BREAST LIFT WITH AUGMENTATION

Level of Placement
In addition to several types of incisions and implants, there are also two possible locations for placement of the implant. The implant can be placed beneath the breast tissue, but on top of the pectoralis muscle. The second, more common method is to place the implant beneath the pectoralis muscle, between the pectoralis and the ribs. The advantages of placing the implant above the muscle are that it is less painful for the first few days and the appearance of the implanted breast matures faster. In addition, contraction of the pectoralis muscle, more noticeable in body-builders, has no effect on the appearance of the breast. The advantages of placing the implant under the muscle are several. First, it provides a more natural appearing breast with a better transition from the upper chest to the breast mound. Second, the rates of scarring around the implant are significantly lower when the implant is placed beneath the muscle. Third, the risk of visible ripples or folds in the implant envelope (a more common problem with saline than with silicone implants) is diminished because of the greater amount of the patient's own tissue overlying the prosthesis. Fourth, the ability to obtain an adequate mammogram is enhanced with placement under the muscle, as the mammogram technician is better able to separate the breast from the implant when the muscle is interposed. With the exception of patients who are body builders, Dr. Parson recommends the sub-pectoral technique to his patients.

Every plastic surgeon has their preference for incision and each approach has its benefits and disadvantages. No one way is correct all of the time. Dr. Parson varies his choice of incision depending on the specific characteristics of the individual.

The First Office Visit
At the initial consultation, 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 will be arranged. He will also need to 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 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 (mastopexy) may be combined with augmentation to achieve a satisfactory result. A difference in the size of women's breasts or asymmetry is very common. It is common for a patient to 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 choice of implant size. Dr. Parson asks patients to bring to the pre-operative visit a photograph of a woman's breasts that they find desirable. This will help Dr. Parson understand your expectations and determine whether they realistically can be achieved. Other methods of gauging a woman's desire for breast size such as placing implants over their own breasts are often imprecise.

The Pre-Operative Visit
You will meet with Dr. Parson approximately 2 weeks prior to the planned procedure. After the initial consultation, it is important that the patient have adequate time to reflect on the planned procedure, in particular on issues of implant size. Scheduling surgery involves payment of a non-refundable deposit, as there are costs involved with preparing for your operation, and for holding the time. A period of at least 2 weeks off any medications containing aspirin, ibuprofen, vitamin E, or other medications which could adversely affect the ability of the blood clotting mechanism is required to prevent any bleeding complications. At this visit, consent for operation is signed. The size of the implants to be used is finalized. Photographs are taken. A directed physical exam is carried out. All questions relating to the surgery are answered in detail. The surgical fee is due in full at this time and cannot be paid with a personal check or money order. Arrangements should be made for transportation for the day of surgery and for the first post-operative visit (usually 2 or 3 days after surgery). Usually 1 week is required for recovery. Prescriptions will be provided for antibiotics and pain medication.

The Day of Surgery
The operation usually requires up to 3 hours of operating time and recovery, depending on the anesthetic chosen. A board-certified anesthesiologist will provide anesthesia with the greatest degree of comfort.

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