How is this procedure done?

An incision is made in one of three possible areas--under where the dark skin of the areola meets the light skin of the breast (periareolar); under the breast where it meets the chest wall (inframammary) or hidden in the armpit (axillary). During your initial consultation, your surgeon will thoroughly discuss the placement of your incision, the pros and cons for you personally and consider your preferences.

A salt water (saline) filled implant is placed either under or above the chest (pectoral) muscle--depending on your breast tissue, body formation, and amount of sagging (ptosis) of the breast. If the implant is placed under the pectoral muscle, simple movement of the arms automatically moves the implant around in its pocket. In some patients, these muscles are extremely active and can distort the implant so it is important to discuss with your surgeon the right implant placement for you.

Your surgeon's goal is to achieve the most natural appearance possible of the breasts. On rare occasions, during the actual surgery, your surgeon may change the placement of the implant if a more optimum location can be determined. The incision is closed with stitches beneath the skin (subcuticular sutures). The incisions may also be taped for greater support and a gauze bandage applied to help with healing.

You may choose to have other cosmetic procedures, such as liposuction, done at the same time as breast enlargement. Please consult directly with your surgeon to devise the best schedule for you.

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How do I prepare for my breast enlargement?

To help determine the size of your post-operative breasts, purchase several bras in varying cup sizes and alternate wearing them with various types and styles of clothes. When you have chosen the size that feels best for you, bring that bra to your surgeon during your preoperative consultation. This will help your surgeon match it to the implants. Please understand that the degree of your enlargement may be limited by the amount of tissue you have available to cover the implants.

During your preoperative consultation, you will be given specific directions to help you prepare for your procedure. Instructions generally include taking vitamins, cautions about taking certain medication and drinking alcohol, the shaving process and use of antibacterial soap. You must stop taking aspirin or aspirin containing medications for ten days prior to your surgery. Do not eat or drink anything eight hours before your procedure and do not smoke ten days prior to and two days after surgery. If you take daily medication, ask your surgeon if it is safe to take prior to your procedure. If you have any sores on your body, if you have a cold, sore throat or allergic condition, inform your surgeon so you may be examined again prior to your procedure.

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How long does the procedure take?

Operating time is generally one to two hours.

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What form of anesthesia is used?

Your surgeon will discuss with you the two types of anesthesia available. General anesthesia is given by an expert anesthesiologist M.D. (medical doctor). This will allow you to "sleep" throughout the entire procedure. Local anesthesia combined with a sedative may also be an alternative depending on the informed choice you make after discussions with your surgeon.

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Can I return home the same day?

Yes. Breast enlargement is done on an ambulatory basis. However, it is necessary that you have someone to pick you up after the procedure, take you home, and stay with you for at least 24 hours.

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What precautions should I take during my recovery?

When you "awaken" after your procedure, you may be uncomfortable. Your surgeon will give you medication to relieve any discomfort. You will be placed in a surgical bra immediately after your procedure. You will continue to wear this day and night for approximately two days. However, you may remove this special bra for showering purposes during those first two days. You will receive specific instructions to follow during your recovery including rest and sleeping positions, raising your arms, bathing and showering techniques, breast manipulation and deep breathing exercises.

Your surgeon will want to examine you at regular intervals during the first 90 days following your breast enlargement. Sometime after the third day, your surgeon will remove any bandages and check your incision area. You will need your new bra to support your breasts from this time forward. Your breasts may be swollen and bruised for approximately one-two weeks.

In most patients, the scars from the incisions will be pink for about six months and gradually fade thereafter. The scars are usually inconspicuous. Nevertheless, you should know that all scars are permanent and their height, width and final color are not totally predictable.

As with any surgical procedure, small nerves to the skin are interrupted during surgery. Portions of the nipple area may feel numb or have less than full feeling. Sensitivity usually returns over several weeks, but some diminished feeling may last indefinitely.

If you sunbathe, or utilize a tanning bed, you must not do so until any numbness of the breast is gone (to avoid burning). After this point, you must protect the incision site with a sunscreen of SPF 15 or more for at least six months.

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How long before I can return to normal activity?

Most women return to their usual activities in one week. However, you must not lift anything for the first two weeks and do no heavy lifting for the first four weeks.

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What are some of the complications that can occur with breast enlargement?

Even though the implant is well tolerated, your body's natural reaction to a foreign material is to surround it with a thin membrane called a "capsule" in order to stay in the desired pocket. The formation of this capsule is not a problem and occurs in every patient. In some cases, for reasons that are as yet not completely understood, this capsule can shrink around one or both implants, compressing the implant and making it round and firm. This is called capsular contracture and can occur in varying degrees. Although some women may consider some firmness desirable, the capsule can cause the breast to become unnaturally firm, misshapen or uncomfortable. Capsular contracture may occur from a few weeks to several years after the initial procedure. There is no way to predict your body's reaction and if you will develop capsular contracture. Placing the implant under the muscle, in some cases, can reduce the incidence of this condition. If a patient does develop capsular contracture, surgical intervention may be required.

The opposite of capsular contracture can also occur--when breast implants are in a satisfactory position but several months later there is spontaneous expansion of the capsule. This is described medically as an inferior and lateral migration of the implants. If this happens, the patient will require closure of the breast pocket to reposition the implant either through the original incision or through a small inframammary incision.

While there is no evidence that the saline breast implant causes breast cancer, it is recommended that the patient have a preoperative mammogram as a baseline. Thereafter, when having a mammogram be sure to go to a radiology center where the radiologist is experienced in the (Eklund) special technique required for an accurate x-ray of a patient with breast implants.

It is emphasized that regular breast examination and mammograms are the best way to detect early cancers.

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What can I expect immediately after my procedure as well as later on?

Your breasts will appear firmer and fuller immediately following your procedure. As with any surgical procedure, some swelling and/or bruising can be anticipated. Your breasts may not attain their final feel or shape for three to four months. Be sure to address any questions or concerns with your surgeon immediately. Your health and happiness are the most important considerations at any time.

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