Breast Augmentation Surgery
SERVING SCOTTSDALE AND PHOENIX, ARIZONA
Breast augmentation surgery uses prosthetic implants to increase the size of a woman’s breast. This procedure is performed for a variety of reasons: enlarging breasts that have little or no tissue, enhancing the shape of the breast for a more feminine appearance, replacing breast volume that may have been lost after nursing or pregnancy, and correcting asymmetry that may have resulted from underdevelopment of one or both breasts.
Breast augmentation is the number one surgical procedure among plastic surgery patients and has one of the highest satisfaction rates among all operations. Most women are very satisfied with the results of having a breast augmentation and would recommend it for a friend or family member. In addition to restoring lost volume and creating a more youthful, feminine appearance, this procedure can have a very positive impact on a patient’s confidence and self-esteem.
There are a number of different incisions that can be used to perform a breast augmentation, as well different spaces within the breast to place the implant. There are several types of implants to choose from, which differ in size, shape, composition and profile. Dr. Parson understands and appreciates that not every patient is the same, so not every patient should receive the same exact method of surgery.
Breast Augmentation Photos
Please note that all photos are actual patients of Dr. Parson.
Breast Augmentation Incision
Dr. Parson varies his incisional approach depending on each individual. Each plastic surgeon has their preferred method for incision, but not one way is correct all of the time. If a patient does not require a lift, there are generally three ways the surgeon can make the incision:
- Trans-axillary (in the armpit)
- Inframammary (in the crease at the bottom fold of the breast)
- Areolar (in the pigmentation line of the areola and skin)
Each incision has its advantages and disadvantages. You and Dr. Parson will discuss all of these approaches and find the one that works best for you and your body.
The Breast Implant
In the U.S. we have two types of implants available for use – saline and silicone. Saline implants have been available for use for several decades, while silicone implants were reapproved for general use by the FDA (Food and Drug Administration) in November of 2006. The FDA approved silicone implants after vigorous research and testing by independent panels of experts in the field. The FDA recommends that women be over the age of 22 to receive silicone implants, although they may be used at a younger age for reconstructive or symmetry purposes.
Silicone implants have different cohesive levels, the grading of which increases as the cohesive level increases. The most common cohesive levels are the Cohesive Level II and III. The “gummy bear” implants, which became available in the U.S. in May of 2013, are a Cohesive Level III, the firmest level.
Implants are measured in cc’s (cubic centimeters) of how much saline or silicone volume the implant contains. Size is one of the variables of breast implants. Other variables that you will discuss with Dr. Shaun Parson at your consultation include:
- Shape: implants can be round or teardrop shaped (this can have an effect on how the implants sit in the chest and where the volume is distributed).
- Profile: implants can vary as to how much projection they have (this determines how far they “stick out”).
- Diameter: implants can vary in the width of the base (this is important when you consider how wide a patient’s chest is and how much room you have to place the implant within each breast).
- Texture: implants can have rough or a smooth outer shell.
It is preferred that women have completed growth and that their breasts have developed prior to undergoing breast augmentation for the best possible result. Therefore, breast augmentation may not be suitable for women under 18.
Level of Placement
There are two spaces in which to place the breast implant during breast augmentation surgery. The implant can be placed below the breast, but still remain on top of the pectoralis muscle. The second method is to place the implant beneath both the breast and the pectoralis muscle. There are reasons for performing the surgery both ways, but Dr. Parson tends to recommend the “below muscle” location for the majority of his patients.
When the implant is placed above the muscle, it is less painful, and therefore, recovery is faster and the appearance of the implanted breast matures more quickly. This method is advantageous for body builders, where contraction of the pectoralis muscle has no bearing on the appearance of the augmented breast.
When the implant is placed below the muscle, this lends itself to a more natural-appearing transition of the implant to the native breast, creating less of a “shelf-like” appearance. Although, there is more initial discomfort with this placement, advantages include a lower risk of visible rippling or wrinkling of the implant, decrease rate of scarring (capsular contracture) around the implant, and increased visibility during mammograms because of the technician’s ability to displace the implant from breast tissue.
The First Office Visit for your Breast Augmentation
At the first visit, Dr. Parson obtains a pertinent medical and family history, with a particular emphasis on breast issues. If a mammogram has not been performed within the past year, one can be arranged. He will also define the general goals and expectations of the patient. A focused physical examination will be performed. The doctor’s examination will address issues such as the size and symmetry of the patient’s breasts and chest wall, and whether sagging (ptosis) or extra skin is present, and if so how much. If the patient’s breasts are sagging, breast augmentation alone may not be satisfactory. In these cases, a procedure to lift the position of the nipple and areola (mastopexy) may be combined with breast augmentation surgery to achieve a satisfactory result. A difference in the size of women’s breasts or asymmetry is very common. Sometimes, a patient may require implants of a different volume to achieve greater symmetry.
The other important objective of the initial visit is for the patient to clearly relay her desires for size. While bra cup size is a widely used method for categorizing breast size, it is imprecise and subjective. Dr. Parson’s goal is to place the patient’s choice of implant size. Photos are taken and uploaded unto our state-of-the-art TouchMD system, which provides an interactive educational experience for the patient and allows Dr. Parson to evaluate, draw and edit each patient’s photos individually. Patients are then able to log into their account in their privacy of their own home to view photos and review their consultation.
Dr. Parson is one of the few Arizona surgeons to offer the Mentor Volume Sizing System. This system has proven to be effective and accurate in choosing the desired and best implant size for each patient. Specially-developed implant sizers are placed in a bra that mimics what the appearance will look like after breast augmentation surgery.
Patients are encouraged to bring significant others, family members or friends to the initial consultation.
The Pre-Operative Breast Augmentation Visit
It is important that plastic surgery patients take certain measures in the pre-operative period to decrease chances for potential complications. All of your medications will be reviewed prior to this period. Any medications that may cause surgical complications will be discontinued at least 2 weeks prior to operation. Any infections that arise prior to operation, however seemingly trivial, should be reported to our office. Even an otherwise innocent infection can result in a surgical wound infection, and must be treated prior to breast augmentation surgery. A baseline mammogram should also be obtained prior to the operation.
Appropriate prescription medications will be written well prior to your procedure. This allows you to have your medication when you return home from the operation.
Pre-operative photographs are taken at this appointment. These photos will be recorded in the TouchMD system so that you will also have access to them from home. These photos will serve as a marker for you to see the improvement from your breast lift surgery afterwards. You will be asked to sign a surgical consent. The consent explains the potential risks of the procedure in detail. Some of these risks have been explained here, but more discussion will occur at the consultation.
The Day of Breast Augmentation Surgery
All patients are required to register and check-in two hours before the scheduled surgery time. Patients are not allowed to have anything to eat or drink from midnight on the night before surgery Breast augmentation surgery is performed with a general anesthetic. Our board-certified anesthesiologist feels that this method of anesthesia provides the greatest degree of patient satisfaction for this procedure. An augmentation usually takes 1.5-2 hours to perform. Dr. Parson meets with the patient one last time to review details and make surgical markings if needed. After being taken to the pre-operative area, a nurse will take a history, check vital signs and start an IV for fluids. After surgery, the patient remains in the recovery unit for about an hour and is discharged home.
The Post-Operative Breast Augmentation Period
It is important that a capable adult be available for the first 24 hours help patients with transportation, meals, pain control, etc. following the surgery. Pain should not be severe, and is usually well controlled by a combination of: narcotics, anti-inflammatories, and local pain medications. Local pain medication it delivered to the patient via an On-Q Pain Buster Post-Op Pain Relief System (which is an optional benefit provided by Dr. Parson). Dr. Parson recommends this system to his patients and finds that they require fewer narcotics than normal. Antibiotics are continued for 7 days after the procedure to lower the risk of infection. Activity should be restricted to no lifting of greater than 20lbs for the first 4 weeks. Dr. Parson will provide you with a sports bra and instruct you to stay in the bra 24/7 over the next 4 to 6 weeks. This helps with pain and swelling and provides breast. A slight amount of bleeding at the incision sites is normal. The breasts should not be manipulated in any way, unless Dr. Parson directs you to do so. One should be up and walking on the morning following surgery, and a light solid diet begun to the point of tolerance.
Dr. Parson should be contacted immediately for the following:
- Temperature over 101.5 degrees
- Chills or sweats
- Significantly different degree of swelling between sides
- Increasing rather than decreasing pain
The first post-operative visit occurs 2-3 days after the operation. Any dressings or bandages are removed and healing is assessed. After removal of the sports bra, Dr. Shaun Parson will ask you to wear a soft bra or sports bra for 6 weeks. Bras with under-wires are discouraged as these may push the implants upward, creating an unnatural appearance. Cosmetic surgery patients are then allowed to shower and to wash their hair. Submerging in a bath, pool or hot top is not permitted, as this may cause the incisions to separate. Most patients resume a reasonably normal activity pattern and can return to non-physical jobs within 5-7 days after surgery.
Risks of Breast Implants
- Capsular contracture (breast hardening secondary to internal scar formation) – Every individual forms some scar around the implant. This is a normal response of the immune system to a foreign body. For not completely understood reasons, some individuals form thicker scars than others. A thick scar may distort the breast and even cause discomfort. The incidence of this problem has decreased since the use of smooth implants and submuscular placement and is approximately 10%. When treatment is warranted, the scar is incised or removed and the implant is replaced.
- Interference with mammography – Implants interfere with the ability to image the breast by mammography to some extent. Implants placed behind the pectoralis muscle allow the breast to be imaged more effectively by a method called the Eklund Technique. Using this technique, the presence of implants does not represent a statistically significant risk to patient of missing an early breast cancer detection.
- Deflation – The incidence of implant leakage is approximately 2% per year. Today’s implants are better than a decade ago, and so it is difficult to accurately predict what the true leakage rate is. It may actually be lower. In the event of implant deflation, saline (the solution of which 70% of our bodies are made up of) leaks into the surrounding tissues and is absorbed. A relatively brief, simple surgical procedure is required to remove the old implant and replace with another. Implant manufacturers cover the cost of implant replacement for up to 10 years and assist with the cost of surgery as well.
- Inability to breast-feed – This complication is extremely rare. It is possible to disrupt the breast’s ductal system the ducts and thus interfere with lactation. Additionally, the breasts may be too uncomfortable when engorged with milk thereby hindering a woman’s ability to lactate.
- Visible rippling -Individuals with small breasts that have had a large augmentation can be at risk for visible rippling of the overlying skin. This problem is more common in woman with textured implants positioned on top of the pectoralis muscle.
Schedule A Breast Augmentation with Scottsdale Cosmetic Surgeon Dr. Shaun Parson
Breast augmentation is a comprehensive procedure that can help women regain the youthful contours they desire. If you are unhappy with the appearance of your breasts and would like to learn more about breast augmentation, call Dr. Shaun Parson today at 480-282-8386.