All About Breast Augmentation
Before getting into the specifics of breast augmentation, make sure you take a moment and think about why you want an augmentation. Each woman has a different reason for considering a breast augmentation. For some, the person that stares back at them in the mirror is not who they are. Other women want to feel more dramatic. They enjoy being noticed. Some women feel that larger breasts make them more attractive. Sometimes there is a desire to get back what was lost after pregnancy. There are as many different reasons as women. I feel that the only wrong reasons are to fix relationships. Don’t think a breast implant will fix a bad relationship or to improve an abusive one. Making a decision for implant surgery is serious, but I want it to lead to a joyous outcome. Think carefully.
How to Decide on Size?
Size is usually your first decision. Are you looking for a subtle change in your silhouette? A change to your décolletage? Or do you want to turn every head in the room? In order to show you what sizes are possible and reasonable, I will make some measurements of your breasts. Every breast has a ‘footprint’ on the chest wall. As long as the implant fits well within this natural footprint, the implant will look more natural – without the fake look. Expanding beyond this natural foot print looks very unnatural.
The most important measurement is the breast width. This measurement determines the base width of the implant and is the first step in selecting the appropriate implant. The next item to determine is how much projection should the implant have? That depends on how much volume you wish to achieve.
Deciding on the volume can be done a number of ways, but I have found that the easiest is to have you select a bra with the cup size that you desire. Then you come to the office and try on your bra with different trial sizers placed in the cup. Once the volume is chosen, an implant with the desired volume that matches the base diameter is chosen. Trust me, it is easier than it sounds!
What Type of Implant is Best?
Implants have developed significantly since the first silicone gel breast implants of the 1960′s. Manufacturing techniques are now on the 5th generation. Elastomer coated shells and cohesive gels have all but eliminated rupture and gel leakage. The FDA has again affirmed the safety of the silicone gel implants.
The alternative to silicone is the saline filled breast implant. This implant uses a silicone shell also, but instead of being filled with a cohesive gel, it is filled with sterile saline.
Silicone Gel Implant
Which is better? I would have to say the silicone. About 90% of women choose silicone gel breast implants. Saline does have one advantage. If the implant ruptures the saline leaks out and the breast deflates. Quickly. There is no doubt if something happens to the implant. But silicone has these advantages:
- The implants feel much more natural. They are soft and feel very much like a normal breast.
- Longer lasting. The implants typically last much longer. In fact the very first silicone implant was doing fine 47 years after placement.
- Both of the major manufacturers offer a generous warranty for defects in gel implants.
There are two possible placement positions for the implants. One option is to place the implant between the natural breast tissue and the underlying muscle. The second option is to gently place the implant under the chest wall muscles. The implant will do fine if it is on top of the muscle and between the muscle and the natural breast as long as there is a reasonable amount of breast tissue. The natural breast will cover the implant and make it difficult to feel. This is the preferred placement as there is a little less pain right after surgery.
If there is not much natural breast tissue then the implant will do better under the muscle. The elevate muscle softens the edge of the implant and makes the breast look more natural. Since the muscle has been disturbed however, there will be a little more pain after surgery. This extra discomfort resolves very quickly.
Location of the Incision
Possible incision choices for implant placement
There are three common incision sites used in the placement of the implant. Each of course has its it own advantages and disadvantages. The most common site to place the implant is under the breast in the inframammary location. The reason it’s the most popular is that this location allows the best view of the pocket that is created for the implant. It will allow for any adjustments of the fold beneath the breast. Also, if any additional surgery has to be done at a later time, this is the incision that will be used. Choosing a different incision first means that you may eventually end up with two incisions on the breast. The only disadvantage is that this scar will be visible when you are not wearing a top. Fortunately it does not typically form a serious scar.
The next most common incision is around the areola. The advantage here is that the incision is hidden a bit better, although still visible when going topless. The incision typically fades well, but can be seen on close inspection. The main problems with this location is the difficulty in doing revisions if needed.
Lastly we come to the axillary incision. The obvious advantage here is that there is no incision on the breast. The pocket is created from the armpit down. Placement of the implant is done under the muscle from this approach. The biggest disadvantage occurs in people who make prominent scars. The scar is easily seen when lifting your arm or sunbathing.
Getting Ready For Surgery
Post op binder
After the initial office consultation and the followup, there are a few things to consider. You should plan on being off from work for about a week although some patients return in 2 – 3 days. If your job involves any lifting then you will need to arrange for light work or more time off. Typically it takes about 3 weeks until it is safe to lift heavy things and do aerobic exercises. The lifting restriction also applies around the house too. This is a great time for your husband or boyfriend to step up!. If you have neither, then arrange for friends to help you out. Someone should stay with you for a couple of days.
Let’s discuss what type of post operative garment you will need. Typically a comfortable binder will be selected although a soft sports bra will work well. You can also purchase one of the specific post op bras. In some cases I will ask you to purchase an underwire bra. These are not usually worn in the immediate post op period but occasionally, when the inframammary fold is moved, the extra force is needed to help shape the fold.
The last step is to review all of the medications you take. Make sure to discuss all medications with me. Include all of the herbal supplements or over the counter medications too. The reason is that some medications will inhibit blood clotting or healing. I want to do our best to limit any complications and excessive bleeding can cause a hematoma. The medications to avoid include:
- Aspirin or any medication containing aspirin
- Any medication containing ibuprofen
- Tricyclic antidepressants
- Herbal supplements including Gingko Biloba, Fish oils, and St. Johns Wort
The complete list of medications to be avoided can be found here. Please review it carefully and discuss anything on the list with me or my office.
The Day of Surgery
Your surgery will involve a general anesthetic. Although some practices will try to do breast augmentation with some sedation and local anesthesia, I feel that is much too traumatic. I want you to feel comfortable and have minimal pain, so a general anesthetic is preferred.
Since you are going to sleep you will have to avoid eating after midnight before your surgery. By having an empty stomach you will minimize the risks of aspiration while you sleep. While you are sleeping we will use compression devices on your legs to keep the blood flowing and minimize any chance of clots.
Your surgery will last about 1½ hours. You will then spend around an hour in the recovery area. You can be sent home when you can walk to the bathroom, drink some juice, and eat some crackers without difficulty. Your will get prescriptions for pain medication and a very short course of antibiotics. You will also get some pills in case you have nausea. You will find a simple dressing over the incisions and a wide temporary ace bandage. Make sure you have a ride home – you can’t drive on the day of surgery.
Post Op Care and Expectations
The most important thing to remember after surgery is that I want you to call for any problems. I will stress that over and over again. I don’t expect you to know what is normal and what isn’t, so anytime a question or a concern comes up, call me. I will never fuss at any patient no matter how many times they call. If you call after hours you will be directed to call me on my mobile phone.
The day after surgery you may remove the ace wrap and any gauze. You will see a small tape over the incision. Leave that alone. The tape will fall off on its own in one or two weeks. You may shower but just pat the dressing dry – no buffing. Do not get the wound wet in bath water.
There are some exercises that I want you to do after surgery. On the first few days you will be sore and all I ask is that you lift your arms straight up over your head a few times per day. If this is painful then just do what you can. After a few days you should not have trouble lifting your arms. When the initial discomfort settles down I will have you do some gentle pushing on the implant in all four directions – up, down, left, and right. Don’t worry, I will review this with you before surgery and go over it again at your first post op visit.
Risks and Complications
There are definitely risks with having a breasts augmentation. Some are related to the general risks of surgery, others are specific to breast implants. Since I am getting a bit long winded, I think it best to leave this lengthy topic to a post all on its own. So that will be my next post / article – Risks and Complications of Breast Augmentation. See you soon.
To discuss breast implants or to schedule your free consultation, go to my breast implant page for more details.