Cyber Consultation

In my practice, breast augmentation is done as an outpatient at an accredited ambulatory surgical facility. Once you’re asleep, about a two inch incision is made underneath and a little to the side of the breast, tucked in where it meets the chest wall. Through this incision a pocket, either above or below part of the chest muscle, is created to hold the implant which is basically a plastic bag filled with salt water.

This incision gives me good visibility for pocket creation and implant placement, the incision (which is closed with a special suture under the skin) tends to heal very nicely here and it’s tucked in or slightly above the crease. Nipple sensitivity is rarely altered with this approach. Other physicians may do breast augmentation through incisions in the armpit, belly button or through the areola but, in my 30 years of experience, even though technically possible, I’ve never felt these approaches were best for my patients.

Despite the fact that, in the hands of those properly trained in plastic surgery, complications with this procedure are very few and far between and generally not severe, you should be aware of a few things.

This is real surgery. Just because this procedure is a want and not a need doesn’t mean it doesn’t have the same potential complications and consequences (like pain) of any surgery you might have-whether it’s a C-section or an appendectomy.  

Over time, (the literature says 7%) an implant can break or develop a leak. Almost everyone will need an implant replacement at some time.  The saline (salt water) is similar in concentration to what’s in your body so it gets absorbed but now you have a collapsed implant that needs to be replaced which means additional surgery and expense. If an implant fails, currently the implant companies provide replacement and usually some financial reimbursement, depending on how long you have had your implants, but who knows what their policy will be in the future. If a problem comes up it has to be dealt with; otherwise, it’s life like usual. Implants can easily be removed if you ever change your mind. Silicone gel filled implants are back on the market for the general public again but I only use saline implants.   If a patient would benefit from silicone, I will refer them to a surgeon who uses silicone.   Study after study, has shown no higher incidence of disease processes such as cancer, lupus, arthritis, etc., in women who have implants versus those who don’t. Some say the pressure of the implant behind the breasts may make it easier to feel a lump sooner - others say just the opposite. I don’t know. If you do fine a lump, there may be ways to biopsy it without disturbing the implant. You should still do your monthly breast exams. Mammograms do require some special attention, so for your own comfort and to avoid damage to the implant and  make sure you get an optimal reading, advise the radiology technician that you have implants.

In most women, if we were to put the implant right under the breast tissue and skin, there would not be enough padding to cover it well. For this reason, the implant is almost always placed under a part of one of the chest wall muscles. After surgery you can expect swelling, bruising, muscle spasm and for the nipple sensation to temporarily be dull or hypersensitive. I haven’t seen permanent change in nipple sensation with the incision I use. Until the skin and muscle stretches out and the swelling goes down (what we call the settling in process that usually takes a few weeks) we’ll have you wear a bandeau strap to keep the implants in the optimal position. You’ll wake up from surgery with a surgical bra on. This bra is worn (except for showering which you start the second day) for about a week.  You may need to wear the strap (on top your regular bra) longer. The strap is an important part of getting that "natural look" so if I tell you to wear it, please do so.

We advise against breast feeding. What affects the look of the breasts without implants (pregnancy, extreme weight gain or loss, etc.) also effects the look with implants and many of you already know what nursing can do to your breasts.

You’ll be at the surgery center a full morning or afternoon. Leave jewelry and makeup at home. Wear clothing that opens in the front. After surgery, someone must drive you home, stay with you for the first 24 hours and drive you to the first postop office visit. You’ll need ice bags for the first day or two. For the first three days I like you to really take it easy. You won’t be able to lift small children for about a week. After the third day, you can gradually resume all usual activity at your level of comfort. If your job is very physical, plan about 10-14 days off; otherwise most women are back to work in 4-7 days. After the healing process, there are no restrictions what so ever. Do what ever sports, exercise, etc., that you wish, just start gradual and increase the intensity. The breasts can be touched, fondled, etc., when ever you say it’s OK after the first week.

Just like any other surgery, you can expect postop pain to be intense for the first few days. Prescriptions for pain medication and antibiotics are called to your pharmacy in advance to avoid the need to stop at the pharmacy on the way home from surgery.

What size implant is best for you? Here’s how I do it. If you want the best fitting pair of jeans, you have to try them on, right? Likewise, even though I always have a good idea of the size range of implant you’ll need, I don’t try to judge the exact size ahead of time. On your chest wall, there’s so much space from the inside to the outside and from the top to the bottom of the breasts and your skin, tissues and muscle will only stretch so much at the time of surgery. I open this space up and then fine tune the implant size by inserting test implants of different sizes until I find just the right size that gives the best look, shape and proportion for you. We want the breasts to have softness and movement . The space needs to be adequately filled but not stuffed so full it looks like a sausage. You’ve all looked at a photo of a woman and said, " Ohhhhh, can we say breast  implants?" Too large an implant gives a very unnatural look and makes the breast too firm. Stuff a pillowcase too full and it’s very firm and tight. Take a little out and it’s soft, touchable and has movement. Same thing. If you want me to be as generous as possible, or stay on the conservative side, let me know. As far as what size bra you’ll wear afterwards, you just have to have fun trying them on to find out. You know how it is…. buy three bras, all D cups, in different styles by different manufacturers and none of them will be remotely the same size. After the acute healing process you may wear any style bra you like or none at all.  Because we do not want to push the implant out of the proper position in the beginning we want to avoid bras that squish (sports bras) and bras that push up. 

Hands, feet, breasts, etc., are never exactly the same size or shape. I can try to even out major size discrepancies by using more or less saline in one side or the other. Typically, the same amount of saline is used on each side so minor differences that were there before surgery (usually you’ve never noticed them) will persist after surgery.

My surgeon’s fee includes a 24-48 hour postop visit, suture removal at 7-10 days and routine office visits as necessary, usually one between 3-6 weeks and one in 3-6 months.

The typical expense my patients incur is approximately $5,500. This is inclusive of my surgical fee and routine followup, the implants and the facility and anesthesia fees, which are based on actual time used and paid to the surgery center separately from my fee.

All fees for elective cosmetic surgery are payable in advance of the procedure. My staff will be happy to discuss the details and payment options including Mastercard, Visa and Discover and offer advice on financing options you may want to consider.