Breast Augmentation is one of the most common procedures performed in cosmetic surgery today. It is one of the procedures mostly in demand and really one of the safest cosmetic procedures that can be performed on an outpatient basis.
Most patients come in, have the procedure in 1 to 2 hours at the most, and for 15 to 20 may be 30 years or may be even for the rest of their lives they really don't need to undergo a secondary procedure. So it is a pretty safe, very nice procedure that gives you a long-lasting natural result in the right hand. Not only I feel that cosmetic breast surgery enhances ones body and personal self-image, but it really affects the person's whole life. I have had so many patients that come and tell me, "you know doc, you know, I had this procedure with Dr. Shane and I feel like I am a much happier person; my whole life, my relationships, my you know work ethics, everything else has changed because of it", and its seldom you get to do a procedure as a surgeon that has such an enormous effect on the patient's body and life, and psychology in one hour. I mean, you know, it is an incredible feeling as a surgeon to have, that you can do something like that. Breast augmentation really is performed in two different ways, either by transferring fat from one place to the breast area or by placement of an implant. As you know, breast implants are either silicone or saline and we will talk about the different types implant and then you can place those implants either over the muscle or under the muscle. We will talk about the differences and why one would be preferable to the other. Then, some patients need a lift and there are different kinds of lifts and some people don't, some people need their implants placed under the muscle and partially over the muscle, and for some patient it need to be completely under the muscle. Then, to make things more complicated, some patients need to have the implants pushed more in the center to create a cleavage and appropriate for their body and some people really need to put the implants apart or more lower placement in order to enhance their breasts in the right way and also help with some natural skeletal or structural, I would not want to call it deformity, but really it is. Some people have, for example, too indented of a chest wall and so these implants could actually improve that indentation or irregularity in the chest wall structure and some individuals have too much of a projection in certain areas of the chest, so by placing these implants, for example in the center where we call a sternum, that big bone, the longitudinal bone in the center, some people have actually chest walls that look like this, sort of in a, I don't know how to describe it, but it is sort of an angle with the sternum in the center and the breast sort of pointing away from each other, by placing the implants more centrally, we can actually improve the contour of their chest wall as well as enhance their overall appearance. Bottom line, it is an incredible procedure, both for a surgeon who is performing it and for patient generally that receives these procedures. My satisfaction rate is probably the highest with breast augmentation, not because only I perform them most commonly than any other procedure because of the high demand, but also because just overall, you know, patients come in to get bigger breasts, they get breasts, they are happy. So, as long the breasts look good, they are enlarged and they had no complications and this was very safe and natural result they seem to be extremely static about it and refer a lot of people to us. Now, we can sort of get a little bit more in depth as far as the various procedures that are necessary on each patient and what these each are.
First, let us talk about implants. There is silicone and saline. silicone implant, as you know, silicone implants were pretty much the first implants that were used. There was a huge controversy as far as their safety was concerned in the 80s, because of this, there was a ban on the silicone implant, and FDA really, I don't know of another product or entity that was more under scrutiny for a longer period of time than silicone implant. For years, since 1982 and now 2004, almost 2005, so many years they studied silicone and its effect on the body and they have yet not found one proof that it has any long-term or short-term side effects, so they are re-approved for the use in human body and the silicone implants that are now being re-approved are high-cohesive silicone gel implants which means even if the bag containing the silicone gel breaks, the cohesive effect, the cohesive force between the molecules of silicone are so much stronger than the force that would be perhaps gravity or other pressure, that pretty much silicone stays in tact, in one lump and does not move as easily as the previous silicone perhaps used to and so it does not cause as much of a problem. Pretty much, the bottom line is, it is a pretty safe implant, it is very natural, it is lot more natural than saline in feel and in look, as you know, implants have what we call ripple. Ripple is to implant, I always to my patients, as threads are to tires. You can't separate the thread from the tire. You cannot separate ripples from implants. What are ripples? Ripples are the waviness around the circumference of an implant. Saline has a lot more ripple than silicone does, so that is one of the visual benefits of having actually a silicone implant instead of a saline implant. The next thing is a just a visual defect of just having a soft tissue added to you own breast that has same almost consistency, will give you a lot less of the circumferential ball look, so most patient want a very natural breast enhancement. They don't want to really have this, you know, too big basket balls, sort of type of, the way they describe it to me "breast fitting" you know, on their chest, and that is something that silicone can easily do for them and the feel obviously. The difference between the feel of the silicone implant versus a saline implant is; silicone implant is a lot softer and the same almost consistency as fatty tissue is, and you know, fatty being sort of they call it, you know the kids, usually the young girls that come in, they say "gummy bear implants." They feel that gummy bear, sort of gooey feeling, they call it and that is really true. It feels sort of like the same consistency as adipose tissue has fat versus saline, which feels sort of like your contracted thigh muscle. If you sort of harden your thigh muscle and touch it, it feels somewhat firm. It is not soft and fatty in consistency, so you know, most people don't like to have hard feeling, you know, in their breast, they want to feel that they are natural you know in touch, in feel, and so silicone is more readily able to do that for more patients. Saline is on the other hand a very safe implant in the sense that saline is a solution consisting of water and salt, so when you have the salt water, which is pretty benign in the human body, if it is in the same, you know, concentration as the fluid in blood and that is what saline is. It is the same concentration as blood, is completely safe. Matter of fact, it is what we use in hydrating patients, in giving fluids through the IV to patients intravenously in the hospital. It is so safe that we use it on a day-to-day basis, if anybody has been to the hospital they know they put a tube that goes to a bag and that bag contains saline, so its very safe. So it is very safe, so if the implant breaks it is just as if you got, you know, that same fluid that you would give directly into the vein, around the tissues it gets absorbed, goes into the veins and then that is it. The body extracts it through the kidneys. Its pretty safe. No complication, and matter of fact, the worse case scenario is that the implant is going to leak or break, it is very difficult to break saline implant. The pressure test that matter of fact, I stand on the implants very often and jump up and down just to prove a point. They will not almost ever break on blunt pressure. It takes a sharp instrument to break those implants. The chest wall will break. The bones will break before the implant breaks almost, so it is hard to break the implant, even in an accident most commonly you will not break them. So, that's how safe they are and very strong. So, that's a saline implant. The side effect of having either saline or silicone implant as an augmentation procedure is very very minimal. The bottom line is that worse case scenario is rejection of implant and that is very rare. I have done hundreds and hundreds and hundreds of implants and I have yet to go back on my own patients, I am thinking as I speak, I am thinking to know if really honestly I have gone back to take these implants out or take away the scar tissue, I have not yet. A lot of times, I can actually soften the capsule or contraction scar. The scar that forms around the implant just by mere pressure, it will crack the capsule and become soft again, and then I teach the patients how to continue to massage and give them some medications and vitamins as on, and they feel that, you know, the consistency, the softness is good enough that they don't really need to go back and have surgery. So, now lets talk about various approaches to breast augmentation. For silicone implant, as you know, because silicone comes in as a prefilled implant and they are pretty large, there has to be enough of an opening or incision in order for me to be able to place the implants, you know into the pocket, so it either has to be periareolar; meaning from around the areolar, the colored part of the nipple or under the breasts. That's for silicone implants. For saline implants; however, we have options. We can go from under the arm, axillary approach. We can go from around the nipple, transareolar, or periareolar. We can go from belly button, transumbilical, or we can go from under the breast, submammary, so these are various approaches and sometimes patients have previous scars and I can use them as well, so I would actually completely prevent any new scarring. That's approach. As far as placement is concerned, meaning either over the muscle or under the muscle. Now, what muscle are we talking about? I am sure you have seen these body builders people who go to gym and workout a lot. I am sure most of you patients watching this video go to the gym all the time and work out pecs, pectoralis muscle. Pectoralis muscle is a muscle that attaches to the clavicle, the collarbone, and then here into the center to the sternum and its a flat muscle, sort of as big as your hand, and it sits right on top of the chest wall. I can place the implant right underneath the muscle or right over the muscle underneath the breast gland and the skin. The advantage of placing the implants under the muscle is, the muscle usually is thick and creates an additional covering to the implant. So, not only it makes it less noticeably visually, it also makes it less noticeable in types of contact, you know, when somebody touches it, so basically it is a much better approach in most patients. Not everybody is a candidate but it is my preferred technique to put the implants in. It is more complicated in essence from a surgeon's point of view to learn to perform these procedures, you know, I performed these mostly in 9/10 cases and I have trained almost all the surgeons that work with us to perform this procedure, so in our center, that's the most preferred technique. Number 2, certain patients who are not candidates, what we do is, we either place them over the muscle or I prefer doing them, what I call, under and over the muscle. I believe I try to cover as much of the implant as possible with the muscle and if they are not a candidate for a full submuscular placement, meaning completely under the muscle at least they get enough of a coverage so that the superior aspect border of the implant, in other words, the top part, where the implant is showing when they wear bikini or other type of open clothing, it does not show as a round, you know circumference, like sort of a ball, so that is an advantage to putting it under the muscle and you know it is worth that extra half an hour of time in the operating time. The other aspect is some patients do need lifts and so we combine a breast lift with a breast augmentation, depends on what that particular patient's level of ptosis or drooping is. There are different types of lifts. There are different grades of ptosis. There are different types of lifts that are associated with each grade of ptosis. So obviously, you know, either myself or one of my associates, who will examine you will help you decide as to what the best approach is particularly for you. My belief is the less the scar, the most natural results are my preferred outcomes and that is what we really try to go towards, not necessarily to do the most ideal textbook techniques, because you know what, that textbook technique may be perfect according to the textbook, but may not be the best procedure for you. You are the patient, you are the one I am an advocate of, so I am not trying to impress the textbook or the writers of the of the textbook, but I am trying to make you happy and make sure that this procedure is going to give you the best lifestyle after you have had it, so what I would do is, I would not device a technique that would give you the absolute bare minimum scarring for the level of improvement that you are going to have or enhance the self-image you are going to have as a result of the procedure. The different types of lifts, I am sure some of you have educated yourself on this, but it is pretty simple. There is called a crescent lift, which is a very simple incision around the superior aspect or the top half of the areola. We take sliver of skin and lift up the areola that way, that's for a very mild ptosis, like grade I we call it, then we have the circumareolar or circumferential incision around the areola and we take a doughnut of skin away and we give a lift to the patient, that is usually for a grade II or close to grade II ptosis or drooping. Then there is a grade III ptosis and that is for patients who have really the nipple areola complex pointing pretty much completely down versus the grade II where the nippled areola is not completely down, although it is lower than the fold underneath the breast, so for those patients, we either would do what we call a keyhole technique or lollipop technique where the scars around the areola and also a vertical portion to that scar, or they would need what we call an "anchor scar", where there is an incision around the areola vertically down from the lower border of the areola down to the fold and then also transversely around the fold. I will try by any means possible to prevent scarring in any procedure I do and my associates that work here as well with me have been trying to the exact same thing. So, the bottom line is, our goal is to minimize scar that's why we have devised various technique including transumbilical technique that I call an internal reverse lift, where I go in and instead of actually lifting the nippled areola complex, I lower the fold, so that you get a visual lift effect, so we minimize the need for the actual breast lift through cutting incision. We will discuss all of that with you if that is procedure you need or you may be a good candidate for. Make sure you ask about that, so the bottom line is, to sum it all up, there are no two patients that are identical. There are no two patients whose life styles are identical. There are no two patients who need the exact same identical procedures. Every patient is unique, every lifestyle is unique. We will try our absolute best as surgeons here at the New Me Institute to give you a procedure that best fits your particular needs. Just relax and make sure you feel comfortable enough to ask about anything and any possible options that you may have outside of what the doctor may initially introduce to you. I am available to you 24x7 as I said many times before. My goal is to surpass your expectations and give you a five star service in everything that we do. Now, you have come for a consultation, you have gotten to like us, you have decided this is the place for you as hundreds of patient before you have decided this is the place to have cosmetic surgery. To enhance your healing and improve your chance of getting an excellent outcome with very very minimum to no complications or delays in healing, we start before surgery, not necessarily just after, so two or three weeks before surgery, you need to stop taking any aspirin, any Motrin, any herbs, any vitamins. No tobacco or any type of nicotine use at all. No smoking of anything else and no alcohol or anything that may complicate your surgery or postoperative course. Then, prior to surgery, you will be given IV antibiotics intraoperatively; in the surgery, if your age is such that it requires preoperative by a specialist, any internist or a cardiologist, you will be guided to do that. Before surgery, you will be asked to have a mammogram of your breasts to make sure that we have a preoperative image of your breast tissue, so that if there is a question afterwards, you have a baseline. And now, this is the night before your surgery. What I would need you to do, is stop taking any medications and/or any vitamins and herbs that you have stopped, don't take them obviously the night before surgery and the day of surgery unless you've asked and you are sure you can take them, you are going to take nothing by mouth from 12 midnight of the night before our surgery, it is called NPO nothing per oral, nothing my mouth, so that includes fluids, liquids of all kinds obviously and food, after midnight none. You will make sure you have arranged a ride, obviously you are not expected to be able to drive the day of surgery, you cannot drive yourself home, so you need to have a ride, I am sure you have arranged that ahead of time, and that individual will bring you to the center preferably and come to pick you up after the procedure is completed. Make sure that individual is able to manage in case they need to contact me and take care of you and care for you. I want that person to be over the age of 21, a responsible person that you trust. Obviously, you know who that person is around you and I don't want you to feel uncomfortable for me to be able to share information with that person and/or give them instructions as far as what to do in case they need to do something on your behalf or for you. The other thing is that, that individual will be handling your pain medication and your antibiotic dosage for the first 24 hours of the procedure. They need to know and be trustworthy to handle that type of responsibility. As far as the postoperative care immediately after the surgery you most likely will not have any drains after breast augmentation. The old technique was that they used to put drains in, I don't do that, most associated doctors, almost all the doctors that work with me and have been trained at the New Me Institute do not do that, so you most likely will not have one. If you are going to have a drain either for your breast surgery or another associated procedure to the breast augmentation such as tummy tuck, mini-tummy-tuck or any other procedure the nurse will teach you how to care for the drain, generally, make sure you learn how to milk the drain, make sure there are no clots formed in the tube of the drain, make sure that you keep track of the output of the drain on a 24-hour period and make sure that you care for the drain very carefully, so you don't accidentally pull it out, and these are all the things that u have to make to sure, you ask the nurse or the doctor on the day of surgery and they will explain it to you before you leave the surgical center. Make sure the individual that comes with you and he is taking you home is going to go through the postoperative care plan with your nurse or doctor before taking you home, so that they are completely comfortable doing all of those things. If you want to discuss those things ahead of time we encourage that, I definitely encourage it. You are going to have a preoperative visit and that would be about a week or two weeks before surgery and you will have a preoperative on the day of surgery with the surgeon and the nurse, make sure you take out an opportunity to ask any questions that remain unanswered or you are note clear about. Make sure you address everything. The key is for you to feel comfortable, so the bottom line is, I want you to know that we are here for you any time but most importantly, you know, feel comfortable to ask anything ahead of time, I want you to absolutely have the most smooth and event-free healing that we can possibly offer you. The usual recovery time for breast augmentation is amazingly, amazingly small. In other words, most patients that have surgery on a Thursday, they go back to work on Monday of the following week, so it is just two or may three days of, I wouldn't even call it intense pain, or discomfort. Basically, most patients whom I have spoken with, they rate C-section or hysterectomy as a 10 in magnitude of pain or 9 and they rate, you know, giving birth an 8 and they rate breast augmentation a 6 or may be a light 7, so it is not that bad only for a day or two, and usually very controllable with pain medication, after that most patients are able to just pretty much go back to work, and as long as their work does not entail any lifting or moving any heavy objects. I would then encourage patients to not go back to heavy exercises for a couple of weeks at least, meaning aerobics, you know, they can walk if they really back to exercise in about a week or so, but as long as they have very supportive sport bras and so on, and in a couple of weeks they start light aerobics. In about a month, they can do very light weights, may be about 5 to 10 pounds in my experience. Again, doctor by doctor, some of these suggestions and opinions may vary so my colleagues and my associates who are here may actually have a different recommendation for you, make sure that after the procedure you qualify their specific preference but pretty much this is universal in the sense of, you know, than the big picture. Three months later is when I actually tell patient's they can go back to most routine activities including full exercise and wearing under-wire bras, I prefer patient's not to wear under-wire bras for about three months after surgery after which they can wear under wire bras, before that time, sport bras or the surgical bras that you obtain from the New Me Institute would be perfectly ideal for you to wear. Pretty much sexual activity and so on is another big question most patient ask and three days, the same thing two or three days pretty much, obviously everything that we talk about depends on the patient. Your body is the best judge, so if you feel that you are not ready for whatever it is, then you are not ready for it. I really encourage you to be, you know, very tuned into your own body and sort of decide if you are ready to try, and if you try something new or different and you feel that your body is telling you to stop, then you stop, and every visit you have with us and there is plenty of visits that we schedule for you at no extra charge for you, you make sure you ask specifically, whatever it is that you want to do is appropriate for you. #2, you can call any time. If you feel that, you know, you are not sure you don't want to risk it, just call and ask and make sure before you go ahead and undertake any new activity or any activity that may postpone or complicate your healing. I rather have you be more conservative than not. Not everybody is able to go back to work in two days, nor everybody is able to go driving two, three or four days, makes sure of course you don't take any, you know, pain medicine or anything if you are going to drive, so you should be at a level where you can control pain without really any codeine or codeine derivatives, so you should be able to tolerate the pain with either Tylenol or extra strength Tylenol for pain. Postoperatively, definitely we will be on an antibiotic medication and make sure that you do not stop until the doctor has asked you to stop, make sure u ask if you are not sure as to if you should stop or not. Again, there is no cookie cutter technique, there is no cookie cutter postoperative course for every patient. Every patient is unique and you have to make sure that in fact the written or described postoperative care plan is still appropriate for you. So, we welcome you to call and make sure specifically. The other thing is that you will have antibiotics as I mentioned before, that you will be taking postoperatively, there will be some Ace bandages and perhaps cling gauzes, special bras that you will be asked to purchase and/or wear if you don't need to purchase them, of course, they will be provided to you. You need to be wearing these until such time that the doctor asks you to stop wearing them or modifying the way you wear them. Then postoperatively, obviously I would encourage you to not undertake any new activities until you are absolutely instructed specifically to feel free and go ahead and do it. If you are not comfortable with that new activity, call, it is always better to be safe. The bottom line here is we want you to be absolutely comfortable with us. We are here for you any time. This is your home, this is your place, call us, ask us, feel free to contact us at any time. You are only a phone call away or just one, you know, door knock away, I mean just walk in if you need to. If you are close by ask somebody. We always welcome you to our center.
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