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Breast augmentation is a procedure to enlarge or enhance the shape of the breasts. Women who desire larger or more shapely breasts are candidates for this procedure. It is not uncommon to have postpartum atrophy (decrease in size of breasts after pregnancies) along with breast ptosis (droopy breasts). A breast augmentation may improve on minimal ptosis (drooping) of the breast and help correct minor asymmetries. On occasions, a mastopexy (elevation of the breasts) may be necessary if the amount of ptosis is more than minimal to provide the appropriate appearance to the breasts. A small incision is made either under the breast, around a portion of the areola or in the axilla (armpit). A saline filled implant is inserted, usually under the muscles of the chest wall, but may also be placed above the muscle and just under the breast tissue. It has been my experience that the softness of the breasts after surgery is better maintained when placing the implant under the muscle. The incisions and placement of the breast implant will be discussed fully with you. The outer shell of the implant is made of silicone but there is no silicone gel present in saline implants.
Surgery It is imperative that aspirin or products containing aspirin not be taken at least 3 weeks prior to surgery. Also refrain from any herbal supplements, as some may have an effect on increasing bleeding during the course of surgery. Remove all makeup and mascara from your eyelids. If you wear contacts lenses, it would be preferable that you wear glasses when you arrive to the surgery center. You should shower well on the day of surgery prior to coming to the surgery center. Start taking Vitamin E, 2000 IU, daily for one week prior to surgery. A "sleep bra" will need to be purchased and brought to the surgery center. Anesthesia The procedure is performed under general anesthesia or under heavy sedation and local anesthesia as an outpatient. The anesthesiologist and the surgical facility will bill separately for their services. Duration of Surgery The operating time will vary depending on the patient and the extent of the procedure. Generally the time is 1 to 2 hours. The procedure could take longer when a mastopexy is also performed.
After Surgery Patients return home after the operation wearing a bra and wrapped with an Ace bandage. A light "sleep bra", without underwire, will need to be purchased prior to surgery and brought to the surgery center. "Sports bras" should not be used. The bra helps to support the breasts to lessen discomfort and to help maintain the implants in an anatomical position. The bra should be worn at all times for the first 2 weeks. After this time you may sleep without the bra. You should not go bra-less for 4 to 6 weeks after surgery. If the bra is too tight it may cause ulceration of the skin and should be loosened or removed and another bra used. Do not lift anything heavier than 5 pounds for the first week. You may lift your arms above your head. Ice packs may be used over your chest to assist in decreasing some of the swelling. You may shower the second day after surgery. If you bathe, do not allow the incisions to soak under water. You may remove the bra to shower or bathe. Any dressings may be removed to bathe except for the Steri-strips. Initial discomfort is controlled with oral medication. Stitches are usually removed in 7 to 10 days. Breast massages will be instituted once the discomfort subsides (usually within 3-7 days). Your physician will review the type of massages when you return for your follow-up appointment. You will need to take Vitamin E, 1000 IU/day, after surgery. Return to Normal Activity Most people return to their usual activities and to work approximately 1 to 2 weeks after surgery. Strenuous sports and other activities should not be performed for 3 to 4 weeks. You may drive when driving does not cause pain, or when you are no longer taking pain medication. Photographs Photographs are taken at the time of your consultation. These are important aids in the preparation of surgery and become a permanent part of your record. Post-surgical photographs are also taken. Scars You should expect a scar between 1 and 2 inches long. The length will depend on the location of the incision, either under the breast, around a portion of the areola or in the axilla. The scars will fade with time. This usually takes 9 to 12 months. All scars are however permanent. The width, height and color of scars are unpredictable. You can improve on the appearance of the scar by massaging the scar with Vitamin E. Wear a sunscreen of at least SPF of 30 or greater when outside to protect the scars from sunlight during the healing process. Pregnancy During pregnancy and after childbirth your breasts will get larger. It is safe to breast-feed. Many women with breast implants have nursed successfully. However, any surgery on the breast can theoretically interfere with the ability to breast-feed. Diminished Sensibility As with any surgical procedure, small sensory nerves to the skin surface may be cut when the incision is made or when skin is undermined. Portions of your breast will feel numb or have less than full feeling. In addition, the nerves to the nipple may be stretched during the procedure resulting in a decrease or loss of sensibility of the nipple. The sensibility (feeling) in these areas gradually returns, usually within 2 to 3 months as the nerve endings spontaneously heal. During the healing process the breast skin and/or nipples may become hypersensitive for a period of time. Some diminished sensibility may last indefinitely. Swelling Swelling of the breasts or any site following surgery is normal. During the first 1 to 2 weeks your breasts will feel and look larger due to the implants and the swelling. The breast skin may appear shiny due to the swelling. The swelling will start to subside after the second postoperative week. It may take as long as 2 months for the last bit of swelling to recede. You may expect about 50% of the final improvement at 2 weeks and about 75% at 1 month. Some patients continue to see improvement out to 6 months, but changes after 3 months are subtle.
Complications HEMATOMA A collection of blood in the pocket containing the breast implant occurs in 2 - 3% of women. The body will absorb minimal bleeding. A larger collection may necessitate aspiration to drain the collection. Occasionally, it will require additional surgery. INFECTION This is uncommon but possible. We attempt to minimize this risk by giving intravenous antibiotics during the procedure and oral antibiotics after surgery. Most infections are mild and are treated with antibiotics. Occasionally a serious infection develops which necessitates removal of the implant. It can usually be replaced in 3 to 6 months. WRINKLING With the use of any implants, wrinkling of the implant under the skin may be visible on the skin surface. Occasionally the edge of the implant can be felt. These problems are usually mild and require no additional treatment. Wrinkles may improve with time. This is potentially less of a problem if the implant is placed under the muscle. ASYMMETRY Most women have breasts of slightly different size and or shape. If these differences exist prior to surgery they may remain after surgery. Rarely, in spite of careful attention to detail, the dissected pockets may end up slightly different in size or shape. If this is not noted while you are in surgery, and poses a problem after healing, you may need a small procedure in the future to adjust the difference. DEFLATION If for any reason the valve or implant covering fails, the saline will leak out and be absorbed by your body. This causes no medical harm as saline is the fluid given intravenously, but will require replacement of the implant in a secondary procedure. The probability of saline implant leakage is reported to be approximately 1% per year. There is a manufacturer's warranty that comes with your implants and you will be provided with information regarding this. LOSS OF SKIN, BREAST TISSUE OR NIPPLE This is extremely rare. When it does occur, it is usually the result of an infection that has grown out of control. This is another rare occurrence. The areas of loss are usually small and heal with conservative care. BREAST CANCER There is no evidence linking breast implants with breast cancer. The only clinical studies show that the prevalence of breast cancer in women with implants is the same or lower than in women without implants. In addition, studies have shown that the stage of breast cancer detected in women with implants is the same as in the general population. INTERFERENCE WITH MAMMOGRAPHY You should inform the mammography technician that you have implants. Special views are used to image as much of the breast tissue as possible. Placing the breast implant behind the muscle places it farther from the breast tissue and may make imaging the breast tissue more complete. Even under the most ideal conditions a thin rim of breast tissue may not be satisfactorily seen, and it may be possible that a suspicious lesion is missed. CAPSULAR CONTRACTURE This is the most common complication of breast implants. A fibrous membrane, called a capsule, forms around the implant after it is placed in the pocket that is created at surgery. Under ideal circumstances the pocket will maintain its original dimensions and the implant will rest inside and remain soft and natural. For reasons that relate primarily to the healing characteristics of the individual patient, the scar capsule may shrink in some women and compress the implant resulting in various degrees of firmness. The contraction can occur shortly after surgery or many years later. It may appear in one breast or both. The current theories suggest that a low-grade infection may trigger the process. Placing the implants in a sub-muscular pocket, rather than above the muscle, appears to decrease the incidence of tight capsules. Capsular contracture is not a health risk to the patient. It can however detract from the quality of the final result and may cause discomfort, pain or distortion of the breast contour. Cases of firm or painful contracture may require surgical correction to remove the thickened capsule and change the implant. Rarely, if the contracture persists and cannot be eliminated, the implants may need to be permanently removed.
I mention these complications not to alarm or frighten you since the usual outcome after this surgery is quite favorable. The majority of patients are very satisfied. I present this information to you to fully educate you on the side effects, undesirable sequelae and complications no matter how remote they may be.
Dr. Morales Recommends Theraderm Skin Products for his patients before and after surgery.
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