Before and After Breast Surgery Augmentation

Before your Breast Augmentation surgery

Before you undergo breast augmentation surgery, Dr. Pautler will ask you to do the following:

• Have a mammogram: If you are 30 or older, Dr. Pautler will send you for a mammogram. A mammogram is a special way to take a digital image of your breasts. Having a mammogram is purely a precaution to make sure that there are no suspicious areas in your breast. If there is a positive finding on the mammogram, Dr. Pautler will consult with you and refer you to a general surgeon before proceeding with breast augmentation surgery. If you have a very strong family history of breast cancer, Dr. Pautler may send you for a mammogram even if you are younger than 30.



• Stop Smoking: Cigarettes contain nicotine, a powerful substance that decreases blood circulation especially in the areas that need it most: your plastic surgery wounds. Smoking after your breast enlargement, your plastic surgery wounds heal slowly, infection risk increases, and recovery from breast augmentation surgery may be prolonged. You need to stop smoking at least four weeks before and six weeks after your planned breast augmentation surgery. Nicotine-containing chewing gums and patches are as harmful as cigarettes, so do not use them. If you absolutely cannot curb your smoking, Dr. Pautler asks that you be honest about it and let her know because she may need to alter her breast augmentation surgical plan for you.



• Take Vitamin C: This vitamin helps boost plastic surgery wound healing. It is available over-the-counter and is helpful to take two weeks before and two weeks after breast augmentation surgery.



• Stop taking aspirin, ibuprofen or other non-steriod, anti-inflammatory medications including herbals and supplements that cause blood-thinning such as Ginko Biloba: These types of medications and supplements can increase your risk of a bleeding complication during and after breast augmentation surgery, so avoid them. Aleve, Advil, Motrin, Naprosyn, Bufferin, Anacin, Toradol and Alka Seltzer and similar products are examples of products to avoid before and after breast augmentation surgery. Inform Dr. Pautler of all medications and supplements that you take to see what you need to avoid. Tylenol is permitted, as are the pain medications that Dr. Pautler prescribes after breast augmentation surgery. Examples of blood thinning medications include Plavix, Lovenox, or Coumadin and their generic alternatives. Inform Dr. Pautler if you are taking this type of medication, as these will need to be stopped as well for breast augmentation surgery.



• Discontinue birth control pills three weeks before breast augmentation surgery if you are a current smoker or if you have a history of blood clots, high blood pressure, or heart disease. Resume the birth control pills three days after breast augmentation surgery.



• Bring button-down top to wear home from breast augmentation surgery: Pullovers are cumbersome and can cause discomfort or damage at your plastic surgery wound sites as you raise your arms to get the top on and off. Wear button-down tops during your recovery from breast augmentation surgery because they will be easier to put on and take off without risking injury to your breast enlargement.

After Your Breast Augmentation Surgery

After your breast augmentation surgery, there are several items to do and consider for your own health and plastic surgery wound healing. They are:

• Refraining from taking aspirin, ibuprofen, other non-steroid anti-inflammatory medications, blood thinners and other herbals and supplements for at least two weeks after your breast augmentation surgery.



• Diet: No restrictions. You can eat what you like provided you don't have an upset stomach from the anesthesia you received during your breast augmentation surgery.



• Limit activity: Refrain from any exercise or strenuous activity for the first week after breast augmentation surgery including: housecleaning, vacuuming, anything with requiring arm movement, and brisk walking. The day after breast augmentation surgery, it is permissible to go out or run errands but do not carry any heavy bags. Limit your lifting to no greater than 12 pounds. Do not lift or carry small children. Instead, have someone else put them on your lap and you can hold them. Two weeks after your breast augmentation surgery, Dr. Pautler will remove your sutures, assess your level of plastic surgery wound healing and determine whether or not you can increase your activity level. Typically four weeks after breast augmentation surgery, restrictions are lifted and exercise can be resumed.



• Obtain compressive sports bras: A compressive sports bra is required for your breast augmentation surgery. The recommended type is one that zips in the front. It must be worn day and night for at least the first week or so after your breast augmentation surgery. After your sutures come out, you can wear other bras but light compressive bras and full-coverage bras are still recommended. In some cases, especially if you have a large cup size, you should even wear a light compressive bra while you sleep.



• Stop smoking: NO SMOKING FOR AT LEAST 6 WEEKS AFTER BREAST AUGMENTATION SURGERY! Dr. Pautler strongly advises that you stop smoking altogether for your overall health as well.



• Bathing: It is permissible to shower after Dr. Pautler removes the support that she places during breast augmentation surgery.



• Scar maintenance: You should massage your plastic surgery scars a few times a day with a product such as vitamin E oil, cocoa butter or Mederma applying pressure while massaging the scars. The pressure during the massage is more important than the type of cream product used. Combined with massage, these emollients can help accelerate softening, fading, and maturation of scars from breast augmentation surgery. Silicone preparations are also available, but costly, and more suitable for patients that have a known tendency to form poor scars. Every individual is unique. Some women heal quickly and some heal slowly. In general, skin type determines the quality of the scar. Despite the most meticulous technique, some individuals heal poorly, while others heal beautifully. Age can also play a factor in healing time after breast augmentation surgery. The older you are the less red and tender your breast augmentation scars may appear while younger women may have pink or reddish scars that will be tender for several months and may take up to a year to fade. The scars involved for breast augmentations are fortunately very small.

Risks of Breast Augmentation Surgery

Plastic surgical breast enlargement with a silicone or saline breast implant is an inherently safe procedure; however, some risks are involved. The following lists some of the potential complications from breast augmentation surgery and describes how Dr. Pautler solves any problem that could arise from breast augmentation surgery.

• Breasts appear hard, painful, bluish and larger, it may be a hematoma: It is normal to have a little bleeding around your breast implant after breast augmentation surgery, and your body will absorb this small amount. However, an excessively large amount of bleeding around the breast implant is known as a hematoma. The blood must be removed or it can become infected or cause thicker scar tissue around the breast implant. If this breast augmentation complication occurs, the blood is removed either by a special needle (by a radiologist) or in the operating room. In this case of additional plastic surgery, Dr. Pautler removes the breast implant, cleanses the pocket to remove the blood, and then the breast implant is replaced with a small drain that will be removed after recovery from breast augmentation surgery.
  

• Breasts feel slightly harder, uncomfortable or are sitting slightly higher; it may be a capsular contracture: This is the rare case of a tightening of the natural capsule that your body forms around the breast implant. The capsule may need to be loosened or removed to provide a more pliable pocket where the breast implant can be positioned. The capsule where the breast implant was placed can shrink or contract and become thicker and tougher causing the breast implant to feel firmer. This can happen soon after breast augmentation surgery or years later, in one or both breasts. What causes this breast augmentation complication to occur is unclear, but some sources believe that a very low grade infection or blood around the breast implant could contribute. This breast augmentation complication is not a health risk and minor cases usually do not need further treatment, but if severe, a procedure called a capsulotomy may need to be done. This plastic surgery procedure opens up the capsule to loosen it, so the breast implant feels soft again. The risk of capsular contracture from breast augmentation surgery cannot be eliminated, but Dr. Pautler minimizes the risk during breast augmentation surgery and with early massage of the breast implant.
  

• Breasts appear large and distorted, it may be a seroma: Similar to a hematoma, this is a collection of body fluid around the breast implant. It requires treatment due to risk for infection or capsular contracture. It would be treated just like a hematoma.



• Infection: Highly unusual, but possible. An infection from your breast augmentation surgery requires treatment with oral, or possibly intravenous, antibiotics. Mild infections will resolve quickly. A more serious infection may require removal of the breast implant, and delay replacement of the breast implant for 6-8 weeks. Warning signs of a possible infection are warmth, redness of the breast, more pain on one side than the other, and non-healing of the incision made during breast augmentation surgery. If you are contemplating any dental work before or after your breast augmentation surgery, please discuss with Dr. Pautler, as this could possibly increase your risk for infection from breast augmentation surgery.



• Wrinkling or ripples appear on the breasts: The breast implants can be visible with patients who are extremely thin, even if the implant is placed under the muscle. Typically, you can only see the breast implant in certain positions. Although not visible in clothing, breast implant rippling or wrinkling can be bothersome. Possible solutions include placing additional fluid in the breast implant (rendering it a little harder in feel), replacing the breast implant to a different shape or type of breast implant, or breast implant removal. This risk tends to occur in extremely thin women who desire dramatic breast augmentation.
  


• Breast implant palpability (ability to feel the breast implant): It is normal to feel the breast implant at the bottom of the breast and all patients experience this sensation to some degree.
  

• Decreased breast sensation: Nerves can get cut during the breast augmentation surgery, so it is possible to have numb areas after the breast augmentation surgery. Most of these numb areas on the breasts regain sensation over a few weeks, but a permanently numb area can remain. Rarely does this affect the nipple, but it is possible. In some cases, nerve regeneration requires 1-2 years.



• Breast implant rupture: Although rare, a breast implant can develop a leak or rupture. With silicone breast implants, it is possible to diagnose a rupture with MRI or ultrasound. The FDA recommends frequent MRI monitoring yearly, starting three years after receiving your breast implants. With saline breast implants, it is obvious that a breast implant has ruptured. In either case, further breast augmentation surgery to replace the breast implant is required.
  

• Breast implant distortion: When the breast implant is placed under the pectoral muscle, flexion of this muscle can temporarily change the shape or flatten a breast implant but resumes its normal breast shape when the muscle relaxes. This is a normal condition of breast implant placement underneath the pectoral muscle and is not harmful.
  

• Breast implant displacement: A more common risk with shaped breast implants, but can also occur with round breast implants. This breast augmentation complication refers to dislocation of the breast implant from a variety of factors including: trauma, lifting arms over the head too early after breast augmentation surgery, or breast implant pocket stretching from a seroma or hematoma, described previously. If the breast implant displacement appears unappealing or causes a very obvious asymmetry, additional plastic surgery may be needed to reposition the breast implant.
  

• Asymmetry of the breasts: Very few women have perfectly symmetrical breasts, especially in regards to nipple placement. Asymmetries of the breasts can be more obvious after a breast enlargement. Rarely, an asymmetry with respect to pocket placement of the breast implants can occur, where one breast implant sits a little higher or lower than the other. This breast augmentation complication may not be apparent during breast augmentation surgery, but may become a problem later, during recovery as healing proceeds. Minor cases of this breast augmentation complication can be corrected with massage or a special band worn above the higher breast. A secondary plastic surgery procedure may be required to correct the problem.



• Mammograms with breast implants: You can still receive mammograms with breast implants, but additional views will need to be taken. When breast implants are placed in the breast tissue itself, some tissue is obscured. With implants under the muscle, more tissue can be imaged, but there is always a chance that some tissue will not be visualized on the mammogram, so continued self breast exams are important. The presence of breast implants does not affect breast cancer risks.
  

• Breastfeeding with breast implants: Many women are able to breastfeed successfully after a breast enlargement with breast implants; however, there is always a chance that it may not be possible.
  

• Loss of cleavage: Extremely rare, this breast augmentation complication occurs when the breast implant pockets come in contact and the skin and muscle on the breastbone is lifted. This breast augmentation complication is correctable with a plastic surgery procedure, but may necessitate temporary removal of breast implants or placement of post-operatively adjustable breast implants to allow the breast tissues to re-adhere to the breastbone. The risk is slightly higher for this breast augmentation complication when large breast implants are placed on a relatively small chest or when breast implants in the breast tissue are removed and replaced under the muscle during the same breast augmentation procedure.
  

• Loss of skin, breast tissue or nipple: Either a serious infection or an underlying poor plastic surgery wound healing is usually the cause. Women with uncontrolled diabetes or are heavy smokers may have poor plastic surgery wound healing. Mild cases are treated with plastic surgery wound care and heal well; however, more serious cases may need revisional surgery or breast implant removal.