One of the questions that I’m frequently asked is how to bring my breasts closer together. In reality, you really can’t do this. The reason is that our breasts are put on our chests in a particular position. When we’re doing surgery, we’re not moving the position of the breasts; we can make the tissue larger or smaller, or we can lift it, but the actual footprint of the breast will not change. Therefore, there’s really no way to bring the breasts themselves closer together. To make them appear as if they’re closer together, a push-up bra is the most secure and reliable method. Larger breasts will make it appear as if the size and the distance between the breasts are smaller, but it’s not physically bringing the breasts back together.

Following breast augmentation surgery, most swelling will generally resolve within two to three weeks.

The risk of hematoma following breast augmentation surgery is less than 1%. If you have a hematoma, which is a collection of blood around the implant, you'll notice something is different. One breast may be suddenly larger than the other. You may have a new onset of swelling and bruising. You may have some drainage of blood from your incision. If any of these things happen, it's best to contact your plastic surgeon right away. And to go in for an evaluation.

Patients frequently wonder whether or not they should wait for breast augmentation until after they've had their children. And this is different for every patient.

What I recommend to patients is that if you’re interested in breast augmentation now and you're not actively trying to get pregnant, it's totally fine to go ahead with your surgery.

Some patients prefer to wait until after they've had their children, and that's also completely acceptable. I do find that when patients have had implants placed prior to having children, in most cases, they are able to breastfeed.

Many women are concerned that their breasts are asymmetric, and the reality is that almost 99% of women have some degree of asymmetry between the breasts, whether in shape or in size.

To correct this during breast augmentation surgery depends upon the patient's anatomy. Keep in mind that if we're putting in implants, it's going to augment any differences between the breasts. So, in some cases, I may use a different size implant for the smaller breast. In some cases, just using the same size of implant and just expecting a small asymmetry is acceptable.

Following breast augmentation surgery, patients will note variable amounts of pain. In general, patients are sore for the first one to two days after surgery. At which point they can switch over to Tylenol or extra-strength Tylenol, and most of my patients are very comfortable with that.

One interesting thing that I've seen in patients following all types of breast surgery, be it breast augmentation, breast reduction, or breast lift, is that they will have some unusual nipple sensitivity or breast sensitivity for several months. They may be at rest, not performing any particular activity, and they'll feel sudden, sharp pain in the breast. It will just last a millisecond, and then it's gone. This is very, very typical, and it will get better and disappear with time.

The risk of infection following breast augmentation surgery is less than 1%. However, it's really important to look for signs if there's a problem. Some items to look for include redness of the breast, drainage, pain, fevers, and general malaise. If you notice any of these symptoms, it's best to just call your plastic surgeon and request that you be seen for an evaluation.

Following your breast augmentation surgery, I advise patients to hold off on any strenuous activity for approximately two weeks. This includes sexual activity. In terms of light errands, patients can do those the same day.

When patients ask if they can drive a car, what I recommend is that they not be on any pain medication prior to driving. We just don't want anything to impair your judgment.

As every surgeon and every physician will tell their patients, smoking is one of the worst things you can do for your body. We really recommend to patients that they stop smoking prior to surgery at least four weeks prior to surgery and at least eight weeks after surgery. For a number of reasons.

The first is that your anesthetic course will be much smoother if you don't have active smokers coming into surgery.

The second is that after surgery, your healing process will be a lot easier. Smokers do tend to have worse healing and scarring.

Finally, specifically with breast augmentation, we find that smokers have a higher rate of capsular contracture. Your body is generally creating more inflammation, and this is causing more scar tissue around your implant. So, for a number of reasons, we recommend that our patients not smoke prior to and after surgery.

Following breast augmentation surgery, I ask my patients to begin raising their arms above their heads as soon as the night after surgery. I do like to get my patients back to strength and activity relatively quickly. Some surgeons will not let patients do this, but I find that when patients do get their activity back faster, they return to feeling better much more quickly.

Following breast augmentation surgery, your breasts will be a bit swollen, and you may notice that the implants are in a high position. This is especially remarkable after the placement of saline implants, which do take longer to descend. What I recommend to patients is that you be quite patient for the first several weeks as your swelling comes down. And you’ll notice that your implants will fall into position very naturally. Typically, it could take about six months, or sometimes even a year, for your breasts to fully settle and for the implants to come into perfect position.

After women have had children, and particularly if they've nursed their children, they'll notice a change in their breasts. Typically, the breasts will droop, and they may lose some fullness in the upper aspect of their breasts. So, sometimes those patients will come to me, and they'll say, “I don't really know what I need. Do I need a breast augmentation? Do I need a breast lift or both?” And this really varies from patient to patient.

With the breast augmentation, what we're really doing is just increasing the volume of the tissue that's there. With the breast lift, we're bringing the breast up and suspending it prior to closing the skin. You can combine these procedures if it's necessary, but they do two completely different things.

A breast lift just lifts the breast tissue; it doesn't make it any bigger, and a breast augmentation makes the tissue larger without actually lifting it. So, what a patient needs would depend on her specific anatomy and her goals.

There are three main incisions that can be used for breast augmentation.

These are the inframammary incision, which is in the crease beneath the breast. The periareolar incision is in the nipple areolar complex right around the breast, and the third is in the axilla, or the armpit. Some patients, if they have a very small nipple and don't want an incision on the breast, will opt for the axillary incision.

Most frequently, we'll see very small-framed Asian patients request this incision. This is a perfectly acceptable incision, although there are some limitations.

The first is that it's a bit harder to access the breast, indicating that the visualization towards the tissue is a bit more difficult for the surgeon.

The second issue is that there is a risk of nerve injury to the upper part of the wall. And the third problem is that placing very, very large silicone implants through this small incision is a bit more difficult.

Following breast augmentation, every patient will develop a thin capsule around her breast implant. This is a small shell of protective tissue. Whenever the shell becomes thicker, this is termed capsular contracture. And in general, if a patient has significant capsular contracture, she may notice pain and firmness in the breast. She may also notice some distortion of the breast implants.

Following breast augmentation surgery, it's a little debatable about how long you need to sleep on your back or sit in an upright position. I personally allow patients to sleep on their back or on their side the night of surgery. Some surgeons will advise their patients to sleep on their backs, so it's best to ask your surgeon what he or she recommends.

It can be very overwhelming for a patient to try and select her own breast implants. For this reason, we recommend that you see a board-certified plastic surgeon to have your measurements taken and determine which size, shape, and profile of implant will fit the best into your tissues. It is almost impossible for a patient to do that on her own.

Following breast augmentation, it is not absolutely necessary to massage your breast implants. If you wish to do it, you can move the implant to the side to the middle up and down and do this gently two to three times per day for about four to six weeks after surgery. If you have anatomic teardrop shaped implants in, we don't recommend that you do massage because this can cause the implant to rotate.

The decision to undergo any elective surgery, including breast augmentation, is an extremely personal one. So, it is up to you to decide how, if, and when to tell your family what you're having done. You may or may not have support from your family. It's very helpful to have at least a supportive friend who can guide you through the process, but it is truly a personal choice.

Following breast augmentation, in my opinion, it is not necessary to wear a surgical bra at any time. There's absolutely no data in the literature to show that wearing a surgical bra makes any difference in a patient's result. Some surgeons, however, do like to have their patients wear a bra. And they may have their own specifications of how long it should be worn. So, I do recommend that you ask your surgeon about what he or she recommends.

Following breast augmentation, recovery is generally three to four days. I advise patients immediately after surgery to go home, take a nap for two to three hours, and then get up and start doing their normal activities. I do ask patients to avoid any strenuous physical activity, including sexual activity, for approximately two weeks. However, most patients can return to light activity right away and can return to non-strenuous work in three to four days.

When selecting a surgeon for breast augmentation surgery, we recommend that you choose a board-certified plastic surgeon for your surgery. Whether it's in the United States or any other country, you should not be going to someone who does not perform breast augmentation surgery on a regular basis.

It's safe to have your surgery done out of the country, as long as your surgeon is certified and you are able to reach him or her in the event of an emergency.

TUBA refers to trans-umbilical breast augmentation. And, in this procedure, an incision is made around the umbilicus or the belly button, and then the skin is tunneled underneath to reach the breast. This is generally not a good incision for breast augmentation, although it sounds attractive.

The first problem is that silicone breast implants cannot be placed with a small incision and extended through this distance.

The second problem is that the warranty on your breast implants will be void if this incision has been used.

Creams and pills for breast augmentation are generally not effective. Certain pills and creams that contain estrogen can temporarily enlarge the breast, but the results are not permanent.

When choosing a breast implant size, in general, 25 CCs is not going to make a significant difference in your size. However, if you're very small and you're getting a 150 CC implant and deciding between that and a 175 CC implant, 25 CCs will make a little bit of a difference. For a patient who's getting a 500 CC implant, going to 525 CCs is not going to make a significant difference.

Pain following breast augmentation surgery is highly subjective and varies significantly from patient to patient. However, I find that if patients return to physical activity sooner rather than later, they will find that they have much less discomfort.