestern In Dallas. Unfortunately no plastic surgeon can completely prevent capsular contracture and it does sometimes occur.

Not only can you get a mammogram with breast implants but you should. Breast cancer is a common disease for ladies both with and without implants and mammograms should be done. When implants are present the mammogram technician will need to do additional special views to make sure all breast tissue is visualized.

This is a complicated answer and it really depends on your preferences as well as when you think you may become pregnant. If you are planning on children in the next year or two then it likely makes sense to wait as pregnancy certainly can change the size and shape of a woman’s breasts regardless of whether she has breast implants. If you are thinking about children many years from now then many ladies will tell me it is worth it to them to enjoy their bodies more now and if a revision needs to be done after pregnancies they accept this potential.

Most ladies who receive breast augmentation via a crease incision can breast feed after breast augmentation. Regardless of whether the implant is below the muscle, dual plane, subfascial, or above the muscle most patients will be able to breast feed. While most women with breast implants are able to breastfeed if they were able to breastfeed before breast augmentation there is a small risk of not being able to breast feed. One study showed that 87.5% of patients with an incision at the areola were not able to breast feed. Thus unless Dr. Sorokin is doing a lift he prefers to use an inframammary or crease incision. The question of whether or not they should choose to breastfeed is a separate issue altogether. Many pediatricians recommend breastfeeding because antibodies in breast milk are very helpful to the baby. That being said breast feeding changes the shape and size of the natural breast. This is a complicated personal decision that each patient will need to make on her own however certainly she can try to breastfeed if she would like to.

Just like natural breasts, breasts with implants will age over time. Larger breasts are subject to gravity, aging, and weight fluctuations just as the rest of the body is and sometimes the breast may sag over time.

This is a question I get asked quite often. I’ve had multiple ladies in their 50s ask me if I am their oldest breast augmentation patient and my answer is that I have treated many ladies in their late 60s and this is certainly not uncommon. Many ladies will come in and say that they have thought about doing this for their entire life and now would like to proceed. My answer is simple, if you are a healthy patient then age is really just a number. Certainly I see candidates for surgery in their 60s and later who are more healthy than some 40 year olds that are not surgical candidates due to medical problems.

Multiple studies have shown that women with breast implants are not at higher risk of developing breast cancer. In addition it is great news that breast implants do not delay the detection of breast cancer and evidence from the National Cancer Institute show that having breast implants does not stop the patient or their doctors from finding breast masses. A very important statistic is that patients with breast implants that do develop breast cancer have the same chance of being cancer free 5 years after treatment as women without breast implants. A rare cancer known as breast implant associated anaplastic large cell lymphoma is a type of cancer that can indeed develop around textured breast implants in the capsule or lining of the implant pocket. For this reason Dr. Sorokin only uses smooth walled breast implants. This is a cancer of the immune system and not a breast cancer however patients need to know about this especially if they have older textured breast implants.