Advanced Art of Cosmetic Surgery     Thomas M. DeWire, Sr., MD, FACS    Specializing in Cosmetic Plastic Surgery     Richmond, Virginia, USA 

 

 

                  Advanced Art of Cosmetic Surgery     Thomas M. DeWire, Sr., MD, FACS    Specializing in Cosmetic Plastic Surgery     Richmond, Virginia, USA

Breast Implant Procedures

Breast Augmentation Mammaplasty

Frequently Asked Questions

 

Breast Augmentation Frequently Asked Questions:

Where is the surgery performed?

Because  placement  of implants  in the  submuscular  position requires complete muscle relaxation, particularly via the trans-axillary route, outpatient  general anesthesia  is  used.    Since early 2003  we have maintained a fully-equipped ambulatory surgery center, employing Anesthesiologists (MDs) who  are  certified  by the American  Board of  Anesthesiology  to  perform  anesthesia  services. To  maximize  patient  comfort  and safety,  our new  Outpatient  Cosmetic  Surgery  Center has two  operating  rooms  fully  Class  C certified (all  depths  of  anesthesia) by the American Association  for  Accreditation of Ambulatory Surgery Facilities (AAAASF).    Virtually all  of  our surgical  procedures are  performed in this  state-of-the-art outpatient surgery facility.

 

What is the cost of breast enlargement or augmentation?

The surgery  fee  for Breast  Augmentation at Advanced Art  of Cosmetic  Surgery is  currently  $3000  for primary breast enlargement,  and the  OR  and  anesthesiology  fee  (which is offered as a special procedure package rate)  is an additional $2900  (OR cost is higher for silicone implants, due to the much higher  cost  of silicone implants)  in our ambulatory surgery center.  Some  procedures,  such  as exchange of  existing  breast  implants,  complex  revisions  for  problems  with surgeries  done elsewhere,  or  when  breast  skin  lift  (mastopexy) is needed,  will  entail  higher fees.   A  separate  consultation fee  of $50 is charged,  and  brings the  total  cost  to  $5950  for  a  straight- forward  primary saline breast  augmentation.   Fees for  augmentation with   mastopexy,  and for revision  surgeries  must  be quoted  based  on  findings at  consultation,  or  photo  and questionnaire  data  provided  via mail  or   e-mail.   See:  Augmentation Data Sheet   

 

What preparations are necessary for anesthesia?

Patients should arrive for surgery having had nothing to eat or drink for at least 8 hours. Patients who take certain medicines, such as blood pressure medication,  are  usually instructed to take their morning dose with  a  sip of  water.  Someone must be  available  to drive you home  after the surgery, and  stay  with  you  at home  the  day of  surgery.   We  always  advise all patients  who smoke to  quit  for  several  weeks  to months before surgery,  since poisonous carbon monoxide gas and many of  the chemicals in tobacco smoke,  including nicotine, cause circulatory  compromise to healing wounds,  leading to poor  healing  and  excessive scar  formation.   Smoking  also leads to significantly higher pain levels after surgery because of  the nicotine  irritation  of the injured  nerve  endings  at  the surgery site.   Patients  who  smoke generally have  a  higher risk of complications than non-smokers.  This risk is reduced, but  not completely relieved  by quitting smoking well  before surgery,  and resolving  not to resume  post-op.  Lab tests or EKG   tracings may  be  necessary depending upon your age and risk factors.   A recent mammogram is necessary if  you are over 40  or  have  a strong family history of breast cancer.

 

What should I do to prepare for Breast Enlargement?

To limit the risk of bleeding,  patients should avoid drugs  that interfere with clotting,  including  aspirin  and  anti-inflammatory drugs (such as ibuprofen (Advil, Motrin)  or napoxen sodium (Naprosyn,  Aleve)) for at least 7 days before  surgery.   Vit. E, fish oil  and omega 3  fatty acid supplements  should  also be  stopped  for  at  least  3-4  weeks before  surgery  (since  they inhibit  clotting   protein   production   by  the  liver), as should all homeopathic  remedies, such  as St. John's Wort.   Alcohol  should  be eliminated  for 24  hours before surgery.  To limit the risks of infection  or  germ contamination that could lead to implant scar capsule formation,  you should not shave for 14  days  before  surgery  (to  prevent shaving nicks and ingrown  hair that  could  harbor  germs),  until the morning  of  surgery when  you  should shower thoroughly with soap,  and then shave your armpits in the shower, just  before coming to the surgery center.

 

What should I wear on the day of surgery?

Comfortable loose clothing that  is easy to put on and take off should be worn,  including a top that opens in the front.

 

How can  I decide what size  my breasts should be following Augmentation Mammaplasty?

Achievable breast  size  does  not  necessarily  equate with achievable breast  beauty.   Enlarged  breasts are beautiful only if the shape is beautiful as well.  After pre-op discussion, and review of photos (you are welcome to bring photos from magazines if you desire), I usually recommend that the breast be augmented  to the  largest  size that  is attainable without leading to distortion of the breast shape.  This is an important concept, because if  the  only goal  is  to achieve the largest conceivable  breast  size,  there  will be  a point  where  the overall shape, and thus beauty of the breast, is compromised.  At the time of surgery I  insert  a  temporary disposable breast implant  sizer  which is used to determine the  largest implant  size that  still maintains a beautiful breast shape.   I  then use the  permanent saline  implants  of the  same  volume, and make  final adjustments to the  pockets  to  maximize breast symmetry  and  shape.   It is best to have  the  augmented breasts  look  "too good to be true",  but  yet as  natural  as possible, thus avoiding the  appearance of the the obviously augmented breast.

 

What will my breasts look like after Breast Augmentation?

Although the final  shape of  your  breasts will  ultimately be based on the existing shape of your breasts  before surgery, shortly post-op you will have a significant amount of swelling and possibly some distortion .  Early on, implants placed via the trans-axillary route will  appear to be quite full at the upper pole of  the breasts, and  this  will gradually  resolve over the first few weeks, to several months.   See also shape evolution

 

What if I become pregnant after Breast Enlargement?

Many women have concerns about how a subsequent pregnancy will affect the results of breast  augmentation.  Although there is  no certain answer to this question,  there  is usually little change in the result, as most women,  augmented or not, see little change, or only mild breast tissue volume loss after pregnancy,  but most do not tend  to sag.   Those  women who were borderline for sag,  or who  had  many stretchmarks before  breast augmentation,  may  benefit  from  a  secondary breast lift  after  pregnancy,  but  they  are  also  probably the same group that  would have needed  a  combination breast augmentation and  breast lift,  had  they  waited until  after their pregnancies to  seek breast enlargement.   In my experience, about 20% of women will  need  a breast lift with augmentation, whether  or  not  they  have  had  pregnancies  before  seeking breast  enlargement.

 

Will Breast Augmentation Affect Breastfeeding?

Generally  there  is  no  change   in  ability  to  breastfeed  after Breast Augmentation, as the gland of the breast is not affected by the surgery.  An exception to this is the technique of implant insertion where an  areola incision  is  carried  directly  through the  breast  tissue  to   achieve  a   pocket   over   or  under  the muscle, as the surgery may disrupt some of the ducts,  limiting some of the gland available for future breastfeeding, but even this situation probably will not prevent breastfeeding.   Further, breast  implant  insertion   via  an  areola  incision  can  still  be done via a route that skirts the lower breast tissue,  preventing tissue damage.   With  trans-axillary  augmentation  technique, and submuscular placement,  the  breast gland  and ducts are completely undisturbed,  and  thus there is no interference with breastfeeding.   I usually  favor the  trans-axillary route,  mainly to avoid the need to damage  the  breast skin with a scar,  and  also  to  allow   submuscular   placement   without  ever  cutting through  the chestwall muscle  to  achieve  implant  placement.

 

How will I feel after surgery?

Submuscular placement of breast implants by any route is an uncomfortable procedure early post-op, because  of the trauma of lifting the  muscle.  I do not cut muscle attachments, but the stretching  of  the  muscles to  create a  large enough submuscular pocket causes local pain with movement of  the arms, especially early post-op.  There is also a tendency to feel some  "burning"  discomfort  along the  outer aspect  of each breast after surgery,  reflecting the stretching of some of the sensory nerves to the breast and skin.   This discomfort is transient  and  responds to post-op  anti-inflammatory  meds such  as ibuprofen  (Motrin,  Advil).  Narcotic  pain  relievers are  used  early post-op  to provide  comfort,  as  well.   Most women  also find  a  great  deal   of  relief by  the  use  of  the post-op implant displacement massage regimen that we use, and  thus most  report  a  surprisingly comfortable  recovery.  The  massage technique is  essentially  physical therapy for the muscles,  and effectively relieves the muscle spasms that cause the bulk of the discomfort.      See:   Post-op Massage

 

 

What do I have to do after surgery?

After  Breast  Augmentation, I close the axillary  incisions  with hidden (subcuticular)  stitches that are  stabilized  with special skin tapes.  You  will  leave the hospital with an ace bandage, wrapped  like a  tube  top,  and  a  small  gauze  pad  beneath each  arm.   The  morning  after  surgery  you  will  remove  the gauze  bandages,  and  the  ace  wrap,  leave  the  skin tapes alone, and we may instruct you to wear a bra, or to go braless for  some  period,   to   allow   the  implants  to  settle  properly. Shower at  24-48 hours, and  pat the skin  tapes  dry.   The first   follow-up is usually 1 -  3 days after surgery,  to  begin moving  the  implants  about  in  the  vertically oversized  submuscular pockets,  relieving   muscle   spasm,   limiting   capsule    scar  formation,  and  in  most  cases , helping  to  prevent   capsule  contracture.  I will  see  patients  back as  often as  needed  to assure  that  the   submuscular   pockets   remain   fully   open. Normal  activity can be resumed as soon as  comfort   allows,   with  the exception of  exercise,  which is restricted for 14 days post-op.    The   sutures   are   removed  at   about   6 - 8  days,  and  slip  out  without  effort  or  discomfort.

 

 

What are some of the risks of Breast Augmentation Surgery?

As  with any surgery,  there are a number of  risks associated with Augmentation  Mammaplasty.    Among  these  risks are included:  bleeding, infection, scarring, asymmetries, injury to local nerves and  blood  vessels  (including the nerves to the nipples), blood or serum accumulation, wound healing delay, and the potential for dissatisfaction.  Risks inherent to the use of  implants  include:   Implant  failure  with  leakage  of saline or silicon, potential  interference with mammography,  potential firm scar formation around the implants  (capsule contracture), implant displacement,  and  alleged  risks of  illness,  which remain scientifically  unsubstantiated  in  association  with  implants.  At  the time  of  consultation,  we spend a great deal  of  time discussing  the various risks, as well as ways to limit them in each individual patient.  Additional  risks  for silicone implants can be reviewed by viewing the Silicone Information Page .

 

 

Related  Breast Augmentation Links:   To Other photo Illustrated Procedures:

Important  Information  About  Implant  Breast  Enlargement

Trans-Axillary Breast Augmentation
Trans-Axillary Breast Incisions Scars
Breast Augmentation Shape Evolution
Breast Augmentation Shape Determination
Cleavage Determinants
Post-Op Implant Massage Technique
Implants Over versus Under the Muscle
Special Considerations in Augmentation
Breast Surgery in African American Women
Breast Augmentation FAQs
Breast Augmentation with Mastopexy or Breast Lift
Revision Surgery for Augmentation Problems
Important Information about Silicone Breast Implant Use
Nipple Reduction/Shaping
Mastopexy or Breast Lift

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Thomas M. DeWire, Sr., MD, FACS
Advanced Art of Cosmetic Surgery
3974 Springfield Road
Glen Allen, VA 23060
Richmond, Virginia, USA
804-290-0200
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©Copyright 1997-2013  Advanced Art of Cosmetic Surgery:  Thomas M. DeWire, Sr, MD, FACS   Revised:   January 23, 2013 12:29 AM