Dave Stringham asked:




Women choose to have breast augmentation surgery to improve their self image. Some feel dissatisfied because their breasts never developed to a size that meets their expectations. Others want to bring balance to a breast that is somewhat smaller than the other. Often women want the procedure to restore their natural breast volume, which may have decreased as a result of pregnancy, weight loss, aging or even breast cancer surgery.

In modern times, it is important to have your personal habits in mind when considering surgery on your breasts. Many women enjoy sunbathing in European settings. Some use the endoscopic technique with breast augmentation which leaves no scars whatsoever on the breasts. The same minimally invasive techniques on the face for facelift or browlift procedures to accomplish plastic surgery with no visible scars is used.

During your initial consultation, you will be encouraged to discuss your desires, fears, expectations, and goals. The first and foremost objective is the creation of breasts that you envision yourself with. In addition to increasing breast size, plastic surgeons will strive to create a more aesthetically pleasing breast by improving shape, balance, and proportion.

Additional cosmetic procedures may be necessary to improve your results. If your breasts are sagging (ptotic), your plastic surgeon may suggest that a breast lift procedure ( mastopexy ) be performed in conjunction with your breast augmentation surgery. In this manner, your breasts are lifted to the correct youthful position and made fuller at the same time.

It is important to stress that breast surgery does not cause cancer. The surgery lasts from one to two hours and is usually performed in a surgical facility under a light, general anesthetic administered by an anesthesiologist. A long acting, local anesthetic is also added to help eliminate discomfort following surgery. While the procedure is carried out, you will be on a specially designed table that can be placed in a sitting position. This allows your plastic surgeon to try different implants and ensure that the proper size is used with you in an upright position.

The breasts are enlarged by placing soft implants through a small incision, using one of three different approaches: axillary (armpit), around the nipple, or under the breast. Your plastic surgeon will discuss your preferences and his recommendations. Various types of implants are now available including saline (sterile saltwater) and silicone.

One of the following techniques is used, depending on your body structure, and preference: Endoscopic: This is the most modern technique for breast enlargement surgery. A small incision is made in the axilla (underarm) and a small endoscope is used to introduce the implant either under the pectoralis muscle or the breast tissue. Absorbable sutures are used through the procedure to assure your comfort. The unique features of this technique are the small incisions necessary to perform the procedure, and the location of the incisions in the axilla or armpit. Therefore, no scars are visible on the breast or at the breast crease leading to excellent aesthetic results. It is ideal for those patients with smaller breasts where the scars on the breast would be visible, and for those who have a predisposition to abnormal scarring.

Axillary (Underarm): This approach is utilized when a patient’s breasts are small, in good position, and relatively symmetrical. The implant is introduced through a 1 to 1 1/2″ incision in the center of the axilla, and is generally placed under the muscle mass. In patients who are extremely muscular, this placement may show movement of the implant; in such cases, the implant is placed over the muscle tissue. Absorbable stitches are placed in the underarm area, and a small tubular drain may be used to collect fluid for a day or two in order to decrease swelling.

Nipple: This commonly used approach involves a 1 to 1 1/2″ incision on the lower border of the pigmented areola and allows not only enlargement but some correction of shape and position discrepancies. The incision generally heals well with minimal scarring. Although blockage of nipple ducts is a theoretical problem, it rarely occurs. Most women are able to breast feed after this procedure.

Inframammary incision: In a small number of cases where the areola is very small, an incision is made at the crease below the breast. This approach may be suitable in women with prior breast surgery or with the most complicated breast augmentations.

For the first two days after surgery, you should rest at home. You are encouraged to walk around your home, but give your body a chance to take a break from your daily routines. You may experience much less discomfort than you expected, but will probably want a mild pain medication such as Tylenol. Stronger medication will be available if you need it.

By the third day you will be up and walking around. When you get up out of bed, try rolling on your side toward the edge of the bed and bring your knees up to your waist. Move your legs over the side of the bed and gently help yourself up by pushing up with your elbows. The idea is to let your legs do most of the work so your arms can rest. When you shower, gently wash your stitch line with mild soap, and then apply a thin layer of a mild antibiotic ointment such as Bacitracin or Polysporin.

Most patients are driving by the fifth to seventh day, and return to work or school in one to two weeks, depending on the level of activity required and the rate of recovery. You should be reminded that driving should be avoided while taking strong pain medications containing morphine derivatives such as Vicodin.

Half of the swelling is resolved in two weeks, three-quarters by one month, and the remainder in one to three months. Avoid reaching above your head to grasp objects for 4 weeks or until instructed otherwise by your plastic surgeon. Any change in sensation following surgery is typically temporary; resolution can occur over several weeks to several months. Although breast-feeding is desirable for infants, it can have an effect on the operated breast, sometimes resulting in size reduction, and discomfort. This should be considered before a decision is made about breast surgery and subsequent pregnancy and nursing.



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