Breast Augmentation

"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. He immediately made me feel comfortable and very confident in his abilities as a surgeon. I highly recommend him to anyone. You won't find a more caring competent surgeon!!!" – Mary Ann

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. We want to create a breast that is proportionate to the patient's body, yet is clearly the highlight of their figure.

Breast augmentation is performed with saline implants placed under the chest wall muscle. Saline is just a fancy name for salt water in the same concentrations as the salt water in our bodies. The salt water is then put in silastic balloons which we then call implants. The implants are placed under the muscle for several reasons.

First, the implants look and feel much more natural under the muscle rather than on top of the muscle. The thicker consistency of silicone implants allowed placement above the muscle, but the less viscous saline implants produce a less natural, and therefore less desirable result if placed above 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 surgery procedure, and saline implants do not cause a problem.

The breast augmentation procedure is performed in our private surgical suite. We use twilight anesthesia 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.

Pre-op: 5 feet, 5 inches, 120 lbs., B-cup. Surgery: 340cc round smooth Silimed saline implant inflated to 360cc in a submuscular position. Post-op: D-cup.

Post-op

Patients are discharged approximately 1 hour after the breast augmentation 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 breast enlargement procedure to check on you and to answer any questions.

We see breast enlargement patients back in the office within 1 to 4 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 next appointment is approximately one week after breast augmentation where we check to make sure that the breast exercises are being done correctly. We then see the patients in 6 weeks when most of the swelling and skin stretching will have occurred. We usually do not want patients wearing a bra for the first 3 weeks as the bra may cause the pocket to become smaller and lead to capsular contracture. Occasionally when the fold under the breast needs to be reinforced, we will recommend wearing a bra earlier. In this instance, we increase the exercise routine to compensate for the bra.

Potential Risks

"I just had breast augmentation last Friday. I had a wonderful, caring and compassionate doctor named Robert Gordon Graper. I had wanted my breasts enlarged for over 20 years and at the age of 44 now had the money and chance to get them done. I researched for the last 2 months every surgeon I could find in the Charlotte, NC vicinity. The first thing that caught my attention about Dr. Graper was his photograph of him on his "Welcome" page online. His eyes are those of a gentle, compassionate person, and when I met him for the first time his manners and aura added to my secure feelings about him. And Dr. Graper and his wonderful staff set me and my boyfriend at ease the very first day at my consultation appointment. Needless to say I am so happy and pleased about my results, that I am recommending Dr. Robert G. Graper to anyone who wants the best!" – Thanks Dr. G!!

Like any plastic surgery 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 that 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 with breast augmentation 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 plastic 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 risk as well as a financial risk in any surgical procedure.

Some patients experience temporary increased or decreased nipple sensation changes after breast enlargement surgery, but it is rare to have a permanent change.

Most breasts are naturally slightly asymmetric in size, shape or position. We will try to correct this asymmetry if possible. Occasionally we will introduce an 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 the patient is unaware of any asymmetry and is very pleased with her result.

 

The implants are very durable and tolerate all everyday activities without any problem. The implant manufacturers report implant deflation is 3% at 5 years. If this happens, the implant company will replace both implants if you desire, and provide $1200 toward the cost of the breast augmentation surgery. 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 using saline implants placed 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 10% of the patients at 10 years.

Though saline implants do not inhibit normal reading of mammograms, the American College of Radiology recommends that breast augmentation patients get 3 views in a mammogram exam rather than the standard 2 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 in this location. Breast enlargement patients must be very thin for this to be a significant problem.

Frequently Asked Questions

Patients frequently ask, how long will my implants last? Will I ever have to have my breast augmentation redone? These are good questions and have common sense answers.

There are 2 main reasons to reoperate 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 and have 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 breast shape my need help over the years.

So if one wants their breasts to continue to look as good as possible, additional plastic 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, plastic surgery might be important to maintain an optimum breast shape as stretching and atrophy also occur without implants.

Overall, breast augmentation 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.