Quick Recovery Breast Augmentation
Quick Recovery Breast Augmentation in Minneapolis
I specialize in rapid recovery breast augmentation, also known as the “no-touch technique,” a surgical procedure that uses special instruments and techniques to minimize tissue damage and avoid touching the ribs (hence the term “no-touch”). It causes far less trauma to the surrounding tissue than traditional approaches and dramatically reduces my patients’ pain and suffering as well as their recovery time. After I began using this technique, my staff and I interviewed each patient postoperatively to assess the results. We discovered 95 percent returned to normal daily activities within 24 hours. At our cosmetic surgery center in Minneapolis, my staff and I, as well as the anesthesiologists and recovery room nurses, absolutely, unequivocally see a signiﬁcant difference in my patients’ recovery times. I now recommend this technique for almost all of my breast augmentation patients.
Breast augmentation is a popular surgery among women. It certainly is my most common surgery. Nationally, the average age of a woman seeking this procedure is around 32. However my patients range from age 18 to women in their 60s. The average patient likely has had two or more children and has breast-fed at least one of them. Breast-feeding can cause the skin and breast tissue to lose elasticity. This causes breasts to sag and sometimes involute, which means they actually become smaller. In fact most women’s breasts become smaller after bearing children even if they don’t breast-feed.
Breast augmentation can:
• Enhance breast size or shape.
• Restore breast volume or shape lost through pregnancy. This isn’t vanity. Many women are simply reclaiming their past ﬁgures from B.C. (Before Children).
• Help your clothes and swimwear ﬁt better.
• Correct asymmetries or differences in breast size.
• Reconstruct breasts after mastectomy for cancer or premalignant conditions.
Waking up in the recovery room and seeing their new breasts for the ﬁrst time is one of the most exciting parts of the surgery. However many women feel they have two huge, hard torpedoes glued to their chest, instead of natural soft breasts. The implants may be swollen for a few days, and are naturally tight. Their new breasts will soften gradually and take on a more natural shape over the next six months.
Many patients also are reluctant to go as big as they want because of worries the change will be too obvious. I tell them to go home, start stuffng their bras with silk stockings or handkerchiefs, and wear loose clothing. That way the change won’t be as noticeable. If a patient suddenly appears larger overnight, an acutely aware person (usually her mother!) may put it all together.
So how do you decide which size to pick? Terms like “bigger,” “not too big,” and “just enough,” don’t communicate your image too clearly. “Big to you and big to me are two different things,” I tell my patients. Placing implants of various sizes or plastic bags ﬁlled with rice into your bra may be slightly more helpful. I measure a patient’s rib cage, breast fold, tissue thickness, breast width, and even the distance to the belly button and shoulders during my examination to better ascertain how she will carry a certain size implant. Careful measuring helps me to better appreciate what she and God are giving me to fashion. They say a picture is worth a thousand words. In the case of breast augmentation, it’s worth 10 times more. I sometimes ask patients to bring in pictures from Victoria’s Secret or a similar catalog to help me understand what breast size they want. They can also choose from our oﬃce preop and postop photo album. One to three pictures is suffcient because any more can be confusing. I refer frequently to these pictures in the operating room as I perform the procedure.
Once the implants are inserted, I sit the patient up while she is still asleep. Then I walk around and look at my work from every angle, constantly adjust- ing the implants’ position and size. I try my best as an artist and a human being to match the pictures she has brought in. I tell patients, “I’m an artist, but I’m also trying to be a mind reader.” I want to give each woman what she envisions, and pictures help me do that.
I also encourage patients to review my before and after gallery. You can look for patients with your body proportions, age, height, weight and cup size both preop and post op. Pay attention to any differences you may see in the preop photos from one side to the other. You can print these out and bring them in as well. Rank your photos in terms of size and implant position just right, a little too high, too low, whatever—and write your notes on the picture. Be frank about your expectations. Too many pictures—more than two or three—can be confusing, however.
Many of my St. Paul and Minneapolis patients want cleavage from breast enlargement, but often this is not possible. I release the muscle attachments as far toward the middle of the breastbone as I can, but after that it’s between you and God (or a really great bra) whether or not you will have cleavage. If you have a wide space between your breasts because of a broad sternum, you will never have cleavage.
Breast Implant Types
I use both silicone and saline implants. Silicone gel implants look more natural and feel softer with less chance of visible wrinkling. Studies show silicone implants do not increase the incidence of disease or the chances of developing breast or other cancers. The FDA recommends MRI scans to follow gel implants postop. Saline implants, on the other hand, are less expensive. I can insert a saline implant through a smaller incision and can more easily adjust for minor size discrepancies between each breast during surgery. Implants come in various shapes. About 99 percent of the time, I insert a standard round implant. Discuss the pros and cons of each shape with your surgeon.
The Breast Implant Procedure
I favor putting implants under the chest muscle because my radiology colleagues think this position interferes less with mammography and the early detection of breast cancer than if the implant is placed on top of the muscle. Not all surgeons agree on this, but I like to err on the side of caution. The alternative is to place the implant on top of the muscle but under the breast tissue. The incidence of irregularities is much higher when the implant is placed on top of the muscle in a patient who has little overlying breast tissue to cover the edges of a saline implant (incidentally, this isn’t as big a problem with silicone).
Potential approaches to insertion include incisions in the armpit, around the areola, in the crease at the base of the breast, or even through the belly button. I let the woman decide on the location of her incision. Most women choose the armpit incision because they don’t want a cut on their breasts.
The incision is the entry point I will use to create a pocket for an implant. Once the implant is in position, the incision is closed.
Before we begin surgery I use a marker to draw the incisions and the entire surgical plan on a patient’s chest. I guess the body is the ultimate canvas on which to draw. The plan includes the type of incision (the patient picks one of three incisions), implant size on each side (equal amounts on each side or more on one side if the breast is smaller), placement of the implant (high, middle or low) and ﬁnally placement toward the inside or outside of the breastbone. While looking in a mirror she veriﬁes our plan is exactly what she has in mind. Crystal-clear communication is essential to ensure the patient gets the results she wants.
Patients take three Hibiclens (chlorhexidene) showers the night before surgery. Washing the chest and armpits helps prevent infection. During surgery I give a speciﬁc intravenous antibiotic which kills the exact germ implicated in the formation of breast implant capsules (ﬁrmness). Surgery is done on a same- day basis and takes less than 30 minutes to complete. With modern techniques, many patients have surgery on a Friday and are back to work on Monday. Pain medication is prescribed to alleviate any discomfort. I also prescribe a muscle relaxer and anti-nausea medication. Patients may not have to take antibiotic pills after surgery.
After your surgery, there are three very important things to do. The ﬁrst is getting your arms over your head. You should begin to do this six to eight hours after surgery. Do a set of three arm raises every hour before going to bed. The worst thing a marathoner can do after a race is to lie around doing nothing. Instead, stretching and walking help the muscles to recover more rapidly. The same principle holds true for the quick recovery method. You may lift objects that weigh less than 30 pounds and drive a car if you’re oﬀ prescription pain medication.
The second is actually a don’t: Don’t baby your breasts. You can’t hurt or rupture your implants or rip open your stitches, a common but unnecessary fear, by going about your daily routine. Look at your breasts in a mirror. Touch them, and get to know them. They’re not the same as what you’ve been used to all these years and they are going to feel weird for a while, so it’s important to become familiar with them.
Finally, lie on your breasts—yes, that’s right—for 15 minutes every day starting the evening of your surgery. Plan on doing this every day after surgery for one year. You will feel better and lessen the risk of developing scar tissue around the implant, which almost always occurs within one year.
Road to Recovery
You can and should go about your normal activities after your procedure. Your surgeon will give you guidelines regarding aerobic activities, dressings, and other issues at discharge time.
You should be able to return to work within a few days, depending on the activity level required for your job. Your breasts will be sensitive to direct stimulation for two to three weeks, so you should avoid physical contact during that time. Your scars will be ﬁrm and pink for at least six weeks. They may remain pink and the same size, or may even appear to widen, for several months. Your scars will never disappear completely but will deﬁnitely fade and ﬂatten over time.
You may ﬁnd that you feel a little depressed in the week or so following surgery. This is a normal reaction to the anesthesia and the changes your body has undergone. Just ride it out, and try not to worry about it too much. You will feel better soon.
When having mammography, notify the technician about the implants so additional views can be taken to examine the breast tissue more eﬀectively. An implant will impair the accuracy of a mammogram to some extent. Choose a radiologist who is familiar with the special techniques that can enhance the results of the exam.
Risks and Limitations
Implants can rupture. One patient asked why, wondering if the valve was the problem. Instead, a rupture is usually a small pinpoint leak that can develop on the implant’s edge. It’s like an old sweater that has worn through the elbow while the buttons are holding just ﬁne. The implant’s valve would be like the buttons—still working—while friction on the implant shell day in and day out can cause an area to spring a leak.
Many patients have the idea saline implants need to be replaced after a speciﬁc number of years. Automatic replacement must be necessary because the tabloids at the grocery store checkout line said so. Not really.
Your auto windshield only needs to be replaced if it is cracked, which is different from the routine maintenance to change your oil. Actually, there is no need to replace a saline implant unless it ruptures. I have patients whose implants have been ﬁne for almost 20 years. I also have a small percentage of patients whose implants have ruptured and needed replacement.
Rarely, implants can become infected. It is extremely important to have surgery at an approved facility with ﬂawless sterile technique. The most common complication of breast implants is excessive ﬁrmness, where the breast is harder than the patient or surgeon would like. This happens in about three to ﬁve percent of women following surgery in my experience. Nipple numbness occurs in about three percent of cases. I have patients sign an extremely long consent form, which lists virtually every known complication or adverse outcome.
In addition to those already mentioned, these could include:
• Capsular contracture—scar tissue around an implant that causes pain, ﬁrmness, and sometimes, a misshapen appearance.
• Calciﬁcation—calcium deposits that form in the tissue around an implant, causing hardening and pain.
• Wrinkling and folds—wrinkling or creasing of the implant surface that may result in irritation to surrounding tissue or deﬂation of the implant.
These all may sound scary, but complications are rare. Your surgeon can answer any questions you may have about the risks and can put them in perspective to ease your mind or help you decide not to proceed with surgery.
Your decision to have breast augmentation is a personal one, something you have done for yourself. If the surgery has met your expectations, that’s all that matters. If you have any additional questions or would like to schedule a consultation in my surgical center.