Breast Augmentation

O.K., if you've made it this far you are really interested in what the experience of having your breasts enhanced is all about. We'll try to help you feel what it is like from consultation to recovery.

At your consultation you'll meet with one of our doctors who will listen to you about your history and perform a brief examination to determine what will be your best option. We'll help you decide what type of implant and what size will give you the results you want. You'll be able to ask any questions you might have, (not a bad idea to write them down beforehand), and to touch and feel the implants. You'll also see pictures of some previous patients who have chosen the same implants and review their results. If you would like, we will also put you in touch with one of our patients who have had an augmentation so you can talk to them privately and have them tell you what their experience was like. Feel free to bring a girlfriend, boyfriend or husband with you. The more "ears" the better. You can also elect to come back again if you think of more questions. Our goal is to make you comfortable and knowledgeable before your procedure.

During your pre op visit we will give you a complete packet of information, including commonly asked questions and what to expect for the first week after surgery. You will also get prescriptions at this time to increase your post operative comfort. Photographs will be taken for your chart (your face will NOT be in them) either at this time or on the day of surgery. You will have plenty of time to ask questions and to make sure you are ready. We will also review the implant type and size with you.

On the day of surgery, which is only done in a safe, licensed hospital owned facility (either INOVA Fairfax outpatient or Johns Hopkins Suburban outpatient facility), you will meet the caring nurses and anesthesiologists before being escorted to the OR where you will fall asleep and be taken care of in a gentle, respectful manner. It will seem as if no time has passed and you will be in the recovery room. You will have little to no pain because we have developed a method that markedly improves the post operative experience. It works so well that it has been published in the American Society for Aesthetic Plastic Surgery's national journal so that others may benefit. www.cosmeticplastics.com/article-lesspain.asp, www.cosmeticplastics.com/pdf/TumescentBreastAug.pdf As soon as you are awake you will be escorted to your car to go home. We will call you later in the day to make sure you are doing well.

Your first follow up visit will be within the week. You'll be given massage instructions and the paper tape placed on the small incisions at the time of your procedure will be changed if needed. We will also review how to minimize any scarring. The next visit will be a few weeks later and all subsequent visits will be further apart. There is no limit on how many times you can be seen. We want you to feel as if you are family and well taken care of. Your safety and happiness are our primary concerns.

www.cosmeticplastics.com/pdf/TumescentBreastAug.pdf

Implant shapes and sizes:

We like and use Mentor implants. They make a good product and stand behind them with warranties and customer service. After using various shapes and textures over the years, we have found round, smooth implants to give the most natural appearance. The implants assume a tear drop shape when you are upright and lay flatter as you recline, just as a natural breast does. They come in three different profiles: Moderate, Plus and High Profile. We'll go over the best option for you based on the size you choose and your particular anatomy. The filler material is either saline (salt water of the same concentration found in your cells) or a silicone gel material. The safety of both of these has been tested and approved by the Food and Drug Administration.

Determining your size:

We can measure you preoperatively and determine your correct bra size and then add the implant volume you choose and remeasure to get an idea of the bra size you will be after the augmentation.

You can do this at home by first measuring your chest circumference in inches just below your breasts as well as your breast width. To measure your circumference, wrap a soft measuring tape around your chest just below your breasts (where your bra strap would go) and determine how big around you are in inches. Next, measure the width of your breasts by determining where the breast tissue starts on the outside of your chest and where it ends near the middle of your abdomen. Do this while sitting up and measure over the nipple.

Improved Technique for Determining Bra Size

You can then use the measurements and the chart above to determine your current bra size. If you measure some rice in a measuring cup in milliliters (mls.) and place it in a footsie stockinette, you can tie the footsie, mash it into a flat, rounded shape and put it over your breast and remeasure to get an idea of what that volume would lead to in bra size.

Implant placement location/Incision placement:

We find that for the vast majority of patients the breasts look the most natural when the implant is placed beneath the muscle. This markedly decreases the chance that there will be "step off" in the upper part of the breast that result in a round looking breast. A gentle natural looking slope is our goal. Full, but not abnormal in appearance. See Photo Gallery

A small incision must be made to develop the pocket for the implant. This is typically made in the lateral breast crease where it is well hidden. Over time the scar fades to a faint line. It can also be made around the areola (dark area around the nipple) if the areola is of sufficient size. This area also heals very well. The use of the armpit and belly button incision sites has some definite drawbacks in precisely forming the lower breast crease.

Implant fill material:

Breast implants are filled with either saline (dilute salt water as found in your body) or gel (a gummy bear silicone material). We have found both to give excellent results. Both are FDA approved and are safe. www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108790.htm
Both have pluses and minuses. The incision is slightly shorter with saline and the implants are less expensive. Gel has been described by some as more natural feeling. The choice is totally yours.

Anesthesia safety:

Your safety is our primary concern. That is why we only operate in hospital owned and operated outpatient facilities, ( Suburban Johns-Hopkins outpatient Center: www.suburbanhospital.org/services/OutpatientSurgeryCenter.aspx or INOVA Fairfax outpatient surgery; www.inova.org Both provide the very best in modern, safe anesthesia services. We will be happy to put you in touch with them prior to your surgery to answer your questions and allay any fears.

Post operative discomfort:

We have developed a way to markedly decrease your postoperative discomfort. During your procedure we will infiltrate the pocket area with tumescent solution and then inject all of the muscle areas that we have had to disrupt with a long acting anesthetic. Tumescent solution is what we use to perform liposuction. It makes the area numb and decreases any bleeding. This helps to keep you comfortable after the surgery for several hours. It also allows us to use less narcotics in recovery so you feel like yourself faster and go home sooner.

www.cosmeticplastics.com/article-lesspain.asp

www.cosmeticplastics.com/pdf/TumescentBreastAug.pdf

Massage technique:

After surgery it is important to maintain the pocket size. Implant massage begins approximately one week after surgery and consists of gently moving the implant back and forth in the pocket. Starting earlier may lead to bleeding and is not needed. We will instruct you in the technique during your first visit. A bandeau elastic strap may also be used to help the implant settle in the pocket.