Breast Augmentation

Breast Augmentation or Augmentation Mammoplasty is the enlargement of the breast and usually involves saline or silicone implants. They can be used to change the contour, shape ,size or balance of the breasts. Augmentation may be combined with other procedures such as mastopexy  (breast lift) to solve additional problems you might have.

Why Breast Augmentation?

Deciding to do any surgery is a very personal decision. While the support of others may be a comfort in your decision it is still yours to make. Those who are most satisfied will be those who find personal satisfaction  in their goals and new body image. Those who undertake this because they think it will make them better accepted by others, or even for the satisfaction of their spouses will seldom find their choice worthwhile. This is clearly one of those things you are doing for you and you alone (although others may also like your new look or your increased self confidence).

Who might benefit?

By far the most frequent reason given by our patients is that they have always had breasts they thought were too small and that they just want to restore the normal proportions they feel they never had. Many others feel they want to return to the fullness they had before pregnancy . However, the list is almost endless and can include asymmetry (one breast larger than the other),irregular shape, incomplete development of one or both breasts, or any combination of these. Some problems may require alteration of the skin as well (such as mastopexy for drooping) in combination with the augmentation.

Who can have surgery?

Although this surgery is generally safe, it almost always involves a general anesthetic (but not absolutely always) so women should be in good general health. Make sure to tell us all your health issues so we can ensure that the surgery you want to have can be safely performed. There is no strict upper age limit so long as you are in good health. Not only should your body be able to withstand having surgery, but it is important to be in good mental health. This is a significant body image change so even the timing of surgery needs to be considered to make sure you will be comfortable with your decision in years to come. This decision should not be made during times of significant stress . Lastly, this is a surgery for adults( and with silicone implants, it is even illegal to use them on anyone less then 22yrs old)!

Where do I start?

The first step is a consultation with an experienced surgeon. Both Drs. Sweitzer and Zickler have over 20yrs of experience with hundreds (thousands?) of breast implants . It is unlikely you will have a problem or question the  haven’t encountered before. We will carefully listen to your goals and desires and make a treatment plan with you. We will ask for medical information to make sure the surgery will be safe and effective for you. An exam with measurements and photography will be part of your treatment planning session . You will see photos (there are a few on this site, but volumes in our office) of others with your shape, size, body type, age and weight as part of the communication process to make sure we understand exactly what your mental image of the new you might be. Only then can we hope to achieve what you want.  We will then spend just as  long trying to communicate to you what part of your dreams are achievable and where the limitations of your own body may make for some trade-offs. We may also use trial sizers to help you see what your new breasts will look like in your outfit. To facilitate this you want to bring a non-padded stretch type bra (like a sports bra not the unyielding wonder woman bulletproof shaped bras) and a stretch top  (not a baggy sweatshirt). If we don’t do this at your first consult, don’t despair there will be time at your preop visit. You will get a chance to ask any questions you want about anything that has to do with  breast augmentation. Plan to spend at least an hour with us.  You will get a realistic price estimate that takes into account the implants you’ve chosen, your surgery site, the lab tests you need and anything else that will go into your particular cost.

What is surgery like?

Your surgery is unique depending on the decisions you’ve made with us during your consultations, but a general surgery is performed at a surgery center like the one downstairs in our building. You will meet aboard certified anesthesiologist and an anesthetist as well as the nurses who will be taking care of you. Your surgeon (Dr. Zickler or Sweitzer) will also meet with you just before surgery and may make some markings on your skin to help with the intraop planning. The surgery will be under general anesthesia and will take a little less than 2 hrs. Your family will be able to visit with you for the hour or so that it will take for you to be completely over your anesthesia and then you will be safe to go home. Plan for the whole event to take about 5 hrs and absolutely have someone responsible drive you home and stay with you for about 24 hrs after your anesthetic.

Will it hurt?

This is surgery, and placing an implant behind your muscle will stretch it out.  It will feel like a pressure on your breast bone and will last 3-5 days. Usually this is controlled with narcotic pain medicines, but if desired a long acting local anesthetic (Exparel) can be used to minimize this discomfort. Unfortunately since exparel is still under patent it costs about $3oo.

Recovery time

Expect to be able to remove your dressing on the day after surgery. You will have chest pressure for about 3-5 days as above. As this fades, you should be able to resume almost any normal activity, but most women plan on 5-7 days out of work if your job is sedentary (and 2-6 wks if your job is strenuous and very upper body intensive). We usually remove stitches at about 5 days, and plan another visit at about 2wks to check your progress. During the first 2 weeks it is recommended that you keep your elbows below you shoulders (no reaching up).Your pectoral muscle which stretches over your implant is a shoulder muscle that is relatively stationary when your shoulder moves from alongside you to 90 degrees. From there, the higher your arm and elbow go. the more your pectoral muscle moves up with your shoulder. This could cause malposition of your implant until the scar capsule is well formed, which is usually good enough at about  2wks. By about 6 weeks you should be healed enough for almost any activity including contact sports. Yu still may not be at your best in some competitive sports after a 6 wk layoff so plan accordingly if you are in golf or tennis matches.

What are the risks?

This is a surgical procedure, and all the risks of surgery and anesthesia apply. Implants also have their own associated risks, like risk of rupture (deflation) of saline or silicone. Your body will also react to anything placed within it, and a scar capsule contracture may result. As everyone is naturally uneven (asymmetric) there may be residual or heightened asymmetry after the surgery. You will usually experience some temporary change in sensation in your breast and nipples  and in some, this change may be permanent. You may even decide that you don’t like having implants once you get them. The list of possible outcomes with any surgery is endless make sure you talk with us about your particular concerns, and how problems might be fixed if they occur. After a thorough discussion you will have a full understanding of your particular risks and can decide with us whether surgery is a smart decision for you.

Silicone or saline?

Lets make this a blog post. Basically all implants are made of the same silicone elastomer (shell) and only the filling is different. Saline implants are filled with the same injectable solution they use for IV fluid, while silicone implants are filled with a more dense gel of silicone. There are differences in the cohesiveness of the gel. The silicone implants are less likely to show rippling or dimpling but require MRI surveillance to detect leakage. (expect a blog post soon with much more detail on the differences)

Above or below the muscle?

Unless you are a body builder who likes to bench press her body weight and more, chances are you’re better served with implants behind your muscle. Although its initially more painful to put them there, and the results may take a little longer to look natural, there are many advantages to this retropectoral position. The upper part of the implant will be covered and concealed by the pectoral muscle which is especially important in thin women or those with small breasts (who need the implants in the first place). Placing the implant behind the muscle also makes it less likely to interfere with future mammograms or breast feeding. The biggest reason however, is to decrease the likelihood of capsule contracture.

Next steps

Call us. Especially if you think you are going to have your surgery elsewhere. The consult is free (yeah really). We can give you much more individual advice and information in a personal consultation than we could ever post on a generic website.