Breast augmentation (enlargement) mammaplasty is a plastic surgery procedure to enhance the size of the breasts. In the performance of cosmetic breast enlargement procedures, breast implants filled with normal saline (physiological salt water) are inserted behind the breast and pectoral muscles, so as to increase the bustline by one or more bra cup size.

Breast enlargement cosmetic surgery, with saline-filled breast implants, have been performed for thirty (30) years. Since the early 1960's, more than two million women have increased the size of their breasts, undergoing breast augmentation mammaplasty.

Why do women choose to have breast augmentation mammaplasty? Most patients decide upon breast enlargement cosmetic surgery because they want to enhance the body contour of themselves, who, for personal reasons, feel their breast size is too small. Other patients choose to replace their breast volume lost in their breasts following atrophy (reduction) of their breasts volume after pregnancy.

Some patients who have breast augmentation mammaplasty are women who have already had children. Others are women who have yet to have children or experience pregnancy.

Currently, at the recommendation of the American Society of Plastic and Reconstructive Surgeons, the saline-filled breast implants are utilized for cosmetic augmentation mammaplasty. Most surgeons utilize breast implants made in the USA.

Most plastic surgeons perform breast enlargement cosmetic surgery under general anesthesia, so that the patient will sleep through the operation with no pain or discomfort. Other surgeons may use a local anesthetic.

Some plastic surgeons perform breast implant cosmetic surgery in the operating room of a hospital, working with the hospital anesthesiologist who provides medical care and general anesthesia to the patient. Other surgeons perform the surgery in their office operating rooms.

Breast enlargement cosmetic surgery is usually performed as an out-patient surgery by the plastic surgeon. That is, most patients return home without having to stay in the hospital overnight, following the performance of their breast enlargement cosmetic surgery. Most patients do rest in the recovery room of the hospital for one to two hours, following their surgical performance in the operating room. My patients receive intravenous fluid and medication to prevent or relieve any pain or discomfort while they are resting in the hospital recovery room following their surgical procedure, so that the patient will be comfortable when they return home, following their out-patient surgery in the hospital.

After surgery, patients receive medications which prevent or control any pain or discomfort. Most plastic surgeons will also provide intravenous antibiotics for their patients during the breast surgery in the operating room, and to prescribe oral antibiotic for the patient after surgery, to maximize the prophylactic prevention of possible infection.

Most plastic surgeons will advise their patients to return to their office, one or two days following their out-patient breast enlargement procedure, for a follow-up visit. During that time, most plastic surgeons will change the surgical dressing for their patients and help in putting on the post surgical molding bra. Most plastic surgeons will also advise and show patients the technique of molding and conforming the newly enlarged, desired shape of the patients breasts, gently guiding and molding the inserted implants in a comfortable, desirable position supported and molded by the post-surgical molding bra.

The plastic surgeon will also work with the patient and advise them of a continued regiment of breast massage following their surgical procedure. This post-operative breast massage method helps promote softness of the breasts following the surgical implants.

I. Consultation Information

A. Paperwork - Bring all paperwork that was provided to you by thatlook.com. There may be questions for yourself and our staff.

B. Be prepared to fill out some general background info, such as name, address, telephone, social security, etc. Also, most physicians have questionnaires about your health history, preferences, allergies, medications, etc.

C. Consent Forms - Probably of most concern to the prospective patient is a form which gives permission for photographs. Photographs are important to both the physician and the patient. The photographs will be taken in a secure setting with dignity preserved. We are interested ONLY in the area for potential surgery. Your face will not be included in the photo area. The photos can be used immediately to demonstrate any abnormal concerns such as breast size differences, sagging of breasts, general body structure and any other items of concern to both the physician and the patient.

D. History and Physical Exam.

1. History provides a background to answer important issues: Have you ever had a breast lump? Have you ever had a biopsy? Have you had children? Did you breast feed? What is your mother's history? Any breast disease? Any breast cancer?

2. Physical Exam - The doctor is looking for any lumps in the breast, painful areas, abnormal nipples (inversion, extra nipples, etc.), sagging breasts, breast size, differences right vs left.

E. The Actual Consultation - Items to be Covered

1. Explanation of Incision and Implant locations.
2. Demonstration of Implant Types - Textured, smooth, round, contoured.

3. How the surgery is performed and where local anesthesia with sedation vs. General anesthesia. Office vs. Surgicenter vs. Hospital

4. Where the surgery is performed and Patient Requirements

a. Nothing by mouth after midnight the day prior to surgery

b. Loose fitting clothing - easy to get on and off

c. Someone to take you to the facility and to drive you home afterwards.

d. Ability to rest at home or elsewhere in a quiet, supportive environment

5. Implant size, Selection of Type

6. Risks of the Procedure

a. Infection

b. Bleeding

c. Others

****How does the Surgeon cope with these problems?*******

II. How Long Does the Surgery Take?

A. The length of the procedure varies from surgeon to surgeon and upon the complexity of the procedure.

Average time for simple augment

-1 hour to 2 hours

Complex breast lift and augment

-2 hours to 3 hours

BEWARE OF SURGEONS who say they are unusually quick (i.e. 15 minutes) or surgeons who take a long time (6 to 8 hours). For the later group, I don't know what they are doing and you should know why UP FRONT - because you are the one who has to sleep that long and there should be a good reason why!

Conversely, if the surgery is done too fast - is it being done well?

Generally, I tell patients to expect the following:

1. Be at the facility 1 to 2 hours ahead of scheduled time.

2. The surgery should take 1 to 2 hours.

3. The time in recovery room - 1 hour.

4. Most patients stay under observation in a holding area or SPU (Short Procedure Unit) for another 1-2 hours before they go home. Why? We want to be sure that you are fully recovered prior to discharge and that pain, nausea, etc. are reasonably under control.

5. The facility or physician's office will probably contact you the next day to check on your progress. I ask every patient to physically come to my office the next day to check their overall status and the operation site.

III Healing/Recovery and Follow-up Period

A. Pain - There is pain with an operation. No pain, no gain is a trite expression - but true! We will provide you with a narcotic such as Percocet or Tylenol with Codeine. You can even ask for the prescription ahead of time so that it can be filled prior to surgery and be available for you at home.

The greatest discomfort is in the first 24 hours. The pain then subsides gradually. Try not to take the pain medication unnecessarily or around the clock like every 3 hours. Too much pain medication can result in nausea and vomiting. As soon as possible switch to something like Motrin which is kinder on the stomach. I will also prescribe a tranquilizer or sedative to help with sleep for the first week after surgery.

At the first post-operative visit your dressings are changed and advice is given as to the type of bra and the potential size to look for.

I like to do breast surgery on Thursdays. This gives the patient Friday and the weekend to recover, rest and cope with the discomfort. A few patients even have returned to work on the following Monday. However, most will take the following week off as well. Stitches come out one week after surgery. Exercises (mild) for the arms and shoulders will be demonstrated. Probably in 2 to 3 weeks, you will be able to resume full activities.