In general, placing breast implants under the muscle allows them to appear much more natural. It decreases the rate of infection associated with the implants and decreases the rate of complications associated with the implants. It allows the breast implants to sit higher for longer and have more support and less tendency to drop or droop with time. There is also lower incidence or rate of capsular contracture. In other words, the breast implants tend to stay softer for longer under the muscle than they do over the muscle. Over-the-muscle augmentation is best performed in patients who are extreme weight lifters and who are unwilling to sacrifice any bench-press or butterfly-press strength. It’s also best in patients who want more of an unnatural appearance. If your goal is to have a natural-appearing breast augmentation result that has the longest-lasting result and maintains the implants as soft as they possibly can be while also minimizing infections and other complications, I recommend breast augmentation under the muscle. If you want a very unnatural appearance or obviously augmented appearance or if you are an extreme weight-lifter, then I recommend breast augmentation over the muscle.

The answer to that really depends not only on your body frame and size but also your tastes. Selecting the right breast implant size is a multi-step process in our hands. It begins with you bringing in “wish pictures” (often found on the Internet) to tell me or show me what breasts you like. From there, I actually let you try on breast implant sizers. I let you look in the mirror at what those breast implants are going to look like and feel like on you. From there. I perform unique Crisalix 3D imaging, during which I show you a three-dimensional image of yourself with that breast implant size in to give you another way to make the decision.

To confirm the decision, I’ll use a new virtual reality system that we have. I’ll actually let you step into a virtual world, where you have the breast implants in place and can look at yourself from all sorts of different angles, including down at your chest, and see the breast implants in place. I believe that by using a combination of wish pictures, trying the physical breast implants on, three-dimensional imaging, and virtual reality, we can select the perfect breast implant size for you.

Breast implant manufacturers have created what they call different profiles of breast implants. For a given breast implant size, there is a slightly different shape to the breast implant. As we go up in profile from a moderate profile implant to a moderate plus profile implant or a high profile implant, the higher profile tends to extend further away from the chest. As we go up in profile for a given breast implant size, the implants also become narrower so that a breast implant that is a high profile implant will be much narrower across the chest than would a moderate or moderate plus profile implant.

The significance of that is two-fold: When we are selecting the implant profile, we want to maximize not only how much the breast implants extends away from the chest, but we also want to match the breast implant profile to your chest width because we want to make sure that the breast implants cover the entire chest width so that we can really maximize the cleavage in the middle, while not overdoing it or creating a “uni-boob” or “side boob” look.

I believe that maximizing the cleavage in the middle is just as important as maximizing how much the breast implant extends away from the chest. As we are selecting the different breast implant profiles, I’ll actually have you try the breast implants on in our office. I will have you select the volume, and once you select the volume that you like, we will then match that to the width of your chest and your dimensions in order to select the perfect implant dimensions and profile for that volume.

Then I will show that to you in our three-dimensional imaging system and also on our virtual reality system, so you can ensure that you are getting the perfect breast implant for you.

There are four commonly performed approaches for breast augmentation. These include the following:

The first is a trans-axillary approach, which is an armpit incision. The advantage to this is, of course, that there is no scar on the breast. The disadvantage to this is that the scar is quite noticeable and can be seen anytime you wear sleeveless clothing.

The next option is the trans-umbilical or “belly button” approach. The obvious advantage to this is, again, that there no scar on the breast. The disadvantage is that we have to drag the implants from the belly button up to the breast. In the process, we can create micro-fractures on the shells of the implants, which can significantly decrease their life expectancy. I definitely do not want to do this because we want to make sure that the implants will last as long as they can and give you the best and longest-lasting results. This approach significantly compromises their implants. In addition, because the access incision is placed so far away from where we are placing the breast implants, it’s very, very difficult to accurately place the breast implants. While I do remove the scar from the breast, I also create a situation where it becomes very difficult to accurately locate the breast implants. This significantly increases the risk that you experience lopsidedness or asymmetry between the two breasts.

The next approach is to go through the nipple. The advantage there is, of course, that the scar hides in the collar of the nipple. The disadvantage is that I am cutting directly along the nerves that supply the nipple, which means decreased sensation and decreased ability to breastfeed.

The final approach is the infra-mammary or under-the-breast approach. Hiding the scar underneath the breast makes it visible only when you are completely naked and someone is below you, lifting the breast and looking up. This is far and away, in our opinion, the best hidden of all of the incisions. It provides the best visualization for the surgeon, which ensures that you have the most accurate implant placement so that the breast implants can sit as symmetrically as possible. It is also, in our opinion, the least visible of all of the incisions. It is the incision recommended for the majority of our patients. It also allows us to stay far away from the milk ducts, which means that it will have no effect on breastfeeding over the long-term as well.

This is one of the most common questions that I receive when patients come to my clinic. The answer to this really requires an in-person examination to determine the location of the breast tissue and where we want it to be after the augmentation.

At the consultation I will take specific measurements designed to help us determine whether or not doing a breast lift or just a straightforward breast augmentation is better in a given case. We will also run 3D simulations with and without breast lifts so that you can see what the benefits and the downsides of a breast lift would be for you. I will also review patients who are similar to them and on whom we have performed either breast augmentation alone or breast augmentation with lifts, so you can look at the cases side-by-side and determine which look is best for you.

Having fuller more voluptuous breasts is a very important part of feeling feminine and more confident for women. The breasts give the female body more proportion, curves and shape, which makes many women feel more sexy. There are a variety of factors that make women unhappy with their breasts. Such factors include the effects of aging, gravity which leads to sagging, post pregnancy changes and natural asymmetry. A breast augmentation helps women improve the overall appearance of the breasts and cleavage. This results in an improved self esteem, confidence and feeling sexier about your body.

Reasons why women seek breast augmentation include:

– Improved body proportion
– Correct loss of fullness or sagging due to aging, gravy, or pregnancy
– Improve cleavage appearance
– Increase breast shape and size
– Correct asymmetry of the breasts (one breast is larger than another)

WHAT TECHNIQUES ARE INVOLVED?
Breast augmentation involves the placement of an implant under the patient’s breast tissue to enhance the size and shape of the breast. The breast implants are usually inserted using an incision placed under the breast at the crease, but can also be put in via an incision in the armpit or around the nipple.

Breast augmentation surgery takes about one and a half hours, and is usually done under general anaesthetic. The operation itself involves accessing and creating the pocket into which the implant will be placed, using one of the insertion routes mentioned above: breast-crease, armpit or nipple.

Incision Options
There are three different types of incisions that can be performed when getting a breast augmentation surgery. These incisions are Inframammary (incision below the breast), Transaxillary (through the armpit), and Peri-Areolar (along the lower edge of the Areola). Dr Vigo will go over the different options available to you during your consultation, showing you the benefits of each option and explaining exactly how they are performed including the associated recovery time for each.

Inframammary
An inframammary incision is the most common incision when getting a breast augmentation. This incision is made in the fold below the breast and carries a very low risk of complications. Inframammary incisions are highly recommended for large pre-filled implants such as silicone. These incisions are usually discreet as it goes along the natural crease below the breast, however, on occasion the scar may be visible due to the size or shape of the implant. All patients heal at different rates. Your incisions will be monitored after surgery and tailor your scar managment to optimize healing and appearence. Proper care and maintenance of your incisions will be closely followed with you as you heal.

Peri-Areolar
A Peri-Areolar incision is done around the bottom edge of the areola and is typically four to five centimeters in length. This incision is very discreet after it is healed. Often times it is impossible to notice as it goes along the natural edge of the areola. The trade off risks and benefits of their incision approach will be disscused at the time of your consultation. Some women may experience difficulty with breast feeding after this incision approach. Nipple sensitivity is also jeopardized with this approach compared to other incision sites.

Transaxillary
A Transaxillary incision is the least visible of the different incision options as it is made in the armpit. This ensures there are no scars anywhere near the breasts. The breast augmentation procedure is performed using an endoscope during the surgery, which allows the surgeon to see the implant inside the pocket. Having the ability to see the implant inside the pocket allows for the best surgical decisions and precise placement of the implant. Implant type is limited by the incision, as only round smooth implants can be placed through this incision.

Once the pocket has been created, the surgeon may insert a trial implant to check that the size chosen is appropriate. The trial implant is removed, the definitive implant inserted and the incision wounds are stitched. You will be able to go home the same day. Postoperative pain in these procedures is easily controlled. Your chest will feel tight. Your breasts and ribs below your breasts will be tender. Patients will be mobile from day one and should be back to full exercise within six weeks. Patients are recommended to take around one to two weeks off work immediately after the operation in order to ensure you recuperate fully.

Implant Placement Options
There are two choices when it comes to the placement of the breast implants you select. They are subglandular (above the muscle) or submuscular (below the muscle). The benefits of each of the different placement options will be discussed with you at your consultation with a recommendation of a specific placement option depending on the natural shape of your breasts or your overall goals for getting a breast augmentation.

Subglandular
Subglandular placement is when the implant is placed above the muscle. During this placement, the implants are placed below the natural breast tissue and the surgery is usually quicker but the recovery time is about the same as below the muscle. One of the benefits of subglandular placement is that if future surgery may be required due to rupture or leakage, it allows for easier access to the implant. However, subglandular placement does also have its downsides, such as an increased risk of capsular contracture, concerns about breast views on mammography, and the implant may be able to be felt through the skin.

Submuscular
Submuscular placement is when the breast implant is put under the pectoral muscle. The benefit with submuscular placement is that the final result of the breast augmentation will look and feel more natural. Any breast imaging will be easier including mammographies, because it is easier to differentiate the implant from real breast tissue. Most patients are able to drive in a few days and you may shower the next day. Most surgeons agree that implants under the muscle are in the best position for the long term health of the patient.

Dual plane augmentation
When slender women with slightly drooping breasts seek breast augmentation surgery, surgeons often combine these two routes, placing the implants partly behind the breast and partly behind the muscle. Through this combined approach surgeons try to give patients the benefits of both techniques. This is called a dual plane augmentation.

BEFORE BREAST AUGMENTATION SURGERY
Before going into breast augmentation surgery, it is very important to get a good nights rest. You must follow the instructions given such as limitations to food or medications the day before surgery. All of this is important to get the best results and have the quickest recovery possible when getting surgery.

On the day of surgery make sure you have a friend or family member drive you to the surgical facility. You may be very sleepy from anesthesia after the surgery. Before surgery, your surgeon will review the choices you selected and answer any final questions or concerns you may have.

Your body will then be marked and you will be guided through exactly what will happen during the surgery.

Breast Augmentation is another name for Breast Enlargement or Breast Enhancement, and is also known as Boob Job. It is the single most requested plastic surgery in the world.

For women, their breasts play an important part in their overall personality and it also gives them a lot of confidence. Many women feel the need to have breast surgeries – some for cosmetic reasons, some due to deformities, and some due to mastectomies (removal of breast due to cancer). Whatever the reason, it is important to know that it is a surgery, which would need proper medical expertise and support.

So, before deciding to undergo this surgery, it is imperative to get a clear understanding of the process, and the do’s and don’ts associated with it. Being a leader in breast surgeries, and the best in the field of Breast Augmentation Dubai, I share the relevant information here for you.

What is Breast Augmentation Dubai or Boob Job?
Breast Augmentation is a surgical procedure which helps improve the looks of your breasts, making them larger and if needed fuller too. It is also referred to as breast enlargement or breast enhancement or breast reconstruction, or augmentation mammoplasty, or breast implants surgery. Breast augmentation can be done as an outpatient procedure with twilight anesthesia (patient goes back home the same day), or as an inpatient procedure with general anesthesia (requires overnight stay at hospital or clinic). In this procedure, a well-trained surgeon, will either insert an ‘implant’, or ‘fat’ grafted from other parts of your body into your breasts, helping them get bigger and fuller.Breast implants come in different types, shapes and sizes, and their quality has improved dramatically over the years. The method of inserting the implants differs according to the patient’s needs. More details are given below. Fat grafting breast augmentation is a technique wherein your own body fat from other parts of the body is extracted and injected into your breasts. This is mainly used when the need for enlargement is small and a more natural result is preferred.

Breast Augmentation Dubai is a cosmetic surgery which is used to increase the size of breasts and enhance its shape and contour. It is considered as the most demanding job cosmetic surgery.

For women, breast is an important part of their personality and better-looking breast can greatly improve their self-confidence. There are various reason for which people undergo this surgery some women do it for cosmetic reasons while some due to deformities then there are those who need them as an after treatment of cancer. Whatever the reasons are it should be kept in mind that it is a surgical procedure and one should consult with their doctor before going ahead with the procedure.

Breast Augmentation Dubai will provide you with a long-term and effective solution to your worries regarding the size of your breasts. The implants will give you large, supple and natural looking breasts that will transform your body from an average to a beautiful one. Breast Augmentation Cost in Dubai primarily depends on the breast implant type you choose. Most commonly used breast implants for breast enlargement in Dubai include Saline Implants and Silicone Implants.

Why Breast Augmentation?
Usually breast augmentation is done to enhance the shape, size and texture of breasts, and to make them appear larger and fuller. This may be needed for cosmetic reasons or for reconstructive purposes, such as mastectomy after breast cancer, or correction of deformities. The reasons can be very personal and the decision should be made by you and your surgeon after understanding your needs, and more importantly your expectations. You should be aware that a breast augmentation surgery does not automatically correct sagging or drooping breasts. A breast lift procedure may be required to rectify sagging breasts, which can be performed together with your breast implant surgery or independently, at a later date. A well planned and executed procedure can help regain breast volume, get a better shape, reduce asymmetry, improve balance of breast & hip contours, increase fullness and size of breasts, and also help enhance self-image and self-confidence.

Deciding about Breast Augmentation Dubai
Breast Augmentation is a common and popular procedure which will make your appearance different from your existing one. Nevertheless, it is a surgery, thus it is important for you to decide carefully before going ahead with your decision. Common questions that we suggest you ask yourself are:

Why do I need this augmentation?
Will it give me more confidence and contentment?
Will I be comfortable with this change?

Once you have answers to this and any other personal questions, you must then take the most important steps of identifying the best breast surgeon, and breast clinic in town. This will ensure that you get the best consultation, advice, and results for your desired procedure. A top breast augmentation surgeon is one who is appropriately certified, well qualified, has loads of experience, has worked with different solutions and techniques, and is well respected amongst his peers and patients. The surgeon should have a good track record of consistent and quality results. Also during your initial consultation, remember to ask him to share the ‘before’ and ‘after’ photos depicting his work.

A well-known and respected clinic for breast augmentation is one which has a good team of surgeons, anesthetists, and nursing staff. Their location should be convenient and the premises should be approved by the medical authorities. They should have a reputation of successful surgeries, and their team should be able to explain the entire aspect of the procedures to you in detail.

Who is a good breast augmentation candidate?

You are a good candidate for Breast Augmentation surgery in Dubai if:

You have naturally small breasts or have lost volume and shape due to mastectomy or trauma to the chest.
Your breasts are uneven or have lost volume and shape due to pregnancy or significant weight loss.
You are physically healthy and are not suffering from any ailment that can hinder wound healing.
You are not pregnant or breastfeeding.
You have realistic expectations with the outcomes of surgery.

Breast Augmentation Goals
Breast enhancement surgery aims at improving the appearance of breasts by making the following improvements.

Increases fullness and projection of breasts.
Improves the size and contours of small breasts.
Improves the symmetry of breasts.
Makes the breasts firmer and perkier.
Breast augmentation is indicated in following people:

Young women with very small breasts or hypo plastic breasts
Women after pregnancy or weight loss who have lost size of breasts
Women with mild to moderate sagging of breasts due to pregnancy, weight loss or aging process.
Asymmetrical breasts due to birth deformity.
Tuberous breast deformity where the shape of the breast is very narrow and tubular.
Reconstruction of breasts after breast removal surgery due to mastectomy or breast cancer.
A normally healthy woman, with stable blood pressure, not pregnant, nor currently breast feeding are generally good candidates. Being a non-smoker also helps. And importantly, you should be in the age bracket where your breasts have developed fully, which is a minimum of 18 years of age.

If you feel that some of these descriptions match you, come and talk to our experts, we will be able to guide you to the next steps towards having a fuller upper body.

What are the types of Breast Augmentation?

There are 3 main types of implants –

Silicone Implants
Saline Filled Implants
Fat Grafting or Fat Transfer from other parts of your body

SILICONE BREAST IMPLANTS
Silicone implants were first produced in the early 1960s, and are still extremely popular. They are silicone shells filled with a plastic gel, which makes them feel more like real breasts than other options. The quality of the gel and the shell itself has evolved with time and research, making them quite long lasting and with a superior feel. These days highly cohesive silicone gel breast implants, also referred to as “gummy bear breast implants” are gaining popularity over traditional or regular silicone implants. The gel inside these implants is quite similar in structure to the “gummy bears” sweets – so even if there is any mishap, or leak, the gel does not drip out. More than 90% of women prefer silicone implants, which now come with up to 15 years warranty. These implants are available in both teardrop (natural anatomy shape) and round shapes.

Advantages:
Being softer, they feel more natural
In a sub-glandular position (above the breast muscle), they hold better
Lower chances of “rippling”
The insert, being gelatin in nature does not leak or drip easily
They are long lasting

Disadvantages:
To insert them, a relatively larger incision is needed
In the rare case of a rupture, it is harder to detect (silent rupturing); so regular screenings are essential

SALINE FILLED IMPLANTS
These are also silicone shells, but are filled with sterile salt water solution, similar to the fluid that makes up most of our body. The feel of these implants is much firmer than gel, less natural, and thus fewer women prefer this as an option.

Advantages:
A smaller incision is needed to insert the Saline filled implant
The fill level is adjustable, giving greater variability in sizes
In the rare case of rupture, the saline content is immediately dispelled from the body, and the change is obviously visible

Disadvantages:
Their feel is not quite natural
These usually require to be placed behind the muscles
Due to the liquid filling, it can cause rippling
Both the Silicone and Saline-filled implants come in different shapes, sizes, and texture. During your consultation with our surgeon, you will see samples of these and understand the pros and cons of each. Follow the surgeon’s advice on which would suit …

Once your surgery is completed, you must follow all the instructions given to you in order to heal properly and have a good outcome.

The following instructions are your obligation. Use this as a checklist of progress as you heal. Included are normal post-surgical experiences and key health considerations that may be a cause of concern.

TYPICAL POST-OPERATIVE SYMPTOMS
Typical symptoms of breast augmentation and signs to watch for following surgery with silicone breast implants include the following:

Tightness in the chest region and stiffness
Tingling, burning or intermittent shooting pain. These are normal experiences as the skin, muscles and tissue stretch to accommodate your breast implants, and as sensory nerves heal. Pain medication and muscle relaxants will help you cope with any discomfort. If you have drains, you may experience additional localised discomfort. Consistent sharp pain should be reported to our office immediately.

Hypersensitivity of nipples or lack of sensitivity
This is normal and will gradually resolve over time. You may also experience a small amount of fluid or milk seeping through the nipples. If this becomes painful or excessive notify my office immediately.

A feeling of heaviness
It is normal for your chest to feel heavy as you adjust to your implants. This will subside within 2-4 weeks following surgery.

Shiny skin or any itchy feeling
Swelling can cause the breast’s skin to appear shiny. As the healing process advances, you may also find a mild to severe itchy feeling of the breasts. If the skin becomes red and hot to the touch, contact our office immediately.
Asymmetry, the breasts look different, or heal differently
Breasts may look or feel quite different from one another in the days following surgery. This is normal. Although no two breasts in nature or following surgery are perfectly symmetrical, breast massage and time will produce breasts that are similar in shape, position and size.

A sloshing sound or sensation
This is not the result of your implant, but rather of air that is trapped in the implant pocket and fluid that may naturally accumulate. This is perfectly normal and will resolve within 2-4 weeks.

AFTER SURGERY CARE
Your greatest discomfort usually occurs the first 24-48 hours after surgery. During this time, take all medications prescribed by me as directed. It is helpful to take pain medication with bland food to avoid nausea, which may occur if taken on an empty stomach.

Wear garments as directed after surgery. An additional garment may be picked up at the office. Contact the office before taking any Aspirin, ibuprofen (Motrin/Advil) or Aspirin-like medications. You may take Tylenol, if you are not taking a pain medicine that already contains Tylenol (acetaminophen), such as Percocet (oxycodone) or Norco (hydrocodone).

Eat easily digestible foods. These are tolerated well the first 24 hours after surgery. If you are not experiencing nausea, you may resume a normal diet. Drink plenty of non-caffeinated beverages and eat fruit and food high in fiber to avoid constipation. Should constipation occur, discontinue pain medication (if tolerated). For relief, you may try magnesium citrate (purchased at your local pharmacy) or prune juice. It may take up to 24 hours to produce a bowel movement. These treatments may be repeated as needed.

AFTER SURGERY ACTIVITY AND HYGIENE INSTRUCTIONS
No lifting over 10-15lb. until cleared by myself. When at home, take frequent rest periods – you may walk for short distances, as walking is important to prevent clots from forming in your legs. As you increase your activity, let comfort be your guide. If it hurts, don’t do it.

Do not resume jogging, aerobics, sexual or vigorous activity until cleared by myself. No heavy household chores (laundry, vacuuming, sweeping/mopping, etc.) until cleared. You may shower 24 hours after surgery. Do not submerge incisions or drains (if present) under water such as in bath, lake, river, pool or hot tub. If present, leave steri-strips (flesh colored bandages) in place. All other dressings may be removed to shower.

Continue to wear the garment, placed on you at the time of surgery, 24/7 except to shower or to launder the garment. Two weeks after surgery, you may discontinue sleeping in the garment and only wear it during the day. While taking pain medicine, have someone assist you with daily activities, particularly personal hygiene.

Limit arm usage to routine daily functions such as brushing your teeth, eating, washing and combing your hair. Avoid vigorous arm motion that requires pushing, pulling and/or lifting heavy objects.

As you heal and soreness subsides, let pain be your guide for your activity level. If it hurts, don’t do it. Check with me before returning to work, particularly if your job requires heavy lifting or vigorous activity.

Avoid sleeping on your abdomen until all soreness has subsided. You may find sleeping propped on 2-3 pillows more comfortable. Avoid sunbathing for 4-6 weeks or until cleared by myself.

Do not wear an underwire bra for 6 weeks. At that point, you may wear a bra of your choice. However you will need to wear a good supportive bra for exercise or vigorous activity. Preferably a sports-type bra that has cups versus one that just compresses the breasts.

Do not smoke for 6 weeks as smoking delays the healing process.

WOUND CARE
You may have several layers of dressings. After 24 hours, you may remove all dressings except the flesh-colored bandages (steri-strips) or clear “tape” (Prineo). Leave either of these dressings in place until your follow up with your surgeon. If either of these dressings comes off, please contact my office for further instructions.

Do not put anything on your incisions except soap and water unless instructed.

Please notify me if:
– You have a fever greater than 101 that lasts more than 24 hours.
– You develop excessive swelling, redness or warmth of incisions.
– You experience severe pain not responding to pain medication.
– You develop thick, odorous drainage or bleeding that does not subside. – You experience shortness of breath.
– One breast appears twice the size or more than the other.

AFTERCARE: BREAST AUGMENTATION SUMMARY
Dressings
On day two from surgery remove all gauze in the bra and throw it away. Shower, and then pat the incisions (steri-strips or skin glue) with a clean cloth. Replace soft bra. You will not need gauze unless you have some slight drainage from the incision sites and want to keep this from getting on your clothes.

Bathing
You may shower two days after surgery (48 hours after surgery). Do not bathe, swim, hot tub, lake swim, or use a whirlpool until incisions are fully closed. I will determine when you are cleared for these activities based on your physical exam. You may feel lightheaded on your first or second shower, therefore a shower assistant is mandatory. Sitting on a chair in the shower is also helpful if you feel more comfortable.

Medications
Complete your course of antibiotics. Arnica may reduce bruising and you should take a complete course. Take prescribed pain medication only as directed and consider Extra Strength Tylenol in place of narcotics. Take medications with food to reduce nausea. Resume pre-operative medications unless otherwise directed by your operating physician or personal physician.

Swelling
Initially, there will be quite a bit of swelling. This swelling over the first couple of days. You will notice that your implants/breasts seem high on your chest. This is often very normal. On day 5 you will start massaging your breasts. This will assist with the implants settling and the capsule to form flexibly. Do not apply heat or ice to any treatment areas. Your ability to sense if your skin is getting too cold or hot is not normal and you may burn yourself.

Massage
Start gentle massage of the breasts at day 5. I or my office staff will demonstrate this technique for you at your post-operative visit. Lymphatic massage has also been shown to help people with fluid retention following surgery. Do not lie on your stomach.

Diet
Start with a bland soft diet and increase this slowly. Slowly resume a balanced healthy diet. This is often difficult following surgery as you are not feeling at your best and are limited in the amount of physical activity you can do. Limit the amount of salt to take in as this will affect your swelling. Drink plenty of fluids. Avoid alcohol.

Clothing
Avoid tight fitting bras that dig into your skin or incision. Wear a soft bra that gives moderate support and opens from the front. This makes it easier to take it on and off.

Smoking
It is well known that nicotine impairs healing and increases your risk of infection. Your scars and final outcome are negatively affected by smoking/nicotine as well.

Driving
Do not drive or operate any heavy machinery for 24 hours following surgery and/or until you are not taking pain pills. You will need someone with you mandatorily for 24 hours following surgery.

Glossary 2
1. How To Use This Educational Brochure 10
2. General Information About Breast Augmentation With Breast Implants 11
2.1 What Gives The Breast Its Shape? 11
2.2 What Is A Silicone Gel Breast Implant? 12
2.3 How Do Breast Implants Work In Breast Augmentation? 12
3. Deciding Whether To Have Breast Augmentation Surgery With Implants 12
3.1 Am I Eligible For Augmentation With Silicone Gel Breast Implants? 13
3.2 Contraindications 13
3.3 Precautions 14
3.4 Warnings 15
3.5 WhatAreTheAlternativesToImplantationWithSilicone
Gel-Filled Breast Implants? 17
4. Risks Associated With Breast Implants 18
4.1 What Are The Potential Complications? 22
4.2 What Are Other Reported Conditions? 30
5. Benefits Associated With Breast Implants 36
6. Preparing For Breast Augmentation With Silicone Gel Breast Implants 37
6.1 Should I Have Breast Augmentation? 37
6.2 Breast Augmentation With Implants – Understanding The Procedure 38
6.3 Choosing The Right Implant For You 4…

A
American Board of Medical Specialties (ABMS): an organization that certifies physicians as specialists. This group comprises 24 member boards, including the American Board of Plastic Surgery. Rigorous membership standards include educational requirements, professional peer evaluation and exams.
American Board of Plastic Surgery (ABPS): the medical specialty board that certifies plastic surgeons.
analgesic: a pain reliever.
anatomical implant: a contoured or teardrop-shaped implant.
anesthesia: a numbing agent.
areola: the disc of pigmented skin around the nipple; plural: areolae or areolas.
arnica montana: an herb used to treat swelling and bruising.
American Society of Plastic Surgeons (ASPS): the professional organization of board-certified plastic surgeons.
American Society for Aesthetic Plastic Surgery (ASAPS): the sister organization of the ASPS. All board-certified plastic surgeons are members of ASPS, but ASAPS members specialize in cosmetic surgery.
asymmetrical: unequal, unmatching.
axilla: the armpit or underarm area; plural: axillae.
axillary: related to the armpit or underarm region.

B
band size: measurement of the rib cage denoted in bra sizes. It is measured in inches.
Benelli mastopexy: a type of breast lift performed by removing a circle of skin around the areolae complex and pulling in the breast tissue. Also known as a concentric, periareolar, or donut mastopexy.
bilateral: both the right and left sides. For example, a bilateral mastectomy is the surgical removal of both breasts.
board certified: an important term regarding the credentials of a physician or surgeon.
bottoming out: a condition which occurs when the lower poles (halves) of the breast slide under the inframammary crease.
breast envelope: the skin and subcutaneous tissue that covers the breast and helps give it shape.
breast lift: also called mastopexy or mastoplexy, the surgical procedure used to raise and firm sagging breasts.
bromelain: a homeopathic remedy derived from the pineapple stem which may reduce swelling and bruising.

C
capsular contracture: a complication that occurs when scar tissue forms around the implant, resulting in painful breast stiffness and possible leakage of the fluid inside the implant.
capsule: the fibrous tissue around the breast implant.
cleavage: the area between the breasts.
cohesive: marked by a tendency to stick together.
Cooper’s Ligament: the connective tissue that attaches the breast gland to the overlying skin.
cutaneous: relating to or affecting the skin.

D
dissect: to separate tissue in surgery; to place an implant, your surgeon must first create or dissect a pocket within your breast.

E
endoscopic surgery: surgery performed using an endoscope (a small camera) and special surgical tools. Endoscopic surgery usually involves one or more small incisions and a shorter recovery time than traditional open surgery.
epinephrine: a hormone secreted by the adrenal glands during conditions of stress. It raises the blood pressure and breathing rate, and constricts blood vessels.
expander implant: a temporary breast implant that is slowly inflated with saline to stretch the tissue in preparation for a permanent breast implant.

F
fascia: a sheet of connective tissue that covers or binds muscles or organs.
fibrous tissue: tissue containing tightly woven strands of collagen protein.
fluffing: a condition that occurs when the breast implants drop into a slightly lower, more natural position, after the skin and muscle have completely relaxed during healing. Also called dropping.
form stable: Another name for highly cohesive or gummy bear breast implants. Form stable breast implants are filled with viscous gel that won’t migrate in the event of a rupture.

G
general anesthesia: a type of anesthesia often used for breast augmentation. Under general anesthesia, you are fully asleep.
glandular: relating to or involving glands, gland cells, or their products.
gummy bear implants: nickname for a type of breast implants filled with highly cohesive silicone gel. This viscous filler has the consistency of a gummy bear, so if the implant ruptures, the gel won’t migrate.

H
hematoma: a break in a blood vessel, causing a blood clot or localized, blood-filled area.
hemorrhage: an abnormal flow of blood from an incision or wound.
hypoxia: lack of oxygen to the body.

I
inferior: lower or closer to the feet.
inframammary crease: the crease below the breasts where the breast envelope meets the skin over the rib cage.
inframammary incision: an incision in the inframammary crease used to place breast implants. Also called the “crease” or “fold” incision.
intercostal arteries: the arteries responsible for the blood supply to the breast.
intracapsular rupture: type of implant rupture in which a silicone-filled breast implant breaks, but the silicone is contained within the capsule.
intravenous sedation: sedation or anesthesia delivered through an intravenous (IV) line.

L
lactation: producing milk from the breasts.
latissimus dorsi flap reconstruction procedure: a reconstructive procedure that uses the latissimus dorsi (a back muscle) to form a breast mound.
lobules: the part of the breast where milk is produced. The lobules are gathered into lobes. There may be as many as 20 lobes per breast.
local anesthesia: anesthesia that numbs a small part of the body.
lidocaine: a local anesthetic, also called Xylocaine.
lumpectomy: surgical removal of breast tumor tissue.
lymph node: any of the small glands that make up the lymphatic system, which carries lymph fluid, nutrients and waste material between the body tissues and the bloodstream. The lymphatic system is a major component of the body’s immune system.
lymphadenopathy: abnormal enlargement of the lymph nodes.
lymphedema: swelling, generally in the arms or legs, that occurs when there is a blockage in the lymphatic system that is preventing lymph fluid from draining well. This tends to occur after certain types of breast cancer surgery.

M
malposition: incorrect or abnormal position.
mamma: breast, organ of lactation; plural: mammae.
mammogram: a breast X-ray.
mammography: the use of X-rays to form a diagnostic picture of the breast.
mastectomy: surgical removal of the breast or breasts and associated tissue.
mastopexy: breast lift.
micromastia: abnormal smallness of the breasts.
myectomy: excision of muscle.

N
nipple: the bulge of pigmented, erectile tissue in the center of the surface of the breast from which milk can flow.

O

P
pectoralis major: either of two large, fan-shaped chest muscles. These are the muscles that a breast implant is placed beneath in submuscular or subpectoral placement.
pectoralis minor: the small chest muscles. These muscles are targeted with a Botox breast lift.
periareolar: surrounding the areolae complex of the nipple.
pocket: a cavity made in the body by dissection. In breast augmentation, the pocket is the space created for the implant.
pole: the upper or lower half of the breast or breast implant.
ptosis: sagging.

R
regional anesthesia: anesthesia that numbs a region of the body. This type of anesthesia is not routinely used for breast augmentation.
rectus abdominus fascia: the fascia covering the rectus abdominus muscle of the abdomen. It is used to help cover the breast implant in full submuscular implant coverage.
rippling: the appearance of ridges or wrinkles in a breast implant.

S
saline: salt water.
saline-filled implants: a type of breast implant that is filled with sterile saline.
sedation: a state of calm or sleep.
seroma: a collection of fluid under the skin.
serratus muscle: a muscle on either side of the chest that is connected to, and covers, the ribs. It is used in conjunction with the pectoralis major muscle and rectus abdominus fascia in full submuscular breast implant placement.
silicone: the second most abundant element on Earth and a staple ingredient in commercial products, from pacifiers and breast implants to non-stick bakeware and adhesives.
silicone-filled implants: breast implants filled with silicone gel.
sternum: the breast bone between the two breasts.
submuscular, full submuscular: implant placement patterns. Full submuscular placement involves placing the implant entirely under the muscle.
supine: face up.
symmastia: condition characterized by touching, in the center of the chest, of the two breast implants; also called kissing implants and “uniboob.”
symmetrical: similar in size and shape.

T
tachycardia: a rapid heart rate.
thoracic: relating to or located within the thorax or chest.
thromboembolus: obstruction of a blood vessel by a blood clot; plural, thromboemboli.
thrombosis: localized coagulation of blood.
transaxillary: though the axilla (armpit).
transverse: lying or going across at an angle.
transumbilical breast augmentation (TUBA): a procedure in which breast implants are inserted via the belly button.
tubular (or tuberous) breasts: a breast shape caused by a small breast base and/or herniated areolae.
twilight sedation: a light form of sedation anesthesia that provides full sedation, but you can be roused.

U
umbilical: relating to the navel or belly button.

V
vasoconstrictor: a drug that constricts the blood vessels.

G
C H A P T E R 54
The dual plane approach to
breast augmentation
Steven Teitelbaum
History
The breast implant pocket choice has a profound effect on
the appearance of the augmented breast. Along with the selection
of the device itself, it is the most important preoperative
decision. Critical manifestations of this choice may not be
apparent for many years, as some effects of the implant on
the soft tissue occur gradually yet inexorably.
The most commonly described pocket locations are: (

BREAST AUGMENTATION DUBAI
Breast augmentation, sometimes referred to as a “boob job” by patients, involves using breast implants or fat transfer to increase the size of your breasts. This procedure can also restore breast volume lost after weight reduction or pregnancy, achieve a more rounded breast shape or improve natural breast size asymmetry.

WHAT BREAST AUGMENTATION SURGERY CAN DO
– Increase fullness and projection of your breasts
– Improve balance of breast and hip contours
– Enhance your self-image and self-confidence

WHAT BREAST AUGMENTATION SURGERY CAN’T DO
Breast augmentation does not correct severely drooping breasts. A breast lift may be required along with a breast augmentation for sagging breasts to look fuller and lifted.
Breast lifting can often be done at the same time as your augmentation or may require a separate operation. I will assist you in making this decision.

Who is a good candidate for breast augmentation?
Breast augmentation is a deeply personal procedure, and it’s important that you’re doing it for yourself and not for someone else, even if that person has offered to pay for it. Patient satisfaction is high, specifically when they want the procedure themselves.

You may be a candidate for breast augmentation if:

– You are physically healthy and you aren’t pregnant or breastfeeding
– You have realistic expectations
– Your breasts are fully developed
– You are bothered by the feeling that your breasts are too small
– You are dissatisfied with your breasts losing shape and volume after
pregnancy, weight loss or with aging
– You are unhappy with the upper part of your breast
appearing “empty”
– Your breasts are asymmetrical
– One or both breasts failed to develop normally or have an
elongated shape

WHAT TYPES OF BREAST IMPLANTS ARE AVAILABLE?

Saline breast implants
Saline breast implants are filled with sterile salt water. Should the implant shell leak, a saline implant will collapse and the saline will be absorbed and naturally expelled by the body.

Saline breast implants provide a uniform shape, firmness and feel.

Structured saline breast implants
Structured implants are filled with sterile salt water, and contain an inner structure which aims to make the implant feel more natural.

Silicone breast implants
Silicone breast implants are filled with silicone gel. The gel feels a bit more like natural breast tissue. If the implant leaks, the gel may remain within the implant shell, or may escape into the breast implant pocket.
Gummy bear breast implants
Form-stable implants are sometimes referred to as gummy bear breast implants because they maintain their shape even when the implant shell is broken.

The consistency of the silicone gel inside the implant is thicker than traditional silicone gel implants. These implants are also firmer than traditional implants.
Shaped gummy bear breast implants have more projection at the bottom and are tapered towards the top. If a shaped implant rotates, it may lead to an unusual appearance of the breast that requires a separate procedure to correct.

Placement of gummy bear implants requires a slightly longer incision in the skin.

Round breast implants
Round breast implants have a tendency to make breasts appear fuller than form-stable implants. Higher profile options can achieve even more projection.
Because round implants are the same shape all over, there is less concern about them rotating out of place.

Smooth breast implants
Smooth breast implants are the softest feeling. They can move with the breast implant pocket, which may give more natural movement.

Smooth implants may have some palpable or visible rippling under the skin.
Textured breast implants
Textured breast implants develop scar tissue to stick to the implant, making them less likely to move around inside of the breast and become repositioned.

Texturing offers some advantage in diminishing the risk of a tight scar capsule. Implant manufacturers occasionally introduce new styles and types of breast implants, so there may be additional options available.

Whether you choose saline or silicone implants, it is important for you to monitor your breast implants and follow-up with appropriate checkups.

HOW SHOULD I PREPARE FOR BREAST AUGMENTATION?
In preparing for breast augmentation, you may be asked to:

– Get a blood test
– Take certain medications or adjust your current medications
– Stop smoking
– Avoid taking aspirin and certain anti-inflammatory drugs as they can
increase bleeding
– arrange for someone to drive you to and from surgery and to stay with
you for at least the first night following surgery.

WHAT SHOULD I EXPECT DURING MY BREAST AUGMENTATION RECOVERY?
During your breast augmentation recovery, your breasts will be wrapped in gauze dressings and an elastic bandage or support bra will minimize swelling and support the breasts as they heal.

Immediately after surgery, you will be taken into a recovery area for close monitoring. You may be permitted to go home when you are stable for discharge, typically after an hour or so.

WHAT RESULTS SHOULD I EXPECT AFTER BREAST AUGMENTATION SURGERY?
While a breast augmentation yields larger breasts right away, the final results may take a few weeks as the swelling subsides and the skin stretches. Some patients may need to wear a bandeau to help shape their breasts, especially if they have underlying asymmetry or very small breasts to start with. Incision lines may take several months to fade.

Having fuller more voluptuous breasts is a very important part of feeling feminine and more confident for women. The breasts give the female body more proportion, curves and shape, which makes many women feel more sexy. There are a variety of factors that make women unhappy with their breasts. Such factors include the effects of aging, gravity which leads to sagging, post pregnancy changes and natural asymmetry. A breast augmentation helps women improve the overall appearance of the breasts and cleavage. This results in an improved self esteem, confidence and feeling sexier about your body.

Reasons why women seek breast augmentation include:

– Improved body proportion
– Correct loss of fullness or sagging due to aging, gravy, or pregnancy
– Improve cleavage appearance
– Increase breast shape and size
– Correct asymmetry of the breasts (one breast is larger than another)

WHAT TECHNIQUES ARE INVOLVED?
Breast augmentation involves the placement of an implant under the patient’s breast tissue to enhance the size and shape of the breast. The breast implants are usually inserted using an incision placed under the breast at the crease, but can also be put in via an incision in the armpit or around the nipple.

Breast augmentation surgery takes about one and a half hours, and is usually done under general anaesthetic. The operation itself involves accessing and creating the pocket into which the implant will be placed, using one of the insertion routes mentioned above: breast-crease, armpit or nipple.

Incision Options
There are three different types of incisions that can be performed when getting a breast augmentation surgery. These incisions are Inframammary (incision below the breast), Transaxillary (through the armpit), and Peri-Areolar (along the lower edge of the Areola). Dr Vigo will go over the different options available to you during your consultation, showing you the benefits of each option and explaining exactly how they are performed including the associated recovery time for each.

Inframammary
An inframammary incision is the most common incision when getting a breast augmentation. This incision is made in the fold below the breast and carries a very low risk of complications. Inframammary incisions are highly recommended for large pre-filled implants such as silicone. These incisions are usually discreet as it goes along the natural crease below the breast, however, on occasion the scar may be visible due to the size or shape of the implant. All patients heal at different rates. Your incisions will be monitored after surgery and tailor your scar managment to optimize healing and appearence. Proper care and maintenance of your incisions will be closely followed with you as you heal.

Peri-Areolar
A Peri-Areolar incision is done around the bottom edge of the areola and is typically four to five centimeters in length. This incision is very discreet after it is healed. Often times it is impossible to notice as it goes along the natural edge of the areola. The trade off risks and benefits of their incision approach will be disscused at the time of your consultation. Some women may experience difficulty with breast feeding after this incision approach. Nipple sensitivity is also jeopardized with this approach compared to other incision sites.

Transaxillary
A Transaxillary incision is the least visible of the different incision options as it is made in the armpit. This ensures there are no scars anywhere near the breasts. The breast augmentation procedure is performed using an endoscope during the surgery, which allows the surgeon to see the implant inside the pocket. Having the ability to see the implant inside the pocket allows for the best surgical decisions and precise placement of the implant. Implant type is limited by the incision, as only round smooth implants can be placed through this incision.

Once the pocket has been created, the surgeon may insert a trial implant to check that the size chosen is appropriate. The trial implant is removed, the definitive implant inserted and the incision wounds are stitched. You will be able to go home the same day. Postoperative pain in these procedures is easily controlled. Your chest will feel tight. Your breasts and ribs below your breasts will be tender. Patients will be mobile from day one and should be back to full exercise within six weeks. Patients are recommended to take around one to two weeks off work immediately after the operation in order to ensure you recuperate fully.

Implant Placement Options
There are two choices when it comes to the placement of the breast implants you select. They are subglandular (above the muscle) or submuscular (below the muscle). The benefits of each of the different placement options will be discussed with you at your consultation with a recommendation of a specific placement option depending on the natural shape of your breasts or your overall goals for getting a breast augmentation.

Subglandular
Subglandular placement is when the implant is placed above the muscle. During this placement, the implants are placed below the natural breast tissue and the surgery is usually quicker but the recovery time is about the same as below the muscle. One of the benefits of subglandular placement is that if future surgery may be required due to rupture or leakage, it allows for easier access to the implant. However, subglandular placement does also have its downsides, such as an increased risk of capsular contracture, concerns about breast views on mammography, and the implant may be able to be felt through the skin.

Submuscular
Submuscular placement is when the breast implant is put under the pectoral muscle. The benefit with submuscular placement is that the final result of the breast augmentation will look and feel more natural. Any breast imaging will be easier including mammographies, because it is easier to differentiate the implant from real breast tissue. Most patients are able to drive in a few days and you may shower the next day. Most surgeons agree that implants under the muscle are in the best position for the long term health of the patient.

Dual plane augmentation
When slender women with slightly drooping breasts seek breast augmentation surgery, surgeons often combine these two routes, placing the implants partly behind the breast and partly behind the muscle. Through this combined approach surgeons try to give patients the benefits of both techniques. This is called a dual plane augmentation.

BEFORE BREAST AUGMENTATION SURGERY
Before going into breast augmentation surgery, it is very important to get a good nights rest. You must follow the instructions given such as limitations to food or medications the day before surgery. All of this is important to get the best results and have the quickest recovery possible when getting surgery.

On the day of surgery make sure you have a friend or family member drive you to the surgical facility. You may be very sleepy from anesthesia after the surgery. Before surgery, your surgeon will review the choices you selected and answer any final questions or concerns you may have.

Your body will then be marked and you will be guided through exactly what will happen during the surgery.

Once your surgery is completed, you must follow all the instructions given to you in order to heal properly and have a good outcome.

The following instructions are your obligation. Use this as a checklist of progress as you heal. Included are normal post-surgical experiences and key health considerations that may be a cause of concern.

TYPICAL POST-OPERATIVE SYMPTOMS
Typical symptoms of breast augmentation and signs to watch for following surgery with silicone breast implants include the following:

Tightness in the chest region and stiffness
Tingling, burning or intermittent shooting pain. These are normal experiences as the skin, muscles and tissue stretch to accommodate your breast implants, and as sensory nerves heal. Pain medication and muscle relaxants will help you cope with any discomfort. If you have drains, you may experience additional localised discomfort. Consistent sharp pain should be reported to our office immediately.

Hypersensitivity of nipples or lack of sensitivity
This is normal and will gradually resolve over time. You may also experience a small amount of fluid or milk seeping through the nipples. If this becomes painful or excessive notify my office immediately.

A feeling of heaviness
It is normal for your chest to feel heavy as you adjust to your implants. This will subside within 2-4 weeks following surgery.

Shiny skin or any itchy feeling
Swelling can cause the breast’s skin to appear shiny. As the healing process advances, you may also find a mild to severe itchy feeling of the breasts. If the skin becomes red and hot to the touch, contact our office immediately.
Asymmetry, the breasts look different, or heal differently
Breasts may look or feel quite different from one another in the days following surgery. This is normal. Although no two breasts in nature or following surgery are perfectly symmetrical, breast massage and time will produce breasts that are similar in shape, position and size.

A sloshing sound or sensation
This is not the result of your implant, but rather of air that is trapped in the implant pocket and fluid that may naturally accumulate. This is perfectly normal and will resolve within 2-4 weeks.

AFTER SURGERY CARE
Your greatest discomfort usually occurs the first 24-48 hours after surgery. During this time, take all medications prescribed by me as directed. It is helpful to take pain medication with bland food to avoid nausea, which may occur if taken on an empty stomach.

Wear garments as directed after surgery. An additional garment may be picked up at the office. Contact the office before taking any Aspirin, ibuprofen (Motrin/Advil) or Aspirin-like medications. You may take Tylenol, if you are not taking a pain medicine that already contains Tylenol (acetaminophen), such as Percocet (oxycodone) or Norco (hydrocodone).

Eat easily digestible foods. These are tolerated well the first 24 hours after surgery. If you are not experiencing nausea, you may resume a normal diet. Drink plenty of non-caffeinated beverages and eat fruit and food high in fiber to avoid constipation. Should constipation occur, discontinue pain medication (if tolerated). For relief, you may try magnesium citrate (purchased at your local pharmacy) or prune juice. It may take up to 24 hours to produce a bowel movement. These treatments may be repeated as needed.

AFTER SURGERY ACTIVITY AND HYGIENE INSTRUCTIONS
No lifting over 10-15lb. until cleared by myself. When at home, take frequent rest periods – you may walk for short distances, as walking is important to prevent clots from forming in your legs. As you increase your activity, let comfort be your guide. If it hurts, don’t do it.

Do not resume jogging, aerobics, sexual or vigorous activity until cleared by myself. No heavy household chores (laundry, vacuuming, sweeping/mopping, etc.) until cleared. You may shower 24 hours after surgery. Do not submerge incisions or drains (if present) under water such as in bath, lake, river, pool or hot tub. If present, leave steri-strips (flesh colored bandages) in place. All other dressings may be removed to shower.

Continue to wear the garment, placed on you at the time of surgery, 24/7 except to shower or to launder the garment. Two weeks after surgery, you may discontinue sleeping in the garment and only wear it during the day. While taking pain medicine, have someone assist you with daily activities, particularly personal hygiene.

Limit arm usage to routine daily functions such as brushing your teeth, eating, washing and combing your hair. Avoid vigorous arm motion that requires pushing, pulling and/or lifting heavy objects.

As you heal and soreness subsides, let pain be your guide for your activity level. If it hurts, don’t do it. Check with me before returning to work, particularly if your job requires heavy lifting or vigorous activity.

Avoid sleeping on your abdomen until all soreness has subsided. You may find sleeping propped on 2-3 pillows more comfortable. Avoid sunbathing for 4-6 weeks or until cleared by myself.

Do not wear an underwire bra for 6 weeks. At that point, you may wear a bra of your choice. However you will need to wear a good supportive bra for exercise or vigorous activity. Preferably a sports-type bra that has cups versus one that just compresses the breasts.

Do not smoke for 6 weeks as smoking delays the healing process.

WOUND CARE
You may have several layers of dressings. After 24 hours, you may remove all dressings except the flesh-colored bandages (steri-strips) or clear “tape” (Prineo). Leave either of these dressings in place until your follow up with your surgeon. If either of these dressings comes off, please contact my office for further instructions.

Do not put anything on your incisions except soap and water unless instructed.

Please notify me if:
– You have a fever greater than 101 that lasts more than 24 hours.
– You develop excessive swelling, redness or warmth of incisions.
– You experience severe pain not responding to pain medication.
– You develop thick, odorous drainage or bleeding that does not subside. – You experience shortness of breath.
– One breast appears twice the size or more than the other.

AFTERCARE: BREAST AUGMENTATION SUMMARY
Dressings
On day two from surgery remove all gauze in the bra and throw it away. Shower, and then pat the incisions (steri-strips or skin glue) with a clean cloth. Replace soft bra. You will not need gauze unless you have some slight drainage from the incision sites and want to keep this from getting on your clothes.

Bathing
You may shower two days after surgery (48 hours after surgery). Do not bathe, swim, hot tub, lake swim, or use a whirlpool until incisions are fully closed. I will determine when you are cleared for these activities based on your physical exam. You may feel lightheaded on your first or second shower, therefore a shower assistant is mandatory. Sitting on a chair in the shower is also helpful if you feel more comfortable.

Medications
Complete your course of antibiotics. Arnica may reduce bruising and you should take a complete course. Take prescribed pain medication only as directed and consider Extra Strength Tylenol in place of narcotics. Take medications with food to reduce nausea. Resume pre-operative medications unless otherwise directed by your operating physician or personal physician.

Swelling
Initially, there will be quite a bit of swelling. This swelling over the first couple of days. You will notice that your implants/breasts seem high on your chest. This is often very normal. On day 5 you will start massaging your breasts. This will assist with the implants settling and the capsule to form flexibly. Do not apply heat or ice to any treatment areas. Your ability to sense if your skin is getting too cold or hot is not normal and you may burn yourself.

Massage
Start gentle massage of the breasts at day 5. I or my office staff will demonstrate this technique for you at your post-operative visit. Lymphatic massage has also been shown to help people with fluid retention following surgery. Do not lie on your stomach.

Diet
Start with a bland soft diet and increase this slowly. Slowly resume a balanced healthy diet. This is often difficult following surgery as you are not feeling at your best and are limited in the amount of physical activity you can do. Limit the amount of salt to take in as this will affect your swelling. Drink plenty of fluids. Avoid alcohol.

Clothing
Avoid tight fitting bras that dig into your skin or incision. Wear a soft bra that gives moderate support and opens from the front. This makes it easier to take it on and off.

Smoking
It is well known that nicotine impairs healing and increases your risk of infection. Your scars and final outcome are negatively affected by smoking/nicotine as well.

Driving
Do not drive or operate any heavy machinery for 24 hours following surgery and/or until you are not taking pain pills. You will need someone with you mandatorily for 24 hours following surgery.

Electing to undergo breast augmentation surgery can be both thrilling and intimidating. Although the operation has many great benefits, many people are often unaware as to what exactly goes into getting the procedure. Typically, the surgery will encompass three phases: consultation, operation, and recovery. Each step of the process requires its own level of consideration. By taking the time to learn about each phase, you can ensure that you get the results you want. Before beginning the process, however, you have to decide if the procedure is for you.

Is breast augmentation right for me?

Before setting up a consultation, patients should take the time to consider if the procedure is right for them. The process requires time, money, and enduring some physical discomfort. Since the procedure involves an initial investment, you should take the time to think about your desired outcome and what you would consider a good value for your money. Once you have a clear idea of what you want, you can then meet with a surgeon to get their opinion on how to best achieve these results.

The consultation

Although many patients have their first consultation with some idea of how they would like to appear after the operation, you can also ask surgeons for recommendations. A breast augmentation specialist will have performed many surgeries by the time you enter their clinic, so surgeons have a working knowledge of what people prefer when it comes to breast augmentation. Doctors can use computer-assisted visualization tools to determine the best size and implant type for your body.

During the consultation, the doctor will explain the entire process of the breast augmentation. Beyond size, you will have to choose the kind of implant material you would like. The two main choices are silicone or saline, which will determine firmness and shape. Depending on your choice, you will have to select a shape, which can be round or teardrop, among other choices. Depending on what you choose, the doctor will then recommend either to place the implant below or above the muscle.

The procedure

Breast augmentation is usually an outpatient procedure, though some can elect to stay overnight. The surgery will last between one and two hours, and you will likely receive general anesthesia. During the procedure, the surgeon will make cuts under the breast, under the arms, or around the nipples. After they insert the implants, the surgeon will close the incision with a suture.

Recovery

Although breast augmentation surgery once required a significant amount of recovery time, patients are often able to return to work shortly after the operation. To reduce swelling and pain, you should sleep upright, such as in a recliner, for the first 48 hours after the operation. You should expect to reduce any strenuous activity for two or three weeks after surgery, including limiting the amount of times you raise their hands above your head, which will help reduce swelling. This reduction in activity includes exercising and lifting heavy objects. Generally, after eight weeks, most people will be able to return to normal levels of activity.

Tips for healing

To make things easier on yourself after the operation, you should set aside clothes for the week and perform any necessary housework prior to the surgery. The week after the operation will be the most difficult, so you are encouraged to do the legwork beforehand so you can rest that week. Ice packs and loose-fitting clothing will go a long way in helping to alleviate discomfort from the breast augmentation surgery. Lastly, drink lots of water to stay hydrated during the process.

Make sure that you are well informed about all the aspects of breast augmentation before making the final decision to undergo the procedure. If you’re confident that you can handle each step of the procedure, you’re much more likely to have an easy recovery and be thrilled with your final results.

There are multiple factors that go into determining the best implant size for you. Breast measurements, desired size, characteristics of your breast, tissue and chest wall are all critical in making the right selection.

Breast implants are measured in cubic centimetres. That’s why you’ll typically see CC when labeling size, like 350CC. Breast implants come in a whole range of sizes, from about 80CC up to 800CC. Obviously, the higher the number, the bigger the breast implant size. The width of the base also varies, fom 7.4cm to 17.2cm.

Don’t measure your breast size by your bra

Bra cup size is not an accurate way to measure breast size. It is imprecise, because bra sizing standards vary from manufacturer to manufacturer and even country to country. Despite being labeled the same cup size, the actual volume may be different. That’s why it’s best if you bring in the exact bra you want to wear after your surgery to your sizing session.

How I help determine a proportionate implant size

From a medical standpoint, it’s important that I also consider your specific body measurements when deciding on what size is right for you. An overly large implant can cause complications, both right after surgery and a few years down the road. Such complications include separation of incision lines and excessive sagging. However, I also understand that an overly small implant won’t improve your body contour sufficiently.

Measurements, like your shoulder width, height and ribcage width is used to determine a range of implant sizes that would achieve proportionate improvement as well as reduce your risk of complications.

Factors that you should consider when choosing breast implant measurements

There are multiple factors that come into play when selecting the right implant size. If you don’t carefully pre-plan, you could run into situations in life that would adversely affect you and your new implants. You should take into consideration the following when selecting your implant size:
Fitness and exercise

Do you like to exercise regularly? If so, perhaps it’s best to stay conscious of the fact that breasts over a certain size can make some physical activities more difficult or cumbersome, such as running and tennis.

Your personality

Are you the type of person that likes to attract attention, or are you more quiet and reserved? The larger the implants, the more attention you could attract. You may want to opt for a slight increase in size, just enough to balance out your body contour for a more natural look.

Be true to yourself

You shouldn’t base your decision on breast size based on an actress that you saw on the internet. They are not you. You should select a size that accurately reflects your own personality and lifestyle. Don’t base your chosen size on how your girlfriend looks, either. Her body is different and the breast size she has may not look very flattering on your body.

Communicate effectively with your doctor

A breast implant consultation is a two-way street. You need to express your expectations and it’s my job to understand them so I can help you achieve them. If you feel that your concerns are not being addressed, don’t be afraid to ask for more clarification or explain your situation further. I’m here for you!

Know what you want

You should not agree to undergo the surgery until you’re confident that you’ll like your new look and size. If you have any doubts prior to your surgery, talk to me about them! We can also schedule another in-clinic implant sizer session.

As you can see, there are many factors that you need to take into consideration when selecting your implant size. You shouldn’t choose a size because it looks good on a friend or celebrity. You should select a size that is right for you. The process is personal and while you should take your doctors suggestions into consideration, you have the final say in the size you select.

Answer your surgery doubts

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Breast lift surgery (also known as Mastopexy, or breast reconstruction) helps to restore the elasticity of female breast tissue which can be stretched, most often through factors such as; weight loss, pregnancy and childbirth, breastfeeding or ageing. The improvement in self-esteem and confidence can be remarkable, making a breast lift one of the highest ranking cosmetic procedure in satisfaction.

The procedure is designed to lift breasts that hang abnormally low over the chest, with the majority of their volume sitting at their base. It can be an effective way to enhance the breasts, without drastically changing their size. During the procedure, one of our highly-qualified surgeons will lift and reshape your breasts, giving them a firmer and more youthful appearance. Additionally, we can re-position the nipples higher on the breast so the changes are proportionate and natural To ensure the best possible results, I may also recommend a breast enlargement or reduction to be performed alongside your breast lift if appropriate. This will be discussed at your initial consultation.

MASTOPEXY: AT A GLANCE
– Surgery time 2 hours
– Hospital stay day case
– Sleeping position sleeping on back recommended for 1-2 weeks.
– Reasonably mobile 1 day
– Washing shower after drain removal (if any) or 2 days post op
– Driving 1 week
– Exercise including gym 4 weeks
– Sexual activity restricted activity after 4 weeks
– Full recovery 6-8 weeks
– Time off work 1-2 weeks
– Bras & garments sports bra worn for 4 weeks

HOW THE OPERATION IS PERFORMED
A Mastopexy or breast uplift is usually required if the position of the nipple is pointing downwards or if it lies below the natural crease of your breast (the inframammary fold.) It is performed under general anaesthetic as a day case procedure, meaning advanced sedation techniques are employed to enable patients to recover more quickly after surgery and return home on the same day.

THE INCISION SITE
Generally this procedure is performed to rejuvenate and reshape the look of the breasts – due to the scarring associated with this particular breast procedure, the incision sites will be considered in great detail. There are various places where the incisions can be placed as detailed below:

Periareolar mastopexy or ‘donut’
This method of uplift addresses the loose/sagging skin or envelope of tissue. The incision in this instance is limited to the circumference of the areolar only and is often combined with an augmentation to help restore lost volume. This method proves satisfying for most patients although there is a potential risk of the extra weight of the settling implant distorting the areolar, although the benefit is that scars are kept to a minimum.

Vertical or ‘’lollipop’’ mastopexy
This method helps to reshape the breast very well indeed, however there will still be a visible scar down the centre and underside of the breast. The scar does eventually fade with time – this method is best suited primarily for breast lifts and breast reductions of any size without augmenting and adding further weight to the breast whilst it heals.

Traditional ‘T-Scar’ or ‘Anchor’ technique
This is by far the most common and preferred technique of uplift – typically, your scar will start around the areolar, travel vertically down the underside of the breasts and then horizontally across the natural breast crease or inframammary fold. There is of course a consideration around scarring, however, with our expert aftercare team your wounds should heal beautifully and with time fade almost completely. This method usually incorporates an augmentation very well as the new weight of your breasts is distributed evenly across all incision sites.

Often as part of a mastopexy procedure your nipple will be realigned – the aim of this surgery is to rejuvenate the look of low, pendulous breasts, therefore, the nipple will be repositioned so that after your surgery, when you stand in front of the mirror naked your nipple is adjacent to the midline of the upper arm.

THE TYPES OF STITCHES/SUTURES
All sutures are placed below the skin and are dissolved by the body over the course of a few weeks. Nothing needs to be pulled out/removed by a nurse following your procedure. Often surgeons will seal the wound with tissue glue, to limit the risk of superficial wound infection – this glue peels off over 1-2weeks.

ASYMMETRY
Most women have some form of minor breast asymmetry. One side may differ from the other in volume, position of the nipple or shape of the chest wall – this is completely normal and your surgeon will be able to assess how best to correct these variances during your procedure.

AFTER CARE
How you behave in the immediate weeks after your operation can significantly impact the results you are able to achieve, for example, wearing the correct supportive post-operative bra will support the breast position and protect the settling scars during the crucial initial healing stage. You must also ensure that you lie resting in a slightly elevated position to help reduce swelling, you must also try to not move yourself up the bed using your arms as this action moves the muscle on your chest and could potentially move the implants or cause bleeding. You should use your stomach muscles and bottom to move up the bed. Do not allow anyone to assist you up the bed by lifting you up from under the armpits.

An appointment will be made for 1 week after your surgery where your incision sites will be checked, cleaned and redressed and you will be given instructions on how to care for these areas for the remainder of your healing. A follow up appointment will also be arranged at 2 weeks, 1 month and then 3-6months time.

I advise patients should be able to return to their normal day-to-day activities after about two weeks – we would recommend one week off work with the option of two if you require, as swelling is greatest during this time and it is advisable to give wounds an appropriate time to heal. During this period, it is advisable to keep all physical activity to a minimum including visits to the gym, practicing aerobics, yoga or any other sports that involve using your arms.