Breast Implant Questions

A small sample of questions that seem to get asked frequently about our approach to offering breast implants under local anesthesia.

Photo of Dr. Ted and Joyce Eisenberg's book on all sorts of questions about breasts
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This is an amazing book written by Dr. Ted Eisenberg and his wife Joyce. Everything you or your friends could ever think to ask about breasts.

What is a breast implant?
A breast implant is a medical device that is used to enhance the shape, appearance and feel of the breast. The implant is placed inside the body to add volume and shape to make the breast look and possibly feel better. The implants are made out of a silicone outer shell and filled with silicone gel or salt water (saline solution). Some implant types contain both saline and silicone gel in separate chambers as a single implant. There was a time when silicone gel was considered too dangerous to go in the body. In reality, after further extensive testing, the silicone gel was considered safe by the FDA for use in breast implants. If you are afraid if having 'silicone' in your body at all, saline implants may not work for you either. The bag that holds the saline is a silicone elastomer. Many other implanted medical devices use silicone elastomer coatings and they are also considered safe by the FDA for human use.
How are saline implants and silicone implants different?
The implants are different basically only based on what fills the inside. Both implants however have very similar outer shells made of silicone elastomer (the bag part). The inside of a silicone implant is made of a silicone gel. The inside of a saline implant is filled with water containing a small amount of salt. The main difference is silicone implants feel more like the real thing. Saline implants can feel a bit more like water balloons. The appearance and the complication rates are very similar for either type of implant. Both type of implant will wrinkle on the sides if the capsule gets small by contracting. The wrinkles are closer together and slightly more noticeable for the saline implants.
Am I a good candidate for breast implants?
Your are a good candidate if....
  • You feel having breast implants will make an improvement in your sense of well-being or relationship.
  • You are healthy enough to have surgery.
  • You have breasts that can be changed for the better with breast implants.
  • You have a realistic understanding what breast implants can and cannot do for you.
How old is too old for breast implants?
Of course the answer is 'you are never too old'...
  • As long as you feel having breast implants will make an improvement in your sense of wellbeing or relationship.
  • As long as you are healthy enough to have surgery safely.
  • As long as you have breasts that can be improved with breast implants.
  • Local anesthesia increases the safety factor for placement of breast implants and is expected to allow older women to feel safer about having breast implants.
The oldest patient Dr. Kolegraff has ever been caring for that had breast implants was 80.
How young is too young for breast implants?
Of course the answer is NOT 'you are never too young'...
  • You should be at least 18 years old to have saline implants.
  • You should be at least 22 years old to have silicone implants.
  • Your breasts should have developed to their full adult size and shape.
How much does it cost?
We charge $5,400 to put in silicone gel implants under local anesthesia.
  • This is the fee if we can put them in under local anesthesia in our clinic as an outpatient.
  • You will need to purchase antibiotics, pain medication and anti-nausea medication from your pharmacy which will cost extra.
  • You will also need to purchase a post-surgical support bra (a not so delightful looking thing) to wear during your recovery.
We charge $8,600 to put in silicone gel implants in the hospital under general anesthesia.
  • This is the fee if we need to put you asleep with the help of anesthesia in the hospital.
  • You will need to purchase antibiotics, pain medication and anti-nausea medication from your pharmacy which will cost extra.
  • You will also need to purchase a post-surgical support bra (a not so delightful looking thing) to wear during your recovery.
Saline implants will cost slightly more but will still be more economical if we can place them under local anesthesia in one of the re*be® Clinic procedure rooms. We get a volume price break from the manufacturer for silicone implants. It is not always the best idea to shop for the cheapest price when looking for a cosmetic procedure. Finding a clinic with a surgeon experienced in doing surgery and caring for patients that have had surgery is also important for getting a good result. Passion for good results is important to what we offer at re*be®.
Where will my incision be?
incision scar of result 2 patient under the right breast

Incision under the right breast.

The photo shows a really nice result for this patient but everyone scars differently. Your results will be different. We can place the incision in the fold underneath your breast or we can go through the lower edge of the areola(the brown part of the nipple area). Our preference is to use the incision in the fold underneath the breast. This makes creating the pocket less painful when using local anesthesia and seems to result in less bleeding during and after the operation. The incision for silicone implants we try to make 5 cm long (about 1.97 inches). The incision for saline implants can usually be less, closer to 3 cm in length. There are many good breast implant surgeons who prefer to use an incision in your armpit. More recently a technique has been developed to place breast implants through your belly button. These last two techniques are more difficult if not impossible under local anesthesia and are not offered at re*be®.
Can you really do the same operation under local anesthesia?
Yes we can. We have been successfully placing silicone gel breast implants and saline breast implants underneath the muscle using local anesthesia since September 2014. Local anesthesia works just as well to place the implants above the muscle. Local anesthesia for years has been known as a safer alternative to general anesthesia for many procedures. There are now breast implant surgeons all over the planet who have begun to use local anesthesia for this procedure. Placing breast implants under local anesthesia had become popular beginning more than 6 years ago and is expected to increase in popularity into the future. Local is not only is it safer than general anesthesia it is less costly. At re*be® in Okoboji, Iowa we have been using local anesthesia exclusively for our laser ablation procedures for varicose veins. Local anesthesia is been used for face lifts, thigh lifts, breast lifts, laser liposuction, skin excisions, lipoma excisions and may other procedures.
Do you charge for a breast implant consultation?
No (not yet). We do not charge for cosmetic consultations at this time. The decision to have cosmetic surgery is a difficult one. One of our early breast implant patients had spent 25 years thinking about having the procedure as well as researching the procedure. We will assist you in collecting all the information you need to make a good decision about what would be best for you. You are more than welcome to see us for a complimentary consultation to discuss your concerns. If you have decided to have surgery elsewhere or have already had your procedure and just have more questions you will be welcome to come and see us. Many surgeons who do charge for a consult will credit that amount back to your account if you decide to go ahead with the implants. We do not have a charge like that at this time. Cosmetic procedure consultations are complimentary (free).
Do I need a mammogram before I have breast implants?
Yes. We do recommend a mammogram be done prior to getting breast implants. Your breast tissue will change after the surgery. Breast cancer is more common than most of us would like to believe and screening prior to a breast procedure such as breast implants is a very good idea. If you are getting regular mammograms now they need to be up to date prior to surgery. If you have never had a mammogram and are less than 35 years old you may opt out of a pre operative mammogram if there is no history of breast cancer in your family. There is some small risk to the radiation exposure of the mammogram and your insurance may not cover the procedure. These are real considerations however detecting undiagnosed breast tumor before breast implant surgery is always our preference. Your attention will be focused on your breasts after the procedure and the peace of mind knowing things are ok should be reassuring enough to justify the risk and cost of the procedure. We understand opinions are all over the map on this question the above is currently our recommendation.
Will I be able to breast feed after I have breast implants?
Probably you will. We place the implants behind the breast tissue lifting your natural breast up and forward. The glands that make the milk are not disrupted much if at all from this procedure. Your breast tissue will likely work ok after the surgery. The implants can put pressure on the glands and many people believe this could reduce the amount of milk you are able to make. The milk when it comes into the breast after your baby is born may also be more uncomfortable due in part to the pressure from having the breast implant in place. Breast feeding an infant successfully is more difficult than many people appreciate. I have heard it estimated that as many as 25% of modern women are not able to successfully feed a baby just with breast milk. This number will be expected to be higher in women who have had breast implants.
Will my nipples be numb after I have breast implants?
Probably not but this is a known risk of the breast implant procedure. We place the implants behind the breast tissue lifting your natural breast up and forward. The nerves to the nipple area can be stretched or disrupted during the surgery. If this does happen you may experience some numbness in a portion or all of your nipple. The numbness is fortunately rare and if it does occur is more often temporary. Numbness seems to go away with time but not always, meaning it could be permanent. Every effort is made to minimize this problem. Doing the procedure under local seems to help because we can check the sensation to the nipple during the procedure. If this does happen unfortunately waiting for the sensation to return is the only and usual treatment course. The larger the implant being placed the higher the chance of nipple numbness.
Can you remove breast implants under local anesthesia?
Yes. We have so far had no difficulty removing breast implants under local anesthesia. Our fee for this is $1500.00. Removing breast implants under local anesthesia takes about 10 minutes a side usually. The procedure is quite well tolerated and would not expect to interfere with your ability to drive yourself home or back to work afterwards. If you can get a driver it is always a good idea. We can also remove ruptured implants and breast capsules if necessary under local anesthesia.
What is the pencil test all about?
This test is to give you a rough idea if you could need a breast lift after your implants are placed. While you are standing or sitting up straight place a pencil underneath your breast horizontally. If you breast is unable to hold on to the pencil and it falls down it is less likely you will need a lift. If you can hold onto the pencil with your breast look straight at your nipple. If the pencil is above or at the level of the nipple you may do well with breast implants only. If your nipple hangs below the level of the pencil you will probably do better with a combination of implant and a breast lift. This is a rough guide to the degree of breast drooping called ptosis. The pencil test has quite a history and has been used to determine if you need implants in the first place or even if you need to wear a bra. The test, although used seriously by some, is more 'tomfoolery' than practical. (tomfoolery = 'prank') Everyone doing the test will end up meeting the pencil test criteria for breast implants.
Will I lose much blood during the surgery?
No. Breast implant surgery is not usually very bloody. Blood loss in some cases can be less than a tablespoon. Blood loss from a tubal ligation or even a laparoscopic gallbladder surgery would be expected to be silimar. What is expected and what happens can be quite different. Major blood loss requiring a blood transfusion or admission to the hospital should be extremely unlikely during breast implant surgery.
Will pictures of my breasts end up on the internet?
Only if you give us permission to use your pictures will they end up on the re*be® website. If you are showing off our work somewhere else such as collecting beads at Mardi Gras, getting a tan on a clothing optional beach, making new friends at a motorcycle rally and someone else takes your picture then maybe.
Will I need to remove my nipple ring before surgery?
Yes. We would encourage you to remove it at least 2 days before the procedure and then never put it back in. Nipple ring tracts are hard to sterilize and can harbour bacteria that cause infection. Nipple rings as fashion are an individual taste. At re*be® we would encourage you to leave then out. Adding breast implants to improve the appearance and feel of your breast enhances your appearance by smoothing and filling and softening your curves. Nipple rings made of hard metal add a hardness, sharp edges and seem to distract from the goal of breast implant enhancement. You may replace your piercing a week after we have placed your implants if you feel strongly about it.
Can my breast implants pop if I fly on an airplane?
No. Silicone gel implants do not change size noticeably with changes in an airplane's cabin pressure. Saline implants do not change much either. If you have saline implants and have some air in them changes in the airplane's cabin pressure will cause the size of the bubbles to change. In that case you could notice a sloshing sound and even experience some sensation of your implant getting slightly larger as the cabin pressure drops. Although very interesting, this is usually of academic interest only and not a concern for your health.
Can my breast implants pop if I go scuba diving?
No. Silicone gel implants do not change size noticeably with changes in water pressure. Saline implants do not change much either. If you have saline implants and have some air in them changes in the surrounding pressure will cause the size of the bubbles to change. In that case you would be very unlikely to notice the implants get smaller as you dive deeper. Although very interesting, this is usually of academic interest only and not a concern for your health. In the water everything looks somewhat bigger, even your breast implants. This effect is caused by the light getting bent as it passes through the air water surface as well as the way our eyes work under water. Nothing really changes the size however. It is an optical illusion. Silicone gel will absorb slightly more nitrogen than saline but this will not change your decompression calculations because the amount is very small. The nitrogen will slowly diffuse out of the implants when you return to the surface. Medically useless information but good to know if you run out of things to talk about in the bar after a good day diving with folks interested in breast trivia. In spite of what you will read on the web, silicon gel breast implants float. We are planning a short video to confirm our independent research on this subject.
How do you pick the size of my breast implants?
We (you, me, and the staff at re*be®, and any significant other persons you want to be involved) help to pick the size of your implants. The sizing process for breast implants is the same for silicone and saline implants. The using pre-shaped implants and textured implants add additional factors that may very slightly change your sizing decision. We provide a 'low tech' breast sizer kit to help you pick the correct size implants for your frame. This is really a difficult decision for some people and one common reason to have a reoperation is to change the size of the implants. Usually the change if it is for size is to go bigger. The sizer kit is two short nylon stockings and a bag of rice. You fill the stockings with equal amounts of rice using the guideline that 200 cc of rice per side is going to increase your breasts roughly one cup size. Wearing the 'test implants' with an unpadded bra or sports bra will give you a pretty good estimate of your new shape at any given breast size. This will also show how you might look in clothes with the new implants. Wearing the 'test implants' in public may also give you an idea of the reaction you may get from those around you with your new-look. If you are completely unable to choose a size all of us at re*be® will be glad to suggest a size for your frame. Remember there is also a shape consideration. The implants come in sizes and shapes so unless you do this allot we can with your decision. Do not ignore your personality and how you relate to others to choose your implant size. Your new-look will be part of your presentation to those around you. Our society as most do makes assumptions and categorizes people based on their profile literally. Amazing as it may seem, waitresses in most type of service environments claim some increase in tip income with increases in breast size.
Does breast augmentation or enhancement mean the same thing as breast implants?
Not exactly. Breast augmentation means increasing the size (volume) of the breast and implies this is being done for cosmetic reasons to improve the size, shape and feel of the breast. Breast augmentation can be done with breast implants but other augmenting substances can be used as well, Recently there has been a service in a larger city where your breast could be augmented with just saline injections. The procedure was interesting and the marketing equally so. Several hundred cc's of normal saline were injected into each breast just prior to a big event. Your breast would be swollen from the saline and the effect would last barely 24 hours. Breast vacuum pumps will cause swelling similarly using your own body fluid to temporarily swell your breast tissue. We do not offer this at re*be® or ever intend to offer it. There are clinics where you can go to have your own fat removed from somewhere on your body and then reinjected in your breast as an augmentation. This has been done for years now but the results of fat injection augmentation vary and the procedure keeps changing. The clinics that use your stem cells with the fat for breast augmentation claim the best results. Fat injection may change your mammogram making scars that can look like breast cancer resulting in the need for a breast biopsy or several. Getting things even with fat injection breast augmentation is difficult as not all the fat will live and lumps can occur. The terms 'breast enhancement' can be used interchangeability with 'breast augmentation'. Breast implants are one of several ways to augment your breasts. The related term 'breast reconstruction' is usually reserved for breast procedures that are medically necessary such as after cancer surgery. Breast reconstruction is usually covered by insurance and can imply a wide range of different options.
Can you do a breast lift under local anesthesia?
Yes. A breast lift can be any number of a wide range of procedures. Breast lifts, breast reductions, nipple lifts and many other procedures are being done under local anesthesia in increasing numbers around the world. This patient had marked nipple ptosis and following implant placement 4 months earlier underwent a breast lift using local anesthesia. The technique of 'Staple First' of Dr. Ted Eisenberg was used to do the breast lift stage and contributed greatly to the good result for this patient.
Photo of patient with severe breast ptosis before treatment

Breast droop before treatment

Photo of patient with severe breast ptosis after breast implants done under local but before the breast lift

Implants were placed under local anesthesia but were not expected to improve things.

Photo of patient with severe breast ptosis after breast implants and a breast lift all done under local anesthesia.

Four months later a breast lift was also done under local anesthesia with expected improvement in nipple position and breast shape.

Check this website frequently as there is always something new going on at re*be®.

Rebe Skin and Vein Clinic
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