Breast Augmentation (cont.)
Incisions - Pocket Location - Silicone vs. Saline - Implants and Mammography - Implant Massage Exercises
Surgery
The procedure is performed on an outpatient basis with general anesthesia. The patient is first marked in an upright position prior to entering the operating room. If a patient has inverted nipples, this can also be addressed at the time of surgery. Long-acting local anesthesia is also either placed in the implant pocket itself or injected as intercostal nerve blocks to minimize postoperative discomfort. This should last at least 6-8 hours. At the end of the procedure, the patient is placed in a dressing consisting of gauze padding and ace bandages placed circumferentially like a tube top.
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Age: 54 yo
Procedures: Breast augmentation; Correction of inverted nipples
Incision: Inframammary
Implants: Saline, moderate profile
- Left: 275 cc
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Right: 275 cc
Time after surgery: 1 month |
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Recovery
The most common complaint after breast augmentation surgery is pressure on the chest. This is due to the pectoralis major muscles contracting against the implants in response to being stretched. This will subside as one’s body adjusts to the implants, and muscle relaxants such as valium offer significant relief to patients in the immediate postoperative period. Sleeping with a folded towel under each shoulder may also help to take tension off the muscles. The patient is seen back in the office a few days after surgery for dressing removal at which time she is placed in a soft bra.
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After |
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Age: 39 yo
Incision: Inframammary
Implants: Saline, moderate profile
- Left: 250 cc
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Right: 250 cc
Time after surgery: 2 years |
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Implant Massage Exercises
Implant massage exercises are started soon after surgery. The goal is to manipulate the implant around the pocket to keep the pocket larger than the implant itself. This allows the implant to move around more naturally with changes in body position and also minimizes the incidence of capsular contracture. Exercises are performed twice a day on each side.
Patients are instructed to use the right hand to massage the left breast and vice versa. The exercises are performed in 2 directions. First, the hand is held so that the little finger is touching the inframammary fold. The patient is then instructed to turn the palm toward the body to push the implant in an upward direction, hold it in that position for a few seconds, and then release. This should be a rocking motion, not a lift. This is then repeated with the other breast. The second exercise is to push the implants toward the center of the chest, hold for a few seconds, and then release.
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Age: 36 yo
Incision: Periareolar
Implants: Saline, moderate profile
- Left: 300 cc
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Right: 400 cc
Time after surgery: 14 months |
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Risks and complications
Risks and complications are uncommon, but may occur. They include, but are not limited to: infection, bleeding, scars, sensory changes of the overlying skin and nipple (increased, decreased, lost), capsular contracture, implant deflation, persistent asymmetry, and need for revision in the future.
Capsular contracture is our primary concern after breast augmentation. The capsule is the scar tissue which normally forms around the implants. If this scar tissue tightens around the implants, it may cause distortion and/or discomfort. This may be treated initially with more aggressive massage exercises. Accolate, a medication typically used for asthma, may also be added, as it can lessen capsular contracture in some patients. If these measures are unsuccessful, surgery is needed to remove the scar tissue and reopen the pocket. Implant massage exercises are then restarted a few days later to maintain the larger pocket and prevent recurrence.
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After |
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Age: 32 yo
Procedures: Bilateral capsulotomy; Implant exchange from anatomic textured saline to smooth round silicone implants
Incision: Inframammary
Implants: Silicone, moderate profile
- Left: 450 cc
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Right: 450 cc
Time after surgery: 2 months |
Procedures that may complement
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