Breast Augmentation (Breast Implants)
Description
The Surgical Procedure
What to Expect After Breast Augmentation
Resuming Physical Activities
Frequently Asked Breast Implant Questions
Before/After Breast Implant Photos
Description
Breast Augmentation increases the size and fullness of the breast.
Women whose breasts are disproportionately small, have sagged or "deflated" after childbirth, or who have unevenly-shaped or sized breasts are candidates for the procedure. If the breasts droop too much, a breast lift may be required in addition to or instead of the augmentation.
Choices like the location of the incisions, the position of the implant whether under or over the muscle, the implant size, choice of implant type and shape are chosen for each patient based on their needs. There is no evidence of a causal link between breast implants and breast cancer.
The Surgical Procedure
The procedure takes approximately two hours. Placement of the implant is usually centered on the nipple-areola. Placement above or below the muscle is decided on an individual basis and incisions used to place the implant vary with patient preference and anatomy.
The surgery is performed on an outpatient basis under general anesthesia. The size (cup size - cc) and type of implant (silicone or saline) to be used, along with their relative advantages will be discussed with Dr. DeWeese at the pre-operative appointment.
The exact cost of this procedure varies depending on the extent of the procedure. The surgery package price includes the surgeon's fee, the anesthesiologist's fee, the hospital and operating room expenses. Cosmetic breast augmentation surgery typically costs between $7,500 to $9,000.
What to Expect After Breast Implant Surgery
Bed rest is the order of the day, along with plenty of fluids and no aggravation. During the first week, a brassiere will be fitted and you will be permitted to shower, perhaps as quickly as two to three days post-op. Initially, the breasts will appear to be slightly higher than normal. Over three to six weeks the implant will descend to a more natural position. Also, the chest will feel somewhat sore for the first few days. This should abate very quickly, and by the end of the first week you should be very comfortable.
Resuming Physical Activities after Breast Augmentation
- Driving may be resumed - 2 weeks
- Non-contact sports - 3 weeks
- Contact sports - 6 weeks
- Sexual activity - 2 weeks
Frequently Asked Questions about Breast Implants
Q: How long do I need to be off work?
A: It is recommended that you take one week off work after breast augmentation surgery and continue to avoid strenuous activity and heavy lifting for 4 weeks after the surgery. Please do not drive for 2 weeks after surgery.
Q: What age is too old to get a breast augmentation?
A: Breast augmentation can be performed from an age of 18. You are NEVER too old to improve the appearance of your breasts.
Q: Should implants be placed under the muscle or over the muscle?
A: Every patient’s anatomy is different; therefore, the only way to know which procedure would give you the best cosmetic result is to have a board certified plastic surgeon examine you and discuss your options.
Q: Is it necessary to wait until after having children before having breast augmentation surgery? Do breast implants interfere with breast feeding?
A: It is a matter of choice for each woman. More than half of patients perform the surgery before having children and the majority of them have no problems breast feeding afterwards. The incisions are small and the surgeon attempts to minimize the amount of disruption of the glands in the nipple/areola. The underlying breast implant does not harm the breast fed baby in any way.
Q: How do I decide what size implants to get?
A: The size that a patient decides to achieve is a very personal decision. Often the patient wishes to achieve a “natural look” to simply improve the proportionality of the upper and lower body. Some patients, however, want a “round” look. For these patients a “natural look” is not a priority and they are not concerned if other people know that they have had a breast augmentation.
In making this decision, it helps to discuss your goals with your surgeon. Pictures are often helpful as a form of communication between the patient and the surgeon. Often discussing “cup size” is useful but one must be careful since “cup size” depends on the manufacturer of the bra. Furthermore, implant sizes are measured by volume (cc), which does not directly translate to cup size.
Q: Do breast implants interfere with mammography?
A: Yes. Breast implants, regardless of their location in the sub-muscular or sub-glandular location, can interfere with a mammogram. Generally, the breast implants placed in the sub-muscular position tend to interfere with mammography less than those placed below breast tissue. Mammography centers are accustomed to performing mammography displacement techniques on patients with breast implants.
Q: Can sensation of the nipple/areola be lost after breast augmentation surgery?
A: Yes, a small percentage (<5%) of patients have permanent nipple/areola sensation loss after breast augmentation surgery. Many patients have temporary loss or hyper-sensitivity of the nipple/areola complex. The surgeon takes great care during the operation to avoid injury to the nerve supply to the nipple/areola complex.
Q: How do I decide on the incision (approach) to be used during breast augmentation?
A: Several incision options are available to perform the breast augmentation. These include:
- Around the areola - this incision tends to heal very nicely and becomes barely visible with time.
- Under the breast (just above the intramammary fold) - this incision is good for patients who have some excess skin under the breast. An incision can be hidden in this area
- In the axilla (armpit)
The choice of the incision is made by the patient and the surgeon. In general, we try to use the incision which is best hidden and therefore less visible. often , the decision is made based on the patient's anatomy.
Q: How do I decide to go over or under the muscle with the breast implant?
A: The decision to do a sub-muscular (under the muscle) or sub-glandular (under the breast tissue) breast augmentation is based on several factors - including the patient’s preference and anatomy. Each type of augmentation has its pros and cons.
All things being equal, a sub-muscular breast augmentation is preferable. This type of augmentation is associated with less chance of seeing or feeling the breast implant. This operation is also associated with a decreased risk of breast implant hardening (capsular contraction or scar tissue formation). Sub-muscular breast augmentation interferes with the performance of mammography less than sub-glandular breast augmentation.
On the other hand, sub-muscular breast augmentation is generally associated with more patient discomfort and a longer period of time to achieve the final cosmetic results compared to the sub-glandular breast augmentation. Weighing the pros and cons of each type of augmentation, Dr. DeWeese prefers to perform a sub-muscular augmentation to achieve an end result with fewer complications and a better aesthetic result.
Q: What is capsular contracture?
A: This is scar tissue that forms around the breast implants causing the breasts to harden. This hardening may be associated with tenderness and pain. This is the most common complication following breast augmentation. Sub-muscular breast augmentation helps to deter capsular contracture. Massage may be useful, especially for implants placed above the muscle. If severe capsular contracture occurs, it may be necessary to remove the scar tissue and replace the implant (preferably in a sub-muscular position).
Q: What is the difference between textured and smooth implants?
A: Texturing refers to the surface of the breast implant. Textured implants have a rough surface in an attempt to prevent contracture formation (especially when the implants are placed above the muscle). This does not appear to be relevant in the sub-muscular position. Textured implants may be associated with rippling more than smooth implants.
Q: Who should perform my breast augmentation surgery?
A: The physicians most qualified to perform breast augmentation surgeries are board certified plastic surgeons. It is important to get information regarding the surgeon’s training. Can the surgeon perform this procedure in a major hospital in your city? What do other patients say about the surgeon’s ability to communicate and his level of post-operative care?
Q: What do the implants feel like?
A: In general, implants feel firmer than your own breast tissue. Also, the appearance and feel of augmented breasts depends on how much breast tissue the patient before surgery. The more tissue the patient already has, the more natural the look and feel of the breast after implants.
Q: What medications should I stop before surgery?
A: Do not take any medication containing aspirin or ibuprofen. Herbs or weight loss medications should also be stopped at least 2 weeks before surgery.
Q: How do I reduce post-operative nausea?
A: Unfortunately, nausea is a common problem after many surgical procedures. Many medications can be used intra-operatively in an attempt to reduce this problem. Post-operative nausea can be reduced by minimizing the use of narcotics and taking any medication with some food in the stomach. If nausea is not relieved by these measures, anti-nausea medication may be prescribed.
Q: How do I know if I need a breast lift?
A: A breast lift (mastopexy) is an operation used to treat ptotic (sagging) breasts. A consultation with a board certified plastic surgeon can help answer this question.In general, evaluating the position of the nipple/areola complex in relation to the fold under the breast (infra-mammary fold) will help determine the need for lifting.
Different types of breast lifting operations are available depending on the severity of the sagging. Reviewing pictures of patients who have had a breast lift may be helpful.
Q: What can I expect post-operatively?
A: Most patients experience a moderate to significant discomfort. This seems to be increased with sub-muscular breast augmentation compared to sub-glandular breast augmentation. Many patients are unable to sleep because they are not used to sleeping on their backs. Soreness of the back and neck may be related to this difficulty finding a comfortable position. Some patients choose to use 2 pillows and sleep in a reclined position.
Q: What is symmastia?
A: This is when the two breasts come together in the midline (cleavage area). This may be done to “increase cleavage” by dividing the soft tissue or muscle fibers at the medial edges of the breast. This can be seen with implants placed over or under the muscle. It is a correctable problem.
Q: What is a “tubular breast”?
A: Tubular breasts, otherwise known as constricted breasts, are associated with some breast tissue deficiency especially medially (around the cleavage area). The appearance of the breasts can vary greatly from a very severe deficiency of breast tissue to mild deficiency. Often the patient will have different size and shape between the right and left breast. This assymetry is a correctable condition. Implants can be used to improve the size, shape and symmetry of the breasts.
Q: When do the stitches come out?
A: The stitches are absorbable, they usually do not need to be removed because they dissolve on their own.
Q: When can I take a shower again?
A: After the initial dressing has been changed, you are allowed to shower.
Q: If I have to have the surgery redone later in life, will the incision be made in the same place as the original?
A: Yes, usually the incision would be made in the same area.
Q: What are expanders? Will I need expanders to achieve the size I want?
A: Tissue expanders are like implants with a fill port for use in stretching tissue. Expanders are not ususally necessary.
Q: Do you make over-sized pockets?
A: Pockets are slightly larger than the implants used which allows movement, making the augmented breasts resemble natural breasts as much as possible.
Q: If I develop a capsular contracture and the implants have to be removed, will I be able to have them put back again?
A: Most of the time, patients wish to have implants replaced after removal of capsules (capsulotomy).
Q: What guarantees are offered with the implants?
A: The implants are under lifetime warranty by the implant manufacturer. For a small fee, additional insurance also provides a stipend to return to the operating room if an implant leak occurs within the first 10 years.
Q: Who prescribes the pain killers and may I get them prior to surgery?
A: All necessary prescriptions will be prescribed by the doctor one or two weeks prior to surgery (at the pre-op appointment).
Q: How long do I have to wear the special bra or "bandeau"?
A: The amount of time depends on your specific situation. On average, the bandeau will be worn for 2-4 weeks after the procedure by our cosmetic surgery patients. This will press the implants down. Wearing the bra is important. Following Dr. DeWeese’s directions will give you the best possible results. Each patient is different and the recovery time will also be different.
Q: When can I start to exercise?
A: Dr. DeWeese does not recommend heavy weight lifting or strenuous exercise until 6 weeks after the procedure. Patients may walk and do leg exercises as soon as it feels comfortable.
Q: How long is the recovery?
A: Every patient is different in their recovery. Most patients are able to resume the majority of their normal activities 6 weeks after the procedure.
