How the Process Works – The Consultation

When a patient makes the decision to explore the possibility of getting a breast augmentation, a consultation in our office is scheduled. The consultation is free and without any obligation. During the consultation, the patient will articulate the goals she hopes to achieve with breast augmentation. In order to be a good candidate for breast augmentation there must be an anatomic situation that can be improved. The patients general health status and fitness for elective surgery is assessed. The procedure is discussed in detail including the general health and realistic goals. Realistic goals means that the patient understands and accepts what result can reasonably be expected with the breast augmentation surgery. The results after breast augmentation surgery are unique for each patient, and it is very important for the patient to understand that no two patients will look alike after breast augmentation. Further, patient goals will vary from patient to patient. At the consultation the indications, alternatives, possible benefits, risks, complications, limitations, and unfavorable results are discussed. The patient has an opportunity to ask questions about anything related to the breast augmentation procedure. If multiple consultations are desired then these are completed. Any additional information that is requested regarding breast augmentation is provided to the patient. If family members, friends, or a spouse wishes to attend the consultation(s), then this is encouraged as long as the patient requests and agrees to their presence.

The Pre-Operative Appointment

After the breast augmentation surgery is scheduled, a pre-operative appointment is also made at which time the procedure is further discussed and the details of the surgery are planned. The various parameters regarding the breast implant are determined (by the patient) including the breast implant type, breast implant shape, and breast implant size. The pre-operative and post-operative instructions are also reviewed at that time. Printed pre-operative and post-operative instructions are also provided for the patients convenience. The breast augmentation procedure is completed at the next appointment. Follow up appointments are made and the patient is followed closely until out of the peri-operative period (about six weeks). After the six weeks period the patient can then return to their primary care physician for regular care and breast cancer surveillance, and will also be seen in my office for follow up appointments as well.

Pre-Operative Evaluation

The pre-operative breast evaluation is an important part of the process to get breast implants. The “work-up” is usually very simple in healthy patients. The purpose of the “work-up” is to ensure that patients are healthy enough to undergo a surgical procedure. This is especially true for elective surgery when there are no time pressures to get to the operating room as in an emergency situation. If there are any known health issues they are investigated and in some cases a consultation with another physician is obtained. If any relevant pre-existing medical records are needed, they are also obtained at this time.

The Day of Surgery

The patient arrives at the office at the scheduled time. The preoperative instructions are reviewed and checked for compliance. It is very important to follow these instructions before surgery. The operative plan is reviewed with the patient and the “time out” protocol is completed. The “time out” protocol is a check list to help ensure that everything have been completed, checked, and approved on the day of surgery. The patient is a participant and integral part of the “time out” protocol. The Certified Anesthesia Staff then obtains a medical history, does a physical exam, and then starts an intravenous line (IV). In some patients, a pre-operative evaluation is performed by the Anesthesia Staff before the day of surgery. The breast augmentation procedure is then completed and the patient goes home after meeting the facility discharge criteria. The patient is seen in the office the day after surgery and on a weekly basis for several weeks. At about 6 weeks after the breast augmentation, the post operative appointments are spaced more widely. There is no fee for post-operative appointments.

The First Week After Breast Augmentation

Recovery after breast augmentation involves the breasts proper, the body as a whole, and returning to normal activity. The first week after breast augmentation there is some swelling and soreness. The swelling usually peaks at about 48 to 72 hours after the breast augmentation and begins to slowly subside after that time. The discomfort after breast augmentation is easily controlled with oral pain medicine. The anesthesia drugs (sedation) that are used for breast augmentation are effectively gone from the system in less than 24 hours. Activity can be increased gradually in the first week after surgery (see activity section). Most patients can perform daily living activities on the day after surgery, including meal preparation, child care, and other activities . It is helpful to have a “support person” for the first 48 hours after surgery, and a responsible adult should be with you for the first 24 hours. Many patients will return to work 2 days after surgery as long as strenuous activity (heavy lifting) is not required. Immediately after breast augmentation, it does take some time to become accustomed to your new breast size. Some patients will go through a brief period thinking they are “too big”, but most patients are very happy with their size after a brief period of time. Most patients will become accustomed to their new size within a week. As a general rule, travel far away from home is not advisable in the first week after breast augmentation. Following post-operative instructions in the first week after breast augmentation surgery is very important. It is important to communicate freely with Dr. Herring, to ask questions, and voice any concerns if any arise.

Activity Level After Breast Augmentation

The activity level of patients seeking breast augmentation varies widely. As a result, the return of “full activity” will also vary widely. Over the past 30 years, the protocols for post operative recovery have changed dramatically. For example, some surgical procedures “required” a week hospital stay and a week of complete inactivity. We now know that this was the worst possible recovery protocol that could be implemented. Patients should be active after surgery. This does not mean a marathon the day after surgery, but some level of activity (daily living activity) is much better for the patients and has been proven to be safer. Some patients are now treated with other modalities after surgery if they are at higher risk for having problems such as lower extremity venous thrombosis (blood clots in the legs) which can be fatal if they contribute to a pulmonary embolus (blood clot in the lungs). Many procedures are now performed as outpatient surgery, with the patients returning to work in several days. It is well established that some activity after surgery is beneficial to the recovery period, and the lack of some activity after surgery can be detrimental.

When considering breast augmentation, most patients can perform daily living activities the day after breast augmentation surgery. Most patients can participate in strenuous activity approximately 3 to 4 weeks after breast augmentation. There is some theoretical risk to “overdoing it” immediately after any surgery, including breast augmentation. For example, strenuous exercise the day after surgery may cause excessive bleeding (hematoma) in the breast pocket which may require additional surgery. This is because strenuous exercise can elevate blood pressure (non-pathologic hypertension) which has been shown to increase the chances of bleeding after surgery. After surgery, there should be a gradual increase in activity to normal levels and not a period of inactivity followed by an abrupt initiation of full activity. Many patients do well by using their comfort level as a general guide to activity after breast augmentation. As with many things in life, common sense is a good guide to recovery after breast augmentation. After the initial recovery period (full recovery is complete) there are no limitations to activity. It is always advisable to wear a fitted sports bra when engaging in strenuous activity such as jogging after breast augmentation. Patients should exercise common sense when returning to activity following the breast augmentation procedure and follow written post-operative instructions.

Follow Up After Breast Augmentation

Follow up after surgery is a very important part of the breast augmentation procedure. The follow up appointment serves several purposes. The most important purpose is to help ensure that the patients post-operative recovery is proceeding as expected. Another important reason is to assess the long term result, which can only be determined by long term follow-up. It is important the follow up care be done by the surgeon that performed the procedure. Follow up care for cancer surveillance is usually performed by a primary care physician.

The Breasts After Augmentation

The breast goes through several changes after the breast augmentation procedure. Some of the changes are visible and obvious and some are not. Immediately after surgery the breasts are very firm. This is partly a result of the breast implant stretching the breast tissue. The breast tissue is in a new position and is stretched over the breast implant which is a greater surface area than in the pre-operative state. As the recovery period proceeds, the breast tissue relaxes (dynamic response) in time over the breast implant and becomes softer. Usually there is a significant change in breast softness in about 6 weeks. Immediately after the breast augmentation procedure there is excessive fullness in the upper part of the breast. As the breast tissue relaxes, the breast is also firm as a result of swelling immediately after the breast augmentation procedure. Breast swelling (edema) is a natural response to the surgical procedure. The breast swelling will subside over a period of several weeks in most patients. After the swelling of surgery subsides and the breast tissue stretches, the breast will become softer and more natural feeling. The softness of the breast is partly dependent on the breast implant, and on the type of implant. Breast softness is also partly dependent on the amount of breast tissue, and the amount of glandular tissue versus fat (adipose) in the breast. The size of the breast will change after surgery. Early changes in breast size (decrease in size) are a result of the resolution of swelling. The change in size due to resolution of swelling is minimal and occurs in the first several weeks after the breast augmentation procedure. The breast will also decrease in size over a longer period of time (years) due to the natural aging process. As the breasts age, the glandular tissue decreases in volume which decreases the overall volume of the breast. The breast tissue can also decrease in volume as a result of dynamic pressure atrophy. The phenomenon can be observed in almost any living tissue (with a few exceptions). Pressure applied over a long period of time to living tissue causes change, and in this case, decreases in volume of the breast tissue. This can occur to the ribs under the breast implants, although this is a rare observation.

As the breast age over time tissue integrity decreases. Breast tissue can also decrease in tissue integrity as a result of pregnancy. The result is more breast sagging as aging progresses. This is a very gradual change and at some point patients may want a breast lift (mastopexy) at a later time. The incision site of the breast augmentation surgery also goes through stages of healing. After breast augmentation, the skin and the subcutaneous tissues (tissue just under the skin) are swollen. This causes what is sometimes referred to as a “healing ridge”. Just as with the breast tissue, the skin swelling subsides in about three weeks. The appearance of the of the incision (the scar) for breast augmentation improves over a 2 year period in most patients unless there is an adverse wound healing diathesis (tendency) for adverse scars (hypertrophic scar, keloid). Research over the last 25 years has shown that there are therapeutic measures that can be performed after surgery to improve scars. We always use these therapies for patients undergoing breast augmentation. This emphasizes the importance of follow up after the breast augmentation procedure. Tissue changes that cannot be seen are also occurring inside the breast. Within hours after the breast augmentation procedure a “capsule” (scar tissue) begins to form around the breast implant. This is the body’s normal response to the presence of a foreign body, the foreign body being the breast implant. If the “capsule” remains larger than the implant, the breast will remain soft. If the “capsule” shrinks, thickens, and becomes tight, the implant will be more firm. The status (condition) of the capsule should be closely followed by the Plastic surgeon to help ensure that a problematic “capsular contracture” does not occur, and if one does occur, to discuss treatment options. As with post-operative care for the scar after breast augmentation, the inside of the breast can also be followed by the Plastic surgeon. The Plastic surgeon should follow breast augmentation patients after surgery to monitor the incision site (scar) and the breast “capsule” so that if adverse healing (keloid, hypertrophic scar, hyperpigmented scar) occurs then treatment can be offered.

Dr. Herring & his team provided excellent care throughout my breast augmentation procedure & aftercare. They were available at any time via cell phone for questions or concerns. I’m very pleased with my results. I highly recommend for your plastic surgery needs.

Dawn Strickland

July 20, 2021

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Breastfeeding After Breast Augmentation

Patients frequently ask if it is possible to breast feed a baby after breast augmentation. The two issues related to breast feeding after breast augmentation are the ability to breast feed, and the quality of the breast milk. Studies have shown that the breast milk after breast augmentation does not contain any more silicone than breast milk in the patient without breast augmentation. Breast milk after breast augmentation is generally thought to be safe, although some researchers write that this has not been “proven”. The ability to breast feed could be affected by breast surgery. Breast augmentation procedures that cause the least injury to the breast glands, breast ducts, and the nipple-areolar process are less likely to affect the ability to breast feed. The breast augmentation approaches that dissect under the breast (infra-mammary incision, axillary incision) as opposed to through the breast (peri-areolar incision) would be desirable based on this assumption. While not a random controlled trial, which is the gold standard in medical research, many anecdotal cases have been seen where patients successfully breast fed a baby after breast augmentation. However, there is no guarantee that a patient will be able to breast feed with or without breast augmentation.

Attainable Goals, Limitations, and Realistic Expectations

There are many benefits gained from the breast augmentation procedure. As with any elective cosmetic Plastic surgery procedure, there are goals that can be accomplished, and there are also limitations. Breast augmentation can increase the volume of the breasts and can also give a small degree of lift in some patients. Following breast augmentation, clothes and bathing suits will fit better, and many patients report improvements in self confidence and self image. Some clothes that were inadvisable to wear for patients with hypomastia (small breasts) can be comfortably worn after breast augmentation, such as a low cut evening dress or a bikini. There are aspects about the breast that cannot be changed or improved with the breast augmentation procedure. Some of these conditions are a result of aging or pregnancy, and some are developmental (natural conditions as a result of development). Skin tone cannot be changed or improved with augmentation mammaplasty. Extreme amounts of excess skin cannot be corrected with an augmentation mammoplasty alone. Stretch marks cannot be eliminated with an augmentation mammoplasty. Patients should not expect to look exactly like another person after surgery, because all patients are unique before and after breast augmentation. Chest wall asymmetry, pectus carinatum and pectus excavatum cannot be eliminated with an augmentation mammoplasty. Breast augmentation will not stop the aging process. It is extremely important that the patient seeking augmentation mammaplasty understand that there are some limitations to the breast augmentation procedure and the procedure is not a panacea (cure all).

Aging of the Breasts

As with any elective cosmetic procedure, the aging process is not interrupted by the breast augmentation procedure. The breasts will change with aging irrespective of the presence or absence of breast implants. The breast tissue can thin to some degree after breast augmentation, which may or may not be attributable to the procedure since this can occur without the presence of breast implants. Breast sagging progresses naturally without breast implants. The presence of breast implants, especially very large implants, may speed the progression of breast sagging. Breast implants are mechanical devices, and like all mechanical devices, can deflate or rupture. At the time this was written, the Mentor company (breast implant manufacturer) has a limited lifetime warranty. Saline breast implants have been used since the early 1990’s with a very high satisfaction rate. This means that the saline breast implant group of patients has been followed for about 25 years. It is generally believed that saline breast implants are safe. It is also believed that saline breast implants are effective. It can also be concluded that most saline breast implants last a long time in most patients. Because the new fifth generation breast implants are relatively new when compared to saline implants, less time has been spent studying them.

Breast Augmentation Information