| Dr. George Bitar 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. Breasts are the ageless sign of femininity and sex appeal. Breast augmentation is done now in ways that accentuate the natural healthy look and minimize the "done" look. Small breasts can be enlarged with saline or silicone breast implants placed under the chest muscle to create nice cleavage and give it a natural, sexy look and feel. The key to achieving a natural look is by choosing the right size implant, proper implant type, proper incision location, and proper implant placement. We will try to address some of the issues that a patient faces when looking to have breast implants. We understand that every patient is unique, and we have a wide variety of options from implant type, to scar placement to different sizes to individualize the procedure to the patient’s wishes.
Very rarely are a woman’s breasts perfectly even, or symmetrical. Sometimes, the lack of symmetry can cause a woman to be distressed, adding prosthetic implants in her bra to achieve symmetry. This is a common situation that women do not like to discuss. The solution is straight-forward. If a woman with uneven breasts seeks a breast augmentation, it is simple to fill one breast implant more than the other to make the breasts as symmetrical as possible. Sometimes a breast augmentation is performed on one breast and a breast augmentation and lift, or a breast lift alone, or even a breast reduction is performed on the opposite breast simultaneously. The treatment plan is agreed upon during the consultation.
Breast Augmentation at a Glance
Pain Level Moderate
Anesthesia General
Duration of Surgery 30min – 1 hour
Scars Hidden in the armpit crease
Final Results 6-12 months
Return to regular activity 1-2 weeks
Resume Exercise 4 weeks
Q. How should one prepare for breast augmentation surgery?
A. An initial consultation is set-up where we will discuss the breast augmentation procedure and to decide whether you are a good candidate for the surgery. Your medical history is reviewed and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. You are asked to stop smoking, if you are a smoker, two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to be seen by your own doctor to give the green light for surgery. You are given the opportunity to talk to patients who have had the same surgery you are considering. I will see you shortly after the surgery (in a day or two usually). You are given garments and complimentary scar management tape and cream when appropriate, all free of charge, to enhance your recuperation. You are seen regularly after your surgery. You are always welcome to come back for follow-up, even years after your surgery, free of charge.
Q. What are the possible immediate post-operative effects in breast augmentation surgery?
A. At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
1- General Complications
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What I do to even lower the risk of complications is to operate at a first class hospital, INOVA Fairfax Hospital, with board certified anesthesiologists and nurses. To avoid post-operative complications, I advocate early mobilization –patients seen in my office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.
2- Bleeding
Bleeding after breast implants can be traumatic to a patient. It usually happens in the hours ensuing the breast augmentation, and usually happens on one side. Sometimes, a small amount of bleeding can be observed, but if the bleeding in a breast after a breast augmentation becomes significant, then the patient needs to have the bleeding removed in the operating room in a usually straight-forward procedure. The rate of hematomas or bleeding after a breast augmentation is reported to be about 2%. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. I use tumescent solution, similar to that used in liposuction, before starting a breast augmentation procedure to decrease the amount of bleeding. That technique plus minimal dissection, handling of the muscle during the procedure and creating the appropriate pocket size for the implant are all techniques that decrease the chances of post-operative bleeding. In my practice the rate of hematomas is about 1%.
3- Infection
Breast implant infections occur in general in about 1-2% of cases. The most important step in avoiding infections, in my opinion, is to perform the surgery at a first-rate surgical facility such as INOVA Fairfax Hospital. Patients are given the appropriate intravenous antibiotics coverage throughout the actual surgery. During the surgery, the skin surface of the patient is cleaned properly. Next, I change gloves multiple times during the operation, and I am the only one who handles the implant in the operating room to ensure total sterility and avoidance of infection. After the procedure, my patients are prescribed a one-week course of antibiotics to minimize infection. As a result of these extra precautions, my implant infection rate is significantly lower than the national average.
4- Capsular Contracture
Capsular contracture is the hardening of the scar tissue around the implant, and occurs in 10%-15% of women with breast implants. It can also be a factor of time elapsed since the implant placement. Every implant will have scar tissue around it; that is totally natural. What is undesirable is for the scar tissue to harden and cause the patient pain or unnaturally-looking breasts. The theories behind the cause of capsular contractures vary. Capsular contractures may be caused by a sub-clinical infection, by significant bleeding during the operation, or by time alone. In the previous section, I discussed how to minimize the risk of infection. In order to minimize the risk of bleeding, I inject the breasts with a tumescent solution, similar to that used in liposuction. The reason for the tumescent solution is to decrease the bleeding during and after the operation and to provide for local anesthesia to decrease post-operative pain. As a result, my rate of capsular contracture has been less than 1%.
5- Rippling
Rippling is the formation of small waves or folds of the breast surface due to a breast implant. Sometimes rippling is visible, other times it is palpable, or both. In the case of breast augmentations, especially with saline implants, this potential result can lead to patient dissatisfaction in up to 10% of breast augmentation patients. In order to avoid rippling, one must understand what causes it. The chest muscle, or pectoralis major, does not cover the chest totally; the lateral edge of the breast is not covered by that muscle, which is used as coverage for a breast implant. Rippling can be avoided or minimized by giving the breast implant maximum coverage with breast tissue and muscle. For that specific reason, rippling is minimized by placing an implant under the pectoralis major muscle and by selecting an implant size that would be covered almost completely by the muscle. As a result, the implant cannot be felt from the lateral edge of the breast. Because of these two guidelines, the rate of rippling among my patients is less than 2%.
6- Deflation or Rupture
Breast implants are devices. Their lifespan of "looking good" varies between different types, the patient’s conditions, and the technique used, but that lifetime is not indefinite. The younger the age of a woman seeking breast implants, the higher the probability that they may have to be adjusted or replaced at some point in the future. The good news is that newer breast implants are made of better material than the old ones and have a longer lifespan, with fewer complications. It is difficult to quote rates of breast implant rupture or deflation because it is a function of time. The best way to minimize this risk is by paying attention to each step in the pre-operative evaluation of a patient, the actual surgical procedure, and the follow-up care. If an implant ruptures or deflates, it needs to be exchanged. Saline implants ruptures are easier to diagnose, but silicone implant ruptures may need MRI imaging to make that diagnosis.
7- Ability to Breastfeed
Women are sometimes concerned that if they get a breast augmentation, they will not be able to breastfeed afterwards. The likelihood of losing the ability to breastfeed after a breast augmentation is very small, since the dissection occurs away from where the milk ducts are located. With the breast augmentation operation described above, inability to breastfeed after a breast augmentation that I have performed has not occurred with any of our patients to my knowledge.
8- Loss of Nipple Sensation
Similar to what has been said about ability to breastfeed, loss of nipple sensation is a potential complication that due to the technique with which I perform this procedure is a minimal complication, with less than 1% occurrence. Temporary loss of sensation from a "stunned" nerve or a bruised nerve may occur in the time period after surgery, but sensation in the vast majority of cases returns within a few weeks.
Q. What are the possible longer-term, local effects in breast augmentation surgery?
A.
1. The scar, although small, can be evident in the underarm area the first few months before it heals completely and fades, but it will never completely disappear.
2. The difficulty to remove an implant from an under-arm scar in the future if a revision is needed; so another approach may be used at that time.
3. The possible loss of sensation in a small area of the underarm.
Q. How is a breast augmentation surgery performed?
A. I offer my patients a variety of breast augmentation procedures, including saline and silicone implants, the different incision approaches (from under the arm, under the breast or around the areola), and above or below the muscle. My personal preference after a significant experience with breast augmentations is performing it in the following manner: A saline implant of modest size (150-400 cc’s), from an underarm approach, and placement of implant behind the muscle.
The procedure is relatively simple and straightforward. A patient, who is deemed a good candidate for this operation, is taken to the operating room. They are given antibiotics, and anesthetized. The breasts are injected with tumescent solution to give some pain relief and decrease the bleeding during surgery. Then a small incision is made in the underarm area. A pocket is created behind the muscle. An implant sizer - think of it as a disposable implant- is placed in the pocket and inflated to the volume desired by the patient. The patient is sat up in the operating room and the breasts are inspected. When a very nice result is achieved, the patient has the sizer removed and the true implant placed in the correct location. After a second look, the small underarm incisions are closed, dressings are placed, and the procedure is done!
Q. What is the recovery time for breast augmentation?
A. 1-2 weeks
Q. How much does breast augmentation cost?
A. My fee for a Breast Augmentation procedure is $4000 for saline implants, or $5,000 for silicone implants which includes all preoperative and postoperative visits. This is an out-patient procedure done under general anesthesia at the hospital. You will also have fees for the facility (operating room) and the anesthesiologist and should expect a total quote of $5191.00 or $6191.00 depending on the implant that you choose.
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