Breast Augmentation

Charlotte Breast Augmentation Surgeon – Dr. Graper

 

Breast augmentation is one of the most requested procedures in plastic surgery. The results are safe and predictably good, which easily accounts for the greater than 95% patient satisfaction rate for the procedure. At Graper Cosmetic Surgery in Charlotte, we want to create a breast that is proportionate to the patient’s body, yet is clearly the highlight of their figure. We will guide the patient into a size that meets their goals and is compatible with their anatomy.

Breast Augmentation: How Is It Performed?

Breast augmentation is performed with saline or silicone implants placed under the chest wall muscle through an incision in the fold under the breast. The incision heals great and is hidden nicely by the fold. This approach is the most accurate, least tender and safest compared to all the other approaches. Since silicone was approved by the FDA, virtually all patients choose either the standard gel implants or the newer textured shaped implants. Each has their advantages and disadvantages, but both are better than saline. The textured anatomical implants are different fundamentally than the round gel implants in that these implants are designed to enlarge and re-shape your breast while the traditional gel silicone implants are designed to just make your natural shape bigger. So if you like the shape of your breasts, the traditional implants may be the best option. If you need an improvement to the breast shape, the textured anatomical “gummy bear” implants may be the best choice.

At Graper Cosmetic Surgery, we like to place the implants under the muscle for several reasons.

First, the implants have a more natural feel when placed under the muscle. Second, the implants are more likely to stay soft when placed under the muscle. Last and most importantly, mammograms are much easier to read when the implants are under the muscle. We certainly should not do anything to prevent appropriate detection of breast cancer following a cosmetic procedure. Breast implants do not create a detection problem when three views of the breast are taken rather than the standard two views.

Breast Augmentation in Charlotte

The procedure is performed in our private Charlotte NC plastic surgery suite. We use twilight anesthesia, during which patients are asleep; they don’t feel or remember anything, but they are breathing on their own. We also use local anesthesia, so that when patients wake up, they have very little discomfort. As the local anesthesia wears off, most breast implants surgery patients will experience a sensation similar to that of a pulled muscle. This makes sense because the muscle has been partially cut to place the implant in the proper position. The muscle then stretches over the implant and this produces the same feeling as having a pulled muscle. This sensation passes at about the same rate as a pulled muscle heals: in about seven to 10 days.

Post-op

Patients are discharged approximately one hour after surgery, when they are alert and can take liquids well. They are sent home where most people sleep for several hours. We write prescriptions for pain medicine, muscle relaxants, antibiotics and nausea medicine for the occasional patient who doesn’t tolerate the anesthesia well. Dr. Graper will call the evening of the procedure to check on you and to answer any questions.

We see our Charlotte breast augmentation patients back in our cosmetic surgery Charlotte office within one to four days after surgery to monitor their progress and to begin breast exercises. By breast exercises, we mean moving the implant in the space or pocket under the muscle. This is very important in maintaining a soft breast and preventing capsular contraction. Breasts get hard when the scar or capsule around the implant gets smaller and smaller so that there is no extra room in the pocket for the implant to move. But, if the implant is moved around in the pocket several times each day, the space will stay larger than the implant and the breast will stay soft. We have our patients do this exercise every day forever. Just as you brush your teeth and wash your face each day, similarly you move your implants as part of your daily routine. This is a very easy, quick and painless way to help keep your breast as soft and natural as possible. The textured anatomical implants do not need to be moved.

The next appointment is approximately one week later when we check to make sure that the breast exercises are being done correctly. We then see the patients in six weeks when most of the swelling and skin stretching will have resolved. We suggest patients wear a bra for the first three weeks as the bra helps support the breast pocket in the correct dimensions created at surgery. Occasionally, when the skin under the breast needs to be stretched, we will recommend wearing an ace wrap over the upper half of the breast to help stretch that skin and help keep the implant in the bottom of the pocket.

Potential Risks

Like any surgical procedure, there are potential risks, just like there are risks in everyday life. For instance, when one drives a car, the risk of a flat tire, a dead battery, or an accident is small compared to the huge benefit of rapid transportation. Similarly, in breast augmentation, the risks are small compared to the benefits of the procedure. Each prospective breast augmentation patient, however, should be aware of the risks so that they may make an educated decision whether to proceed with breast implants surgery. The risk of bleeding or infection postoperatively is small; perhaps 1 to 2%. Correction of these problems may require additional surgery. We do not charge to treat these problems, but there is a facility charge for the cost of doing the procedure that patients are responsible for. So, there is both a small health risk as well as a financial risk in any surgical procedure.

Though the risk of bleeding after a breast augmentation is small (1-2%), we recommend limiting exercise or any activity that increases your heart rate or makes you out of breath to a bare minimum for three weeks. Most patients could do anything they want after surgery and be fine, but a small percentage will damage their tissues with trivial activity and cause bleeding. Bleeding requires us to go back to the operating room and remove the blood. This is an unnecessary expense and hassle that everyone wants to avoid. Since we do not know which patients will bleed, we restrict everyone’s activity to improve safety for all. Walking is all the exercise we recommend, but you can casually walk 10 miles if you want to.

Some postoperative breast implants surgery patients experience temporary increased or decreased nipple sensation changes after surgery. Approximately 5% have a permanent change of decreased sensation that is caused by the nerve to the nipple crossing the same space where the implant must be placed. In this unusual situation, we must cut the nerve or not put the implant in the correct place. All our patients are aware of this anatomical issue and have given us permission to do what is necessary to make the breasts look good.

Most breasts are naturally slightly asymmetric in size, shape or position. We will try to correct this asymmetry, if possible. Occasionally, we will introduce asymmetry. If this happens, together we will assess the risks and benefits of correcting the asymmetry. We will want to make the breast look as good as possible, as our patients are also our ambassadors in the community. Usually our breast augmentation Charlotte patients are unaware of any asymmetry and are very pleased with the results.

The implants are very durable and tolerate all everyday activities without any problem. The implant manufacturers report implant deflation is 3% at five years. If there is an implant deflation, the implant company will replace both implants for free and cover all expenses. Obviously, they are very confident in their product, as this is an excellent guarantee.

We mentioned capsular contraction before as a process where the scar around the implant may become smaller through the normal healing process. This contracture is inhibited by placing the implants under the muscle in the original surgical procedure and performing daily breast implant exercises. If capsular contracture occurs, the breast will get firm and can progress to changes in the breast shape and eventually cause pain. We can easily correct the problem by simply releasing the scar all the way around the implant, but this requires an additional surgical procedure. It is much easier to prevent the problem by compulsively moving the implants every day. This is the biggest problem with breast augmentation and occurs in approximately 8% of patients in 10 years. If a capsular contracture occurs in the first 10 years after surgery the company will cover all the expenses if the surgery is done at our location. Again, a great guarantee.

Though implants do not inhibit normal reading of mammograms, the American College of Radiology recommends that all breast augmentation patients get three views in a mammogram exam rather than the standard two views to help assess the entire breast.

Visible rippling of the implant at the lower outer aspect of the breast can be a problem in very thin patients, even if the implant is under the muscle. This is because the skin is very thin and there is not much muscle or breast tissue in this location.  This mostly relates to saline implants and not silicone implants. Patients must be very thin for this to be a significant problem.

Patients frequently ask, how long will my implants last? Will I ever have to have revision surgery? These are good questions and have commonsense answers.

There are two main reasons to re-operate after breast augmentation. Either the implant has a problem or the breast tissue itself has changed. Implant manufacturing has improved dramatically in the 25 years since it was first introduced. It is reasonable to expect an implant to last an average of 15 years. It is probably unreasonable to expect breast implants to last a whole lifetime when other implanted medical devices like pacemakers, heart valves, artificial joints and penile implants all have to be replaced in 10 to 15 years. However, it is not unusual to see a patient who has had her implants in for 15 to 20 years with no problems.

No one knows how the breast tissue will fare over time either. Between gravity, pregnancy and capsular contracture, there are multiple reasons why the breasts shape my need help over the years. So, if one wants their breasts to continue to look as good as possible, additional surgery may be required to lift the sagging breast or perhaps enlarge the implant size in a shrunken breast. Even if one had no implants, surgery might be important to maintain an optimum breast shape, as stretching and atrophy also occur without implants.

Overall, breast augmentation surgery is a very safe operation with predictably good results. Breast replacement is not for everyone. But for those patients who do not feel good about the small size of their breasts, this is an easy way to dramatically improve the way they feel about themselves. Our goal is to make your proud of your breasts.

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“I have dreamed of having breasts almost my entire life. I am 40 years old and have three children which were all breast fed. At this point in life I decided it was time to fulfill my dream. I found my wonderful Plastic Surgeon, Dr. Robert Graper of Charlotte, NC. After meeting with him I knew instantly that he was the surgeon for me. I highly recommend him to anyone thinking about breast augmentation in Charlotte. You won’t find a more caring, competent surgeon!!!”

– Mary Ann

Breast Augmentation feature with Dr. Graper on The Wellness Hour

Vectra 3D Imaging 

Breast Augmentation education at Dr. Graper’s Seminar

Breast Augmentation in Charlotte – Frequently Asked Questions

What is the procedure like?

Breast augmentation is performed in our private surgical suite. Twilight anesthesia is used, where the patients are asleep; they don’t feel or remember anything, but they are breathing on their own. We also use local anesthesia so that when the patients awaken, they have very little discomfort. As the local anesthesia wears off, the sensation is like that of having a pulled muscle. This makes sense because the muscle has been partially cut to place the implant in the proper position. The muscle then stretches over the implant and this produces the same feeling as having a pulled muscle. This sensation passes at about the same rate as a pulled muscle heals in or about 7 to 10 days.

Most of our Charlotte breast augmentation patients are discharged approximately 1 hour after surgery is completed, when they are alert and can take liquids well. They are sent home where most people sleep for several hours. We write prescriptions for pain medicine, antibiotics and nausea medicine for the occasional patient who doesn’t tolerate the anesthesia well. The doctor will call the evening of the procedure to check on you and to answer any questions.

Who are good candidates for breast augmentation?

Women who are physically and emotionally healthy, have realistic expectations about the results of the surgery, and understand the risks and benefits of the procedure are ideal candidates for breast augmentation.

Women may wish to increase the size of their breasts for a number of reasons, including:

  • feelings that their breast size is too small or disproportionate to their body
  • breasts have become uneven and symmetry is desired
  • significant weight loss may have also shrunk breasts
  • breast size and shape may have changed after pregnancy
What is the typical recovery time?

Recovery from breast augmentation surgery may take two or three weeks. Most patients can return to light-duty work within one week postoperatively. Exercise can be resumed at three weeks postoperatively, and driving can be resumed as soon as the patient feels she can make evasive movements without hesitation and is off all pain medications.

What are the risks associated with the procedure?

Like any surgical procedure, there are potential risks, just like there are risks in everyday life. For instance, when one drives a car, the risk of a flat tire, a dead battery, or an accident is small compared to the huge benefit of rapid transportation. Similarly, in breast augmentation, the risks are small compared to the benefits of the procedure. Each patient, however, should be aware of the risks so that they may make their decision regarding proceeding with the operation. The risk of bleeding or infection postoperatively is small; perhaps 1 to 2%. Correction of these problems may require additional surgery. We do not charge to treat these problems but there is a facility charge for the cost of doing the procedure that patients are responsible for. So, there is both a small health risk as well as a financial risk in any surgical procedure. Some patients experience temporary increased or decreased nipple sensation changes after surgery, but it is rare to have a permanent change.

How much does breast augmentation cost?

The cost of the procedure depends on many variables, so it is not possible to give a price without a personal consultation. Associated costs may include the price of the procedure, operating room costs and anesthesia fees. Please contact us for a personal consultation.