Above the Muscle Breast Augmentation - Dr. Bunkis - Newport Beach CA
Speaker 1: This 27-year-old mother of one child lost some breast volume after she breast fed and her breasts have deflated. You'll see a minor degree of asymmetry like everybody has. You'll see a little bit of ptosis. When you have a little drooping like this, the choices are to do a lift up to here, put an implant in under the muscle or, if you want to avoid the lift scars you can leave the nipple where it is. If you can put your finger under the breast and put your thumb down, the nipple is still above the fold. If the nipple is below the fold, you have to have a lift. But in her case we're going to just put an implant in and we'll put it in on top of the muscle. That way we can drop it a little lower, center it behind her nipple and avoid a mastopexy scar.
Where we're going to make the incision is just above the fold on this side of the breast and that's how long the incisions are. We're going to do this for her in a few minutes here at Orange County Plastic Surgery. She has chosen [inaudible] 310 cc Allergan high profile implant on this side and on this side we're going to use a 340 cc. The incisions, as we saw the mark, are just above the folds. The first thing we do is inject a lot of local anesthesia. She is very deeply sedated. She's not going to remember anything but this type of sedation doesn't take your pain away very well so that's why we also inject a local anesthesia so the anesthesiologist has to give less medication.
We've given the local anesthesia, everything's all infiltrated. We start by making this incision as you saw in the before-surgery picture. Once we get through the skin the rest of the dissection down to the muscle is all done with cautery. And this is a little electric current which allows us to coagulate vessels as we encounter them and drastically reduces our blood loss. We basically continue the dissection down until we can see the muscle. This is the implant we're going to be using on the right side and we pre-soak it in a little Betadine before we put it in. This lessens the chance of getting infections or capsular contractors in the future. We have finished the dissection and I'll show you roughly the size of the pocket. It goes all the way to there, down to there, a little bit lower than the fold as we discussed earlier so that the breast doesn't look droopy. So that's the size of our pocket.
You want a pocket that is much larger than the implant itself and that way the implant will fall towards the armpit when you lay down. It'll go up and down when you're jogging. You want it to look and feel like a normal breast. This is that 310 cc Allergan SRX implant. It's a cohesive gel that is super high profile and you can see that's a pretty small opening and with a little bit of patience, you can get them in pretty easily. Once it goes in, we'll put in some Betadine into the pocket just, again, to decrease the chance of getting infections. And once the implant is in, you can see how it moves inside the pocket. When she lays on her back it will fall a little bit towards the armpit and when she is standing forward it will be here. When she's jogging it goes up and down. That's what a normal breast looks like.
The next step is to close that deep layer of breast tissue so that our opening is nowhere near the [skin]. The skin is closed in two layers. We put a deep suture in which is absorbable but what that does, it takes some of the tension off the closure and just gives us a better scar down the road. And speaking of her scars, you can see it lies above the fold. It's not in the fold. And the purpose of that is when she is wearing a bathing suit or a bra, if it rides up you don't want the incision to show. Once that incision suture is in, we basically run a 4-0 Monocryl which is an absorbable suture. And there are no sutures on the outside and at the end, you'll see the nurse putting on some glue on the incision and that allows the patient to shower within a day or two of the operation. It just makes the recovery a whole lot simpler.
Speaker 2: Go right ahead.
Speaker 1: Oh, now you've seen we've completed this pocket. It's nice and generous. You want the implant to be [hitting] in that pocket so they can freely move sideways and up and down. That's how you get a natural breast. If you put an implant in that's the same size as the pocket, it's going to feel hard and unnatural. We're very fortunate we work with these implant manufacturers and they are giving us a free pair of implants to give away at our March 22, 1918 breast event and if you're interested, come on by, get some more information about any kind of breast surgery, reductions, enlargement and so forth. If you're lucky, you'll go home with a pair of free breast implants.
If you look at this gal now, she's pretty symmetrical. The breasts move normally. If you squeeze them the implant goes out of the way and goes down. That's how you want your breasts to look. And at the end as you can see, we put a little glue on the incisions and this just seals the wound and allows the patient to go take a shower much, much quicker. And this is how we do breasts at Orange County Plastic Surgery. This is how we get our ladies ready for the beautiful Orange County beaches in the spring.
Speaker 3: So this is one of our lovely patients. She is four days postop of a breast augmentation subglandular with silicone gel implants and she's here to tell us a little bit about how she is feeling and doing just a few days out.
Speaker 4: So minimal pain. They look way better than they did before and they move pretty amazingly back and forth. And when I lay down they look really natural. I love them.