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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.
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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
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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.
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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.
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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.
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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.
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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
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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.
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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.
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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
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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.
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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 .
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