📱 +90 544 850 72 32📍 Teşvikiye Caddesi No:9/12, Şişli, İstanbul TR/EN/DEWhatsAppInstagram
Assoc. Prof. Dr. Ayhan Işık Erdal answers

Ask the surgeon: real questions from patients

I've compiled the most frequent questions I receive from my patients during and after consultations, with honest, direct answers. No marketing language, just clinical reality. This page does not replace personal medical advice — individual examination is essential for your specific case. But you'll find honest answers to general questions.

Decision Making

I'm 26, never given birth — will implants affect breastfeeding?

One of the most common questions in my practice. Direct answer: most modern techniques preserve breastfeeding capacity, but some incision types carry risk. Inframammary (under-breast) incision → milk ducts not cut, minimal effect. Periareolar (around nipple) incision → 5-10% chance of duct damage. Axillary incision → ducts untouched. For patients with future pregnancy plans, I prefer inframammary incision + dual-plane placement. During breastfeeding, natural breast changes (growth, sagging) can also affect implant position; some patients may need revision later.

I'm 30, two children, sagging is present. Implant alone, lift, or both?

The center of this decision is nipple position. If the nipple is at or below the inframammary fold (Regnault Grade 2-3 ptosis), implant alone is inadequate — creating what's called "snoopy deformity." Mastopexy (lift) is required, often combined with an implant (augmentation-mastopexy). If the nipple is 1-2 cm above the fold, implant alone may suffice. Measurements are taken: jugular notch-to-nipple, areola-to-IMF, areola diameter. Decision based on these. For most 2-children patients, combined augmentation-mastopexy gives the most natural result.

Fat transfer (lipofilling) or implant?

Depends on the goal. If you want 1-1.5 cup increase and have donor fat (abdomen, thighs), fat transfer alone may work. Advantage: natural look, natural feel, no implant lifespan concerns. Disadvantage: 30-50% of fat is absorbed; volume control difficult. 2 or more cup increase requires implant. Hybrid (implant + fat) prevents implant edge visibility especially in thin patients. Practical advice: in thin patient (BMI 19-22) hybrid, average build implant alone, very small increase fat-only.

Size Selection

What does 350 cc implant translate to in cup size? What's the visual difference?

Hard to give a precise answer; same 350 cc can be different cups in different women. Rule of thumb: 150-180 cc ≈ 1 cup increase, for an average-sized woman. 350 cc, 75A → 75C/D (varies with chest wall structure). What matters is not cc but profile + size matched to anatomy. In wide chest 350 cc looks small; in petite frame same volume appears dramatic. I do 3D visualization in consultation or use "sizers" (test implants) in a bra to see real appearance. Decide based on what the mirror shows, not the cc number.

Does bigger implant mean higher capsular contracture risk?

Valid observation — larger implants create more tissue tension, more seroma, more capsule reaction. But main risk factors are: biofilm (bacterial contamination), atraumatic technique, antibiotic irrigation, implant surface — more important than size. A 250 cc smooth-surface subglandular implant has higher contracture risk than a 500 cc nano-surface dual-plane implant. Still, excessive volume (above anatomic capacity) adds risk. "Natural" volumes (anatomy-matched) safest.

Do you tell exact size at first consultation?

No, I don't commit to a single size at first consultation. What I can tell — 3-4 cc options matched to your measurements, with each option's pros/cons. You choose the final size, planning is done. Pre-op week you can test sizers at home. Stay away from a surgeon who says "definite 350 cc one-shot" — this is factory-style, not personalized medicine.

Safety

When my friends decide to come to Turkey, families say "don't go." What do you say?

I understand — family concern is reasonable. I tell families: "Turkey has 1,500+ board-certified plastic surgeons, 40+ JCI-accredited hospitals. Turkey ranks 2nd globally in JCI-accredited hospital count after the US." The real question isn't the country, it's the chosen clinic. With USHAŞ-licensed clinics, FACS-FEBOPRAS-certified surgeons, JCI hospitals — medical tourism is safe. Cheap "package"-pushing clinics that don't offer face-to-face surgeon contact and that promise guarantees are dangerous — in Turkey or UK alike. Your family can talk to me on WhatsApp video; this often resolves trust concerns.

What if there's a complication? Will you abandon me?

Direct answer: complication management matters more than the surgery itself. Early complications (hematoma, infection) in first 1-2 weeks — this period is in Turkey, monitored at clinic. Late complications (capsular contracture, asymmetry, implant rupture) can happen years later. Then: 24/7 WhatsApp access, return to Istanbul if needed (revision fee discussed), or referral to a trusted plastic surgeon in your country with written report. Instead of "do surgery, send away" approach, I have structured 1-year follow-up standards.

How will I know if my implant ruptures?

Modern silicone implant rupture is usually silent — silicone gel is cohesive, doesn't leak, stays in capsule. Due to absence of symptoms, FDA recommends MRI every 3-4 years for silicone implant patients. Saline implant rupture is obvious: breast suddenly shrinks, saline absorbed. New-generation silicones rarely show extracapsular leak. Clinical follow-up: yearly exam, ultrasound every 5-7 years, MRI every 10 years.

Recovery

How many days after surgery can I shower?

After drains removed (usually day 2-3), warm shower OK. Don't pour soap directly on the wound and rub; warm water flowing over is enough. Bathing (tub immersion) prohibited first 2 weeks — wound infection risk. No sauna or hammam for 4 weeks. No swimming pool for 4-6 weeks (wound must be closed, chlorine irritates).

When can I wear a regular bra?

First 6 weeks only surgical support bra or sports bra — underwire bra prohibited. From 6-8 weeks onward, normal bra with wide wire and light pressure can be worn. Push-up bras after 3 months. Wire pressing on the wound disrupts scar healing; also risk of disturbing implant position.

How soon can I fly?

Short flight (1-2 hours): OK after 1 week. Long flight (5+ hours): OK after 2 weeks, compression stockings essential, frequent movement. No lifting cabin baggage for 4 weeks. This minimizes thrombosis risk (long sitting) and prevents pressure-related swelling.

Long-term

Does an implant last forever? Do I need to replace it every 10 years?

The 10-year myth is wrong. Modern silicone implants (5th generation) come with lifetime warranty from manufacturers. No need to replace without cause. "10-year" figure is a legacy myth from old 3rd-generation implants. Replacement reasons: rupture (~0.5-1% yearly), capsular contracture Grade III/IV (~1-2% cumulative yearly), size/shape change wish, BIA-ALCL suspicion (very rare). My recommendation: don't replace unless symptoms. Asymptomatic MRI follow-up sufficient.

Will pregnancy/breastfeeding ruin my implant?

During pregnancy breast tissue grows; after breastfeeding shrinks and sagging may increase. These natural changes affect tissue around implant. Implant itself unaffected — but breast shape may change. Some patients need mastopexy (lift) afterward. So if future pregnancy is planned, I recommend waiting 1-2 years and then placing implant. If you already have implant and become pregnant: no breastfeeding concern (covered above). Post-pregnancy shape evaluation done 6-12 months after.

Can I get a mammogram with implants?

Yes. Modern mammography won't break implants. Eklund maneuver — special technique pushing implant back to clearly image breast tissue. Disclosure of "implant present" mandatory in clinical history — inform radiologist. MRI used for additional imaging (especially silicone rupture suspicion). Screening sensitivity slightly lower than non-implant mammogram but clinically adequate. Yearly mammogram after 40 unchanged.

Comparison / Practical

How many times do I need to come to Istanbul?

Standard flow: one trip enough (7-10 days). Day 1 consultation, days 2-3 surgery, days 5-7 follow-up, return. Pre-consultation by WhatsApp video — before arrival. Subsequent follow-ups (1 month, 3 months, 6 months, 12 months) by remote video. Optional in-person 6-month visit recommended (especially if revision evaluation needed). Combined with family visit, 6-month visit can be naturally organized.

Is consultation paid?

I offer free video consultation. By WhatsApp or video call, I review your photos, request anatomical measurements, answer questions, suggest planning. In-person clinic consultation has a fee but it's deducted from surgery price later — meaning if you proceed with surgery, consultation becomes "free." I don't endorse paid-consultation-no-refund systems; this pressures patients.

What does an average patient look like in your practice?

Wide spectrum. Most common: 28-45 age, 1-2 children, post-partum shape change women. Average BMI 22-26. Yearly 150-200 breast augmentations, 50-70 mastopexies, 30-50 revisions. International patient ratio ~30% — Germany, Netherlands, UK, Austria, US-heavy. I speak Turkish, English, German.

Which implant brand do you prefer?

Not a single brand. Based on patient anatomy and preference, I use Motiva (especially nano-surface), Mentor MemoryGel, Polytech Microthane (in patients with high contracture risk), Sebbin (economic segment). Brand important but not critical — all these brands meet CE/FDA standards. More critical: surgical technique, biofilm prevention, implant size selection, placement depth. There's no "best" brand, only "most suitable for the patient."

Practical / Other

Do you do single-breast surgery (for asymmetry)?

Yes, single-side operations appropriate in some cases. Clinical situations: congenital asymmetry (Poland syndrome, tuberous breast), one-side developmental deficiency, post-mastectomy reconstruction. Aesthetic dual-breast operations correcting asymmetry can use different volumes.

Do you operate on men (gynecomastia)?

Yes, I perform gynecomastia (male breast enlargement) surgery. This is a separate specialty area; decision process differs (hormone evaluation, drug review). I can refer you to my main site. This page focuses on female breast aesthetics.

Do you do multiple procedures in one session (mommy makeover)?

Yes, I frequently accept mommy makeover patients. Typical combination: breast augmentation/lift + abdominoplasty + liposuction. Total 4-6 hours, 1-2 nights hospital observation needed. Advantage: one anesthesia, one recovery period, cost advantage. Disadvantage: longer surgery, longer recovery, more limited candidate profile (BMI <30, ASA I-II).

Psychological / Expectations

I'm experiencing decision confusion — is this normal?

Completely normal. An aesthetic surgery decision is a process spanning weeks or even months. Confusion shows you take risks seriously — don't worry. I think the healthy decision process is: 1) Define a clear goal ("more symmetric" / "fuller" / "return to pre-pregnancy state"), 2) Surgeon research (3-5 consultations), 3) Wait (at least 2-4 weeks of consideration), 4) Re-questioning ("will I still endorse this decision in 1 year?"), 5) Family/close-circle feedback. I don't operate on an undecided patient — I'd send them away to think more.

Will I regret this after surgery?

Statistical answer: 5-10% of patients experience regret at some point. Reasons for regret: too big chosen, too small chosen, didn't feel natural, partner didn't approve. To prevent: 1) Have your partner attend consultation, 2) Try "sizers" for size selection, 3) Request 3D visualization, 4) See real patient photos close to your dream result. Implants are removable — explantation lets tissues recover (if no silicone illness suspected). But there's no "won't regret" guarantee; that's why the decision should be slow.

My partner doesn't want me to do it — what should I do?

Very sensitive situation. Distinguish between partner's concern and control. Concerns (health, cost, outcome) are discussable; I invite partners to consultation, explain risks/processes together — concerns usually dissipate. But controlling/prohibitive stance ("I don't want, I forbid") is different. The decision is yours. Some patients delay due to family pressure; others continue alone. Personal boundary.

I'm having panic attacks before surgery — is this normal?

Pre-op anxiety is very common, 40-60% of patients experience it. Surgery fear is evolutionary — not irrational. Management: 1) Anesthesiology consultation (premedication plan — Midazolam 30 min prior), 2) Clinic tour (operating room, team familiarity), 3) Pre-op briefing (knowing every step), 4) Breathing exercises, 5) In severe cases short-term anxiolytic. If panic attacks become persistent, let's postpone — operating with unmanaged pre-op anxiety affects both experience and recovery negatively.

Financial / Cost

What's the total cost — any hidden fees?

I have a single-fee transparent approach: After consultation, one figure is given. Included: surgical fee, anesthesia, hospital operation and 1-night stay, implant (premium brands included), all post-op follow-ups (1 year), prescriptions, bra. Not included: hotel/travel (your choice), possible revision (free within 5 years for implant/medical reasons; discounted for other reasons). Video consultation free; in-person clinic consultation paid but deducted from surgery price. By Turkish regulation, web pricing in TL prohibited — personal quote given in writing in consultation.

Cheaper clinics exist — what's the difference?

Very cheap "package" clinics typically save through: 1) Surgical team (assistant doctors, not board-certified plastic surgeons), 2) Hospital (unofficial, illegal clinic), 3) Implants (off-record or generic), 4) No certified anesthesiologist, 5) No post-op follow-up. Result: cheap price but high complication risk; revision cost ends up 2-3× original. Fair price range in Turkey 2026 in CHF/EUR: 2,500-4,500 (premium implant + JCI hospital + academic surgeon). Much below this is suspicious.

Is credit card installment or financing available?

Yes. In Turkey, Visa/Mastercard 3-9 month installments possible (varies by bank). Beyond that, financing rare in Turkish clinics — medical loan market underdeveloped. For international patients: 30% deposit, balance on operation day (transfer, card, sometimes PayPal). Due to devaluation risk, prices given in CHF/EUR.

Will my insurance cover this?

Cosmetic breast augmentation generally outside insurance coverage — Turkey SGK doesn't cover, private health insurance doesn't cover, foreign insurances (TK, Krankenkasse, NHS, etc.) don't cover. Exceptions: post-mastectomy reconstruction, Poland syndrome, severe congenital asymmetry — these may be covered locally; consult. Complication treatment (e.g. infection healing) may be covered by some foreign insurances (Swiss Krankenkasse policy covers this).

Social

How do I explain this to my workplace, can I get leave?

Practical advice: instead of "plastic surgery," "minor surgical procedure" suffices — legally you don't need to give details. Leave: 1 week strict rest, 2-3 weeks light duty (office, partial hours). Physical work (warehouse, nurse, server) needs 4-6 weeks. If employer wants medical certificate: doctor writes "soft tissue surgery rest"; breast-specific not required. Long planning: align surgery with vacation period or project end.

Can I hide this from family members?

Parents and close family may not need to know — but you need an excuse for the 1-week rest period. Practical: "I'm tired, I'll rest for a week," "doctor recommended for back pain." Hiding from spouse harder — physical change becomes obvious in 2-4 months. If you want to keep it private, tell me — I can help with operation report, billing address, follow-up timing. But living with secrecy weighs heavily long-term; often surfaces unexpectedly.

When can I go out, do social activities after surgery?

Light social (cafe, short walk): day 5-7 OK. More active social (shopping, restaurant): day 10-14. Wedding, party, crowded place: after 4 weeks. Swelling worst first 2 weeks — clothes may not fit well, photos may show "new breasts." If important social event coming, time surgery accordingly (4-6 weeks before).

Can I plan summer vacation / beach time?

Beach/pool: after 6-8 weeks (wound fully closed, bra pressure tolerated). Bikini outdoors: 8-12 weeks (scar not fully matured, sun pigmentation risk). Direct sun on scar prohibited 6 months (even with SPF 50+). For surgery aligning with summer: April-May surgery ideal for August beach season. October-November surgery sufficient for next summer's matured result.

Work / Sports

When can I return to the gym?

Gradual return: 4 weeks: light walking, 30 min/day. 6 weeks: light cardio (elliptical, bike), light lower body weights (squat, lunge). 8 weeks: running, more intense cardio, full lower body weights. 10-12 weeks: upper body weights (push-ups, bench press, lat pulldown), pilates, active yoga poses. 3 months: full activity. Timeline varies by placement (submuscular longer, subglandular shorter).

When can I do yoga, pilates?

Light restorative yoga (lower body only): 4-6 weeks. Yin / Hatha (no upper body opening): 6-8 weeks. Vinyasa, Power Yoga, Pilates upper body components (chaturanga, plank, downward dog): 10-12 weeks. Pilates reformer most movements OK after 12 weeks. Always tell your trainer — they'll make modifications.

When can I cycle?

Stationary bike (gym): OK after 4-6 weeks. Outdoor cycling: 6-8 weeks (vibration, fall risk). Mountain bike / downhill: 12 weeks. With cycling bra, pedal position doesn't pressure inframammary fold; safe. Falls always possible — fall within 2 months can disturb implant position.

When can I swim?

4 weeks prohibited (wound not closed, chlorine irritates). 4-6 weeks: shower water cleaning only (no pool). 6-8 weeks: pool OK (wound fully closed, chlorine tolerated). Sea: after 8-12 weeks (salt's sterilizing effect doesn't bother but waves/currents can be traumatic). Stroke: butterfly prohibited 12 weeks (dramatic upper-body opening); freestyle prohibited 8 weeks; backstroke prohibited 6 weeks.

When can I do bench press, lat pulldown?

Heavy pectoral exercises require care especially in submuscular implant patients. 10-12 weeks: light weight (5-10 kg dumbbell incline press). 3-4 months: medium weight. 4-6 months: heavy weight. Bench press caution: if submuscular, pectoral contraction can push implant sideways ("animation deformity") — disadvantage especially for bodybuilders. For my bodybuilding patients I prefer subglandular or dual-plane.

Do I need yearly check-ups?

Medically: yearly physical exam + ultrasound every 5-7 years (capsule contracture, fluid collection) + MRI every 10 years (silicone implant rupture check). Practically: international patients don't prefer yearly visits — WhatsApp video follow-up done, ultrasound/MRI done at local clinic, reports sent to me, remote evaluation. If clinical findings (hardness, asymmetry, pain), Istanbul visit needed.

When can I travel internationally / business trip?

Business travel (flight): short distance (1-3h) after 1 week, long distance (5+h) after 2 weeks. No cabin baggage lifting for 4 weeks. Meeting/presentation (sitting): 1 week OK; tiring conference circuit 2-3 weeks. Hotel: mid-range OK; luxury hotel spa package (sauna, hammam) after 4 weeks. Business dinners and one-off events still require surgical-support bra (first 6 weeks).

General / Decision Support

How do I choose a good surgeon — what to look for?

5 critical criteria: 1) Certification: FACS (American Board), FEBOPRAS (European Board), ABPS, Turkey TPRECD board — at least one. 2) Academic affiliation: University position, peer-reviewed publications, congress presentations. 3) Case volume: Yearly 100+ breast surgeries (neither too few nor factory-style). 4) Hospital: JCI accredited, USHAŞ licensed. 5) Communication: Surgeon who listens, doesn't say yes too quickly, explains alternatives. Red flags: WhatsApp packages, guarantee promises, clinical recommendation only from photos, 1-hour decision pressure.

I consulted multiple surgeons, all say different things — who to trust?

Very common and healthy process. Different surgeons may prefer different techniques; this isn't "wrong," just experience-area difference. For decision: 1) If 3 surgeons say same thing, probably right (e.g. "ptosis present, mastopexy needed"). 2) If only 1 says different — either innovative or wrong; question. 3) Ask yourself: "Can I communicate with this surgeon for 1-year follow-up?" Between two equally qualified surgeons, communication quality is decisive. 4) Trust intuition — "this surgeon took me seriously" feeling matters.

Should I trust internet forum reviews?

Mixed answer. Positive: Real patient experiences, useful for expectation management, info on clinic atmosphere. Negative: Many fake reviews (especially Trustpilot, Google reviews), clinic-PR-planned reviews, exaggerated anecdotal complaints. Practical use: 1) Prioritize academic sources: PubMed, peer-reviewed journals. 2) Forums/Reddit: look for patterns — single negative review with mostly positive = OK; all positive with no criticism = fake. 3) Review dates: clustered same period = SEO operation. 4) Ultimately: trust your own consultation experience more.

Send your question

For questions not covered above: WhatsApp video consultation is free. You can send photos for anatomical measurement; individual evaluation is done. Common questions not yet covered will be added to this page.

Selecting your implant

The right implant for you is decided in consultation — based on anatomy, lifestyle, and goals.

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