Breast Surgery & Procedures
Breast Augmentation / Mammoplasty:
Enhance the size and shape of the
breast using saline implants. Mammogram required after age 35 or family
history of breast cancer.
LENGTH:
1.5 to 2 hours.
ANESTHESIA:
General Outpatient Surgery.
SIDE EFFECTS:
Temporary soreness, swelling, change in nipple sensation,
bruising. Breast sensitive to stimulation for a few weeks.
RISK:
Infection. Asymmetry. Tightening & hardening of scar tissue
around the implant (capsular contracture), or rupture
of implant; either may require surgery to release the scar tissue,
to remove or replace the implant. Increase or decrease in sensitivity
of nipples or breast skin, occasionally permanent. Accurate mammogram
requires special technique.
EXERCISE:
Resume 1/3 intensity at 3 weeks. Low impact activities at 1/3 duration of exercise, repetitions, amount of weight and pulse rate. 2/3 intensity at 6 weeks. Full intensity including high impact (running, horse back riding, high impact aerobics) at 8 weeks.
PHYSICAL CONTACT with Breast:
3 to 4 weeks.
FADING & SCAR IMPROVEMENT:
6 to 12 months.
SWELLING:
Moderate/Significant 4 weeks, Subtle/Mild 2 to 3 months,
all of which are dependent upon extent of procedure(s).
DURATION of RESULTS:
Variable. Implants may require removal or replacement
at some time in the future. TIME frame usually years or decades!
OFFICE VISIT:
1st 5 to 7 days / 2nd Visit 10 to 14 days. Anticipated visits: 4 to 5 the first 3 months then yearly.
GARMENT WORN:
Support as needed 6 weeks.
PAIN MEDS:
Ibuprofen or Narcotics as needed.
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More about Breast Augmentation
Introduction to Breast Enhancement
with Prosthetic Implant
Augmentation mammoplasty or surgical enlargement of the breast has been performed
with prosthetic implants since the 1960's. There have been many modifications and
improvements made since that time. There are a variety of incisions, implant types/shapes,
and implant pockets which may all be custom tailored to fit your individual needs. In
addition to the information contained here, during your consultation and examination, we
will review specific factors which pertain to your individual case. (As you review this
information, please write questions in the margins that we can address during your
consultation.)
The breast is composed of two basic units, the skin envelope and the breast tissue within
that envelope. There is normally a wide variation in breast sizes, and the size of the breast
often changes significantly during a woman's lifetime. As the breasts enlarge during
puberty, both the breast tissue within the envelope as well as the skin envelope itself
increases in size. This increase may vary significantly from woman to woman, but the larger
the breast becomes, the greater the gravitational effect on the tissue within the skin envelope
and hence the greater the stretching of the skin envelope. Following pregnancy, the
glandular tissue within the envelope involutes or shrinks, often to a smaller size than the
breast was originally. The amount of breast enlargement during puberty or pregnancy
depends on many factors including genetics and breastfeeding.
Breast augmentation is a useful procedure to increase the volume within the skin envelope.
There is a definite limit to the size to which a breast can be enlarged if we are to
maintain normal breast appearance and shape. In a native breast, no matter how large,
the upper pole of the breast seen in profile should appear slightly concavely curved. When
you are standing, breast tissue normally settles to the bottom of the breast, and without a bra
there is very little rounding of the upper pole contour of the breast. If, during augmentation,
an excessive amount of volume is placed within the skin envelope in the fonn of an implant, this can exceed the capability of the envelope to accommodate that size and maintain a normal upper pole contour. The result is an unnatural appearing bulge in the upper part of
the breast. Besides being unnatural, this appearance is a telltale sign of augmentation and
does not aesthetically mimic the normal breast.
Cleavage is not a function of the normal breast form. Rather it results from a bra pressing
the breast tissue toward the middle of the chest. No degree of augmentation will provide
cleavage without a bra. We feel very strongly that a well done augmentation enlarges the
breast, but preserves all of its natural features so that it does not appear operated on or
unnatural. Often, immediately after your surgery, there will be fullness in the upper pole of
your breasts. Over the next six weeks to six months, the lower half of the skin envelope will
stretch slightly due to gravitational effect and settling of the implant into its pocket. As the
lower portion stretches, the slight bulging in the upper pole will be relieved, leaving a natural
profile. During your consultation, we can further discuss your individual desires regarding
breast size, as there is a range of implant sizes that your tissues can accommodate.
In women with very small breasts (A cup), there is a relative paucity of breast tissue within a
tight skin envelope. Implants are best placed beneath the pectoralis muscle to provide
additional soft tissue coverage over the prosthesis. Due to the tight skin envelope, the newly
augmented breast will seem excessively full, especially in the upper pole, but as the lower
pole skin stretches out to accommodate the implant, the breast will take on a natural shape
and contour. This process may take up to six months. In larger breasts (B and C cup) or
breasts that have been stretched by pregnancy, the implants usually settle into their pockets
more quickly. Occasionally, a mastopexy (breast lift) may need to be added to the
procedure to lift excessively sagging breasts.
There are several sizes and shapes of implants that are used in breast augmentation.
Currently, silicon-saline filled implants are approved by the FDA for cosmetic breast
enhancement. Clinical studies have been underway since 1992 on silicone filled implants,
and as of January 2007 silicone fined implants have been approved for unrestricted use in
breast enhancement. We utilize round implants in women who have a nice natural shape to
their native breast and simply desire volumetric enhancement. Anatomic implants are most
often used for breast reconstruction patients, and aesthetic patients who need to change both
the form and the volume of their native breasts.
There are three basic approaches currently used for augmentation mammoplasty. One
involves an incision beneath the breast (inframammary approach), the second utilizes an
incision around the base of the areola (periareolar approach), and the third, an incision high
in the armpit (transaxillary approach). The inframammary approach places an incision
in the fold beneath the breast and is visible mostly only when lying down. It is the original
approach for augmentation and has been used with success for over forty years. One major
disadvantage with this approach is the placement of a scar on the visible breast mound. I would emphasize that at least 90% of all scars placed by a board certified plastic surgeon will result in good or inconspicuous appearing scar after scar maturation is complete (one year).
Some incisions however, no matter how precisely closed will result in a poor scar. Some
individuals, due to their healing characteristics, may form scars, which are more visible,
raised, and red in color. They do not mature as well and may not completely fade in color
and firmness over a period of time.
Using the periareolar approach, an incision is placed around the base of the areola at the
junction of the darkly pigmented skin with the lighter skin of the breast. A tunnel is then
created through the breast tissue down to the chest wall, and a pocket is created for implant
placement. Although the periareolar incision usually heals inconspicuously, it does place a
scar on the visible portion of the breast. An unsatisfactory scar in this location can be visible
whether standing or lying down. In addition, an incision directly around the areola carries a
slightly higher risk of nerve damage to the nipple that can result in decreased sensitivity or
numbness.
Using the transaxillary or armpit approach, the incision is placed in the highest portion of
the armpit hollow, usually within an existing crease. A tunnel is created from that point
behind the breast for placement of the implant. A camera is inserted through the tunnel, and
the dissection is carried out precisely, with the aid of television monitors. The obvious
advantage of the transaxillary approach is that it avoids placement of a scar on the visible
aesthetic unit of the breast. There are other advantages however. Although the pocket
created is similar to that with other approaches, I have found that the nerves to the nipples
are very infrequently, if ever, affected. When properly placed, the incision in the armpit
heals inconspicuously, and can only be seen with close scrutiny. Even with activities such as
tennis or dancing in a sleeveless dress, light always comes from overhead and the armpit is in
relative shadow. One disadvantage of this technique is its inability to be used for some
revisionary surgery.
Commonly, should a revision be necessary (for implant deflation,
malposition, or capsular contracture) a second incision on the breast mound is required. Also
the implants tend to ride a little higher initially before they settle into their pocket.
With any of the three approaches, the small scar is approximately 5 em (2 inches) long, and
requires approximately one year to totally mature for its best appearance. Initially, the scar is
a very faint line, which then becomes reddened and slightly raised and stays that way for a
period of two to three months. As the redness fades, the firmness also subsides for about one
year. The scar is then mature, faded in color, inconspicuous and soft. When closing any of
the incisions, I turn the skin edges slightly upward or everted, and you will notice a very
slight ridge along the incision for a period of weeks. If skin edges are not everted at the time
of closure, scar contracture which occurs over a period of 3 months can result in a depressed
scar which is more visible and less desirable. When the edges have been turned upward
slightly, as healing occurs, the scar flattens and becomes less visible.
Regardless of the incision chosen, I most frequently place the implant beneath the pectoralis
major muscle. This muscle is the large flat muscle on the front of the chest wall. This
requires release of the inferior attachments to the chest wall to accommodate the implant.
When the implant is finally positioned, only the upper one-half of the implant is actually
covered by the muscle. This slight pressure by the lower border of the pectoralis muscle on
the upper border of the implant additionally helps prevent the unnatural upper bulging
appearance of the augmented breast. Subpectoral implant placement also helps minimize
the risk of capsular contracture (deforming scar formation around the implant). I close all
of my incisions with dissolving stitches. These reabsorb over a period of time, avoiding the
need for suture removal. You are allowed to shower the day following surgery. For
transaxilIary incisions, simply towel dry the incisions, and you may use dry spray deodorants
beginning two days after surgery. You may shave two days following surgery up to the very
edge of the incision, and as the small ridges subside over a period of about two to three
weeks, you can shave directly over the incision. For all other incisions, clean dry gauze is
sufficient dressing.
I personally feel that the transaxillary approach offers some distinct advantages over the
other two approaches, however, I continue to perform large numbers of procedures using the
inframammary and periareolar approach either due to your specific wishes, or a specific
reason which we may discover at the time of your consultation and examination that might
make one procedure more favorable than another.
In general, breast augmentation surgery is performed under a light general anesthetic. I
believe (as do our board certified anesthesia colleagues) that this is a better and safer
approach than local anesthesia alone or local anesthesia under sedation with intravenous
drugs.
Breast augmentation can sometimes be combined with other surgical procedures, usually
producing slightly greater, but nevertheless acceptable risks. A decision in this regard must
be strictly individualized, depending on the type of other surgical procedure being performed
as well as other medical and surgical factors.
In large series of patients studied following augmentation, there has been absolutely no
evidence to suggest that placement of implants in any way causes cancer or delays its
detection. Although there is a small percentage of breast tissue that cannot be
visualized on mammography following augmentation, clinical and self breast exam
detection of abnormalities is increased. Thus women with implants have the same risk
of developing breast cancer as the remainder of the population, and should they develop
cancer, their stage and prognosis is identical.
The purpose of all types of cosmetic surgery is to improve your appearance as much as
possible. This change will hopefully improve your quality of life by improving your self image in a very positive way. By addressing and improving those specific areas which detract from your appearance, leaving the positive aspects of your appearance undisturbed,
this type of surgery results in an overall improvement in your appearance. Cosmetic surgical
procedures are not magic. They are detailed procedures designed to improve specific aspects
of your appearance. They can do no more than that. Whether you are happy with the results
of cosmetic surgery will depend largely on how well you communicate to us which specific
aspects of your appearance you are unhappy with and how well we communicate to you what
a surgical procedure can and cannot do toward alleviating the problem. Plastic surgery does
not perform miracles. A combination of art and science, plastic surgery is not an exact
science. Some of the factors involved in producing the result (such as your healing
characteristics) are not totally within your or our control, and therefore, it is impossible to
warrant or guarantee the results of your surgery.
After talking with you and examining you, I will make every effort to clearly and precisely
give an opinion about whether a specific surgical procedure can significantly improve your
areas of concern with a high degree of reliability and a minimal level of risk. All cosmetic
surgical procedures involve some trade-offs. I will try to outline these clearly for you and
answer any questions you might have. The final decision regarding having the surgery is
yours, and I encourage you to consider it carefully and deliberately.
AT YOUR INITIAL CONSULTATION VISIT
When I visit with you in the office, I will review your past medical history, as well as your
desires regarding augmentation. Age is not a limiting factor in determining who can have an
augmentation mammoplasty, as long as your general health is good. We will review
extensively the information contained here, as well as more specific information with respect
to your specific needs. After examining your breasts, I can much more precisely define
recommendations for you.
In this consultation, I would expect you to be frank in discussing your expectations with me.
Do not hesitate to ask any questions that you may have. I will be equally frank with you,
explaining the factors that could influence the procedure and the results.
I cannot make the decision for you regarding whether to undergo surgery or not. I can only
advise you regarding the surgical options and anticipated outcomes I would expect for you
based upon your individual anatomy, desires, and realistic expectations. I will define goals in
a surgical plan at this initial consultation. Follow up appointments will include time to ask
further questions or review the procedure so that you are comfortable with its nature and
implications. I will educate you and define the operative scenarios and choices available to
you, but you must make the final decision regarding the surgical procedure. When a decision is made to proceed with surgery, preoperative photographs will be taken.
These photographs are essential to the planning, execution, and follow-up of your procedure.
They are taken with you in the standing position (the position in which you are most often
seen). You are lying down during the procedure and I refer to these photographs frequently
as your tissues appear very differently than when you are standing.
Surgical fees for the procedure will be discussed with you. They depend upon the nature and
the extent of the procedure being performed. All fees for cosmetic surgeries are payable in
advance and include the cost of surgery as well as all postoperative to allow up care.
Additional fees are required for the surgical facility and anesthesia care, and will be collected
on the day of your preoperative visit at the surgery center.
BEFORE YOUR AUGMENTAnON MAMMOPLASTY
Our nurse and office manager will make all arrangements regarding scheduling of your
surgery and will give you specific instructions as well as reconfirm these with you by
telephone and/or letter. Since both of our schedules must be coordinated with the surgical
facility and anesthesia schedules, please allow our personnel a reasonable amount of time to
make these arrangements. They will make every attempt to accommodate your requests.
Good general health is mandatory for a problem free and predictable recovery from any
surgical procedure. Wellness and good general health result from proper diet, regular
exercise and appropriately timed medical evaluations focused on preventative medicine.
Good nutrition, vitamin and herbal supplements, as well as adherence to holistic health
principles are important concepts in maintaining wellness. Certain supplements, although
generally beneficial, may have adverse effects during surgery. Please advise us about all
your medications and supplements, so we may advise you regarding their safety in regard to
your surgical procedure.
We believe that good nutrition is an important component to excellent surgical outcomes.
Multiple studies show that most Americans aren't getting the recommended daily intake of
necessary vitamins and minerals, much less the optimal amount. These suboptimal levels of
nutrients have been linked with major diseases from heart disease to cancer.
We use a three phase healing program with nutritional supplements to help you recover more
quickly and with less downtime. We have you start this a week or so ahead of time to ensure
that you are boosting your body's immune system and removing anything that could interfere
with anesthesia or increasing bleeding. Immediately following surgery we give you nutrients
that help reduce pain and inflammation and detoxify the anesthesia and other medications.
The third phase has additional healing nutrients to support your recovery.
Routine laboratory tests including blood counts and blood chemistries, a pregnancy test when
applicable, and an electrocardiogram if you are over 50 years old, will be performed prior to
surgery. These tests are performed routinely to screen for any abnormalities, which might
complicate your anesthesia or surgery. A recent mammogram may also be required to
complete your preoperative evaluation.
Do not take any aspirin or any drug containing aspirin for at least two weeks prior to
your surgery. Aspirin may retard platelet function, a blood component that is important to
normal blood clotting mechanisms. There are many drugs which contain aspirin. Before
taking any drug, check the label carefully to assure that it contains no aspirin.
Do not eat or drink anything 8 hours prior to surgery. Safety in the administration of
anesthesia or sedation requires that your stomach be absolutely empty for this interval of time
before surgery.
Shower or bathe normally the evening prior to surgery. Do not shave the armpit area
for at least twelve hours prior to surgery, if you are having the surgery with the transaxillary
incision.
You should wear loose fitting, comfortable clothing the day of surgery. A loose fitting shirt
with buttons in front is preferable to any type of clothing which must be put on over the head.
Please be sure that you have all of your questions answered prior to going into the surgical
facility. I prefer that you make an additional appointment in the office if necessary to answer
questions regarding your surgery. On the day of surgery, I will visit with you briefly
immediately prior to surgery. Any final questions will be answered at that time.
Arrange for someone to drive you home at the appropriate time following your procedure,
and arrange for someone to stay with you the night of surgery.
THE DAY OF SURGERY
I usually prescribe sedation or pre medication prior to your being brought to the operating
room. In order to minimize total necessary doses of drugs, sedation is best administered
through an intravenous line rather than given in shot form into your muscle. It is normal to
be slightly excited or apprehensive immediately prior to the surgery, and this will be
alleviated quickly once your intravenous line is inserted. Our anesthesiologist will speak
with you and answer all of your questions regarding your anesthetic.
Prior to moving to the operating room, 1will ask you to sit up briefly so that I can make small
marks in the armpit areas and/or beneath the breasts, depending on the approach, to use as
guidelines during your surgery. Once in the operating room, you will then be positioned
comfortably, and will have no recall of further events during your surgery.
The operation is performed using a general anesthetic. In addition, the medications have a
profound amnesic effect, and you will have no recall of any events during the procedure.
Actual surgical time usually ranges from 45 minutes to an hour and a half depending on the
technique chosen.
Incisions are made according to the approach being used and the tissues are appropriately
separated. Pockets are created behind the breasts to receive the prostheses. After the
prostheses are inserted, you will be moved to a sitting position on the operating table. I
carefully inspect both sides to assure symmetry and make additional adjustments if
necessary. The incisions are then closed with dissolving sutures, which will reabsorb and do
not require removal.
At the completion of your operation, you will be transferred to the appropriate recovery area
where you will remain until you awaken. I purposely like for you to remain drowsy, since
you will be much more comfortable. After an appropriate interval of observation, usually a
few hours, you will be allowed to leave with someone to drive you home and stay with you
the evening of the surgery.
You will have been given prescriptions for pain medication and antibiotics with instructions
for each at your preoperative visit.
AFTER YOUR AUGMENTATION MAMMOPLASTY
Since I want you to remain drowsy and comfortable the evening of your surgery, fill your
prescription for pain medication before surgery and take one immediately on arrival at home.
Pain medication is best taken with a small amount of food and not on an empty stomach since
nausea may occasionally occur. Make yourself comfortable, not necessarily in bed; a couch
or comfortable chair is fine. You will continue to be drowsy and will awaken intermittently
during the evening. Use the pain medication as directed to remain comfortable. Intermittent
cold compresses for the first 48 hours after surgery may help with swelling and discomfort.
Do not try to eat any heavy foods the evening of surgery. Liquids or light foods are
preferable. You may resume a normal diet the next morning. Should you experience any
nausea the evening of surgery, drink small amounts of liquids only: no food until morning.
Anti nausea medications are generally not needed; any nausea experienced from the
medications used in surgery will usually be gone the next morning. If you have a history of
nausea after anesthesia, please inform your anesthesiologist the morning of surgery and you
will be given anti-nausea medications during the procedure that will help minimize this
occurrence after surgery.
Bandages placed at the time of surgery over your incisions may be removed the next
morning. Incisions require no special care. All stitches are placed beneath the skin and will
reabsorb.
You may shower and wet the incisions twenty-four hours after surgery. After showering, dry
the armpit or other incision area normally with a towel. For transaxillary incisions, spray
deodorant, which converts to dry powder when sprayed is preferable, and may be used two
days following surgery. Do not use wet spray or roll-on deodorants in the armpit areas for at
least two weeks.
You may shave the armpit areas beginning two days following surgery. As I explained to
you preoperatively, the ridges formed by the incision lines will regress over a period of
weeks as the skin heals. Until this area flattens, you may shave over the ridges, but simply
take reasonable care in these areas.
You may experience some small lumps in the armpit area following surgery. These are small
lymph nodes, which will generally regress without any treatment over a period of seven to
ten days. If you see redness spreading one half inch or more from the incision area or any
drainage from the incisions, notifY me immediately.
If you are given a prescription for antibiotics following surgery, take the prescription until
ALL of the antibiotics are completed.
Resume normal tasks of daily living as rapidly as possible. The pain from the procedure
decreases to about half of its intensity each 24 hours following surgery. Postoperative
discomfort is most marked only during the first 24 hours and regresses rapidly thereafter.
Resumption of normal activities, for example, lifting the arms to comb the hair and lifting
objects of normal weight, speeds the recovery process and reduces the pain more rapidly.
Immobility tends to cause continued discomfort and increased muscle spasms. The only
limitation to activity is if you feel significant pain. Discomfort is normal with motion
initially, and there is nothing that can be harmed by normal activity. Most patients are
back at work in 5-7 days. Call the office for an appointment to be seen as directed following
surgery.
You may resume light exercise at 3 weeks following surgery. This includes low impact
activities at 1/3 duration of exercise, repetitions, amount of weight, and pulse rate. Your
exercise tolerance should gradually increase to 2/3 intensity at 6 weeks, and be at full
intensity by 8 weeks. This includes high impact activities such as running, horseback riding,
and high impact aerobics.
Postoperative Healing
Postoperative healing requires some mandatory down time as part of the surgical recovery
process. Post surgical healing requires the body to repair the surgical wound (whether in the
skin, fat, muscle or bone) with scar tissue. The bruise and tissue fluid in the wound are
gradually replaced by stronger scar or fibrous tissue over a period of 6-8 weeks. Until the
time that the healing area is strong enough to maintain tissue integrity, the wound is held
together by the sutures (stitches) placed at the time of surgery. Too much wound tension
(stress) before the strength of the healing tissue is satisfactory, can cause disruption of the
incision. I place sutures very precisely to account for these healing characteristics to
maximize your postoperative activity, comfort, and safety. However, your inherent healing
characteristics significantly dictate these parameters. Stretching, movement, massage, and
return to normal activities of daily living in the early postoperative recovery allow for the
optimal return to your full normal life style.
After the initial burst of high energy healing and the bulking up of scar tissue, the wound
enters a maturation phase, and the scar tissue becomes thinner, less red, and stronger. The
maturing and stabilization of scar tissue occurs over a period of 6 to 12 months. Long-term
changes tend to be more subtle, slower, and less evident than short-term changes that occur in
the first 6 to 8 weeks.
There are no absolute parameters regarding return to postoperative activities and one must
adjust for variation in pain tolerance, invasiveness of surgery and healing variations.
In general, you cannot speed up the healing process, only slow it down by too much activity
too soon. Overexertion can lengthen the period of time for pain to decrease, swelling and
bruising to resolve, and the final surgical results to be evident. Healing occurs for up to one
(1) year, sometimes longer. The latter changes tend to be subtle and gradual, and therefore
not nearly as dramatic as in the initial 6 to 8 weeks.
Please be patient with your own healing. Any change in your appearance affects your
perception of self-image and requires an adjustment period of days to weeks. It is normal to
have mild feelings of doubt or a low mood during this period in the first 1to 3 weeks
following surgery. These feelings are then rapidly replaced by positive feelings as healing
progresses and you adjust to your improved appearance.
Normally following this procedure, a small amount of fluid will accumulate within the
pockets surrounding the breast implant. You may be able to feel or hear a slight sloshing of
the fluid as you move your implants. This fluid is reabsorbed by the body over a period of
two to three weeks and is inconsequential.
Massive accumulation of fluid or blood within the pocket occurs very rarely (approximately
I% of the time) postoperatively and should this occur, your breasts would become extremely
large, tight and painful, and you should notifY me immediately if this occurs.
In the thirst few weeks following your procedure, your breasts will appear slightly ful1 in the
upper portions, with a slight outward (convex) curvature to the upper portions of the breasts.
This fullness regresses as the lower portion of the breast skin envelope stretches from the
weight and gravitational effect on the implant over time. As the stretching in the lower
portion of the breast is complete (up to 6 months) the upper pole profile of the breast
becomes straight or slightly concave.
Since discomfort from this procedure diminishes rapidly, pain medication should be
necessary for a maximum of three to five days. Most patients usually require pain
medications for only 24 to 48 hours.
Should you develop any of the fol1owing symptoms, please call our office: a) elevation of
temperature to or above 101 degrees, b) extreme swelling or tenderness in either breast, c)
any prolonged or significant bleeding from incision lines (slight drainage for 24 hours is
normal), d) redness along the incision lines or elevation of temperature in the breasts. A
small amount of bruising may normally occur in the armpit area or beneath the breasts, and
may appear 1-4 days fol1owing your surgery. If bruising occurs, it subsides in 1-2 weeks.
If you should have any other questions or problems, please contact our office at
(303) 443-2277.
LIMITATIONS, RISKS, AND POSSIBLE COMPLICATIONS OF AUGMENTATION
MAMMOPLASTY
With any surgical procedure, a very small percentage of untoward complications can occur.
These complications are rare, and I mention them not to alarm you, but only to inform you.
No two breasts are the same size or shape. Placing an implant changes the contents of the
skin envelope, but it does not change the shape or size of the envelope itself. Hence, the size
and shape differences will inevitably be present to some degree fol1owing surgery, just as
they are present before surgery. I make every attempt to equalize the volumes of the breasts,
but due to differences in the size and shape of the skin envelope, which we are not
modifying, some differences always persist. These differences are usually quite subtle, and
within the normal range of variation of normal breasts.
Due to stretching of the breast and nerves to the skin of the breast, particularly on the outer
half, about one-third of patients experience very subtle tingling sensations or pin-pricking
type sensations on the outer half of the breast, as wel1 as on the inner aspect of the upper arm
due to similar stretching necessary to place the large prosthesis through the very small
incision. A similar number (about one-third) of patients notice a slight increase in nipple
sensitivity for a few weeks following surgery. All of these effects are subtle, of no concern, and usually subside spontaneously within a brief period. Very rarely, numbness of one or both nipples can occur and be permanent.
It is possible to have untoward side effects to any drug which is administered, during surgery.
Severe side effects are extremely rare, but can be life threatening. It is for this reason that I
insist on performing your surgery in an optimal setting where all conceivable equipment and
medical backup are available should you have an unexpected reaction. Anesthetic or
sedation risks are extremely minimal. Many cases have been vastly over publicized by the
media, and most have occurred in settings where less than optimal facilities, equipment and
personnel are present.
At the time of the operation, I will control all bleeding which is present, however it is
possible for additional bleeding to occur within the pocket following the procedure. This
complication occurs in approximately I%or less of cases, but may require returning to the
operating room, removing stitches from your incision, and removing the blood, which may
have collected. If bleeding occurs, it most commonly happens in the first 48 hours following
surgery, but may very rarely occur later. In my experience, it is rarely related to your activity
level, hence we recommend returning to normal activities of daily life as previously outlined.
As with any surgical procedure, infection may occur following your augmentation, despite
pre and postoperative administration of antibiotics, and meticulous sterile technique during
surgery. Fortunately, this complication occurs in less than I%of cases. If the pocket
containing the implant becomes infected, the implant must be removed. It must be left out
for approximately three months in order to allow all infection to subside, and then can be
replaced. Although extremely rare, this complication is a significant nuisance requiring
artificial filling of the brassier cup on the affected side during the interim period of healing.
Excessive firmness of the breast caused by capsular contracturema.up to 5% of
cases. Although I minimize the risk of capsular contracture by using smooth implants in a sub-muscular pocket and instituting implant displacement exercises immediately after surgery to keep the pocket open, I cannot predict who will develop problems or when.
Capsular contracture can occur in the early months or years down the road. I will follow you
closely should a problem develop and always be available for an appropriate treatment.
All of the above mentioned complications of augmentation mammoplasty are unusual, but
occur occasionally despite the most vigorous standards of surgical practice. They are listed
not to alarm, but simply to adequately inform you prior to your surgery.
CONCLUSION
Augmentation mammoplasty is a reliable and rewarding procedure, which enlarges and
improves the appearance of the breasts in properly selected circumstances. In addition to a significant positive effect on the individual's self image, patients often describe a feeling of
increased self confidence and increased versatility in types of clothing which can be worn.
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