Breast Enhancement
General Information
In our society today, it is extremely important for us to feel good about the way we look. For this reason many women are considering cosmetic surgery to feel better about themselves and improve the way they look in their clothes. Because an individual’s body build is determined greatly by genetic influences, women may not be able to achieve the look they want through diet and exercise alone. Today, through modern technology, many women are able to alter the shapes of their bodies. Some with small, underdeveloped or asymmetrical breasts choose to undergo breast augmentation. Breast augmentation is a safe, effective surgical procedure designed to improve the contour of a woman’s body by implanting specially designed materials beneath the breast or chest wall muscles.
Before Surgery
Prior to surgery, a complete medical history is taken in order to evaluate your general health. A thorough examination of the breasts is also made to determine the most effective surgical approach, implant size and implant style. At the consultation Dr. Hendrick will discuss with you the type of anesthesia to be used, the procedure, what results might realistically be expected, and the possible risks and complications. Photographs of your breasts will be taken for the record and you will have an opportunity to try sizers on. Feel free to bring pictures of breasts you think are attractive in size and shape.
Mammograms will usually be requested or ordered. Preoperative instructions include the elimination of certain drugs which contain aspirin or ibuprofen in order to minimize the possibility of excess bleeding.
The Procedure
A breast augmentation is done in our office surgical suite as an outpatient surgical procedure. You will be given local anesthetic with sedation or general anesthetic. You will have no pain whatsoever during the procedure. Dr. Hendrick may choose from a variety of surgical approaches, depending upon what changes are desired. There are four ways to place an implant:
* An inframammary incision is an opening made in or just above the hidden fold beneath the breast.
* An areolar incision is made under the nipple.
* A transaxillary incision is made in the underarm.
* An umbilical incision is made in the navel (belly button).
Regardless of which incision is used, breast tissue is raised to create a pocket either under the breast tissue or beneath the chest wall muscle. An implant, usually containing a saline (saltwater) solution, is inserted into the pocket. Different sizes of implants may be used to correct breast asymmetry.
After the implant is securely in place and inflated, small sutures are used to close the incision. A breast augmentation can take 1 to 2 hours, depending upon the procedure and extent of the surgery.
Following Surgery
Following surgery, you will be sent home to recover under supervision and with postoperative instructions. You will have a dressing, surgical bra and strap.
Pain connected with the procedure is minimal to moderate and is controlled with oral medication. Antibiotics will be prescribed to prevent infection. Instructions for the day of surgery include bedrest and limited activities. Dr. Hendrick determines when normal activities can be resumed; however, strenuous exercise and overhead lifting must be avoided for several weeks.
Sutures are removed in about 7 days, at which time Dr. Hendrick may recommend massage to keep the breast supple. Numbness around the treated area may occur, but this condition is usually temporary. Swelling and discoloration disappear in a few days, and scars from the incisions, although permanent, are “hidden” and fade significantly with time.
FAQ
What kinds of implants are available?
The most common types are gel filled and saline filled. Each has a silicone rubber envelope. Saline implants are primarily used. The FDA requires saline implants to be used for primary augmentation. If you have had previous breast augmentation surgery or meet other criteria you may qualify for silicone gel implants under a “Silicone Gel Study”. Implants are available with a smooth or textured surface and can be round or tear-drop in shape. Smooth round implants are used in most cases.
Is this breast operation dangerous?
There is some risk with any operation. This operation is about as dangerous as a tonsillectomy but not as dangerous as an appendectomy. This operation is performed under local or general anesthesia and usually as an outpatient. The patient arrives for surgery in the morning, has the operation and goes home that day without staying in a hospital.
Can breast implants cause breast cancer?
In the millions of cases where breast implants have been used, there have been no reported cases where cancer was caused by the implant. An augmentation will not prevent cancer from developing.
Does breast implant surgery leave unsightly scars? Whenever the skin is cut, a scar line remains after healing. The surgeon tries to make the scar as invisible as possible. Usually the small scar that remains is not easily seen. It may be under the fold of the breast, under the nipple, under the arm or hidden in the navel (belly button).
How may I find out from the FDA the present status of breast implants?
The FDA toll-free consumer information line number is 888-463-6332. Ask for the book “Breast Implants - An Information Update”. A lot of up-to-date information can be obtained from the FDA.
How long will the implant last?
The exact lifespan of an implant is unknown and varies from woman to woman. Implants last many years in some women and have to be replaced more frequently in others. Saline implants are expected to deflate eventually and may have a lifespan of only 5 to 10 years though they may last longer. The person choosing saline implants should expect to require further surgery at additional cost to themselves to repair or replace implants in the future. Some manufacturer warranties may apply.
How is the size of the implant determined?
By discussion with your surgeon. Your surgeon wants your new breasts to have a pleasing, balanced appearance in proportion to your shoulders, chest and hips. Filling a plastic sandwich bag with water and placing it in the bra can help determine the size desired.
Can one breast-feed if she has implants?
Even women without breast implants are sometimes unable to breast-feed. For this reason, breast-feeding with implants can’t be assured. The implant is placed between the breast gland and the pectoral muscle or under the muscle and does not usually interfere with the normal functioning of the milk ducts. Many women have been able to breast-feed successfully after breast implant surgery. Dr. Hendrick can locate incisions so as to maximize this possibility, but the patient has to accept the chance breast-feeding won’t be successful. Furthermore, the repeated engorgement and relaxation of nursing breasts can produce a lasting sagging and drooping of the breast, which could compromise your long-term result. If you feel you want to breast-feed, you may do so with the above facts in mind.
Will I still have feeling in my breast and nipples?
Yes, usually. There may be reduced feeling right after surgery. With few exceptions sensation improves in a few days to a few months. There can be some permanent numbness.
Can I expect any problems or complications with my breasts after implant surgery?
Yes, possibly. Although thousands of women have implant surgery each year, each person’s reaction to surgery is different. Breasts with saline implants may not look or feel normal. The most common problems are hardness, loss of sensation, hematoma, infection, rejection, deflation, asymmetry, wrinkling or rippling, distortion, rupture and interference with mammography and breast-feeding. Cancer and autoimmune disease may occur with or without implants but at this time there is no proven association between breast implants and development of these diseases.
What may I do after the surgery? How long will it be before I can start normal activities?
Some of this depends on where your incisions and implants are located. For the first few days you must rest and relax. You will be wearing a jog bra without underwiring. You may sit or lie on your back or either side. You may be up to the bathroom and for meals. There should be no housework at all for the first two to three days. After three days, all “normal activities” may be resumed, except for strenuous exercise and heavy lifting. Most strenuous activities can be resumed after four to six weeks. Following surgery, Dr. Hendrick will give you specific instructions regarding your participation in everyday activities and athletics.
How will I feel?
You will feel drowsy as the anesthetic wears off. You may feel some soreness, swelling or discomfort, but this is quite natural. You may feel tired and exhausted. These feelings are normal and usually last only a short while.
How much will the entire procedure cost?
Fees will vary depending on your unique anatomy and needs. However, a “typical” breast augmentation at Heartland Cosmetic and Reconstructive Surgery costs as little as $3800 (cash discount price) and includes surgery, surgery suite, anesthesia and follow-up visits.
Is breast implant surgery covered by medical insurance? Usually not, but this too can vary. It is a good idea to check with your insurance company ahead of time if you have questions.
Can breast cancer be detected if one has implants?
Breast implants are not known to cause, but may delay, detection of breast cancer. Self-examination should be performed once a month about a week after your period, when the breasts are usually not tender or swollen. This is recommended by the American Cancer Society (ACS) whether or not there are breast implants. Mammograms are more difficult to interpret after augmentation but can be supplemented with ultrasound when necessary. It is still important to get mammograms regularly after age 40. This recommendation is the same whether or not there are breast implants. Any lump that develops needs to be diagnosed. Most breast lumps are benign.
Can the breast implants be broken?
The material is very elastic and easily stretched, thus it is difficult to break the implant. Patients have been victims of blunt trauma to the chest sufficient enough to fracture their ribs, yet did not rupture the implants. This does not imply that they absolutely cannot be broken, but it would take a considerable force to break an implant. If in the unlikely event it did break, it would have to be replaced.
Does flying affect breast implants?
Flying does not affect the implants. Many stewardesses have implants and fly almost every day.
Are patients put to sleep for this surgery?
The surgery is successfully performed with IV sedation and local anesthetics, which speeds recovery and minimizes postoperative nausea. The surgery can also be done using general anesthesia.
Why do some breast implants develop firmness?
An unusually thick capsule of scar tissue that forms around the implant causes the firmness. Some scarring is expected and necessary to maintain the position of the implant. Some people form thicker scars than others do. The newer implants seem to cause less scar formation. Implants placed beneath the chest muscles may have less tendency to form thick capsules.
Can a person go bra-less after breast implants are placed?
Certainly, if inclined to do so. However, a bra should be worn during jogging, running, tennis, horseback riding, and any other time the breast might get jostled.
What about more information?
Besides the information and product literature we provide to you, you can also get more information from the following resources:
The American Society of
Cosmetic Breast Surgery
1-949-645-6665
www.ascbs.org
Mentor Corporation
1-800-Mentor8
www.mentorcorp.com
McGhan Corporation
1-800-624-4426
www.mcghan.com
Food & Drug Administration
1-888-info-FDA www.fda.org.gov/cdrh/breast implant
If you are interested in learning more about breast augmentation at Heartland Cosmetic and Reconstructive Surgery, please contact our office at 1-866-760-0900 or 785-309-0900.
POST OPERATIVE INSTRUCTIONS
YOUR FIRST 24 HOURS
A family member or friend must drive you home because you have been sedated. Someone should stay overnight with you. If you have any questions, please ask one of our nursing staff.
POSITION
During the first week, attempt to sleep on your back instead of on your side. We want your implants to stay in a perfect position during the initial healing process. This is not a “life or death” issue. However, if you cannot sleep on your back, sleep in another comfortable position. Elevate your body from the waist up on two pillows. You may need assistance getting up and down.
MEDICATIONS
You will be given prescriptions for your comfort and care. It is important that you use the medications as directed unless you experience abnormal symptoms that might be related to medication usage. In general you will be prescribed pain medication, an antibiotic, and a muscle relaxant. Symptoms such as itching, development of a rash, wheezing, and tightness in the throat would probably be due to an allergy. Should these occur, discontinue all medications and call the office for instructions.
ASPIRIN AND ANTI-INFLAMATORY PRODUCTS
There is a risk of developing bleeding into your wound area for two weeks after surgery. For this reason, aspirin and anti-inflammatory over-the-counter products (Motrin, Ibuprofen, Advil, etc.) must be avoided for two weeks after your surgery. If the pain medication we prescribe is insufficient or not tolerated during this period, please let my office know and we will prescribe an alternative.
VITAMIN E
Start vitamin E 1000 units daily one week post breast augmentation. (Take for one year or more.)
MASSAGE
Begin breast massage two to four days after surgery IF directed. This should be done for about five minutes, three times a day, for two to three months. After surgery, we will instruct you how to do this massage, if indicated.
ACTIVITY
You should be resting the remainder of the day of surgery. Elevate your body on two pillows. You may want to sleep in a recliner or lounge chair. You may need assistance getting up and down. After three days, all “normal activities” may be resumed, except for strenuous exercise. During the first week, do not lift over 10 pounds. Avoid lifting children, pets, or any heavy objects for 8-10 days. When you do lift children or objects, hold them closely to your chest to avoid straining your arms and lift with your legs, not your waist. It is important that you not engage in strenuous activities in the first 3 weeks after surgery. Aerobic exercise will raise your blood pressure, which could cause late bleeding and harm your results. Jogging, tennis, swimming, golf and the like may be resumed 4 weeks after surgery. Do not use a hot tub or soak in a tub with breasts under water for 6 weeks. Let your body tell you what you can do or not do. If you job keeps you sedentary, you may return to work when you feel comfortable, several days after surgery.
DIET
If you have any postoperative nausea, carbonated sodas and dry crackers may settle the stomach. If nausea is severe, call our office. If you feel normal, start with liquids and bland foods, and if those are well tolerated, progress to a regular diet.
SMOKING
Smoking reduces capillary flow in your skin. We advise you not to smoke at all during the first 2 weeks after surgery.
ALCOHOL
Alcohol dilates the blood vessels and could increase postoperative bleeding. Please do not drink until you have stopped taking the prescription pain pills, as the combination of pain pills and alcohol can be dangerous.
DRESSINGS
Depending on the incision used, you may be asked to wear a sports bra, a binder strap, both, or nothing at all. After surgery there will be bandages over the incisions. There may be blood on the bandages. IF bleeding appears excessive don’t hesitate to call my office or answering service. The bra and/or breast strap act as a “dressing” holding the breasts and implants in perfect position. Try to keep the bra “even”. We will typically want you to wear the bra and/or strap at all times, 24 hours a day, until Dr. Hendrick informs you to change this routine (typically from one to six weeks). After this one to six week period,
Dr. Hendrick will instruct you as to what type of bra and/or strap routine to follow. Do not wear an underwire bra for 3 months IF your incision is in the fold of the breast.
SHOWERING AND BATHING
You may shower after Dr. Hendrick removes the bandages the day after surgery. Leave any adhesive strips (Steri-Strips) on your skin. (Do take your bra off while you bathe.) If you prefer to bathe, do not allow the incision lines to soak for more than a few minutes in the bath water. If no adhesive strips (Steri-Strips) were used on your skin (e.g. armpit incisions), clean the incisions twice a day with peroxide.
SHAVING AND DEODORANT
IF your incisions are in the armpit, do not shave or use deodorant in the armpits until the sutures are removed.
SUTURES
Dr. Hendrick will remove the sutures approximately one week following your surgery.
EXPOSURE TO SUNLIGHT
Scars take at least one year to fade completely. During this time, you must protect them from the sun. Even through a bathing suit, a good deal of sunlight can reach the skin and cause damage. Wear a sunscreen with a skin-protection factor (SPF) of at least 15 at all times when in the sunshine. Be extremely careful if areas of your breast skin have reduced sensitivity--you might not “feel” a sunburn developing!
DRIVING
You may drive when driving does not cause pain and you are no longer taking pain medication. This usually occurs in 4-6 days if you have a car with power steering.
SEXUAL ACTIVITY
You may enjoy sexual activity as your body allows with the following restriction: Please reread Activity above and apply the same concept to sex.
POSTOPERATIVE APPOINTMENTS
It is very important that you follow the schedule of appointments we establish after surgery.
HEALING OF SENSORY NERVES
Regeneration of the sensory nerves is accompanied by tingling, burning, or shooting pains, which will disappear with time and are nothing to be alarmed about. If, however, this is accompanied by swelling or redness, infection, or bleeding, then you will need to see Dr. Hendrick at the office.
ASYMMETRY
It is quite common for the two breasts to heal differently. One may swell more, one may feel more uncomfortable, or the shapes may differ initially. After complete healing, they should look remarkably similar and natural. Patience is required, but if you are concerned, ask questions of Dr. Hendrick or the nursing staff.
"SLOSHING SENSATION"
You may hear and feel “sloshing” in your breast after surgery. This is not the implant! It is the air that is trapped in the space around the implant and the natural fluid that accumulates after an operation. It will be absorbed by the body within a few weeks.
SHINY SKIN
The skin of your breasts may become shiny. This is a result of the swelling that occurs after surgery. Within a few weeks, the edema and the swelling will subside and the skin will look more normal.
SENSITIVITY
As the nerves regenerate, the nipples commonly become hypersensitive. This will subside with time. You may find that gentle massaging helps.
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