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BREAST AUGMENTATION
(Breast Implants)

During the pubertal and late teenage years, the developing female breast goes through a period of rapid growth. This phenomenon is due to the response of mammary (milk) glands and ducts as they enlarge and mature in preparation for the production of milk during the child bearing years. In those women who are destined by heredity or congenital deformity to have a limited or absent breast development, the operation of breast augmentation is available.

At the present time, the most widely used implant in the United States is the Saline Implant. This implant is placed within the breast either pre filled or inflated with a solution of saline, better known as salt water. The composition of the saline is identical to the fluid found in the patient's own body. Thus , if a rare leak or deflation were to occur, there would be no harm to the patient. Silicone implants, long considered a standard by plastic surgeons, are available for patients with indications as assymetry, thin tissues, or certain anatomical findings. Silicone implants can also be used to replace older silicone implants, if the patient desires. Other implants as Soy, Peanut Oil, and other fillers are still under study and investigation and as such, not available except in special study situations.

Candidate for Breast Augmentation

The usual candidate for this surgery is the young woman who is unhappy with her breast size following Breast development. Generally no implant surgery is offered before age 18 and may be delayed until the early twenties, if there is a possibility of further growth of the breasts. The other candidate is the woman in her 30's or early 40's, who has been left with a small breast following breast involution (deflation) after her child bearing and breast feeding years. Occasionally, these women may need a breast lift or mastopexy (see previous section) along with the augmentation.

Breast Augmentation is performed utilizing one of three routes: Transaxillary (through the armpit), Transareolar (through the pigmented area around the nipple), or inframammary (through the fold beneath the breast. Each of these routes are frequently used and there are advantages and disadvantages for each. For instance, the transaxillary route is generally selected by the unmarried woman with small (size A or B) breasts for the least noticeable scar. The inframmary route is best for the woman desiring a larger implant and for those with assymetry (different sized breasts). Each of these routes will be considered for the augmentation candidate and discussed with you during your consultation.

In addition, the implant is placed either on top of the chest muscle (supra pectoral or sub mammary) or behind the muscle(subpectoral).

The choice of the implant position is made based upon the implant route, size of the breast to be augmented, size of the implant desired, and quality of the breast tissue. In addition, the life style and exercize habits of the patient are important considerations. For instance, a body builder with enlarged pectoral (chest) muscles would not be advised to have a subpectoral implant due to camouflage of the result, possible displacement and muscle impairment. Again, this choice will be discussed with you during your consulation.

All implants will interfere to some degree with postoperative mammagrams (breast Xrays). However, many breast centers are skilled in these exams following breast augmentation, thus reducing the risks of overlooking any breast findings. The patients are advised to discuss this added risk with their own physicians especially if there is a history of breast disease or cancer within their family.

Preparation.

Any patient over forty may be asked to see her internist for medical clearance. Special tests, including a mammogram, will be requested of all patients, to ensure that they are healthy and that there will be satisfactory healing. Smoking and aspirin ingestion is prohibited for two weeks before and two weeks after surgery. Aspirin will cause more bruising and bleeding, thus prolonging the recovery period. It has been found that smoking may lead to delayed healing and more noticeable scars. Occasionally, a hyperbaric oxygen treatment is recommended for smokers to prevent postoperative complications.

You will be given prescription for homeopathic and pharmaceutical preparations to prepare your system for surgery.

Anesthesia

General Anesthesia is the anesthetic method of choice for the Breast Augmentation. With this approach, there is complete rest, safety, and no discomfort during the procedure. In addition, because the operation can take up to two hours, your vital signs are must be monitored for fluid, medication and inhalation anesthetic needs. This is better accomplished with this type of anesthesia. You will have an opportunity to discuss this with Dr. Sokol and our Anesthesia staff.

Procedure

You will enter the Nova Surgicenter through a private and discreet entrance. After routine charting is accomplished, you will meet with Dr. Sokol. He will review your photos with you and with a mirror explanation and your input, will point out the operative plan for augmenting your breasts. He will then mark your breasts with a special indelible ink. These marks will indicate the plan of your anticipated surgical procedure. The anesthesiologist will then prepare you for surgery with the application of special monitors, medicines and equipment to insure the procedure is not only safe for you, but comfortable as well.

Postoperative Period.

Following the procedure you will be taken into our recovery room. A special bed will be available that is electrically positioned for comfort. In addition you will be wrapped in a special heating blanket of circulating warm air to maintain your body temperature and ensure comfort. Occasionally, drains are utilized to monitor the operated area for any bleeding. These drains are small silastic tubes that allow the recovery staff instant insight as to how your operative site is healing. If used, drains are removed after the drainage becomes minimal.

You will be attended by our recovery staff and monitored for approximately 2 hours. Thereafter you will have your operative area examined and be checked by our anesthesia staff. After the recovery room staff is satisfied that you are safely recovered from surgery, you will be permitted to go to your after care facility.

After Care

After Care Facilities - Many patients elect to use an aftercare facility in a nearby hotel. These are fully staffed with 24 hour expert nursing care. All patients in these facilities have had cosmetic surgical procedures. Thus the nurses are experienced with your specific needs as well as what to be aware of with this particular type of surgery. In addition the entire after care staff are highly attuned to your privacy and comfort. Meals and transportation to your postoperative office visits are provided. You will be seen by the nursing staff the next day to inspect your operative site, redress your breasts and arrange for your next visit.

If you live less than one hour away from the office, you may wish to go home with a family member or friend that can devote the time to you. If you prefer, a nurse will be arranged for you. Nearby hotels can be utilized if you prefer to stay there with a nurse, relative or friend. This situation is especially recommended if you live more than one hour away from the office. You will be seen by our nursing staff the next day for a dressing change before you go to your own home.

Pain

Many patients experience little or no pain following breast surgery. Everyone is different and you may feel some discomfiture. You will be provided with a prescription for pain pills that will assist you during the first 48 hours. This is the period that some patients experience pain. Generally, sutures are removed by the tenth day and replaced with special supportive tapes called steristrips. These are left on for an additional 7-10days. Thereafter they may be removed by the patient. It is normal for the patient to experience numbness in the breast envelope and nipple-areolar area for the first 6 weeks to 6 months after surgery. Some patients experience lightning shocks or crawling sensations in the numb areas. These are signs that sensation is returning and a welcome phenomenon.

Activity

It is recommended that for the first 3-4 days that you sleep on your back with the head elevated on one or two pillows. This will reduce the swelling and lead to a more comfortable and shorter postoperative period. No bending over, keep your head above your heart at all times. No lifting, sudden movements or exercising is permitted for the first seven to 10 days. You may take short walks by day 5-7 if you are comfortable. By day #10 you may use a stationary bicycle. set at low resistance for 10 minutes. Future use can be doubled every other day until you have reached your preoperative level. You may return to aerobic exercise classes in 3-4 weeks wearing a good supportive athletic bra.

No intimacy, caressing your breasts, emotionally charged situations, or alcohol is permitted for the first 7-10 days. No smoking is permitted for 14 days. This will ensure a safer, shorter postoperative period, without increased bruising or delayed healing.

A return to your employment or social schedule can occur as soon as you are comfortable and pain free. We generally recommend that the patient take off at least 7 to 10 days.

Complications.

Complications are rare after breast surgery. Some of the more well known are infection and bleeding (hematoma), or fluid accumulation requiring drainage this may be associated with increasing pain, enlargement and firmness of the breast. Capsule formation is due to scar tissue developing around the implant. This complication may occur as early as 6 weeks or as late as years after the surgery. Although the cause is unknown, it is thought to be due to a low grade infection or unrecognized breast trauma. In both of these situations, the body deposits scar tissue around the implant. If the process continues, a firm implant results. Antibiotics are recommended during teeth cleaning and any infectious process to prevent these infections. Any trauma to your breast resulting in bruising must be reported. If a capsule resulting in firm or painful breasts does occur, additional surgery may be required. In addition, breast implants require replacement every 10 to 15 years. Implants left in longer, are subject to breakage, leakage and deflation.

Rarely, irregularity of healing, permanent numbness, nipple retraction, and inability to breast feed can occur. The latter are the more severe and may require further operative and/or non operative treatment. These include but are not limited to hypertrophied and/or keloid scars, skin loss including nipple loss or irregularity, permanent numbness and finally inability to breast feed. Dr. Sokol has not encountered any permanent complications in his own practice. Scar treatment and revisions have been performed if indicated. These long-term or permanent complications are quite rare.

Results

The goal and of augmentation mammaplasty is to provide the patient with more attractive breasts. Most women, seeking augmentation, are generally happy with their breast shape but desire a larger mammary profile. The resulting augmented breast allows the patient to feel more confident in today's more revealing clothes and swimsuit wear. Patients generally remark about this new sense of confidence and have frequently referred to themselves as feeling more feminine and self assured.

Before & After Photos



Patient 1 - Augmentation Mammaplasty Age: 31 Height: 5' 3 Weight: 110 Implant: Silicone, 200cc Placement: Retromammary Incision: Transareolar Post-op photos taken at: 1 year Estimated cup size change: A to B



Patient 2 - Augmentation Mammaplasty Age: 35 Height: 5' 5 Weight: 125 Implant: Silicone, 400cc Placement: Retromammary Incision: Inframammary Post-op photos taken at: 1 year Estimated cup size change: A to full C



Patient 3 - Breast Augmentation Age: 34 Implant: Silicone, 300cc Placement: Subpectoral Incision: Inframammary Estimated cup size change: B to C



Patient 4 - Breast Augmentation Age: 28 Implant: Saline, 300cc Placement: Subpectoral Incision: Transaxillary Estimated cup size change: A to C



Patient 5 - Augmentation Mammaplasty Age: 19 Height: 5' 4 Weight: 110 Implant: Saline 300cc Placement: Subpectoral Incision: Inframammary Post-op photos taken at: 2 months Estimated cup size change: A to C



Patient 6 - Augmentation Mammaplasty Age: 34 Height: 5' 8 Weight: 121 Implant: Saline, 340cc Placement: Subpectoral Incision: Inframammary Post-op photos taken at: 3 months Estimated cup size change: A to C