What is it?
Breast Augmentation is a procedure for enlarging the breasts. The usual indication for this procedure is a woman who has small and underdeveloped breasts or a patient who has lost the natural firmness of her breast after pregnancy and breast-feeding.

What alternatives are there for breast augmentation?
Unfortunately, to this date there is no good alternative to breast augmentation without the use of breast implants. Autogenous tissues (your own body’s fat and skin) used for breast augmentation will leave an unsightly scar and therefore these tissues are not used for augmenting the breast.

What does it accomplish?
The purpose of the operation is to enhance the aesthetic appearance of the chest and to improve the proportions of the chest as compared to the rest of the body. Often this also improves the self-esteem and psychological well-being.

What happens during the first consultation?
In the first consultation you will get a chance to discuss your concerns with our patient care coordinators and Dr, Marefat. We will tell you what you need to know about your procedure and will help you determine what is best for you. You will receive information booklets and pricing on the procedures.

How is it done?
The operation is usually done under general anesthesia. This method of anesthesia is in the best interest of the patient in terms of the comfort and the ease with which the procedure is performed. There are three commonly used incisions in this type of surgery including the incision in the mammary fold, the periareolar skin, and the axillary area. The method that I recommend is the inframammary fold incision. The breast implant can be placed either under the muscle or the breast tissue. I prefer placing the implant under the muscle because I believe that it not only provides a greater amount of camouflage for the breast implant it also reduces the risk of capsular contracture (hardening of the breast). Occasionally a breast lift is performed at the same time as the breast augmentation in breasts that require repositioning of the nipple areola complex.

Procedure: Breast Augmentation continued

What can I expect after surgery?
You should expect a moderate degree of swelling and discoloration for the first week or two after surgery. The expected postoperative recovery would be approximately one week during which time you should limit your activities and rest as much as possible. The first two or three days are likely to be the most uncomfortable for you with a moderate degree of pain which is easily relieved with oral pain medications. After three to four days you should be able to attend to minor activities around the house and go on short walks. By the fifth or sixth day you should be able to return to work. Majority of patients return to work within a week. Although some patients feel good enough to exercise in the second week most do not resume their normal exercise routine until the third or fourth week. Undoubtedly with the placement of the breast implant there will be some changes in the your lifestyle. These would include the protection of the implant from being injured during strenuous activities and the protection of the breast from injuries sustained during mammography.

What size implants should I choose?
You should choose a size that is becoming to your body and you think is right for you. Many patients come to my office and say that they don’t want to be “too big”. However, you must know that the most common complaint of patients after this operation is that they wish they were a little bigger. I therefore recommend my patients to choose a size that is a bit larger than what they think is ideal. During the operation I choose an implant that is appropriate for the frame of my patient by placing a temporary sizer and looking at the breasts while she is put in a sitting position. Based on this sizer I choose the permanent implant for my patient. I generally increase size of her breast by one or two cup sizes.

What risks are involved with this operation?
This operation is one of the safest operations we perform. However like any surgery there are risk factors associated with operation. I will tell you what I generally discuss with my patients in their second consultation prior to surgery. You should understand that all these complications that I will mention are extremely rare and are not a deterrent to surgery for most people.
A complete list of possible side effects and complications will be provided to you when you schedule your surgery. You should talk to your surgeon for more information on each of these possible risks.
Bleeding. This is very uncommon with breast surgery because we are generally not cutting tissues but using blunt tipped instruments to dissect the pocket. However we have had some reports of bleeding in the literature about this complication. There are those who are at higher risk of bleeding. The use of some medications such as aspirin or coudamin (a blood thinner) could put you at higher risk of bleeding. If you are contemplating surgery you should refrain from using Aspirin containing products from two weeks before surgery until two weeks after surgery. Some people with history of uncontrolled hypertension can be at higher risk of bleeding after the surgery. There are some individuals who have some problem with their coagulation system that they were not aware of and consequently have had bleeding after surgery. If you have bleeding after surgery it may entail returning to the operating room to stop it.
Infection. It is very uncommon to get an infection with this procedure. We usually give all our patients antibiotics both before and after surgery. If infection however, occurs we will treat it very aggressively with sronger antibiotics.
Skin discoloration. This can occur in any surgery. It is due to blood metabolites and is usually temporary and self-limiting. Sometimes these blood pigments stay in the subcutaneous tissues permanently. These are very rare and generally occur in patients with darker skin complexion. If this occurs we may need to treat your skin with certain bleaching agents which could help ameliorate the problem
Discomfort and pain. This is easily controlled with oral pain medications. With the use of the tumescent technique and the use of the local anesthetics in the tissues both the pain and the discomfort should be minimized.
Capsular contracture. This is firmness of the breast caused by the shrinking of the capsule surrounding the implant. This capsule is essentially scar tissue that forms around the implant. Depending on your body’s natural reaction against the implant this scar tissue may be insignificant or alternatively, it may be quite significant. If the latter is the case, the implant will become harder to touch, losing the natural softness of breast tissue. At times it may be so severe as to make the breast visibly deformed. Unfortunately there is no way that one can predict in whom this problem will occur. It may occur in one breast but not the other. Should this problem occur we might have to perform another operation in order to correct the contracture. The treatment options for resolving this type of problem include non-treatment if the condition is mild or it is surgical correction if the condition is severe. Among surgical options Closed capsulectomy (release of the contracture by external pressure) is no longer done. Today almost all Capsular contractures are treated by Open capsulectomy. This entails returning to the operating room and releasing the capsule by making incisions in the scar tissues. The release of scar allows the breast implant to occupy a larger space and thus become softer to touch. At this time if there are any changes that need to be made to the position and shape of the implants may be done.
Implant Failure. Implants can leak or develop a malfunctioning valve. This will result in loss of the fluid in the implant and consequently loss of volume from the breast. There seems to be a need for replacement of approximately one percent per year for each implant.
Wrinkling or Rippling of Implants. In women who are very thin or have very little breast tissue, there is a risk of seeing ripples created by the implant on the surface of the breast. Sometimes the edges of the implant may be palpable. This may be related to the quality of the skin to a certain extent and if that is the case, it may be corrected with tightening of the breast skin. Occasionally it may be necessary to change the implant and place a different or a larger implant. In most cases, such problems have a remedy and can be corrected.
Detection of early breast cancer. There may be a slight increased risk of compromised detection of early breast cancer with having an implant. However, with improved, state of the art, radiological techniques for detection of breast cancer, this is unlikely.
Connective tissue disorders. The risk of developing connective tissue disorders is rare and unsubstantiated. Problems such as arthritis have been implicated as being caused by silicone implants. However, unless you are in a study protocol, you would not qualify to have silicone implants placed as a primary procedure in Breast Augmentation. We use saline implants that do not have any association with connective tissue disorders.
Future pregnancy. With regards to the effect of the breast implants on future pregnancy and nursing you should not have any problems, however there have been cases in which after implant placement the patient has not been able to nurse. If it is very important for you to nurse your child it may be more prudent to wait until you have had your children.
Insurance coverage for implant related problems with the breast. Certain insurance carriers may not cover you for problems related to the breast implant since it was placed for aesthetic reasons. You should have no problem however, in obtaining coverage for the breast diseases unrelated to the implant surgery.
Mammography. It may be a good idea to obtain a baseline mammogram prior to placement of the implant. I recommend this in all patients over 35 years of age.
Calcifications. Sometimes with breast surgery there may be a small degree of trauma to the breast tissues or the fatty tissues in the area and this may result in late calcifications. Occasionally, these calcifications may create some doubt as to the presence of breast cancer. If this occurs it may be necessary to biopsy the area in order to rule out cancer.
Scarring. Occasionally there may be excessive or obvious scarring in the incision. This happens very rarely however, and it does improve with time. If the scar is unacceptable after a period of observation, we may need to revise the scar.
Anesthesia risk. Anesthesia has its own risks and complications. However, with modern equipment and techniques the risks from surgical anesthesia are minimal.
Loss of nipple sensation. This risk has been reported in the literature in about 15% of patients. However in my experience I have not found it to be a common problem. Of course there may be some temporary changes in nipple sensation that is entirely normal. This could be a minor change in the sensitivity of the nipple or on occasion it can be a complete loss of nipple sensation. Unfortunately there is no relationship between the type of incision used and the development of this problem. If you have significant erotic sensation in your nipples you may want to reconsider having this operation.
Minor Asymmetry. Most women have minor asymmetries in their breasts and this is completely natural. If there is a major difference between the two sides of the breasts this can be corrected to a certain extent. Major problems of asymmetry cannot be completely corrected and may persist after the operation.
Implant movement and visibility. Certain position changes may cause indentations in the breast that reveal the presence of the implant. This has generally been a problem in women who are very muscular and whose muscle contractions can displace the implants in its pocket.
Life threatening problems. Such problems are very rare in cosmetic surgery. However, Should you develop any major complications and should you require hospitalization for any of these problems we will not hesitate to admit you to the hospital or the operating room in order to circumvent any serious health risk.

Disappointment with results. Some patients are disappointed with the results of their surgery. This is sometimes related to the fact that they had unrealistic expectations in terms of the outcome of the operation

Am I at risk for breast cancer with this operation?
There may be a slight increased risk of compromised detection of early breast cancer with having an implant. However, with improved, state of the art, radiological techniques for detection of breast cancer, this is unlikely. Furthermore the saline implant is completely clear in the x-ray making it easier for the radiologist to see all the breast tissue. Patients who have breast implants are more likely to examine themselves and to be examined by a health professional. For this reason, the likely hood of having an undiagnosed tumor is less.

What about risk of Connective tissue disease and arthritis with breast implants? The rare and unsubstantiated risk of connective tissue disorders such as arthritis relates to silicone implants and you should not worry about this with saline implants.

Will breasts implants affect future pregnancies or breast-feeding?
You should not have any problems with nursing, however there have been few cases in which the patient has not been able to nurse. Certainly this is not a common complication of this operation

When are the sutures removed?

Sutures are generally removed 2 weeks after surgery.

How many visits do I have after surgery?
We like to see our patients frequently after surgery. You are seen by the Doctor or nurse within 2-3 days of surgery. Then the normal postoperative routine is: 1 week, 1month, 3 months, 6months, and 12 months. Of course if there is a need you may be seen more. After a year we encourage our patients to come for routine follow-up visits every 3-5 years.

When can I cover my bruises with makeup?
You should be able to put makeup on the bruises after the first week. However we do not recommend your putting makeup on your incisions until they have completely healed because this may result in tattooing of the skin by the pigments of the makeup.

Will insurances cover costs for future problems with my implants?
Most insurance carriers may not cover you for problems related to the breast implant since it was placed for aesthetic reasons. You should have no problems however, in obtaining coverage for the breast diseases unrelated to the implant surgery. The breast implant manufacturers give lifetime warranty for their products. Some manufacturers will also cover for costs of surgery if the product was found to be defective. You should ask your plastic surgeon for details about coverage.

Should I get a baseline mammogram?
It is a good idea to obtain a baseline mammogram prior to placement of the implant. I recommend this in all patients over 35 years of age.

Am I a good candidate?
The best candidate for this surgery is a woman who has small and underdeveloped breasts or who has lost the natural firmness of her breast after pregnancy and breast-feeding. Women who have very asymmetrical breasts are also good candidates. Generally the younger you are the better a candidate you are for cosmetic surgery. But the physiologic age of person is more important than the chronological age. That is to say you may be 60 years old, but your skin and general health could be better than most who are 50 years old.

Procedure: Breast Augmentation continued

What does the surgery cost? The cost of surgery varies but here are some guidelines that will help you determine roughly what you could expect. Remember that these are only rough estimates. These estimations include the cost of the operating room and the anesthesia. The fee may be subject to change without notice. The best way for you get an accurate cost analysis is to see a doctor.

Breast Aug: $5,050

How do I pay for surgery?
You can pay for surgery by certified check, Credit card, or cash. Payments for cosmetic surgery are expected prior to the procedure. If you are scheduling several weeks in advance of surgery you can pay by personal check.

Are there scars?
Yes. But these scars usually heal very well and become almost imperceptible after several months. The benefit of having the scar in the fold of the breast is that even if it does not fade completely it is still hidden in an area that is usually not seen.

Does it hurt?
Yes. However, the pain involved in breast augmentation is very tolerable. We have heard our patients describe it as ‘muscle aches and pain’ or just ‘soreness’. I like to inject the area of surgery with a long lasting anesthetic solution that significantly reduces the pain in the first few days after surgery. Many patients do not finish the pain medications prescribed to them for pain relief. But having said that remember that pain is very subjective, and it is not easy to predict what degree of pain you will have.

Will I be awake during surgery?
No. I like to do this procedure under general anesthesia. If there are risk factors related to your health for having general anesthesia we can sometimes do this procedure under heavy sedation. If you are having just a small touchup procedure and this can be done in the office then you will be awake. However if you are having a large revisional procedure, or having multiple changes made to your breast you will most likely be done in an outpatient facility under general anesthesia,

Where is the surgery performed? (i.e. office suite or hospital)
The surgery is done in an Ambulatory Surgery Center. I do not do this operation in the office. The Surgery Center provides a safe environment without the inconveniences of a busy hospital operating room.

Are medical photographs taken?
Yes. In all cosmetic and reconstructive cases medical photos are taken. Photographs are mandatory because this is the only way for us to compare you before and after results. Photographs in plastic surgery serve much the same role that x-rays serve for orthopedic surgery.

Date Revised: 1-25-07

 Copyright © 2004.
  To report any corrections, please contact the webmaster.
  Sitemap