Prospective patients are encouraged to speak with previous patients about their surgery and results. Dr. Gershenbaum and his staff are always available for questions. Following the initial consultation and after appropriate time for reflection and decision-making, an appointment is scheduled for routine preparation and informed consent. Additional questions and concerns are also addressed. Routine blood analysis and medical clearance is required prior to surgery.
Breast Augmentation Operation
This surgical procedure is performed in our new state-of-the-art outpatient facility, Brickell Riverfront Surgery Center, under general anesthesia and will take approximately one to one and a half hours to perform. In the holding area prior to surgery, the patient’s “before” pictures are taken and then the breasts marked. After speaking with the anesthetist/anesthesiologist, the patient is brought to the operating room. After asleep, local nerve blocks combined with a medication that shrinks blood vessels and capillaries to reduce any bleeding are instilled. Next, the incisions are made and the “pockets” created, generally under the pectoralis muscle. The pockets are washed with an antibiotic solution and then the implants are placed with the aid of the Kellar Funnel. The operating room table back is elevated to place the patient in a sitting position to check implant position and symmetry. Minor adjustments are made to the implant “pocket” as necessary to obtain the best possible results and symmetry.
After the table back is lowered, a long acting anesthetic is placed into the “pockets” which greatly reduces postoperative discomfort. The incisions are closed with sutures predominantly below the surface of the skin to avoid cross-hatching suture marks and optimize the chances for the finest scars. Steri-strips are applied as well as being placed in a post surgical bra.
Breast Augmentation Recovery
Following the surgery, patients generally report mild to moderate discomfort which is easily controlled with medication. Varying degrees of swelling, bruising and firmness subside over several weeks to months. Any sutures (stitches) on the skin are removed after five to seven days. Patient’s can generally return to work after several days to one week. Light exercise may begin after to four to six weeks. A support bra is generally worn for two to three months following surgery and is encouraged as much as possible thereafter to maintain the contour.
Recovery and healing will vary from patient to patient and depend on the extent of the surgery. Over the weeks and months, the breasts will soften and relax, looking and feeling more natural as swelling subsides and the effects of gravity and tissue relaxation act on the newly implanted breasts. It must be remembered that complete healing takes time and patience, taking up to one year before realizing the final result of the surgery.
Breast Augmentation Complications
As with most surgical procedures complications are unlikely when performed by a skilled and competent surgeon. Complications include, but are not limited to anesthesia risks, bleeding, infection, capsular contracture (firmness or hardening of the healing tissues around the implant), deflation, poor healing with prominent or obvious scars, numbness, altered nipple sensation, loss of nipple sensation, asymmetry in breasts and/or areolas, enlarged areolas and need for revision surgery or implant removal. Also rare, but possible are blood clots or emboli (blood clots which dislodge and travel in the blood stream to distant sites).
Venodyne calf compression devices are used for every breast augmentation surgery (as well as other surgeries). Venodynes are pressure cuffs that fit over each lower log from the ankle to the knee circulating every one to two minutes to reduce the pooling of blood in the lower extremities and further reduce the possibility of blood clots or emboli. Smoking seriously decreases blood circulation in the skin which increases the risks of complications and poor healing.
Breast Augmentation Frequently Asked Questions
Are connective tissue diseases caused by silicone gel-filled breast implants?
Breast implants are the most studied medical devices in history. “Evidence suggests diseases or conditions such as connective tissue diseases, cancer, neurological diseases or other systemic complaints or conditions are no more common in women with breast implants than in women without implants.”
Do silicone gel-filled breast implants cause cancer?
It is estimated that approximately ten to eleven million women around the world have breast implants. Breast implants remain as the most studied medical devices in history. The Food and Drug Administration (FDA) has identified a possible association between breast implants and the development of breast-implant associated anaplastic large cell lymphoma (BIA-ALCL), an uncommon cancer of the immune system. The FDA believes that women with breast implants that have textured surfaces have a very low but increased risk of developing Breast Implant associated Anaplastic Large Cell Lymphoma. There is no proof, at this time, that breast implants actually cause this cancer. Continued studies are ongoing to further define the relationship between the condition and breast implants. ALCL is an uncommon cancer that can develop in any part of the body, most commonly the lymph nodes and skin. When associated with textured breast implants, this ALCL is found in the scar tissue capsule that forms around the implant, and not in the breast itself. The lifetime risk of developing BIA-ALCL from a textured implant is estimated to be from one in 4,000 to one in 30,000 and generally presents in roughly eight to ten years after the surgery, or perhaps longer. Symptoms may include breast enlargement, pain, asymmetry, a lump in the breast or armpit, a persistent skin rash, hardening of the breast, or a fluid collection developing at least more than one year after receiving an implant. For any patient experiencing these or any symptoms, they should see their doctor for evaluation.
As for smooth surface implants, published studies indicate that breast cancer is no more common in women with breast implants than in women without breast implants. To date, “There appears to be no increase in primary or recurrent breast cancer in women implanted with smooth shell implants.” Studies are ongoing.
What are the effects of silicone gel-filled breast implants on pregnancy and breastfeeding?
Women with breast implants do not risk exposing their breastfed children to excessive amount of silicone. The Institute of Medicine concluded, “No evidence of elevated silicone in breast milk or any other substance that would be deleterious to infants was found in women with silicone gel-filled breast implants.”
Although we have had numerous patients able to breast-feed after breast augmentation, breastfeeding difficulties have been reported following breast surgery including breast augmentation.
How will silicone gel-filled breast implants effect having mammograms?
Current recommendations for getting screening mammograms are no different for women with breast implants that for those without implants. Radiologists experienced in the evaluation of women with breast implants should interpret mammography exams. It is essential that you tell you mammography technologist before the procedure that you have a breast implant. You should request a diagnostic mammogram rather than a screening mammogram because more pictures are taken with diagnostic mammography. The technologist can use special techniques to reduce the possibility of rupture and to get the best possible views of the breast tissue. MRI is also, at times, requested for diagnostic and/or screening purposes
Are breast implants permanent?
Breast implants are not considered lifetime devices. You will likely undergo implant removal with or without replacement over the course of your life. Whether undergoing augmentation or reconstruction, be aware that breast implantation is often not a one-time surgery often requiring additional surgery and doctor visits over the course of one’s life.
Is it possible to develop a silicone allergy ?
It is possible for anyone to develop an allergy to almost any substance on earth. However, silicone allergies are very rare. We are all exposed to silicone in our environment everyday. It is found in many household items such as polishes, suntan and hand lotion, antiperspirants, soaps, processed foods, waterproof coatings and chewing gum.
Which implants are the “Gummy Bear” Implants ?
Today’s silicone gel implants are made from a cohesive silicone gel, different from the more liquid silicone of earlier implant manufacturing. “Gummy bear” implants refer to cohesive silicone gel implants. The confusion comes from “gummy bear” Implants in reference to the standard cohesive silicone gel, versus the more crosslinked/bonded anatomical form stable implants. The reality is that some surgeons will call the standard cohesive silicone gel implants “gummy bear” implants, and others will refer to only the highly cohesive form stable implants as “gummy bear” implants. Since the term “gummy bear” implants is only a reference / description of the newer type of implants, simply ask the surgeon if he is referring to standard cohesive gel or the highly cohesive form stable implants if you wish to be sure.
Do Breast Implants Have Warrantees?
Allergan
- Lifetime free replacement of implants in the event of rupture or deflation
- Up to $3500 financial assistance for 10 years in the event of Natrelle Gel Implant rupture
- Free implant replacement for 10 years in the event of Baker III/IV capsular contracture for Natrelle Gel Implants
- Additional financial assistance up to $2400 for 10 years for saline implants available for an additional $200.
Mentor
- Lifetime free replacement of both implants for rupture or deflation
- Up to $3500 for 10 years in the event of implant rupture
- Free implant replacement for Baker III/IV capsular contracture or late seroma complications
- Additional financial assistance up to $3500 for 10 years available for an additional $300
Sientra
- Lifetime free replacement of a ruptured implant and opposite side replacement if needed
- Up to $3600 toward surgery for rupture within 10 years of surgery
- Free implant replacement for capsular contracture within 5 years of surgery.