Breast augmentation is the most common surgical procedure that the majority of cosmetic surgeons perform. It is also one of the most satisfying procedures for both patients and surgeons alike. My technique for breast augmentation has evolved over the past 20 years. I would like to share with you the way I do breast augmentation.
Patient selection: Most patients interested in breast augmentation are healthy, fortunately. However, we still have to check to make sure they do not have any issue with severe overweight and bleeding/clotting problems. It is also important to recognize if there is tuberous breast deformity or droopiness (ptosis). These conditions will likely require additional procedures. We also spend quite a bit of time discussing the sizes of implants. I have found that sizers provide invaluable realistic “preview” of what a particular size of implants will look like.
Type of anesthesia: I use general anesthesia for breast augmentation. Nerve block or sedation alone, in my opinion, is not adequate.
Place of surgery: I do all my breast augmentation operations in an AAAASF certified ambulatory facility, Sandia Surgery Center. The ambulatory center setting provides the most sterile and safest environment for surgery with maximal efficiency. It also provides the most professional individuals who are most familiar with all the procedures and who have worked with me for many years.
Incision: I prefer under-the-crease incision of the breasts. In the vast majority of patients, the incision is about 1.5 inches long and heals very well in an inconspicuous location. The same incision also provides an easy access if re-operation, such as change of implants, should be performed in the future. I would be happy to discuss with you the other alternative incisions during a personal consultation.
Placement of incision: With very few exceptions, I place implants under the pectoralis major muscle layer. I feel strongly that the submuscular placement reduces the chance of capsule contracture, provides a softer appearance over the implants, and reduces the droopiness over time.
Type of implant: Saline or silicone? Smooth vs textured? Anatomic vs round? Regular gel or “gummy bear” (ShapeStable)? There are certainly many choices. In fact, too many. In the past couple of years, I have used silicone implants in over 90% of cases, and it is getting higher. I also generally use round, smooth, moderate plus profile Mentor implants most of the time. Of course, the final decision is made on an individual basis.
Closure: I generally do not use drains, and I place long-lasting anesthetic medication into the implant pockets to reduce the post-op pain. Absorbable sutures are used in the closure so that no stitches will need to be removed.
Duration: From the time of entering the operating room to the time of exit, the breast augmentation surgery usually take about one hour.
Recovery: Most people spend about 30-40 minutes in the recovery room (PACU). Patients report feeling tightness of their chests, although the pain experience can vary quite a lot. I tell patients not to lift their arms overhead and not to lift over 5 pounds for the first 5 days. It is important to get up and walk to prevent blood clots in the legs (DVT). If your job is not physically demanding, you may be able to return in 4-5 days. Most people are able to do some exercise by 5 days and can do more vigorous exercise in 3-4 weeks.
I have tried to cover some important questions that many patients have asked over the years. Hopefully, this outline addresses your concerns. For your personal free consultation with me, call my office please.