There are Many Reason Why Women Consider Breast Augmentation

Most of women who think about breast augmentation have considered the procedure for years. Sometimes they tell us they have always felt out of proportion in clothing; other times they have seen their breasts change following childbirth. The majority of breast augmentation candidates want natural looking breasts and many express fears they will emerge from surgery appearing "fake" or too big. Some even tell us they just want to look like they do when they wear their padded bra-- without the bra.

The Consultation

The pursuit cosmetic improvement begins with the first consultation. All cosmetic consultations are with one of our two doctors, not a patient coordinator. Yes, it takes more time for the doctors but, it's our belief that you want and need to hear about the surgery from the person who'll be doing the surgery. Few practices do this, but it is important to get to know your surgeon.

We believe its essential to listen to the patient-- not only to discuss the procedure and its inherent risks, but to tailor the discussion to the factors that make each of us different and challenging. A careful examination is also directed toward explaining to the patient what positives and negatives her unique anatomy brings to the table.

At the end of the consultation, you will receive a price quote. This quote should be for everything except your postoperative medications. Again, not to criticize any plastic surgeons, but giving a patient the "surgeons fee" without the cost of surgical bras, anesthesia, operating rooms, postoperative visits, etc. has become far to common and unfairly reflects a price far less than your final cost. When you leave the office you should know the bottom line.

Sizing

A second visit is needed by virtually all cosmetic patients. At that visit consent forms are reviewed, a detailed description of the anticipated recovery is discussed and preoperative photographs are taken. For breast augmentation patients, a sizing is also done.

In a recent survey to patients who have undergone breast augmentation surgery, the single most common complaint was: "I was told I'd be a particular cup size, and I'm not that size." When we asked these women how they selected their implants, some said they asked for a particular cup size and were told not to worry the implant would be picked for them. Others were told to put rice in bags and to calculate their preferred implant size based on the volume of rice. Others were shown computer simulations which supposedly showed what they could expect postoperatively.

In this practice, we do sizings by putting patients in their postoperative bra and letting them try sizer implants in the bra with a top and in the bra alone. While we won't claim this is a perfect means of selections, it does give patients the opportunity to see the difference 50 or 100 ccs makes in their final appearance. We offer our advice when it comes to the final decision but, firmly believe that the patient not the spouse, significant other, or doctor is the one who needs to be happy with the ultimate choice. We offer all patients the opportunity to come back in before surgery a second time, if they wish, to confirm their decisions.

Implants

We use saline implants made by Mentor and Inamed (formerly McGhan). While some plastic surgeons use one brand exclusively, it has been our experience that some women "fit" better in one brand or the other. Both manufacturers stand behind their products with generous warranties and both have proven time and again their safety. We do not use "lesser" brands such as PIP or Silimed which are cheaper but do not have the track record of Mentor or Inamed. In more petite patients who desire larger implant sizes, high profile implants may be an alternative. In most cases, when implants get larger they also get wider.

In more petite patients this can lead to the implant extending into the armpit. High profile implants offer more implant volume with a narrower base giving the desired volume without the negative effects of traditional implants.

We strongly believe in overfilling of saline implants. The tendency of saline implants to ripple is well known and in some patients it can be not just felt but seen when the patient bends forward. Placing the implant below the muscle is certainly a consideration to minimize rippling but, overfilling the implant by 10% can turn a good result with palpable rippling to a great result without it.

Occasionally patients ask about anatomic (teardrop shaped) implants. The plastic surgical literature is replete with cases in which these implants have rotated within the pocket resulting in a "strange" looking result which often needs to be corrected surgically. For this reason, we, and 86% of plastic surgeons nationally, prefer round implants.

Dr. Frank is also an investigator with the Silicone Gel Adjunct studies of both Mentor and Inamed. As investigators we have access to the newest gel implants. These implant are available to select patients interested in alternatives to saline implants.

Incisions

Dr. Frank has extensive experience with each of the three standard implant incisions: inframammary, periareolar and transaxillary. Each has its advantages and disadvantages. The incisions are typically small, well concealed and closed with dissolving sutures which do not need to be removed. To date, we have not seen the advantage of the TUBA technique when considered with its limited exposure and the inability to make revisions using the original incision.

Implant placement

Subglandular implants (over the muscle)

When implants were first introduced, most were placed under the breast but over the chest wall muscles. In patients who are small breasted, placing the implant over the muscle results in a very round appearance to the upper portion of the breast. Some patients complain of a "fake" or "Baywatch" appearance and others can have visible rippling over the cleavage. For these reasons, we generally prefer subglandular implants only in patients with enough of their own breast tissue to minimize these negatives.

Submuscular implants (under the muscle)

Most of the patients we see prefer a more natural postoperative appearance. In these patients, we often recommend submuscular implant placement. Placing the implant under the muscle not only improves the postoperative appearance. Capsular contracture (scar tissue formation around the implant which can distort the shape of the breast) is much more common in implants over the muscle. Mammograms are easier to read when the implants are under the muscle and the likelihood of being able to breastfeed postoperatively is increased. The benefits must be weighed against more pain in the immediate postoperative period.

Stryker Pain Pump

In an attempt to make the postoperative recovery more comfortable for our patients, we are now pleased to offer the Stryer Pain Pump as an option for patients having breast augmentation. The pump is designed to supplement pills for pain control not replace them. The pump was developed for pain control in total joint replacement patients and has been used for cosmetic surgery patients for several years.

The pump consists of a thin tube (similar to an epidural catheter) placed in the implant pocket at the time of surgery. This catheter is attached to a reservoir which is filled with a long acting local anesthetic. Over the course of the first two days after surgery the pain medications is delivered to the place where it is most needed resulting in a significant decrease in oral narcotic use. A regulatory valve prevents overdose. The catheters are typically removed by the patients once the reservoirs are empty.