Breast Augmentation

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Who is a candidate for breast augmentation?

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.

What is breast augmentation?

Breast augmentation is a surgical procedure in which an implant is inserted behind the breasts in order to enlarge and shape them.

Where will my breast augmentation be performed?

We perform our breast augmentations at a JCAHO-certified ambulatory surgery center.

What type of anesthesia will be used for my breast augmentation?

Your breast augmentation will be performed under general anesthesia (i.e. you will be asleep). We use only board-certified physician anesthesiologists.

Where are the scars from a breast augmentation?

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.

When can I return to work after breast augmentation?

Most women with desk jobs can return to work in 4-7 days. Women with more physically demanding jobs will require a longer recuperation.

How painful is breast augmentation?

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.

When can I drive after breast augmentation?

Most women can resume driving one week after breast augmentation.

Will insurance pay for a 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.

When can a patient sleep on their stomach after breast augmentation?

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.

How soon can I exercise after breast augmentation?

Most types of exercise can be restarted 3-4 weeks after breast augmentation. Performing physically strenuous activities earlier than this can impair healing.

What can be done for breasts that look more deflated than saggy?

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.

Can I get breast implants at the same time as a breast lift?

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.

Do I need a breast implant with my breast lift?

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.

Can you inject fat to enlarge my breasts?

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.

What are the signs of a ruptured silicone implant?

Signs of a ruptured silicone gel implant may include:

  1. New pain or discomfort in the breast
  2. A change in the appearance of the breast
  3. Hardening of the breast
  4. A change in the way the breast feels

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.

Are there special precautions for breast implant patients when scuba diving?

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.

What can be done for implants that fall to the side when I lie down?

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.

Is it normal to have a sore throat after surgery?

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.

Can I donate blood before surgery?

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.

Should breast implant patients take antibiotics for teeth cleaning?

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.

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