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GENERAL INFORMATION
Breast Augmentation is performed to increase the size and fullness of the breast. Women whose breasts are disproportionately small, or whose breasts have sagged or "deflated" after childbirth, or who have unevenly-shaped or sized breasts, are candidates for the procedure. 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 (M.D.) who remains in attendance throughout
the operation. All of the required monitoring, anesthesia delivery and emergency
equipment are present at all times. Further information, including any questions
you may have, will be explained and discussed fully by our anesthesiologist
prior to your surgery.
PREOPERATIVE PREPARATION
You must be in good health to undergo any elective cosmetic surgery. A physical
examination and routine lab work will need to be performed by your own primary
physician. If you do not have a primary doctor, we can refer you to local
doctors in our area. We do not provide these services. It will be required
that all this pre-op paperwork is in our office 1-2 weeks prior
to surgery.
It is very important that our office is aware of any medical conditions and all medications you are taking.
It is imperative that you not smoke 2 weeks prior to surgery, and 2 weeks after surgery. This would impede your healing greatly. Talk to us about options.
It is a required that someone drive you home upon your discharge. Also arrange for transportation to and from our office for your post-operative appointments until your doctor gives you permission to drive.
DO NOT take aspirin or aspirin-containing products for 2 weeks prior to surgery and for 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, discussed pre-operatively with your doctor, one of two incision sites will be chosen, 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 takes usually than one 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 which size is ideally suited.
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 no
long-range 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 may 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 and the resulting firmness, and is slightly more likely
to occur when the axillary approach is selected. Breast indentation
with position change may also occur, particularly with implants placed below
the chest wall muscle, in very athletic patients. Rarely, 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 of the procedure include unsightly scar
formation in the incision, rupture or leakage
of the implant requiring replacement, or rare, unsubstantiated, but possibly
related connective tissue disorders such as arthritis.
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 the implants.
Regular self-examination and physician follow-up are essential, even for
women who chose not to have breast enlargement. Some health insurance carriers
may exclude patients from coverage for breast diseases occurring after 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 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 expected. You will be given pain medication pills, to
be taken, as you need. 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 them. 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 to relative insignificance 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, for 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 things.
At six weeks: resume all previous activities with clearance from Dr. Moelleken. Avoid sun exposure to incision site for months following surgery, as this may result in a hyperpigmented scar.
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Breast Augmentation - 330cc saline implants
Subpectoral placement / Inframammary Incision
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Breast Augmentation - 330cc saline implants
Subpectoral placement / Inframammary Incision
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Breast Augmentation with 360cc Smooth Saline Implants
Inflated to 375cc with a submuscular inframammary incision.
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Breast Augmentation with 360cc Smooth Saline Implants
Inflated to 375cc with a submuscular inframammary incision.
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Breast Augmentation with 330cc Smooth Saline Implants.
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Breast Augmentation with 330cc Smooth Saline Implants.
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Breast Augmentation.
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Breast Augmentation.
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Removal and Replacement of Breast Implants.
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Revision to Implant Placed Above the Muscle and Nipple Asymmetry.
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Before and after Breast Augmentation with 390 cc
Smooth Saline-Implants inflated to 400cc (Inframammary Incision).
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Before and after Breast Augmentation with 390 cc
Smooth Saline-Implants inflated to 400cc (Inframammary Incision).
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Before and after Breast Augmentation with 330cc Smooth Saline Implants.
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Before and after Breast Augmentation with 330cc Smooth Saline Implants.
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