Top surgery aug

WHO IS A GOOD CANDIDATE?

While it is not a requirement to have undergone hormone therapy, it is recommended to try and maximize native breast growth with >12 months of hormone therapy to obtain optimal surgical results. Patients who have plateaued in their breast development after a sufficient time on hormone therapy are very good candidates for this surgery, as often times hormones alone will not give a sufficiently sized breast.

Additionally, consideration must be given to where the implants are placed - either above or below the pectoralis major muscle. For a more natural looking result, implants are often placed below the pectoralis major muscle, however consideration must be given to how thick or strong the pectoralis major muscle is as well as how wide the sternum is, as this limits how close together the implants can be placed. During the initial consultation, Dr. Kayan will review the pros and cons of implant placement in the subglandular or subpectoral positions as each patient may differ in what position gives the best result for their goals.

IMPLANT SIZING

Everyone has different shaped breasts and different degrees of ptosis. This does influence how the patient will look post operatively. Sizing in our office is done first by asking the patient’s current breast size and seeing what their goal breast size is. On the day of the consultation, we will go over this, and we will size the patient at the time of consultation or at the time of their pre-surgery appointment, depending on available time. Bring a sports bra and clothing such as a tank top, as this will help most with seeing the appearance with different sized implants. We will try on various sizes under the clothing to help narrow down the range. We usually order a range of sizes on the day of surgery, so the patient is not committed to any size until the day of surgery. Photos of desired size/shape as well as what the patient feels is too small or too large are helpful.

*Up/Downsizing Policy: Patients wanting to upsize or downsize within 1 year after surgery will just need to cover the cost of the implants and operating room/anesthesia, the surgeon's fee is waived. Our primary goal is to ensure patients are happy with their results.

THE PROCEDURE

Breast augmentation is done as an outpatient procedure in an ambulatory surgery center. Surgery is done under general anesthesia and takes less than 1 hour. An incision is made either under the breast (inframammary fold) or around the nipple (peri-areolar), and a saline or silicone implant is placed either above the muscle (subglandular) or below the pectoralis major muscle (subpectoral). The incisions are closed with dissolvable sutures and skin glue, and the patient is wrapped in a compressive ACE wrap. The length of the incisions depends on what type of implant is placed, as well as how large the implant is. Saline implants require smaller incisions (4cm or less), and most silicone implants between 225-325cc can be done through an incision around 4cm. For silicone implants in the 325-450cc range, the incision is between 4½-5cm, and larger implants above that will require incisions >5cm. Slightly larger incisions are needed for more cohesive gel implants because these implants are less deformable and do not fit through a smaller incision as easily as standard gel implants.

IMPLANT TYPES

Both saline and silicone implants are commonly used, and both are FDA approved and safe. In addition to the price difference (saline implants are less expensive), there are other important differences. Both have an outer shell made of silicone. Saline implants come deflated and are filled with sterile saline during your surgery. Silicone implants come pre-filled and with set sizes. Projection refers to how much the implants project forward from the body - moderate, high and extra high. We have sizers for each one to determine what the patient’s goal look is. Silicone also comes in different levels of cohesivity and in textured and anatomic types. The most commonly used implants in our practice are smooth round silicone implants, and among this group, it is the patient's choice if they want regular gel, the most cohesive gel, or the hybrid type. Prices differ between each type, with a higher price for each level of extra cohesivity. The advantage of a more cohesive implant is the silicone gel is less likely to leak into the surrounding tissue in the case of a rupture. More cohesive implants also have less tendency to ripple, which is advantageous if a patient is very thin with very little breast tissue. The only difference in feel is that more cohesive implants can feel firmer.

RECOVERY

All dressings may be removed, and patients may shower after 48 hours. After showering, most people will either re-wrap in the ACE wrap or put on a tight, front closure sports bra. These can be purchased online or at any sports apparel store. We advise patients not to do any overhead reaching for 1 week and avoid lifting more than 5lbs. or do any high-end exercise for 4-6 weeks after surgery as this can disrupt healing and cause bleeding. Some type of chest compression will need to be worn 24/7 for the full 4-6 weeks, then patients may be fitted for an underwire bra 6 weeks after surgery or after the incisions are completely healed. The implants will appear to sit very high up on the chest at first and will start to settle down into place starting around 1 month after surgery. It takes anywhere from 3-6 months or longer for the implants to settle into their final position.

LONG-TERM MAINTENANCE FOR IMPLANTS

If a saline implant ruptures, it is noticeable quite quickly as the breast will return very quickly, usually in less than a week, to its original size. If a silicone implant ruptures, it is not obvious. The FDA recommends that patients with silicone breast implants get an MRI 3 years after their initial surgery, and every 2 years thereafter to screen for implant rupture. The lifespan of a breast implant is 10-15 years.