Thank you for the inquiry, I have included a
good deal of information below:
On November 17, 2006, the US FDA finally announced that release of silicone implants, without major restriction, is forthcoming. Information that must be reviewed and considered by patients who are interested in silicone implant breast augmentation is found on my website, starting with the page: Important Information concerning the Release of Silicone Implants . I am a principal investigator in the Mentor Core Gel Silicone Study, which served as the basis for the FDA's release of silicone implants, and the study will conclude in about 2010-2011, after 10 years of follow-up, continuing to assess silicone implant safety and efficacy. The core findings of that study are found in the Mentor silicone gel informed consent brochure linked from that page.
A brief word about correspondence: Please state your full name in all correspondence, as I will file it by name, and retain it for a period of 60-90 days, but will then delete it if there is no further activity. Please keep your own file of such correspondence, as you can forward it to me if you resume correspondence after your files have been deleted from my computer. Post-op patient correspondence files are kept indefinitely.
Find below an augmentation data sheet, a questionnaire, and pre-op recommendations. Let me know if you have further questions. If you plan to coordinate a consultation with a surgery date, then sending photos will also be important. See below:
Certified: American Board of Plastic Surgery
AACS offers a fully certified Ambulatory Surgery Center accredited by: AAAASF (American Association for Accreditation of Ambulatory Surgery Facilities, Inc) with anesthesia services provided only by Doctors of Anesthesiology.
We no longer mail brochures, etc., since they are available online. However, the brochure information is generic, and the information on my pages seems to be far more specific, comprehensive, and pertinent to my particular techniques. Of course, individual specifics must be identified and addressed at consultation.
The ASPS brochure link for breast augmentation is: www.plasticsurgery.org/surgery/brstaugm.htm
BEFORE and AFTER PHOTOS:
Many examples of results of my breast surgeries are found on the pages of my WebSite, including most other common cosmetic surgery procedures, and even more are found on the pages of:
ImplantInfo.com at: http://www.implantinfo.com/beforeandafter/dewirepix.htm (cases 60-70,199,200). Also check visitors photosets 9, 81, and 101 at: http://www.implantinfo.com/photocenter/visitors/index.html
ImplantForum.com at: http://www.implantforum.com/dewire/photos.html (14 full photo sets)
PATIENT PERSONAL WEBSITES with PHOTO SETS
Slo2Jo's Site: From Los Angeles: repair of symmastia and severe bottoming-out using Silicone Gel implants (Mentor Adjunct Silicone Study). Access requires a MSN Communities password which you can get via a link from the entry page. This is worthwhile, as it is a good site.
Many patients have posted unsolicited comments about their experience at: Nicole's Site and Nikki's Site
Mia from Maryland with commentary interaction by Dr. DeWire, and OR and progress photos: http://www.implantinfo.com/personal_experiences/visitors/Mia-159-story.aspx
Mandy from Ohio: http://www.implantinfo.com/personal_experiences/visitors/11ma.htm
Kate from Northern Virginia: http://www.implantinfo.com/personal_experiences/visitors/18kate.htm
Teresa from Texas: http://www.implantinfo.com/personal_experiences/visitors/74.htm
LINKS to Dr. DeWire's photos on these and other sites:
Those traveling for surgery should have a family member, or companion, accompany them to allow for simple post-op care, transportation, etc. If you are unaccompanied, you may hire a nurses aide from a local agency to do these things for you in the first 4-8 hours after surgery (Cost: $14 per hour).
Information for out of town patients can be found on this page: http://www.advanced-art.com/Guests.htm
Some maps showing where our patients have traveled from are found here: www.advanced-art.com/Map-Demographics.htm
I show patients examples of Mentor saline and silicone implants since silicone has been released for limited general use.. Silicone implants can be placed via the axilla with special equipment (Keller funnel), though longer incisions are needed to place pre-filled silicone implants. Silicone implants carry a significantly higher cost than saline implants.
ANATOMICAL AND TEXTURED IMPLANTS:
All Mentor saline and silicone implants available in the US currently have a limited lifetime replacement warranty for the devices themselves, and a $1200 cash benefit to defray Operating room and anesthesia costs for replacement of failed implants during the first 10 years. The warranty is in effect only in the instance of an implant deflation, and Mentor will provide up to two implants, without charge, for each instance of failure for life, also allowing for change of size, or type, if requested. Mentor also offers a warranty enhancement if purchased ($100) in the first 45 days post-op. This warranty is offered direct from the manufacturer to the patient, and the patient must make the contact. An informative brochure concerning the warranty will be given to you with the post-op instructions. The enhanced warranty has a term of 10 years, and will increase the reimbursement to as much as $2400 to defray expenses. I receive no financial consideration for the extended warranty purchase, but it is a reasonable idea. Further information on the Mentor warranty is found here: http://www.mentorcorp.com/breastsurgery/augmentation/cs_ba_warranty.htm .
SHAPE AFTER AUGMENTATION:
Since the result of augmentation is usually a larger version of the existing breast shape, you will probably keep the same shape you have, as long as the implants are not so large that they change the basic breast proportion dimensions (base width to projection proportion) or so large as to introduce distortion.
CHOOSING IMPLANT SIZE:
Don't get too set on an exact implant size. Choosing the size that you think you need before surgery is the easiest way to be disappointed. The exact same size implants will look different if placed in each of 10 women (or 100 for that matter). This is because each woman's individual chest shape/breast shape/breast base dimension/ breast volume/tissue stretch characteristics/sternal depth/pregnancy history/height/weight/etc, are distinctly different. I always suggest a size range, then use a disposable saline implant sizer at the time of surgery to determine the largest implant size that will fit without distorting the breast shape. This always assures the best size for each patient, and sometimes even I am surprised at what looks best. I have specific pages addressing this at:
Hopefully this will help with understanding choice of size.
OVERFILL of SALINE IMPLANTS:
Implants are designed and fabricated to contain a "nominal" fill volume. This is the minimal volume to which the implant should be filled to prevent physical/mechanical complications (internal chafing, etc) that could lead to premature failure and deflation. The implants are also designed to accept a certain maximum volume (max. fill volume). Using the nominal (minimum) fill volume, implants (mainly textured surface implants) tend to ripple to some extent, and this is especially detectable in implants placed above the muscle. By overfilling implants, but not beyond the maximum design fill volume, the implants show progressively less tendency to display rippling or surface wrinkling, but in turn they become progressively more firm to the touch, again especially textured surface implants, which by a function of their design need to be thicker than the smooth surfaced implants. Thus, overfill will lead to less potential for visible or palpable wrinkling of the implant, but a greater degree of firmness of the implant itself. This firmness has nothing to do with firmness related to capsular contracture, which is an entirely different issue. Rippling remains more of an issue for textured implants than for smooth.
IMPLANT INSERTION INCISION:
BREAST LIFT WITH AUGMENTATION:
Subglandular placement of implants in lieu of performing a needed lift usually only compounds the problem later by causing much more tension on the already hyperstretched skin, and merely leads to the need for a more extensive lift procedure in the future for most patients. Additionally, implants over the muscle will permanently interfere with cancer-screening mammography, and have a much higher rate of visible rippling, implant palpability, bottoming-out and capsule contracture. For these reasons, I cannot recommend or endorse subglandular implant placement.
MASTOPEXY WITHOUT IMPLANTS
Similar to augmentation mastopexy, a mastopexy alone will improve the breast shape proportion, reducing the vertical dimension, and returning the nipple to the appropriate level, however, upper pole breast fullness is not restored by this approach usually, and for that reason, implants (small or large) are often needed to provide the desired effect of breast fullness. This will differ for each patient. Mastopexy is discussed on the page: http://www.advanced-art.com/Breast-Lift.htm Mastopexy charge is usually $5500 and the OR and anesthesia are generally in the range of $1800 and $950-$1050 respectively.
BREASTFEEDING AFTER AUGMENTATION
REVISION OF EXISTING AUGMENTATION PROCEDURES:
I have utilized both smooth saline and smooth silicone implants in the majority of these cases to provide improvement in both shape, and feel of the resultant breast augmentation revision results.
Further current information concerning silicone
implant safety can be found at: http://www.breastimplantsafety.org
Fees for Augmentation with mastopexy are higher than augmentation alone, as the surgery takes significantly longer to perform. Surgery fee for augmentation with Benelli mastopexy is $5000-5500, OR fee is $2900-$3100, and anesthesiology fee is $850-$950. Other more complex mastopexy procedures have higher fees, depending on the length and complexity of the procedure. Please call the office for details in this regard (804-290-0200).
Surgery fees for patients coming here for redo augmentations, and revisions for complications, are priced according to level of difficulty, and expected length of surgery, and often range from $4500-$8500+ (not including anesthesia/OR fees). Silicone implants are available to augmentation patients, but do entail a substantially higher fee, due to the higher cost of silicone implants. Hospital fees, if applicable, are subject to change, since they are outside of my control, but almost all procedures are done in my AAAASF-certified ambulatory surgery center. Consultation fees are higher ($125) for patients who are seen for evaluation of previous surgery by other doctors, since the history, exam and data-gathering are generally more complex. Old records and photos are also requested in the instance of consultation for revision procedures.
TO FIND OUT MORE ABOUT AUGMENTATION AT ADVANCED ART OF COSMETIC SURGERY:
Check out the discussion boards at www.implantinfo.com , www.implantforum.com , and www.justbreastimplants.com, You will find some useful data there, but you must be discerning, and weigh some of the advice there with "a grain of salt". Many of my active and future patients also post there from time to time. I also have a large series of patient before and after photos displayed in the photo galleries on Implantinfo.com and Implantforum.com .
Implantinfo photos: http://www.implantinfo.com/beforeandafter/dewirepix.htm cases 60-70,199,200. Also check visitors photosets 9, 81, and 101 at: http://www.implantinfo.com/photocenter/visitors/index.html. I also have photosets posted at ImplantForum: http://www.implantforum.com/dewire/photos.html.
About Sending Photos: For examples see this page: Photo Submission Examples
]] SURGERY DATE:
]] FULL ADDRESS:
City: State: Zip:
]] Phone Number(s) with Area code:
Home: ( )
Work: ( )
Cell: ( )
Pager: ( )
]] Preferred Stable E-mail Address:
]] Date of Birth:
]] Current Bra cup and band size: _____ (for breast surgery patients only)
]] Do you sag with nipple at or below the level of the folds beneath your breasts?:
]] What size do you want to achieve?:
}}Are you interested in saline implants, or silicone
]] Do you have any medical conditions such as: Diabetes, high blood pressure,
or heart disease?
Are you presently under the ongoing care of a physician? Please elaborate:
Do you have a history of previous surgery? Procedures:
]] List any medications you take regularly and dosages and their reason (include aspirin,
vitamins, Birth control, homeopathics):
]] Are you allergic to any medicines?
]] How many pregnancies if any?
FOR BREAST SURGERY PATIENTS: (be sure to send photos from all angles)
]] Have you had any breast surgery in the past? What? Result
]] If you are planning to come for revision of an existing augmentation, when was it done?
Incision Site: Implants over or under the muscle:
What implant type (silicone or saline): High or Moderate Profile: Smooth or Textured:
Anatomical or Round: Implant Manufacturer:
Implant size: Fill volume (for saline):
Can you obtain your old operative report(s):
Why do you want/need revision?:
]] Have you ever had a mammogram? Results:
If over 40 and you should have a mammogram within a year before surgery.
]] Is there a family history of breast cancer or breast disease?
FOR LIPOSUCTION AND TUMMY TUCK PATIENTS: (Be sure to send photos of all areas of concern from front, back and sides)
]]Which areas of concern do you think will benefit from liposuction?:
]]Have you had liposuction before?
}}Have you had any abdominal or leg surgery in the past?: What?:
FOR EYELID SURGERY PATIENTS:
]] An eye exam report, including a test for glaucoma and examination of the retina will be needed before surgery. You will need to forward a copy of this report (within the last year) before proceeding.
]]]]Please send these answers back to me, and I will save them for your file.
To cut data, use the cursor to highlight it with the left mouse key depressed, and click Ctrl-C. To paste it, place the cursor on the new document and click Ctrl-V. Answers can now be added to the pasted document.
PRE-OP REQUIREMENTS and RECOMMENDATIONS:
]] Some patients may require lab work or an EKG before surgery, this will need to be coordinated for patients from out of town, especially if they are having surgery in the Office Surgical Suite. Hospital patients will have these tests at the hospital, as warranted.
]] To limit risk of bruising and bleeding: No aspirin, ibuprofen (Advil;Motrin;Nuprin) or other arthritis pill, or any combination medicine (such as cold or flu pill) that contains them for 7 days pre-op.
Vitamin E and Vitamin C should be stopped for 3-4 weeks pre-op due to potential for increased bleeding and impairment of clotting.
]] Stop any homeopathic medicine (herbal teas; Ginseng, St.John's Wort) for at least 4 weeks pre-op, because they are unregulated regarding side effects, and many may impair clotting, or interfere with serum chemistry pre-op.
]] Do not drink alcohol for 24 hrs. pre-op
]] Do not shave axilla for 10 days (Breast augmentation patients only), or groin hair (lipo patients), until the AM of surgery to limit risk of ingrown hair.
]] Arrive for surgery with an empty stomach and nothing by mouth for 8hrs pre-op (except cardiac meds with a sip of water)
]] Wear a loose garment that buttons in front to the hospital or office the day of surgery (e.g. a sweat suit)
]] Do not wear jewelry to the hospital or office for surgery
]] If you are from out of town bring light snacks, saltines, baggies for ice chips, lifesavers or hard candy, mild soda (e.g. ginger ale) or juice to keep in your hotel room, along with books, or magazines.
]] Be sure that you are not pregnant (if applicable) pre-op. Honest- this happens!
]]For patients who take Birth Control Pills, you will be given an Rx for antibiotics to take after surgery, and be mindful that antibiotics may compromise the effectiveness of the contraceptives in your current cycle. Be sure to take appropriate precautions in this regard.
]] For BA patients, bring or send me photos of the "look" that pleases you, but remember, that the final result will be greatly related to the existing dimensions and shape of your chest and breasts, as well as height, weight, etc. This helps me to communicate what you consider to be a various cup size.
}} For Abdominal Liposuction or Tummy Tuck patients, extra care should be taken to clean the belly button with soap and water and a q-tip with each shower for a week before surgery.
]] Patients who smoke, should obviously quit smoking for several weeks ahead of time to prevent impairment of wound healing, and heightened discomfort associated with Nicotine, Carbon monoxide poison gas in smoke.
revised: January 22, 2013 11:46:00 PM