How to Even… Get Breast Implants
I had a breast deformity. Here’s EVERYTHING about how I approached surgery.
When I was a teenager, it became clear that I had a breast deformity. Being deformed in an intimate way did a number on my self-esteem, which, in turn, set me on a path towards a very unhappy future. However, at age 21, I got a boob job — and now, nearly 15 years later, I can’t even imagine how my world would’ve looked otherwise. I’m extremely happy for the choice I made.
Surgery is a hugely personal matter, and there’s no “wrong” decision, as long as your choice has been made by you, for you, and uncoerced. Hence, I write without self-righteousness or judgment, and without any intentions of convincing you to choose one route or the other. I’m simply writing this because I recognize that any big decision becomes way less intimidating when you feel informed about the options. So I’ll be insanely thorough… and since you’re reading this, I’ll assume you’ve mostly decided to get surgery — but no pressure!
First I’ll explain how I chose a doctor. Then, I’ll go deep into the various factors to consider, and I’ll close on the post-op experience. While having a deformity influenced my choices, most of this info is still useful to anyone.
Shortlisting and Choosing a Surgeon
If I’d had friends who’d had breast reconstructions for the same deformity, I would’ve started by asking them for referrals… but I had the great luck of being the ONLY person I knew who had congenitally deformed boobs. Yay! So I started from scratch, scouring the websites of plastic surgeons within a 3-hour radius of where I lived. Location matters, since you will have multiple pre-op and post-op appointments. (I’m lucky: my hometown sits within 3 hours of 3 major cities. If your home is more remote, it’s worth it to look further.)
I studied before-and-after galleries to check out each surgeon’s boob jobs in general, but I paid special attention to whether or not they had experience with my particular issue. If someone did great work in general but failed at (or didn’t even feature) tuberous breasts, I didn’t book a consult with them.
In the end, there were just 5 surgeons who seemed experienced with my deformity, and I met with them over the course of a summer. I also brought either my mother or my then-boyfriend into each appointment to help me remember/write down the details and give me their opinions on the doctors too. At each consult, I did two things:
First of all, I carefully browsed any additional before-and-after photo albums in the office (again, particularly any photos of tuberous breasts). One doctor’s results looked shoddy. I x’ed him off.
The second thing I did was ask, in detail, what the procedure would be for correcting my asymmetry (e.g., implant type, incision placement, etc. — I’ve included a bunch of recommended questions below) and what kind of post-op breast sensation and function I could expect. Basically, I was trying to get a feel for how aggressive their approach was, how intimidated they were (or weren’t) by my deformity, and so on.
The answers were illuminating: one surgeon wanted to do a multi-stage surgery that would cost tens of thousands of dollars and would include expanders and a ribcage correction. No other doctor found such an expensive, lengthy approach necessary, so I counted him out. Another surgeon was so unmemorable that I honestly can’t recall why I eliminated him… which might sound silly, but listen: you don’t want a forgettable surgeon; you want a brilliant one who makes you feel truly at ease.
Finally, I was down to two whose work was absolutely gorgeous. One’s approach was very aggressive to the breast tissue, and he said I’d likely be unable to breastfeed as a result. I didn’t want to be that aggressive.
The other explained candidly that it was uncertain whether I could breastfeed at all, surgery or not — but his surgical approach was less aggressive. And he was very patient and genuinely thoughtful with any and all questions. Moreover, when I expressed other physical insecurities, he insisted that I was beautiful and didn’t need to worry about the things I was fretting over. This showed me a lot about his character; he wasn’t out to profit wildly off my every insecurity. Rather, his genuine aim was to help me feel confident and happy.
This was the right guy.
Ultimately, there’s a “go with your gut” element. Good bedside manner won’t ensure a satisfying result if the talent or the expertise are missing… but neither will talent or expertise alone. Find someone with all those qualities. You’ll have your implants for a long time… and any attendant scarring potentially forever… so it’s worth spending months (or more) to find the right surgeon, rather than pick someone iffy just to “hurry up and get it done.”
Truly, you’ll be happier knowing you didn’t rush this.
Being Informed about Implant Technicalities
Breast surgeries differ in a thousand ways. There are different places to make incisions, different planes on which implants can be inserted (over the muscle, under the muscle, or a combination), different “profiles” of implant (this effectively refers to how far they stick out from your chest vs. how broadly they spread out against the chest wall), different types of implant material and fill, and even factors like whether you might need pre-implant expanders or adjustable implants (i.e., implants with a port that allows for size-adjustment injections, before being permanently sealed months later).
You should read about all of these factors before you visit any surgeons, so that you can be prepared to discuss them and so that the details won’t go over your head during the consultations. You should also browse photos of different implant types, incision types, and placements, in order to get a sense of what fits your aesthetic. (There are lifestyle considerations, too — do you powerlift? do you intend to have a child in the next couple years? — but we’ll get to those later.)
No other patient can tell you what to select; the specific approach your surgeon(s) will recommend will ultimately depend on a number of factors that are very specific and unique to YOUR breasts. In fact, each breast might need something slightly different. In my case, my doctor recommended adjustable, saline-filled, dual-plane implants (i.e., under the muscle at the upper portion, over the muscle at the lower portion), with an incision around the areola. Frankly, I can’t remember my implant profile (or even if I have the same profile on each side), but your surgeon will advise on how to achieve the look you want.
Your surgeon might also advise something you weren’t planning on. For instance, I’d hoped to correct my asymmetry by operating on just one breast, but every doctor I saw recommended a bilateral approach. I trusted my surgeon’s expertise (plus the fact that a bilateral operation was the unanimous consensus) and am glad that I did, even though that wasn’t my original idea.
In any case, if anyone recommends something that you 100% do not want — and especially if other surgeons you admire don’t agree with that approach — you can always look for somebody else.
Aesthetics… and Tradeoffs
I wasn’t interested in “going bigger;” I just wanted my breasts to match. (And in the end, I was able to use my old bras afterwards — just that now both my boobs filled the cups.) In any case, I wasn’t willing to compromise on certain aspects of the aesthetics. For example, I wasn’t thrilled about having peri-areolar incisions, but I was more concerned about overall symmetry, a nice shape, and a good fit inside clothing. I’d have scars anyway, so they might as well be where my surgeon recommended them. If he felt he could do the best job by going in through the areola (rather than beneath the breast or through the armpit), then I trusted him. (Any surgeon should explain their reasons, of course. Don’t trust anything blindly. Ask questions. It’s their job to answer.)
“Feel” was another aesthetic I was willing to compromise; I don’t know how things are now, but back in 2005, it was explained to me that silicone-filled or gummi bear implants often had a more natural feel, while saline-filled implants were deemed safer with respect to the risk of serious complications down the line. I opted for safety. My reasoning was thus:
My breasts were never going to look or feel like “perfect” natural breasts. Because they simply were not. They started off deformed, and now, to look less deformed, they would have scars. However, I didn’t see any reason to increase my risk of health problems down the line by choosing an unnatural fill, nor did I want to hinder the work of a surgeon whose judgment and experience I trusted by insisting that he operate in a style that was against his recommendations (e.g., a different incision site).
So, fine: I’d have some scarring, and I’d have implants that might feel crinkly in certain spots (they do… marginally… if I’m looking for the crinkles), and I may or may not suffer some nerve damage (I don’t feel like I did…), and I may or may not ever have been able to breastfeed in the first place (haven’t tried yet…)… but allllll things considered, I felt good about the tradeoffs I was making.
Ultimately, choosing a surgeon you really trust, and a procedure you can feel comfortable with, makes a huge difference in your peace of mind.
Living in the U.S., I knew I’d likely have to pay for the surgery out of pocket. Surgery for my deformity is technically classed as a reconstruction, which insurances will sometimes pay for, and surgeons can petition the insurance to cover it. (Doctors can also give you advice on financing.) Alas, my particular insurer denied it. Oh well.
Still, I promised myself at the outset that if it came down to a difference of a couple thousand dollars, I would not let cost be the deciding factor if my ideal surgeon happened to be more expensive. In the end, there was only one surgeon I was all-around thrilled with, so I didn’t end up having to make serious cost comparisons anyway. (And he wasn’t even the most expensive!)
But my attitude was this: I was already unhappy with my breasts. I wanted to be happy with them. And I’d be looking in the mirror at my investment every single day, for a long. time. Yes, I was a college student from a blue-collar family, so money was definitely an object… but I decided this was not a situation for being thrifty.
Look at it this way: assume that you’ll have scars from the surgery to begin with. Now, would you rather have scars AND still be disappointed about the outcome, but have saved money?… or would you rather have your scars but LOVE your outcome otherwise, even if it meant that you spent a few months (or a year or so) longer making payments? For me, the latter felt like the better choice.
Your body is worth your investment.
Lifestyle and Health
Brainstorm questions regarding life with implants, both short-term and long-term. Ask everything. Really. Ask it. And if your doctor seems annoyed, then that doctor isn’t right for you. Any good surgeon will understand that this is a big deal and will want to empower you with info.
But if you don’t even know where to begin, here’s a quick list:
What is the timeline for my expanders/adjustables? (Important to consider if you’re planning on relocating soon but your process might take months.) Can I lift weights with subpectoral or dual-plane implants? Can I sleep on my stomach? How long after surgery must I wait before it’s “safe” to sleep that way again… or jog, or swim, or expose my incisions to UV light, or lift heavy items? Will I be able to work out the same way post-op as I do now? If not, what shouldn’t I do?
How about sex — when can I have sex again? How long do I need to wait before my breasts can be bounced/sucked/squeezed again? Before my nipples can be sucked/nibbled/pinched again? What are the chances that I might lose sensation after this surgery? Will I be able to breastfeed after this surgery? What might happen to my results after pregnancy/childbirth/breastfeeding? Do you recommend I wait until after [X life event] to have this surgery?
Are there health risks to having this particular implant size/placement/type? How often will I have to replace them? Can the original surgery be done under local anesthesia, or is general anesthesia necessary? How about the follow-up procedures? (*For example, my initial surgery was done under general anesthesia, but follow-up adjustments were normal office visits involving injections; sealing the implants involved small incisions under local anesthesia.)
One more thing: nowadays there are many, many personal essays and journalistic pieces out there about first-person experiences with implants. Read them. Broadly. They might inspire further questions.
Then ask those questions too. I can’t emphasize enough: ask, ask ask!
There’s lots to consider here — first and foremost, your health. Ask what kind of pre-op prep is necessary. Are there certain vitamins, minerals, supplements, or medicines that you should (or shouldn’t) be taking for a set period before or after surgery? Be 100% transparent with your surgeon about any medication you take, or any drinking or drug habits; when it comes to surgery, failure to disclose these things can be life-threatening. Take very seriously any instructions your surgeon gives you about any and all of this stuff.
Your doctor might want you to get blood work beforehand. This is important. Might I also recommend, ask your doctor to order a full iron workup (in your blood tests) too. It’s possible to be dangerously low in ferritin without being anemic (speaking from experience here), so unless your doctor checks your iron directly, they won’t necessarily realize the problem—but low iron can increase your risk of hemorrhage. So get this test. It’s important. (And don’t take iron unless a doctor gives you the go-ahead after testing; iron can be very dangerous if you’re not deficient.)
Also ask what you should do if you start to feel like you’re coming down with any illness before your surgery. Most doctors will insist that you postpone, because it’s very unwise to have surgery while your body’s already contending with an infection. This may seem inconvenient (My friend’s mother has had to postpone her reconstruction for this — twice.), but it’s seriously for your own good — not just for the sake of achieving an optimal look, but for your very survival.
Beyond these life-or-death considerations, then you’re left with the general question of when to schedule. I’d recommend choosing your surgery date based largely on your mid-range plans. I opted to have surgery during winter break in my senior year of college: several weeks to recover before school would resume, several months to recover before making a previously-scheduled international trip that coming March, and half a year to heal before summer/pool/sweat/sunblock season (didn’t want fresh incisions to get irritated).
You should also consider your access to recovery support; you’ll want to stay with a relative or a friend for a week or two afterwards (more on why in a moment). Think about where and with whom can you recover most comfortably, and ask whether there’s a certain window of time that works best for them. If so, see if you can accommodate their preferences too.
Recovery and Results
I’ll admit, in the very last seconds before my anesthesia took effect, I had a slight bout of panic on the gurney and wondered if I should cancel the surgery (Oh my God! This is so permanent! And what if it goes wrong?!). But I passed out moments later as the anesthesia took effect, and when I woke up post-op, I was really, really happy and relieved about my decision.
Since my surgeon was 2.5 hours away from my town, I stayed the night before and also the night after in a hotel near the surgical suite. This eliminated a lot of stress: no need to exhaust my body with an ungodly wakeup time on the big day, plus I had the reassurance afterwards that, if any major complications arose immediately, I’d be close to the doctor, rather than 2.5 hours away (or stuck in traffic while I was still puking out the anesthesia — it happens).
For the next few weeks, then, I recovered at my parents’ home. It’s good to have someone for help with the bandages, washing, dressing, preparing food for you (you won’t be lifting anything heavy — not even a carton of juice), etc. It’s also good to have a place where you can sleep supine, but with your upper body slightly elevated. My parents had a recliner, so that was perfect.
All in all, my breast surgery wasn’t as painful as I’d expected. By contrast, I had a rhinoplasty at the same time, and the rhinoplasty was the MUCH more painful procedure. My chest didn’t even feel particularly painful at all; it just felt really “full,” like a pressure inside my breasts, and that pressure feeling subsides as your tissue gradually stretches to accommodate the implants. I didn’t even take the heavy-duty painkiller my doctor prescribed; I just used ibuprofen. I didn’t want to risk addiction. (Also, I get migraines, and I figured, If I can handle those headaches without painkillers, I can handle surgery. It was true.)
Aesthetically, recovery was a slow-evolving thing. It takes time for the swelling to subside so that you can see how your new boobs “really” look. It also takes quite a few months for implants to settle into place and assume a natural-looking position… but that’s okay. Because it WILL happen in time, and until then… well, your boobs will just look wildly uplifted! One thing never went away: if I squeeze my right pec, my previously-deformed boob, with very little breast tissue, looks like it’s winking. I was mildly embarrassed about this at first, but then I realized, “Well… who the eff cares?” I’ve never met a person worth having in my life who judged me for having implants, so… yeah, let her wink all she wants. She’s a happy tit.
Meanwhile, my incision site continued to evolve in look and feel for a long time. Thankfully, I’m not particularly prone to scarring, but my breast scars never totally went away (and if your surgeon decreases the size of your areolae, like mine did, the excised skin and hair follicles are permanently gone). The scars are more visible in harsh light (like sunlight), and more severe in the region where my breast had to do the most stretching (in my case, this is the lower, inner quadrant of my right breast). Whatever you do, let all scabs heal fully, and be very, very gentle with them; do not try to “help” them off once they start to flake. Really. And avoid UV light.
I started using an OTC scar-healing serum months after surgery and felt it made a difference. The scars have continued fading over the years, but the scar tissue can still be felt, and it was particularly stiffer in the first year or two post-op — to the point that my areolae looked slightly erect (almost like little pointy hats) for a long time. I’m not sure what made them flatten down gradually to be flush with the contour of my breast again (maybe the fact that I massaged the area to soften the scar tissue once the incisions healed?), but they did. You can ask your surgeon about this. I’m sure they’ll have heard of it. No need to freak out.
I followed my doctor’s pre-op and post-op vitamin and supplement (e.g., arnica) recommendations, and I trust that my healing was assisted by those. I also made sure to do the exercises my surgeon recommended, and religiously. Namely, I had to do two different types of boob squeezes, morning and night, a certain number of times each. This was to limit the risk of capsular contracture, a problematic type of internal scarring. I did this routinely for years. I don’t always remember to do it anymore, but then I realize I often just kind of squeeze/bounce my boobs absentmindedly when dressing or undressing: the exercises apparently became an instinctive habit. I’ve had three different doctors ultrasound my breasts over the past 2 years, and they’ve all emphatically assured that my implants look wonderful (internally), in the sense that there seems to be no problematic scarring. Having had these implants for 14 years, I attribute the good long-range outcome partly to my doctor’s handiwork, partly to luck, but also partly to the fact that I took the exercises seriously for a very, very long time.
The takeaway is: follow your surgeon’s care instructions.
One More (Big) Thing…
Breast surgery changed my life for the better. But while it helped that I no longer had to look in the mirror and stare at a deformity, it also helped immensely that I started seeing a counselor for several years afterwards. Nobody just wakes up with implants and finds that all their personal problems have vanished. Body modification like this can be a deeply healing, empowering move, but the actual re-patterning of your mind (and your lifestyle) come through profound inner work.
So by all means, invest in your body, and may that investment reap benefits for your mind, your heart, and your spirit… but also invest directly in your mind, heart, and spirit. They’re the parts of you that matter most.
More about my deformity and healing journey here: