Breast Augmentation - Cosmetic Surgery

For women who have small breast, an uneven breast, asymmetrical or fallen bust line, breast augmentation with or without a breast lift is a very satisfying procedure. Over the years several new approaches have emerged, along with the availability of different shapes of implants. It is imperative that you carefully review your options, and choose your plastic surgeon carefully. Breast augmentation can be performed once a women's breast have fully developed.

Breast augmentation can be performed in conjunction with a breast lift. The combination of the two procedures has many advantages and disadvantages.
The implant is placed either under or over the pectoral (chest) muscle.
Saline implants are the most common breast implant used in the United States, unless you choose to participate, and qualify for silicone gel implant clinical study. (You must go to a physician who is approved to place silicone implants. You must qualify for silicone study)
You must meet certain requirements to qualify for the use of silicone breast implants.
No known illnesses are associated with saline-filled implants; if the saline implant ruptures, the body will absorb the saline, which is harmless. Saline is salt water.
No known illnesses are associated with saline-filled implants; if the saline implant ruptures, the body will absorb the saline, which is harmless. Saline is salt water.
Saline implants are available with smooth-walled or textured surfaces.
Saline implants do not feel as natural as silicone gel implants.
Numerous worldwide studies have consistently shown no link between silicone gel implants and any illness or disease. However, this does not discount the concerns of women who have questions about the association of silicone and autoimmune diseases.
Implants should not hinder breast self-examination unless there is extreme scarring around the implant. Known as capsular contracture.
Breast implants can interfere with mammograms.
Breast implants can interfere with breast sensation.
Breast implants can interfere with breast feeding.
It is extremely important to notify your mammography technologist of the presence of breast implants; additional views are necessary and special care needs to be taken to minimize the possibility of rupture.

ALTERNATIVES TO SURGERY
There are no known non-surgical method of breast enlargement. Exercise can strengthen the muscle but, it has no effect on the size of the breast. Hormones and over the counter remedies have no effect on the size of the breast.

PREPARING FOR SURGERY
You and Dr. Shureih should be in full agreement on the desired outcome of your breast augmentation and the desired final size of the breast. Bring pictures from magazines showing your desired look and shape. You also might bring in a full-cup bra in your desired cup size. Depending on the laxity of the tissue and the size of your breasts, Dr. Shureih may recommend a breast lift in conjunction with your breast augmentation surgery.

You will also discuss with Dr. Shureih the placement of the implants either above or below the pectoral muscle. The location of the incisions, and the type of implants (silicone or saline, smooth or textured). You will also be given more specific instructions on eating and drinking, smoking and taking vitamins and medications. Carefully following these instructions will help your surgery proceed more smoothly.

THE PROCEDURE
With saline implants, the incisions are just over an inch long because the implants are inflated after insertion into the pocket. A larger incision is necessary for silicone implants because they are inserted in their inflated state.

Three possible locations for the incisions.

Inframammary in the crease underneath the breast.
Periareolar on the lower edge of the areola, as a half circle.
Axillary in the underarm. The implant is placed with the aid of an endoscope.

The implants may be placed either above or beneath the pectoral muscle; each position has its own advantages and disadvantage. Additionally, implants vary in, shape, and texture. Silicone implants are available only to certain patients: those who already have them in place, those who have had repeated problems with saline implants, those who have had a mastectomy, and those who have severe ptosis (drooping) of the breast(s) requiring a lift or patients with specific deformities. Saline implants are inserted before inflation so that there is a smaller incision. These implants are available in round or teardrop shapes, smooth or textured surfaces. Textured implants may adhere better to tissue.

Finally, it is important to remember implants will NOT last an entire lifetime. At some point, you may need replacements or revision, and this fact must be kept in mind when electing to undergo in breast augmentation surgery.

Anesthesia
Breast augmentation is usually performed under general anesthesia, but may be performed under intravenous sedation with local anesthesia especially when positioned above the muscle.

Level of Pain/Discomfort
When the implant is placed above the muscle there is minimum discomfort during the postoperative period. The discomfort may be more pronounced if the implant is placed beneath the muscle. Most discomfort can be controlled with pain medications. Pain pump, a devise that drip local anesthetic into the implant pocket can be used to decrease the level of pain.

PRE- AND POSTOPERATIVE INSTRUCTIONS
The following suggestions are intended to make you feel more comfortable and help you heal:

Stop smoking, discontinue the use of alcohol, and stop taking vitamin E and any medications containing aspirin or ibuprofen three to four weeks before surgery and for three weeks after surgery.
Check with Dr. Shureih regarding any other medications (including homeopathic/herbal products) that you are currently taking.
Do not have food (including gum or mints) or drink (including water) for a minimum of six to eight hours prior to surgery. (Follow the surgical facility's preoperative instructions.)
Have someone stay with you the first night after surgery.
Do not lift anything heavy, or do any heavy activity for three weeks after surgery.
Dressings - this procedure requires a supportive bra, to wear for four to six weeks after surgery. You may want to purchase a second garment to wear while you launder the other. Do not wear an under wire bra, especially if the incisions are in the crease underneath the breast.
Apply cold compresses, usually for twenty minutes every hour for a minimum of forty-eight hours. Do not apply cold compresses to the nipple area.
You must sleep on your back with your upper body elevated for at least the first week to ten days.
The breasts must not be exposed to the sun or tanning beds, especially while bruising is visible, because the pigmentation of the skin may change permanently. Optimally, sun and tanning beds should be avoided completely for skin care and health.

RECOVERY
The initial healing period for a breast augmentation can take, on average, from one to two weeks, however everyone heals differently. Healing is affected by many factors, including your genetics, whether you smoke and/or drink alcohol, pain tolerance, and the extent of the surgery.

The first day after surgery, you will probably experience soreness and tenderness and will probably want to sleep. You can expect some swelling and bruising, which usually heals in two to three weeks. Minor swelling can last as long as six to twelve weeks. Bruising can last up to six weeks. You may also experience some temporary numbness, and itching around the incision sites. If the incision sites itch, do not scratch; instead gently rub them with an antibiotic ointment. Initially the breast looks full, gradually the implant settles and gives the breast a more natural appearance. This may take nine month to one year.

RISKS / COMPLICATIONS
Although problems are unlikely, you must be aware of the complications associated with breast surgery. Complications that can occur include bleeding, hematoma (a collection of blood under the skin), changes in nipple sensation, infection, and asymmetry, which may require another surgery, and scarring. Every effort is made to keep the scars as inconspicuous as possible. Most scars fade over time and become barely noticeable. Capsular contracture, interference with mammogram, interference with sensation, interference with lactation, need for further surgery, deflation, rippling, and unsatisfactory results, too big, too small.

The most common complication in breast surgery is known as "capsular contracture". The body attempts to "wall off" the implant by forming a fibrous capsule around it. The thickness of the capsule formed varies from patient to patient, and the presence of postoperative hematoma or infection. Depending on the severity of the capsule, it may require surgical release or removal and/or implant replacement.

NEW_YOUÖONLY BETTER
Almost all women report enormous satisfaction with breast augmentation surgery. The fuller appearance helps clothing and swimwear look much more appealing. Many women cite that new breasts help to create a more balanced look all over the body, and may give the appearance of a smaller waistline. For women who had extremely small breasts, this surgery can give a psychological boost to self-esteem.