20 Things You Need to Know Before Getting a Boob Job

DO YOUR RESEARCH. BECAUSE BIGGER BREASTS AREN'T ALL THEY'RE CRACKED UP TO BE.

As the stigma around plastic surgery wanes, procedures are on the rise, and none of them is as popular—or as classic—as the boob job. According to a recent report by the American Society of Plastic Surgeons, 300,378 people received breast augmentation in 2017, a 41% increase from 2000, making it the most commonly requested surgical procedure on the market. As omnipresent as the boob job appears to be, however, getting big boobs still a serious surgical procedure, and there's a lot that someone should take into consideration before embarking on such a costly undertaking. We spoke to Rian A. Maercks, a noted plastic surgeon based in Miami, Florida, on all of the things you should know before getting work done. 

1. Breast Augmentation Doesn't Just Mean "Bigger"

When speaking with potential clients, the first question Dr. Maercks asks is, "What do you want from the breast augmentation?" That might seem like a silly question, as the answer is no doubt "big boobs" or simply "bigger." But there's a lot more nuance to the procedure than you ever realized. bigger how? Do you want them to be big big or are you looking for something a little more natural? Do you want to change the shape or just the size? Do you want lots of cleavage? What is your concept of "perfect breasts"? All of these questions matter. 

"I don't like the term breast augmentation, because I don't like to make them look bigger so much as 'prettier.'" Dr. Maercks said. 

2. Do Your Due Diligence

Different plastic surgeons have their their own methods and preferred procedures, and the best way to get the one that works for you is to approach them the way you an artist whose paintings you want to hang up in your apartment. Check out their Instagram pages and think to yourself, "Do I like his/her work?"

3. Decide Between Saline And Silicone

There are two basic types of breast implants—saline and silicone—and they both have their pros and cons. Silicone gel implants feel more like real breasts, which is why they are generally more expensive and popular (Eighty-four percent of implants used in 2016 were silicone). However, saline implants are less prone to scarring or leaking and make it easier to detect cancer. Talk to your doctor about what options are right for you based the quality of your skin, the results you want, and your long-term concerns.

4. Don't Expect The Results to Last Forever

No matter what implant you choose, complications can arise that might require additional surgery in the future. Implants aren't lifetime devices, and twenty-five percent of women need a breast implant revision surgery ten years after their first operation. A deflated saline implant, ruptured silicone gel implant, thickening scar tissue, extreme weight loss, and even pregnancy can change the look of your new big boobs and require another operation.

5. Know Your Options

There are different approaches to boob jobs depending on the kind of results you want. A lot of people, for example, go for dual plane augmentation, in which the implant is placed under the pectoral muscle at the upper, and sometimes mid, part of the breast, but the lower part of the implant is not covered by the muscle. While this is perhaps the most commonly requested type of boob job, it isn't Dr. Maercks' preferred placement, as it makes the big boobs look really fake. Subpectorally placed implants tend to "bottom out" quickly as well, which means your big boobs don't have great longevity and patients will have to come in for additional revisions over the course of their lives. 

6. Research The Surgeon's Specialty

Within the plastic surgery community, subfascial breast augmentations are increasingly considered to be preferable to dual plane. In a subfascial placement, implants are placed between a strong tissue layer called pectoral fascia and the pectoralis muscle. Dr. Maercks has invented a modified version of this procedure called Cold-Subfascial Breast Augmentation, which, according to him, produces the best results.

"My system makes the breasts look more natural, with a teardrop shape, so that it looks like they're in a very supportive bra," he said. The point is that most plastic surgeons have their own trademark procedure, so it's worth knowing what their specialty approach is. 

7. Consider a Fat Transfer

In what sounds like voodoo magic that's too good to be true, it is possible to get a fat transfer, in which the surgeon literally take fat from one body part and shoves it into another.

"In the right patient, a fat transfer is great, Dr. Maercks said. "The right patient is someone who has fat, particularly in their side waist, and doesn't have empty pockets in the breast."

Meaning that if you're top-heavy and if you have a bit of extra belly fat, and your breasts haven't totally given in to gravity, this procedure could give you the Kim Kardashian bod you've always dreamed of. Some plastic surgeons won't do this procedure because they're worried there hasn't been enough longitudinal research to prove that you aren't hindering hinder future breast cancer detection by moving fat cells around, but increasing research has largely put that concern to rest. "Several years ago, some people were concerned that fat grafting increased your risk of breast cancer, but in the last 5 years no one would make that argument anymore," Maercks said. "Radiologists agree that it's no different from any other augmentation."

8. Consider a Composite Augmentation

According to Dr. Maercks, the optimal results really come from a composite augmentation, which is the cold-subfascial combined with a fat transfer. The problem is that this procedure is double the price because it's two augmentations in one surgery. 

9. Compare the Cost

According to the American Society of Plastic Surgeons, the average cost of a breast augmentation surgery was $3,719 in 2016, but that doesn't include anesthesia fees, hospital or surgical facility costs, medical tests, post-surgery garments, prescriptions for medication, and the surgeon's fee, which can bring it up to $10,000 or more. The cost of a boob job varies quite a lot by state, as well as country. New York has some of the highest costs, whereas Miami has some of the lowest. A lot of doctors also charge $300 or more just for consultations, which can make the process seem daunting if you're on the fence. The easiest thing to do is to call the office to inquire about cost. For example, Dr. Maercks charges $15,000 for breast augmentation, and $30,000 for a composite augmentation, but that covers everything, including the consultation.

10. Don't Cut Corners

There are a lot of countries in the world in which, thanks in large part to the exchange difference, you can get a boob job for significantly less than here. Thailand, Turkey, Mexico, and Belgium, for example, are popular "medical destinations" where the affordability of the boob job will more than offset the price of the flight over. Generally, however, Dr. Maercks wouldn't advise venturing outside of your home country for a surgical procedure. "There's a lot of things that's worth saving money on," he said, "but plastic surgery isn't one of them."

11. Plan Ahead

It typically takes 3 months or even more to schedule your appointment for surgery. So while there's no "right" time necessarily to start doing you research and making arrangements, doing so in the fall is popular as it enables you to get the surgery in the wintertime and be all spruced up for spring.

12. Make Room for Recovery

Thanks to modern advances, the recovery time for boob jobs is much shorter and lighter than it was 10 years ago. With Dr. Maercks, the patients usually send in photos for a virtual consultation, discuss options, and then book the surgery. A few months later, they fly out to Miami to get the procedure, do the surgery, take a long-lasting pain-relieving drug called Exparel, and just lounge by the pool for a few days before going home. Dr. Maercks does ask that patients stay for at least 5 days in case anything happens, but even that means you can be in and out while only taking a few days off from work.

13. Think About the Future

Unless your incision is made in the nipple, getting implants shouldn't interfere your ability to breastfeed after giving birth, so a boob job doesn't hinder your pregnancy. Getting pregnant, however, can hinder your boob job, because pregnancy does often change your breasts, and breastfeeding with implants can create exaggerated breast engorgement. If you're thinking of getting pregnant in the next 12 months or so, Maercks would suggest holding off on a boob job until after giving birth. According to Maercks, if you don't have any concrete plans to start a family in the future, there's no reason not to go for your big boobs now.

14. When It Comes to Big Boobs, Age Matters

Now that being shapely is back in style (thanks, Kim Kardashian and Emily Ratajkowski) Maercks has definitely noticed a boom in younger people coming in asking for breast augmentation. The FDA recommends that only women over the age of 18 get saline breast implants and only those over 22 get silicone breast implants, but those are just guidelines. There is no actual regulated minimum age for implant surgery, but because your breasts can continue to develop up to 20, it's really not a good idea to go for a breast augmentation earlier than that.

15. Rome Wasn't Built In a Day

Contrary to popular belief, you can't go from a size A to a DD in one surgery. Most surgeons will recommend going up one or two sizes, then doing another surgery sometime in the future if you want to go bigger. Your body and skin need time to adjust, after all.

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16. Don't Be Embarrassed

As time goes on, the stigma around plastic surgery becomes smaller and smaller, so there's no reason to let shame stop you. As Dr. Maercks said of boob jobs: "It's just normal these days."

17. Consider the Drawbacks

When you embark on a boob job, it's easy to only think of the positives, but there are a lot of negatives that even your plastic surgeon might not tell you beforehand. "I wish someone had told me that my big boobs were going to get so saggy after breastfeeding," one of my friends said. "I wasn't planning on having kids when I got my boob job three years ago, but now that I have a baby they are down to my knees."

18. Don't Be Afraid to Grill Your Doctor

Doctors have a tendency of doing the "I'm sorry I'm very busy" dance, but they need to answer all of your questions, regardless of how long it takes. The best thing to do is to make a long list of all of your questions prior to making an appointment, so you can knock them out one by one. It's an expensive procedure that, unlike a haircut, is supposed to last most of your life, so think of long-term concerns as well. For example, you might not be worried about breast cancer at the age of 27, but think about how you'll feel twenty years from now.

"I would have reconsidered my boob job if I had known that getting a mammogram would now be more difficult," one of my friends said. "At the time I was 25 and mammograms were the last thing on my mind. But now that I'm at an increased risk of breast cancer, it's something I wish I had known and taken into account."

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19. Talk to Other Women Who Have Had One

Your doctor is obligated to inform you of all of the possible risks associated with getting big boobs, but there are a lot of ways it can inconveniently affect your lifestyle that a doctor might fail or forget to mention. For that reason, it's a good idea to go on forums or ask friends about what day-to-day life is like after a boob job. In addition to breastfeeding issues, some of my friends complained that they had trouble exercising, and one had a particularly brutal horror story.

"My implant flipped inside my body while having sex," she said, of her new big boobs. "I had to to get it repositioned. I would have loved to know that that thing can MOVE."

20. Don't Expect It to Solve All Your Problems 

When accepting a client, what Dr. Maercks takes into account most of all is whether her desires are reasonable or the product of body dysmorphia. "There's a lot of young women with beautiful breasts who want to get breast augmentation and I try to talk them out of it," he said. No matter how good a boob job is, it won't cure deep-set body image issues.

When a good friend of mine got a boob job, she thought it was going to make her happy, as had felt insecure about her small breasts for her entire life. Instead, she said that, after the initial high, she became depressed, and just found other body parts to obsess over. More than anything, it's important to really consider why you're getting a boob job before doing it. If it's because your boob are asymmetrical and you want to fit better in clothes, then it's fine. If you think of it as a fun change, somewhat like a radical new haircut, then it's also fine.

But if you think it'll suddenly make you see yourself completely differently, or believe it'll make you more lovable, there might be greater emotional issues at work, and it's worth consulting with your therapist before making any drastic moves. Big boobs are great, but nothing is as important as your mental health.

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