Breast Augmentation is one of the most talked about plastic surgery procedures available today.  If you are reading this article, you have probably thought about having the procedure yourself, or perhaps someone close to you is contemplating it and you are wondering what they are in for.  We talked to Dr. Andrew Cohen, Chief of plastic surgery at Cedars Sinai hospital in Beverly Hills and asked him to give us some insight into the most commonly asked questions about breast augmentation and some of the things that he feels people should definitely know before committing to having the surgery.

Dr. Andrew Cohen in his office
Dr. Andrew Cohen

CONNECT WITH LIFE:  What is the most common type of breast augmentation?  Is it a lift, a reduction or an increase in size?

DR ANDREW COHEN: Our most common request is to increase the volume of the breast and to for them to be more perky and lifted.

CONNECT WITH LIFE: Your clients must come in with many different shapes and sizes of breasts, how do you pick the right implant for the right body?

DR ANDREW COHEN: The best way is to examine someone. We first measure their chest wall and make sure that the implant fits their chest walls. The other thing we do is to put the implant in the bra and look at them in mirror to make sure it looks authentic to the patients size.  By putting implants in a bra we show them what they may look like so a really good way to tell.

CONNECT WITH LIFE: When someone comes to you and says ‘I want a breast augmentation,’ how do you decide, if mentally they’re doing it for the right reasons? And do you think that even matters?

DR ANDREW COHEN: It does matter; you ask them ‘how long you’ve been thinking about it? What size bra are you? Where do you want to go?’ Because I can give you a hint, if they want to go for a double F, well that’s not always appropriate. It’s got to fit their body. So I start by interviewing them and asking why they are doing it, how long have been they thinking about doing it, what size do they want to be. Then I show them pictures and they show me pictures of breast implants that they like so I can get an idea. It’s all about meeting a person’s expectations.

CONNECT WITH LIFE: Have you ever said to someone ‘I’m actually not going to do that because that’s not appropriate.’

Dr.-Andrew-Cohen-on-Breast-Augmentations-6DR ANDREW COHEN: Yes. I turn down people all the time. Sometimes if they want it to be too big you know triple D’s, F’s. I have to decline.  It’s just not realistic.

CONNECT WITH LIFE: A lot of people say if you have had an breast augmentation before you have children you can’t breast feed later? Is that true?

DR ANDREW COHEN: You can breast feed. I mean there’s no guarantee, it all depends. Sometimes the breast isn’t producing a lot of milk anyway, regardless of implants. So I tell people that there’s about an 85% chance you should be able to but there’s a 15% chance you may not produce enough milk.

CONNECT WITH LIFE: Does having an implant block the milk ducts or anything?

DR ANDREW COHEN: No. Sometimes you can interfere with the milk ducts but the way I make  my incisions I dissect down, so I’m trying to stay away from the milk ducts as much as possible. Technically there’s a chance you could injure a milk duct or two because your right there. We try and preserve the milk ducts when we are operating. I do have patients who got implants and were able to breast feed.

CONNECT WITH LIFE: Are most of your clients moms who have had children?

DR ANDREW COHEN: Moms, teenagers and women in their 20’s before having kids.

Dr.-Andrew-Cohen-on-Breast-Augmentations-4CONNECT WITH LIFE: For the average mom who maybe had kids and has a tummy and saggy breasts from breast feeding or just from just age or gravity… What are the risks involved?

DR ANDREW COHEN: There are risks with any surgery. For a breast augmentation it can be infection, bleeding, scarring, the need for elevation, if it’s a little less symmetric, encapsulation which is the scar tissue that’s forms around the implant.

CONNECT WITH LIFE: It sounds like these are all risks that are not fatal. They seem solvable, so is there a fatality risk I mean a lot of people talk about ‘oh Kanye West’s mom died doing cosmetic surgery.’

DR ANDREW COHEN: Well, I don’t know her, but from what I know, she didn’t have medical clearance for surgery. That’s what I have been told. Look, I don’t know her, I’m not her doctor but I have read what you have read. And I know she didn’t have medical clearance so she didn’t go to a facility to take care afterwards, she went home. I strongly encourage my patients to go to an aftercare facility called Serenity where there’s a nurse there to take care of them. Sometimes when we go home and after big long surgeries things can happen.  In other words people can have a hard time breathing after cosmetic surgery and that’s serious. If they go to an aftercare facility the nurses are going to check on them and make sure the binders are not too tight, that your breathing, your oxygen levels are normal, you have a monitor to make sure you’re breathing okay.

CONNECT WITH LIFE: How do you know which clients need to go to a center to get that care or is it all of them need that?

Dr.-Andrew-Cohen-on-Breast-Augmentations-3DR ANDREW COHEN: That’s a good question. Not all doctors send clients to after care but I do because I’m a safe surgeon. 90-95% of my patients go to Serenity and they are all so thankful, they say ‘thank you doctor for making me go.’  You don’t send them home after a big operation. I just request they spend one night in Serenity. It gives patients one night where you get looked after and are comfortable.

CONNECT WITH LIFE: How long they have to stay there?

DR ANDREW COHEN: I usually suggest one night. But usually people end up staying one to three nights.

CONNECT WITH LIFE: Are breast augmentations conducted under a local or general anesthetic?

DR ANDREW COHEN: General Anesthetic


DR ANDREW COHEN: I won’t say always. There are some doctors that would sneak it under a local. I think that’s painful and ridiculous. That’s not healthy. It’s very painful to go under the muscle you need to be comfortable.

Dr.-Andrew-Cohen-on-Breast-Augmentations-5CONNECT WITH LIFE: What are the most common questions women ask when they come and  meet you for a breast augmentation consultation?

DR ANDREW COHEN: What size should I be? Do I need a lift? The answer will be different for each patient. It should fit your body. It doesn’t have to be too big. Its going to fit your body don’t make them too enormous.

CONNECT WITH LIFE: And then what about the issue of needing a lift as well? Do all patients need a lift in an augmentation?

DR ANDREW COHEN: Generally speaking if the nipples are below the fold where your breast ends and your chest begins then you need a lift. I would have to examine the patient though. It depends. If you have enough breast tissue I don’t put an implant at all. All I have to do is to lift.

CONNECT WITH LIFE: How much size do you lose just doing a lift?

Dr.-Andrew-Cohen-on-Breast-Augmentations-2DR ANDREW COHEN: It’s just depends on the person. I’ve seen several patients who have had a lift with no implants.

CONNECT WITH LIFE: What if your patient is a heavy smoker?

DR ANDREW COHEN: I do operate on smokers but I need them to stop smoking 2 to 3 weeks in advance. Nicotine in the system makes it difficult for the body to heal.

CONNECT WITH LIFE: What are three things all patients should know before undergoing a breast augmentation?

DR ANDREW COHEN: Make sure your plastic surgeon is board certified and spends time with you. You should make sure you are familiar with their previous work. Secondly, make sure you’re comfortable with the size that you’ve decided on with your surgeon and thirdly make sure the facility you are going to have yoru surgery in is also certified.

CONNECT WITH LIFE: Do you warn patients that a breast augmentation may not make them happy if they have depression?

DR ANDREW COHEN: Well my happy patients are also happy afterwards. The unhappy people are usually not happy afterwards.