Breast Augmentation Overview
Breast augmentation, also known as augmentation mammoplasty, is a surgical enhancement procedure to accentuate the size and shape of a woman's breasts. While breast augmentation will make the breasts larger, the surgery will not move the breasts closer together or lift sagging breasts. Breast augmentation is tremendous help to patients who desire a fuller profile, who have lost breast volume due to pregnancy or nursing, or who have undergone breast reconstruction and want to gain a more natural look again.
CONTACT US
Call the office at (573) 443-5500. Our experienced patient support representatives are happy to answer your telephone questions, 8AM to 5PM, Monday through Friday. We have detailed information packets for all of our cosmetic procedures, and are happy to mail them upon request.
PACKAGE PRICES
Prices change periodically-please call the office for a current quote. Financing is available.
PREOPERATIVE CONSULTATIONS
Preoperative consultations for cosmetic procedures are performed free of charge. Appointments are available Mondays and Wednesdays 8AM to 5PM. The consultations usually last 45 - 90 minutes. Dr. Seaberg will do a detailed medical history and physical examination. You will have a chance to review before and after photos of other breast augmentation patients who started out with chest measurements and breast shape similar to your own. If you have already found results that you like, on the internet or in a magazine, please bring those photos with you to the consultation. Based on your goals, your ribcage size, and your breast size and shape, Dr. Seaberg will help you select your incision location, your implant size, and any modifications that might be best for you.
BREAST IMPLANT OPTIONS
FDA APPROVAL OF SALINE-FILLED BREAST IMPLANTS
Silicone gel-filled breast implants were invented in 1963. Saline-filled breast implants were invented in 1969. At that time, the FDA was only responsible for regulating drugs, and the number of medical devices available was so limited that no one felt federal regulation of them was necessary. In 1976, Congress passed the Medical Device Amendments to the Food and Drug Act, expanding the FDA's authority and responsibility to include regulation of medical devices, such as breast implants, which were already on the market. Congress did not provide the FDA with any additional funding to support this new set of responsibilities, however. The agency therefore placed most devices (including breast implants) in class II, requiring general controls and performance standards, but no detailed studies. This situation continued until 1981, when a clever attorney in San Francisco successfully sued Dow Corning on behalf of a patient with rheumatoid arthritis. The attorney had read the part of the Medical Device Amendments that states that devices must be proved safe and effective before being released for use. This wording places the burden of proof entirely on the manufacturer, if a patient develops a problem and alleges that the device created that problem. Since no one knows what causes rheumatoid arthritis, the manufacturer couldn't prove that the breast implant DIDN'T cause it. The patient won the case--for 3 million dollars. The six men and women on that San Francisco civil federal jury didn't have any medical training, and didn't base their decision on any scientific studies. They just decided that, in this particular case, the manufacturer couldn't prove that the implants DIDN'T cause the woman's rheumatoid arthritis. Since this was the first case addressing the issue, however, it became the law of the land that breast implants cause rheumatoid arthritis. On January 19, 1982, the FDA responded by proposing to place breast implants in class III, requiring stringent testing. In 1988, after Dow Corning had lost several more lawsuits, the FDA finally did reclassify breast implants into class III. In 1992, the FDA placed silicone gel-filled implants under restriction, for research use only, and left saline-filled implants on the market in the same "not approved but also not restricted" status that had been the case ever since 1976. In 1994, the FDA met with manufacturers to set the ground rules for pre-market approval testing of saline-filled breast implants. In March 2000, the implant manufacturers completed their 5 year pre-market approval studies and submitted the data to the FDA. On May 10, 2000, the FDA approved saline-filled breast implants for general use.
FDA APPROVAL OF SILICONE GEL-FILLED BREAST IMPLANTS
In 1992, the FDA placed silicone gel-filled breast implants under restriction, for research use only. Research studies were initiated for women who had had a mastectomy for cancer, for women who already had silicone gel-filled implants from a previous procedure, for women who needed a breast lift, and for women who had previously had problems with saline-filled implants. In 1997, Congress approved funding for the Institute of Medicine of The National Academy of Sciences to conduct an independent, unbiased review of all past and ongoing scientific research regarding the safety of silicone breast implants. After reviewing literally every scientific study ever published regarding silicone gel-filled breast implants, the Institute identified 17 studies that were of sufficient quality that they could be trusted. These high quality studies had age-matched control groups of women without implants, so the occurrence of diseases in women with implants could be compared to the incidence of those same diseases in women their same age, who did not have implants. They had a large enough study population that a statistically valid conclusion could be drawn, and they had been conducted in a careful scientific manner. On June 15, 1999, the Institute of Medicine published their findings: "A review of 17 epidemiologic reports of connective tissue disease in women with breast implants was remarkable for the consistency in finding no elevated risks or odds ratio for an association of implants with disease." Although women with implants do sometimes develop connective tissue diseases, it has turned out that those diseases do not occur more frequently in women with implants than in women without implants. I am a clinical investigator for both McGhan and Mentor silicone gel-filled breast implants. Those studies are no longer enrolling new patients, but I continue to follow patients for their 3yr, 5yr and 10yr checkups. In November, 2006, the FDA eased the restrictions on silicone gel implants, and made them once again available for general use in breast augmentation, with conditions: the patient has to be at least 22 years old, and agree to participate in a post - approval study with followup exams at 1 year, 3 years, 5 years and 10 years. MRI examinations to check for silent rupture are recommended at three years, and every two years after that. The advantages of the silicone gel-filled implants are that they feel more natural to touch than saline-filled implants, and don't show visible rippling at the edge of the implants. This is particularly advantageous if the implants are placed above muscle, in the "sub glandular" position. The disadvantages of the silicone gel-filled implants are that they add $1000 to the cost of your procedure, and require you to participate in the post-approval study protocol for 10 years after the implants are placed.
IMPLANT MANUFACTURERS
In May 2000, the FDA approved two American companies, McGhan Medical and Mentor Corporation, to produce saline-filled breast implants for cosmetic breast enhancement. Both companies manufacture implants in several styles, offering round and contoured shapes, and smooth and textured surfaces. Following a series of corporate mergers, McGhan Medical is now part of Allergan.
IMPLANT MANUFACTURERS' GUARANTEE
ALLERGAN IMPLANT WARRANTY: Standard warranty (Included with all implants, no extra charges or paperwork) 1. Lifetime free replacement implant, if original implant fails. 2. The replacement implant can be any size or style. It can be different from the implant it is replacing, if you like. 3. If rupture occurs in the first ten years after the implant was placed, Allergan will pay up to $1200.00 to help cover the cost of the surgery to replace the implant. Extended warranty (Requires submission of a registration form and payment of $100 to Allergan within 1 month of breast augmentation surgery.) 1. Lifetime free replacement implant, if original implant fails. 2. The replacement implant can be any size or style. It can be different from the implant it is replacing, if you like. If you would like to replace both implants at the time one of them fails, Allergan will provide 2 free implants. If the style you select costs more than the style you are replacing, you will be liable for the difference in price between the two styles of implant 3. If rupture occurs in the first ten years after the implant was placed, Allergan will pay up to $2400.00 to help cover the cost of the surgery to replace the implant.
MENTOR IMPLANT WARRANTY: Standard warranty (Included with all implants, no extra charges or paperwork) 1. Lifetime free replacement implant, if original implant fails. 2. The replacement implant will be the same or similar type as the original implant. 3. If rupture occurs in the first five years after the implant was placed, Mentor will pay up to $1200.00 to help cover the cost of the surgery to replace the implant. This warranty covers implant deflation due to crease fold failure, patient trauma, or unknown cause. It specifically does NOT cover removal of intact implants due to capsular contracture, wrinkling or rippling. It further does NOT cover implant damage during reoperative procedures, open capsulotomy, or closed compression capsulotomy. Extended warranty (Requires submission of a registration form and payment of $125 to Mentor within 1 month of breast augmentation surgery.) 1. Lifetime free replacement implant, if original implant fails. 2. The replacement implant will be the same or similar type as the original implant. 3. If rupture occurs in the first ten years after the implant was placed, Mentor will pay up to $1200.00 to help cover the cost of hospital and anesthesia charges, and up to $1000 to help cover surgeon's fees for the surgery to replace the implant. This warranty covers implant deflation due to valve failure, crease fold failure, patient trauma, or unknown cause. It specifically does NOT cover removal of intact implants due to capsular contracture, wrinkling or rippling. It further does NOT cover implant damage during reoperative procedures, open capsulotomy, or closed compression capsulotomy.
IMPLANT FILLING MATERIAL
Normal saline solution is distilled water with 0.9% salt added, to exactly match the salt concentration of your natural body fluids. Everyone's natural body composition is 71% normal saline. If a saline-filled implant should wear out someday and begin to leak, the normal saline solution that leaks out will be immediately absorbed into the circulation and cleared by the kidneys, with no harm to your body.
Silicone is a polymer made by hooking together several individual silicone molecules to form a chain. The physical characteristics of the polymer change, depending on the length of the chain. Short-chain silicone polymers are oils, slightly longer chain silicone polymers are gels, still longer chain silicone polymers are rubbery in consistency, and longest chain silicone polymers are solid plastics. Silicon, the core atom in the silicone molecule, has many chemical characteristics similar to carbon, which is the core atom for all biological molecules. This chemical similarity is believed to be the reason for silicone's biological compatibility. Silicone is the benchmark substance for biologic nonreactivity in the US Pharmacopoeia. Stainless steel, polyethylene, polycarbonate and all the other substances used in implantable devices (heart valves, artificial joints, etc.) are all rated in comparison to silicone.
IMPLANT SHELL
The implant filling material is contained within an envelope, or "shell," made of silicone rubber. Another word for silicone rubber is "elastomer." The room-temperature vulcanizing process for creating a smooth-surface, silicone-rubber elastomer for saline-filled implants was developed in 1969. In 1979, the manufacturer changed the design of the filling valve to its present form. In 1986, surface texturing became an available option. The theory behind surface texturing was that the textured surface would prevent capsule contracture. This has proven to be partly true if implants are placed in the subglandular position, but has been shown to not make any difference if implants are place in the submuscular position. The two advantages smooth implants have over textured implants are that they are thinner-walled and more flexible (therefore less likely to be detectable by touch,) and they cost less. The elastomer shell of the Mentor implants is somewhat thinner and more flexible than the elastomer shell of the McGhan implants. At 3 years follow-up, 79% of patients with each kind of implant had good cosmetic results, natural in both appearance and feel. Among the 21% for whom the implants had a cosmetic imperfection, Mentor implants had a higher incidence of visible wrinkling, and Allergan implants had a higher incidence of being detectable by touch. (This is for saline implants. Gel implants are much less likely to cause visible rippling or feel abnormal to touch.)
IMPLANT SHAPE: ROUND VS CONTOURED
Contoured implants are wider than they are tall, and project forward in front of the chest wall farther than similar-sized round implants. Since they are not round, they look strange if they get tilted or rotated. To help keep them fixed in place, they have textured surfaces. Since they don't move, we don't do softness exercises on them. I use them frequently for breast reconstruction after a mastectomy, and occasionally for above-muscle breast augmentation in female body builders. I use round implants for most breast augmentation. I almost always use smooth-surfaced implants for augmentation, because they feel more natural to touch than textured-surface implants.
IMPLANT SIZE
Information is available from several sources to help you select your implant size. Photos: Internet photos from breast augmentation websites can be helpful, especially if information is included about the ribcage size of the person in the photo. (Try www.implantinfo.com). Photos from men's magazines can be helpful as a demonstration of a desired postoperative look, but selecting the implant that will take you from your starting ribcage size and starting breast shape to the postoperative appearance of the model in the photo requires long experience, good judgment and a certain amount of luck on the part of your surgeon. Trying on bras and implants: If you will wear a knit top to your office consultation, we can fit you with a bra in your desired postoperative size, then try different sizes of implants to see which size fills out the bra. You can then put your knit top on to see how you look in the mirror with that size bra and implants.
SURGICAL OPTIONS IN BREAST AUGMENTATION
Surgical options in breast augmentation revolve around two questions:
1. In which layer of the chest wall should we make the pocket for the implant: directly behind the breast gland tissue, in front of the pectoral muscle? or behind the pectoral muscle, between the muscle and the ribs?
2. Which incision should we use to gain access to the pocket - axillary, periareolar, inframammary or umbilical?
BASIC ANATOMY
The chest wall has 3 main layers: the breasts in front, the pectoral muscles in the middle, and the ribs behind. Certain features of the anatomy of the pectoral muscles have bearing on the decision whether to place the breast implants directly behind the breast gland tissue and in front of the pectoral muscles, in the "subglandular" position, or behind the pectoral muscles, between the pectoral muscles and the ribs, in the "subpectoral" position. The pectoral muscles are attached to bone only at their ends. The inner end of each muscle attached to the breastbone. The outer end of each muscle attaches to the upper arm at the shoulder. Between these anchor points at the breastbone and the shoulder, the back surfaces of the pectoral muscles have no attachment to the underlying ribcage. This allows them to glide freely over the ribs when the shoulders move. It also makes it easy to separate a pectoral muscle from the underlying ribcage tp create a "submuscular " pocket into which a breast implant can be placed. In contrast, the front surfaces of the pectoral muscles have many attachments of connective tissue and blood vessels to the overlying breast tissue. These attachments have to be divided when an implant pocket is created directly behind the breast gland tissure for "subglandular" placement of a breast implant.
IMPLANT PLACEMENT: SUB-GLANDULAR VS. SUB-MUSCULAR
Since the medical word for "breast" is "mammary gland" the implant position directly behind the breast tissue is termed "sub-glandular". The deeper position, behind the pectoral muscle, is called "sub-muscular". At first glance, it would seem simpler to place the implant directly behind the breast tissue, leaving the muscle undisturbed. Due to the multiple connections between the pectoral muscle and the overlying breast tissue, however, this does not really apply. It disturbs more tissue connections and blood vessels and nerve endings to separate the breast tissue from the front surface of the pectoral muscle, than it does to separate the back surface of the pectoral muscle from the rib cage. Sub-muscular breast implant placement is usually preferred, for several reasons: (1) the muscle provides additional natural soft tissue cover for the implant, thereby helping prevent the edges of the implant from being seen or felt, (2) long-term follow up studies have consistently shown a lower rate of capsular contracture and superior breast softness with sub-muscular implant position, (3) sub-muscular implants don't press as directly against the breast gland tissue as sub-glandular implants do, so are less likely to interfere with breast feeding, and (4) mammograms are easier to perform effectively when the implants are separated from the breast tissue by the intervening pectoral muscles. Sub-glandular implant placement may be preferable if the preoperative breast shape has significant ptosis. In this situation, sub-glandular implant placement may produce a more natural breast shape.
INCISION LOCATION/EXPECTED SCARRING
The breast provides four areas where an incision can easily be hidden: in the skin fold where the lower edge of the breast joins the chest wall (inframammary), in an underarm skin line axillary), at the edge of the darker-colored skin that surrounds the nipple, using the natural change in color and texture from darker nipple skin to the lighter-colored breast skin to camouflage the incision(periareolar), or at the edge of the bellybutton (umbilical). Each incision has certain advantages and disadvantages. The INFRAMAMMARY INCISION in the lower breast skin fold provides the most direct access to the subpectoral space. It disturbs the least amount of tissue, has the shortest operating time, requires the least amount of anesthetic, and provides the best access for dealing with complications such as wound infections, hematomas, and capsular contractures. On average, it is the most likely of the three incisions to leave a visible scar at the completion of healing, but this is minimized by placing it exactly in the skin fold, and keeping it short (usually about 1 inch in length). The AXILLARY INCISION in the underarm is the best hidden of the three incisions. Even if the scar should heal badly, for whatever reason, it is still hidden from view in a part of the body that no one ever looks at very closely. It provides the least direct access to the implant pocket, and requires the deepest sedation of the three incisions. The nipple incision is not really in the nipple. It is at the color change between the darker "areola" skin around the nipple and the lighter skin of the surrounding breast. For this reason it is also called the PERIAREOLAR INCISION. To get to the subpectoral space from the periareolar incision, I have to cut through the breast gland tissue to get to the pectoral muscle, split the pectoral muscle, and then make the implant pocket. After the implant is correctly positioned in the pocket, the muscle split and breast incisions are repaired. The cut through the breast gland makes this incision more likely to interfere with breastfeeding the other two incisions, and this approach has the longest operating time, and requires the largest total dose of anesthetic. The resulting scars, however, are consistently the thinnest and hardest-to-find of the three incisions. I have extensive experience and equally good results with all three incisions, and you may choose the one you prefer. The umbilical (TUBA) incision is preferred by some doctors and patients. I have seen it described at plastic surgery meetings, but the asymmetries and distortions in many of the postoperative photos have made me shy away from trying to learn it. "NO-TOUCH" TECHNIQUE Two prominent plastic surgeons have developed different surgical techniques that they have called "no-touch." Richard Mladick of Virginia Beach, Virginia places submuscular implants via incisions around the nipple. To keep the implant from touching the breast ducts or glands, he uses a sterile silicone sleeve to isolate the implant and keep it from touching the breast tissue as it is being inserted into the subpectoral pocket. The silicone sleeve is then removed and discarded before the incision is closed. John Tebbetts of Dallas, Texas has recognized the role of rib bruising as a source of postoperative pain following breast augmentation. His "no-touch" technique emphasizes avoiding any touching of the ribs with surgical instruments during the dissection of the subpectoral implant pocket. I think these are both good ideas and I have incorporated both of them into my routine surgical practice.
ANESTHESIA
Local anesthetic is always injected into the operative site before the operation. It helps separate the tissue, making the surgery easier to perform. It also causes the constriction of blood vessels, which reduces the amount of bleeding during surgery. To minimize your awareness of the surgery, your local anesthetic will be supplemented, either with sedative medications given through your IV, or general anesthesia. CAPSULE CONTRACTURE: As the body heals following breast implant surgery, a smooth layer of scar tissue forms over the entire inner surface of the implant pocket. This scar tissue has genetic programming to contract a little bit more every day, until the implant pocket completely disappears. Since the implant is there, the pocket does not completely disappear, but it does shrink until it begins to squeeze the implant. The implant becomes spherical as the scar tissue tightens around it. The end result of this process is an abnormally firm and spherical breast, fixed in position on the chest wall and unable to change shape or position in response to gravity. To prevent this unnatural result, we surgically create an implant pocket significantly larger than the size of the implant. The implant thus is given room to move around in response to gravity. When one is upright, the implant fills out the bottom one-half of the breast. When one lies down, it is moved by gravity to the outside of the pocket, pulling the breast skin outward in a natural way.
ANTICIPATED OUTCOME
You can expect your breast size to increase by one to two bra cup sizes. Pre-operative nipple position or chest wall contour, unique to your own body, may limit implant size choices. Breast shape may change, usually becoming more rounded following the operation. Sometimes asymmetry between the two breasts can be improved by the surgery, but complete correction is unlikely, and perfect symmetry should not be expected.
BREAST IMPLANT SOFTNESS EXERCISES
To prevent scar contraction, one needs to do implant softness exercises daily. The idea is to push the implant to the edge of the pocket, and hold it there under pressure for 10 to 15 seconds, to stretch out the scar tissue by however much it has contracted since the day before. Doing this in each of the four directions of the compass every day keeps the implant pocket the original size it was made at the time of the surgery. The implant is then able to move naturally in response to gravity and the breast stays soft. If patients do not do the softness exercises, 40% of them will develop abnormal breast firmness within three months of the surgery. Faithfully performing the softness exercise routine reduces the capsule contracture rate to 5% at 1 year after surgery, and 9% at 3 years after surgery.
WEARING A BRA IN THE FIRST SIX WEEKS AFTER SURGERY
When I see you in the office for your first postoperative visit, I will assess your implant position relative to breast shape and nipple height. About 90% of the time, implant position is perfect. If implant position is good, I will encourage you to go without a bra most of the time for the first 6 weeks after surgery. This will help your chest wall muscles relax to accommodate the presence of the implants. Many patients find that they feel too free without a bra, and choose to wear a stretchy sports bra without an underwire for at least part of each day. This works fine, too. If the implants are riding too low, I will fit you with an underwire bra and tape it in place to close off the lower part of the implant pocket and help it heal back together. While you are taped into the bra, you may have occasion to stretch your arms above your head, as when leaning over and reaching out to arrange the blankets when making a bed. As you do this, you may feel a "clunk" as your implant falls below the underwire of your bra, all the way to the bottom of the implant pocket where we are trying to get the muscles to heal back to the chest wall. If this happens, use your hands to boost your implants back above the underwire, tighten your bra strap to the next hook, and try to avoid stretching that far again for a few more weeks. If the implants are riding too high, I may ask you to wear a compression strap for 3-4 weeks postoperatively, to help expand the lower edges of the pockets. The compression strap works best if you wear it without a bra. If the implants are too close together in the center of the chest, I will place a rolled towel between your breasts and ask you to wear a tight-fitting underwire bra to hold the towel in place for 3-4 weeks after surgery.
AUGMENTING THE PTOTIC BREAST
Ptosis (Pronounced "toe' - sis" - the "P" is silent) is the medical word for sag or droop. Ptosis is the noun. The adjective form is ptotic.(Pronounced "taw' - tic") Breast ptosis is defined by comparing nipple height to the height of the lower breast skin fold on the chest wall. Pseudoptosis is when the lower breast gland tissue has fallen below the lower breast skin fold, but the nipple remains above it. Grade 1 ptosis is when the nipple is at the same level as the skin fold, or up to 1cm below it. Grade 2 ptosis is when the nipple is 1 to 2 cm below the lower breast skin fold. Grade 3 ptosis is when the nipple is 3 or more centimeters below the lower breast skin fold. Pseudoptosis may be treated by placement of a larger - than - average breast implant, or by a circle nipple lift and placement of a small-to-average size implant. My favorite treatment for grade 1 ptosis is a circle nipple lift, followed 1 year later by breast augmentation. My favorite treatment for grade 2 or 3 ptosis is a vertical breast lift, followed 1 year later by breast augmentation. Most patients who need both augmentation and a lift insist on having both procedures done at the same time, without the 1-year delay inbetween. I do as they ask, but caution them that with the breast lift scars under pressure from the implants during the first year after the procedure, the scars tend to turn out wider than if they had been allowed to mature before the implants were placed. In order to avoid external scars on the surface of the breast, some patients with ptosis elect to have placement of breast implants without a lift. This increases the size of the breast and makes it protrude farther out in front of the chest wall, but the breast shape usually stays the same. Subglandular implant placement is preferred over submuscular for ptotic breasts, to avoid producing a double contour deformity.
DOUBLE CONTOUR DEFORMITY
If a breast implant is placed below muscle behind a ptotic breast, the curve of the implant may be visible at the edge of the breast as distinct from the breast gland tissue. The curve of the breast gland tissue in front of the muscle may be different than the curve of the implant behind the muscle. If the 2 curves don't meet perfectly, a step-off may be visible. The effect is similar to a double dip ice cream cone. If the submuscular breast implant is too high relative to the breast tissue, the double contour will be above the nipple. If the submuscular breast implant is too low relative to the nipple, the double contour will be at the lower breast skin fold. If the submuscular breast implant is positioned just right, there will not be a double contour deformity postoperatively. The augmented breast will be larger than preoperatively, and will retain the same ptotic shape it had prior to augmentation. If the breast implant is placed in the subglandular position, it can be positioned low relative to the nipple, often creating a significant breast lift effect without creating a double contour deformity.
BREAST AUGMENTATION SURGERY TIMELINE
TWO WEEKS BEFORE SURGERY you should stop taking ASPIRIN, or any aspirin-family drugs like Ibuprofen. Take plain Tylenol instead. This will reduce your risk of bleeding during surgery, and bruising afterward. . Other herbs and medications that interfere with blood clotting include arnica, garlic and Vitamin E. Avoid them all for 2 weeks before surgery.
5 DAYS BEFORE SURGERY you should start taking Mephyton, an orally effective form of Vitamin K, to "tune up" your clotting system and further reduce the risk of bleeding and bruising. (We will call in a prescription for Mephyton to your pharmacy when you officially schedule your surgery.) You should not drink any alcoholic beverages or use tobacco products during the 5 days you are taking Mephyton.
THE DAY OF SURGERY you will be asked to arrive at the hospital 90 minutes before your surgery start time. You will meet your anesthesiologist, and the plastic surgery OR nursing team. Dr. Seaberg will see you in the preop holding area before surgery, to review your procedure with you and mark your incisions. You will then be taken to the operating room. Your surgery will take about 2 hours to perform. You will awaken in the recovery room with gauze bandages covering your incisions and a 2 inch acewrap encircling your chest above the breasts. After you regain alertness and independence, a trusted companion will drive you home. YOU WILL NOT BE ABLE TO DRIVE YOURSELF HOME AFTER SURGERY! The first night after surgery you will need someone to pamper you at home. They should bring you ice bags to put on your breasts, put extra pillows beneath your arms, and bring you water and crackers and pain pills, as you will be very sore.
THE DAY AFTER SURGERY you should remove the ace bandage from your chest. Remove the gauze bandages covering the incisions. Underneath the gauze dressings are short strips of 1/2" tape (Steristrips) covering your sutures. Leave these in place. You may shower and wash your hair. Wetting the steristrips briefly in the shower will not hurt them. Take your medications as prescribed. Drink milk or eat easily digested food like toast, crackers or cereal before you take pain pills. A little food makes the pills less likely to cause nausea.
TWO OR THREE DAYS AFTER SURGERY come to the office for instructions on how to do your breast implant exercises. You will want to take 2 Vicodin pain pills 1/2 hour before your appointment time. Because of the pain pills, you will need a companion to drive you to and from the office this day.
FIVE DAYS AFTER SURGERY you will be asked to return to the office to have your sutures removed. I will also ask you to demonstrate your technique with the breast softness exercises during this visit. You should now a feel a sensation of pressure in your breasts, but it should not be severe enough to require pain medication. Many patients liken it to pre-menstrual congestion. Some patients will feel a need to take their Vicodin this day. Others will be able to get by with Celebrex and Tylenol. If you can get by without the Vicodin, you can resume driving this day.
TWO WEEKS AFTER SURGERY another office visit is scheduled to evaluate breast softness and make sure that you are healing as you should. You may resume any kind of exercise program that you like, on the 14th day after surgery.
SIX WEEKS AFTER SURGERY another office visit is scheduled to evaluate breast softness, and to review your technique in doing the breast softness exercises. By this time you should be comfortable in a bra, and I encourage you to wear one regularly from this point on to prevent breast droop.
ONE YEAR AFTER SURGERY your implants should have "dropped" and your breasts will have assumed their natural, final contour. You will return to the office for a checkup, measurements and photos.
THREE YEARS AFTER SURGERY if you have gel-filled implants, you will be asked to come in for a checkup. MRI examination of the breasts to check for silent implant rupture is recommended at the time of this visit.
FIVE YEARS AFTER SURGERY if you have gel-filled implants, you will be asked to come in for a checkup. MRI examination of the breasts to check for silent implant rupture is recommended at the time of this visit.
TEN YEARS AFTER SURGERY if you have gel-filled implants, you will be asked to come in for a checkup. MRI examination of the breasts to check for silent implant rupture is recommended at the time of this visit.
HOW YOU LOOK IS UP TO YOU
Why have over a million American women chosen to have breast augmentation? My patients tell me the answer is simple: self-esteem. A woman who goes shopping for clothes a week after her breast enlargement soon discovers that most everything she tries on, fits. Clothes she could never wear before now look terrific. This boosts self-esteem every day for the rest of her life. Although the results of breast augmentation are not always completely perfect, the great majority of women who choose implants are happy with their results, and enjoy looking great in anything they choose to wear.