Women dissatisfied with the size, shape or appearance of their breasts are candidates for breast augmentation. The procedure is also useful for reducing the differences between asymmetric breasts and for restoring the appearance of breasts that have been altered by pregnancy. Breast augmentation should not be performed on women under the age of eighteen. There is, however, no absolute upper age limit provided the patient is in good physical health.
Breast augmentation is a surgical procedure in which an implant is inserted behind the breasts in order to enlarge and shape them.
We perform our breast augmentations at a JCAHO-certified ambulatory surgery center.
Your breast augmentation will be performed under general anesthesia (i.e. you will be asleep). We use only board-certified physician anesthesiologists.
All surgical procedures result in scars. Fortunately, breast augmentations can be performed through small incisions that leave very short scars. The most common incision locations are in the crease underneath the breast, around the lower edge of the areolas, or in the underarms. Incisions in these locations heal very well in most women.
Most women with desk jobs can return to work in 4-7 days. Women with more physically demanding jobs will require a longer recuperation.
We use advanced electrosurgical techniques that are gentler on the tissues and reduce post-operative pain. Most of our patients liken the discomfort following their breast augmentation to the soreness felt after an overly intense workout.
Most women can resume driving one week after breast augmentation.
In rare instances of trauma or significant deformity, medical insurers may pay for a breast augmentation. The vast majority of breast augmentations are cosmetic and therefore, not covered.
Breast augmentation patients should not sleep on their stomachs for at least 3 months after surgery. After that, they may sleep on their stomachs as soon as it feels comfortable.
Most types of exercise can be restarted 3-4 weeks after breast augmentation. Performing physically strenuous activities earlier than this can impair healing.
This is a situation that often occurs after breast-feeding. Loss of breast tissue after lactation makes the breasts look deflated even though the breasts and the nipples haven’t dropped much. Most often, this problem can be corrected without a breast lift. Placement of breast implants to restore the lost volume will usually produce a pretty and natural-appearing result.
We will usually perform breast augmentation and lifting at the same time in women who need and want both procedures. Sometimes the procedures will need to be separated if there is marked asymmetry, very advanced sagging, or health issues that prevent a single-stage procedure. The wait between stages is usually three to six months.
Many women will benefit from the placement of a
modest-sized breast implant in conjunction with their
breast lift. The implant adds shaping and firmness to
the breast. Most importantly, the implant helps to
restore fullness to the upper part of the breast. There
are no breast lifting techniques that effectively and
reliably restore upper breast fullness without an
implant.
Not all women will want or need
breast implants with their lift. In most cases, though,
the breasts will look perkier and prettier if an implant
is added.
Fat can definitely be used to fill and enlarge many areas of the body. It is particularly good for buttock augmentation and it will work for modest increases in breast size. Unfortunately, as transferred fat heals, it often develops tiny calcium deposits. These calcifications can look like breast cancer on mammograms making breast cancer screening difficult.
Because of this problem we do not currently recommend fat transfers to the breasts. This procedure may become useful in the future as improved techniques and/or increased use of breast MRI eliminates the calcium deposit problem.
Signs of a ruptured silicone gel implant may include:
You should also consider the possibility of rupture after a strong blow to the chest (fall, car accident, etc.)
In most cases, breasts with ruptured implants look and feel the same as they did before the rupture; the history and physical exam are not reliable for detecting rupture.
The best test for rupture is a breast MRI. MRI's will detect 80-95% of ruptures.
Yes, but they are minor. Silicone gel implants are
heavier than water and will subtly alter your buoyancy
and trim in the water. This may require gear or
technique adjustments. This does not apply to saline
implants which are buoyancy-neutral. Divers are also
advised to avoid buoyancy compensators with constrictive
chest straps, which can put undue pressure on the
implants.
Pressure changes themselves are
unlikely to damage the implants. In a study performed by
the Divers Alert Network (www.diversalertnetwork.org), implants experienced a very small increase in gas
bubble size and overall volume. The effect was more
prominent in silicone gel implants because nitrogen is
more soluble in silicone. Regardless, the volume change
was not sufficient to damage the implants and the gas
bubbles disappeared with time.
The first thing to determine in these situations is why
this is happening. In most cases, it is because the
implant pocket is extending too far to the side. This
can happen over time due to pectoralis muscle pressure
on the implants. The treatment for this is a
capsulorrhaphy - a procedure where the outer part of the
pocket is tightened with sutures.
Sometimes,
the pocket is not too wide and the implants lie to the
side because the the breast skin has stretched. This can
sometimes be improved with a breast lift but there is a
significant chance of at least partial recurrence.
In
all these situations, we should keep in mind that
natural breasts fall to the side when a woman lies down
so not all of these laterally displaced implants need
treatment.
Sore throat can happen after surgery. It is usually caused by the endotracheal tube the anesthesiologist uses to help you breath. It is somewhat more common in women than in men. The soreness is usually mild and goes away within a few days. A severe sore throat or one that lasts for more than a few days should be reported to Dr. Schwartz.
Donating blood causes a temporary anemia. This usually corrects within 1-2 weeks. Nonetheless, we recommend that patients do not donate blood for at least one month before cosmetic surgery.
Some patients have expressed interest in donating blood for their own use, if needed. Since most cosmetic procedures are designed to produce minimal to moderate blood loss, transfusion is almost never needed. While you are, of course, free to self-donate blood, this would almost always be unnecessary.
I do recommend that my breast implant patients take a dose of antibiotics before dental work.
The problem is that dental work introduces bacteria into the blood stream. If that bacteria gets to the breast implants, it can cause an infection or a capsular contracture. Either of these may require surgery to fix.
Now it's unlikely that a dental cleaning will lead to any problems with your implants but since the consequences can pretty significant, it's worth taking the antibiotics as a precaution. Ask your dentist to prescribe whatever antibiotics he or she uses for patients with heart valves or other implants.
One additional note: You should avoid any dental work for the first 2 months after your breast implant surgery.
