Premiere Plastic Surgery

Your Consultation

Prior to your breast surgery, your board-certified surgeon will carefully evaluate your general health status and any pre-existing health conditions that could compromise the outcome of surgery or risk your health. Also, your surgeon will get detailed measurements of your breasts and the quality and quantity of your existing breast tissue to determine the proper choice of breast implant and technique. 

The surgeon may also suggest a breast lift, or Mastopexy, in addition to breast augmentation in situations where there is excessive laxity or drooping of the breasts. If this is the case, breast augmentation alone would be insufficient to solve and correct this condition. 

A mammogram six months before surgery is required, and photos of your breasts will be taken before and after surgery.

The Breast Augmentation Procedure

Breast augmentation is done on an outpatient basis in an ambulatory surgery center, usually under general anesthesia. 

There are several options for the type of incision used dependent on your indvidual breast anatomy and the type and size of implant that will be used. Not all options are available to every patient. The implant type, pocket placement and incision approach all have relative advantages and disadvantages. 

The following are the different type of incisions:

Infra-mammary

Incision is made in the fold under the breast. 

Peri-areolar

Incision is made around the nipple. 

Trans-axillary with endoscopic assist

Incision is made under the arm. 

All incisions are kept short and inconspicuous. Your surgeon will choose the surgical technique as well as the size and type of implant that will produce the result each individual desires. 

Implants can be inserted either under the breast tissue (sub-glandular) or partially under the pectoral muscle (sub-pectoral or sub-muscular). When implants are placed in a sub-muscular position (under the breast tissue and the pectoral muscle), there is less chance of capsular contracture, which is the shrinkage of the tissue capsule surrounding the implant that causes both implant and breast to feel unnaturally firm. Placing implants in a sub-glandular position (directly under the breast tissue) may be advisable in some cases, depending on the thickness and laxity of the breast tissue, and also the ability of the breast tissue to decently cover the implant. 

Once the desired pocket has been created, a temporary implant is placed to determine the proper shape and size of the final implant. In this stage, the surgeon will evaluate your pre-operative photos and your desired results based on your previous discussions with the surgeon, as well as the photos you may have shown for comparison. The final implant is then chosen, inserted, and properly positioned within the pocket, and checked to insure that your breasts have the shape and size you expected before surgery. However, there can be no guarantee as to the final cup size of your breasts after the operation.

A local, long-acting anesthetic will be used in the space around the implants to insure minimal pain or discomfort when you wake from surgery. Incisions are carefully closed with multiple layers of hidden sutures and surgical tape. However, in the case of revision surgery on the breast for encapsulation or other problems, drains are never placed. You will then be placed in a soft surgical bra with a supportive wrapping around the chest. You will wake up in the recovery room with minimal pain, or mild to moderate muscular soreness that is similar to a strenuous workout, after the implants have been placed partially behind the muscle. 

The surgeon will help you in deciding which incision, pocket placement, and type of implant you should have to get your desired results. They will utilize the most advanced techniques in order to minimize your risks, optimize your results, and return you to your normal, unrestricted activities as quickly and comfortably as possible.

Recovery

Make sure someone is able to assist and drive you home and be available to care for you continuously for the first 24 hours. Since no drains are required except in the case of re-operative breast implant surgery, our patients are allowed to shower the day after surgery. Some pain or discomfort might be experienced the first day or two which is easily controlled with analgesic medications. But there should be minimal bruising. Also, tightness in the breast area is normal as your body adjusts to the implants. There can be more discomfort and spasms when the implants are placed below the pectoral muscle. If this occurs, your surgeon may prescribe a muscle relaxant to control the spasms. 

Patients should be able to return to normal daily activities like washing and driving about 2 to 4 days after the surgery. In the first 2 weeks after the procedure, a bra should be worn at all times, except when showering. Moderate exercises like walking are allowed after the first week, while vigorous exercises like jogging and aerobics can be resumed in 3 to 4 weeks’ time. Patients should avoid heavy lifting, bathing, or swimming for the next 2 to 3 weeks. You may return to work in a day or two, but do avoid any strenuous activities. 

Your breasts may be appear somewhat swollen after surgery, but within a few weeks, the actual shape and size of your breasts will be apparent so you can begin to wear bras and clothes that you prefer. 

Your surgeon suggests for you to get breast examinations at no cost from our office every 6 to 12 months. Continue breast self-examinations monthly, and have mammograms as recommended by your gynecologist or personal physician, generally yearly after age 40. We do request that you forward copies of all your mammography results to our office.

Risks

Every operation has potential complications, like adverse reactions to anesthesia, bleeding, infection, poor healing of the surgical scar and pain. Post-operative bleeding or formation of a seroma (a collection of the watery portion of the blood around the implant) may require re-operation and drainage, and may be associated with an increased incidence of infection or capsular contracture. 

Although rare, infection of a breast implant may occur that will require the removal of the implant for up to several months until the infection is completely cleared, and only then can the implant be re-inserted. The formation of a fibrous tissue capsule around a breast implant after surgery is a body's normal response to the placement of a foreign object in the soft tissue. 

Capsular contracture is a process of gradual but aggressive shrinkage of this tissue capsule surrounding the implant. This causes the breast and implant to feel unnaturally firm and often times painful. Capsular contracture is usually progressive, worsening with time, over the course of several months to years. This situation may result in asymmetry of the breasts. The occurrence or severity of this condition varies with each individual. There is no reliable data as to how often it occurs. Asymmetry may also occur as a result of unexpected problems with early healing after implant placement. 

When the saline solution of a saline breast implant leaks either through the valve or through a puncture or defect of the outer shell of the implant, it would cause deflation and would require surgical replacement. Most implants are covered by a manufacturer’s warranty against deflation. 

Patients are reminded that sensory changes may occur in the nipples or outer breasts. Also, patients with a very small volume of breast tissue or thin skin before surgery may notice visible wrinkling or rippling of the implants, especially saline, and more commonly when larger size implants are chosen. Another reminder is that there may be delayed wound healing for patients with diabetes, a history of radiation, autoimmune disease, or smokers. Surgical scars may be unsightly. In order to avoid these problems, a thorough medical evaluation should be done before the surgery. 

Studies show that breast implants should not affect fertility, pregnancy, or a woman’s future ability to nurse. It is a fact that not all women may be able to breastfeed even without the implants. If the peri-areolar (nipple) incision is used for the procedure, there may be a greater risk of scarring within the breast or alteration in the ability to breastfeed as compared to the axillary (under-arm) or inframammary (breast fold) incisions, but there is no evidence gathered for it to be scientifically proven. 

Breast augmentation may not be a one-time surgery. It is very likely that additional surgeries and doctor visits will be necessary over the course of your lifetime to maintain the appearance of your breasts after the procedure. This might be because of problems related to the implants themselves, like deflation, capsular contracture, or rupture, or because of aging changes, like pregnancies, weight gain, and loss of breast tissue, that affect the appearance of the breasts over time. 

Health insurance does not cover breast augmentation, except in rare cases of congenital deformity or some types of reconstruction. Insurance may not also cover re-operation or additional future surgeries or additional doctor visits if complications arise.

Frequently Asked Questions

Q: How much increase in cup size can I expect?

A: The size of your breasts after breast augmentation will depend on the implant used and the ability of your breast tissues and chest wall muscles to expand with the implant. In general, women with relatively large breasts can go larger than women who have very little breast tissue to begin with, and petite women cannot go as large as women with a larger physique. There is no guarantee as to the final cup size. 

Q: Are silicone breast implants dangerous?

A: To date, silicone breast implants have been shown to be safe devices that do not pose any greater risk of causing disease than saline implants. If there is evidence showing that silicone breast implants could lead to systemic disease, your surgeon would never use them. We do not hesitate to recommend silicone breast implants to a patient if the circumstances dictate that this would be the best choice of implant. 

Q: When will the sutures be removed?

A: Sutures will be removed after a week to 10 days.

Q: Do I need to massage my breasts and for how long?

A: We will give you detailed instructions if massage is required after the surgery. Smooth implants, whether saline or silicone, above or below the muscle, must be massaged immediately after surgery to maintain the softness of the breasts. Maintaining a large space around these implants prevents or delays the encapsulation process. Textured implants do not require massage. 

Q: When can I bathe?

A: You may shower 24 hours after surgery. Do not immerse your breasts under water or take baths in the tub, pool or ocean until 3 weeks after surgery. 

Q: When can I resume exercise?

A: You may walk or ride a stationary bicycle within two days. No strenuous upper-body exercises for two to three weeks following surgery. Avoid any activity that may cause any discomfort. 

Q: When can I wear my preferred bras or clothes?

A: The swelling will settle in two to four weeks. The breasts are not likely to change much in size at that time, but may continue to soften and improve in shape. You can now wear your bras and preferred clothes at this point. You should wear the post-surgical bra given by our office for the first two weeks at least. 

Q: Will I need additional operations on my breasts in the future?

A: It is likely that you will need future surgeries on your breasts in order to maintain their appearance. 

Q: How long will my implants last?

A: Most implants last for 10 to 15 years. Any type of breast implant is subject to wear and tear and deterioration due to aging over time. Like a heart valve or artificial joint replacement, they are not to be expected to last forever. The implants are covered by a manufacturer's warranty against manufacturing defects, and most companies provide financial assistance for re-operation and implant replacement at no charge in the event of implant failure. However, you may incur other financial costs which are not covered.