Frequently Asked Questions

Am I a good candidate for breast augmentation? 

One or more of the following feelings or conditions may indicate that you are a good candidate for Denver breast implants:

• You are self-conscious that your breasts are too small
• Disproportionate measurements- swimsuits that fit your bottom do not fit your top
• You feel self-conscious wearing a swimsuit or tight-fitting tops
• Childbirth has changed the size and shape of your breasts
• Weight loss has changed the size and shape of your breasts
• Asymmetry between your breasts:  One may appear larger than the other

Contraindications (inadvisable treatment) for breast implant surgery include women who are currently pregnant or nursing, have an existing malignant or pre-malignant cancer of their breast without adequate treatment, or have an active infection anywhere in their body. An active infection anywhere in their body or other serious systemic medical disorders or diseases should be discussed with your primary physician and the surgery cleared.  Your personal safety always comes first.

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How will Dr. Goldstein evaluate me for breast augmentation surgery? 

Dr. Goldstein will examine your breasts and torso and take confidential photographs for your medical record. He will consider such factors as the size and shape of your breasts and the proportions between your breasts, waistline and hips. Other considerations are the quality of your skin and the placement of your nipples and areolas (the pigmented skin surrounding the nipples). If your breasts are sagging from childbirth, weight loss, or natural aging, a breast lift may be recommended in conjunction with your augmentation breast surgery.

You will be asked to discuss your medical history including your family history of breast cancer. This will include information about any medical conditions, drug allergies, medical treatments, and current medications you are on. Previous surgeries including any surgery of the breasts and results of mammograms will be discussed. It is important for you to be honest and open and provide complete information.

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What pre-operative steps are necessary for my breast enhancement surgery?

Depending upon your age, and medical and family history, Stephen Goldstein, MD may recommend a baseline mammogram before surgery and another mammographic examination afterwards. These tests will establish a firm baseline to detect future changes in your breast tissue. Following breast augmentation, you are advised to perform monthly breast self-examination. If you are a smoker, you will be asked to stop smoking at least three weeks before your surgery. All aspirin products and over-the -counter anti-inflammatory drugs (such as Ibuprofen, Motrin, Alleve, etc) causes increased bleeding, and you will be advised to stop taking these medications two weeks before surgery. It is permissible to take Tylenol prior to surgery. We require that you do not eat or drink any fluids 8 hours before your surgery. We will provide you any special instructions specific to your situation. Breast augmentation is usually performed on an outpatient basis and you need to make arrangements for someone to drive you home after surgery and to stay with you for the first 24 hours following surgery.

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What type of implants will be used?

Approximately 300,000 women in the United States underwent breast augmentation in 2005. Each woman has her own personal reasons for considering breast augmentation surgery. For some, they desire fuller breasts with a more pronounced profile. For others, it may be to improve the shape of the breast due to the gradual changes to the body that come with childbirth or the effects of age and gravity. 

The availability of both saline-filled implants, which consist of a silicone shell filled with sterile saltwater, and silicone gel-filled breast implants creates new options for women considering breast enhancement surgery. All women over 22 years old seeking cosmetic breast augmentation surgery have the option of selecting FDA-approved silicone breast implants. 

• Advantages of Silicone Implants

Many surgeons and patients with breast implants have the opinion that silicone implants have a more natural look and feel than saline implants due to the fact that silicone gel has a texture similar to breast tissue.

• Advantages of Saline Implants

Saline implants have some advantages over silicone implants. Silicone implant ruptures are harder to detect. When saline implants rupture, they deflate and the results are usually seen almost immediately. When silicone implants rupture, the breast often looks and feels the same because the silicone cohesive gel will not leak beyond the implant into surrounding areas of the breast without a visible difference.

Dr Goldstein has been successfully using Mentor breast implants successfully for over twenty years.  For more information visit MentorCorp and www.breastimplantsafety.org

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What size implant do I choose?

Always be frank and open in discussing your desired breast size so that there is clear understanding from the beginning. It is very important to be realistic in your goals and approach to choosing implants that are best suited for your body type. It may help to bring several photographs from magazines illustrating what you perceive your ideal beauty is and the harmony between breast size and body proportions.

Keep in mind that breast size is not uniform in terms of bra-cup size. Cup size can vary significantly among bra styles and manufacturers. For this reason, Dr. Goldstein will have you "try on" different sizes by placing various sized implants into your bra. Over the years, this has proven to be the best method.

It is important to maintain realistic goals and reasonable expectations. Don't assume that bigger is always better! Implants that are too large not only will upset the natural beauty and balance of your figure, they also may be more prone to cause advanced sagging. In addition, implants that are too big may cause breast pain, neck ache, upper and lower back ache, and shoulder pain. The best approach is to select implants that will look and feel like a natural part of your body. Dr. Goldstein’s staff is experienced and ready to help you make the proper choice.

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Are implants safe?

In 1999,  the Institute of Medicine concluded that silicone implants do not cause any major health problems.

Saline-filled breast implants have always been safe, a fact that has been supported by more than 30 years of clinical experience throughout the plastic surgery community. Research and reports from the last decade have shown that silicone gel-filled implants do not pose additional risk to women’s short-term or long-term health.  Dr Goldstein’s clinical experience with saline and silicone implants exceed over 20 years.

Breast implants, like most medical devices, are not meant to last a lifetime. Women need to be aware that they have a responsibility to maintain good breast health with an annual mammogram and follow-up visits.  Dr Goldstein encourages his patients to be seen yearly, at no additional cost, for routine breasts examination.

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What causes a breast implant to deflate or rupture?

All implants carry a risk of rupture. The implants we use have a very low rate of deflation. Saline deflations are less than 3.7% at 7 years and Mentor MemoryGelTM silicone deflations are less than 0.3% at 3 years. Breast implants deflate or rupture when the integrity of implant shell is violated. If a saline implant leaks or breaks inside a woman’s body, the salt water is simply absorbed into her tissue. Deflation can occur immediately or progressively over a period of days and is noticed by loss of size or shape of the implant. If the implant is a cohesive silicone gel implant, the rupture may be silent and not recognized. MemoryGel™ implants feature a cohesive, gelatin-like substance that acts as a solid rather than a liquid. The cohesive silicone gel will maintain its shape if pulled or stretched. If there is a leak or rupture of the implant, the MemoryGel™ binds to itself reducing the chance that the silicone may spread beyond the implant. This is why the FDA recommends that a MRI Scan be obtained three years after your initial surgery, and ever two years thereafter.

Some implants deflate (or rupture) in the first few months after being implanted and some deflate after several years. Potential causes of deflation are many and may include damage by surgical instruments during surgery, over filling or under filling of saline implants. Mechanical pressure to the implant shell can occur with capsular contracture or closed capsulotomy. Mechanical stresses due to intense physical manipulation, excessive compression during mammographic imaging, or severe blunt trauma have been reported to cause implant deflation. You should also be aware that the breast implant may simply wear out over time and deflate/rupture. Sometimes implant deflations or ruptures can occur for unknown or unexplained reasons. Deflated or ruptured implants require additional surgery to remove and to replace the implant.

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Are the implants guaranteed?

Dr. Goldstein provides for his patients the Mentor Enhanced Advantage Warranty:
This optional warranty is paid for by Dr. Goldstein and provided to our patients for both saline-filled and silicone-filled breast implants. To be eligible, you must enroll within 45 days from your surgery. The policy covers the following:

• Lifetime implant product replacement policy
• 10 years and up to $2400 financial assistance for operating room, anesthesia, and surgical charges not covered by insurance from the date of implant.
• Free contralateral (opposite side) implant replacement upon surgeon request
• Non-cancelable terms

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Where is the surgery performed?

Your breast augmentation surgery will be performed in a JCAHO accredited ambulatory care surgical facility where thousands of surgical procedures are performed yearly on an outpatient basis. Hundreds, if not thousands, of these procedures are aesthetic and cosmetic surgical procedures. This means that the staff is not only professional but very experienced and familiar with the type of breast enhancement surgery that is being performed. This is a state-of the-art facility with the finest medical equipment and protocols in place to ensure your safety

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What type of anesthesia will be provided? 

Your comfort and safety always comes first. Dr Goldstein uses only Board Certified Anesthesiologists to administer the anesthesia in a controlled and safe setting. The vast majority of Dr Goldstein’s patients choose to be put totally asleep under general anesthesia. Some desire to have their breast augmentation surgery performed under light sedation with a local anesthetic.  Whichever you choose, in all cases, careful monitoring and the proper choices of anesthetic agents by our anesthesiologist assure that you are comfortable while the surgery is performed in a safe manner. 

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Where are the incisions placed?

Only one incision is required for each breast. An incision can be made either underneath the breast, just above the crease, around the lower edge of the areola or within the armpit.  These incisions are small and inconspicuous.

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How is the surgery performed?

Prior to surgery, Dr Goldstein will perform a physical examination, evaluate your condition, and prepare you for your surgery. Any questions or concerns are answered and addressed and then the informed consent process is completed.   

Operative markings are made prior to surgery with you standing in a relaxed upright position, delineating appropriate surgical landmarks. These markings are essential for symmetry between the breasts and allow for the placement of the implants to be as exact as possible. Because the surgery is performed lying flat on your back, its imperative that these markings be made while standing to avoid any shifting and distortion that may occur when lying down. In addition, correlation between your photographs are made and utilized during the operation as an additional reference.  Several times during the operation, by means of the mechanized operating table, you will be placed in the upright position ensuring that proper placement of the implants has been achieved.

You are made immediately comfortable by the anesthesiologist via general or local with sedation anesthesia. The operation takes about one and half hours to perform.  One incision is required on each breast and can be made either underneath the breast, just above the crease, around the lower edge of the areola or within the armpit. If we are using saline-filled implants, an incision of less than one inch is made. Silicone gel-filled implants require a slightly larger incision in comparison to saline-filled breast implants. Through this incision, a space is made both beneath your breast tissue and the major chest wall muscle, known as the pectoralis major muscle. This muscle is separated from the underlying tissues and very little of it is actually cut. This means that the muscle can return to its pre-operative level of function with little loss of long-term strength or power. 

Once the pocket or space has been created, the implant is inserted and placed in its proper location. If saline implants are used, the implant is inserted deflated and a closed system is employed to fill the implant to its desired volume with sterile saline. The silicone gel implants are pre-filled and thus require a slightly longer incision for its insertion into the space. Prior to closure, local anesthetic medication is placed around the implant to help eliminate any immediate post-operative pain. 

After surgery, you will be taken to the recovery room under the supervision of several registered nurses. Typically it takes about and hour or a little more to wake up. The overwhelming majority of our patients go home immediately following surgery. We do require someone to take you home and stay with you the first 24 hours following the surgery. However, if your breast augmentation procedure is being performed in conjunction with other cosmetic procedures, such as liposuction, tummy-tucks, etc., you may choose to stay overnight in our accredited facility. 

Very small bandages are placed over each incision which are removed several days later. Usually, a special band is applied over the breast post-operatively placing gentle downward pressure.
Immediate side effects are temporary soreness, swelling, change in nipple sensation, bruising. The breast may remain sensitive to stimulation for a few weeks.

View 3D Animation of the Breast Augmentation Procedure

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How long does it take to recover from colorado breast augmentation surgery? When can I resume my normal activities?

Depending on your job, it is often possible to return to work within a few days or a week. Typically, one may return to light exercises following the end of the first week. Vigorous activities such as aggressive swimming, weightlifting using the pectoral muscles, or high impact activities such as running are recommended at full recovery at four to six weeks. Sexual activity should be avoided for at least the first week following surgery. After that, care must be taken to be extremely gentle with your breasts for at least the three to four weeks.

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How long will the results last?  

Except in the event of implant deflation requiring surgical replacement with a new implant, the results of your breast augmentation surgery will be long-lasting. Please be advised that breast implantation may not be a one-time surgery. Gravity and the effects of aging will eventually alter the size and shape of almost every woman's breasts. Eventually you may become dissatisfied with the appearance of your breasts and choose to undergo a breast "lifting" procedure to restore their more youthful appearance. Like most medical devices, breast implants are not considered lifetime devices. You may need to undergo implant removal with or without replacement over the course of your lifetime due to deflation or rupture.

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What happens after the surgery?  Do I have to visit the doctor?

Please remember that the relationship with your plastic surgeon does not end when you leave the operating room. During the first three months following the surgery, Dr. Goldstein will see you in his office for follow-up care at prescribed intervals.  Ultimately, you are encouraged to schedule routine yearly visits. There are no professional fees for these follow up visits. Mammographic evaluations and other imaging are recommended at the frequency for your age group.
You are always encouraged to call the office and speak to a member of our staff if you have questions or concerns.

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What risks are related to breast augmentation?

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What is scar capsular contraction?

Everyone heals with scar tissue. Scar capsular contracture is the most common problem associated with breast implants. It occurs because the body is simply trying to heal around the implant. Naturally forming scar tissue develops around the implant as the body heals. The scar capsule may shrink and tighten, making the breast feel firmer than normal and sometimes causing pain and an unnatural appearance. There is no special testing that we can do ahead of time to predict who is at more likely to experience this condition. Capsular contracture may occur on one or both sides or not at all. The degree of scar capsular contraction may vary from hardly noticeable to extreme, and may vary from one side compared to the other.

Steps to avoid this complication include the proper choice of implants, placing the implant beneath the pectoral muscle, and making a space around the implant slightly bigger than the implant itself. Post-operatively, implant displacement exercises will be performed daily moving the implant to maintain this open space. In addition, Dr. Goldstein places his patients on Vitamin E and anti-inflammatory medication for three months following surgery. If a scar capsule is felt to be forming, additional medication and ultrasound treatment may be ordered.

In severe cases, the disfigurement or discomfort resulting from scar capsular contracture may require surgery to remove the scar tissue around the implant.  In extreme cases Scar capsular contraction could be a recurring problem, necessitating permanent implant removal.

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What pre-operative steps are necessary for my breast enhancement surgery?

Preparing for surgery is very important and it begins with your knowledge and education of breast augmentation procedure.  We want to make sure that you fully understand the nature of operation, the inherent risks and complications of both the implants and breast augmentation surgery, and post-operative care and recovery.  Reading material describing all of the above, including the operation, implants, post-operative instructions, and consents forms will be given to you. This material should be read and re-read until you have a full understanding and comprehension of breast enhancement surgery.

Depending upon your age, and medical and family history, Dr. Goldstein may recommend a baseline mammogram before surgery and another mammographic examination afterwards. These tests will establish a firm baseline to detect future changes in your breast tissue. Following breast augmentation, you are advised to perform weekly breast self-examination. If you are a smoker, you will be asked to stop smoking at least three weeks before your surgery. All aspirin products and over-the -counter anti-inflammatory drugs (such as Ibuprofen, Motrin, Alleve, etc) causes increased bleeding, and you will be advised to stop taking these medications two weeks before surgery. It is permissible to take Tylenol prior to surgery. We require that you do not eat or drink any fluids 8 hours before your surgery. We will provide you any special instructions specific to your situation. Breast augmentation is usually performed on an outpatient basis and you need to make arrangements for someone to drive you home after surgery and to stay with you for the first 24 hours following surgery.

If there are any questions or concerns, you should always discuss these with Dr. Goldstein and /or his staff before your breast surgery.  Never proceed with an operation until you are fully satisfied and comfortable with your decision to have breast augmentation and have a comprehensive understanding of the surgery.

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Is silicone safe?

All mammary implants are comprised of silicone. The outer shell of the implant is made of silicone in the solid state.  If you think of a mammary or breast implant as a balloon, the balloon wall or implant shell is made of solid-based silicone. What the balloon is filled with determines what type of implant it is.  If the silicone implant shell is filled with sterile salt water, then it’s termed a “saline-filled” breast implant.   And, conversely, if the silicone outer ‘balloon’ shell is filled with a silicone gel, then its called a “silicone gel-filled” implant. Dr Goldstein uses both types of implants in his cosmetic practice, affording his patients a choice of what is best for their individual needs.

We all have contact with silicone on a daily basis. Silicone can be found in many household items, such as polishes, sun-tan and hand lotion, antiperspirants, soaps, processed foods, waterproof coatings, and even chewing gum. Silicone is ubiquitous and found everywhere in medicine.  It is used to coat syringes and IV tubing, used in various medications such as anti-acids, and numerous medical devices. The overall safety of silicone has been defined the best by the Institute of Medicine when the concluded that:

”There is no evidence that silicone implants are responsible for any major diseases of the whole body.  Women are exposed to silicone constantly in their daily lives.”

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Can breast augmentation surgery be performed at the same time with other surgical procedures?

Yes.  Breast enhancement may be a stand alone procedure or done in combination or conjunction with other cosmetic surgical procedures.  It’s not uncommon to perform breast lifts, liposuction, tummy-tucks, or other body contouring procedures at the same time with breast augmentation surgery.

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Will breast augmentation cause me to loose breast or nipple sensation?

Feeling in the nipple and breast can increase or decrease after breast implant surgery. Usually this change is temporary. The range of changes may vary from no feeling to intense sensitivity, or both, in the nipple or breast following surgery. Changes in feeling are usually temporary but may be permanent and may affect sexual response or the ability to nurse a baby.

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Will I be able to breast feed after breast augmentation surgery?

There are many variables related to a Mother’s ability to breast feed.  Having a Breast Augmentation may interfere with your ability to successfully breast-feed. To optimize your chances to breast feed following breast enhancement surgery, Dr. Goldstein recommends not to utilize the periareolar incision site as it may significantly reduce the ability to successfully breast-feed.  Also, he prefers to place the breast implant beneath the pectoralis chest wall muscle, limiting possible injury to the breast gland-ductal system.

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Do silicone implants harm the developing fetus?

There have been concerns raised regarding potential damaging effects on children born of mothers with breast implants. To date this is unproven. A review of the published literature suggests that the information is insufficient to show definitive conclusions.

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