| Dr. David Kahn 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?
Breast augmentation is an increase in the size of the breast. Today the most reliable way to achieve this is with implants; either saline filled or silicone filled. There has been a rebirth of interest in fat injections for breast augmentation, however we do not have long term experience with this and I think the results are less reliable.
The other aspect of breast augmentation to consider is the shape of the breast. In some case, such as if the breast droops, a breast lift (mastopexy) will also be recommended to obtain the best possible shape to the resulting breast.
Q. How should one prepare for breast augmentation surgery?
The best way to prepare is by becoming informed. I would only recommend the websites of recognized organizations. Two good sites are the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.
I also recommend that people see more than one surgeon. Obviously, too many can be confusing. There are no guarantees in medicine. You want to find a surgeon who understands you and you think can deliver the result you are hoping for.
Personally I am not a big fan of pictures. Different patients have different goals. You do not know the goals of the patient in the photo. They may have wanted to look bigger or smaller than you think looks good. Also, pictures can hide things that can be seen or felt such as rippling of an implant, hardness or distortion from muscle movement. And lastly, if you want to see pictures, make sure they show you some where they did not get the result they were hoping for. Everyone shows you their best results. That said, pictures in the privacy of a consultation can be very helpful to explain a procedure and help to make sure your expectations are reasonable and achievable.
Q. How is a breast augmentation surgery performed?
There is no standard breast augmentation operation. Each surgeon has their own opinion, and experience as to what will provide the best results in their hands. But the essentials of breast augmentation surgery can be broken down into 3 components; incision placement, location of implant pocket, and type of implant used.
The three main incisions used for breast augmentation surgery include in the armpit, around the areola, and below the breast (infra-mammary). An incision that heals well will be hard to see in any location. I often ask the patients to consider which incision they would want if it were to heal poorly. The advantage of the areola and infra-mammary incisions are that they can be hidden by clothing. I believe the infra-mammary incision has several other advantages including that it allows the surgeon better visualization for the surgery, avoids going through the breast tissue itself, and is also the incision typically used for revision surgery. I favor the incision underneath the breast for several reasons, but will also use the other two if that is what the patient desires.
The implant is typically placed in a plane either underneath the breast and on top of the pectoralis muscle or in a plane that is partially underneath the pectoralis muscle and partially underneath the breast tissue. Each location has advantages and disadvantages. The decision of which location to place the implant I think is best made after a discussion with the surgeon and understanding what their opinion is.
Lastly, there are 2 types of implant fillers- saline solution (salt water), or silicone. The shell of the implants are the same and can be either smooth or textured. Most surgeons and patients consider the silicone implants to be more natural. Silicone implants were reintroduced to the market in November 2006. In the time that they were taken off the market until they were brought back to market they could still be used but the patient had to enter a study. Many of the risks of breast implants are the same for both silicone and saline implants. The risks of silicone implants that resulted in the FDA moratorium have not been established with any convincing evidence in studies to this point in time. Ir-regardless, implants are not lifetime devices, and a patient should consider their own risk tolerance when making the decision of what type of implant they desire.
In the end, while I have some biases as to what I believe are the best choices in technique to give the optimal result, I do believe that different surgeons can obtain good results with differing techniques. In the end, the choice of what technique to use I believe is best left to the surgeon who is offering their experience and advice to give the patient the best possible result. The patient can then consider from the surgeons that she has seen in consultation which surgeon is most likely to give her the result that she is hoping for.
Q. Who is a good candidate for breast augmentation?
The best candidate for breast augmentation is someone who is in good health, and has a positive self image. The surgery can enhance one's appearance and improve self-confidence, but it is not intended to change how others view or treat you. The surgery should not be embarked upon to try and convince someone to like you, marry you, or promote you. It is a personal decision and something that you do for yourself and no one else.
The surgery also may not meet your ideal vision of what you would like to look like, so it is important that the patient have realistic expectations and understands the limitations of surgery. The ideal candidate also understands that the breasts will continue to change over time as the body changes, weight is lost or gained, or as pregnancy changes the characteristics of the native breast tissue. As a result the patient understands that additional surgery may be needed in their lifetime to maintain the appearance of the breasts. And finally, the ideal candidate understands that implants are man made devices and will likely require additional surgery at some point in their lifetime should there be a problem with the implants.
Q. What are the risks associated with breast augmentation?
The standard risks for and surgery include bleeding and infection. Implants are prosthetic devices and as such may need to be removed if the patient develops an infection. They can usually be replaced some time after the infection has cleared. The other common risks include capsular contracture, rippling, palpability, asymmetry, poor healing scars, leaking implants, a result that does not meet the patients expectations and the possible need for revision or secondary surgery.
Size is a challenging aspect of breast augmentation surgery. Surgeons will do what they can to minimize as much as possible the need for revision surgery based on size. Bra size, I believe, is a poor measure for size. It is well known that most women wear the wrong bra size and that fitting is variable. They Wall Street Journal had an article about this in the last few years. Many women own several different size bras based on what fits well. This is often due to factors such as how much padding there is, the type of bra and how the manufacturer cuts the material. In the end, I think it matters more that you like the way it looks and not what some manufacturer (i.e.-Victoria Secret, Warner, etc) has labeled the bra size.
Q. What is the recovery time for breast augmentation?
This can be variable from patient to patient and by technique used. I find that most patients will be sore for a few days. Many describe the pain as a bad muscle pull, or like they just did 100 push ups. Time to get back to activities will vary by surgeon preference. I try to limit activities that cause a lot of breast movement such as running, and arm exercises like swimming and tennis for 4-6 weeks. I do encourage people to walk around right after surgery.Other activities such as a stationery bike are okay after their first post-op visit. Another often asked question is "when can I drive?" My answer is once you are no longer in pain and are no longer taking narcotics.
Q. How much does breast augmentation cost?
Price will vary by surgeon, type of implant used, type of anesthesia and facility. Ideally, I think cost should not be an issue. You should not make compromises to save money. You want to be comfortable during the surgery, and minimize the chances of complications and revisions. That said, all things being equal, more expensive does not necessarily mean better results. Again, the key is to find a surgeon that you are comfortable with and are confident that they can achieve the results you are hoping for. One also has to realize that secondary surgery will incur a cost if needed. Your surgeon may not charge you for revision surgery, but there may very well be a charge incurred if you need to return to the operating room and require the services of an anesthesiologist. $6000-$8000.
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