Breast Enhancement Procedure
General Information
Breast Augmentation is performed to increase the size and fullness of the breast. Candidates for this procedure include women whose breasts: are disproportionately small; whose breasts have sagged or "deflated" after childbirth; and who have unevenly-shaped or sized breasts. If the breasts droop too much, a "lifting" procedure (mastopexy) may be required in addition to, or instead of the augmentation. Mastopexy, along with reconstruction of the breast after mastectomy, will be discussed later.
THERE IS NO EVIDENCE THAT BREAST AUGMENTATION BEARS ANY RELATIONSHIP TO BREAST CANCER.
The Anesthesia
Breast Augmentation surgery is performed under a "light" general anesthetic (patient is asleep). This technique provides excellent operating conditions while affording maximal patient comfort and safety. The anesthetic is administered by a board certified anesthesiologist, who remains in attendance throughout the operation. Prior to surgery, our anesthesiologist will provide additional information and answer any questions you may have. Required monitoring, anesthetic delivery and emergency equipment are present at all times.
Preoperative Preparation
You must be in good health to undergo any elective cosmetic surgery. A physical examination and routine lab work needs to be performed by your own primary physician. If you do not have a primary doctor, we can refer you to a local one in your area; we do not provide these services. It will be required that all pre-op paperwork be in our office 1-2 weeks prior to surgery.
It is very important that our office be aware of any medical conditions and all medications you are taking.
It is imperative that you not smoke 2 weeks prior or 2 weeks after surgery. This would impede your healing greatly. Talk to us about your options.
It is a required that someone drive you home upon discharge. Also arrange for transportation to and from our office for your post-operative appointments until we give you permission to drive.
DO NOT take aspirin or aspirin-containing products for 2 weeks prior or 2 weeks after surgery.
An adequate diet with vitamin supplements, especially Vitamin C, is recommended. You should be in the best nutritional state possible prior to surgery.
If you will be preparing your own meals at home after surgery, have on hand easy to prepare foods.
The Surgical Procedure
The surgery is performed in the office surgical suite under general anesthesia. The suite has two fully equipped, state-of-the-art outpatient operating rooms.
Depending upon the anatomy of your breasts and your preferences, you will discuss with your doctor which type of incision will be used: either around the lower half of the nipple-areola, or most commonly, in the fold beneath the breast itself. The breast implants may be placed in a pocket created either above or below the pectoralis muscle on the chest wall. The implant size is determined intra-operatively by placing multiple sizers until the desired shape and size are achieved. Stitches are placed in the skin and deeper tissues, and a mild pressure dressing is applied. Suction drains are occasionally placed in the implant pocket, and are generally removed within 48 hours. The procedure usually takes an hour and a half.
The size and type of implant to be used, along with their relative advantages, and the decision to place the implants above or below the chest wall muscles, will be discussed with your doctor at the pre-operative appointment. Factors such as existing breast size, chest size, general body configuration, and most important, your personal preference, will all be considered carefully. It is an artistic decision and one involving the differences in every patient's physiology and anatomy.
Possible Complications
Bleeding is unusual, but if it does occur (usually within the first 24 hours) a return trip to the operating room may be required to re-open the incision, remove the implant, stop the bleeding, reinsert the implant and reclose the wound. Because of the difficulty of visualizing a bleeding point through an armpit incision, another incision around the nipple may be required, but this is a very remote possibility. In any event, if properly treated, a bleeding episode will cause not cause long term difficulties.
Infection is extremely rare, but if present may require removal of the implant for several weeks or months.
Numbness of the nipple, or less commonly chronic pain in the breast(s) or nipple, may be caused by the operation, and may be permanent.
Firmness of the breast because of scar capsule formation, is the most common long-term problem with breast implants, and has been greatly reduced by placing the implant beneath the muscle. Nonetheless, firmness can occur months to years after augmentation, may occur in one or both breasts, and is an inherent risk for any patient undergoing the procedure. This may manifest itself as an unusual feeling of firmness in the breast, a breast that does not move naturally with changes in position, or in some cases, a visual distortion in the shape of one or both breasts.
Asymmetry of the breasts may occur as a result of scar capsule formation. It is also more likely to occur with the axillary approach. Breast indentation with position change may occur with implants placed below the chest wall muscle, in very athletic patients. Additional surgery may be required to correct these problems, at a nominal fee that is frequently covered under most types of health insurance.
Other less-common risks include unsightly scar formation in the incision and/or rupture or leakage of the implant. To correct these issues, a replacement may be required. In rare circumstances, unsubstantiated, but possibly related, a connective tissue disorders such as arthritis may occur.
Breast augmentation generally has no effect upon the ability of women to breast feed their infants.
For women undergoing the procedure after age 35, or with a strong family history of breast cancer, a screening mammogram will be performed. Despite improved techniques of breast imaging, early detection of breast cancers may be adversely affected by the presence of implants. Regular self-examination and physician follow-up are essential, even for women who choose not to have breast enlargement. Some health insurance carriers may exclude patients from coverage for breast diseases after breast augmentation.
Although most patients report that breast augmentation is one of the most gratifying things they have done to improve their appearance and self-image, some patients may experience a feeling of unhappiness or disappointment with the results following surgery. It is extremely important for you to discuss any of these feelings with your doctor, no matter how unimportant they may seem to you.
What to Expect after Surgery
Initially, the breasts will appear to be slightly higher than normal. This is especially true if the implants are placed under the pectoral muscle. Over three to six weeks the implant will descend to a more natural position. Also, because of the submuscular placement, the chest will feel somewhat sore for the first few days. This should abate very quickly, and by the end of the first week you should be comfortable.
Post Operative Care
Activity: Post-operatively the patient is encouraged to ambulate soon after surgery, with frequent periods of resting.
After resting for one to two hours, you may go home (with proper assistance) or to an after-care facility. Limited activity along with plenty of fluids is necessary. You will be given pain medication to be taken as needed. You will be seen the day after surgery, and then again five to six days later for suture removal.
Showering is usually permitted after 72 hours. Do not attempt to peel off the steri-strips; the nurse will change these. Soaking in the bathtub is not recommended for two-three weeks.
The key is to pretend the arms are "broken" and avoid heavy lifting or pressure on the arms. This is imperative, as not moving the implant is very important.
Avoid lying on your abdomen for 2 weeks. Optimal sleep position is elevated on your back with 2 pillows. Keep a pillow under each arm, and a pillow under your knees.
After one week of resting at home, "normal activities" such as driving, working, socializing may be resumed, except NO exercise or sports for four weeks.
After 2-3 weeks, or when all scabs have fallen off begin using Scarease gel (apply lightly every night), and Vitamin C & E serum (apply lightly- every morning) directly to incisions for several weeks. These products can be purchased in our office, and can be mailed to out-of-town patients.
Ancillary Procedure
If the breasts are too saggy, a breast lift (mastopexy) may be recommended, either instead of or along with breast implants. This cannot be done through an armpit incision, and incisions around the nipple are almost always required. The scars should fade with time, and the benefits of having rounded, firm, pleasantly shaped breasts should far outweigh the negatives of the scars. Implants are also used, although in a different technique, by reconstructing a breast that has been removed because of a tumor (mastectomy).
The details of these two procedures will be explained to you separately. In general, though, whenever an implant is used, the procedural details and complications are similar to those listed above.
The foregoing information is an overview. Anything that you are unsure of should be discussed openly with the doctor or nurse.
Resumption Of physical Activities
GENERAL RULES OF THUMB- "broken arms for two weeks"
TWO, FOUR, SIX RULE
FIRST WEEK: TAKE IT EASY!!! PATIENTS WHO ARE TOO VIGOROUS FREQUENTLY DEVELOP COMPLICATIONS!
At two weeks: Take long walks on a flat surface. No other kind of workouts. Any activity that would raise your blood pressure would compromise the healing incisions and newly developing blood supply.
At four weeks: Light exercise such as aerobics, but no weight training. Start light. For example, if you normally do 30 minutes on a treadmill, begin with 15 minutes, then increase as your body gets used to it. Use vitamin C and E concentrate and scar-fade gel as soon as the incisions are completely healed, usually 3-4 weeks.
At six weeks: You may resume all previous activities with clearance from Dr. Moelleken. Avoid sun exposure to incision site for several months following surgery, as this may result in a hyper-pigmented scar.
