Breast implants are an excellent way to replace lost volume, correct underdevelopment, and get a proportionate figure. The number of people electing cosmetic plastic surgery continues to rise each year. With over 300,000 performed in 2018 alone, breast augmentation remains one of the most popular cosmetic procedures. Cosmetic surgery is a big decision with a lot of frequently asked questions. Here are some important things to know about breast augmentation to help you make an informed decision.
What Is Breast Augmentation?
This is a surgical procedure is to enhance the shape, and size of the breasts. The most common way to achieve this enhancement is with an implant. It can also help restore balance in cases of significant asymmetry.
Are All Breast Implants The Same?
Composition of a breast implant is a silicone outside shell that’s either filled with medical grade silicone gel or sterile salt water (saline.) The latest techniques in breast augmentation emphasize the importance of tissue based planning. This means selecting a breast implant that matches the footprint of the breast. Therefore, breast implants also come in different sizes and shapes to accommodate a preferred breast width, desired volume, and projection. Within these implants, there are choices with regards to round vs anatomically shaped (teardrop) implants and smooth vs textured implants. Dr. Fichadia will perform a detailed physical examination and recommend implants that will fit your body and achieve the desired cosmetic outcome.
What Questions Should Be Asked In Selecting A Plastic Surgeon?
Picking a qualified facility and plastic surgeon is very important to achieving a positive and safe breast augmentation outcome. You’ll want to know about the following areas before making a selection:
- Is the surgeon certified by the American Board of Plastic Surgery?
- Is the facility accredited by an accreditation organization such as the Joint Commission, AAAASF, AAAHC, or Medicare? Are the anesthesiologists experienced with this procedure?
- Is the cleanliness of the facility, friendliness of staff, and overall level of comfort a match for your needs?
- What’s the surgeon’s experience with this particular procedure?
- What protocols and procedures does the facility and surgeon use to help ensure patient safety?
- Are there any future considerations for breastfeeding, mammograms, scars, and revisions?
- How will breast implants affect your lifestyle?
What are the different approaches to breast augmentation?
Dr. Fichadia offers the following approaches to breast augmentation:
This incision is the most popular one among plastic surgeons in the United States. This incision is made along the breast crease under the breast.
The incision under the breast is generally recognized as the best approach for a number of reasons. It is very versatile, gives excellent access to the breast, and can be used for virtually all breast augmentation procedures, including challenging cases such as misshapen breasts, tight tissues, and revisions.
The incision is hidden in the crease of the breast, which is an important factor for many women. There is also less contamination with bacteria. More nerves are avoided, and the breast tissues are usually not cut so there may be less painful. This incision can also be used for revision procedures.
Nipple Incision (Peri-areolar)
The nipple incision is recommended for some patients who have underdeveloped or misshapen breasts, such as constricted or tuberous breasts. Since it requires cutting through the breast tissue, there are more pain, swelling, and changes to nipple sensation compared to other incisions.
The nipple incision is made around the lower part of the areola. The scar is barely visible on most Caucasians, but on patients of other races, the scars frequently pigment and thicken.
It’s important to note that this incision requires pushing the implant through the breast. Though we don’t really think about it, the ducts within the breast have bacteria within them. When the implant goes through the ducts, those bacteria can get on the implant. Low-grade infection/inflammation results in capsular contracture, which remains the leading cause of revision surgery after breast augmentation. Dr Fichadia makes it a top priority to reduce the possibility of capsular contracture. Therefore, while she offers this incision when needed, she prefers using the inframammary incision if otherwise indicated.
How to prepare for a breast augmentation surgery?
Before your breast augmentation:
A well prepared patient before surgery will make the recovery much quicker, easier and safer. Here are some tips to ready yourself for implant surgery:
Stay off of all medications that thin your blood for 2 weeks prior to surgery (i.e., aspirin, Motrin, Advil, Alleve, ibuprofen, naprosyn, Anacin, Bufferin, etc.) and 2 days after surgery.
Arrange for transportation to and from the surgical facility as it is typically an outpatient surgery, and takes under 2 hours to perform.
Arrange for a responsible adult to be with you the day of surgery.
Fill all your prescriptions in advance and bring your pain pills with you to the surgery center.
Review and confirm with your doctor the choices you have made for your procedure regarding size of implants, type of implant, incision choice and location of implant.
Ice bags to breasts for 48 hours after surgery helps to reduce swelling and pain–arrange to have ice bags, gel packs or frozen vegetables ready for immediate placement after the procedure.
Review how to prevent thrombophlebitiis (DVT) in the post-op period
Report any sign of a cold or infection immediately to the doctor
Take a shower the night before surgery and the day of surgery and use a special surgical soap called Hibiclens, this can be provided by your doctor or purchased at a pharmacy.
Wear comfortable, loose-fitting clothes that do not have to be put on over your head the day of surgery.
Remove all earrings and body piercings the day of surgery, remove all makeup.
Do not eat or drink any food or water after midnight on the night before surgery.
Leave all your valuables and jewelry at home the day of surgery.
If there is any chance of pregnancy, perform a home pregnancy test and bring the results into the surgery center the day of surgery.
If you are experiencing your period, use an external sanitary napkin, tampons can cause toxic shock syndrome and need to be removed before surgery
What Does Recovery Look Like?
Recovery varies per patient since your overall health and lifestyle habits before the surgery can greatly impact your ability and speed of healing. Following applies for a standard breast augmentation under the muscle. Breast augmentation over the muscle has a slightly quicker recovery.
Rapid Return Stretches Following Breast Augmentation
Perform these exercises immediately in the recovery room and at least once circuit each hour while awake until your first post-operative visit. Although these are illustrated in the sitting position they can be performed in the standing position as well. Our goal is to progressively stretch the pectoralis muscle. If the exercises are not performed, the muscle tends to contract and shorten which may cause more discomfort (as is seen with a hamstring pull.) Remember: NO HEAVY LIFTING or SUDDEN MOVEMENTS.
With your arms hanging straight down at your sides, pull your shoulders up toward your ears and roll your shoulders back slowly in a circular motion. Maintain an upright posture and sit at the front of the seat. Roll your shoulders for 10 to 15 repetitions in one direction before reversing direction for an additional 10 to 15 repetitions.
While seated upright at the front of your seat, hold your arms straight out to each side and slowly rotate your hands in a small circular motion. Complete at least 10-15 revolutions in each direction, rotating forward, then backward.
This places the pectoralis muscle on full stretch. Place your arm over the head with your forearm resting on the top of your head while your hand reaches for the opposite ear. Avoid tilting your head. With the other hand, slowly pull on the elbow and hold it as you take a few slow breaths. Hold this position for 10 to 15 seconds with each arm.
Pain: In general, breast augmentation is tolerated very well. You will be sore the first 2-3 days. The primary reason for the pain is the muscle being elevated from the procedure. Take Tylenol and Celebrex on a schedule, staggering their doses alternately. It is possible that you will be taking narcotic medication for the pain in the first two days. Typical, by day 3-5 patients wean themselves off of narcotics and feel much better. There is a lot of variation patient to patient. Some may be done with narcotics by day 3, others continue on. After a week, there should be no more pain. If you experience any discomfort after one week, Tylenol should be sufficient to manage it.
Showering and Bathing – You may begin showering on the evening of surgery. Do not submerge yourself underwater (e.g., bath, pool, ocean) for the first three weeks after surgery.
Try to sleep on your back with your head slightly elevated after surgery. This will help with the swelling.
Activity restrictions –
Most women are able to return to desk-job type activities within 3-4 days, although things such as exercising and other strenuous activities should not be attempted for a minimum of 4 weeks, on average. No sexual activity for 2 weeks. At 2 weeks, it’s OK to get back to low impact cardio exercise.
For the first 6 weeks after breast augmentation, we advise against any activity that involves:
high impact activity (like jumping, jogging, martial arts)
big arm swinging (like tennis, golf)
lifting more than 15-20 pounds (lifting your baby is OK if you do it with your elbows close to your chest)
repetitive motions (sweeping, vacuuming, raking leaves)
How Long Do Results from a Breast Augmentation Last?
This is yet another question that’s highly individualistic and based on the style of implant chosen. While breast implants don’t come with an expiration date, they are not meant to be lifelong devices. It is possible to need another surgery around 10 – 15 years. The reasons for reoperation can range from size change, capsular contracture, implant leakage, weight gain or loss, asymmetry, or evolution of your personal aesthetic goals. Excessively large implants tend to have problems such as excess skin stretching and thinning, bottoming out, etc in the long run.
Schedule a Consultation
If you are interested in learning more about Breast Augmentation in Portland, Oregon, contact Dr. Fichadia. She is a double-board certified plastic surgeon known for delivering amazing results to her patients with excellent care. She can answer any and all questions you may have regarding breast augmentation and how it can benefit you. To make an appointment call her office today or fill out an online form.