Breast augmentation is the most popular cosmetic surgical procedure in the U.S according to the American Society of Plastic Surgeons. In their cosmetic national data bank statistic reports of 2013, breast augmentation ranked as the number one cosmetic procedure with 290,224 cases preformed in that year. That is a 37% increase when compared to 2000.
Dr. Roudner’s surgical goal is to augment the breast as desired by the patient, while maintaining a natural and youthful appearance of the breast with minimizing visible scars.
Dr. Roudner may use a Saline or Silicone Implants or use fat grafting while performing the augmentation procedure depending on the patients desires and needs while taking into account anatomical and soft tissue characteristics. Top Breast Implants Doctor 2011.
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Breast implants are a prosthesis used in breast reconstruction, breast augmentation and breast lift surgery to enhance the size of the breasts improve the breast form and create a feel similar to natural breasts in women undergoing breast reconstruction. They are also used in treatment of severe breast and chest deformities and asymmetries that are either congenital or acquired.
The implants have a vulcanized silicone shell and may have either a silicone gel inner fill, saline inner fill or a combination of both.
In the breast reconstruction process a temporary tissue expander (an expandable implant) is gradually filled with sterile saline in order to create an appropriate pocket for a future breast implant prior to its exchange for the permanent implant. In cases of sever chest and breast deformities it maybe necessary to use a solid silicone implant created out of a CT scan model.
Many different materials and devices have been used since the first breast enhancement procedures. Autologous adipose tissue (patients own fat and soft tissue) was used by Czerny in 1895 to correct a defect created by a tumor removal. Prior to Czerny attempts with paraffin injections concluded in severe complications. Other substances such as glass, rubber, polyethylene and more have been unsuccessful in obtaining a safe and long lasting breast augmentation results.
Other forms of breast augmentation were used such as flaps and currently used in breast reconstruction surgery. Silicone injections in the 1950’s were complicated by granulomas and hardening of the breasts and required excision. The first silicone breast implants were made by Thomas Cronin and Frank Gerow and the Dow Corning cooperation and were used in 1962 in a breast augmentation procedure. The first saline breast implant was manufactured in France in 1964. The saline breast implant was the only available implant in the 1990’s and early 2000 while silicone breast implants were investigated by the FDA for safety issues. Saline implants allow placement of the breast implant through a smaller incision those creating smaller scars. The saline implants can achieve great results if placed submuscularly in women with adequate soft tissue but are more likely to involve rippling, palpability and are more noticeable in women with thin small breast.
Currently a fifth generation silicone breast implants are been used. The fifth generation silicone breast implants are in a semi-solid gel state which decreases the ability of the gel to leak or “bleed” as well as makes the possibility of the gel migrating through out the body very unlikely. The fifth generation silicone implants are improved and safer implants which have a lower incidence rate of capsular contracture and of device-shell rupture.
1. Primary breast augmentation – to aesthetically improve the size, form, shape and symmetry of the breast.
2. Primary breast reconstruction – in congenital (born with such as tuberous breast) and acquired (breast cancer, trauma, etc) breast deformities.
3. Revision breast surgery – correcting unfavorable results after primary augmentation and reconstruction cases.
An incision at the border of the areola and the lighter breast skin is made. This incision is typically the most concealed out of the four type of incision and gives an excellent approach to create the pocket and position the implant as well as adjust the infra-mammary fold. It is used in the peri-areolar breast lift approach.
Commonly used incision made below the breast fold. This incision is generally less concealed than the periareolar but gives a faster approach to create the breast pocket for the implant. Harder to control the infra-mammary fold and can not be used in certain cases. The infra-mammary fold incision may result in a thicker and wider unsightly scar. surgical scars.
An incision is made in the axilla (underarm). A endoscope (lighted camera) is used to assist in creating the breast pocket for the implant. Scar is less concealed then the periareolar approach and if a second procedure is needed in the future scar tissue in the region may make this approach less attractive. Also has a tendency to have higher ridding implants with this approach.
An incision is made in the belly button and a tunnel created to the breast. This approach is only applicable for saline implants. Higher risk of chest trauma since it is a blind approach. This incision site is not recommended.
The implant is placed below the chest muscle (pectoralis major muscle) or partially under the muscle in its superior portion and under the breast tissue in its inferior pole, also know as a “dual plane”. This placement offers better coverage of the implant and reduces the palpability and visibility of the implants and reduces the risk of developing capsular contracture. Another benefit of this approach is the increased amount of breast tissue that is seen on mammographic imaging of the breast.
Patients undergoing breast augmentation procedure are seen in the office at time of consultation and two weeks prior to surgery for pre-op. At that time necessary blood work and other test are performed, consents are reviewed and signed and medical clearance is obtained as necessary. Pre-op photos are taken. Patients that smoke are required to stop smoking 4 weeks before the procedure and for 3 weeks after the surgery. It is important to inform Dr. Roudner if you smoke at the initial consultation.
Medications (aspirin, ibuprofen, etc) supplements and herbs can cause bleeding problems during the surgery and post surgery. Therefore a list of any medication, supplements or herbs that should not be taken a few weeks before the procedure is given at the time of the consultation.
Prior to surgery it is important to eat a healthy diet and avoid drinking alcohol a few days prior to the procedure. Exercise and being in good shape prior to surgery is generally good for the patient’s overall health and a speedy recovery; however, day prior to the breast augmentation procedure patient’s should avoid strenuous exercise.
Patient’s should not eat or drink anything, including water, after midnight the night before surgery. The patient’s should shower the night prior to the surgery and wash the surgical site with antimicrobial soap. After the shower the patient’s should avoid wearing any products such as: oils, creams, makeup, moisturizers, or lotions — including deodorant.
Removing any nail polish from at least one fingernail and toenail will be helpful for the anesthesia person in order to monitor the blood circulation during the procedure using a pulse-oxy-meter.
The morning of the surgery the patient’s may brush their teeth, but should not swallow more than a sip of water. If instructed by the primer care physician, patient’s may take any needed prescribed medication with sipping a minimal amount of water.
On the day of surgery the patient should wear loose-fitting clothes that open in the front and comfortable flat shoes that are easy to put on.
Arrangements for transportation of the patient to and from the procedure as well as a someone to stay with the patient for the first 24 hours after surgery should be made in advance.
Care for small children, should be arranged prior to the surgery as well as preparation of extra food and drinks. Responsibilities at home and at work should be taken care of prior to surgery in order to have worry-free and relaxing recover.
Prescription medications maybe filled at the time of surgery by the person accompanying the patient to surgery or a in advance prior to the day of surgery.
The preparation for breast augmentation is quite similar to other elective surgical procedures except for a mammogram that is required prior to surgery for any women from the age of 30 and above or earlier if a history of breast cancer in a first degree relative is detected at an early stage of life.
The surgery is performed in the surgical suite at the surgical center or at the hospital if needed due to patient’s medical history. The patient is recovered in the post anesthesia care unit and is discharged home the same day unless it is necessary to keep the patient over night (rare).
The first few days after surgery are usually the most difficult ones with some pain and discomfort. By the third day most patients have a significant improvement. On the third day Dr. Roudner will examine the patient at the office to ensure that the breast are healing properly and that the breast is soft and the pockets are open. Follow up visits are at one week, ten days, two weeks, six weeks and three months and one year. Most of the swelling is gone by six weeks and the final results are seen at six months to one year.
The procedure maybe performed under twilight sedation (person is sedated but not unconscious) with local anesthesia or it maybe performed under general anesthesia.
The procedure should take between 45 minutes to two hours depending on the complexity of the case the surgeon and technique used.
The patients are seen in the office and follow a protocol given at the time of pre-operative visit. The doctor and the nurses review the instructions with the patients as recovery progresses. The first 3 weeks after surgery only sports bras are used and after that a wire bra maybe used. Swelling subsides over a period of six moths to a year but significant reduction of swelling is noticed by six weeks. It is not uncommon for one breast to swell more then the other.
The post-operative instructions are to avoid sun exposure for a minimum of 6 weeks but ideally a 6 months period.
Patient should plan to have 5 days of rest with complete bed rest the day of surgery except for getting up to the restroom. The day after surgery the patient should be out of bed gradually mobilizing at home with out strenuous activity. On day five the patient should be able to drive. Gradual light exercise maybe started on the 4th week after surgery with full activity at six weeks after the surgery.
Any surgery has risk and possible complications. Serious complications after breast augmentation surgery are rare, but may include: Post- surgical bleeding (hematoma), infection, seroma, capsular contracture (hardness of the breast- scar formation around the implant compresses the implant), scaring, change in nipples sensation (undersensitive, oversensitive or numb), nipple areolar compromise (extremely rare). Other less sever complications: Asymmetry, rippling, palpability, malpostion, rupture, deflation, leaking.
With breast implants filled with saline (salt-water) solution a deflation of the implant due to a break or leak in the shell of the implant will be noticed as a reduction in the size of the breast, your body will absorb the solution with no harm.
Although it is rare, women with breast implants may experience symptoms such as joint pain or swelling, fever, fatigue, breast pain and others symptoms associated with diseases of the immune system. The implants were studied extensively by the FDA and no correlation between the presence of the silicone implants and those symptoms has been found. The FDA considers the implants as a safe device to use in surgery. On going studies are being conducted to further evaluate correlation between those symptoms and the implants.
There’s no evidence that breast implants cause breast cancer, some clinical studies have showed the females with breast implants may detect the presence of breast cancer earlier then women that do not due to the heightened awareness of their breast and frequent breast massage.
No negative effect of the implants on fertility, pregnancy, or the ability to breast feed has been found although breast feeding may require additional supplementation.
Women with breast implants require special technique while obtaining a mammogram and should make the technician aware that they have breast implants.
Women who suffer from low self esteem or lose of femininity due to congenital or acquired absent, small or asymmetric breasts or women that lose their breast volume, shape and form after pregnancy or significant weight lose could be great candidates for breast augmentation surgery.
Breast augmentation surgery can improve the shape, contour and volume of the breasts. It may also improve on very mild sagging of the breast as well as give more cleavage to certain patients. It may also improve on some asymmetries of the breast creating a more even appearance. all these benefits may improve the self esteem and confidence of women that have been bothered by these deficiencies at a young or more maturing age.
The procedure can be performed either under twilight sedation (person is sedated, but not unconscious) with local anesthetic or under general anesthesia.
Most healthy women 18 years of age are good candidates for saline implants and 22 years old women are good candidates for silicone gel implants. (Women how are not good candidates for breast augmentation surgery are women who are pregnant, breast-feeding, have an active infection, have malignant or pre-malignant breast cancer that has not been adequately treated, or are under the age of 18). People with poor overall health and history of poor healing capabilities (such as smokers, chronic alcohol users and various medications), who have had previous breast surgeries, suffer from bleeding tendencies, infections and are predisposed to develop a hardened capsule around the implant should be selected out carefully for surgery after these issues have been corrected.
Patient after breast augmentation surgery should have 5 days of rest at home. By the fifth day the patient should be able to drive and by 7 to 10 days should be able to return to non- strenuous work (no heavy lifting). By three to four weeks a gradual return to activity at the gym with exercise like stationary bike are OK. By six weeks the patient should be fully recovered except for rare cases.
It depends on the individual. Some patients recover with minimal pain or discomfort while some others have a more difficult time after surgery. Most patients have moderate pain in the first 3 days after surgery. After that period thing improve rapidly. The more active the patient becomes the more often pain stops them from more strenuous activity. That is the safe guard mechanism of the body to prevent injury. The patient should stop any activity at that point and rest. In very rare occasions pain persists for a long period and is mostly do to nerve regeneration or compression and needs to be treated if possible.