BREAST SURGERY

There are many reasons a woman would seek out a breast augmentation. Often the breasts have lost size or perkiness after childbearing or breast feeding. Sometimes nature did not provide for an adequate size. The confident feeling of filling out a dress or bathing suit is desirable for many women.

There are many choices in breast augmentation and I believe it is important that the patient be given all of the options at the time of her consultation. There are saline and gel implants, as well as expandable implants and shaped implants. The gel implants come in different consistencies and with smooth or textured surfaces. The placement of the incision can also be in numerous places.

I take these considerations as well as the preoperative state of the breast, the size of the patient, her desires and activity levels and address all of these at each and every consult. Using 3D computer imaging, I can usually show the result that I think will be pleasing to the patient and achievable surgically. This is truly a customized approach for each individual patient.

My surgery technique is likewise different than most. Having done thousands of breast enlargement procedures, I have been able to streamline these operations to allow an easier recovery for my patients. I have developed a "soft touch" technique where there is very little blunt tearing of tissues, all separating of tissues is done with an electric forceps. I find that under the muscle patients can get back to all but the most physical of activities in a just a few days. I don't put lots of restrictions on what my patients can and can not do. I also don't place large constrictive bandages. We only place a small Band-Aid type dressing that is waterproof and will allow for bathing right away. These are among the happiest patients.

Aesthetic Surgery of the Breast can enhance what nature did not adequately provide or restore form and size to the breast adversely affected by pregnancy and childbearing. Dr. Salzman is a nationally recognized Aesthetic breast surgeon having been chosen among the very few to participate in manyof the FDA approval studies of the newer high strength and form stable silicone gel breast implants.

"BREAST SURGERY CONSULTATION"
At the office consultation, you will first be seen by one of our nurses who will go over your history of health and specifically any breast related operations or family history of breast cancer. Dr. Salzman will meet with you to discuss your desires as well as go over your health and talk about your activities that you may enjoy. You will be examined by the doctor looking at the size, shape, symmetry and position of the breasts on the chest wall. We will also look at the bony shape of the chest wall and even the curvature of the spine. The nurse will take several 2 dimensional and 3D photos and the patient will redress and reconvene in our library to meet with Dr. Salzman. Here, Dr. Salzman will show you the different breast implants, saline and gel, and discuss the benefits and drawbacks of each.

Using the latest 3D computer imaging, Dr. Salzman will be able to simulate the anticipated result and compare different size options.This new 3D sizing replaces the older methods of placing the implant over the existing breast to simulate the post operative result. A life-like image on a very large flat panel monitor is quite impressive and predictive of just how you will look with your new breast. He will also tell you all of the options of where the incision can be to help you decide which is best for your particular needs. If a lift or reduction is necessary or desired, he will detail the different approaches he uses and determine which will produce the optimal outcome. All of the general risks as well as the unique risks of the individual procedure will be discussed. You will have opportunity to ask questions and explain your goals. He will explain the procedure, the anesthesia as well as the anticipated recovery in detail. When you are satisfied that you have all of the information to make an informed decision you will meet with our patient care coordinator to discuss the fees and possible dates that the surgery could be done.

THE PROCEDURE

Breast augmentation and breast reduction are commonly done as an outpatient procedure at the Jewish East Outpatient facility across the street from the office. We commonly use a laryngeal mask anesthetic as well as long acting local anesthetic in the breast area. Here, a rubberized insert is placed in the back of the mouth whereby inhalational gases can be given to keep you asleep and numbing medications are added to relieve pain. Intravenous medications are given prior to the mask so that you do not feel or remember anything. We also use a BIS monitor to measure your brain wave activity. With this technique, we can give you just the right amount of anesthesia to keep you asleep and yet wake up quickly with little hangover effect. The operation takes less than an hour for augmentation and about two hours for lifts and reductions. You will recover in both facilities in private rooms attended by a recovery nurse. Typically you will be able to leave to go home in about an hour after the procedure is finished.

RECOVERY

After you get home, you will usually be tired and sore. If an implant is placed under the muscle, you may feel tight and experience muscle cramps for several days afterward. For reductions and lifts the uncomfortable feeling usually lasts just a day or two. You may shower the next day. All of the sutures are hidden under the skin and will dissolve on their own. We would like you to limit your activities for the first week. By the second week you may walk, lift light weights and do less strenuous aerobic workouts. In patients with implants under the muscle, we would like them to avoid exercises that make forceful contracting of the pectoralis such as flys or bench presses. Most patients may return to all activities except contact sports after two weeks. The shape of the operated breast changes with time. After about 6 weeks in both augments and lifts or reductions the shape becomes more rounded and pleasing as the tissues stretch.

OTHER OPTIONS

If the breast size is smaller than desired and the skin has stretched after childbirth or weight loss, then a combination procedure with both an implant and a lift, mastopexy, may be necessary to make the more favorable youthful breast size and shape.