1. How are the breast implants put in?

The vast majority of my implants are placed through the inframammary crease where I feel I can create a more precise pocket which yields a better long term position and result. There are however a few options for implant placement in the primary breast augmentation. Possible incision locations include periareolar (around the nipple), inframammary (in the fold beneath the breast), transaxillary (in the hollow of the armpit), and transumbilical (through the belly button). NOTE - The transumbilical approach may void the replacement policy of some implant manufacturers. The most commonly used incision is inframammary but this depends on your plastic surgeon. Many plastic surgeons use this incision because it arguably gives good control in placement of the implants and the incision is usually not visible although with any incision, there will be a scar. Some plastic surgeons feel that there may be more of a chance in alteration of sensation utilizing this incision as well as a questionable decrease in the ability to breast feed in the future. Some plastic surgeons feel that there may be a higher rate of capsular contracture due to an increased exposure to bacteria found in the patient' s milk ducts. The transaxillary incision is a procedure in which an incision is made in the armpit. Some plastic surgeons feel that this incision gives less implant placement control. The Transumbilical (TUBA) procedure uses an incision inside the umbilicus (belly button). Many plastic surgeons feel that the disadvantages outweigh the advantages.

My preference is to place the implants in the partially sub-muscular position because I feel it lends to a more natural overall breast look post-operatively. I also feel that in most patients leaving the suspending ligaments in place that connect the muscle to the skin of the breast (Cooper' s Ligaments) more support of the overall breast is maintained. However, the placement of a breast implant above or below the muscle is determined individually for each patient after a careful discussion of your goals followed by a comprehensive examination. There is a different appearance to the breast after each procedure and patients will have their input in this decision as well.


2. What is a "drain" and when is one used?

A drain is placed in an area of surgery if it is felt that fluid may accumulate there. I do not routinely utilize drains in breast augmentation surgery.


3. What about doing other operations at the same time?

You should choose a board-certified plastic surgeon to provide your care. I am board-certified by the American Board of Plastic Surgery and the American Board of Surgery. These require re-certification every 10 years and I have re-certified in each of these boards in my effort to ensure currency. I will provide information below to show how you can verify if a physician is board-certified in the specialty you are seeing them for. Your plastic surgeon should be board certified by the American Board of Plastic Surgery (www.abplsurg.org) (215-587-9322). This board has strict criteria in order to become board certified. It is one of the 24 member boards of the American Board of Medical Specialties, (www.ABMS.org). They provide on-line verification of board certification (www.ABMS.org) or (866) ASK-ABMS.

A physician can be certified by other boards representing their area of training, but they may not have the proper training to do cosmetic surgical procedures. A series of weekend courses and seminars cannot begin to replace 2 or 3 years of a plastic surgery residency. To be board certified in plastic surgery a doctor must graduate from an accredited medical school, do residency training in an accredited program, and complete an approved residency in plastic and reconstructive surgery. They also must practice a minimum of two years after graduation, and pass both written and oral examinations in plastic surgery. Board certification takes approximately about 8 years after graduation from medical school.

There is a difference between state medical license and board certified in plastic surgery. Any doctor can get a state medical license, but they do not necessarily have the training in plastic surgery.

Your safety should be the most important consideration in any elective procedure(s). Your general health, your medical history, the length of time the combination of procedures will take, When you will recover, etc. are just a few of the issues to consider. This is perhaps one of the most important questions to ask.


4. Why must I have an adult stay with me the first night?

You will most likely not feel like cooking or doing the simple things to take care of yourself for the first night. This is especially true if you are taking pain medications. I see all patients back in my office the day after surgery and you will need someone to drive you. It is simply the safest thing to have someone as your caretaker for the first night or so after surgery.


5. What measures can be taken to prevent capsular contracture?

Choosing a board-certified plastic surgeon is the first step to decrease the incidence of complications. A Plastic Surgeon is both a reconstructive and a cosmetic surgeon who has completed training in an accredited plastic surgery residency. The techniques employed in aesthetic surgery are derived from those used in reconstructive surgery. In fact, aesthetic surgery is an extension of reconstructive surgery. It requires competent surgical skill, a sense of harmony of the body parts and good aesthetic judgment on the part of the surgeon. It is common for many plastic surgeons to devote their time to aesthetic/cosmetic surgery procedures.

Typical cosmetic surgery procedures include Rhinoplasty (cosmetic surgery on the nose), Blepharoplasty (cosmetic surgery on the eyelids), Face Lift (cosmetic surgery to tighten facial tissue), all facets of breast surgery to correct asymmetry, increase or decrease the size of the breast as well as tightening and lifting procedures, and all body contouring procedures (Tummy Tuck, Body Lifts, Liposuction, etc.) . A cosmetic surgeon is a physician who has not completed a plastic surgery residency who performs cosmetic surgery procedures. This can be an OB/GYN, General Surgeon, Family Practice, Emergency Room Physician, etc. They may state that they are board certified which they may be, but not by the American Board of Plastic Surgery.

Placing implants partially under the muscle, using implant massage in smooth implants, following your plastic surgeon' s instructions carefully are all ways to decrease the risk of capsular contracture. In spite of excellent care, there is still a risk of this occurring. You will need to be followed closely by your plastic surgeon as you heal.


6. What is meant by the Rapid Recovery method? How much swelling is there after operation?

This is a catch phrase used to make a patient feel as though they will heal more quickly. The rate at which you heal depends on the size of the implant used, is it above or below the muscle, does your plastic surgeon use a pain pump or place local anesthesia in the pocket around the implant. Every plastic surgeon strives for their patients to be up and about on the night of surgery but everyone heals in a little bit of a different manner.