Questions about Breast Augmentation Charleston

Am I a good candidate for breast augmentation?

The best breast augmentation candidates are women who feel a lack of femininity or self-esteem because of absolutely small or disproportionately small breasts, women who have lost breast volume and developed sagging breasts following pregnancy or significant weight loss, women who have lost upper pole fullness due to age or weight loss, and women with tuberous breast deformities.

What is the difference between saline and silicone implants?

Both are good implants in their own way. The saline implant comes deflated and can be placed through a relatively small incision. However, because it is filled with a fluid (saltwater) it can look and feel like a baggie full of water. The visual issues are particular problems in very thin women or women with very small breasts. The issue of palpability is present in almost everyone. The new-style silicone implant is also a very good implant. Multiple scientific studies have been done which show that there is no link between silicone and any disease process. There are very few problems with visual rippling and the silicone implant, because it is filled with a gel, feels close to normal breast tissue. The silicone implant, however, comes prefilled and therefore requires a somewhat larger incision for placement. The silicone implant is also twice as expensive as the saline implant. The surgical fee is the same for either implant.

What is the Keller Funnel?

The Keller Funnel is a device that enables us to put a silicone implant through a smaller incision than would usually be required. It also enables us to place the implant with much less trauma to the implant and surrounding tissue. We use the Keller Funnel in almost all cases when we are placing a silicone implant.

What incision sites are available?

There are four sites available (peri-areola, inframammary crease, axillary, and umbilical). In our practice, we use the peri-areolar (around the edges of the areola) or inframammary crease (underneath the breast) approaches exclusively.

Do you have a specific recommendation as to the choice of incision site?

I prefer the peri-areola approach (the incision runs around the bottom half of the areola). From my perspective, there are three shortcomings of the inframammary crease incision. First, the entire weight of the implant is directly on the inframammary crease incision. This leads to scar widening; so the scar in the inframammary crease is more noticeable than a peri-areola scar. It is my experience that the peri-areola scars are often quite inconspicuous.

The second problem is in the creation of the inferior sweep of the implant pocket. If not done correctly, the inferior aspect of the breast can look either blunted on one side or the implant can actually sit too low (we call this “bottoming out”) making the nipple appear to be too high. It is easier to get this correct from the peri-areola approach.

Finally, I like the fact that the implant is a lot further away from the outside with the peri-areola approach than with the inframammary crease approach.

How do you know what size implant to use?

I will ask you how large you wish your breasts to be. Someone who wishes to be a medium B-cup has a very different picture in their head than someone who wants to be a small D-cup. Then we will perform a physical exam to determine whether or not your anatomy and specific tissue characteristics will allow for placement of the size implant that you desire. Not all patients can be as large as they would like. And some patients actually are better off being a little larger than they initially desire in order to correct other underlying problems (such as excess skin and breast sagging following pregnancy).

Finally, as part of the initial consultation, we will use a sizing system that will allow us to determine fairly precisely what size implant will best give you the result that you desire. That will give us a starting point.

In the operating room, after we create the implant pocket, we will place a temporary implant into the pocket which we call a sizer. This sizer can be rapidly adjusted with air and we can quickly judge whether our starting point is perfect or something a little smaller or a little larger is perfect. We have all sizes of implants on hand, so we never have to worry about not having the appropriate size available.

Are all breast implants placed underneath the muscle?

I place the vast majority of breast implants underneath the muscle. I feel that such placement gives you the highest likelihood of obtaining a natural-appearing result. Also sub-muscular placement is better for mammograms. However there are some preoperative problems (e.g. severe tuberous deformity) and some patient occupations (e.g. bodybuilding, masseuse, etc.) which are better dealt with by sub-glandular placement.

Do implants cause problems with mammograms and the detection of breast cancer?

First, implants do not cause breast cancer. There are numerous studies which demonstrate this. Breast cancer can be detected in women with breast implants in the same way and at similar stages as in women without breast implants. However special views must be obtained. Mammogram technicians will do this routinely when told that the patient has breast implants.

Do I have to replace my implants every 10 years as reported on the Internet?

Those statements are incorrect. Implants with no problems need not be replaced.

How long do I have to wait after breast-feeding to have surgery?

We recommend 4-6 weeks.

Where will the operation be performed?

The surgery is performed in our office operating suite. It is fully accredited by the American Association for Accreditation of Ambulatory Surgery Facilities.

What kind of anesthesia will I have?

Our anesthesiologist will give you medication through an IV. Once you are asleep, we will inject local anesthesia into the surgical areas. You will be breathing during the procedure so there is no breathing tube or ventilator needed. You will not feel or hear anything during the procedure.

How long does breast augmentation surgery take?

Usually about one hour.

How much pain will I have after surgery?

During surgery, we will inject both short-acting and long-acting local anesthetic after you are asleep. This helps to limit the amount of medication that the anesthesiologist will be required to use. It also provides a 3-4 hour window postoperatively where pain is minimal. When the local anesthesia does wear off, there will be a fair amount of discomfort related both to the surgical procedure itself and to muscle spasms (if the implant is placed below the muscle). However by that time, you will have taken one or two pain pills and the muscle relaxer, which will help significantly. Most of our patients feel reasonably well by the second or third postoperative day taking Motrin or Aleve for daytime pain relief and require prescription medication only at night to help with sleep. Most of our patients are driving and back to work by the fifth or sixth day postoperatively.

What postoperative medications will I require?

We will prescribe a medication for pain relief, muscle relaxer to help with muscle spasm, an antibiotic, medication to help with nausea if it occurs, and a medication to help reduce swelling and bruising.

How much swelling and bruising will I have?

There is swelling and bruising after any surgical procedure. How much, of course, varies with the individual patient. Swelling and bruising are usually maximal at about 48 hours after surgery. Bruising is usually gone in a week or so. The majority of the swelling is gone in 4-6 weeks.

When can I shower following surgery?

We recommend that you wait until the second postoperative day for your first shower.

When can I drive following surgery?

Most patients will no longer require prescription pain medication during the daytime by the second or third postoperative day and usually feel strong enough to drive by the third or fourth postoperative day.

How much work will I miss?

Most of our patients are feeling reasonably well on the second or third postoperative day and are back to work (assuming that this work does not require heavy use of the arms) in 5-6 days.

How long do I have to wear a sports bra after surgery?

Usually 1-2 weeks. Longer if the incision is in the crease, as an underwire bra will be painful for a few weeks with the incision in that location.

What is a bandeau?

The bandeau is a strap that runs from one side to the other over the top of the breasts. When implants are placed in the sub-muscular position, the muscle spasm that is experienced following surgery can drive the implants too high or too far laterally. This strap prevents that and its use is important. There are some patients in whom for one reason or another we will not find its use necessary (e.g. if the implant is placed above the muscle), but we do recommend it in the majority of patients.

What is the approximate cost of Charleston breast augmentation?

Approximately $4200-$5000. The silicone implant is more expensive than the saline implant. This includes the surgeon’s fee, the anesthesia fee, and the operating room fee.

Do you recommend postoperative massage?

It is not clear whether massage is necessary to keep the implants soft when the implants are placed under the muscle. However, it certainly does not hurt and therefore we recommend it. We start at the first postoperative visit (making allowances for pain and tenderness, of course) and we recommend continuing it for one year.

Does breast implant surgery affect nipple sensation?

Nipple sensation can be affected by placement of the implant. This has nothing to do with the location of the incision. It has to do with the fact that the nerves that provide sensation to the nipple are necessarily stretched in creation of the implant pocket. In most cases there is no long-lasting effect. However in a few cases, there can be some permanent loss of sensation.

Can I tan after surgery?

Sun exposure while there is still bruising is definitely not recommended as it can lead to permanent pigment changes in the skin. The same is true of the scar from the incision site. As long as the scar remains red or pink (usually 3-6 months) sun exposure is not recommended for the same reasons. However the use of sunblock on the scar (some sun will get through your bathing suit) will allow you to go to the beach.

What is capsular contracture?

Capsular contracture is an unsatisfactory aesthetic result that can occur following breast augmentation. It is, fortunately, not common (5-10% in most studies) however when it occurs, the result can appear obviously fake rather than natural.

Breast implants, whether saline or silicone, are foreign material. The body recognizes them as such, and lays down a membrane around the implant to separate it from the rest of the body. This membrane is called capsule. Everybody with breast implants gets a capsule.

In most cases, this capsule is thin, pliable, and flexible and allows the implant to move and assume a teardrop shape under the influence of gravity. Hence the breast will appear normal. But in 5-10% of cases the capsule thickens and begins to contract and squeeze the implant. The effect is very much as if two hands were squeezing a water balloon. The breast then looks too round, the implant looks too high, and the breast is firmer than normal. The overall effect is that the presence of implants is obvious.

What Are the Different Degrees of Capsular Contracture?

There are various degrees of capsular contracture. In mild cases (which are more common) the effect is subtle and can be hidden with clothing. In more advanced cases, the result is much more obvious and more difficult to hide with clothing. There are no medications which reliably prevent or modify capsular contracture. There is a surgical procedure which removes the old capsule, and replaces the old implant. This procedure, however, is not always successful.

It would be preferable therefore, to prevent capsule contracture in the first place. Unfortunately we do not know the cause. We do not know why some women get it and some women do not. We do not know why some women get it on one side and some women get it on both sides. We do not know why some women get it six months after surgery and others six years after surgery. Because we do not know these things, we do not reliably know how to prevent capsule contracture.

What Do We Know about Capsular Contracture?

However we do know some things. We know, for example, that if implants are placed under the breast but over the chest wall muscle (sub-glandular), capsular contracture occurs more frequently than if the implants are placed under the chest wall muscle (sub-muscular). If this is the main reason for the popularity of sub-muscular implant placement over sub-glandular implant placement.

In addition, we know that textured surface implants are less likely to have capsular contracture then smooth surface implants if the implant is sub-glandular. If the implant is sub-muscular there does not seem to be any difference between textured and smooth implants. As the smooth implant generally feels softer and more natural than a textured implant, this is yet another reason to place the implant in the sub-muscular position.

Does Singulair Prevent Capsular Contracture?

Finally, there is the question of the use of the drug Singulair. Singulair is a common asthma medication. It was found fortuitously that some women who underwent surgical correction of capsular contracture had a better result if they also happen to be taking Singulair for asthma. Thus, some years ago, plastic surgeons started using Singulair in almost all cases of surgical correction of capsular contracture. This led some to think that its use might be helpful in primary breast augmentation in terms of preventing capsular contracture.

There is absolutely no evidence that the use of Singulair prevents capsule contracture in primary breast augmentation. However it is a drug with very few side effects and only has to be used for 2-3 months. Therefore Dr. Terranova gives his patients the choice of using it or not following primary breast augmentation.

Contact Charleston breast augmentation surgeon Dr. William Terranova

If you have further questions about breast augmentation and are in the Charleston, South Carolina area, please contact William Terranova, MD today for an initial consultation.