• 
  American Society
  of Plastic Surgery
• 
  American Society of
  Aesthetic Plastic Surgery
• 
  American Association for Accreditation
  of Ambulatory Surgery Facility

SELECT A PROCEDURE: Breast Augmentation | Breast Reduction | Breast Lift

Procedure: Breast Augmentation

Breast augmentation is a procedure to enlarge or enhance the shape of the breasts. Women who desire larger or shapelier 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 (about 1 inch) is made either under the breast, around a portion of the areola or in the axilla (armpit). A saline filled or gel-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. Since the FDA approval of silicone implants there has been an increase demand for these implants. The incisions and placement of the breast implant will be discussed fully with you. Typically if you decide on a silicone implant, the incision will be under the breast in the breast fold. The size of the desired implants will be decided with you to achieve the most appropriate result and contour.

Surgery

Depending on the individual patient additional procedures may be combined with a breast augmentation. Since your breasts will be examined at the time of your consultation we can discuss these options. The most commonly performed additional procedures are a mastopexy, nipple reduction and liposuction. If previous breast surgery has been performed and implants are to be exchanged then capsulotomies (release of scar tissue) may be necessary.

Before Surgery It is imperative that aspirin and ibuprofen or products containing aspirin not be taken at least 3 weeks prior to surgery. Also refrain from consuming any energy drinks and 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 bathe well on the day of surgery prior to coming to the surgery center. It is okay to brush your teeth the morning of surgery.

Start taking Vitamin E, 2000 IU, daily for one week prior to surgery. A "sleep bra" will be provided for you.

Anesthesia The procedure is generally performed under general anesthesia as an outpatient. Any concerns with anesthesia should be discussed fully with the anesthesiologist, including postoperative nausea. 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 or if there has been previous breast surgery or if liposuction or nipple reduction is performed. There will be additional costs for additional procedures.

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.

After Surgery

A soft "sleep bra" will be provided and you will be wrapped with an Ace bandage. 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 change your bra for a more pleasing one but should still be a “sleep bra”. "Sports bras" or bras with underwire should not be used. 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 3rd 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. A pain medication delivery system (pain catheter) is available for an additional charge that will provide continued anesthesia to the surgical area for 3 days or more. 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.

Scars You should expect a scar between 1 to 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.

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, but especially with saline implants, rippling of the implant under the skin may be visible or palpable. Occasionally the edge of the implant can be felt. The usual area for feeling the implant is along the side of the breast and just underneath the breast. These problems are usually mild and require no additional treatment. This is potentially less of a problem if the implant is placed under the muscle. In women who are very thin or who have very little breast tissue then feeling the saline implant is more of a reality.

ASYMMETRY Most women have breasts of slightly different size and or shape. If these differences exist prior to surgery they most likely will 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 and LEAKAGE 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. If you have silicone implants then ascertaining whether the implants are leaking would be more difficult. The manufacture’s recommendation is to obtain a MRI to visualize if the implant is suspected to be leaking.

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, during or after pregnancies, after breast feeding 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.

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Procedure: Breast Reduction

Breast reduction surgery is performed to reduce the overall size of the breasts and to elevate the nipple position. Some women will experience both shoulder and back pain by carrying an excessive amount of breast tissue. This can possibly hinder the ability to be active and hence result in a general increase in weight. A hygiene problem can also occur with maceration (irritation) of the underside of the large breasts rubbing on the chest and abdomen. It is also not unusual to have decrease sensibility (feeling) to the nipples because of stretching of the nerves going to the nipples.

A reduction mammoplasty is usually allowed by your insurance company but in the recent past it has become increasingly difficult to have this covered. Your insurance company may place arbitrary amounts of breast tissue that needs to be removed for them to allow coverage. This may restrict how a surgeon could provide you with the best result when the goal is the amount removed rather than the final appearance. If your insurance company denies coverage than you will be financially responsible for the surgery. Having a reduction mammoplasty may also interfere with future breast feeding. In patients who have undergone gastric bypass or a weight reduction procedure, then it is not uncommon to not only have large breasts but now they have become very droopy.

Surgery

In a reduction mammoplasty both skin and breast tissue is removed. The nipple is reduced and elevated to a more aesthetically acceptable position. The usual scars are located around the areola, vertically down to the inframammary fold where the breast meets the chest and horizontally along this fold. The nipple and areola is left attached to the underlying breast tissue so that the blood and nerve supply is maintained. Drains may also be used to assist in decreasing the postoperative accumulation of body fluids. If the breasts are excessively large, than the nipple and areola may have to be removed as a skin graft. This possibility will be discussed with you on your preoperative visit. On occasions liposuction may also be added to help decrease the amount of adipose (fat) tissue along the sides of the breasts.

Anesthesia The procedure is performed under general anesthesia, usually 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 2 to 4 hours.

Before Surgery It is imperative that aspirin and ibuprofen or products containing aspirin not be taken at least 3 weeks prior to surgery. Also refrain from consuming any energy drinks and 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 bathe well on the day of surgery prior to coming to the surgery center. It is okay to brush your teeth the morning of surgery.

Start taking Vitamin E, 2000 IU, daily for one week prior to surgery. A "sleep bra" will be provided for you.

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.

After Surgery

Patients return home after the operation wearing a support bra. The bra helps to support the breasts to lessen discomfort. An Ace bandage may also be used to wrap the breasts postoperatively for further support. Your first postoperative visit will be at 3-4 days when the dressings are changed and the drains removed. The skin staples, if used, are also removed at this time and Steri Strips applied to the incision. The bra should be worn at all times for 2 weeks. After this time you may start using a soft "sleep" bra without underwire. A "sports bra" should not be used. You should not go braless for 4 to 6 weeks after surgery. If the bra is too tight it may cause ulceration of the skin. Remove the bra immediately if the bra feels too tight or if it hurts.

You may shower 3-5 days after surgery. If you bathe do not allow the incisions to soak under water. You may remove the bra to shower or bathe. Initial discomfort is controlled with oral medication.

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. This usually takes 2-3 weeks.

Scars You should expect a scar around your areola, which usually is difficult to see once it has faded. Another scar extends from the 6 o'clock position of the areola to the point where the breast meets the chest. Another scar runs along the fold under the breast. 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. Massaging the scars with Vitamin E oil after 2-3 weeks will also assist with the appearance of the scars. Silicone tape will also help in reducing the redness of the scars. Wear a sunscreen of at least SPF 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, as they would normally during pregnancy. Depending on the type of procedure that is right for you, it may not be possible to breast feed after breast reduction surgery. This may be directly due to the surgery or to changes in sensibility of the nipple after surgery. 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 normal feeling. Although not common, the nerves to the nipple may be stretched or cut during the procedure resulting in a decrease or loss of sensibility of the nipple. The sensibility in these areas gradually returns, usually with 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 of the skin and/or the nipple 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 may look larger due to the swelling. The breast skin may also 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.

Complications

HEMATOMA A collection of blood in the area of surgery occurs in a small percentage 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 may require additional surgery to treat.

ASYMMETRY Most women have breasts of slightly different size and or shape. If these differences exist prior to surgery they may remain different after surgery. Rarely, in spite of careful attention to detail, the breasts 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.

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 or possibly from smoking. This is another rare occurrence. The areas of loss are usually small and heal with conservative care.

MAMMOGRAPHY If you are at the age when mammography is indicated, a mammogram will be performed prior to breast reduction and approximately six months after to establish a new baseline against which future mammograms can be compared.

 

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.

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Procedure: Mastopexy (Breast Lift)

A mastopexy or breast lift procedure is performed to reduce or eliminate breast sagging or ptosis. Breasts will have a tendency to sag after pregnancy and breast feeding. The original volume of breast tissue will diminish after breast feeding but the skin of the breast does not. There may also be changes in both the areola and nipple. In patients who have undergone a gastric bypass or a weight reduction procedure then the breasts become very droopy with an increase amount of skin. There will also be a significant loss of breast volume.

Surgery

It is not unusual to surgically reduce the overall size of the areola and/or nipple along with the breast lift. This is accomplished by removing excess skin and leaving as much breast tissue as possible. The nipple is elevated to a more aesthetically pleasing position. In many cases, a breast lift alone is not enough to achieve the proper breast contour and size and so a breast augmentation with an implant will be necessary.

Scars are present around the areola, vertically down to the fold where the breast meets the chest and horizontally along this fold (an “anchor-type” incision or inverted “T”). At times for very minor amount of ptosis (sag) a “donut” type mastopexy can be performed. This is an excision of skin around the areola with a circular tightening. The scar will be a circular one along the border of the areola. This possibility will be discussed with you when you meet with your surgeon.

Anesthesia The procedure is performed under general anesthesia, usually 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 2 ½ hours. The procedure could take longer when a breast augmentation is also performed or if there has been previous breast surgery or if liposuction or nipple reduction is performed. There will be additional costs for additional procedures.

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.

Before Surgery It is imperative that aspirin and ibuprofen or products containing aspirin not be taken at least 3 weeks prior to surgery. Also refrain from consuming any energy drinks and 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 bathe well on the day of surgery prior to coming to the surgery center. It is okay to brush your teeth the morning of surgery.

After Surgery

Patients return home after the operation wearing a bra and an Ace bandage. The bra helps to support the breasts, to lessen discomfort and to help maintain the implants (if an augmentation is performed) in an anatomical position. The bra should be worn at all times for the first 2 weeks. After this time you may change your bra for a more pleasing one but should still be a “sleep bra”. "Sports bras" or bras with underwire should not be used. 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 3rd 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. A pain medication delivery system (pain catheter) is available for an additional charge that will provide continued anesthesia to the surgical area for 3 days or more. 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 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.

Scars You should expect a scar around your areola, which usually is difficult to see once it had faded. Another scar extends from the 6 o'clock position of the areola to the point where the breast meets the chest. Another scar runs along the fold under the breast. Both of these scars also fade over. This usually takes 9 to 12 months. All scars are however permanent. The width, height and color of scars are unpredictable. 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 and/or mastopexy 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.

Complications

HEMATOMA A collection of blood in the surgical site occurs in a small percentage of patients. If a breast augmentation is performed then blood in the breast 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 or RIPPLING Occurs when breast implants are inserted. With the use of any implants, but especially with saline implants, rippling of the implant under the skin may be visible or palpable. Occasionally the edge of the implant can be felt. The usual area for feeling the implant is along the side of the breast and just underneath the breast. These problems are usually mild and require no additional treatment. This is potentially less of a problem if the implant is placed under the muscle. In women who are very thin or who have very little breast tissue then feeling the saline implant is more of a reality.

ASYMMETRY Most women have breasts of slightly different size and or shape. If these differences exist prior to surgery they may remain different after surgery. Rarely, in spite of careful attention to detail, the breasts 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.

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 surgery with breast cancer. Breast surgery may result in scar tissue that at times might appear to be a mass on mammogram. If an implant is used the 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.

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.

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The best way to get more information on the procedure you are interested in is to schedule a consultaion. Click here to schedule a consultation, or fill out the form.

You may also call our SLC, UT office at
Telephone: (801) 743-0700
Fax: (801) 743-0701
for more information.

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