Because placement of breast implants in the submuscular position requires complete muscle relaxation, particularly via the trans-axillary (through the arm pit) route, outpatient general anesthesia is used. We have state of art offices with fully-equipped ambulatory surgery centers, employing American Board of Anesthesiology (ABA) certified anesthesiologists to perform services. Virtually all of our surgical procedures are now being done in these state-of-the-art surgery facilities in Los Angeles, Riverside, San Bernardino and Orange Counties.
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 plastic 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.
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, Alleve)) for at least 7 days before surgery. Vit. E should be stopped for at least 3-4 weeks before surgery (since it inhibits 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, you should not shave for 10-14 days before surgery (to prevent shaving nicks and ingrown hairs that could harbor germs). On the morning of the breast augmentation surgery, shower thoroughly with soap, and then shave your armpits in the shower, just before coming to the hospital
Comfortable loose clothing that is easy to put on and take off should be worn, including a top that opens in the front.
Breast size does not necessarily equate breast beauty. Enlarged breasts are beautiful only if the shape is good. After pre-op discussion, and review of photos (you are welcome to bring photos from magazines if you desire), our doctors 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 compromises the breast's appearance. At the time of surgery, our doctors insert a temporary disposable breast implant sizer, which is used to determine the largest implant size that still maintains a beautiful breast shape. The doctors 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.
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, breast 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.
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. There may be 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. In our experience, about 20% of women will need a breast lift with augmentation, whether or not they have had pregnancies before seeking breast enlargement.
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. However, 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
Submuscular placement of breast implants by any route is an uncomfortable procedure in the early post-op, because of the trauma caused by lifting the muscle. Our doctors 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. 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.
After breast augmentation, our doctors 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. On the morning after the 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 spasms, limiting capsule scar formation, and in most cases helping to prevent capsule contracture. Our doctors will see patients back as often as needed to ensure 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.
This is highly unpredictable, as is breastfeeding if you WERE NOT to have breast surgery; just as one cannot predict IF the person would be able to breastfeed, so too, can we not predict IF they would be aable to WITH breast surgery. The technique of "Below the muscle", that we use 95% of the time, is the least anatomically damaging to the blood supply of the breast tissue itself, protecting the fascial, and perforator vessels from the muscle, thus enabling normal functioning of the breast tissue. Some pressure-effect theories, as well as SHAPE change of the nipple-areola complex with breast surgery, are noted to affect breastfeeding.
As per your surgeons' directives, otherwise support with WIRE bra's only after a period of 3 months. This is so that the weight of the implants can restrict the regrowth of the muscle to its previous position, which would result in a high, squared off breast in the upper pole.
As with any plastic surgery, there are a number of risks associated with augmentation mammaplasty. Among these risks are: 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 breast implants include: implant failure due to leakage of saline, 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.
The following frequently asked questions about breast augmentation surgery are under development. Please return later when we have supplied the answers.
How big can breast implants be for silicon and saline?
Can sclerotherapy be done on the chest if you have breast implants?