Before & After

This patient wore an A cup bra and wished to be a full B. She underwent breast augmentation with a 210cc biodimensional (anatomic) implant placed beneath the muscle through a transaxillary incision. The patient is shown here about 10 months after surgery.

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Breast Augmentation

Women who choose to have breast augmentation surgery do so to improve their self-image. Some feel dissatisfied because their breasts never developed to a size that meets their expectations. Others want to bring balance to a breast that is somewhat smaller than the other.

Often, women want the procedure to restore their natural breast volume, which may have decreased as a result of pregnancy, weight loss or aging.

What Makes a Good Candidate for Breast Augmentation Surgery?

• You are bothered by the feeling that your breasts are too small
• Weight loss has changed the size and shape of your breasts
• After having children, your breasts have become smaller and have lost their firmness
• Dresses that fit well around your hips are often too large at the bustline
• One of your breasts is noticeably smaller than the other
• You feel self-conscious wearing a swimsuit or form-fitting top.

In addition, there are several musts for anyone considering breast augmentation- - if you are a young woman, your breast development must be complete - you must be emotionally mature and fully understand your own motivations for wanting the procedure (the best reason is to feel better about yourself) - you must have realistic expectations, knowing that the procedure can bring improvement, but not perfection.

The Consultation

A personal consultation with our Cosmetic Surgeon is the first step for every patient considering breast augmentation. During this meeting, I will assess your physical and emotional health and discuss your specific cosmetic goals for surgery.

You should arrive at the consultation ready to provide complete information about:

• Previous surgical procedures
• Past and present medical conditions
• Medications you are taking, including herbal remedies or nutritional supplements
• The results of mammograms you have had
• Any history of breast cancer in your family

I will help you understand the factors that may affect your results. For example, gaining or losing a significant amount of weight may change your breast size. Pregnancy can also alter breast size in an unpredictable way. If you are over 35 a mammogram should be considered prior to surgery.

During this exam, I will consider the size and shape of your breasts, the quality of your skin and the placement of your nipples and areolas (the pigmented skin surrounding the nipples). I may suggest additional cosmetic procedures to improve your results. For example, if your breasts are sagging, a breast lift procedure may need to be performed in conjunction with your breast augmentation surgery.

The Implant

There are currently two basic types of breast implants approved for use. Saline and silicone gel filled implants.  Silicone gel implants now have two subtypes available.  The saline filled implant has been in use for several decades and since 2006 the silicone gel implant has been made available again. The silicone gel implant approved in 2006 is a cohesive gel implant that I have been using in about half of my patients.  Now in 2013 a more highly cohesive “form stable” silicone gel implant is available.  This is the implant that the press has labeled the “gummy bear implant”

The saline filled implants can be placed through the smallest incision, about 3 cm (1 ¼ inch) since the implant is filled after it is inserted. The saline filled implant is slightly firmer and does have a greater chance of rippling.

The cohesive silicone gel implant is a little softer and has less chance of visible rippling but does require a bigger incision, usually about 4-5cm (1.5-2 inches). If the silicone gel implant leaked you probably would not even know it as the gel is cohesive and will most likely stay together and continue to give a nice result. The manufacturer does recommend replacing them if they have a shell defect. Since you would probably not even know it the manufacturer recommends patients to have an MRI to check for rupture 3 years after the surgery and every 2 years thereafter.

The highly cohesive silicone gel implant approved in 2013 will usually take a  5-6cm incision (2-2.5 inches).  The gel in this implant is even more cohesive which enables the implant to shape the breast more but can be slightly firmer.  This implant seems to have an even less risk of rippling.

We will discuss the differences between these options at length during your consultation.

The Procedure

The surgery is performed under a general anesthetic and usually takes less than 1 1/2 hours. Incision options include an incision at the edge of their areola, axillary (armpit) and lower border of the breast incisions. The incision at the edge of the areola is usually not an option with silicone gel implants due to the length of the incision needed. I place most implants beneath the pectoralis muscle, however just beneath the breast tissue is a good option for some patients. Beneath the muscle gives more coverage and support in most women.

Preparing for Surgery

When the date for your surgery has been set, I will provide you with specific instructions for the days immediately before and after your surgery.

Including:

• Avoiding certain medications that may complicate surgery or recovery (aspirin and ibuprofen)
• Stopping smoking for one week before and after surgery is recommended
• Nothing to eat or drink after midnight before your scheduled surgery
• Arranging for help or special care following surgery.

The Recovery

Day of Surgery

After your surgery you will spend 1-2 hours in the recovery room and then discharged home. You will be given prescriptions to get filled. You will need someone to drive you home. Sleep with several pillows behind you to keep your head and chest elevated. There will be a mildly compressive wrap over the breast area to help reduce swelling. Ice packs may be used during the first 24 hours if you wish. You will need someone to pamper you this first day, as you will be very sore.

Day 1 (After Surgery)

You may take the wrap and dressings off your chest and shower. Leave the small steri-strips on that cover the incision. No dressings need to be put back on. You may go braless or wear a loose fitting sports bra, whichever is most comfortable. Do not wear an under wire or pushup bra. Do as little as possible around your house. Lift nothing over 5 pounds. Do not bend over to pick things up.

Days 2 - 7 (After Surgery)

You will slowly feel better with discomfort gradually improving. The breasts will be swollen and usually are fuller in the upper part of the breast. You may gradually increase your activity, but still no bending over and lifting over 5 pounds. You will be asked to come to the office about 1 week after your surgery for a check up. Do not drive as long as you are taking pain pills.

After 1st Week

Pain and swelling continue to improve. Some people feel up to working, doing light activities only, after the 1st week. Gentle massage on the breasts in a downward direction may be started. Gentle sexual activity may be resumed. Most swelling is gone after 3-4 weeks. The fullness in the upper portion of the breast gradually decreases and may take several months to reach your final result. You will be asked to come back to the office about 2 weeks after your last follow-up visit.

After 1st Month

You may resume most activities but still no heavy lifting over 30 pounds. Mild exercise programs may be resumed. You will be asked to come back to the office for another follow-up visit about 7 weeks from the date of your surgery.

After 2nd Month

No restrictions. Continue to occasionally massage the breast. You will be asked to return to the office for a follow-up visit at about 3 months from the day of surgery and yearly thereafter.

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