Breast Augmentation Orange CountyBreast Augmentation
Orange County breast augmentation involves using implants to create fuller breasts or to restore breasts that never fully developed or may have lost volume due to weight loss or from pregnancy. Few things can make a woman feel more self conscious than a perceived inadequate breast size and few things can make a woman feel more attractive and sexier than receiving a breast size she perceives as perfect!
Breast augmentation can increase the fullness and projection of a woman’s breasts, improve the balance and proportions of her figure and improve her self-image and self-confidence. The following information has been prepared to familiarize you with facts about breast enlargement. You are requested to read this information thoroughly and to discuss any questions, which might arise with your surgeon before proceeding with the surgical procedure known as breast augmentation. You are also requested to keep this form as a reference in the postoperative period.
BREAST AUGMENTATION INTRODUCTION
Many women feel that their breasts do not match their overall body physique. Breast augmentation is one of the most common aesthetic surgical procedures in the United States of America. Small breast size may be due to a lack of normal breast development or to a decrease of breast volume following pregnancy or menopause. This procedure is designed to give the female patient a fuller breast.
Every effort is made not to alter your breast tissue during a breast enlarging procedure. This operation is performed by creating a pocket behind your existing breast tissue, above or behind your pectoral muscles, by placing an implant in the space, and by simply pushing your breast tissue forward, thus enlarging the appearance of the breast. Most patients have been exceedingly pleased with this operative procedure, even though life-long follow up and the need for subsequent surgical procedures are the rule and not the exception.
The increase in breast size will be limited by the tightness of your tissues, but significant improvement can usually be achieved! As unfair as this might seem, the smaller your breasts are to begin with, the smaller a breast implant will have to be selected during surgery, simply because there will not be any room to put in bigger implants! On occasion, especially in patients who begin with a very small breast, a secondary procedure to insert larger implants may become desirable at a later time, after tissues have had an opportunity to stretch. The fees for all secondary procedures will the patient’s responsibility.
Options regarding implant size and type will be discussed with you before the procedure and every effort will be made to create an optimal breast for you, but the final determination of an appropriate implant has to rest with the surgeon, and this final decision cannot be made until the pocket has been dissected during your surgical procedure.
It is important to understand that no person is perfectly symmetrical from one side to the other, even before a surgical procedure. Every attempt will be made during surgery to minimize your side-to-side dissimilarities, but such differences are natural and always persist to some degree, even after the most successful operation. And it is not unusual to have a greater degree of asymmetry after surgery than existed before implants were placed - this occurs because the formation of the scar layers around the implants and how the implants “settle” is not under the patient's or surgeon's control!
There is no evidence that breast surgery alters the possibility of developing breast cancer. Mammography and MRI techniques have improved in recent years. In spite of these advances, there is a theoretical risk of compromised detection of early breast cancer following an augmentation mammoplasty. If a cancer were to develop, its detection by mammography could be made more difficult, depending on the location of the cancer within the breast, the position and size of the implant and the type of implant employed, and an MRI may be recommended. Regardless of your decision to have an augmentation mammoplasty or not, it will still be necessary for you to examine yourself monthly for breast lumps and to undergo mammography as suggested by your personal physician. All women, whether or not they are contemplating breast surgery, are encouraged to obtain a baseline mammogram at age 35 (or even sooner if recommended by your gynecologist because of a family history of breast cancer) and a yearly mammogram or MRI after the age of 40.
If one does not cut around the nipple, normal breast function should not be altered by an augmentation procedure. Although not all women are able to breast feed, even without a breast operation, this procedure should not alter the ability to breast feed should this become desirable later. One cannot, however, rule out possible effects on future pregnancy and nursing, particularly when incisions are placed around the areolae (“nipple incision”).
BREAST AUGMENTATION PREOPERATION PREPARATION
You may visit your surgeon at Orange County Plastic Surgery as many times as you wish to have all of your questions answered. At your final preoperative visit, which will take at least an hour, your final questions will be answered and you will confirm that you have understand the procedure to be performed, that this material has been explained to you, that you have read and understand these information sheets, and that you accept the risks by signing the informed consent forms. You may request a copy of the consents contained in this packet. You will be given prescriptions for surgical soap, pain pills and antibiotics along with instructions for their use. Certain laboratory tests will also be required within two weeks of surgery. If you are over the age of 50 or any history of cardiac problems, you will have to obtain a cardiogram, and this will have to be performed at any doctor’s office or laboratory about two weeks before surgery. You may have blood drawn by our office nurse during your final preoperative visit, or, if you prefer, at your family doctor's office or any state licensed laboratory (e.g. Kaiser Hospital, etc.). All patients will be asked to stop smoking at least a month prior to surgery in an effort to maximize your body's ability to heal the incisions following the operation.
As with all other elective procedures, the patient should avoid ibuprofen (Advil®), all Aspirin® products and excessive quantities of vitamin E (the small amount contained in most multivitamin preparations is not harmful) for two weeks before surgery, as these inhibit the clotting mechanism and increase your chances of unnecessary operative bleeding. A separate list of other medications, which can potentially affect clotting capabilities, will be discussed along with your preoperative instructions.
Patients will be given a prescription for Hibiclens® soap. It will be necessary to scrub the surgical site (from the neck to the belly button and from one armpit to the other) for ten minutes the evening prior to surgery and for one final time on the morning of surgery before leaving for the surgical suite. Scrubbing the skin with Hibiclens® these two times will decrease the number of bacteria on your skin and minimize the chance of developing an infection after surgery.
Your anesthesiologist will discuss the available options for accomplishing your surgery comfortably and safely. Your anesthesiologist may call you the night before surgery to discuss the anesthetic care plan with you. But if you miss the call or your anesthesiologist does not call you, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the Surgery Center (Orange County Surgery Center in Newport Beach, Southern California or the Tracy Surgery Center in Tracy, Northern California), prior to your procedure. It is absolutely imperative that you make arrangements in advance to have someone drive you to and from the Surgery Center on the day of your operation and that a responsible adult spend the first day with you at home after surgery.
BREAST AUGMENTATION OPERATION
A deep sedative or light general anesthetic will be used. An anesthesiologist will be present at all times to insure your comfort and safety. The operative time is approximately an hour and a half. A small incision is placed in the fold beneath the breast, around the areola or in the armpit. A pocket, which will accommodate the implant, is created beneath the breast tissue, either above or below your chest muscles. The location of your incision, as well as options relating to implant types, sizes and location of the pocket will be discussed with you at length pre-operatively. Implants vary greatly in type (and cost!), but basically all have a silicone rubber shell. Implants used today are filled with either silicone gel or saline (salt water) solution. Implant surfaces may consist of traditional smooth rubber or a textured rubber surface. In addition to the traditional implants, your surgeon has the option of choosing different profile or anatomic shaped implants for you. With so many implants available, it is obvious that no single implant is ideal for all circumstances. Your surgeon will review the latest controversies regarding breast implants, FDA regulations and your options.
The manufacturer of your breast implants expects the implants to last a long time, but everything man-made does break or wear down eventually. The life span of all types of implants can be shortened by trauma or mechanical failures. Such a rupture may be clinically undetectable to you or your surgeon if you have silicone gel filled implants, but could be picked up during mammography or other specialized tests. Rupture or leakage of the older gel implants often led to gel migration or formation of lumps within your breast as a result of scar tissue developing around the free silicone, necessitating future breast biopsies and implant replacement. Today’s gel-filled implants contain a “cohesive” gel that stays intact even with shell rupture, will be less likely to migrate and easier to remove. However, rupture of a saline filled implant, will generally be obvious because the breast will resume its previous size and shape over a short period. Unfortunately, no one can predict in advance when an individual implant will fail. Replacing an implant will become necessary if a leak is detected. It is strongly suggested that you return to see your plastic surgeon at least once a year for a breast examination. These examinations are provided by our office without cost to you.
You may choose to have a catheter inserted which is connected to a “pain pump” which infuses local anesthetics into the surgical field for the first few days. Such pumps will greatly enhance your comfort during the early postoperative phase. It is more common than not to have leakage around the pain pump insertion sites - this is normal and all you can do is reinforce the site by adding more dressing material! A loose circumferential wrap is fitted at the completion of your operation, mainly to hold your dressings in place. You will be instructed when to remove this wrap and to begin implant manipulations (“massages”).
BREAST AUGMENTATION POST-OPERATIVE CARE
On your day of surgery you can expect to feel sleepy. Even if a pain relief pump is used, there may be a severe feeling of tightness and discomfort throughout the chest area, perhaps radiating into your arms or back area, for which pain medication will be prescribed. The pain relief pump infused local anesthetics automatically and very slowly in the surgical field – you will not notice any medication flowing in the tubes and you cannot adjust the flow rate! Each day thereafter, you will notice an improvement, and should take less pain medication.
Please remember that no two sides ever heal the same after an operation and that this is normal. Major discrepancies, however, should be reported to your surgeon. Please follow the instructions below to minimize complications.
1. Keep ice bags applied to your chest on the day of your surgery and the next day, even a third day, as this will help easy the discomfort.
2. Do not shower until instructed to do so. Normally, showering can begin after the pain relief pump catheters have been removed on the third day or so.
3. If the underarm incision has been used, you may have an Ace bandage or circumferential chest wrap applied to the top half of the breasts in an effort to keep the implants as low as possible during the initial healing phase. Leave the dressings in place until your return visit.
4. If the underarm incision has been used, the suture line will be covered with a clear plastic dressing. Please remove this plastic sheet while showering on the day of your second post-operative visit - usually five to seven days after your operation.
5. If your incisions are placed around the nipple or under the breast fold, you will most likely have a light wrap place around your chest at the end of your operation. You may begin lightly massaging the breasts (i.e. moving the implants up, down, in and out as instructed by your surgeon) but do not shower until returning to see the doctor (usually, two to four days after your operation). Keep all gauze dressings that were placed over your incisions dry and intact.
6. A small percentage of patients experience significant nausea after any operation. This may be due to your pain medication or antibiotics. Please let us know if this persists and we will ask you to stop taking some of these medications, and if necessary, change your prescriptions.7. During your final pre-operative visit, you will be given prescriptions for pain medication and antibiotics. The antibiotic tablets are to be taken on a daily basis, beginning on the day following your surgery. To minimize the possibility of nausea, always take these antibiotics or the pain pills on a full stomach.
8. Do not do anything which increases your discomfort level prior to your first office visit after the operation. To avoid unnecessary swelling or bleeding, do not bend over, strain, exercise or do any other activities that could increase pressure in your chest during the first week. It is very unusual for bleeding problems to develop after the first week. You will be encouraged to resume your normal activities after the second office visit. You will also be asked to begin your massages after the first visit.
9. Sexual intercourse, and all other vigorous physical activity, may resume as soon as you are physically comfortable doing so.
10. You may drive a car with caution wearing a seat belt beginning 48 hours after your last pain pill. Do not drive while taking pain pills or other sedatives!
11. Most patients prefer to sleep on their backs initially after surgery. You may resume sleeping on your sides or stomach whenever you are comfortable doing so. During the first month, your surgeon would prefer that you do not wear a brassiere and that you move your implants frequently (“massage”), in order to keep the pockets large. A good rule of thumb is to massage your implants each time you have to go to the bathroom - that way you will not forget, and will have another activity to remind you to move your implants, half a dozen times each day. After the first month, you may use your own discretion regarding a brassiere. Wearing a push-up bra or any with pressure wires during the initial healing phases may be uncomfortable, but if this is not the case, you can wear whatever you are comfortable in after the first month. During the first month, you may occasionally wear a bra for a special dress or evening, but do not routinely wear a bra during this period. Thereafter, you may wear any bra that you wish.
12. It is recommended that patients begin applying MD Performance® Ultimate Scar Formula the incisions to optimize healing. The Ultimate Scar Formula should be applied twice daily as directed until the scar has finished healing (scar should turn flat, soft and without a trace of pink or purple left).
13. The skin may itch after any surgical procedure. After the first week, the skin can be moisturized with the MD Performance® Avocado CoQ-10 Body Balm – this will relieve the dryness and itchiness and help any crusts fall off the suture lines quicker.
14. Recovery rates vary from person to person, depending to a large degree on patient motivation. Most patients feel well enough to drive a car and perform desk work between three and seven days after surgery. Aerobics instructors usually resume teaching fourteen to twenty one days after surgery, but everyone feels some discomfort related to the surgery for weeks or months to come. The best rule is to avoid activities that cause significant discomfort and to enjoy those that do not.
15. Resume examining your own breasts within a month of your procedure and have your gynecologist do a routine breast examination yearly. Also return to see your surgeon at least annually for a breast examination as a plastic surgeon can best determine any implant related problems in an augmented breast. Mammograms may be ordered by your gynecologist or personal physician as necessary. We request that copies of your breast mammography report be forwarded to our office as well as to your gynecologist’s or personal physician's office. Generally, a baseline mammogram is suggested at age 35, an annual mammogram for women after the age of 40, but earlier or more frequent mammograms may be recommended by your personal physician.
KEEPING MY BREASTS SOFT
The human body's natural reaction to implants, regardless of type, is to surround them with a layer of scar tissue. This happens each and every time. Scar tissue has a natural tendency to contract and compress the implant, which may cause the external breast to appear unnaturally firm (such scar tissue may cause one or both breasts to be painful and to look uneven). In addition, particularly in patients with a small volume of breast tissue initially, surface wrinkling may be evident, especially in patients who choose to have textured surface, saline filled implants, and in those with implants placed above the pectoral muscles.
The surgeon always places each breast implant in a pocket or space, which is larger than the implant itself; as long as this pocket stays larger than the implant, your breasts should remain soft and look natural.
In order to minimize the degree of scar contracture that your body develops around the implant we recommend active exercise and daily implant manipulation (i.e. “breast massage”) as will be described to you by the surgeon or the office staff. These exercises must be continued on a daily basis. Should breast hardness develop, a corrective operation may be required, at your cost, to remove or release the scar tissue in order to soften the breast; such secondary operations are not always successful.
Please feel free to contact our office regarding any other questions or problems you may encounter.
BREAST AUGMENTATION POSSIBLE COMPLICATIONS
Every activity in life, whether driving automobiles or having surgery, is associated with risk. The following inherent risks must be understood and assumed by the patient if we are to proceed with this operation. Although most patients have a very satisfactory result, complications may occur following any surgical procedure. Complications requiring reoperation are probably higher following breast implant surgery than any other type of aesthetic operation, and when including implant replacement, close to 100% of patients end up requiring at least one more operation during their life times. Problems which can arise include those already mentioned associated with the implants (including ruptures and capsular contractures) and the following: infection, hemorrhage into the breast pocket, chronic pain, increased breast asymmetry, an enlarged pocket with the implants too close to each other over the sternum (i.e. symmastia), an abnormal "double fold" along the bottom part of your breast, an abnormal lowering of the breast fold, breast flattening or indentation upon tightening of the pectoral muscles, unsightly scars at the site of the incision or untoward reactions to anesthetic administration.
A moderate amount of discomfort is normal with every procedure, but breast augmentations, particularly with implants placed beneath the muscles, results in significant discomfort, perhaps analogous to that felt after a C-section. You will be given ample pain medication to help control the discomfort. In addition, at the time of your procedure, your surgeon can insert a pain relief pump, a tiny catheter through which local anesthetic can be infused during the first few days after surgery.
Should unusual bleeding occur after the procedure, your breast will immediately become noticeably asymmetrical (the one with the bleeding will be much larger), painful and swollen. This will necessitate a return to the operating room to stop the bleeding and to remove the blood clot, and result in additional fees to the patient.
Infection, a rare complication, usually cannot be cleared unless the implant is temporarily removed to allow complete obliteration of the infection before the implant can be replaced. This can take up to six months before it is safe to reinsert the implant.
Other problems, which occur but are usually of transient nature, include allergic reactions to medications, postoperative nausea or vomiting, hypersensitivity of the nipples, tightness in the chest wall and shooting or burning pains at the sides of the breasts. Frequently one or both nipples or other areas of the breasts may become numb temporarily, but occasionally this may prove to be permanent.
A rare and unsubstantiated, but possible, relationship between the silicone gel and connective tissue disorders such as arthritis and lupus has been alleged. There are other, very rare, potential complications from this operation in addition to the ones that have been mentioned, but it is not possible to advise you of every conceivable complication. Serious complications, even death, after any type of cosmetic surgery are relatively rare. The need for reoperation after breast augmentation, as has been mentioned, is common, but most patients end up with a very satisfactory result.
The foregoing was not intended to frighten or upset you, but to insure that your decision to have this operation is made with your awareness of the possible risks.
All fees will be discussed freely in advance by the office staff. Not only do insurance companies not cover the cost of such cosmetic surgery, but they may place exclusion for breast disease on your future policies. In compliance with suggestions adopted by the American Society of Plastic Surgeons®, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in her motivation and can afford the surgery, thus creating a better patient/physician relationship. A non-refundable deposit will be required to secure your desired surgery date. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but no later than two weeks before surgery. Additional fees are also required for laboratory tests, surgical facility fees, the anesthesiologist, and if necessary, mammography. If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, implant costs and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict.
It is important that you understand that the patient is responsible for all costs associated with all secondary surgical procedures or for the treatment of any complications that may arise as a result of this elective surgery.
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Except with the ThermiTight™ procedures, pre and post-op photos will be taken of the treatment site for record purposes.