Breast Augmentation

Like most life decisions, you will have to weigh the risks versus the benefits. Each woman will perceive the risks and benefits for herself differently. On the positive side, breast augmentation patients studied after surgery report higher self-esteem and confidence, enjoying their appearance more both in and out of clothing. That must be weighed with the recognition that in all likelihood this is not a “once-in-a-lifetime” procedure – at some point a breast revision may be necessary. Complications such as infection after breast augmentation surgery can occur. Scar tissue can form around breast implants; implants can deflate or rupture; implants can get out of the right position; there are additional costs in the future; there can be changes with mammograms, and much more that each woman considering breast augmentation should consider. Despite all these tradeoffs, when women come in to have these problems treated, they are usually so happy with their implants they rarely are willing to do without them.

Saline implants are still popular in Dr. Stephenson’s practice. There are three reasons for saline implants: they are less expensive, they can be introduced through the smallest incisions, and some patients – despite all the evidence proving silicone is safe – remain skeptical. Silicone gel implants are the softest implants and are FDA approved.

There is a misunderstanding that saline implants are unnatural and produce a “fake” look. This is not always the case. Saline implants work very well in clients that have a modest amount of breast tissue (B cup or more) to produce a soft natural appearing breast. Silicone implants are naturally softer than saline implants and can work well with all cup sizes but work especially well in clients that have a smaller breast size (A cup). Dr. Stephenson will couple his expertise with your desired outcome determine which implant will be right for you.

Dr. Stephenson does not use textured implants due to their association with Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). BIA-ALCL is not breast cancer BUT it is a type of non-Hodgkin’s lymphoma (cancer of the immune system). In most cases, BIA-ALCL is found in the scar tissue and fluid near or around textured implants. Dr. Stephenson recommends smooth, round implants in all situations.

Let’s think about shoes for a minute. There is an ideal shoe size for your foot. If you select a shoe that is too small your foot will be cramped. If you select a shoe that is too large, your foot will not fill the shoe. This same principle is true with breasts implants: a breast implant that is too large and it will look round and fake; A breast implant that is too small and it will be loose and empty on the top.

With a breast, the shape changes as the volume changes meaning you cannot have the same shape with any volume. If you want to look relatively natural, there is a limit to how large you can go. If you want to look relatively filled, there is a limit to how small you can go.

Clients may want to look smaller than what anatomically is the ideal size for their breasts. That is okay, so long as they understand their breasts may not be totally filled up, and that they may be empty on the top.

At other times, clients may want to be larger than that ideal size. If they do go larger, there are two tradeoffs. The first is that the result will look rounder and less natural. The second is that the size and weight of an implant that is too large for their tissues will more rapidly stretch the skin over time and compress the breast tissue. This could lead to rippling and an implant that can be felt. Additionally, stretched skin may lead to the need for a breast lift in the future.

If a breast is simply deflated or empty, falling back against the body without droop, then an implant can fill it up. If the breast has drooped or sagged, with either the nipple low or tissue hanging down beneath the fold under the breast, a breast lift is often required.

The best incision is under the breast in the crease of the breast. There are other options for incisions and most clients decide on incision based upon where they want the incision. Each incision sets up an entirely different operation. Risks and complications are different, and those issues can be more problematic than the healed incision. The crease healed incision typically is very faint and hidden in the crease underneath the breast.

The armpit incision tends to be more painful and less accurate than the other approaches. If a revision is necessary, another incision usually must be made typically in the breast crease. The healed armpit incision can be visible with a sleeveless blouse or dress.

The nipple incision yields a scar that is barely visible on most but not all Caucasians, but on patients of other races it very frequently gets either depigmented or hyperpigmented and thick. This results in a very conspicuous “smiley face” in the area of the breast that is the focus of the considerable attention. Operating through the breast tissue can lead to more pain, swelling, and changes in nipple sensation. Most important of all, is the fact that this incision requires placing the implant through the breast. When the implant goes through the breast tissue, bacteria can get on the implant. The bacteria that cause the inflammation that causes capsular contracture. This remains the leading cause of revision surgery after breast augmentation.

Dr. Stephenson places the implants in a “dual plane.” This means that the upper and inner areas of the implant are placed behind the muscle, where coverage is necessary in order to prevent the implant from being visible. The lower and lower outer part of the implant have no muscle in front, because in this area we need to usually expand the breast. The dual-plane technique combines the benefits of both being in front and being behind the muscle, while minimizing the downsides of each.

The most critical measurement is the distance from the nipple to the bottom of the breast, and even if the nipples are at unequal height, these distances must be the same. If it is short on one side, that nipple will point down; if it is long on one side the nipple will point up. Once that distance from the nipple to the bottom is determined, Dr. Stephenson precisely makes a pocket that will fit the implant. This is yet another reason to favor the under the breast incision, as it affords Dr. Stephenson the most direct, well-lighted visualization of the operation, so that nothing is performed blindly through a dark tunnel.

There is a risk of some sensation loss. The most common area to lose sensation is on the skin is a small area of the lower outer aspect of the breast. Whether this happens is related to the course of the nerve to this patch of skin. Less common, but more important, is whether sensation is lost in the nipple. The nipple incision is more apt to create this problem, but with all incisions this is a risk. The major nerve to the nipple comes from the very side of the breast, thus the larger the implant, the wider the pocket the greater the chance of this injury. Even when everything is performed perfectly, some clients can permanently lose sensation and all patients must be able to accept that risk before proceeding.

Yes, but extra views of the breasts are necessary. These views are called displacement views. At times, the implants shadow a part of the breast tissue. The displacement views shift breasts away from the implants allowing better visualization of the breasts. If visualization is still an iss for accurate reading of the mammogram, the radiologist may order an ultrasound or an MRI in addition to the mammogram. While insurance companies pay for a standard mammogram, some do not pay for the extra views or extra studies needed because of the breast implants.

No. The risk of breast cancer does not change if you have an implant. Cancers are not detected later, larger, or with a worse prognosis (outcome). The fact of having the uniform implant behind the breast tissue rather than the irregular rib cage, can make it easier to feel the breast tissue and more breast cancers are picked up by the patient with implants than those without.

They will look “fake” if the client desires that result. If your implants are properly sized for you, then they will not look fake. Remember, the thicker the tissue and the smaller the implant, the more natural they will look. The thinner the tissue and the larger the implant, the more “fake” the result.

How long implants last and how long it will be until you have your next surgery are two different issues that are often confused. A deflated or ruptured implant is not even one of the top reasons for having a revision. The most common reasons patients have another surgery is the development of scar tissue, drooping, implant getting out of position, wanting a change in size, etc. Implants only deflate or rupture at a rate of about 1% per year. Sometimes those deflations or ruptures can be noticed as a change in the breast. At other times the patient cannot detect a difference and the break can only be detected by an MRI.

When a saline implant deflates or ruptures, it does so over a period of days or weeks. There is no danger with this event, but you will develop asymmetry.

If a silicone gel implant ruptures the breast can feel different. The breast can feel harder, but it requires an examination to detect a suggestion of a rupture. Careful examination of the breast yields a rather amorphous feel to the breast implant instead of discrete borders of an implant. There is no evidence that a ruptured silicone implant will make you sick but Dr. Stephenson recommends that his clients with a ruptured silicone implant have the implant removed and replaced.

Occasionally after nursing the skin stretches and the breast looks empty and the breasts droops. Occasionally capsular contracture develops. If these issues occur, a revision may be necessary.

Detailed instructions will be provided to you after you have scheduled your surgery. The bra you will need to wear after surgery will be provided to you. On the day of surgery, it’s recommended to wear a comfortable sweatshirt top that you can easily zip on and off.

In most cases, clients are well enough to go home after a breast augmentation and do not need to go to an aftercare facility. However, some patients may choose to go to an aftercare facility if they do not have someone to watch over them the night of surgery or if their home environment is not conducive to relaxation and recovery. Dr. Stephenson has a vetted list of aftercare facilities for his clients.

Most patients describe the recovery period as more sore than painful. They may feel achy and experience pressure, but the pain is typically not sharp or severe. Pain gradually builds up, so if you start feeling uncomfortable, taking a pain medication as prescribed by Dr. Stephenson will help alleviate the discomfort.

Dr. Stephenson will personally call you on the night of your surgery. He will also provide you with his personal cell phone and email address so that you can reach him directly if needed.

You can drive when you are off all narcotic pain medication and feel totally unrestricted by your discomfort such that you could make any movement you might need to safely drive your car. The timeline is different for each client. Dr. Stephenson typically recommends 2 weeks after surgery.

Dr. Stephenson suggests you wait a minimum of 4 weeks to be sure that everything is healed. There is always a chance of causing bleeding if you start much before that time. When you start, listen to your body. You will be a little out of condition and a bit sore. But you will get back to where you were before surgery very quickly.

Any activity that elevates your heart rate or blood pressure, bending hard, straining or sweating. Light walking is beneficial starting the day of surgery.

Sex can be resumed as you feel comfortable. Most often patients hit their level of comfort in 3-7 days. Again, respect the fact that you have undergone surgery and try to avoid the manipulation of the incisions.

This is tricky. Unfortunately, your child does not understand your restrictions. Your child still needs your love and attention. If you have support from a partner, family member and/ or friend then they can lift and place your child in your arms. If your child is cooperative and weighs up 10 to 35 pounds, Dr, Stephenson recommends waiting 10-14 days, if at all possible. Don’t try to pick up your child if he or she is upset.

Cigarettes pose a particular hazard to patients undergoing this operation. They shrink critical small blood vessels that are important for healing in breast reduction. Smoking cessation is the best choice for our clients overall health. You should cease smoking at least 4 weeks prior to surgery and wait a minimum of three weeks after surgery if you are compelled to resume. This is a very real and very important issue with this operation.

Dr. Stephenson is never an advocate of sunbathing, since sunbathing damages and ages the skin. This is particularly true in the decolletage area, where sun damage makes women look very aged. Despite Dr. Stephenson’s recommendation if his clients elect to sunbathe, they may do so two weeks after surgery, provided that the incision is protected by something that will totally block the sun (SPF rated clothing). It is a good idea to keep the incision totally blocked from sun for a year or so.

You can take a shower the day after surgery. You should wait about three weeks before taking a bath so that your incisions are somewhat healed.

Dr. Stephenson wants to see everyone 48 hours after surgery to be sure that everything is okay. We offer patients frequent visits thereafter, usually at one week, one month, six months, one year, and yearly thereafter. But some patients will come more frequently, some less frequently. We do not charge for these visits. Some people have little questions they want answered, and other people feel fine on their own. He is always available for a patient who wants to come in.

The upper breast almost always looks too full immediately after surgery. Some of that is swelling; some of that is that the implant will drop down to the bottom of the breast. Pronounced upper fullness usually goes down between 4-8 weeks, but it continues to improve for a full year.

The biggest source of discomfort after a breast augmentation is a muscle that gets stiff. Just think about when you have sat in one position for a long time and the discomfort when you try to move that joint for the first time. Moving freely after surgery will lead to increased comfort during the recovery period.

Swelling increases after surgery, usually peaking about 5-6 days after surgery. After that, the swelling will subside, rapidly at first, and then gradually. After one month, you’ll think the swelling is gone, but it will still go down more at three months, and even more at six months and even a year, though at that point changes are subtle.

Dr. Stephenson does not recommend it. The skin lacks sensation after surgery and sometime prolonged icing can lead to injury of the skin.

Every client is different. Some swell a lot, some swell a little. As the swelling decreases, the breasts will also get softer and more mobile, so that in a sense they can actually be made to look larger once they soften up enough to be pushed up and molded by a bra. Similarly, as swelling goes down, the borders of the breast become better delineated, so that they appear to be more distinct from the chest lending to their fullness.

In terms of potential issues, most problems following breast augmentation are noticeable without specific warning. However, it is important to be vigilant for any significant differences between the two sides, such as pain, swelling, or firmness. If there is a significant difference, it is advisable to contact the office.

One uncommon problem to watch out for is hematoma, which is bleeding after surgery. If one breast suddenly swells, becomes hard, and is painful, immediate medical attention is required. Issues with the incision, such as pain, redness, or discharge, should also be reported to the office. For any serious symptoms like shortness of breath, calling 911 is necessary.

– It is okay to shower 48 hours after surgery and get the incision wet.
– Gently wash your breasts with a soapy washcloth to remove any small crusting.
– After showering, blot the incisions dry and reapply fresh gauze or panty liners.
– Apply a rich moisturizer all over your breasts but avoid putting it over the incisions.

Dr. Stephenson is meticulous concerning his client’s healed incisions. He has found the placement of stitch just beneath skin and removing that stitch 3 weeks after surgery yields a superior aesthetic result.

The quality of your healed surgical incision is mostly determined by genetics and your body’s response to surgery. It is not clear how much applying products to scars will influence their final appearance, but most patients want to do something. Some products that have received positive patient feedback include Scar Guard (a liquid containing steroid, Vitamin E, and silicone), silicone gel strips (such as Neosporin scar strips), and silicone ointment (such as Scar Fade). You can obtain these products from our office and start using them as directed by Dr. Stephenson.

Dr. Stephenson typically recommends the use of a surgical support bra. Dr. Stephenson believes that a supportive bra during the recovery phase prevents the new weight of your breast increasing your discomfort. The bra is provided for his clients as part of their surgical package. When swelling has resolved, and healing is complete the most accurate cup size/bra size can be determined.

Although there is no scientific data supporting the benefits of breast massage, Dr. Stephenson, with almost two decades of experience, has observed that it achieves two objectives: preventing the pocket from contracting around the implant, which can make the implant rigid and immobile, and helping clients become familiar with the “feel” of their breasts and implants. This familiarity aids in detecting any abnormalities during routine self-exams. Dr. Stephenson advises initiating breast massage 7-10 days after the procedure, and his staff will provide written instructions for the massages.

Capsular contracture is the excessive formation of scar tissue around the implant, resulting in a hard, upwardly displaced, and rounded appearance. It is the primary reason for revision surgery following breast augmentation.

To prevent capsular contracture, it is important to avoid nipple incisions to prevent bacterial contamination. Dr. Stephenson performs a gentle operation with minimal bleeding and bruising which is crucial to minimize the risk of capsular contracture. Additionally, diligent adherence to post-surgery arm exercises, massages, and following all provided instructions is necessary. However, there is no specific vitamin or medicine known to prevent capsular contracture.

There is no specific time that an implant will last. The rate of shell failure is about 1% per year. There is a myth that they need to be redone at 10 years, but that is totally untrue. It is just that by around ten years, probably around half of the patients or so decide to have another operation, even though it is not required to do so.

Manufacturer warranties for implants vary and typically cover implant deflation or rupture. These warranties may offer a replacement for the affected implant and its counterpart, with varying levels of financial assistance. It is important to stay updated on the latest warranty information by contacting the office.