Breast Augmentation

If You're Considering Breast Augmentation...

Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman's breast for a number of reasons:

• To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
• To restore breast volume lost due to weight loss or following pregnancy
• To achieve better symmetry when breasts are moderately disproportionate in size and shape
• To improve the shape of breasts that are sagging or have lost firmness, often used with a breast lift procedure
• To provide the foundation of a breast contour when a breast has been removed or disfigured by surgery to treat breast cancer
• To improve breast appearance or create the appearance of a breast that is missing or disfigured due to trauma, heredity, or congenital abnormalities

By inserting an implant behind each breast, Dr. Atwood is able to increase a woman's bust line by one or more bra cup sizes. If you're considering breast augmentation, this will give you a basic understanding of the procedure--when it can help, how it's performed, and what results you can expect. It can't answer all of your questions, since a lot depends on your individual circumstances. Please ask Dr. Atwood or his nurse, Candy, if there is anything you don't understand about the procedure.

The Best Candidates for Breast Augmentation

Breast augmentation can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Atwood.

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you're physically healthy and realistic in your expectations, you may be a good candidate.

Types of Implants

The choice of implant filler, implant size, shape and other features will be determined based on your breast anatomy, body type and your desired increase in size. Your lifestyle, goals and personal preferences, as well as Dr. Atwood's recommendations and sound surgical judgment are also determining factors. Implant manufacturers occasionally introduce new styles and types of implants, and therefore there may be additional options available to you.

Breast implants are medical devices with a solid silicone, rubber shell. The implant shell may be filled with either saline solution (sterile salt water) or elastic silicone gel. Both saline and silicone gel breast implants are approved by the U.S. Food and Drug Administration (FDA). Approval means that an implant has been rigorously researched and tested, and reviewed by an independent panel of physicians for safety.

The size of a breast implant is measured in cubic centimeters (ccs) based on the volume of the saline or silicone filler. Breast implants vary both by filler and in size, but there are additional features to consider:

• Texture: the implant shell may be smooth or textured
• Shape: the implant may have a round profile or one that is anatomic (teardrop or tapered shape)
• Profile: the implant may have a low, medium or high projection (the depth of the implant from the base to the highest point of the implant curve)
• Diameter: the width of the implant measured across it's base (the side of the implant that will be positioned over the chest wall)

Adult women of any age may benefit greatly from the enhancement breast implants provide. It is usually recommended, however, that a woman's breasts are fully developed prior to placement of breast implants. Saline implants are FDA approved for augmentation in women 18 years of age and older. Silicone implants are FDA approved for augmentation in women age 22 and older. Saline or silicone implants may be recommended at a younger age if used for reconstruction purposes.

You should be aware that breast implants are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants. Regular examinations for breast health and to evaluate the condition of your implants are important whether you have chosen saline or silicone breast implants.

All Surgery Carries Some Uncertainty and Risk

Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

The most common problem, capsular contracture, occurs if the scar capsule around the implant begins to contract or tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant. You will be asked to move the implants in a very specific manner during the healing process to help prevent this problem. The incidence of developing capsular contracture among our patients is under 1 percent at 1 year post-op which is well under the national average. Dr. Atwood also asks all women who have breast implants to take a dose of antibiotic prior to all dental and GI procedures, as we have seen this problem develop after those procedures.

As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood. The chances of developing capsular contracture after having a post-op bleed is greatly increased. It is imperative that you not do anything to make your heart beat fast, raise your blood pressure, lift over 2 lbs or use your arms vigorously for 14 days after surgery to help prevent this complication.

A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.

Some women report that their nipples become oversensitive, under sensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.

Breast implants do not generally interfere with a woman's ability to breast feed, or present a health hazard during pregnancy to a woman or her baby. However, pregnancy and the associated changes to a woman's body may alter the results of any breast surgery, including surgery to place breast implants. Because breasts do increase in size with pregnancy, the skin is usually stretched to accomodate the larger size and may not shrink back down to  the same size and shape as before the pregnancy. Therefore, it is important to discuss the options of breast implant surgery with your Dr. Atwood if you are interested in becoming pregnant and breast feeding in the future.

Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak.  This is much more likely to happen when capsular contracture is present.

• If a saline-filled implant breaks, the implant will deflate in a few hours or days and the salt water will be absorbed and naturally expelled by the body.
• If a silicone-gel filled implant leaks or breaks, the elastic silicone gel may remain within the implant shell, or may escape into the breast implant pocket (a capsule of scar tissue that surrounds the implant). A leaking implant filled with silicone gel may not deflate and may not be noticeable except through imaging techniques such as an MRI. For this reason, a woman with silicone breast implants is advised to visit her plastic surgeon every 2 years to assess that her implants are functioning well. An ultrasound exam or MRI screening can assess the condition of breast implants.

Following the placement of breast implants mammography is technically more difficult. Obtaining the best possible results requires specialized techniques and additional views. You must be candid about your implants when undergoing any diagnostic breast exam. If needed an ultrasound exam or MRI may be recommended in addition to mammography.

While the majority of women do not experience these complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of breast augmentation.

Planning Your Surgery

In your initial consultation, Dr. Atwood will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, Dr. Atwood may also recommend a breast lift.

Be sure to discuss your expectations frankly with Dr. Atwood. He will be equally honest with you, describing your alternatives and the risks and limitations of each. You will be given a copy of the manufacturer's brochure about both saline and silicone gel implants -- just so you are fully informed about them.  Be sure to tell us if you smoke, and if you're taking any medications, vitamins, herbs or other drugs.

We will explain why general anesthesia is the safest for this procedure, the type of facility where the surgery will be performed, and the costs involved. Because insurance companies do not consider breast augmentation to be medically necessary, carriers do not cover the cost of this procedure.

Preparing For Your Surgery

You MUST NOT take any asprin, ibuprofen or any medication containing asprin or ibuprofen, no herbs, herbal teas, diet pills or herbs or energy drinks for a full 14 days prior to and 2 weeks after your surgery. This is to lower your risk of an interaction with an anesthesia medication or excessive bleeding during surgery or post-op bleeding. Please check the Medications to Avoid List against all vitamins, supplements and medications you are currently taking. If you have questions please ask your pharmacist or call our office.

No eating or drinking after midnight the night before your surgery. We recomend drinking at least 8 glasses of water the day before your surgery to help you to be as hydrated as possible.  Please avoid alcoholic beverages the day before surgery as these tend to cause dehydration which makes starting the IV harder and increases your risk for post-op nausea and vomiting.

A current mammogram (within the past 10 months) will be required prior to your procedure to ensure breast health and serve as a baseline for future comparison if you are at least 35 years old.

Excellent nutrition before and after your surgery are essential to optimal healing. We do recomend 2 days before surgery you begin taking a multivitamin, until at least 2 weeks post-op, to ensure your are getting all the vitamins and minerals needed. Because Vitamin C is so essential to wound healing we recomend you have a dose 4 times a day for at least 2 weeks. This may be from a food, juice or as a supplement (250 to 500mg at a time is plenty)

In addition to explaining your surgical procedure, Dr. Atwood will discuss anesthesia, the recovery process and your obligations as a patient. We will also discuss where your procedure will be performed. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications of your surgery. There may be a waiting period of several days to weeks from the time of your consultation to the day of surgery.

While making preparations, be sure to arrange for someone to drive you home after your surgery, to stay with you for the first 24 hours and to help you out for a few days.

Where Your Surgery Will Be Performed

Dr. Atwood prefers to do this operation at Physicians Surgery Center. If you prefer another facility or hospital that mayl be arranged.

Types of Anesthesia

Dr. Atwood does breast augmentation with a general anesthesia, so you will sleep through the entire operation. He will be happy to explain why he feels this is the safest thing for the patient.

The method of inserting and positioning your implant will depend on your anatomy and Dr. Atwood's recommendation. The incision can be made either just above the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. The incision just above the breast crease allows the most flexibility of technique to create the optimal shape to the breast. Once healed the scar should not be noticable.

Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either beneath the pectoral muscle and on top of the chest wall (submuscular) or directly behind the breast tissue (submammary or subglandular) or may be placed beneath the pectoral muscle and on top of the chest wall (submuscular placement).  Once the implant is positioned within this pocket, the incisions are closed with sutures.  Gauze bandages will be applied over your incisions inside the bra we provide. The surgery usually takes approximately 1 1/2 hours to complete. You'll want to discuss the pros and cons of these alternatives with Dr. Atwood before surgery to make sure you fully understand the implications of the procedure he has recommended for you.

After Your Surgery

You're likely to feel tired and sore for a few days following your surgery, but you'll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed by your doctor.

Do the arm movements once an hour beginning in the recovery room through the next day except when you are sleeping. On the 2nd post-op day do them every 2 hours and then 4 times a day until your first post-op appointment when you will learn to move the implants instead of your arms. Faithfully doing the arm movements keeps the soreness from setting in and makes a huge difference in how much discomfort you will have.

Get up and walk to the sink or refrigerator to get a drink and to then to the bathroom every 1 1/2 hours except at night. This helps prevent blood clots.

You will need to change the gauze 4x4's at least once a day and possibly more often if needed. The bras we provide are to be worn 24/7 except when you shower for the first 14 days. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades.

Although the incisions are closed with sutures, they will all be under the surface of and within the skin so you will not have any that need to be removed.  You will have steri strips on the surface of the skin. The swelling in your breasts may take three to six weeks to disappear, so we recomend you wait at least 4 to 6 weeks to go shopping for new bras.

Getting Back to Normal

You should be able to return to work within a few days, depending on the level of activity required for your job.

You must wait 14 days to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery.

Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely.

Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group, although the mammography technician should use a special technique to assure that you get a reliable reading, as discussed earlier.

Your New Look

For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance.

Even if you believe your implants are functioning well, it is important that you follow-up as directed with Dr. Atwood to assess the condition of your breast implants. In addition, whether you choose to have breast implants or not, it is essential to your health that you practice a monthly breast self-exam and schedule regular diagnostic breast screenings.

Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you've met your goals, then your surgery is a success.