Case Studies

Breast Augmentation

In the United States, breast augmentation has traditionally been one of the top two aesthetic surgery procedures.  Enlarging the breast has been done for women for more than 100 years.  Prior to the development of silicone breast implants, many other materials were used with varying degrees of success.  Injection of paraffin doesn’t sound too great and indeed it did not produce a very satisfactory result, particularly in the long run.  Various types of sponge materials were developed and again the long term results were not very good.  Silicone for breast implants was developed about 1946, researched extensively for years by the developers, then released for general use by plastic surgeons about 1961.  Since that time the silicone implant has changed in shape, material thicknesses, permeability, gel type, and style.  There have been round shapes, teardrops, ovals, single lumen, double lumen, urethane covered implants and many others.  In my opinion, the best we ever had was the double lumen gel implant with a saline-filled outer shell.  I have many of these implants still in place, some for more than 30 years and many are practically undetectable on palpation.  Unfortunately, those implants are no longer available for use in the U.S. due to the silicone scare of the early 1990’s

Before Surgery

The consultation for breast implant surgery is usually lengthy. There is so much material on the Internet (much of it good but much is hearsay and not to be trusted) that many patients are confused and need guidance in their quest for breast enlargement.  Most importantly is to convey the goal of the surgery.  Essentially breast augmentation does nothing more than enlarge the volume of the breast.  It doesn’t “lift” the breast.  It doesn’t create cleavage (your bra does that).  It won’t make you a movie star!   It will make your clothes fit better.  You will be able to buy the same size top and bottom for your bikini.  We hope that you will feel better about yourself and more self confident.  Of all the aesthetic surgery procedures, breast augmentation produces the most satisfactory results according to patient polls.

You will need to have some idea of the size breast that you want, not an implant size but cup size which is the standard in measuring breasts.  So you understand, a “36 C” stands for the circumference of the chest in inches (the number 36) and the volume or cup size of the breast which is really an arbitrary measurement developed by bra manufacturers (the “C”).  Only the cup size will change with augmentation, not the number size.  You don’t need to know anything about the size of breast implants as that is the job of the plastic surgeon.  All you need to do is convey as accurately as possible what you want to look like.  A picture from a magazine will do nicely in showing the doctor the size you like.  The ultimate size will be the volume of your own breast tissue added to the volume of an implant to achieve your desired size.  If you want to be a “C” cup and you have little breast tissue, you will need a larger implant.  If you have more natural breast tissue, the implant will need to be smaller.  So not everyone will require the same size implant to achieve that “C” cup.

Whether to use a silicone gel-filled implant or a silicone saline-filled implant will be determined by the conditions of your own body. The same is true for placing the implant over or below the muscle.  Also for determining the position of the incision and the shape of the implant.  There are many factors in making these decisions and the consultation is when those decisions will be made.  I prefer to examine the patient before discussing a surgical procedure as I can then tailor the discussion to fit the exact circumstances for that patient.  Every option available that fits the patient’s unique physical and medical condition – and lifestyle - needs to be addressed.

Once the goal of the surgery is decided, once the size and shape of the implant is determined, once the incision site and placement of the implant (over or under the muscle) is agreed upon – the hard part is done.  Planning the surgery is the most important part of breast enlargement.  The doctor needs to have a very clear picture of what you want and how it is to be carried out before you enter an operation room.  And you and he must agree on everything before you even schedule surgery.

There are preparatory things that must be done before any surgery, a preop history and physical examination, lab tests, prescriptions to buy, cessation of smoking, stopping certain supplements, etc, etc.  Make sure that you understand them all and that you follow the presurgery instructions given to you exactly.  There is nothing worse than to arrive at the operating room only to find that you have inadvertently done something that will prevent surgery from happening that day!

The Surgery

Routine breast augmentation takes about an hour.  A long-acting (10 to 12 hours) local anesthetic will be injected into the incision area as well as the breast area in general in order to reduce the immediate postop pain.  Whichever incision used, it is as small as possible to allow passage of the implant.  Saline-filled implants require only a 2.5 cm incision but gel-filled implants require a longer one.  Once the incision is made, the pocket to receive the implant is developed either under or over the muscle.  Subglandular (over the muscle) pockets usually produce less pain and less bruising than submuscular pockets.  Exactly where the pocket is made and how is dictated by the patients own body shape and physical attributes.  Implants placed in the submuscular plane will be slightly further apart than those in the subglandular position.  Properly placed implants will not change the position of the nipples nor will they change the direction the nipple points.  Once the implants are in place and correctly positioned, the incisions are closed with dissolving stitches so that no stitches need be removed later.

Post Surgery and Recovery

When the surgery is completed, a compression bandage will be applied and the patient transferred to the Recovery Room (or PACU).  Augmentation Mammaplasty is usually done as an outpatient so once the patient has awakened from surgery and the vital signs are stable, the patient may go home.  So long as you live within an hour’s drive of the IAS Surgery Center you may then return to your own bed for 24 hours of bed rest.  Sleeping or snoozing for a day is the best way to get off to a good recovery and rapid healing.  Pain is usually not too severe, however, submuscular placement of implants will require more pain medication than the subglandular position as muscles have many more pain fibers than breast tissue.  You will be given prescriptions for pain meds and antibiotics and perhaps muscle relaxants which you will begin once you are at home.  For a week, no driving the car, usually no work, no cooking, cleaning, lifting or reaching.  Take a vacation from all that!  You will have been given a 2 page instruction sheet when surgery was scheduled with before and after surgery instructions and you must follow those instructions exactly.  Nobody wants a complication and these instructions have been specifically designed to prevent postop complications.

Your postop visits will usually be at 2 days postsurgery (to remove the bandages and put you into a postop bra), each week for the next 2-3 weeks, at 6 weeks, at 6 months and at 1 year – and yearly after that.  The skin incision will heal in about 10 days but the interior area about the implant will require 6 weeks to heal.  Don’t expect the breasts to look perfect when the bandages come off.  This isn’t the movies.  Implants frequently have to “drop” into the option position and that will only happen after all the swelling created from surgery has occurred – anywhere from 3 days to 6 weeks.  There are “exercises” to facilitate removal of edema and assist the implants to “drop”.  Warm soaks to cover the breasts will help also in getting rid of swelling.  All of these things will be covered in your instruction sheets.  Photographs will be taken frequently.

Risks & Complications

This is a surgical procedure and therefore complications may occur.  I can’t imagine how many times I have said this to patients during the consultation.  Frequently about this time, a glaze comes over the eyes and the patient “tunes out”.  Risks of surgery and possible complications are not the most pleasant thoughts when you are excited about getting your new look but my advice, pay attention.  The cause of a complication may not be something done at surgery, but rather something you inadvertently do in the postop period.  Simply reaching over your head to get something out of the cupboard in the early postop period, or picking up the baby – these things stretch the pec major muscle and whether your implants are under or above the muscle stretching the muscle can cause bleeding or a hematoma that sets off a string of complications.  The list of usual complications and their causes are covered in detail at the consultation so listen attentively.

One specific complication, over which neither you nor the doctor have any control, is the possibility of an implant leak.  A very small percentage of implants leak.  Whether it is gel or saline, the implant should be replaced and the manufacturer will provide a new implant and some funds to assist with the fees related to replacing the implant so long as the manufacturer’s conditions are met.  You will be given a booklet with the guarantee provided by the manufacturer of your implants.  While it may not be a real page turner, it is best to read it so that if something does happen, you are in the know.

The Cost

When budgeting for breast implant surgery, remember there is the fee for the surgeon, the fee for the implant manufacturer, the cost of the surgery facility and the fee for the anesthesiologist.  There are miscellaneous other costs such as lab tests, medications, preop physical, postop bras, etc.  Once you are seen in consult and all factors evaluated, a final cost will be quoted for you.  If you would like to get a general range of fees, please call the office at 404-252-3672 and ask for the patient coordinator as she will be able to ascertain your general needs and give you a baseline average cost.

 

 

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