October 5th, 2011 admin
In my practice, there are patients that come with the wrong idea that the bigger the implant size, the better the results. This is actually a misconception in breast augmentation. The bigger is not always the better. Determining the right size for you depends on many factors that include your breast proportion, your skin tone, breast anatomy, and the relationship of your breast mound with your chest wall. The breast base refer to the width of your breasts (from midline to the side), which must match closely with the diameter and width of the implant. The bigger the implant, the wider its diameter. If your breast base is 10 cm, then, any breast implant that is placed in your breast needs to be close to this number. If a bigger implant is placed instead, then, the implant will fill your breasts on the sides giving them an unusual look. In addition, if your skin tone is very high, your breasts will not handle significant large implants, thus giving them a very unnatural look. Choosing the right implant for you is the first and most important step for a successful surgery, plus it decreases the risk of breast revision on the long-run.
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October 5th, 2011 admin
Breast augmentation is the most popular cosmetic procedure in America. The breast implant surgeries have risen by 40% in the past decade. Statistics from the American Society of Aesthetic Surgery show that about 300,000 implants for breast augmentation were done in 2010. Breast augmentation enhancement is a very personal decision. One of the most common questions about breast augmentation is how big I can be. There are many factors involved when choosing the right implant for a patient. This includes both the horizontal and vertical breast dimensions, your breast skin compliance (how much your skin can stretch) as determined by your preoperative exam, the dimension of your chest and breast proportion as it relates to your chest wall, and the location of your nipple as it relates to the overall shape of your breast mound. The bigger is not always the better. Multiple factors need to be considered in order to create a beautiful breast shape. In my practice, I consider not only the patients’ desire for an enhancement but also each patient’s specific anatomy to accomplish the best results.
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September 20th, 2011 admin
The profile of an implant is the actual slope or shape of the implant when you see the implant on the side. A high profile implant has a very prominent curvature that results in a breast with a significant projection or fullness on its upper part (upper pole). There are typically three options for breast implant profiles: low profile, moderate profile, and high profile. For the most part, the profile of the implant is determined by the patient’s expectations, desired breast shape, and the patient’s anatomy. In my practice, I use either high profile or moderate profile implants. I think these two options help achieve a nice breast shape and the fullness on the top that most women desire.
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September 20th, 2011 admin
Many patients have indicated me that they want to have a tear drop breast shape. A tear drop breast shape is a breast with mild to moderate fullness on the top and significant fullness on the inferior pole. This is perceived as a more natural shape. But is this really the shape that you want? I always ask my patients if they want to have some fullness on the top. Most of the times patients respond that they do and would like to have this kind of roundness on the top. If you want to have a tear drop breast, there are three things that can be done. First, a low profile implant needs to be placed to create a round breast with minimal upper breast fullness. Another option is to use a moderate profile implant inflated to the minimum manufacturer’s recommendations. The third option is to use an anatomically shaped implant. I typically recommend my patients to have some upper breast fullness because the breast will always settle after surgery. This means that your implant will drop after surgery with time. In my practice in Houston, always use either a moderate profile implant or a high profile implant. This profile will compensate when the breast implant drops or settles after surgery and your breasts will look good after surgery.
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September 13th, 2011 admin
A very common question that I get from my patients is the type of bra that they should wear after surgery. Initially, after a surgery I recommend the patient to wear a sports bra; that is, the same bra most women use to go to the gym. This bra is soft and strong enough to help settle the breast during the healing process. Many surgeons advocate that wearing a bra after surgery prevents the implant from “bottoming out.” I do not believe this is the main reason or purpose for wearing a bra. What is going to determine if your breast is going to unnaturally settle is if too large of a breast implant was chosen rather than putting an implant that fits your breast dimensions. The purpose of the bra is mostly for breast support and comfort.
I recommend in my practice a sports bra for the first 3 months after surgery. You can use a bra with underwire after three months. Experience indicates that using an underwire bra immediately after surgery causes soreness and discomfort because the wire irritates the scar if the augmentation was done at the fold. A particular company called Le Mystere has designed a bra called Le Mystere No.9 for women who have had breast implants. Although you will find a lot of companies selling bras for post surgical recovery, I do not think that in the long-run any of those “special bras” will prevent complications or improve your outcome. The most important factor is to choose the right breast implant that fits your body frame. Do yourself a favor by buying a regular sports bra and you will save some money.
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September 11th, 2011 admin
The breast augmentation surgery itself is as important for pain control as the medications to control the pain. Although there will be always some pain and discomfort after any surgery, there are certain things that can be done to minimize post operative pain by following some strict surgical guidelines. For example, the breast implants are placed either under or above the muscle. To place the implant under the muscle, the muscle itself needs to be cut in order to access the plane where the implant will be placed. Right under the muscle are the ribs. THE RIBS SHOULD NOT BE TOUCHED, BURNED, or BRUISED. The ribs are very sensitive and painful, if bumped or if the covering layer (periosteum) is cauterized (burned to control bleeding) or cut. A very controlled dissection is necessary while at the same time avoid any injury to the ribs. Also, bleeding needs to be controlled while the soft tissue is dissected. Blood creates an inflammatory response that activates many different pathways, including the pain cascade.
In addition in my practice in Houston, I routinely inject local anesthetics at the incision site to control the pain.
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September 11th, 2011 admin
Breast augmentation surgery has a high patient satisfaction. Controlling the pain with medications is the first line of treatment. My main goal for pain management is to control the pain with as low narcotic intake of narcotics as possible. Like I mention before, narcotics (Percocet, Vicodin etc) have a high rate adverse side effects such as vomiting, nausea, constipation, dizziness, somnolence among other things. In my practice in Houston, typically prescribe two medications after surgery that help control the pain while at the same time decrease the intake of narcotics.
The first medication is a non steroidal anti-inflammatory agent like advil, celebrex etc. The key is to take this medication around the clock the first three days after surgery. In other words every six hour regardless of your pain level. Only use narcotics for severe pain. The other medications are to use muscle spasm medications like methocarbamol. I will discussed this medication and its role in controlling the pain in the next blog.
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September 11th, 2011 admin
We already discussed the surgical techniques that, if avoided, will potentially decrease postoperative pain. Now, there are additional medications that can be used to improve pain right after surgery. When the breast pocket is created, this potential space can be irrigated with local anesthetics and anti-inflammatory agents.
Bupivacaine is a long acting local anesthetics that belongs to the same family of lidocaine. These are very common local anesthetics that are routinely used in almost all surgical procedures. So, what is the recipe? Before the breast implant is placed under the muscle 10 ml of buvicaine is irrigated in the breast pocket. This has shown that it decreases pain after surgery. One particular study has shown that irrigating the pocket with 0.5% bupivacaine and ketorolac in the breast pocket improves pain after a breast augmentation procedure. In this study, 30 ml of a mixture of 1ml of ketorolac, 14 ml of saline, plus 15 ml of 0.5 % and bupivacaine were injected in the breast pockets (15 ml into each breast). Patients were followed after surgery and this revealed the following:
- Patients who received pocket irrigation demonstrated an objective decrease in early pain after surgery.
- Beyond 6 hours, there was no significant pain after surgery in those who had pocket irrigation versus those who did not have pocket irrigation.
- There was no difference in terms of narcotic after surgery used in those who had pocket irrigation versus those who had no pocket irrigation.
- Patients who received pocket irrigation reported the use of more narcotics after 1-3 days after surgery.
In my practice, I have seen a decrease in pain after surgery with the use of bupivacaine and lidocaine for breast pocket irrigation. I do not irrigate the breast pockets with ketorolac.
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September 5th, 2011 admin
The surgery itself is as important for pain control as the medications to control the pain. Although there will be always some pain and discomfort after any surgery, there are certain things that can be done to minimize post operative pain by following some strict surgical guidelines. For example, the breast implants are placed either under or above the muscle. To place the implant under the muscle, the muscle itself needs to be cut in order to access the plane where the implant will be placed. Right under the muscle are the ribs. THE RIBS SHOULD NOT BE TOUCHED, BURNED, or BRUISED. The ribs are very sensitive and painful, if bumped or if the covering layer (periosteum) is cauterized (burned to control bleeding) or cut. A very controlled dissection is necessary while at the same time avoid any injury to the ribs. Also, bleeding needs to be controlled while the soft tissue is dissected. Blood creates an inflammatory response that activates many different pathways, including the pain cascade.
In addition, I routinely inject local anesthetics at the incision site to control the pain and we will discuss this in the next blog.
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September 5th, 2011 admin
There are many important factors that affect the recovery, prolong the normal return to everyday activities and also in general the pain.
- Drains: I do not use drains. This is unnecessary and causes more discomfort and pain.
- Bandages: I apply small bandages around the incision site and no circumferential bandages around the chest to avoid significant discomfort and make sure the patients feel much better.
- Movement: You can take a short nap after surgery. Then, you need to move. Take a warm water shower and begin stretching the muscle. You should put your hand above your head. This essentially will stretch your chest muscle. First, put your arms straight to the front and start lifting the arms above your head. Then, do the same thing but put your arms to the sides straight out from the shoulders and slowly lift both arms above the head until you can touch both hands You will need to do this 4-5 times after the surgery and the day after the surgery.
- Eat something more than crackers.
- Take ibuprofen around the clock like mentioned before.
- Take benadryl before bedtime; it will help you sleep.
- Do not lift anything heavy for the first 2-3 weeks.
If you follow these instructions, you should be able to have a very fast recovery.
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