FAQ’s – Breast Augmentation 3

How are the wounds dressed?

After the implants have been inserted and positioned, the incisions are closed. Steri-Strips are applied to the wounds. No additional bandages, bras, garments or other dressings are needed. Scars will begin to fade in a few months and will continue to fade for months or years.

What is the “One-Day Recovery™ Breast Augmentation^™Technique?”

Dr. Epstein performs all of his operations with great care and precision, ensuring that his patients can enjoy a quick and healthy recovery. “One-Day Breast Augmentation Surgery” is Dr. Epstein’s name for a technique based upon the pioneering work of John Tebbetts, M.D. Dr. Tebbetts was the first to describe a technique of breast augmentation with a recovery time of 24 hours and features dramatically less post operative discomfort, blood loss and downtime. One of the best parts about the technique is the fact that the reoperation rate (less than 2%) is far less than the national average (about 20% for silicone gel implants). Dr. Tebbetts personally taught Dr. Epstein this technique in 2004.

With standard breast augmentation surgical techniques, women following breast augmentation surgery complain of a considerable amount of pain, swelling, and bruising. Dr. Epstein employs the “One-Day Breast Augmentation Recovery Technique” in which the amount of swelling is minimal, bruising rarely occurs and post operative discomfort is dramatically less. Our patients can raise their arms up high over their heads before leaving the recovery room. Some of our patients have even brushed their hair and applied makeup before leaving the recovery room to go home!

You may have some soreness and minor discomfort, but in our experience you will most likely not need narcotic pain medicine. Patients typically describe what they feel in the first 24 hours after surgery as a “sense of tightness” rather than that of pain. We will give you a detailed set of postoperative instructions to assist and guide you through the first days after your surgery. When these instructions are followed, a 24 hour return to most activities of daily living (with the exception of heavy strenuous exercise) including driving and returning to work is anticipated.

Although there are no guarantees with any type of surgery, we can offer you information obtained from our extensive experience with this technique. Dr. Epstein surveys his patients following breast augmentation surgery. His 2007 survey revealed that 92% of his patients required nothing stronger than ibuprofen (Advil) after surgery and 86% of his patients returned to normal activities the following day (except strenuous exercise), including driving in most cases. Dr. Epstein continued to refine his technique. In 2009 and 2010, patient surveys demonstrated that 97.5% of his patients required nothing stronger than ibuprofen (Advil) after surgery and 100% of his patients returned to normal activities the following day (except strenuous exercise), including driving in most cases.

Heavy lifting or straining should be avoided after breast augmentation surgery. You can typically return to work within a few days unless your work requires strenuous effort. The sutures are all dissolvable. There are no bras, bandages or straps required after surgery. Showering is encouraged the same day as your surgery! Any post-operative discomfort, swelling, and sensitivity will diminish over the first few weeks. Sensation in your nipples may be altered temporarily, but should return to normal as your breasts heal.

After healing, some permanent scarring may remain, although scars from breast augmentation incisions will typically begin to fade in a few months and will continue to fade for months or years. Scars placed within the crease below the breasts are usually inconspicuous. Dr. Epstein’s goal will be to make them as unnoticeable as possible.

How will I feel immediately after breast augmentation?

Breasts will probably be mildly swollen, rarely bruised and there may be some discomfort for a few days but this will pass. There may be numbness in the breasts and nipples, and this should lessen as time passes. There may be some hypersensitivity of the nipples after this, but this too shall pass and is only a minor annoyance. Most patients do not need narcotics after surgery. In Dr. Epstein’s experience using the “Rapid Recovery” breast augmentation technique, there is no increase in discomfort with placement of the implant below the muscle. In fact, Dr. Epstein places all his implants below the muscle. Using the Rapid Recovery technique, 92% of his patients require nothing stronger than Ibuprofen (Advil) after surgery. 86% of patients resume normal activities (except strenuous exercise) the very next day!

How long does recovery take?

Most patients feel tired and sore after surgery, but this usually passes in a day or two and many patients return to work within a week, although occasionally later. Any post-operative pain, swelling and sensitivity will diminish over the first few weeks. You should avoid strenuous exercise for the first three weeks.

Complementary Procedures

Breast augmentation can achieve dramatic and beautiful results on its own as well as in conjunction with other cosmetic surgery or non-invasive procedures. We sometimes recommend combining breast augmentation with other procedures such as a breast lift for more satisfying results. This is most commonly recommended to treat any sagging that has resulted from aging or pregnancy. During this combined procedure, some breast tissue is removed, the breast skin is tightened and lifted, and an implant is inserted. Note that most women, even those with some sagging after pregnancy, do not require a breast lift concurrent with breast augmentation. Dr. Epstein will evaluate you and discuss whether or not such additional surgery is indicated in your specific case.

Am I a good candidate for breast augmentation and mastopexy?

If you have sagging breasts and loss of fullness in the top portion of your breasts, you are likely a candidate for the breast augmentation. Depending on the degree of sagging, and whether the sagging involves the breast tissue alone or breast tissue and the nipples, you may be a candidate for a breast lift (mastopexy) procedure, either in concert with, or without, a breast augmentation procedure..

When can I expect to return to work and resume my normal daily activities?

It will take several days to return to normal activities after your breast augmentation and mastopexy procedure. However, it is important to your recovery that you ambulate around during that time. Dr. Epstein uses a specialized “Recipe for Recovery” to hasten your recovery. After the procedure, it is often possible to return to work within a week.

Strenuous physical activity should be avoided for at least the first three weeks following surgery. After that, you should be well-healed. If you have any questions about what you should or should not do, ask Dr. Epstein.

What are the risks and complications of breast augmentation and mastopexy?

Complications following breast augmentation and mastopexy surgery are rare and usually minimal. The possible complications associated with breast augmentation and mastopexy include capsular contracture, swelling and pain, infection around the implant, a change in nipple sensation, and breakage or leakage of the implant (implant rupture).

Many possible complications associated with breast lifts and implants can be avoided by choosing an experienced and well-trained surgeon. Dr. Epstein performs all of his operations with the goal of minimizing all possible complications and ensuring his patients’ satisfaction.

Will there be scarring?

Scars are a part of the breast augmentation and mastopexy process. Fortunately, breast augmentation and mastopexy scars, regardless of where they are located, tend to heal extremely well. Scars following breast augmentation are usually small and inconspicuous, and Dr. Epstein will make sure the scar is as unnoticeable as possible. A mastopexy does add additional scars such as around the areola, and occasionally a vertical scar from the bottom of the areola down towards the lower breast crease. In some occasions, an incision is made in this crease as well.

Does breast surgery cause scarring?

Yes, although scars can be hidden with a bra, bathing suit or low-cut top. During surgery, incisions are made in inconspicuous places on the breast to minimize scar visibility (in the armpit, in the crease on the underside of the breast, or around the areola, the dark skin around the nipple). Scars do fade with time. The ultimate result is a combination of the plastic surgical techniques that Dr. Epstein uses to close the wound and your natural biology of wound healing, a factor that neither Dr. Epstein nor you can control.

How will my breasts look and feel after a breast lift with implants?

Breast implants will add to the overall results of the breast lift procedure by lifting the breast and increasing your bust size in a single step. Some discoloration and swelling will occur initially after the procedure, but this will disappear quickly.

After recovery, many women equate the feel of their breasts implants to that of a teenage girl with young, healthy, firm breasts. And when you undergo the breast augmentation combined with a breast lift, your breasts will typically remain full and perky for longer.

Can I breastfeed after the breast augmentation and mastopexy operation?

You will most likely be able to breastfeed after the breast lift with implants procedure, but it may depend on the kind of surgery you had and the type of incisions required.

Will insurance cover the breast lift with implant procedure?

Insurance companies do not usually cover implant surgery performed for cosmetic reasons.

Is breast augmentation and mastopexy too much surgery to do on the breast at one time?

No, breast augmentation combined with mastopexy is not too strenuous on the breast, and the downtime is no more than if only one procedure was performed. Often, when mastopexy and augmentation are performed at the same time, less skin has to be removed, which may result in less scarring.

Should women who are pregnant or plan to be pregnant wait before undergoing breast augmentation surgery?

Women planning to have children do not need to postpone surgery, since breast implants should not affect your ability to breast-feed.

What is out of the surgeon’s control?

There are two things that the surgeon cannot control: wound healing and tissue stretching.

Despite the most meticulous wound closure, a scar may be raised, thickened, widened or pigmented. The final appearance of the scar is due to a combination of factors, most importantly including the way the surgeon closes the wound AND the patient’s biologic tendencies towards wound healing. Some patients just naturally make great scars, and some make less than ideal scars. In my extensive experience with breast augmentation, I have found that in the vast majority of patients, the scars are thin, fade nicely and are not an issue for patient and partner. Occasionally, a scar may be hypertrophic (thick and raised). Fortunately, this is considered rare. Treatment for such scars includes intralesional injections of steroid preparations, scar massage and avoidance of sun exposure.

Any time a foreign material is implanted into the body, scar tissue “capsule” forms around it. Breast implants are no exception to this rule. Most of the time the capsule is thin and pliable, and is neither visible nor palpable and does not affect the aesthetic result of the augmentation in any way. Textured implants were developed to try to minimize scar tissue capsule contracture from occurring. Occasionally, the scar tissue capsule may thicken and contract. This will cause the breast to feel firm and hard. Occasionally, in very rare instances, the breast may be painful. The problem is not the breast. It is not the implant. It is the scar tissue contracting tightly around the implant. Treatment consists of removing the implant and the scar tissue, either in whole or in part, and then replacing the implant. In very rare cases, and I have not had this happen in my practice to date, if a woman has this problem happen twice to the same breast, I would recommend removal of the breast implants and not replacing them.

Whenever a breast is augmented with an implant, it stretches. The degree of stretch is usually appropriate for the size and shape of the implant. Occasionally, the lower pole of the breast may stretch more than is desired. This makes the implant look like it has been placed too low. When I have seen this problem, in the vast majority of cases, the amount of excess stretch is minor and not of concern to the patient. In very rare cases, it may require a surgical revision to be performed in the operating room. Excess tissue stretch, although rare, is somewhat unpredictable. I have seen it happen with good quality tissue and not happen with poor quality tissue. I have seen it happen with smaller breast implants, but not with larger implants. A general rule of thumb is that as you go larger than the recommended size implant, or if the tissue quality is compromised, you will run an increased risk of excess tissue stretch occurring.

Complications That May Arise

Complications following breast augmentation surgery are uncommon. They may include capsular contracture, swelling and pain, infection around the implant, a change in nipple sensation, and breakage or leakage of the implant. Some other complications that may arise from breast augmentation surgery are described in more detail below:

Rupture

As breast implants are mechanical devices, they may fail. When saline breast implants fail, they often deflate quickly and can be easily removed. Device failure rates are approximately 1 – 2% per year, which is small. In the case of saline implants, the valve used for inflation is a common reason for device failure. Silicone gel implants do not have a valve. If the shell cracks, saline or gel may leak out. Your body will absorb the saline with no untoward effects on your health. If a gel implant should rupture, the scar tissue capsule described subsequently in this article will usually contain the gel. The gel is biologically inert and poses no threat to your health, either. Today’s breast implants are made much more durable than previously. A silicone gel implant is made to withstand a compressive force equal to twenty five times that sustained during a mammogram. Over the course of your lifetime, a breast implant may fail and require replacement. Replacement is usually a very simple surgery.

Alterations in Nipple and Breast Sensation

The most common alteration in nipple sensation is a heightened sensitivity, which resolves shortly. In more rare cases, nipple sensation may be diminished which is usually temporary, but can be permanent.

Infection

Infections after breast augmentation surgery are very rare. Many can be treated with oral antibiotics alone. Should the infection involve the implant, the implant may need to be removed so as to allow the body to clear the infection. After six months, the implant may be replaced.

Need for Re-operation

Regardless of the type of implant, it is likely that women with implants will need to have one or more additional surgeries (re-operations) over the course of their lives. Reasons for a breast augmentation re-operation may include the following: capsular contracture, wrinkling, asymmetry, rupture/deflation, and excessive tissue stretching as described above.

Capsular Contracture

Occasionally, the scar tissue capsule that forms around the implant thickens and contracts. This makes the implant and the breast feel hard. When this happens to a mild degree, nothing needs to be done. When the breast gets hard, there is pain or distortion of implant shape, then the capsule needs to be removed and the implant replaced. The exact cause of this is unknown, but two theories are: 1) accumulation of blood around the implant after surgery. Dr. Epstein uses a near bloodless technique when performing the surgery, which helps to minimize the risk of this problem, 2) low grade infection around the implant. Again, Dr. Epstein pays great attention to sterile technique during surgery, incorporating not only two different intravenous and post-operative antibiotics but also a triple antibiotic irrigation during surgery and a special way of draping the surgical field so as to minimize contamination of the wounds. 

Complications

Complications following breast augmentation surgery are uncommon and usually minimal. Although rare, some complications that may occur include capsular contracture, swelling and pain, infection around the implant, change in nipple sensation, decreased milk production while nursing, and breakage or leakage of the implant (implant rupture) as a result of injury. Regular monitoring of breast implants after breast augmentation is recommended to ensure continuing breast and implant health.

Summary

Breast augmentation surgery is one of the most commonly performed cosmetic surgical operations. The surgery is brief, the recovery fairly unremarkable and complications are uncommon. Depending on your age at presentation, you may need to undergo an additional procedure on your breasts at some time in your lifetime.

Recently, women have been given the ability to choose between saline and silicone gel filled breast implants. The latter often produce a surgical result with an unparalleled natural feel to the breasts.

Most women who have undergone breast augmentation have a high degree of satisfaction with their surgery and often enjoy a greater sense of self-confidence and pleasure with their new body contours.

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