DR. EPSTEIN’S COMPREHENSIVE Breast Augmentation Guide

Anesthesia – General, Sedation or Local?

One-Day Recovery Breast Augmentation – The Process

There are 5 key decisions that need to be made with every breast augmentation surgery:

Four main components that make up the process of the One-Day Recovery Breast Augmentation:

  • Patient education
  • Tissue based planning
  • Refined surgical technique
  • Defined post-operative care

Patient Education

Each of the above processes is important, however, patient education is unfortunately often neglected. Even though the surgical procedure may be performed flawlessly from a technical standpoint, without proper pre-operative education the patient will not have an ideal outcome. In fact, one of the main purposes of this website is to provide patient education. The goals of the educational sub-process are:

1. Educate the patient on the practice philosophy. It is essential that the patient understand the rationale for decisions made regarding her breast augmentation procedure. She not only needs to understand how and why the surgery will be conducted a certain way, but also for the patient to assume mutual responsibility that the implant will be selected based on her chosen preferences and in accordance with her breast dimensions and tissue.

2. Via direct doctor-patient interaction, the patient will review her own photographs and understand which key aspects of her augmentation surgery should and will be addressed pre-operatively. She will understand basic concepts including the fact that no patient is 100% symmetric and understand the limitations in correcting these asymmetries, reasons for implant palpability and the likelihood of shape changes in the breasts with time.

3. She will have an expectation of approximately a 98% chance of returning to most normal activities of daily living within 24 hours, 97% chance of requiring nothing more than tylenol or ibuprofen for post-operative discomfort after surgery and a 99+% chance of being able to raise her arms above her head after surgery before leaving our surgical facility.

Tissue Based Planning

Soft tissue based planning is a scientifically proven and published (John Tebbetts, M.D. – Journal of Plastic and Reconstructive Surgery) method associated with not only a recovery in 24 hours or less, but also the lowest three-year re-operation rate. Implant size is chosen based upon a series of measurements of the breast that can be obtained in about three minutes. Proper implant size selection, along with precise pocket dissection optimizes the implant and soft-tissue relationships for the aesthetically most pleasing breast, the shortest recovery time, the lowest re-operation rate and the greatest longevity of the surgical result.

Refined Surgical Technique

Along with greater precision in pre-operative planning, refinements in surgical technique minimize blood loss, local tissue trauma as well as the risk of implant malposition and the need for surgical revision. Using instruments of my own design, the breast tissues can be handled in a very delicate manner with minimal trauma.

Defined Post-Operative Care

Pre-operative planning and delicate surgical technique are only simply not enough! A post-operative “recipe for recovery” (a term coined by Dr. Tebbetts) has been created to help your body “adjust” to the recent surgery and presence of the implants. A treatment regimen has been developed to allow your body to ease into it’s new form with the least amount of disruption to your normal activities.

If your surgeon cannot provide you with all four elements as described above, give you an expectation of a return to normal activities (except strenuous exercise) without any narcotics, pain pumps, placement of long acting local anesthetics inside the implant pocket or special bras, straps and gadgets, then he/she is simply not offering you the procedure as described above.

Why do I go to these lengths to perform breast augmentation surgery? It certainly would have been easier to stay at the status quo. Here is why I do it:

Patient education and surgeon commitment are key requisites to delivering this level of care. My patients are well educated and understand that achieving another level requires their commitment to a scientifically proved process, not just their subjective desires. Patients seek my opinion because I want to learn, have learned, and can deliver a different level of recovery and outcome. When I explain to them what is possible, and the level of scientifically published data behind it, no patient would choose a “traditional” or “rapid” recovery when they can have a 24-hour recovery. Are my colleagues skeptical as to whether I can produce these results? Absolutely yes! And remember, my patients have been experiencing a recovery from breast augmentation in 24 hours since 2004!!! Read my 2013 letter to the editor in Journal of Plastic and Reconstructive Surgery entitled “Nothing Dubious or Unpredictable About 24 Hour Recovery in Breast Augmentation.”

This system was created to be both reliable and reproducible for any surgeon who is willing to learn it and commit to implementing its principles. I am a testament to that. Twenty-four–hour recovery works. It is better for us as well as our patients. When processes are clearly defined and published enabling a patient to be out to dinner and shopping instead of at home in pain, nauseated from narcotics, bound in dressings, with limited mobility, how can a surgeon not at least try to offer a patient the “out-to dinner/ shopping option”?

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