Women have breast augmentation with silicone and saline breast implants performed for a variety of reasons. Breast augmentation enhances the body contours of women who are unhappy with their small breast size. Breast augmentation may also be used to correct differences in breast size between the breasts (i.e. asymmetry of the breasts) as well as restore volume to the breasts that has been lost following pregnancy or significant weight loss. At his offices in Westchester County, New York, Dr. Greenwald offers breast augmentation patients saline and silicone implants through a variety of incisions. During your consultation, your questions regarding breast augmentation will be answered and an operative plan formulated. Prior to your breast augmentation surgery, you will have a full understanding of the risk and benefits of breast implant surgery. A well informed patient preoperatively is more likely to result in a satisfied patient postoperatively.
More and more women in New York are choosing to have breast enhancement procedures including breast augmentations, breast lifts and breast reductions. More than 350,000 women had breast augmentation surgery with silicone and saline implants performed in 2006.
When you arrive for your breast augmentation consultation, Dr. Greenwald will help you decide on the optimal incision for your procedure. No two breast augmentation surgeries are the same and selecting the proper incision is critical. Selecting the proper incision for breast augmentation requires a thorough consultation and examination. Dr. Greenwald typically performs either a periareolar incision or an incision in the crease under the breast (inframammary crease) to insert either silicone or saline breast implants. An in the crease incision is typically referred to as an IMF incision. Patients may also choose to have their implants placed through the axilla or armpit (transaxillary approach). Based on your anatomy and surgical goals, Dr. Greenwald will help you choose the incision that is right for you. Insertion of silicone breast implants requires an incision 1centimeter longer than that required for insertion of a saline breast implant.
To help you determine the optimal breast implant size to help you achieve you goals, Dr. Greenwald will review numerous before and after photos of patients who have had breast augmentation surgery. Most patients are able to identify photographs of patients with similar preoperative anatomy and are able to view postoperative photos of the same patient after breast implant surgery. Dr. Greenwald also has a wide variety of implant sizers (implants that are for demonstration purposes only) that you can place inside your bra at the time of your consultation. Most patients find this to be invaluable in helping determine the size they desire after surgery. Photographs will then be taken and reviewed utilizing imaging software. Asymmetries between the breast will be noted (all patients have some degree of asymmetry that is present before and will persist after surgery). Following your consultation, you will meet with Dr. Greenwald’s patient coordinator who will assist you in scheduling your breast augmentation surgery. You will be given a detailed set of preoperative instructions as well as prescriptions you will need after your procedure.
At our private Westchester County surgical facility, breast augmentation is performed as outpatient surgery with twilight anesthesia. You will arrive to the surgery center one hour prior to your surgery time and be checked in by our nursing staff. You will also be interviewed by one of our board-certified anesthesiologists. Dr. Greenwald will again discuss the proposed breast augmentation surgery (incision, implant size) and answer any additional questions you may have. Dr. Greenwald places the majority of silicone and saline breast implants under the pectoral muscle (see FAQs for submuscular vs. subglandular implant placement). Surgery typically takes between 60 and 90 minutes. You will be discharged from our facility when you have recovered from anesthesia. Someone must be available to accompany you home and stay with you for at least 24 hours after your breast augmentation surgery. Dr. Greenwald will call you the night of your breast implant surgery. Breast augmentation patients are seen for a postoperative visit between 5 and 7 days after their surgery by Dr. Greenwald. Contact Dr. Greenwald’s cosmetic plastic surgery practice.
Dr. Greenwald also provides surgical care for breast lift, breast reduction and breast reconstruction patients.
If you are considering breast augmentation in New York, below are some of the more frequently asked questions about breast augmentation with silicone and saline breast implants:
What do I need to do to prepare for my breast augmentation surgery?
Prior to your breast augmentation surgery, you will need to have preoperative labs drawn and depending on your age an electrocardiogram (ie EKG) and an up to date mammogram. You will also be given prescriptions for pain medications and antibiotics that you should fill prior to your surgery. You will also be given complete postoperative instructions and information about breast implants that you should review prior to your breast implant surgery. You will be given a specific time to arrive at Dr. Greenwald’s operating facility.
If I get pregnant, how will my breast augmentation be affected?
If you become pregnant after your breast augmentation surgery, it is difficult to predict how your breast will appear after you have delivered your baby and breast fed. Although most patients seem to return to their pre-pregnancy state, there are many variables that affect the ultimate appearance of the breast including the duration you have breast fed, the degree to which your breasts have become enlarged during pregnancy and the amount of weight gained during pregnancy.
Will I be able to breast feed after breast augmentation surgery?
If you were going to have the ability to breast feed prior to breast implants, you will likely be able to breast feed after having breast augmentation surgery. The ability to breast feed may be slightly reduced in women who have had their implants placed through a periareolar incision as there is likely some damage to nerves and ducts within the incision. If you have had your implants placed through the inframammary crease or the axilla, breast feeding should not be impaired. Many of my patients have successfully breast fed after augmentation mammaplasty. With regards to breast feeding in the presence of silicone breast implants, the American Academy of Pediatrics concluded in September 2001 “The Committee on Drugs does not feel that the evidence currently justifies classifying silicone implants as a contraindication to breastfeeding.”
Will I maintain sensitivity in my nipples after breast implant surgery?
Most studies site an incidence of sensory loss to the nipples following breast augmentation at 10%. Care must be taken to perform blunt dissection when developing the breast implant pocket laterally. There is likely a higher incidence of sensory loss to the nipples when performing secondary breast augmentations that often require manipulation of an established capsule.
Can mammograms still be performed after breast augmentation surgery?
It is important to consider breast cancer surveillance when making decisions to undergo breast augmentation. Implants placed in the subpectoral position allow better visualization of the overlying breast tissue than implants placed in the subglandular (ie on top of the pectoralis muscle) position. Breast implant displacement views, also known as Elkund displacement views, during mammography allows maximal mammographic visualization of the augmented breast. You should always tell the radiologist performing your mammogram that you have implants. In addition to implant location (subpectoral vs. subglandular), the presence of capsular contracture may also impair mammography. Augmented and nonaugmented patients are diagnosed at a similar breast cancer stage and have a comparable prognosis. The use of MRI and ultrasound techniques are also valuable breast imaging tools in the augmented breast.
What is capsular contracture?
After breast augmentation surgery with breast implants, it is your body’s natural response to form a lining or capsule around the implant just as it would around any foreign body. The lining around a breast implant is referred to as the breast capsule. When this lining becomes firm, it is referred to as “capsular contracture”. A capsular contracture can occur at any time following augmentation mammaplasty but usually occurs in the first few months. The exact cause of capsular contracture is unknown; however, there are many theories regarding the etiology of capsular contracture. Hematoma (ie a collection of blood) around an implant may incite an inflammatory reaction resulting in a thickening of the capsule around a breast implant and subsequent capsular contracture. A subclinical infection of the capsule (bacteria is present in the capsule without overt signs of infection) may also result in capsule thickening. Meticulous surgical technique with careful attention to hemostasis and a “no touch” technique when handling breast implants may reduce the incidence of capsular contracture. In addition, irrigation of the implant pocket with antibiotic solution may reduce the incidence of capsular contracture. Finally, implants placed in the submuscular position, in addition to allowing improved mammography, have a lower incidence of capsular contracture.
How is capsular contracture treated?
There are four grades of capsular contracture as described by Baker (Grade I is a soft, natural appearing breast. Grade II is a slightly firm but natural appearing breast. Grade III is a firm and visible distorted breast. Grade IV is a firm, visibly distorted and painful breast). Grade I and II are clinically acceptable and require no intervention. A Grade III contracture often requires surgical intervention; however, depending on the severity and duration of the contracture, a trial of various medications may be given. A Grade IV contracture typically requires surgical intervention. The goals of surgical intervention for capsular contracture involve removal of the capsule (ie capsulectomy) and placement of the implant into a new breast pocket if possible.
What are the risks of breast augmentation surgery?
The risks of breast augmentation surgery include but are not limited to infection, bleeding, asymmetry and capsular contracture. During your consultation at his office, Dr. Greenwald will review all the risks of breast implant surgery.
Where will my breast augmentation scars be?
Your scars will either be located under the breast in the inframammary crease, around a portion of the areola or in the axilla depending on the incision chosen by you and Dr. Greenwald. Incisions used to insert saline breast implants typically measure 2.5 to 3 cm. Incisions used to place silicone breast implants necessitate an incision at 3.5 to 4 cm in length. All incisions are closed in multiple layers with absorbable sutures in an attempt to ensure a fine line scar. Any scar takes up to a year to mature and breast augmentation incisions are no exception. Most patients feel the trade off of a small, good quality scar are worth the benefits of having breast augmentation surgery.
How soon after breast implant surgery can I shower?
You may shower one day after surgery in most cases. Prior to showering, you will remove a small gauze dressing taking care to leave the underlying steristrips in place. The steristrips typically remain in place until your first postoperative visit which is typically 5-7 days after your breast augmentation surgery.
Will I have drains after my breast augmentation that require removal?
Dr. Greenwald does not use drains when performing primary breast augmentations. Drains may be used in revision or secondary breast augmentation procedures.
How much pain will I be in after breast augmentation surgery?
Pain after breast augmentation varies from patient to patient. Some patients take nothing more than tylenol after their surgery while other patients take the prescribed pain medications for 3-5 days.
When can I return to the gym after breast implant surgery?
You will be instructed not to return to the gym for three weeks following your breast augmentation. Though you will feel absolutely fine prior to this, there are several reports of delayed hematomas occurring following strenuous activity during the early postoperative period. You will also be asked to avoid heavy lifting during this time.
When will I be allowed to drive a car following my breast augmentation?
You are allowed to drive a car when you know longer require the use of prescription pain medications and feel comfortable wearing a seat belt across your breasts.
What if I am not happy with my results?
Breast augmentation patients are amongst the happiest plastic surgery patients. If you are not pleased with the results of your surgery, Dr. Greenwald will work with you to help you achieve the goals you want. The best way to ensure that patients are pleased after surgery is to educate them and make sure realistic expectations exist preoperatively.
