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Frequently Asked Questions

With the rise and popularity of social media and live streaming, Bancroft Feldman Plastic Surgery is proud to share what we've been doing thousands of times since 2011 in our procedure room, on Instagram Live. We do our best to highlight as many patient surgeries and experiences as possible, but due to technical, logistical and financial constraints cannot fulfill every request.

A way to increase the chance of being featured live and/or having surgery filmed is by sharing your story on social media with posts, photos and videos that are linked to @bancroftfeldman for surgery by Dr. Bancroft or @breastexpert for Breast Enhancement by Dr. Feldman. Rather than create specific metrics for evaluation, we simply want to encourage our patient's to “wow” us and showcase their personality, share their unique experience, and demonstrate how they would best represent Bancroft Feldman Plastic Surgery before and after surgery. Stories will be evaluated and ranked for number of likes, follows, re-posts, patient referrals, positive feedback, community service, military service by themselves or family members and creativity.

We try to accommodate most requests, but unfortunately cannot guarantee every one. Our number one priority during surgery is patient safety, then results. As such, payment for breast augmentation is payment for surgical care, but does not include videography, as that's not an essential part of your safety or results.

Should you desire an edited HD, narrated, video of your procedure, this can be pre-arranged for $1000 at your preoperative appointment.

We're as excited about your results as you are, and are equally as thrilled that you're interested in showing off your new look! We do our best to accommodate all requests. The first step in the process is to become a brand Ambassador for Bancroft Feldman Plastic Surgery.

This involves:

Referring at least 3 friends or family who ultimately choose to have surgery with Dr. Feldman or Dr. Bancroft.

OR

Referring at least 5 friends or family who are new injectable (Botox, Restylane, Juvederm, etc.) patients to our practice.

AND

Sharing your story on social media with posts, photos and videos that are linked to @bancroftfeldman for surgery by Dr. Bancroft or @breastexpert for Breast Enhancement by Dr. Feldman. Rather than create specific metrics for evaluation, we simply want to encourage our Ambassadors to “wow” us and showcase their personality, share their unique experience, and demonstrate how they would best represent Bancroft Feldman Plastic Surgery. Stories will be evaluated and ranked for number of likes, follows, re-posts, patient referrals, positive feedback, community service, military service by themselves or family members and creativity.

Again we try to accommodate most requests, but unfortunately cannot guarantee every one, as we're limited by budget and logistics.

Unfortunately we do not have a viewing theater for our operating room, so requests for non-staff members to watch surgery onsite cannot be accommodated. Surgery, and the operating room environment is serious, requiring proper training, accreditation and utmost attention to proper sterile technique, particularly when implantable devices are being placed. As such, our accreditation (AAAASF) and malpractice carriers do not allow for non-employees to be present inside our procedure room when a surgery is being performed.

Although we cannot allow visitors into the operating room, we do often have live social media broadcasts (@breastexpert) and/or YouTube videos of the procedures performed at Bancroft Feldman Plastic Surgery.

This is called a Mondor's cord or band, and is actually a very small superficial vein in or just under your chest/breast skin that was cauterized and subsequently clotted (thrombosed) when making your breast augmentation incision. It's completely benign, and should not be confused with deep vein thromboses (DVT) a much more serious and unrelated condition involving blood clots in the legs. The body will reabsorb the thrombosed vein over time, without lasting effects, but in the short term it can be sore from associated inflammation. NSAIDs like Celebrex, Aleve or Ibuprofen can help reduce discomfort as can warm compresses. The condition is self-limited, resolving over a few weeks, and does not require any additional surgical intervention.

MondorsCord

Unfortunately there is no good evidence in the medical literature to support taking, or not taking, antibiotics prior to dental treatments, so Dr. Feldman likes to take a common sense approach of weighing relative risk vs. benefit and allowing patients to choose.

The concern is that bacteria may enter your bloodstream during dental work, as the mouth harbors normal flora (bacteria) which could potentially travel through your body and end up attached to the implant and/or it's capsule resulting in an infection or contracture. The overall risk of infection in a patient with breast implants is not higher than a patient without implants, but the impact can be more significant as the body may not clear the infection from the implant, requiring removal, or it could result in contracture. Just like in real estate infections are all about location, location, location. Implant infections can become a breast threatening complication.

Some plastic surgeons advocate taking prophylactic antibiotics before any dental work due to the low perceived risk of a single dose of antibiotics, versus the, albeit extremely rare, potential for a breast threatening complication requiring surgery like infection and/or contracture. The reality is there are only a small number of reports of post-dental work breast implant complications, particularly noteworthy as breast augmentation is the most common plastic surgical procedure in the US. Therefore, no direct correlations can be made from the anecdotal evidence. Did the implant complication actually result from dental work or would it have happened anyway? Unfortunately, we currently just don't know. The dentists do not recommended blanket prophylaxis, due to lack of evidence, unless a patient has had prior implant complications like infection or contracture.

So predictably, surgeons who are intimately familiar with the challenges of implant complications err on minimizing any risk, whether its actual or perceived, and dentists err on caution avoiding potentially unnecessary antibiotics use, but give themselves the bail out of deferring to the surgeon for patients with prior complications. This is similar to orthopedic or transplant surgeons who recommend prophylaxis in patients with artificial joints or solid organ transplants, while dentists generally do not.

Although it's extremely low risk, in life, there is never zero risk. So Dr. Feldman tries to stratify the risk and benefits. In Dr. Feldman's opinion a routine cleaning in a patient who goes religiously to the dentist every 6 months, and has no significant dental issue or plaque buildup, would be lower risk than a patient with active infection like an abscess, cavity or periodontal disease and therefore bases his recommendations on overall bacterial load, invasiveness of dental procedure and patient preference.

Dr. Feldman's recommendations are:

If you're having a routine 6 month cleaning and exam, without any active dental problems, and have had no prior breast implant issues, it's completely up to the patient and his/her dentist. We will send prescription if the patient desires, but do not require prophylaxis.

If you haven't been to the dentist regularly (more than 12 months since last cleaning/exam), have a cavity, or think you may require more dental work than just a "cleaning," Dr. Feldman would recommend antibiotic prophylaxis.

If you have significant dental issues like an abscess, multiple cavities, active periodontal disease that create a much higher bacterial load and require invasive dental treatment or have had prior breast implant infection or contracture, Dr. Feldman would require antibiotic prophylaxis.

 

The overwhelming majority of breast implant patients will find dental work, with or without, prophylaxis to be uneventful.

Why are you worried about washing your hair? You just had surgery! You should not be going anywhere or doing anything that requires perfectly done hair, or have gotten hot and sweaty before your post-operative appointment. It's not the time to get creative, and certainly not the time to show off or enjoy your breasts anywhere that requires you to have your hair done. Even laying way back, or forward under the tub faucet, kitchen sink or at salon can jeopardize your results and increase complications. You can easily fix your hair once cleared by Dr. Feldman, without additional surgery and expense.

If your breasts have no issues at your post-operative appointment, Dr. Feldman will clear you to shower and gingerly wash your hair.

When patient's come to their post-operative appointment with hair and makeup done, dressed to impress, Dr. Feldman knows that there is no way they did not over use their arms, take off their bra or shower. Why risk your result?

We want breast augmentation with Dr. Feldman to be a positive experience, but that positivity requires preparation. Let’s discuss aftercare, and what Dr. Feldman believes is important, and what is not, as aftercare, or lack thereof, is a huge influence on the end result. There are many ways around the mountain, every surgeon has his/her own approach, and therefore no one is right or wrong, just different.

If you trust Dr. Feldman to perform your surgery, please trust his restrictions, instructions and appointment scheduling, to get you to heal with the best result and lowest possible complication rate. Remember he and his staff have done this over 3000 times. Dr. Feldman is the @breastexpert and has established an overwhelmingly successful process, that focuses on education, and empowerment, more so than frequent “check ups” as so many of his patients travel great distances for surgery. 

Many of the complications encountered after breast augmentation are preventable and directly attributable to not following activity restrictions, supportive bra use and/or massage after surgery. Compliance with our instructions, and restrictions, plays as large a role, or even larger, in your result and chance of complication as the surgery itself. Unfortunately, actions have consequences, and many times, unapproved overuse, will lead to complications including but not limited to bleeding, bruising, hematoma, contracture, implant malposition or symmastia. Most of Dr. Feldman's patients overdo it, most get away with it, but about 5% don't, meaning approximately 5 out of every 100 surgeries require another operation in the first 6 months that could have been avoided by following our instructions. Following the instructions given by a friend, or what is posted on RealSelf, does NOT overrule or replace our specific restrictions and information. Now is not the time to get creative.

As such, we ask all of our patients, and their caregiver(s), to sign a compliance pledge. These are our expectations: Commit to four mandatory appointments: Your pre-operative appointment (1-2 weeks before surgery), your surgery, your post-operative appointment (1-3 days after surgery) and follow-up appointment (2 weeks after surgery). The  timing of these of these appointments is essential and therefore non-negotiable. We expect patients to be attentive when in the exam room, not distracted by children, recreational drugs, or their phone during all of these appointments. Surgery is serious, and results depend on the information discussed at these appointments. Unfortunately, just coming to these appointments is not enough. Patients need to fully commit to the healing process, following each and every restriction, instruction and recommendation precisely. Physical presence in Dr. Feldman's office does NOT prevent complications, compliance does. As this is not Dr. Feldman's first rodeo, compliance will be confirmed by exam, as patients often tell us what they think we want to hear, while their breasts are screaming a different story. You can't over take it easy, but every little thing adds up to affect your result.

Our patients are always welcome to come back for an optional "bra check" appointment during the first six months after surgery, if that provides additional peace of mind, or is needed to reinforce our guidelines and instructions. Since Dr. Feldman spends so much time with each and every patient, and blocks an hour for any long term follow-up appointment, the schedule remains full. We do our best to prioritize the urgency of add-on appointments, triaging with questionnaires or photos submitted electronically. Depending upon time of year “well visits” can indeed take a few weeks to be scheduled. What other doctor, forget just surgeons, will personally spend an hour or more with you at a consult, 15-30 mins per appointment at your two mandatory follow up appointments, and another hour, if needed, to discuss healing, bras and long term progress? Unfortunately, an extra 30 minute appointment, commonly requested seeking reassurance following non-compliance, doesn’t prevent a complication, rather, following Dr. Feldman's restrictions and instructions 24/7 does. It takes way more work and discipline to behave 24/7 during the healing phase than it does to request an extra appointment, but the proof is in the reliable, predictable, pleasing results and low complication rates achieved by compliant patients who follow our instructions.

Aftercare and compliance with activity restrictions, what Dr. Feldman collectively calls “pride of ownership” is so important, Dr. Feldman starts talking about this during the initial consult. He discusses that patient non-compliance is the most frustrating part of his job and the largest obstacle to an amazing result. 4 out of 5 complications requiring revision surgery are preventable and avoidable. Patients must become their own best advocate. Unfortunately showing up for a couple, or more appointments, seeking reassurance, is not a substitute for following the detailed instructions and restrictions provided religiously. Being physically present at appointments whether there are two or two-hundred, while doing things we ask patients not to do, or choosing not to do things we instruct patients to do, between those appointments, predictably leads to sub-optimal results and/or complications. It’s also important to remember a surgeon really only has one trick, and that’s more surgery, for additional cost yielding less pleasing results. Hope is not a surgical technique or recovery plan.

We use the “teach a patient how to fish, rather than giving them a fish” approach with in-depth, hands on, education at the two week follow-up where we go over bra sizing, massage and long term return to activities, in detail. Countless patients’ friends and family who have had surgery elsewhere, and are present for these visits, always comment that they were never given any of that information. They most likely had a higher number of follow-up appointments with staff, but may have never seen the surgeon again or may have gotten just a quick “pop in." Quantity is NO substitute for quality.

As such, it’s not the quantity of appointments, but rather the quality of education that occurs during the appointment that truly matters, in Dr. Feldman’s opinion.

All of our patients are provided detailed instructions verbally by Dr. Feldman, Jeannette, our RN, as well as instructions in writing via email, paper handout and it’s all posted electronically on the website. In addition, we have 65 frequently asked questions and answers, in an easily understandable, bluntly honest format on our site. No other surgeon goes that far, or spends that much time and effort educating patients about aftercare with so many delivery methods. I encourage all of my prospective patients to look at competitors sites, before and and after photos and to get second opinions to see first hand who is truly focused on your education, result and aftercare, versus who promises "negligible complications, rapid recovery, and wish list picture results." We go to these extreme lengths because we’re focused on one thing, the result. What patients do after surgery is as big an impact on the result as the surgery itself. In fact most competitors deliberately sugar coat, hide or minimize restrictions to avoid scaring off potential patients. We can lead a horse to water, but it’s up to the horse to drink. All of our patients are provided the same information and tools to setup them up for success, but ultimately it’s up to the patient to become their own best advocate thereby possessing true, pride of ownership.

If your rash is mild, and is limited to only your breasts, it's likely a contact dermatitis allergy from the bra (they're brand new unwashed fabric) or the powerful antibacterial soap used to prevent infections during surgery. These reactions tend to be mild, and will resolve when you're cleared to shower after your first post-op appointment. You can take Claritin, Zyrtec or Benadryl to help with mild itching.

If the rash is even more concentrated, in a perfect rectangle, only around your incision/steri-strips, it is most likely an adhesive allergy or mild yeast infection, which also is self-limiting and will improve upon removal of steri-strips. Do not remove your steri-strips without contacting the office first.

If you have a rash all over your body this is likely a drug reaction/allergy. The most likely medication causing this is your antibiotic. Most patients (unless you have been previously diagnosed with a sulfa allergy) have been given Bactrim (generic name sulfamethoxazole and trimethoprim or TMP-SMZ) as it is active against resistant staph aureus infections (MRSA), the most common cause of breast implant infections as published by Dr. Feldman. About 3.5% of woman have a sulfa allergy, and often it does not appear until the second time you take a sulfa antibiotic like Bactrim.

The reaction can range from mild itching, to severe rash, to even difficulty breathing, seeing or swallowing! You want to contact the office and stop taking the antibiotic as soon as you notice the rash. If you have a severe rash, eye, throat or breathing involvement you will need to go to the closest urgent care or ER. The rash and symptoms can progress, and spread, even after stopping the antibiotic for up to two weeks and can take even longer to go away.

You will likely be prescribed a different antibiotic, steroid dose pack and encouraged to take Claritin, Zyrtec or Benadryl as well as Pepcid to help block the histamine release caused the allergy. Topical, over the counter, hydrocortisone creams or SARNA can be applied to the most symptomatic skin areas.

Finally, don't forget to inform all future health care providers of your Sulfa allergy.

Leave the art for oil paint and canvas at collectives in San Francisco. Go with an engineering and science based approach for your breasts at Bancroft Feldman Plastic Surgery.

Dr. Feldman's dimensional planning uses a data driven, analytical approach to select implants based your chest and breast measurements with adjustments for your anatomical asymmetry that therefore will always be proportionate to your frame.

Hope is not a surgical technique nor sizing method.

To better understand what is going on in Dr. Feldman's mind during your exam and implant sizing, let's review some basic engineering, geometry and math terminology he frequently discusses during your consult (and most have forgotten from high school).

Hypotenuse
In geometry, a hypotenuse is the longest side of a right-angled triangle, the side opposite of the right angle. The length of the hypotenuse of a right triangle can be found using the Pythagorean theorem, which states that the square of the length of the hypotenuse equals the sum of the squares of the lengths of the other two sides.

Dr. Feldman may discuss how your rib angle or anatomy will require a different width implant due to prominent breastbone, as the implant will sit on the hypotenuse rather than shorter base width.

Equilateral triangle
In geometry, an equilateral triangle is a triangle in which all three sides are equal. In the familiar Euclidean geometry, equilateral triangles are also equiangular; that is, all three internal angles are also congruent to each other and are each 60°.
The ideal breast aesthetic is an equilateral triangle when measuring the distance from sternal notch to each nipple, as well as the distance between your nipples.

Diameter
In geometry, a diameter of a circle is any straight line segment that passes through the center of the circle and whose endpoints lie on the circle. It can also be defined as the longest chord of the circle. Both definitions are also valid for the diameter of a sphere. In more modern usage, the length of a diameter is also called the diameter. In this sense one speaks of the diameter rather than a diameter (which refers to the line itself), because all diameters of a circle or sphere have the same length, this being twice the radius r.

Dr. Feldman uses round implants almost exclusively, and the implant diameter must match your adjusted chest/breast base width measurement. This is how implants are selected, and it has nothing to do with cc’s or cup sizes.

Slope
In mathematics, the slope or gradient of a line is a number that describes both the direction and the steepness of the line. Slope is calculated by finding the ratio of the "vertical change" to the "horizontal change" between (any) two distinct points on a line.

The less slope an implant has (another way to think of this is width to projection ratio) the more natural a shape it will have from the side profile. The more slope (and therefore projection) an implant has the less natural the breast will be. The slope will be determined by the implant profile. Slope will increase from low to moderate, moderate to full, and full to extra full.

Moment arm (torque)
The magnitude of torque depends on three quantities: the force applied, the length of the lever arm connecting the axis to the point of force application, and the angle between the force vector and the lever arm

The more force, and further from the axis that force occurs, the higher the torque or moment arm. As force due to  implant size/weight increase so does the torque. This is why a result with larger implants will not last as long as more conservative implants all other variables the same. The moment arm or torque on your neck, upper back and shoulders of large perky breasts is much less than those of the same large breasts when they’re droopy, as the droppy breasts have a longer lever arm length. Think about holding a cup of coffee against your chest. You could do it all day long. Now hold that same cup of coffee with arm outstretched. You will only last a few minutes! That’s a moment (lever) arm.

Concave
The word concave means curving in or hollowed inward, as opposed to convex. Pectus Excavatum is a rib deformity with a concave chest shape.

Convex
Convex, meaning "curving out" or "extending outward. Pectus Carinatum is a rib deformity with convex rib shape.

Diverging Lines
Two or more lines that get further and further apart towards the end. Nipples that are laterally malpositioned, or ribs that are angled outwards (pectus carinatum) create diverging breast and nipple lines that may be exaggerated by augmentation as the implant adds projection.

Converging Lines
Two or more lines that get closer and closer towards the end. Nipples that are medially malpositioned, or ribs that are angled inwards create converging lines that may be exaggerated by augmentation.

 

Sources:
https://en.wikipedia.org/wiki/Hypotenuse
https://en.wikipedia.org/wiki/Equilateral_triangle
https://en.wikipedia.org/wiki/Diameter
https://en.wikipedia.org/wiki/Slope
https://en.wikipedia.org/wiki/Torque#Moment_arm_formula
https://en.wikipedia.org/wiki/Concave
https://en.wikipedia.org/wiki/Convex
http://www.mathsisfun.com/definitions/converging-lines.html

A-M-A-Z-I-N-G Results  This ultimately is the ONLY thing that matters. Pricing, implant brand, bra vs. no bra during recovery, proprietary or special techniques, location, years’ experience and catchy marketing gimmicks mean nothing if you're disappointed in your end result. Do you want to read about a surgeon's philosophy or see their actual results? A picture is worth a thousand words.

Before and After Photos of Actual Patients All photos on our before & after and model galleries, are ACTUAL surgical patients of Bancroft Feldman Plastic Surgery. Be careful on competitors' websites as suddenly you're whisked away to a generic gallery of other surgeon’s photos. Why aren't they showing you their patients? They don't have many or aren't proud of their work!

Covering all the Angles Compare our before and after gallery. We show you every view/angle of every patient. Why do our competitors' only show 1 view? Why does patient A have a frontal and patient B have a side view? They're hiding their less than ideal results in those views. Now remember that's likely their best work, so what does an average result look like?

Volume and Sub-specialization Dr. Feldman specializes only in breast enhancement. We operate on 500+ breast patients annually, and see even more consults. As a result Dr. Feldman can identify particular issues with your breasts the competition will miss, ignore or not know how to correct. If you don't identify a particular breast deformity, how can you assemble a treatment plan? Ask your surgeon how many breast augmentations they did last year, not how long they've been in practice. Practice makes perfect and gray hair doesn't guarantee a better result!

Allergan Implants Dr. Feldman uses Allergan implants exclusively, as they have the best durability data, and most comprehensive catalog of silicone implant options. Mentor has inferior durability and is only used since it's cheaper.

Consultation Experience Dr. Feldman's personally trained staff will spend an hour with you at your consult. Don't make such an important decision based on pamphlets, corporate sales staff or videos! We encourage second opinions so you can compare our consult experience to our competitors'. Did you have an exam with a full set of measurements? Did they explain dimensional planning? Did they discuss your preoperative breast anatomy, any deformities present, and whether they will improve, stay the same or could get worse with augmentation?

Dr. Feldman and his staff will make specific recommendations for your body and breasts based on: 1) dimensional planning 2) expressed goals 3) amount and quality of tissue to hide the implant.

Engineering Degree With Dr. Feldman’s engineering training, in addition to the technical ability to perform a breast enhancement operation; he possesses a thorough understanding of the implant materials and the biomechanical impact of augmentation surgery.

Peer Recognition Dr. Feldman has been recognized as publishing one of the most important cosmetic breast surgery articles, of the past decade, by the editorial staff of the prestigious Plastic and Reconstructive Surgery Journal. 

High Profile Clientele Dr. Feldman has operated on Playboy playmates, Miss USA contestants, reigning state and city pageant winners, models from the Ford modeling agency as well as local and regional celebrities, performers and PTA moms.

AAAASF Accredited Operating Room We are Class C (General anesthesia, TIVA and Propofol) AAAASF Certified, the Gold Standard for non-hospital operating room certification. Don't risk surgery in non-accredited facilities or dangerous hospital acquired resistant infections at a large facility.

Although there are no medical, health or safety risks to waiting, after a few weeks the pocket/capsule around the deflated implant begins contracting and scarring down. This creates a cosmetic issue. If you wait 3-6 months, for financial or logistical reasons, you now have to remove all the crinkled contracted scar tissue. When the same implant that deflated is replaced, the breasts no longer will look as good, or as symmetric, as they did prior to failure due to contracture of that pocket and necessary surgical capsulectomy. You now have apples on one side and bananas on the other.

As such, after seeing some less than ideal, delayed, ruptured saline exchanges from other surgeons, in my practice, I require patients to either: 1) have a failed saline implant exchanged within 2 weeks of deflation, or if not possible, 2) require them to voluntarily deflate the other breast implant and wait a minimum 6-8 weeks, with both deflated, so upon replacement the same procedure is then performed on both sides to yield the best symmetry and result. It's all about one thing, the best possible result, as well as durability, not what's the cheapest. An unhappy patient no longer cares about price, and would ultimately spend more trying to improve symmetry.

I explain this policy to any of my patients who select saline (less than 1%) before their primary augmentation and before seeing a failed device from another surgeon.

No you do not. If your breasts look and feel good there has never been a documented medical or safety benefit to time based, scheduled, surgical implant exchange. Surgery has both cost and risk associated with it. Device failure does increase with age, but for Allergan silicone products (which Dr Feldman uses exclusively) their failure rate is 3x lower than Mentor products with thinner shells at 10 years!

At 10 years, with Allergan brand implants, 25-33% of woman have had more surgery, meaning 67-75% have not. The majority are not having complications like device failure or contracture but rather have chosen to have cosmetic surgery, such as going larger or having a lift, most likely due to changes secondary to life events, like pregnancy or weight fluctuations. Overall, it's about a 3% per year, cumulative risk of more surgery, for all reasons. This means your implants, or more likely your result, are unlikely to last forever, and on average half of woman will have another surgery at 15 years, and 100% according to statistics by 33 years.

Simply put: Reviews can be faked or bought, Results can't!

I often hear from my patients that everyone seems to have a 4.5 star or better review rating but the quality of their results are sub standard.

Unfortunately there are thousands of domestic and international marketing, SEO (search engine optimization), and online "web presence" companies who are very willing to create fake profiles on Google, RealSelf, HealthGrades, Amazon and Yelp for a fee. Yelp is the only company that tries to detect fake reviews, which while appreciated, can end up hiding legitimate reviews as well.

Some competitors hire these firms to try to "bury" legitimate bad reviews with dozens or hundreds of fake good reviews. Others want to have more reviews than anyone else so they may supplement a few good legitimate reviews with hundreds or thousands of fake reviews. Worse yet, some will hire companies to post fake bad reviews about their competitors.

In depth, lengthy and detailed reviews, including profiles with before and after photos and specific names of our employees on RealSelf or Google can be a fantastic research tool and opportunity for patients to interact before ever seeing a surgeon and are too challenging and costly to create. On the other hand, anonymous 1-5 star reviews, without name or photos, as their only post, without explanation or detail of the encounter should raise red flags.

When shopping on Amazon you can always find examples where an off brand product is being sold by a third party and has a thousand five star reviews posted in a very short time span. The only 1 star reviews will be actual "Amazon verified purchase" reviews that indicate the product is sub standard when a legitimate review is created by a consumer and sometimes even indicating the other reviews are likely fake. The only way to verify this is to click on the rating and dig a little deeper rather than just seeing 4.8/5.0 1200 reviews on the main page and leaving it at that.

Although it would be incredibly unethical to fake actual before and after photos, unbelievably, there have been instances of photos being stolen and used by other surgeons.

All photos on our before & after and model galleries, are ACTUAL surgical patients of Bancroft Feldman Plastic Surgery. Even our featured homepage photos and procedure thumbnails are our actual patients. Be careful on competitors' sites as suddenly you're whisked away to a generic gallery of other surgeons photos or there are disclaimers about the site filled with stock professional model photos whose look and result cannot be guaranteed. Why aren't they showing you their patients? They don't have many or aren't proud of their work!

Compare our before and after gallery. We show you every view/angle of every patient. Why do our competitors' only show 1 view? Why does patient A have a frontal and patient B have a side view? They're hiding their less than ideal results in those views. Now remember that's likely their best work, so what does an average result look like? When you start putting all of this together you can start figuring out who actually does a lot of breast augmentations and who dabbles pretending to be an expert at anything and everything and spends more time purchasing content and reviews than doing surgery.

The courage to say "No" to a patient when they ask about having another procedure or demand an implant size that won't look pleasing, says far more about a surgeon's ability and passion than anything else.

While nobody can please everyone, we do our best at Bancroft Feldman Plastic Surgery to educate and empower the patient to make the best decisions for themselves. We also try to be honest and paint a realistic picture of expectations before surgery (which is not always fun and glamorous) in order to achieve patient satisfaction after surgery.

If you've had surgery and have had a positive experience we'd love for you to share. Dr. Feldman invests a lot of time on RealSelf and Google.

If you have any questions or concerns about your surgery or results, contact Jeannette jp@bfprs.com to discuss your options.

This happens in a few percent of patients and although uncommon, is typically nothing to worry about. It likely happens from a combination of swelling and increased blood flow to breast glandular tissue during early healing. As long as the milk comes out and doesn't collect around the implant you should be fine. In fact it should stop quickly on its own. If it does not you can try over the counter pseudoephedrine or a combination Zyrtec-D or Allerga-D (only available behind pharmacy counter) or contact Dr Feldman for a prescription to dry the milk. This is why it's important to let Dr Feldman know before surgery if you're still or have recently stopped lactating.

You can gently ride a stationary upright or recumbent bike starting 2 weeks after surgery, but take it easy, this is not the time to log miles and train for the Tour de France or Ironman triathlon. No sprinting, spin classes or road bike on rollers at this time. You can begin longer, more intense, indoor rides at 8 weeks post-op. Riding a bicycle outdoors is inherently dangerous. Trust me from first hand experience and numerous cycling crashes. It's just not worth the risk to ride outside, whether casually around the neighborhood, on a charity ride, or group training ride for at least 3 months after surgery. While you may get away with it, it's just not worth the risk.

Preparing for surgery logistically, emotionally and financially beforehand is one of the most important, and often overlooked, keys to a stress and complication free surgical experience.

The best things to do to before your surgery that nobody thinks of:

  1. Establish a plan with your boss, and co-workers, for activity and lifting restrictions at work. Remember 2lbs for 2 weeks. Most people lift more than they think at work.
  2. Setup full time child care for 5 days and daytime help for at least two weeks, if applicable. Moms will be moms no matter what.
  3. Put gym memberships/personal trainers on hold.
  4. Fill prescriptions, and purchase over the counter laxative of choice (Dulcolax, Miralax or Senna). Read “Your Prescriptions Explained” handout provided at preop appointment.
  5. Bring your prescriptions with you to surgery.
  6. Read information provided at preop and all information/FAQs on our website about what restrictions you will have, and what to expect after surgery, at least twice
  7. Avoid aspirin, Aleve, Ibuprofen, Motrin,  Excedrin, Midol, Vitamin E and Fish Oil supplements for at least 2 weeks before surgery
  8. Clean your house/apt before surgery
  9. Prepare and freeze meals for 2 weeks after surgery, or setup food delivery apps on phone (Door Dash, Grub Hub, Uber Eats etc. for food, Shipt or Walmart for groceries)
  10. Wash and fold all laundry for two weeks of clean clothes
  11. Eat a well-balanced diet high in lean protein
  12. Stay hydrated
  13. Avoid excessive alcohol consumption for two weeks before surgery
  14. Setup a ride for the day of surgery and your first post op appointment
  15. Have a full tank of gas in your car so you don't have to fill it up right as you begin driving after surgery
  16. Work overtime, doubles, extra shifts before surgery to have extra money to ensure you are not forced to overdo it during your recovery at work to pay bills, car note, rent or in the event of a complication. Work less hours, less busy shifts, or book half as many clients as usual upon return to work.
  17. Be proud of your decision to have surgery. Hiding your surgery inherently means you will be unable to follow specific post-operative instructions and restrictions. You don't want a complication and/or revision to be the reason your friends and family find out you've had surgery!

A frustrating part of Dr. Feldman's practice is when patients' fail to take breast augmentation surgery and their results seriously. Many of the complications encountered after breast augmentation are preventable. Setting yourself up for success is essential to minimizing your risks and protecting your investment. It’s no different than putting a case on your new smartphone. If you the crack the screen, or mess up your boobs, it’s no one’s fault but your own.

There are three commonly used types of imaging modalities for breasts:

  • X-rays (Mammogram)
  • Ultrasound
  • MRI

Each technology has benefits and drawbacks.

Mammograms are X-rays of breast tissue. They are done in multiple views and are taken while compressing the breast. Some new mammogram technology may allow techniques that are more gentle. Mammograms are safe after breast augmentation and have extremely low probability of rupturing a breast implant, versus 1 in 8 woman who will develop breast cancer. Mammograms are currently the gold standard for breast cancer screening as they are very specific, meaning they give very few false positive diagnoses. Unfortunately, no test is perfect and mammograms do not have as high a sensitivity, meaning there can be false negative results. New computer aided and 3D technology aims to improve sensitivity while maintains specificity. When implants are placed under the muscle or dual plane they do not interfere with mammography.

Ultrasound uses sound waves to detect abnormalities within the breast. Woman with very dense breasts, implants or abnormalities found on mammogram may be asked to have an ultrasound to further evaluate their breasts in an attempt to improve sensitivity (reduce number of false negative results). Ultrasound can also be useful for looking at breast implant shell for failure or to detect fluid around implants. Ultrasound exams are frequently required by insurance companies to have an abnormality, or to be inconclusive, prior to the insurance company approving a breast MRI. Ultrasound is frequently used as guidance during biopsies as well.

MRI uses a magnetic field and special intravenous contrast to image the breast. Since it requires IV contrast it is the most invasive of the imaging modalities, and requires a specialized MRI machine not available at all medical centers. The recommendation by the FDA for silicone implants is to have an MRI after 3 years then every other year thereafter to look for "silent" silicone implant rupture, regardless of patient age, and may not replace screening mammograms. MRI's are super sensitive meaning they won't miss anything, and have few false negatives, but are not specific about what they detect, which is why they're not a good screening tool. Too many woman would end getting a false positive diagnosis or biopsy for a spot on MRI that turns out to be nothing to worry about. If you stick a needle into your breast for biopsy every two years from a positive super sensitive MRI, eventually the implant will be accidentally ruptured as a result of the test looking for that exact problem! As the MRI is only prescribed for implant status by your plastic surgeon, it would be up to your PCP to decide MRI could supplant your screening mammography. In today's litigious society my guess is no. Finally, there is currently no data to indicate improved outcomes in average breast cancer risk woman with MRI, so very few, if any, insurance companies will pay for breast MRI in otherwise healthy, average risk, patients regardless of implants and FDA recommendation.

First, it’s important to clarify:

  • ALCL is not breast cancer
  • It’s extremely rare, with a total of 359 cases ever reported in the 55 year history of breast implants, versus 692 women diagnosed every single day in the US alone with breast cancer.
  • ALCL seems to have a very strong link, if not exclusivity, to TEXTURED implant shells of which Dr. Feldman has placed only one set.
  • 99.9% of the implants placed by Dr. Feldman have smooth shells.
  • With proper diagnosis and timely treatment ALCL is a curable illness.

The FDA database identified 359 cases of BIA-ALCL as of February 1, 2017. The FDA acknowledges “the MDR system is a valuable source of information, but it may contain incomplete, inaccurate, untimely, unverified, or biased data.” As such, the ASPS task force created the PROFILE database, which has identified 126 confirmed unique cases of BIA-ALCL as of the most recent report available, and a peer reviewed exhaustive literature review published in 2015 identified 173 cases.

The strongest unifying theme, in both databases and literature is the extremely strong link, or even exclusivity, to textured implant shells. The FDA databank identified 28 cases BIA-ALCL with smooth implants in place at time of diagnosis; however, each and every one, previously had textured implants. That means every case of BIA-ALCL, with record of implant specifics, had textured implants at some point prior to diagnosis!

The good news is that Dr. Feldman often cautioned against, and rarely used textured implants. In fact, 99.9% of the implants placed by Dr. Feldman have smooth shells (he has placed only 1 set of textured implants). This instantly reduces your risk of ALCL by at least 90%. In fact, no cases have been documented with smooth shell implants and no prior exposure to textured devices.

If you have an Allergan Natrelle Saline 68LP, 68MP, 68HP, Natrelle Silicone Classic Style 10, 15, 20, 45, Allergan Natrelle Silicone Inspira SRL, SRLP, SRM, SRF, SRX, Allergan Natrelle Silicone Inspira Soft Touch SSL, SSLP, SSM, SSF, SSX or Allergan Natrelle Silicone Inspira Cohesive SCL, SCLP, SCM, SCF, or SCX implants these all have smooth shells. This information was on the card you were given after surgery. If you’re a patient of Dr. Feldman and have lost or misplaced your card, call or email the office (info@bfprs.com) and we can send you a pdf scanned copy of your implant information. The overwhelming majority of implants placed by Dr. Feldman are Allergan 68MP, 68HP for saline, and Style 15 (moderate plus profile), 20 (high profile), SRM (moderate plus profile) and SRF (full profile) for silicone.

If you currently have textured breast implants and have not experienced any sudden changes in the size of one of your breasts or the way your breast looks or feels, the current consensus recommendation of the ASPS and FDA is that no treatment is needed, but rather to monitor for changes. Should any changes occur they recommend quickly contacting a your plastic surgeon for evaluation.

Read even more details here.

This is a frequent concern within a couple of days of surgery, but is normal. Since the implant is much larger than the small incision Dr. Feldman made, as the implant goes in through the Keller funnel some air is trapped in the pocket. This combined with 30cc of local anesthesia (numbing medication) liquid and residual liquid antibiotics ​can create a burping, farting or squishing noise as well as Rice Krispies, crunchy or squishy sensation when pressing on your skin for up to a week after surgery. What you're feeling is normal. The implant did not pop or rupture. Your body will absorb the liquid and air over the first week, so it should by improving by your first post-op appointment. These noises/sensation frequently turn into squeaking, a couple of weeks after surgery, as the early capsule begins forming which is also normal.

Yes! Making breasts larger and heavier with implants, particularly with ​more aggressive high or ultra high profile, means they will actually sag or droop faster than without implants. They (your post augmentation results) don't get frozen in time. Larger breasts, particularly with bigger more aggressive implant styles, require 24/7 bra support. This means you need more supportive bras after surgery than before!

Your skin doesn't care whether it's natural tissue, silicone or saline creating the weight, a DD will never hold up as well as a B cup, although you can achieve reasonable longevity with proper care. Accordingly, Dr Feldman and his team, will discuss bra sizing do's and don't's and proper level of support at each and every follow up, as a well fitting, supportive, bra is essential to maintaining your initial results long term. This "pride of ownership" is no different than putting a case on your smartphone or doing maintenance on your vehicle. A well maintained vehicle will always last longer than one driven like a rental. Despite discussing bra support from consult to preop, and continuing with specific instructions at follow up appointments, some of Dr Feldman's patients still don't support their breast properly and then wonder (or complain) why they end up with sagging breasts, lower or more lateral, than they had hoped. An unsupported implant will only maintain its position for 12-18 months at best.

Nothing holds a breast implant in place except your breast tissue, muscle and skin. Unfortunately, not all patients’ tissue has the same strength and therefore, implants can move over time. Woman with more experience in life, or who have had life events like children or significant weight fluctuations, as well as genetic variations are likely to have weaker tissue than their less experienced, nulliparous (without children) counterparts. The larger, and heavier the implant, the more weight the tissue has to support and sometimes it’s just too much and may “bottom out.” Unfortunately there is no threshold size, as one woman’s tissue can support a very large implant and another woman may bottom out with a smaller implant due to the variables described above. Additionally, non-compliance with post-op activity restrictions, lack of supportive bras, stomach or side sleeping and overuse of pectoralis muscle can all move the implant into a less than ideal position.

As such, the most common reason for revision breast surgery at 10 years is going bigger or having a lift. The implant itself didn't change, so there is no warranty, but your breast and body change around it. This is especially true after life events like pregnancy or weight loss/gain, but happens with normal aging and lack of support.

Newer styles like Allergan Natrelle Inspira high fill ratio implants or Inspira Cohesive high fill ratio are designed to keep more volume in upper pole of breasts, where most of Dr Feldman's patients prefer it, without adding projection and more weight like an ultra high profile would, hopefully leading to longer result durability.

Dr Feldman uses Allergan Natrelle implants exclusively. Mentor does not have these newer implant style options, and has 3x higher failure rate, so pay particular attention to the brand, style and profile not just CC's when shopping with competitors. Read more here.

It depends on your job and how much physical activity and lifting you do.

Most of Dr Feldman's patients return to basic office tasks and intellectual work 3-5 days after augmentation. For patients who don't lift anything more than 2-3lbs and don't have jobs involving other physical activity, Dr Feldman discourages more than a week off, as you will likely get bored at home and get yourself into trouble anyhow.

The first 3-5 days are when you would benefit from adult assistance as you will be relaxing, taking pain medication, napping and just not doing much, allowing your body to heal and focusing on your recovery and nothing else. Binge watching a new show or catching up on movies would be a great plan.

If you work an office job on weekdays, Dr Feldman would recommend surgery on a Thursday and see you first thing Monday AM for postop, with likely return to work Tuesday. If you work weekends, a Tuesday surgery would be ideal with postop check Friday AM.

If you have a job that involves lifting it's best to discuss specific circumstances with Dr. Feldman and Jeannette before booking surgery. The lifting restrictions are 2lbs for 2 weeks, 10lbs for weeks 2-8, 20lbs from week 8-12 and increasing from after 12 weeks.

Specific jobs

Bartender
It would be best to take at least 2 weeks off, and then split tips with coworkers upon return to motivate them to assist with lifting. At 2 weeks you can lift a bottle of liquor, a couple bottles of beer, and gingerly reach into cooler or shake drinks at waist level, but you cannot move a 5 gallon bucket of ice, a case of beer/liquor or keg for 3 months minimum. Moving that much weight before 3 months is a disaster!

Waitress/Server
I encourage waitresses to take 2 weeks off. When you do return after two weeks, do NOT work the busiest shifts or doubles. Remember your new boobs are not healed and you will mess up a $5000+ investment. Once they're healed, after 3 months, you will work the prime shifts, get preferred seating areas and make more money in tips. Upon return to work after two weeks I encourage waitresses to ask their boss if they can hostess for an additional 2 weeks. Carrying a menu will never jeopardize your result. You will obviously make less money as a hostess, but you're protecting your new investment and fixing them, if you overdo it, is hard and costs more money. If that's not possible, and you just take the order and do not deliver food/drinks or buss the table that should be fine at two weeks. If you do deliver the drinks/food, you can carry a single plate or one drink in each hand with elbows at your side at two weeks as well. You may increase to a small tray or two plates at 8 weeks. I do not allow you to carry a large tray overhead for at least 12 weeks. Lastly, I recommend wearing a well fitting, extremely, supportive bra at work, which can be tricky depending upon type of uniform/establishment, but is essential in maintaining your result. Listen to your body if you're tighter, more swollen or more sore you're doing too much!

Dancer/Entertainer
It would be best to take at least 2 weeks off. Switching to bartending or waitressing for 6 additional weeks would be your safest bet. You will make less money in the short term, but remember your results are both a personal AND business investment, and no one will want to pay to see them if you mess them up. Once they're fully healed, after 3 months, if you behaved yourself, and took good care of them they will look amazing and you will work half as hard and make twice as much! If you don't have the option of waitressing, then tip the DJ and do NOT dance on stage and absolutely NO pole work for 3 months. Spend the first 3 months socializing with the clients, using your other assets, protecting your new investment. It would also be worthwhile to modify your work attire to include supportive bra or corsets for maximum support to improve longevity and durability of your result and investment. Listen to your body if you're tighter, more swollen or more sore you're doing too much. You have the most to lose by jeopardizing your result as they must as look good topless as they do in clothes.

RN/Healthcare
Charting, vitals and distributing medication will be below the 2-3 lbs and is possible a week after surgery. A 1L bag of IV fluid is 2.2lbs. However, moving, rolling, cleaning or transporting patients is a disaster during the first 3 months, as is CPR. Every code needs a recorder. Writing down medication admin times/dosages or pushing meds during a code should not affect your results, but performing CPR is contraindicated for 3 months. Make sure your charge nurse knows your role during codes after your surgery, and motivate coworkers, techs, assistants with Starbucks or kolaches to perform all lifting duties.

Teacher
I always caution teachers about doing it at end of summer break, right before the start of a new year, and setting up their classroom as that is too much lifting and arm use for the first few weeks of healing. For teachers, the first Tuesday of your break, if two weeks, or Thursday before a single week off would be ideal!

Fitness instructor
Demonstrating exercises for a few reps with 2-3lbs weights may be possible after 2 weeks, but moderate impact cardio instructing, like step-aerobics, or Zumba cannot be done until 8 weeks. High impact activity like CrossFit, body weight bearing yoga/Pilates poses or spotting clients with heavier weights is not advisable for a minimum of 3 months.

Student/School
No backpacks, or heavy laptops/books for 2 weeks. Your should not expect to spend your recovery studying or catching up on coursework as you should be focused on relaxation and healing as well as taking medication.

Another surgeon never mentioned issues like challenging anatomy, pectus deformity, asymmetry, nipple malposition or tuberous, constricted, breasts, absent lateral show, scoliosis and never discussed any limitations of surgery.

The other surgeon didn't notice or didn't care about your breast or boney deformities or asymmetry. If you don't recognize the problem, how can you ever devise a plan to correct it or discuss realistic expectations if you cannot correct it?

Most of Dr Feldman's patients are receptive to his honest, straightforward approach but a few percent would prefer a sugar coated, reality TV show type experience (full of cutoffs scrubs, mimosas and push-ups in hallway followed by bouncing a beach ball around the office) and choose another surgeon with different style. Dr Feldman is fine with that, and can sleep at night knowing that before taking anyone's money for elective cosmetic surgery, he has done his obligation as a surgeon to discuss the pro's, con's, alternatives and limitations of the current technology/techniques of breast augmentation. Other surgeons choose not to discuss limitations, as they don't acknowledge having any, pretend they have a special proprietary technique, unique suture or secret implant catalog that gives them magical powers which ultimately will yield unrealistic expectations despite a more fun, party like, consult experience.

​It's a constant battle in our practice attempting to refocus patients away from random lucky numbers of cc's and toward a pleasing breast aesthetic. Will you be satisfied with an ugly result just because it falls within an arbitrary cc range? Not a chance. Will you be OK with your desired cup size even with wide cleavage, nipple malposition and no superior fullness? No way. During your consultation and pre-operative visit you were repeatedly reminded to focus the look, not the cc’s or cup size.

It’s not what Dr. Feldman puts in, but rather how pretty your breasts are when you come out of the OR that matters. To achieve the look you chose pre-operatively sometimes requires an implant with different dimensions or size, as during surgery the implant is now placed under your breast/muscle rather than stacked on top as it was in clinic. This is why Dr. Feldman will use sizers to make final implant selection during surgery, and the implant will not be chosen solely by volume (number of cc's) or desired cup size, but rather by what dimensions will help minimize breast and boney deformity/asymmetry and best fit breast/chest pocket dimensions.A surgeon’s obligation is to first do no harm. Placing implants that are too large can cause irreparable damage like numb nipples, stretch marks, symmastia (uniboob) and/or exaggerated nipple malposition. At some point an implant just won’t fit, and you can’t be sent home with implant hanging out of open incision. Placing implants that are dimensionally too small and narrow, will actually yield a less natural looking breast with “bolted or stuck on” appearance and poor overall result.

If you love your result, in 6 months you won’t remember the number of cc’s, and if you picked a random lucky number and had a bad result, you would no longer care about that number. Breast aesthetics are far more complex than just a number of cc's or cup size. In fact, Dr. Feldman never lets his patients focus on, or promises, a specific number of cc's as it's only a setup for disappointment. Sticking sizers in a bra or a computer simulation of your results is simple, but has no upper/lower width and volume limits like surgery does. Whatever the final cc selection, Dr. Feldman can promise he tried multiple options and you ended up with the best balance of size, shape and symmetry.

Some breast and boney deformities or asymmetry cannot be corrected or even completely camouflaged with implants so realistic expectations are essential to be established before surgery. This requires a surgeon who can acknowledge he/she has limitations and cannot magically fix everything. As such, Dr Feldman will always establish what he can make better, what will stay the same and what may look worse at each and every consult.  Dr Feldman will attempt to paint a realistic picture of your result, rather than promise wish list results of other woman's breasts. How a patient chooses to utilize, or if they appreciate that level of professionalism, candidness and honesty is completely up to them. 

This depends on how active you plan on being, how far away you will be traveling and how long you will be gone for.

Breast Augmentation is a real surgery, and the 3 month long recovery is as important to how pretty, even and soft your breasts are as the surgery itself, so this is definitely not something you would do the week before you leave for a cruise or destination wedding. You must account for healing, and even the possibility of complication, when making travel plans. If your travel plans are already made, are not changeable, and are 8 weeks or less from your surgery date, it is always Dr. Feldman’s recommendation to have surgery after your trip. That way you can enjoy your vacation without worry, and focus on your surgery/recovery, and most importantly your results, without distraction afterwards. Three months after breast augmentation, most patients are at their baseline risk, and have no major restrictions, so that’s the safest time to travel without worry. The further the distance, the longer the length and more active you plan on being, the closer to 3 months Dr. Feldman will recommend.

If you plan on relaxing weekend getaway, a couple hours away, and have a travel companion for all lifting, it’s possible, but not recommended, as soon as 2 weeks after surgery as long as you continue to follow your activity restrictions, wear supportive bras 24/7 and protect incisions from UV/sun exposure. But remember, alcohol can lead to bad decision making and impaired judgment, both of which risk and compromise your result.

There is inherently little risk to the act of being on an airplane, pressurization etc. for a short domestic flight, however, the main risk comes from the hustle and bustle of the airport, lifting luggage, dressing/undressing quickly for security, and rushing to a rapid connection or from prolonged international travel. If travelling alone, we do not allow a carry-on, purse, laptop bag, backpack etc. You MUST check all luggage. We also require you have at least $30 in small bills to tip skycap, shuttle drivers, bellhops and attendants to do ALL lifting over 2lbs. (1kg). Remember you are protecting a $5000 investment, and these people will gladly help you protect that investment for a reasonable $2-3 tip.

However, when thinking about a warm weather destination you must also consider these swim restrictions. There are two factors that affect the timing of swimming.
First is the type of swimming
- Being splashed accidentally while your children swim/play (4 weeks)
- Casual lounging or cooling off in water briefly without submerging (6 weeks)
- Swimming for exercise with submersion(3 months)
- Prolonged submersion with snorkeling/scuba diving (3-6 months)
Second the type and cleanliness of water
- A clean, well-maintained and chlorinated pool with being splashed accidentally (4 weeks) causal lounging or cooling off is ok at 6 weeks
- A pond, beach, gulf or open water - 3 months regardless of activity
- Hot tubs are the dirtiest of all, even when they’re well maintained, so 3 months minimum

If you’re extremely active and enjoy skiing, snowboarding, cliff diving, para-sailing, kayaking, wake boarding, surfing, hunting, jet skiing, zip lining, rock climbing, snorkeling or scuba diving type activities that involve a lot of jostling, movement and use of chest, shoulders and upper back muscles, we would recommend a minimum of 3 months before attempting that type of active sporting vacation. Of note, these activities all have inherent risks of injury, regardless of timing after surgery.

You must be your own best advocate, and think about the long term. Should a complication arise while you’re out of the area, local doctors or emergency rooms may be of little assistance, and Dr. Feldman may not be able to assess, diagnose or treat you remotely. Although you may be excited to show off and enjoy your new breasts on a vacation immediately after surgery, if you mess them up, every time you look in the mirror, that vacation will be distant memory.

The term medically necessary is an insurance term from either health insurance or disability insurance companies. This is not a term medical professionals routinely use as part of their care. Elective surgery describes surgery that is scheduled in advance and is not of urgent nature. Examples are a hernia repair, joint replacement or breast augmentation. Surgery for an urgent medical issues like appendicitis or after trauma, is not elective. Cosmetic surgery is surgery that deals with aesthetics and is usually elective. Complications of elective surgery and/or cosmetic surgery can, however, become urgent medical issues.

Bancroft Feldman Plastic Surgery does not accept medical insurance for any cosmetic surgeries. However, some patient’s may try to request time off under their short term disability insurance program.

Your insurance company will argue your surgery is not medically necessary, and you believe it may be. Many insurance companies have pre-existing exclusions, or documented guidelines regarding cosmetic surgery and/or complications of cosmetic surgery in your policy. Your policy is a binding contractual agreement between you, the policy holder, and the insurance company. Therefore, this a discussion best had between you and your insurance company, prior to surgery, after thoroughly reviewing your policy. Bancroft Feldman Plastic Surgery is a boutique cosmetic surgery practice, focused on delivering patient care at reasonable prices, not an insurance approval advocate, and therefore, does not have resources available to aid in this process.

Many patients try to put the surgeon or their staff in challenging positions "just say yes when they call!" It seems that easy from the patient perspective, but it's not our first rodeo. "Just saying yes" still may not lead to approval, and could end up creating a long drawn out legal battle, where ultimately that request will be disclosed to all parties and may void any coverage or payment previously approved. Even worse, in the case of health insurance, such a statement could result in a pre-certification being issued for surgery, and then payment denied after surgery, leading to a huge hospital and anesthesia bill completely independent of Bancroft Feldman Plastic Surgery.

Therefore, at Bancroft Feldman Plastic Surgery, the medical records stand by themselves, as both a record of medical care and legal document, and can be requested for review after proper paperwork (and patient approval in case of third party) and payment is submitted. As such, we do not provide any additional opinions, answers to questions or documentation outside of the medical record.

At your two week follow-up your Steri-Strips will be taken off so you can start scar care after that appointment. The only scar treatment that has been medically proven to work is silicone strips (Common brands are ScarAway, NewGel, etc. available at CVS, Walgreens, Walmart, Amazon) worn 24/7 except when showering for 8 weeks minimum, preferably 12 weeks. Lotions and creams, like Mederma, or roll-on liquid silicone, are not proven in controlled medical studies to improve the look of the scar. The challenge with the silicone strips are that you will not notice an improvement in scar appearance during the treatment, but rather a year later it’s likely the scar will be softer, flatter and narrower. It’s hard to continue something 24/7 for 3 months without positive feedback. If you don’t want to commit to long term treatment like the silicone strips, we recommend using any lotion that works for your skin type (Vitamin E, Cocoa Butter, Aloe, etc.) and lotion your breast and scars at least twice daily. Rub the incision back and forth or in little circles for 90 seconds with firm pressure. This will help break up the scar tissue and may improve the look of your scars. Finally, you must protect your scar from sunlight and UV tanning lights for 12 months. So even if you don’t wear the silicone strips 24/7 for maximum benefit, if you purchase the strips with fabric backing, they can be used under bathing suit to protect incisions from UV exposure and tend to be gentler on your skin than the adhesive from Band-Aids.

There are two factors that affect the timing.

First is the type of swimming

  • Being splashed accidentally while your children swim/play (4 weeks)
  • Casual lounging or cooling off in water briefly without submerging (6 weeks)
  • Swimming for exercise with submersion (3 months)
  • Prolonged submersion with snorkeling/scuba diving (3-6 months)

Second the type and cleanliness of water

  • A clean, well-maintained and chlorinated pool with being splashed accidentally (4 weeks) causal lounging or cooling off is ok at 6 weeks
  • A pond, beach, gulf or open water - 3 months regardless of activity
  • Hot tubs are the dirtiest of all, even when they’re well maintained, so 3 months minimum

Swelling is unavoidable after surgery. The amount of swelling can vary based on many factors. If you have a very tight and developed pec muscle, if you overdo it, overuse one arm, or if you don't limit your activity your first two weeks post op, your risk of swelling greatly increases. The most important way to minimize swelling is to restrict your activity per Dr. Feldman’s instructions and wear the garments provided. Swelling significantly more on one side than the other is a clear indication of overdoing it. Overdoing it increases your risk of bleeding, bruising, capsular contracture, and implant malposition. Swelling typically peaks 48-72 hours after surgery, around the time of your post-op appointment, and slowly resolves over the next 8-12 weeks. Overuse will increase both, the amount, and duration of swelling as well as discomfort. As the swelling resolves, the upper part of your breast will appear prettier, softer and more natural. This is the fluffing portion of what woman refer to as the “dropping and fluffing” that occurs approximately 8-12 weeks after surgery.

Promises of "rapid recovery, lunch hour augmentation, scarless and/or painless" augmentation with "negligible complication rates" are all complete and utter lies. They are 100% marketing hype, potentially even composed by a marketing firm writer without that surgeon's knowledge, trying to get your hard earned money and focus your attention on magical promises, distracting you from what really matters, quality results and low complication rates. Remember the old saying "If it's too good to be true..... It probably is!"

There is no magic technique to allow a faster or more rapid recovery. No surgeon should be using a sloppy technique normally and saving the meticulous technique for a special group of "rapid recovery" patients.

Dr. Feldman performs detailed, meticulous surgery on each and every patient. Even then soft tissue heals slowly in everyone, taking a full 3 months to heal 95% regardless of any ridiculous promises of instant healing made up front. The more conservative the size/style of implant, the less tightness and pressure you may experience, and the prettier your starting breast and less complex the pocket development, the quicker things soreness will resolve and a pretty breast will appear, but "healing" still happens at the same rate. Above the muscle placement will feel less sore faster with less restrictions, as the muscle is not disturbed, but has some significant long term negatives with higher rates of contracture, and much less natural, more visible implant and potential to interfere with mammograms.

The only difference between a regular recovery and these so called "rapid recoveries" is how long or strict a surgeon is with their instructions. Dr. Feldman tends to be very strict, for a longer period of time, but also have a lower revision rate (5% in my practice) than what is published (7-9% at best, typically 25-33% and some even higher!). Fixing things is hard, costs more money and won't look as good. Someone can send you back to work the same day and call it a "lunch hour augmentation" to generate business, and attention, but if the results stink and the complication rate is 50% what a disservice that used car sales tactic was to that patient! Now trying to fix that will cost twice as much as it will look half as good, ouch!

Ultimately what you did or didn't do for a few weeks after surgery doesn't matter if you have a bad result or complication, and will be a distant memory if you love your augmented breasts. So Dr. Feldman will think you're focusing on the wrong thing. Focus on your end result, minimizing complications and adjust logistics to optimize those chances as ultimately results are the only thing that matters.

Find a surgeon who can provide detailed complication rate data (Dr. Feldman even goes as far as doubling the contracture and malposition numbers, since some patients may move and have surgery with another surgeon). In some practices you will never even see the surgeon again or they are just contracted to come and do surgery for a franchise! Best to seek a board certified breast expert doing at least 300 augmentations a year rather than fall for marketing hype!

Each surgeon has his/her own approach and will guide you through their preferred recovery techniques and restrictions. All of Dr. Feldman’s results, reviews and low complication rates have been achieved with his post-operative care instructions and restrictions. Doctor shopping for what you believe to be the best recovery techniques, or shortest restrictions, will jeopardize your result and voids our revision policy. If you trust Dr. Feldman to perform your breast augmentation, an elective cosmetic surgery you just spent thousands of dollars on, trust him to guide you through your recovery. He is the only other person with a vested interest in your results.

Ultimately what you did or didn't do for a few weeks after surgery doesn't matter if you have a bad result or complication, and will be a distant memory if you love your augmented breasts. So I think you're focusing on the wrong thing. Focus on your end result, minimizing complications and adjust logistics to optimize those chances as ultimately results are the only thing that matters.

Smoking can cause significant health problems, from heart disease to asthma to lung cancer. If you are having surgery, it's critical to quit smoking all substances including marijuana. Smoking and/or inhaling any substance into your lungs can increase the risk of anesthesia-related complications like infections, pneumonia, and heart attack. That’s why it’s important to quit smoking at least 2 weeks before surgery and a minimum of 3 months after surgery. With that said, please do not be afraid to tell your anesthesia provider if you have been smoking or using other substances before surgery. The information will remain confidential and will benefit you in the care you’ll receive.

 

This is a great question, and a very important topic given the opioid crisis this nation finds itself in the middle of.
Dr. Feldman will electronically submit all of your prescriptions, including pain medication that you will take only for the first few days after surgery, at your pre-op appointment. We will not refill or provide any additional narcotic pain medication. Dr. Feldman performs 400-500 augmentations per year, so we know how many pills are required to make you comfortable early in your healing. If you have discomfort after that, you’re doing too much and Tylenol will help. Amazingly, the dog never eats the antibiotics, the anti-inflammatory pills never fall in the toilet, and the pharmacy never forgets to fill the nausea pill. It’s not our first rodeo.

All narcotic pain medication, including Hydrocodone (Norco) and Tramadol, have abuse potential. How one compares to the other is a tough thing to measure. Remember the manufacturers of OxyContin came to market advertising how safe their formulation was, claiming it lacked any abuse potential, and we've seen how that has turned out, a complete and utter lie. Tramadol differs from other opioid pain medications as it also works on other pathways similar to antidepressants, which likely explains why some patients get more benefit (and abuse potential) from it than others.

So what are your options if you want to minimize opioid pain medication due to fear of addiction or avoid it altogether due to prior abuse.

Celebrex (Celecoxib), a “Super Motrin” that does not thin your blood, has been fantastic at reducing the duration and amount of pain pill use since it went generic. It's now $20-40 (check pricing on goodrx.com) rather than $400 and Dr. Feldman prescribes it to all Breast Augmentation patients.

Dr. Feldman may offer double strength Celebrex and extra strength Tylenol as the safest, completely opioid free, option. You may experience breakthrough pain for a few days and everyone's pain threshold varies as to how tolerable this would be. However, even a small number of pain pills could put a prior dependent into a tail spin so Dr. Feldman would have to weigh the risk versus benefit, but could also be a reasonable option for 24-48 hours in combination with Celebrex and Tylenol in the case of breakthrough pain.

Ultimately, Dr. Feldman believes the subjective pain score, and ease of filing complaints against physicians who use objective vital sign data to refuse prescribing pain meds to drug seekers, to be the root cause of the opioid epidemic. Obviously there are a few shady physicians running pill mills, but the majority of pain meds are not coming from that environment. The subjective pain score should be eliminated from medicine immediately. Treating pain should be based on objective data. A smiling, laughing patient with normal HR and BP (presuming they're not on a beta blocker) cannot have 10/10 pain. After surgery, it is unrealistic to expect to be pain free, but Dr. Feldman believes many outlets have led patients to believe pain medication will magically make them completely pain free.

Lastly it would be worthwhile to be tested for HIV and Hepatitis, prior to surgery, with any history of IV drugs, particularly given new treatments that are able to cure Hepatitis C and suppression of HIV to undetectable viral loads.

Good sex is equivalent to vigorous exercise with full body muscle involvement. Unfortunately, this means you cannot have amazing, headboard banging, toe curling, fingernail digging and plowing-from-behind sex for a full 3 months after you get your new boobs! This also means NO fun at all, for at least 2 weeks after surgery. However, just like exercise you can slowly increase use as you heal, with very basic sexual activity starting 2 weeks after surgery. As Jeannette says and proudly practices, “Lay back, and let him do all the work! His/her tongue didn’t have surgery.” Do NOT use your arms, core, compress your breasts or lay face down on your breasts at this time. As Dr. Feldman says “Use your other ASSets!” At 8 weeks you can become a little more active, but still positioned on your back, or now, on top, but continue using caution with arm and chest support.


MOST IMPORTANTLY leave your bra on during any seuxal encounters for 3 months. Good things come to those who wait, and you will be able to enjoy your breasts, more than you ever thought possible, once they’re healed and unveiled after 3 months.

ABSOLUTELY NO lifting more than 2-3 pounds until your 2-week follow up appointment. (examples: bottle of water, cup of coffee, can of soda. A gallon of milk is TOO heavy!) Avoid sweating, elevating heart rate and/or blood pressure for the first two weeks as well. 

AFTER Two weeks post op: You may begin NON-IMPACT cardio ONLY. This includes walking on a treadmill, using the elliptical machine without the use of your arms, stair climber, stationary bike, etc. Do not lift more than 10 pounds. No core, chest, shoulders, upper back, arms or leg exercises are allowed at this time.

Two months (8 weeks) post op: You may begin MODERATE-IMPACT cardio, such as light jogging and workout classes like Zumba. Isolated leg exercises on weighted machines are allowed at this time. Body weight (no additional weight held by arms or on shoulders) core work, is also allowed. Still NO chest, shoulder or upper back exercises at this time.

Three months (12 weeks) post op: You are unrestricted at this point, but remember to start slow with low weight (2-3lbs) and high repetitions (50+). Do not do anything too fast or too heavy! Start doing push-ups against a wall/counter and progress to the floor. Pullups should be done with resistance bands. If you do Crossfit, start with a modified workout, and discuss restrictions and plan with your trainer. REMEMBER LIGHT WEIGHT AND HIGH REPS! 

It will take you 9-12 months to regain your pre-operative upper body strength, due to 3 months of not using those muscles, and the change in mechanics from the muscle stretching over the top of the implant. Be patient as it’s worth the wait.

The most frustrating part of Dr. Feldman's practice is when patients' fail to recognize the importance of following post-operative care instructions and activity restrictions. Many of the complications encountered after breast augmentation are preventable, and directly attributable to not following the above activity restrictions. Compliance with our instructions, and restrictions, plays as large a role, or even larger, in your result as the surgery itself. We collectively call this "pride of ownership." Unfortunately, actions, such as working out too soon, or jumping directly into heavy weights, have consequences, and many times overuse will lead to bleeding, bruising, hematoma, contracture, implant malposition or symmastia. Most of Dr. Feldman's patients over do it, most get away with it, but about 5% don't, meaning 5 out of every 100 surgeries require another operation in the first 6 months that could have been avoided by following instructions.

Unfortunately this situation is a very common occurrence. Moms will be mom, people lift more weight than they think at work or patients try to go workout too quickly. Most of Dr. Feldman’s patients’ overdo it, most get away with it but 5% don't. Many of the complications encountered after breast augmentation are preventable, and directly attributable to not following activity restrictions, supportive bra use and/or massage after surgery.

We frequently get emails, phone calls or questions at appointments looking for reassurance. Sometimes patients are honest, admitting they overdid it, seeking reassurance. “I forgot I had surgery and slammed my car door!” “I accidentally picked up my 20lbs child or relative.” “I was in a car accident.” Other times they ask "Do my breasts look ok?" Or "are you sure they look OK?" Dr. Feldman and Jeannette now realize this translates into "Did I mess them up?" as the patient has a guilty conscience and desires reassurance for anxiety relief.

Unfortunately, the answer is always “time will tell” as it may take 2-3 months for complication to develop or become evident after trauma or overuse.

Hematoma's from arterial source become evident in minutes to hours with a rapid change in size and pain, and like pornography, “you will know it when you see it.” A tear in pec muscle that may distort cleavage once swelling resolves, a teaspoon of blood from torn vein or a few popped deep pocket stitches may look fine initially. However 8-12 weeks later can cause cleavage distortion/uniboob (symmastia), contracture or implant malposition (over-lateralization/bottoming out) respectively. So every little thing that occurs during healing adds up. Repeatedly engaging the very powerful pectoralis major muscle slowly drives the implant downward and outward without proper support.

What has already occurred cannot be undone. Rather than focusing on the past, or what we cannot control, focus on setting yourself up for success moving forward and reducing the likelihood of having to overdo it, a second, or third time.

There is inherently little risk to the act of being on an airplane, pressurization etc. However, the main risk comes from the hustle and bustle of the airport, lifting luggage, dressing/undressing quickly for security, and rushing to a rapid connection. We discourage travelling for 2 weeks when possible, however as Dr Feldman is a world renowned breast expert, many of our patient’s travel specifically for surgery. Some out-of-town patients choose to stay in Houston for 2 weeks for the 2 mandatory post-op appointments, others travel back home 3-5 days surgery and return for 2-week check up. Regardless, we recommend a travel companion, when possible, to do all of the travel related lifting, driving and rushing so you can focus on your recovery, and arriving to the airport even earlier than normal. If travelling alone, we do not allow a carry-on, purse, laptop bag, backpack etc. You MUST check all luggage. We also require you have at least $30 in small bills to tip skycap, shuttle drivers, bellhops and attendants to do ALL lifting over 2lbs. (1kg). Remember you are protecting a $5000 investment, and these people will gladly help you protect that investment for a reasonable $2-3 tip.


Out-of-state patients or those from other countries do need to make plans to return for the two-week follow-up appointment that is required for optimal care, if they are not staying in the greater Houston area for that long.

The majority of side effects and complications after breast augmentation are preventable and are a direct result of not following the simple, detailed and thorough restrictions and instructions provided orally, in print, via email, and on our website. During your pre-op appointment, as well as the day of surgery, we go over very important care instructions for what you are allowed to do immediately after surgery and what things you need to avoid. Aside from taking it easy and limiting the use of your arms immediately after surgery, there are things you can do weeks prior that will help decrease your chance of complications. Make sure you have help the first couple of days after surgery as your range of motion will be limited and the heaviest thing you will be able to pick up is a bottle of water. Reducing your consumption of alcohol and blood thinning products weeks prior to surgery and the first couple of weeks after surgery can help reduce the risk of bleeding. Stopping smoking and other nicotine substances prior to surgery can also increase your healing ability. The anesthesia used to put you to sleep can also cause side effects. The most common are nausea, which will be lessened by the medication you will be prescribed to take, and constipation (we recommend purchasing a laxative to get things moving  24-48 hours after surgery). If you have any questions on other things you can or can’t do to reduce the risk of side effects after surgery, we always encourage you READ all of the IMPORTANT information provided at your pre-op appointment prior  to emailing Jeannette with your questions.

Although getting a cold or the flu can happen after surgery, it has nothing to do with the actual procedure. We encourage you to contact your primary care physician for treatment. Dr. Feldman is a surgeon, not a family doctor, and therefore does not treat colds, the flu, urinary tract infections and other general health conditions. If you are concerned that you may be coming down with the flu or a cold before your surgery, let Jeannette, nurse or anesthesia provider know, as measures may be taken to reschedule your surgery if medically necessary. Sometimes an allergy to medications can give you a fever with or without a rash, and is treated by stopping medication.

We do not recommend the use of tanning beds as they cause skin cancer. However, if patients choose to tan, please wait for at least 12 months after your breast augmentation. This also applies to direct exposure to sunlight. Please be sure to protect your incision from ANY UV rays! Cover your incision with a couple of band-aids or silicone strips or bring back the 1980’s bright white bikini tan lines. Exposure to artificial or natural UV rays (sunlight) will permanently tattoo your scar either bright white or dark brown and is not reversible.


We instead recommend spray tanning, which can be safely done as early as 6 weeks after surgery

Constipation after surgery is common and results from anesthesia and pain medication coupled with dehydration. Depending how regular or backed up you were before surgery, how many pain pills you are taking (if you're taking 2 every 4 hours you will become EXTREMELY constipated) and how well you have rehydrated after surgery, will control how aggressive you will need to be with laxatives. We recommend Dulcolax, Miralax or Sennakot (Senna plus has laxative and softener). It will typically take 3-5 doses, so don't give up after a single dose. Dr. Feldman typically recommends a sports drink like Gatorade or PowerAde to help you rehydrate until you have crystal clear urine. Begin taking a single laxative dose on post-op day 2, with another 1-2 doses on post-op day 3, and if you haven't gone at that point, to take one dose every 2 hours on post-op day 4 until you go. Be careful what you wish for, as prescription laxatives are very potent and typically will result in diarrhea. If you haven't gone after 5 doses of over the counter laxative of choice, you may want to get a 2-pack of mineral oil enemas and bottle of magnesium citrate. Use a mineral oil enema first to lubricate, then drink the entire bottle of mag citrate and use second mineral oil enema 30-60 mins after mag citrate if you haven’t had a bowel movement. If you are persistent with laxatives, hydration and enemas, if needed, you will have a bowel movement. Once you've stopped taking your narcotic pain medication and clear your system, your bowels will return to normal movements.

Breast augmentation only make your breasts bigger. It does not move your breast higher on your chest, make them more perky, move nipples up, make them more even or symmetric or remove loose skin. A breast lift is used to shape and move your breasts/nipples, with or without implants to also change the size of your breasts. There is a significant price difference between the two procedures.

This is probably the most common question asked by my cosmetic breast patients with any droopiness or ptosis of their breasts. Which procedure is “best” depends on the patient's expectations and desires. Just remember the implant needs to be centered directly behind the nipple, so wherever your breasts/nipple sit currently this is approximately where you can expect the implant to be positioned/settle. Breast implants alone simply make your breasts larger. They do not lift or shape your breasts. If you are happy with the look and position of your breasts and just want them to be a bit fuller (larger) then a breast augmentation alone may work.

In my practice, my patient's generally expect a youthful, perky breast appearance “pop at the top” or “red carpet cleavage” without wearing a push-up bra. Most of these patients are initially hesitant about the scarring, when in fact they should be more concerned about breast shape, contour and nipple position. I educated them that scars mature and fade over 6-12 months, when breast shape, contour and nipple position generally don't improve and, may in fact, worsen over time.

If you place an implant in a low, droopy, deflated breast you will ALWAYS end up with a "natural" or "matronly" result low on the chest. Some women may be perfectly happy and satisfied with that result. However, other patients who decline a lift, then will come back with a horizontal tan line across their chests (above the top of their implants) from a sundress or tube top, asking why when they wear a sundress or top without a bra, their breasts sit low, or do not have superior fullness. I re-explain that the implant must be centered behind their nipple and that generating this superior fullness would require a larger implant combined with a lift. Some elect to have the lift, and others chose to push their breasts up in a bra to generate superior fullness and cleavage.

Finally, attempting to avoid a lift by using an extremely large, high or extra high profile implant is a nothing more than a short term Band-Aid, and does not address the root cause/problem (i.e. stretched/lax and excess skin/tissue). This does nothing but postpones the lift for a short period of time and will only lead to further tissue stretch and thinning requiring an even larger lift to fix. Ultimately, this approach generates a much more complex (and expensive) surgical problem just months to a few short years down the road, so I never encourage patients to go with this approach. 

Some of you may then ask why some surgeons you've seen offer this approach to droopy breasts, typically without discussing the other abovementioned options and each options pros and cons. The truth is that it's far easier and quicker for a surgeon to place a large implant without regard for the durability, or lack thereof, than perform a more technically challenging, and longer, lift procedure.

 

You will be measured during your consult and offered implants within a 5mm window of those measurements in multiple styles. We will focus solely on the look, and therefore, never promise the number of CC’s or cup size. In Dr. Feldman’s experience a dimensionally sound mod+ profile tends to go from an A+/B- to the magical full C or small D, adding about 2 cup sizes. A high profile (or SRF) would be about 100ccs larger to maintain the same base width and more like a full D but VS will call it a DD or DDD, particularly in a 32-34. Ultimately, try on the different styles and look in the mirror. When you see the look you like, pick that style! This requires a consult, exam, measurements and sizing with Dr. Feldman. Patients select the implant style and their chest dimensions dictate the number of cc's. Dr. Feldman makes specific recommendations to his patients based on:

 

  1. Dimensional planning

  2. Patients’ expressed goals

  3. Amount and quality of tissue available to hide the implant


Here is a link with the explanation of the different implants and what to expect from your consult as well as thousands of before and after photos to see what change implants of a particular size deliver.

If you are currently taking birth control, taking it before, during, and after a breast augmentation will not affect your surgery. In fact, you will be required to pass a pregnancy test the day of surgery before your procedure. If you have any questions about your birth control not involving breast augmentation surgery, we suggest talking to your OB/GYN. Hormonal birth control pills do increase your risk of blood clotting (DVT), as does pregnancy, but this risk is independent of breast augmentation surgery.

Yes. Bancroft Feldman will provide you with a surgical bra after your surgery and you will get a second one at your post-op appointment a few days after surgery. We require you to leave the surgical bra and strap in place as instructed. Looking at your new breasts will not make your result prettier or prevent problems. In fact, it increases pain after breast augmentation as well as swelling, bruising, and the likelihood of complication.

As the swelling resolves the upper part of your breast will appear prettier, softer and more natural. This is the fluffing portion of what woman refer to as the “dropping and fluffing” that occurs 8-12 weeks after surgery. This is why at the post-op appointment and 2 week follow up, breasts often appear extra full at the top, particularly from the side view.

Typically nipples are numb for at least 2 weeks after surgery, and frequently become extra sensitive around 6-8 weeks. Pings, zingers, “pins and needles”, breastfeeding soreness, or sunburn sensation are all common during the healing phase and indicate the nerve regenerating. Sometimes one side can be numb or extra sensitive longer than the other. In most cases sensation will return to normal or near normal, but this can take up to a year (or two) after your surgery for maximum sensation to return as the nerves grow very slowly, about 1 mm each day! Often you can feel the nerves regenerating. It feels like pins and needles, even zingers. We suggest purchasing silicone nipple covers, pasties, or the flower-petal nipple covers to help with extra sensitive nipples.  

Expect to be sore and tired. You had a complex surgery under general anesthesia. We want you to rest and nap often for your first 3-4 days. Sleep will help ensure a healthy healing process.

 

You will sleep on your back for at least 12 weeks after surgery. For the first few weeks, sleeping at a 30-45 degree angle can prevent tossing and turning and reduce swelling. It is very important to wear a supportive bra at night and not sleep on your side or stomach during the healing phase. If you do choose to try side or stomach sleeping after 12 weeks, you MUST wear a bra, and take standardized photos of you cleavage every 5 days, as the pressure of your body weight will tend to push your implants into your armpits! If you notice your cleavage or implant position changing immediately stop sleeping on side or stomach and return to back sleeping. Side or stomach sleeping in the first 12 weeks voids your revision policy.  

It is normal for there to be a slight swelling difference, from one side to the other. Often times this occurs on the hand/arm you use more, indicating overuse. It’s also important to remember breasts are cousins not twins, and they will always have a slightly different size and appearance. However, it is never normal to have a significant difference swelling in combination with bruising, increasing pain, redness, or fever. If one breast swells significantly more than the other (one will literally touch your chin) that is a concern and could be an indication of a problem such as hematoma. Should that develop please contact the office ASAP for evaluation

A few weeks after surgery you're still very early in healing, as it will take 3-6 months to assess final results. It's not uncommon for asymmetry at this time, due to one implant dropping faster or more pec swelling in the side you use more, particularly if you have been doing too much! It's best to take it easy, further restrict use of side that has more swelling or has dropped faster, as those are both signs of pectoralis major muscle overuse, and wear supportive bra 24/7.

Regardless, it's not worth worrying about at this time, because a revision wouldn't be offered for 4-6 months anyhow. By that time you'll likely see a more even final result as dropping and fluffing has occurred and swelling resolved. Also it's important to remember breasts are cousins, not twins, so some asymmetry is always normal, particularly depending how different your breasts started before surgery. Implants just make your breasts larger. Patients' often forget what their breasts looked like before surgery by the time they hit the recovery room, which is why we provide standardized printed before and after photos at your follow up appt.

ABSOLUTELY NO lifting more than 2-3 pounds until your 2-week follow up appointment. (examples: bottle of water, cup of coffee, can of soda. A gallon of milk is TOO heavy!) Avoid sweating, elevating heart rate and/or blood pressure for the first two weeks as well.

At 2 weeks you can lift 10lbs.

 At 8 weeks 20-30lbs

Sometimes patients get used to the way their breasts look when they are swollen and are disappointed when the swelling goes down. We like to call that "boob greed or envy"! Patients should wait 3-4 months before making any decisions as results can change, particularly once you transition from a surgical sports bra to sexy push up bras and clothing. Not only that, a larger implant may not have safely fit at the time of surgery. However, with Dr. Feldman's dimensional planning approach, and focusing on the overall look, not cc’s or cup sizes, it is unlikely you will be disappointed!

Implants do not have a "shelf life or expiration." There is no documented medical or safety benefit to scheduled surgical exchange. Surgery has both significant cost, and risk. Therefore, Dr. Feldman does not recommend scheduled exchange if your breasts look and feel good.

At 10 years about 33%, or 1 in 3, women have had more surgery for all reasons (3% per year cumulative risk), but only 8% of the 33% was due to implant failure (Allergan Silicone Implant data) with warranty coverage. This means 25% were choosing to have cosmetic surgery, for additional fee not covered by warranty, such as changing sizes or having a lift due to life events such as pregnancy, weight fluctuations or not wearing supportive bras. You are 3-4 times more likely to choose to have cosmetic surgery, as your breasts have changed around the implant, than you are to have a device failure/warranty claim.

Both saline and silicone implants carry a lifetime warranty against device failure, but silicone implants include a 10-year warranty to help pay some of the surgery fees (up to $3500) should the device fail. To put it simply, both have a lifetime “parts” warranty and silicone includes a 10 year “labor” warranty. For saline implants that “labor” portion of the warranty is an additional $200, thereby negating most of the price savings. This, however, is not a total satisfaction guarantee and warranty only applies if the device fails.

 

The short answer: YES!

Pregnancy causes major changes to a woman’s body, and breasts, with or without implants. It is impossible to say how much pregnancy will change your overall breast appearance, but we guarantee one thing - they will NOT get prettier. It’s an important distinction to note that pregnancy does not ruin or damage the actual breast implant, and therefore there is no warranty for pregnancy. Your body has changed around the implant, as a result of the weight fluctuation and hormones of pregnancy. Many women will require larger implants and/or a lift after pregnancy to improve their breast appearance. Nipples and areolas frequently become larger and darker as well. As Dr. Feldman discussed at your consult, less natural implant style selection can increase the likelihood of needing additional surgery with life events like pregnancy, and therefore, we always recommend woman who anticipate having children, select more conservative implant styles.

Massage is one of the most important activities you can do after surgery to care for your breasts and reduce the risk of contracture or hardening/scarring of breast pocket. Frequent and vigorous massage takes care of all healing irregularities as well as keeping your breasts soft and fine tuning your results. The reason you massage is to move the implant around in the breast pocket. That keeps the breast healthy and natural looking. You can find more information on massaging on our follow up instructions page.

 

At Bancroft Feldman Plastic Surgery if a surgery will take longer, such is the case with challenging anatomy, rib/pectus deformity, significant deflation/ptosis and asymmetry like a tuberous breast deformity or if multiple sizers will be utilized with the possibility of using two different size implants, the price will be higher. The higher price doesn't mean the surgeon makes more money. The cost of surgery, regardless of where it is performed, is always based on length, as a longer surgery has higher anesthesia, nursing and OR expenses, uses more medication/supplies and will take longer in the recovery room. We can give you a basic idea of cost from virtual consult and will confirm pricing after your consultation.

We do not price match, as there is no apples to apples comparison when it comes to surgery. This is especially relevant if they do not use Allergan implants. Many offices are running loss leader pricing on cheaper and less natural saline implants, which very few of Dr. Feldman's patients will select after detailed discussion. Why not advertise silicone pricing which the vast majority of patients will select.

The cost of surgery, while seemingly extremely important initially doesn't matter if you have a bad result, or complication, and will be a distant memory if you love your augmented breasts. Surgery is very different than buying a car, where the car was manufactured at the same factory, and is the same quality, regardless of dealer or sales price. Even if the same size implant and same technique is used, results and complication rates will vary greatly by surgeon and facility.

Check out our reviews, video testimonials and before and after gallery of Dr Feldman's actual patients, showing every view/angle of each and every one and compare to our competitors. Why do they only show 1 or 2 views and not all of them?

Dr Feldman is a world renowned breast expert and you won't find a more extensive before and after gallery. He only does breast augmentation and does 400-500 per year! That's more than many surgeons will do in their entire career. Think about that. Very few surgeons do 300+ augmentations per year. Most plastic surgeons dabble and try to perform many different surgeries, becoming an expert at none.

Focus on your desired look, minimizing complications and adjust logistics to optimize those chances. Ultimately your result is the only thing that matters.

Lastly, Dr Feldman only uses Allergan Natrelle brand implants that have a failure rate 3x lower than cheaper Mentor implants. Allergan silicone has only 8% failure at 10 years versus Mentor's 25% failure. That's 1 in 4 woman with Mentor! Most competitors are using Mentor because they're cheaper, but Dr Feldman refuses to put them in due to their inferior durability and high failure rate. Mentor also does not have as many new implant options, like high fill ratio Allergan Natrelle Inspira, or even newer Allergan Natrelle Inspira Cohesive implants, to reduce rippling and deliver more superior fullness which gives the "new normal, red carpet cleavage push up bra" look most patients are requesting. In fact over 90% of Dr. Feldman's patients are selecting high fill ratio Inspira implants!

We encourage you to complete a virtual consult and schedule with Dr. Feldman, to compare his consult experience to our competitors. Only then will you fully understand the difference.

The quote provided after your consultation for surgery at our AAAASF accredited surgery suite, is good for 30 days, and includes: surgeon fees, anesthesia fees, implant cost, operating room fees, two postoperative bras, consult with Dr. Feldman, follow-up appointments (first 2 appointments are mandatory) for up to 6 months after surgery, pre-op appointment with patient coordinator, and Keller Funnel. Prescriptions will be given at pre-op appointment and are not included but typically are $30-60 even without insurance. We recommend checking GoodRX.com for best pricing. If surgery is to be performed at a local hospital for safety reasons or by choice, pricing will vary greatly. You will pay Bancroft Feldman Plastic Surgery the surgeon’s fee and implant cost, and will be given an estimate of operating room and anesthesia fees payable directly to the hospital, and will likely receive a balance bill afterwards for any additional charges, that is completely independent of our practice.

The vast majority of Dr. Feldman’s patients’ won't have dressings to change, or drain tubes to care for after primary augmentation. Lifts, reductions and revisions frequently require drains.

Everything in life, surgery and breast augmentation is a tradeoff of risk and benefit. Generally when making things larger, and filling a tight space, like during augmentation, drains are not needed, but when making something smaller or using certain biological meshes as is common during exchanges, lifts or reductions, the body wants to fill that previously occupied space with fluid. The positive of a drain is a pathway for blood and fluid to exit without collecting. The negative is an opening in the skin and pathway for infection to enter. So, in general, with meticulous tissue handling and hemostasis, during a primary augmentation, a drains risk outweighs its benefit and therefore is not needed.

However, never say never in medicine. Dr. Feldman has, in fact, put a drain in one primary augmentation, out of thousands performed. That patient turned out to have a 1 in a million, previously undiagnosed, genetic clotting disorder requiring a hematologist and very specialized lab tests to discover. So it would be foolish to say "never" or define drain use as outside a standard of care. A talented surgeon and breast expert must be able to recognize when something is abnormal, in real time, during surgery, and adjust surgical technique accordingly, constantly reassessing above-mentioned risk benefit ratio.

In it most basic form breast augmentation simply makes your current breasts larger. Since Dr. Feldman is a breast expert he can go a little further to attempt to minimize and camouflage some differences, but your breasts will always be cousins and will never be sisters or twins. One technique that may minimize size difference is using two different size (and sometimes styles/profiles) of implants. Although differential implant sizing can sometimes be beneficial, other times, it may introduce new asymmetry or risk distorting breast anatomy/cleavage. This is why Dr. Feldman will use sizers to make final implant selection during surgery. Breast aesthetics are far more complex than just a number of cc's or cup size. In fact, Dr. Feldman never lets his patients focus on, or promises, a specific number of cc's as it's only a setup for disappointment. Remember they are not custom implants. They're from a standard catalog, so putting a larger implant on one side may be closer in size (but still wouldn't be perfect) but could yield a wider and taller breast as increasing volume/size also increases base width. This is why choosing a breast expert to perform your surgery is so important.

Saline implants come empty from the manufacturer and are filled during surgery with sterile salt water. Therefore they can, in fact, be filled differently, but it’s not as simple as you may think. They have a minimum and maximum fill volumes typically about 40cc different. The minimum fill volume is mandated by the manufacturer, otherwise the warranty will be voided. The base width and projection will be provided at this minimum volume. As you begin to overfill the device it’s width becomes narrower, projection significantly greater and it begins "balling up" or lifting the widest part of the implant away from your chest wall, sometimes yielding a very different aesthetic. However, often times the smaller breast would actually benefit from a wider implant, rather than narrower as happens when you overfill a saline implant, so a larger shell is used with similar fill ratio but larger volume as compared to the other smaller side. Silicone implants (which are filled at factory) always get wider as you increase volume avoiding this saline unique issue altogether. Allergan has begun providing max fill volume width and projection data on saline implant catalog sheets. As you can see this is a highly complex dimensionally driven discussion.

Many surgeons lack appreciation that breast aesthetics involve far more parameters than just volume and fail to understand the dimensional changes different fill ratios create. This is why seeing a breast expert like Dr. Feldman is so important. You will provided a device ID card after surgery that will list implant part number and fill volume, if you choose saline implants.

During your consultation and pre-operative visit you were repeatedly reminded to focus the look, not the cc’s or cup size. It’s not what Dr. Feldman puts in, but rather how pretty your breasts are when you come out of the OR that matters. To achieve the look you chose pre-operatively sometimes requires an implant with different dimensions or size, as during surgery the implant is now placed under your breast/muscle rather than stacked on top as it was in clinic. This is why Dr. Feldman will use sizers to make final implant selection during surgery, and the implant will not be chosen solely by volume (number of cc's) or desired cup size, but rather by what dimensions will help minimize breast and boney deformity/asymmetry and best fit breast/chest pocket dimensions.

A surgeon’s obligation is to first do no harm. Placing implants that are too large can cause irreparable damage like numb nipples, stretch marks, symmastia (uniboob) and/or exaggerated nipple malposition. At some point an implant just won’t fit, and you can’t be sent home with implant hanging out of open incision. Placing implants that are dimensionally too small and narrow, will actually yield a less natural looking breast with “bolted or stuck on” appearance and poor overall result. If you love your result, in 6 months you won’t remember the number of cc’s, and if you picked a random lucky number and had a bad result, you would no longer care about that number. Breast aesthetics are far more complex than just a number of cc's or cup size. In fact, Dr. Feldman never lets his patients focus on, or promises, a specific number of cc's as it's only a setup for disappointment. Sticking sizers in a bra or a computer simulation of your results is simple, but has no upper/lower width and volume limits like surgery does. Whatever the final cc selection, Dr. Feldman can promise he tried multiple options and you ended up with the best balance of size, shape and symmetry.

Breast implants are not be affected by altitude or high pressure. Several of our patients travel in from out-of-state and even from other countries. Most patients, if they’ve been compliant with our post-surgical instructions, are okay to fly after being seen by Dr. Feldman at their first post-surgery appointment.

The weight of a breast implant depends on the size and if its saline or silicone. Silicone is lighter than saline for any given cup size. An average 400cc implant weighs less than a pound and the largest 800cc implant will only weigh about 1.76 lbs.

 

There is no age limit to getting implants! Women over 40 will be asked to complete a mammogram prior to breast augmentation surgery and obtain medical clearance from their medical doctor. There may be some cases where we require lab work or medical clearance from a primary care physician even under 40. You are never too old to feel confident and pretty!

 

Men can get implants, however Dr. Feldman does not have specific training or experience in this area, and therefore will recommend patients to fellow surgeons who have notable experience with transgender patients.

We recommend waiting 3-6 months after completely stopping breastfeeding before getting breast implants. If you were able to breastfeed prior to having breast augmentation surgery, you should be able to breastfeed after, however in some cases milk ducts can be damaged during surgery, thus interfering with your ability to breastfeed after a breast augmentation. Dr. Feldman will not offer incisions through the areola for women who desire children as this cuts through the breast ducts and has the highest chance of interfering with breastfeeding. Placing implants under the breast, and under the muscle, will likely not affect your ability to breastfeed.