Breast Augmentation FAQ: Answers From Dr. Cohen

 

By Dr. Michael Cohen, MD, FACS

Most patients arrive at a breast augmentation consultation with the same cluster of questions: Which implant is right for me? How much will it cost? When can I go back to work? A well-informed patient makes better decisions and recovers with far less anxiety, and the questions below are the ones Dr. Cohen's team at Belcara Health hears most often. Read through them before your visit, and you'll walk in ready to have a real conversation rather than a crash course.

What Is the Most Common Breast Augmentation Question Patients Ask?

The most common breast augmentation question is "Which implant size is right for me?" Size selection depends on your existing breast tissue, chest width, skin laxity, and lifestyle goals. In our practice, Dr. Cohen uses 3-D imaging and tissue-based planning to match implant dimensions to your anatomy rather than simply choosing a cup size.

Implant Type and Sizing Basics

What is the difference between silicone and saline implants?

Both silicone and saline implants have an outer silicone shell. The difference is what fills them. Saline implants are filled with sterile salt water after placement, so the incision can be slightly smaller. Silicone implants come pre-filled with a cohesive silicone gel that closely mimics the feel of natural breast tissue. Most patients who prioritise a natural look and feel choose silicone, while saline implants remain a reliable, cost-effective option with straightforward rupture detection (the implant deflates visibly). The FDA recommends MRI monitoring for silicone implants every few years, though your surgeon will give you a personalised screening schedule.

How is implant size chosen?

Implant size is measured in cubic centimetres (cc), not cup sizes. Cup sizes vary by bra brand and are not a reliable surgical target. In our practice, Dr. Cohen uses a combination of your chest wall width, pinch-thickness of your existing breast tissue, and your stated lifestyle goals to identify a range of implant volumes that will sit proportionately on your frame. You will have the opportunity to try sizers during your consultation so you can see and feel approximate outcomes before committing to a size.

What is the difference between round and anatomical (teardrop) implants?

Round implants are symmetrical and create fullness across the upper and lower pole of the breast. Anatomical, or teardrop, implants are shaped to be fuller at the bottom and tapered toward the top, mimicking a natural breast silhouette. Anatomical implants require a textured surface to prevent rotation, whereas round implants may be smooth or textured. For patients seeking natural-looking enhancement, both options can achieve strong results depending on your starting anatomy. Dr. Cohen will review which profile aligns with your goals at your consultation.

What implant profile should I choose?

Profile refers to how far the implant projects forward from the chest wall relative to its base width. Low-profile implants have a wider base and less forward projection, while high-profile implants have a narrower base and more projection. If you have a narrow chest but want noticeable volume, a higher-profile implant may be appropriate. Your tissue-based measurements guide this decision more reliably than personal preference alone.

Is there a weight limit or BMI requirement for breast augmentation?

There is no universal BMI cutoff, but your overall health, skin quality, and tissue thickness all affect candidacy and the recommended implant type. Patients who smoke or have poorly controlled chronic conditions are asked to address those factors before surgery. Dr. Cohen will review your full medical history at your consultation.

Placement and Incision Options

What does "over the muscle" versus "under the muscle" mean?

Implant placement refers to the layer of tissue in which the implant sits. Over-the-muscle (subglandular) placement positions the implant between the breast gland and the pectoral muscle. Under-the-muscle (submuscular or dual-plane) placement positions the implant partially or fully beneath the pectoralis major muscle. Submuscular placement is associated with lower rates of capsular contracture in many studies and generally produces a more natural upper-pole slope, particularly in patients with limited native breast tissue. Subglandular placement involves a shorter recovery and is preferred in certain anatomical situations, such as patients with significant existing breast tissue or those who are very physically active and do not want animation deformity (implant movement with muscle flexion). Dr. Cohen will explain which option your anatomy supports.

Where are the incisions made?

The three most common incision locations are:

• Inframammary fold (IMF): A short incision in the crease beneath the breast. This is the most common approach because it offers direct, precise pocket dissection and keeps the scar in a naturally concealed location.
• Periareolar: An incision around the lower half of the areola. Scarring blends with the colour transition of the areola but involves passing through breast tissue, which is relevant for patients planning to breastfeed.
• Transaxillary: An incision in the armpit. No scar on the breast itself, but pocket dissection is performed remotely, which requires endoscopic technique.

Most patients at Belcara Health choose the inframammary approach. Dr. Cohen will discuss the tradeoffs of each option relative to your anatomy and goals.

Will the scars be visible?

All incisions leave a scar. The inframammary scar typically matures to a thin, pale line that sits within the breast fold and is not visible when you are standing. Scar maturation takes 12 to 18 months. You will be given a scar-care protocol to follow postoperatively to support healing.

Motiva Preservé Candidacy

What is the Motiva Ergonomix implants?

Motiva Preservé is a next-generation silicone implant featuring a proprietary nano-textured surface (SilkSurface) and a progressive gel fill designed to move with the breast naturally. The shell is engineered to reduce gel bleed and the surface is designed to minimise the chronic inflammation associated with textured implants. Motiva implants also include a BluSeal indicator layer that allows visual confirmation of shell integrity and a Q Inside Safety Technology microchip for traceability.

Am I a candidate for breast augmentation?

Candidacy for breast augmentation at Belcara Health is determined during your consultation, based on your health history, tissue characteristics, and aesthetic goals. In general, ideal candidates are patients who:

• Are in good overall health with no active autoimmune conditions
• Have realistic expectations for a natural result
• Prefer a lower-profile, anatomically proportionate outcome
• Are committed to the recommended follow-up imaging schedule

Dr. Cohen will confirm your candidacy during your consultation after reviewing your health history and examining your tissue characteristics.

How do Motiva Ergonomix implants differ from standard silicone implants?

The key differences are the SilkSurface nano-texture (which aims to promote a more organised tissue response than macro-textured implants), the progressive gel cohesion (softer than traditional cohesive gel while maintaining shape), and the integrated microchip for lifetime traceability. Traditional smooth-shell silicone implants remain an excellent, well-studied option. Whether Motiva Ergonomix are the right choice for you depends on your anatomy, your longevity goals for the implant, and your candidacy assessment.

Have Motiva Ergonomix implants received FDA clearance?

Motiva Ergonomix breast implants received FDA approval for breast augmentation in the United States in 2024. Please confirm current regulatory status with Dr. Cohen's team at the time of your consultation, as this information is subject to update.

Cost and Financing Overview

How much does breast augmentation cost at Belcara Health?

The total investment for breast augmentation at Belcara Health varies by patient and surgical plan. It typically includes the surgeon's fee, anaesthesia, operating facility fee, implant cost, and postoperative visits. The cost of Motiva Ergonomix implants differs from standard silicone implants. Dr. Cohen's team will provide a personalised, itemised quote after your consultation.

What factors affect the total price?

The main variables that affect cost are:

• Implant type: Motiva Preservé implants carry a higher implant fee than standard silicone or saline.
• Placement approach: Submuscular dissection is technically more involved than subglandular placement and may affect operative time.
• Revision vs. primary augmentation: Revision surgery is typically more complex and is priced separately.
• Any combined procedures: If you are combining augmentation with a lift (augmentation mastopexy), the surgical time and fee increase accordingly.

Does insurance cover breast augmentation?

Cosmetic breast augmentation is not covered by standard health insurance. Reconstruction following mastectomy is covered under the Women's Health and Cancer Rights Act. If you are seeking augmentation for purely aesthetic reasons, your procedure will be self-pay.

What financing options are available?

Belcara Health works with trusted patient financing providers to offer plans with a range of term lengths and interest options. Your patient care coordinator will walk you through the application process after your consultation so you can focus on your surgical plan, not your budget, during the appointment.

Recovery Expectations

How long does breast augmentation recovery take?

Most patients return to a desk job or light work within 5 to 7 days after surgery. Lifting anything heavier than 5 to 10 pounds, vigorous exercise, and overhead activity are restricted for approximately 4 to 6 weeks. Full recovery, meaning the implants have settled into their final position and swelling has fully resolved, typically takes 3 to 6 months. Your individual timeline will depend on whether your implants are placed above or below the muscle (submuscular recovery is longer), your baseline fitness, and how closely you follow postoperative instructions.

What does the first week after surgery look like?

You will wake up from anaesthesia in a surgical bra, which you will wear continuously for the first several weeks, and your chest will feel tight and tender, particularly if your implants are placed under the muscle. Most patients describe the sensation as pressure rather than sharp pain, and it is managed effectively with the prescribed analgesic protocol. You will be seen in our office within the first few days for your first postoperative check. You should plan for a responsible adult to drive you home and stay with you for at least the first 24 hours.

When can I sleep normally?

For the first 2 to 4 weeks, you should sleep on your back with your upper body slightly elevated. This position reduces swelling and keeps the implants in proper position while the pocket heals. Side sleeping is typically permitted at around 4 to 6 weeks once the pocket has stabilised, though Dr. Cohen will confirm this based on your progress.

Will I lose nipple sensation?

Temporary changes in nipple and breast skin sensation are common and occur in a significant proportion of patients. Permanent loss of sensation is less common. The nerve most at risk is the fourth intercostal nerve, which provides sensation to the nipple-areola complex, particularly with periareolar incisions or very large implants that stretch the nerve. In most cases, sensation normalises over 3 to 12 months as nerves recover.

Can I breastfeed after breast augmentation?

Breast augmentation does not prevent breastfeeding in most cases, but certain factors affect your likelihood of success. Periareolar incisions carry a higher risk of disrupting milk ducts and nerves than inframammary incisions. Subglandular placement may put more pressure on the glandular tissue than submuscular placement. If breastfeeding is a priority for you, discuss this explicitly with Dr. Cohen so the incision and placement choices support your goal.

Do implants need to be replaced after 10 years?

Implants do not have an automatic expiration date. The "replace at 10 years" rule is a common misconception. You should consider revision if you experience a complication (rupture, capsular contracture, implant malposition) or if your aesthetic goals change. That said, implants are not lifetime devices. The longer you have them, the higher the cumulative probability of experiencing a complication that warrants intervention. Dr. Cohen will discuss a realistic longevity estimate for your specific implant at your consultation.

What is capsular contracture and how is it prevented?

Capsular contracture occurs when the scar tissue that normally forms around an implant tightens abnormally, compressing the implant. Symptoms range from a firmer feel to visible distortion and discomfort. Rates vary by implant type, surface texture, and placement plane. Submuscular placement and smooth or nano-textured surfaces are associated with lower contracture rates in published literature. Antibiotic irrigation of the pocket at the time of surgery and a meticulous no-touch implant insertion technique are standard preventive measures in our practice.

Booking Your Consult

What happens at a breast augmentation consultation at Belcara Health?

Your consultation with Dr. Cohen is a comprehensive appointment, typically 45 to 60 minutes. You will complete a health history intake, receive a physical examination of your chest and breast tissue, and discuss your goals in detail. Dr. Cohen will review imaging and use 3-D simulation to help you visualise potential outcomes. You will also have the opportunity to handle sizers and review before-and-after photos of patients with similar anatomy.

How do I prepare for my consultation?

Bring a list of any medications, supplements, and prior surgeries. Wear a comfortable top that is easy to change out of. If you have previous imaging or records from a prior breast surgery, bring those as well. Most importantly, come with questions. The consultation is your opportunity to understand exactly what the procedure involves and to confirm that Dr. Cohen's approach matches your expectations.

How far in advance should I schedule surgery?

Surgical availability at Belcara Health varies throughout the year. If you have a target date in mind (before a vacation, a wedding, or a specific season for recovery), factor that into when you book your consultation, since the consultation must precede scheduling.

Is a virtual consultation available?

Confirm current virtual consultation options with Dr. Cohen's office directly, as availability can change.

Book your breast augmentation consultation at Belcara Health to meet with Dr. Cohen, review your options in person, and receive a personalised surgical plan built around your anatomy and goals.

Reviewed by Dr. Michael D. Cohen, MD, FACS