Breast Augmentation

Quick Recovery Breast Augmentation

I know we talk about the way we do breast augmentation that minimizes patient discomfort and makes for a quick recovery but I wanted to share some patient comments from her return some 6 weeks after a silicone gel breast augmentation. She said she went out to lunch on the way home because she felt hungry. We operated on her on a Friday morning. She attended a dinner party on Saturday and went to church on Sunday. After two pain pills on Friday evening, she took only Tylenol. She then went to work on Monday as usual. Talk about quick recovery, that’s almost no recovery. While I believe her story is extraordinary, we have seen that our patients, when they compare their recovery experience to patients of other practices, seem to say that they have experienced less downtime than what they hear about from others. I do think that the attention to detail, gentle tissue handling, almost no bleeding all contribute to this kind of result. Malcolm Gladwell, in his prize winning book, Outliers, talks about having to put 10,000 hours into whatever your chosen area of expertise in order to be great at it. After 20 years and thousands of breast augmentations, I can see what he means. Breast augmentation in our office can be a weekend recovery for most patients. This makes for happy patients and a happier physician.

When New Is Not Better

I have been seeing lately that there is a “new” method of breast augmentation being promoted by non plastic surgeons. They call it “awake breast augmentation” because the patient is awake and under a light local anesthetic.

Supposedly, the awake patient can pick her size while on the operating room table. This shockingly ridiculous method is wrong on many levels. First of all, breast augmentation can be done with out intubation and general anesthesia. The first 1000 or so that I did were done that way. The patient, however, had IV sedation so that she would have no recall of adverse pain and would be comfortable and not anxious.

The use of sizers intra-operatively is hardly ever necessary. The decision of what size the patient can be is dictated by the pre-operative size of the chest wall, the compliance of the breast, the amount of overlying breast tissue and the desires of the patient. Today, using 3D imaging techniques, we have in our office, the size, brand, shape and type of implants can be visualized on the patients body while they are awake and have no medications on board to dull the senses.

Having the patient awake so she can see the result is unnecessary. I’m sure some of the impetus to do this outside of a sanctioned operating room is for cost savings and these docs, without proper surgical training, could probably not gain privileges in accredited operating rooms. Like anything in life, you get what you pay for. There are no shortcuts when it comes to safely, intelligently and skillfully performing an invasive procedure like breast augmentation. So don’t be fooled by impostors. If the doctor has not trained in plastic surgery, you surely can ask where his or her skill has been obtained and has any governing body in medicine scrutinized his or her cases to authenticate their abilities. (Board Certification) If he or she has not trained in a surgical specialty, I recommend looking elsewhere.

Real life breast implant imaging is here!

Plastic surgery has always been a visual science. Its all about peoples perception of their own visual persona that they feel they represent to those around them. We, as plastic surgeons, provide to our patients the ability to improve that image. We, therefore at consultation for these visual improvements, need to convey to our patients what visual changes they can reasonably expect and provide some information about the risks, benefits as well as other optional treatment choices that exist. We call this process a consultation.

Consults for improvement in breast size, shape, or symmetry issues has been dealt with in the past with photographic aids. Beginning about 1996, 2D imaging of breasts with a “Photoshop” like program in which the photo taken at consultation could be manipulated with software tools to depict the possible result. We, as plastic surgeons were kind of guessing as to what the breast would look like with a certain size implant, but with a fair amount of practice, 14 years or so for me, we got pretty good at it.

However, the best manipulations were only viewed on a side view of the breasts where the blue background of the image was behind the actual photo. Not infrequently, the patient or her husband or boyfriend present at the consultation would say “can I see what that would look like from the front?” I would reply, “It’s hard to show that since we are manipulating pixels and without the blue in the background it is difficult to show a 3D change from the front. Someday we will have a camera software combination that can interpolate the change seen from the side to that seen from the front.”

Well, that is day is finally here. We have just installed the first Vectra 3D imaging system in the state of  Kentucky. I have watched the introduction of this technology grow over the last year or so and felt that it was  finally good enough to incorporate into our practice. There are only some 40 of these systems around the US now. The Vectra 3D camera takes  a single image of the breasts or face from 6 different 6 megapixel images then stitches them together and using a very sophisticated mathematical model creates a 3D image of the patient that can be moved around on a large screen display in any direction. Both the results of breast augmentation as well as the facial procedures like facelift, nose surgery,(rhinoplasty), chin tucks can be visualized in 3D.

For the breast augment patient, the choice of the size of the implant was always challenging. I believe that the best, most natural, and longest lasting results are achieved when the base diameter of the implant best fits into the natural size of the women’s chest wall. This photo system actually measures in real dimensions those parameters and can display them on the screen. The data of size, width and projection for all of the implants made by Mentor and Allergan are stored on the system.

We simply click the type and size of the implant and the software applies that to the breast and shows an enhanced version on the screen. We can then rotate that image sideways, vertical, up and down and compare it to the natural untreated image. The view from the top, as the women sees herself is especially compelling. No more guessing, stuffing implants on top inside a bra or adding baggies of rice to estimate the size of the implant is needed to get the job done. We can even adjust for dissimilar size breasts by using different size implants on each side. The look on the few patients faces that have seen this technological advance has been quite satisfying. No you can really “try on” the different implant sizes to get a feel of how you will look after breast augmentation surgery.

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