Quick Recovery Breast Augmentation
The "Quick recovery breast augmentation" and "No-touch" technique of placing implants are both being talked about recently as novel methods of making breast augmentation better. The recovery phase of a breast augment has more to do with the talent and philosophy of the surgeon doing the operation than any other factor. I have been doing breast augmentation for over 20 years now and the method that I have developed for my patients has evolved over time. We know that if less blunt tearing of tissues is done, and only sharp electric dividing of the space needed to accommodate the implant is used, that the amount of bleeding and swelling are reduced making the recovery less painful. I have used a forceps electrocautery device for about 15 years that allows for grasping and coagulation of small blood vessels prior to dividing them such that no blood enters the space where the implant will be placed. The philosophy of the surgeon also matters a significant amount. I do not believe in placing lots of restrictions on lifting, bathing, stretching or the wearing of fancy post surgical bras. None of these modalities are based on solid scientific principles. If a muscle is sore, resting it makes sense but immobilizing it makes for more stiffness. We tell our patients to stretch their pectoralis muscle but don't exercise to the point where extra blood flow will add to the swelling of the area. I place a waterproof dressing over the small incision and allow for immediate bathing. The incisions are sealed off from the outside for the most part in 24 hrs. I do not believe in custom post op bras. If the pocket is made correctly surgically, no bra is necessary early on to immobilize the implant. The implant improperly immobilized by a poorly fitting bra however, may not allow the implant to access the bottom of the pocket as the pectoralis relaxes and gravity allows the implant to drop. We tell our patients that the recovery is 1 to 2 days and that they can go back to all but the most physical activities within a week. Most people go back to work in a few days. Some patients are out to dinner that night! The "No-Touch" technique makes sense in reducing the possible contamination of the implant and the pocket during the time of the procedure. The premise is that small amounts of bacteria that live in the ducts of the breast can gain access to the fluid that naturally occurs around an implant and change forms into something called a biofilm. In this biofilm state, these bacteria can cause more inflammation to the naturally occurring scar that forms around any implant and we call this capsular contraction. Some foreign bodies like the powder on surgical gloves have been implicated in being causative of capsular contracture. For both of these reasons, it seems prudent to me to lessen the contact of the implant and the skin and remove glove powder from touching the implant prior to its placement in the pocket. I will actually glue a Saran wrap like dressing over the prepped skin area of the incision such that the implant never touches the skin as it is being placed. Also, I change my gloves and remove all the glove powder before placing the implant in the pocket. In this way, no part of the implant actually touches the skin as it is placed into the pocket. By utilizing these 2 techniques in breast augmentation, I can offer my patients a rapid return to daily activities and a nice soft and natural result.
INDICATIONS
Smaller than desired breasts. One breast is noticeably smaller than the other. Breasts have lost volume after weight changes or child bearing.
INTENDED RESULTS
Larger more shapely breasts. A more confident and positive self-image. More proportional body shape.
CONSULTATION
There are many choices in breast augmentation and we believe it is important to be given all of the options at the time of consultation. There are saline and gel implants. 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. We 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 computer imaging, we can usually show the result that we think will be pleasing to the patient and achievable surgically. This is truly a customized approach for each individual patient. Dr Salzman's surgery technique is likewise different than most. Having done 1000's of breast enlargement procedures, he has been able to streamline these operations to an easier recovery for his patients. There is very little blunt tearing of tissues; all separating of tissues is done with an electric forceps. We find that under the muscle patients can get back to all but the most physical of activities in a just a few days. We don't put lots of restrictions on what our patients can and cannot do. We 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. There are questions that seem to come up a lot during consultation for breast augmentation and we can address those here.
FDA APPROVES THE USE OF SILICONE GEL IMPLANTS
Dr. Salzman has performed thousands of successful breast augmentations in his 16 years of private practice. During the FDA moratorium on the use of silicone breast implants, Dr. Salzman was one of a few select plastic surgeons in the US to be authorized to use the new silicone gel implants. He was chosen by both Allergan and Silimed as a lead investigator for the pilot study of these new implants prior to their FDA approval. In November of 2006, the FDA reinstated the approval of silicone breast implants declaring that they are safe and effective for women age 22 and older. Silicone gel breast implants are a wonderful alternative to saline and offer a much more natural look and feel.
PROCEDURE DESCRIPTION
Breast augmentation is done under a general laryngeal mask with adjuvant local anesthesia in an outpatient setting. During the procedure, which takes less than an hour, an incision is made either on the breast or in the underarm and a breast implant is placed either below or on top of the pectoralis muscle. The separation of the space (pocket) is all done with electric cautery forceps to facilitate healing and make for a smoother recovery. We sit the patient up in the operating room after both implants are in place and make any adjustments necessary to achieve the best symmetry. The incisions are closed with absorbable sutures hidden under the skin a small dressing is placed and the patient goes home.
RECUPERATION AND HEALING
Breast augmentation patients have a mild to moderate uncomfortable feeling that lasts several days. Pain is controlled with oral medications and muscle relaxers are given if the implant is placed below the muscle. We ask the patient either wear no bra, a jog bra or the bra that we will supply for the first few weeks. No under wire bra should be worn for 6 weeks. Under the muscle implants will appear high on the chest wall for a few weeks then drop into the proper location in the pocket to give a pleasing shape to the breast. Patients may shower the next day. Most patients with non-physical type jobs may return to work in a few days.
OTHER OPTIONS
Another option if the breasts are droopy and in a low position on the chest wall is a breast lift (mastopexy). There are several different types of breast lifts that can be done with an implant placement at the same time.
NOTES
The specific risks and suitability of this procedure for a give patient can be determined only at a consultation. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.