Breast Augmentation

Over the years, Dr. Ferrari of Premier Plastic Surgery Center has perfected a breast augmentation procedure called “Quick Recovery Breast Augmentation”. When most surgeons perform breast augmentations, they typically utilize blunt trauma techniques to create the pocket which will accommodate the implant. As a result, there is bleeding and bruising of the tissues which causes more inflammation and therefore more pain.

Dr. Ferrari’s techniques start weeks before the surgery ever begins. First, we educate patients as to the nutritional supplements they can begin taking preoperatively to help their bodies heal faster.

Local anesthetics are injected after the patient is put to sleep, but before the surgery begins. This allows the surgery to be done with less intravenous medications which results in a decreased inflammatory response to the surgery which again, leads to less discomfort.

Dr. Ferrari performs the surgery without blunt trauma, but rather with careful and precise creation of the pockets for the implants with meticulous attention to stop any bleeding. Excess blood left in the pockets will cause more irritation of the tissues and lead to more inflammation and more soreness.

At the end of the procedure, local anesthesia is either sprayed into the pocket to assist with post-op discomfort (which lasts for a few hours) or, if you choose, a pain pump can be placed which gives pain relief for about 3 days.

These pain pumps use local anesthesia and do not cause sedation so you can be alert and have your pain controlled. As a result, many of our patients do not need to use any narcotic pain medications, thus avoiding the potential side effects of those drugs, and enjoying a quicker and more pleasant recovery.

We also encourage light activity to keep the muscles from becoming stiff and uncomfortable. A light compression ace wrap and bra are put onto your body after surgery to further reduce your post-operative swelling and tenderness. We encourage our patients to return to non-strenuous activity within 24 hours of their surgery. Most of our patients typically say that the procedure was much easier than they ever thought it would be and highly recommend it to other women. Their only regret is that they didn’t do it sooner so they could enjoy the benefits of their appearance longer!

When making this decision it is important that you consider your aesthetic goals and lifestyle.

Advantages of Under the Muscle (Submuscular) Implants

• Saline implants typically look better under the muscle because there is more coverage of the upper part of the implant which tends to hide the edge of the implant. Also, saline implants have a higher tendency to show visible rippling and the pectoral muscle can minimize the visibility of the rippling in the cleavage area. The muscle does not cover the lateral or inferior aspects of the implant (i.e. technically called “partial submuscular”) and therefore rippling may be visible in these areas. Silicone implants can be put under or over the muscle and look good in either position.
• Mammograms are slightly better with submuscular implants
• Some studies show that the capsular contracture rate is slightly lower for submuscular implants when compares to the implants that are placed under the breast gland (subglandular), but other studies show no difference.
• If the implants are placed in the subfascial plane over the muscle, then the rate for capsular contracture is about the same as under the muscle placement. At Premier Plastic Surgery Center, we have a very low capsular contracture rate (less than 3%). If capsular contractures do occur, our office has a non-invasive LASER which we can use to often times soften the capsular contractures without performing additional surgery.
• If you do not work out your pectoral muscles, the pectoral muscle can help hold the weight of the implant allowing for less chance of sagging. If you do work out and do a lot of chest exercises, there is a good chance the implants could drift laterally and inferiorly over time due to the stretching out of the internal pocket by the pectoral muscle flexion.

Disadvantages of Under the Muscle (Submuscular) Implants

• Post-op recovery can be more painful because the muscle gets stretched and a small portion of the muscle has to be cut. To lessen the pain, we recommend you consider getting a pain pump at the time of the surgery. The pain pump numbs the area where it is injected and can alleviate your pain for up to 3 days. The pain pump uses local anesthesia and does not cause sedation so you can still feel alert. Additionally, you will not have a need for narcotic pain medications, thus avoiding any potential side effects of those drugs.
• When you have the implants placed under the pectoral muscle they can ride high for up to three months.
• Whenever the muscle is flexed, your breasts will move with the muscle. Some women have indicated this breast animation is disturbing or unnatural as it has brought unwanted attention and questions regarding why their breasts move that way.
• If you do upper body exercises such as weight lifting, resistance training, Yoga, or Pilates the pectoral muscle can stretch out the implant pocket over time and cause your implants to drift laterally and downward. Repairs for this shift require additional surgery. The implants must be removed, the implant pocket will have to be adjusted with multiple internal stitches, and new pocket will have to be created above the muscle in the subfascial plane. Some women require the removal of excess skin at the same time in order to regain a normal breast shape, which leads to additional scarring.
• If you are a more athletic woman, we recommend you consider getting silicone implants above the muscle for the most natural look and feel.

• Less Pain. You will not have to get the pain pump as mention above. Most patients go back to work in a few days versus a week (for under the muscle patients).
• Quicker Recovery. When implants are placed above the muscle, the muscle does not lift the implant. Therefore there is no time spent with the breasts riding high.
• Minimal Animation. When the pectoral muscle is flexed, there is minimal animation. Therefore, you can perform heavy chest exercises without dislodging the implants.
• Softer Feeling. This is because in submuscular position, the pectoral muscle tone can exert constant tension on the implant making it feel firmer, but when placed above the muscle, the silicone is able to move without tension.
• Internal Bra. The fascia above the pectoral muscle is a strong sheet of connective tissue. If we place your implants in the subfascial plane, it will act as an internal bra, preventing your implants from dropping over time.

In the 1990’s, there was some controversy as to the safety of silicone gel implants. The media portrayed silicone implants as toxic substances that were ruining women’s lives. Dow Corning decided on a $4 billion settlement instead of trying to fight the lawsuits. The FDA restricted first-time augmentation patients from getting silicone gel. However, what most people don’t realize is that the FDA did not completely ban silicone gel implants from the market. For example, if a woman had saline implants that rippled, she could get them exchanged for silicone implants; if a woman needed a breast lift along with augmentation, she could opt for silicone implants; and if a woman had breast cancer and needed reconstruction after mastectomy, she could choose silicone implants.

So, you must ask yourself; if the FDA thought silicone implants were dangerous, then why would they allow them in cancer patients? You should also ask yourself why the United States was the only country in the world to put a ban on silicone implants. The story is long and convoluted involving political and financial gain. In 2006, after the implant companies repeated all their safety studies for 10 years, the FDA re-approved silicone gel implants for women over 22 years old. They found no link between silicone implants and disease or cancer. Premier Plastic Surgery Center was one of the offices that was allowed to use silicone implants during the years they were “banned”. We submitted our data to the FDA which helped get the silicone implants re-approved for general use. Prior to 2006, about 35% of our patients chose silicone implants. Now, over 90% of our patients choose silicone because of the more natural look and feel.

Benefits of Silicone Implants

• They look and feel more natural. Even though the implants are round, they take on more of a teardrop shape when compared to the saline implants. For small breasted women, this is particularly important. In addition, silicone implants look good under or over the pectoral muscle (see above for details). You could also choose to have an anatomic (“teardrop”) shaped implant placed which has the most natural appearance of all the implants. Some refer to this implant as the “gummy bear” because the silicone consistency is like chewing gum (and not like the old silicone which was like pudding).

Benefits of Saline Implants

• The cost is lower and it’s easy to diagnose ruptures. The cost for saline implants is less than for silicone implants. Also, if a saline implant ruptures, your body absorbs the fluid making it obvious that you need to have a replacement. If the silicone implant ruptures, it is difficult to diagnose because the breasts look and feel the same due to the new “cohesive gel” used to fill the implants. You would need the help of a radiologist to detect a leaky silicone implant. For that reason, the FDA has recommended (but not required) that women with silicone implants undergo an MRI scan three years after surgery and every two years after that. The good news is that the new silicone implants have a cohesive gel that tends to stick together (“gummy bear”) and not migrate like the old silicone gel. Migration of the gel could cause the breasts or underarm lymph nodes to become lumpy, but there is no evidence that this caused disease or cancer.

Disadvantages of Saline Implants

• Rippling. Saline tends to feel like a bag of water and not a natural breast. Because of this, the most saline implants are placed under the pectoral muscle to try and mask the rippling.

Thanks to general anesthesia, you will feel nothing during your procedure. Post-surgically, discomfort levels can vary. While over-the-counter drugs are usually sufficient, Dr. Ferrari can prescribe analgesics as needed.

All surgeries carry risks. Risks specific to this procedure may include:

• Capsular contracture
• Implant leakage or rupture
• Shifting implant positioning
• Breast-implant-related illness
• Hematoma or seroma formation
• Changes in breast or nipple sensation

Whenever any synthetic device is implanted in someone, the body will form a scar tissue capsule around the object. The good news is that this scar tissue capsule can help hold the weight of the breast implant and thereby reduce the tendency to droop over time. However, in some women (for reasons we don’t fully understand), the scar tissue capsule can shrink and squeeze the implant. We call this a “capsular contracture”. If this occurs, the breast will feel firmer and the implant typically takes on the form of a sphere. The capsular contracture can also change the shape or position of the breast implant. Typically, the implants are displaced upward. Factors that increase the risk of capsular contracture include trauma, bacterial infection, excessive blood or fluid (i.e. “hematoma” or “seroma”) in the breast pocket, smoking, and radiation.

To prevent capsular contractures, we use meticulous surgical technique to assure complete sterility and ensure that there is no bleeding at the end of the case. We also use powder-free gloves, antibiotic irrigation, and a “no touch” technique (the implant never touches the skin or surgical drapes. It is either in its sterile container or we are inserting it in the patient. Only the surgeon touches the implant; never the scrub tech or nurse.) The “cleaner” the implant, the less likely a capsular contracture will form.

Also, patients with smooth implants are instructed on how to do proper breast massages to further minimize the chance of contracture. Vitamin E along with multivitamins has also been shown to be beneficial. Finally, textured implants may reduce the likelihood of capsular contractures, but some studies failed to show any benefit.

Plan to have someone drive you home afterward. You will be sore and have some lingering mental fogginess from the anesthesia, which would make it difficult to drive defensively.

While you should be able to return to work and driving within a week, please allow six to eight weeks for a full recovery.

All surgical incisions produce scars, which tend to fade over time. Dr. Ferrari aims to make the smallest incisions possible and places them in virtually unnoticeable places, so visible scarring is unlikely to be a concern.