Where are the incisions in breast surgery? Is one better than the other?
There are 3 popular incisions:
There is also an approach thru the umbilicus which we do not advocate. Dr. Pozner prefers to only peform Areolar and inframammary incisions for breast augmentations.
Which is better: Silicone or saline?
Under the age of 22 the FDA only permits the use of saline implants. We prefer silicone in most instances because there is a more natural feel with proper placement.
Do implants increase the chance of getting cancer? Or any other disease for that matter?
Definitely not. There is no documented study that links the use of implants to any increase in any disease or condition.
What is the youngest a woman can have breast surgery?
With few exceptions we would not consider any candidate under the age of 18.
What different shapes or sizes do implants come in?
The most popular shape is a round or slightly void configuration. There are also tear drop inserts as well.
Where does the operation take place?
In our state approved operating facility within our office.
Do I have to be put to sleep?
In our experience it is much better to have this procedure done under IV or light general sedation. There are some centers that do this procedure using local anesthesia, but from or experience of thousands of cases, our technique leaves the patient much happier and less anxious.
What do I have to do to prepare for surgery?
You will receive all the necessary instructions at your consultation and scheduling.
Where are the breast implants placed over or under the muscle? Why?
One of the undesired complications of this procedure is too tight an encapsulation of the insert. Capsule formation is the body’s natural response to any implant. We have found that by placing the implant under the pectoral major muscle, there is less chance of the capsule contracting too much. In addition the prosthesis stays in a higher position for a longer time. This is not to say that over the muscle placement is in any way a bad technique, it is not our preference based on our own and most other plastic surgeons’ experience.
How long does the operation last?
Anywhere from 1-2hours in a primary procedure.
Can I go home right away? Does anyone have to stay with me?
Even using general anesthesia you will go home about 1 hour after the operation is over, It is imperative that some be with you for the first 48 to 72 hours after surgery.
What do my breasts feel like after the surgery?
They will feel firmer and slightly sore. If course the breasts will be bandaged for the first 24-48 hours.
How long is the recovery after breast enlargement surgery? When Can I drive?
We recommend that you do not drive for at least 7-10 days. You will be able to shower within 48 hours.
When Can I exercise?
You may start light lower body exercises within 1 week. Avoid strenuous arm movements for at least 2 weeks and then always with a sport bra support.
Do the implants last forever?
What does The manufacturers provide warranties which will be discussed at your consultation. We have had patients that have had the same implants for over 30 years.
Do I have to do any special exams to make sure they are ok?
We recommend mammograms on a regular basis, and at times some other exams on rare occasions.
Do they interfere with mammograms?
Mammography does not interfere with as well as self exams after following a few simple instructions.
If they are defective do the companies have any warranties to protect me?
This will be discussed at your consultation.
Can I breast feed after breast augmentation surgery?
There is no interference with breast feeding since this is based on hormonal changes.
What is capsular contracture and how often does it occur?
It is the body’s response to any implant and may be accelerated by infection, bleeding around the insert, and sometimes by the body wishing to minimize the intrusion.
What is bottoming out? How do I know if I have it?
Do your breasts look anything like the picture below:
Is it possible to get stretch marks from breast enlargement?
Very rarely and occasionally following pregnancy.
Is breast enlargement surgery safe for breast cancer survivors?
Definitely. It is becoming the treatment of choice after cancer.
Can breast implants lift sagging breasts?
To some extent, depending on the level of sagging. We usually have to combine implants with some skin removal to create a better skin brassiere. This will be discussed on an individual basis.
What are the main reasons patients seek revision breast augmentation procedures?
Previously, capsular contracture, implant rupture, and size were the reasons most women sought revision breast augmentation. However, today many patients tend to complain about poor breast shape and skin texture abnormalities following subglandular saline augmentation.
What are the primary benefits of submuscular conversion?
Conversion to submuscular implant placement provides four main benefits:
More specifically, what type of patients typically seek submuscular revision augmentation?
Patient seeking reaugmentation following subglandular augmentation falls into four broad categories that have considerable overlap.
Patient with adequate tissue coverage seeking size change often request submuscular conversion. Although there are no studies to verify it, in my experience there is considerable evidence that submuscular placement decreases capsule rate and implant palpability.
Palpability and rippling are usually due to inadequate tissue coverage and can be compounded by type of implant used (i.e., textured saline). Submuscular conversion will improve upper pole and medical rippling but will not usually correct lateral rippling. Submuscular conversion with smooth silicone implants may be needed if lateral rippling is extreme.
Preoperative subglandular saline implant with superior pole and lateral rippling. Postoperative after conversion with Mentor smooth silicone 800 cc high profile implants.
Breast Malposition-patient with subglandular implants, especially after multiple pregnancies, often present with grade three pstosis and the “rock in sock” phenomena. Submuscular conversion with mastopexy offers some advantage for long-term support.
Implant Malposition- patients may have misplaced subglandular implants. During consultation a “tilt test” is performed by having patients sit in a power chair. The chair is then lowered to assess the degree of lateral implant movement. Submuscular conversion in itself will improve superiorly and medially displaced implants, but capsulorrhaphy is needed in addition for lateral or inferiorly displaced implants.
Preoperative subglandular 275 cc with dropped left and failed previous repair. Postoperative exchanged with conversion for 400 cc smooth moderate profile with capsule repair.
In my experience, submuscular conversion with capsulectomy appears to improve recurrent contracture. It is important to consider nipple areolar viability in extremely thin-skinned women in which Capslectomy and mastopexy is performed simultaneously.
Preoperative subglandular saline with Baker 3 contracture. Postoperative exchanged the conversion of 425 cc smooth saline with Benelli.
What’s involved in your patient evaluation process?
During patient evaluation, a determination is made regarding the breast pocket dimensions and position, implant size, skin dimensions and nipple position. Both the patient’s and surgeon’s input is important to determine the best surgical plan. For example, a patient with capsular contracture may need a larger implant or mastopexy with a smaller implant after capsulectomy.
What surgical technique do you prefer?
Ideally, an aereolar approach is used, although an existing inframammary incision may be used if mastopexy or full caspsulectomy is not needed. If capsular contracture is present, full capsulectomy is performed. With no siginifigant capsular contracture, the subglandular pocket is opened and the implant is removed. If the fold is to be lowered or remain constant, the capsule is removed from the pectoralis major muscle. The anterior capsule is scored and brushed with a electrocautery device. Partial capsulectomy (at least) is always performed to allow the tissue to heal without serroma or excessive scarring. The pectoralis major muscle is elevated and divided. The muscle is then plicated to the anterior tissues, usually at the level of the superior areola with several 2-0 Vicryl sutures. Sizers are placed to determine size and pocket shape. Drains are placed in all Submuscular conversions. After the implants are placed, the patient is brought to a seated position and symmetry is assessed and corrected. If no mastopexy is indicated, the wounds are closed.
Are the special considerations that must be considered during surgery?
If the inframammary fold needs to be elevated, a capsule flap is elevated from the pectoralis major muscle prior to elevation. The inferior capsule is excised and the tissues closed. The capsule flap is then sutured to the anterior tissues to reinforce the inferior tissue placation.
Overdissection of the medical pocket may create symmastia or excessive cleavage. IN such cases, medial capsulectomy with closure of the overdissected pocket and creation of a submuscular pocket is performed. Postoperative taping and support are essential.
For lateralized subglandular implants, the lateral pectoral attachments are preserved if possible, and the overdissected tissue is corrected with partial capsulectomy and suture of the cut capsule ends.
After submuscular conversion is complete, the skin is tailor tacked with silk sutures to gauge areolar position and the degree and/or necessity of skin excision. Saline implant fill tubes are then removed at the end of the mastopexy.
What breast implant do you prefer for this procedure?
I prefer smooth round implants. A revision augmentation qualifies the patient for silicone gel implants; however, saline implants can be used if the patient prefers. Postoperatively adjustable implants are useful when there is significant asymmetry or insufficient skin.
Dr. Pozner specializes in Boca Raton breast enlargement.
We would love to talk more with you about your own personalized treatment at Sanctuary Plastic Surgery. With your own private consultation, our team of extraordinarily skilled and dedicated plastic surgeons will be able to recommend the right treatment plans for your unique goals and concerns. With offices in Boca Raton and Palm Beach Gardens, men and women in Florida can achieve the most natural and elegant results. Call today to schedule your consultation.