Breast enlargement, or augmentation mammoplasty, enhances the body contour of a woman who is unhappy with her small breast size. Other purposes of this procedure include:
Augmentation mammoplasty is done on an outpatient basis in a surgical center, usually under general anesthesia. An implant (prosthesis) is placed through an incision, under the breast tissue or under the muscle. A breast implant is composed of an outer silicone shell filled with saline or silicone gel. The outer surface may be smooth or textured, and implants come in various shapes to meet the individual woman's needs. The implants may be placed directly behind the breast tissue or underneath the muscles of the chest wall, depending on the individual needs and desires of the patient.
When the implant is placed submuscularly under the breast, there is a lower chance of contracture (contraction of the tissue capsule surrounding the implant), and mammography is more reliable. There is also less risk of visible or palpable implant edges. However, some believe the implant has a more natural appearance when placed above the muscle, under the breast tissue. Your cosmetic surgeon can help you decide which placement and type of implant will work best. Drain tubes may be used. The doctor will discuss the findings with you at your initial visit.
Determining Implant Size
The shape of your augmented breasts depends on the implant. Implants may be round or teardrop-shaped (anatomical). The choice depends on the look you want to achieve: Anatomical implants produce a gentle slope, resulting in a fuller upper area, whereas round implants create a round curve in the upper part of the breast. Another factor to consider prior to surgery is breast width, which determines the amount of "cleavage" between your breasts and the outer curves, which you may want to balance with your hips.
Realistic expectations of this procedure are important. Women often think of breast size in terms of bra cup size. If you are currently a size "A" and wish to be a size "C", there must be adequate existing breast tissue coverage; otherwise you will be warned of visible or palpable implant edges and other possible risks. We will discuss your best options at your consultation.
You must have someone drive you home and stay with you for 24 hours after surgery. You will experience some pain that is controlled with pain pills. Some tightness in the breast area is also normal as your body adjusts to the implants.
You can move about freely after surgery. Wear a bra at all times (except when showering) during the first few weeks following surgery. You will be given specific instructions regarding limitation of activities postoperatively.
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About silicone gel implants: The FDA placed restrictions on the use of silicone implants in 1992 to further investigate their safety and effectiveness. There has been much discussion about the possibility of silicone and, in particular, silicone-gel, being related to autoimmune disease. However, a large study of women with and without breast implants conducted at the Mayo Clinic showed that autoimmune disease occurred with the same frequency in both groups. It is not known what causes autoimmune diseases, seen in middle-aged women. At our facility, we provide saline implants to minimize possible reactions.
Augmentation mammoplasty is a popular procedure that has produced pleasing and satisfying results for many women. Those who are psychologically stable and have realistic expectations benefit the most. A preliminary consultation can help you determine whether breast augmentation is right for you.
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1. Surgical bra and drains may be used. You will be asked to contact our office each day (except the weekends), to report the amount and color of the drainage for the last 24-hour period. When the color lightens and the amount of drainage decreases, the drains can be removed. We will keep you on antibiotics until the drains are removed. Should you find that you are running out of antibiotics, please contact us during office hours, so that a refill can be called in to your pharmacy.
2. You should not change or open your postop surgical bra. In some cases, the doctor may have positioned your breast in the padded bra in a specific position to improve contouring, so it is very important that you leave your post op surgical bra in place. You will be padded with cotton. You should not remove this until we change the dressings or other instructions are given. In some cases, the doctor may have actually positioned your breasts in such a manner that they can be beneficially padded for contouring, so it is very important that you leave your postop surgical bra in place.
3. You will be given a prescription for narcotic pain medication. However, if you have trouble with either medication, please let us know. Typical side effects from pain medication are nausea, vomiting, constipation, itching, and nervousness. Should you experience these symptoms, please stop taking the pain medication and take Extra-Strength Tylenol or notify our office during office hours, if possible. There might be other medications that we could prescribe.
4. Your activities are going to be significantly limited for a number of weeks after having your breast augmentation. Until your drains are out, we ask that you not move your arms up over your shoulder level. Do not raise them up over your head. We do not want any stretching or pulling on the chest wall or the pectoralis muscles. After the drains have been removed, you may then move your arms in a full range of motion, to include over-the-head movements. However, you are asked to avoid exertion, stretching, or any exaggerated arm motions which might cause pulling of the pectoralis muscles. Vigorous, high-impact sports should be avoided for a period of weeks after surgery. We will be going over this in detail before and after surgery. Should you have any questions regarding your activity, please discuss this with us.
5. It is normal for the skin of the nipple, areola, and chest area to feel numb and tingly. This will improve over time. Your breasts may feel heavy and tight. Your posture may have an effect on comfort. It is always best to try to roll your shoulders back, which relieves some of the tension on the pectoralis muscles.
6. It is quite normal for one breast to appear somewhat smaller, higher, larger, or lower than the other. This is common in the first few weeks and months after surgery and will improve with time. It is also very common for the drainage amounts from side to side to be asymmetric. One side may drain significantly more than the other. One side may turn light pink and yellow. One may stay significantly red. This is fairly common.
7. Immediately after surgery, your breasts will be swollen and the implants may appear slightly high. As the healing progresses, the implants drop into the final position and you will be able to appreciate the final size and contour of your breasts. You can expect progressive improvement over a period of weeks and months. Especially early on, for the first few months, you may feel that your breasts are too large. However, as the swelling goes down, you will be happier, on a daily basis, with the appearance of your implants.
8. Bruising and swelling is normal after breast surgery.
9. We will be teaching implant massage. We feel that it is not painful and most women feel that it is pain-relieving. Implant massage helps the muscles to stretch over the implants so that they can settle into position and keeps the scar tissue around the implant at a minimum, hopefully keeping it from contracting. You will not start this until after your drains have been removed. We will be speaking about this in detail the day that your drains are removed.
10. You will be instructed regarding scar massage. Your scars may be red and firm for the first few months after surgery and then should gradually fade and soften over time. Everyone heals differently. However, in some patients, the incision can be almost invisible a few weeks after surgery. In others, it can take a year for the scars to fade. Scar massage will be recommended. We do recommend an over-the-counter scar massage cream called Mederma. It is herbal. You will be asked to do scar massage several times a day when possible. We will give you detailed instructions on when to start and discontinue scar massage after surgery. If you ever have any questions regarding whether your scars are abnormal, please let our office know, and we will examine them, so that will know how best to treat you.
11. We will discuss with you in detail, prior to surgery, the size and shape of the implants that would be appropriate for you. This is based on a number of factors including the width of the chest, the patient's height and weight, skin laxity and patient preference. Regardless of the implant size chosen, it is always our goal to make your breasts look and feel as natural as possible both in and out of clothing.
12. We will discuss with you the benefits of placing the implants in front of, or behind, the chest wall muscles. If you are very thin and do not have a lot of breast tissue, you will probably be able to feel the lower edge of the implant. If you can feel the rib through the breast tissue, you will probably be able to feel the implant.
13. The surgical incision will be closed with both dissolving sutures and one removable suture. The sutures underneath your skin will dissolve over time, by package directions, they take 2-3 months to dissolve. You will feel a ridge around your areola, where we have placed the incision. The suture that has to be removed will be removed in an appropriate fashion, usually within two weeks from surgery. It is not unusual, however, if you see a knot from the sutures popping out along the incision line after that date. It will be, possibly, one of the dissolving sutures. These will usually dissolve on their own. However, they can be troublesome and can give you cause for concern. If so, please call the office during office hours, to be seen. These can then be trimmed or pulled.
14. No implants are permanent. The life expectancy for saline filled and gel filled implants varies. You will be given detailed information about the relative merits of all available implant types at the time of your consultation.
15. Tingling of the skin and shooting pains to the nipple are common for the first few weeks and even months after surgery, as the nerve function returns and the swelling resolves. Most patients have return of normal nerve function within 4-6 weeks from surgery. There are some patients who will have abnormal loss of sensation from their breasts or nipples after augmentation. However, this is rare.
16. The most common, significant complication after breast augmentation can be bleeding, also called a hematoma. There are blood vessels that are cauterized in the breast tissue and under the muscle during surgery. In a small number of patients, one of these blood vessels may bleed after surgery. This is obvious when it occurs. There is usually obvious swelling, more in one breast than the other. Should this occur, please call the office as soon as possible. In most cases, it is related to activity that is too vigorous and too soon after surgery.
17. We ask that you not drive a car while you are taking pain medications. We will discuss this as well as other post operative limitations of activities during your preoperative consultation.
18. Please call for any concerns or problems. It is best to call during office hours, as someone is always in the office who can see you. We cannot make a diagnosis over the phone. Should you describe something worrisome, you may be sent to the emergency room. This can be time consuming and inconvenient, as well as expensive. Insurance companies will usually not pay for emergency room visits for complications due to cosmetic surgery. Should something be bothering you during the day, please do not wait until the evening to see if it gets any better. Especially in regards to medication, it is always better to speak with someone in the office who has your chart in front of them, rather than calling through the exchange at nighttime, when no one has a record of your medications and difficulties that may be particular to your case. The decision to have breast augmentation is an important one. Please feel free to call during office hours, before your surgery, with any questions or concerns.
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