| Dr. Ann Reilley is a plastic surgeon certified by the American Board of Plastic Surgery. Here the Doctor has answered some of the common questions bizymoms visitors have about Breast Augmentation.
Q. What is breast augmentation?
A. A breast augmentation is simply a surgical procedure aimed at increasing the volume of the breast and it is now done by using an implant either filled with saline or salt water or a silicone gel. This implant can be placed either on top of the pectoralis muscle or underneath it. It is typically done under general anesthesia. However, some surgeons do use local anesthesia with some intra venous sedation. The procedure spans over one hour and is performed as an outpatient.
Q. How should one prepare for breast augmentation surgery?
A. Well I think the first thing is to think why you want to have this surgery. It is important for you to only want to do this for yourself and not to please anyone else. So make sure you have the right motivations.
Then I think you have to have some realistic expectations about what we can achieve. For example, if you are a patient and you’ve had four or five children and you’ve breast fed and you have a lot of loose and saggy skin, you are not going to look like an 18 year old girl who has never had any children. Being realistic about your goals is important.
Once you’ve realized that your expectations are reasonable then you need do a careful research on the surgeon who you are going to approach. There are plenty of different ways to find out about a surgeon. A few ways may be word-of-mouth, Internet research, asking your own gynecologist or family doctor or looking out for somebody who has a good reputation in the community. Make an appointment and have a consultation with the surgeon because the doctor-patient relation is very important. Also this is an entirely elective operation and so I think that it is important that you, as the patient, must feel extremely comfortable with your doctor. You must feel like he will really listen to you and understand your goals and not just place his own ideas and simply try to put forward his own aesthetic goals, without taking into account what it is that you are trying to achieve. And if you don’t have a good feel for the doctor, I feel you should go with your instincts. After all, some combinations just aren’t a good fit. Go on and try to get a second or third opinion.
Again it is important to realize that this is completely elective surgery. I always like to tell people that I realize that nobody needs any of what I have to offer. It is simply something that you want. Since it is elective, I strongly feel that we have to set the bars of our standards much higher than other surgeons and other types of surgery.
Another thing is that during a consultation, it is important to be very honest with your doctor about your medical history. Remember that one way to guarantee a bad result is to lie to your doctor. For instance, if you are a heavy smoker or if you have diabetes or other medical illnesses, we need to know about that. This is surgery and it’s nothing like going to a hair salon. Communicate honestly with your doctor about your medical history.
Q. How is a breast augmentation surgery performed?
A. When I see a new patient, I like to get an idea of about why they have come to see me and what their goals are. In case they are coming in for breast augmentation surgery, I remind them that they have just two decisions to make. One is regarding the type of implant that they would like to use and then the size of the implant. Occasionally some patients who come in have an idea of what they want, whereas others are not too sure. We show them each of the two implants and let them get a feel of it. Although it is not as if one is good and one is bad, each one has its own set of qualities.
A saline implant is less expensive. Since we put it in empty, for the incision we can use a smaller incision, which is usually about 3 centimeters. Generally I prefer to use an inframammary fold incision. The downsides of the saline implants are that they are slightly heavier and they tend to have more fill in the bottom portion of the breast than the top portion, which we call the upper pole. Saline implants always have to be put underneath a muscle – if the patient is extremely thin you may be able to feel or see some rippling of the implant on the lower outer portion of the breast.
The gel implant has a very nice feel, it is a little bit lighter and so it maybe better suited for someone who doesn’t have good skin elasticity. It does a slightly better job of preserving the upper pole fill. It is a slightly more expensive implant and requires an approximately 5 centimeters incision to insert it because it comes pre-filled. In some instances it can be put on top of the muscle and in those cases a quick recovery is guaranteed.
Anyhow, once the patient has come to a decision about what kind of implant they prefer, I then get a bra in their bandwidth. I also get some different sized gel implants to use as sizers. The patient will put in an implant in the bra on top of her breast and put back on her clothing or blouse on and take a look in the mirror. In this manner, I will make sure they try many different sizes of implants till they find a size, which gives the look that they want. I think this has been a really valuable tool because the patient, in this way, is participating in the decision about the size of implants that they are going to get. When patients have more ownership in the decisions, I think they end up happier with the final result rather than just saying, "Doctor you just pick what you think will look right." This is because my aesthetic goal and what I think is right might not be on sync with what they want. I think this has been a great tool for my patients.
Prior to surgery we will record the size they liked and during the surgery, we have sterile sizers in the size range that they selected, either saline or gel depending on what they chose. We actually put a sizer into the pocket and sit them up and let them take a look. So the final decision is actually made in the operating theatre.
Anyway, before surgery, once they have decided the type of implant and size, they will have photographs made and we get them to sit with our counselor who will assist with the financial aspects. He or she will also help them select a surgery date and then they will come to the office on the day of their surgery, usually an hour ahead of their scheduled time. They can then meet with the person who is going to put them to sleep. They can also have any final questions answered. Once the surgery is over, they will recover in my office recovery room and will go home a few hours after they arrive.
Q. What are the possible longer-term, local effects in breast augmentation surgery?
A. There’s no doubt about the fact that the breast implant will compress the patient’s remaining tissues so this is a decision that we should remember is permanent – it’s not as if you can have some implants put in and if you don’t like them, you will take them out a year later. Because what happens after the implant has been in place for sometime is that if you were to remove it, the patient’s breasts would look smaller than what they were before. Also the patient needs to know that neither the saline nor the gel implants are lifetime devices. Therefore, repeated surgery, for an implant failure, such as when a saline implant is leaking or implant malposition, there will be a need for other surgeries down the line. The average life span of a saline implant is ten years and in the case of a gel implant, it is likely to be fifteen to twenty years. But patients need to understand that it is not as if one surgery can last an entire lifetime.
Q. Who is a good candidate for breast augmentation?
A good candidate is a patient who is doing this surgery for herself and not for anyone else. Also someone who has realistic expectations and realizes we can’t recreate breasts of an eighteen year old on somebody who has had a number of children. This might also include somebody who won’t pick an outlandishly large size for her breast because over time large implants tend to stretch out and eventually they bottom out and simply don’t look good. The patient has to be in a reasonably good state of health and must understand that they will be back for surgery whether it is 5 or 10 or 15 years down the line.
Q. What type of anesthetic is used for breast augmentation surgery?
A. I personally use general anesthesia so that the patient is completely asleep. However, there are plenty of other doctors who prefer to use a combination of local and intravenous sedation. This really depends on the preferences of the surgeon.
Q. How much does breast augmentation cost?
A. My area of the procedure costs about $5000 and is all inclusive. It might be a little less for saline implants. This figure covers surgeon fees, anesthesia, facility fee and of course the implants. We also do tell patients that whichever type of implant they choose, whether saline or gel, the manufacturers give the patients a lifetime warranty on the product. Even if the patient were to have a failure 10 or 15 years later, they might have to pay a small surgeon’s fee and a smaller OR fee but they would not have to purchase another pair of implants.
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