Breast augmentation is one of the most commonly performed plastic surgery operations. Breast augmentation is extremely popular with a very high satisfaction rate. Breast augmentation increases the volume of the breasts with the use of an implant. Women who desire breast augmentation are unhappy with the size of their breasts and want them to be slightly or significantly larger.

Women who choose to have breast augmentation have many motivations. Some feel their breasts are out of proportion to the rest of their figure. Others are very self conscious wearing swimsuits or formfitting tops because of small breasts. Many women will lose breast volume with pregnancy and breast feeding or through weight loss and want to regain lost volume and improve the shape of the breast. Others have a significant difference in the size of their breasts that they want corrected. Many women wear bras that give the impression of larger breasts for years then decide to pursue breast augmentation. Most women who choose breast augmentation find the changes in their body and the ability to fit into different clothing styles an excellent improvement.

Breast Augmentation Consultation

At your initial breast augmentation consultation, a detailed medical history will be taken including past and current medical conditions, allergies and medications, personal or family history of breast cancer or other breast problems, and the results of any previous mammograms. Dr. Koenig will then discuss with you the breast size and shape that you desire. Sizer breast implants will be available to place in your bra to help with volume decisions. Pre and post operative photos of other patients who Dr Koenig has operated on will be able to be viewed and discussed. Limitations based on quality of the skin or characteristics of the breasts before breast augmentation surgery will be discussed. Most patients desire a natural appearing breast but some patients prefer a breast with more upper pole fullness. Dr. Koenig will review all options with you before you decide. The relative advantages of saline implants and silicone implants will be reviewed and recommendations given.

Breast Augmentation: The Operation

Dr Koenig performs breast augmentation under general anesthesia although it can be performed under sedation and local anesthesia in unusual circumstances. Breast augmentation surgery generally lasts between 1 and 2 hours and all patients are ready to go home shortly after surgery.
Almost all breast implants are placed in the submuscular position and the patient chooses their preferred incision usually periareolar (around the nipple), or inframammary (under the breast). Other incisions are used when necessary.

Breast Augmentation: Recovery

Breast augmentation, particularly when the implant is placed behind the muscle, can be painful. Dr Koenig will do everything possible to make the operation as painless as possible and most patients have much less pain than expected. In some cases, a post-operative pain pump is placed but most patients are comfortable with oral pain medicines. The pain subsides quickly after the first 24 hours and many patients return to normal activity within a few days. The goal after breast augmentation surgery is normal activity in 24 hours and about 95% of patients achieve this. Most breast augmentation patients return to work in less than 1 week, depending on the patient's job.

Breast Augmentation: Complications

Breast augmentation has risks and complications associated with it. Fortunately, most patients do not experience these but it is important for patients to understand the risks and complications that may occur during a breast augmentation procedure. Early complications include bleeding, infection, asymmetry and numbness of the nipples. Nipple sensation returns to normal 98% of the time. Later complications include capsular contracture (hardening of the implants), deflation of the implants and stretching of the skin over the implants resulting in breast drooping and unfavorable shape. Mammography after breast augmentation will not be as effective as it was before with about 15% of the breast tissue not being visualized by the mammogram after implants are placed.

PRE-OPERATIVE INSTRUCTIONS:

BREAST AUGMENTATION SURGERY

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THREE WEEKS BEFORE BREAST AUGMENTATION SURGERY:

• Laboratory and EKG (if they are required) must be done. If you are having your preoperative testing at a lab other than the one we suggested, you are responsible for having the written results of this testing arrive at our office one full week before breast augmentation surgery (our fax number is 585-271-4786).
• BREAST AUGMENTATION SURGERY WILL NEED TO BE CANCELLED IF THERE IS ANY CHANCE THAT YOU ARE PREGNANT.
• All fees are due, including surgical, facility and anesthesia.

TWO WEEKS BEFORE BREAST AUGMENTATION SURGERY:

• Do not take any products containing aspirin, ibuprofen (Advil, Motrin), non-steroidal anti-inflammatory medication or Vitamin E. Tylenol is acceptable.
• Refrain from all nicotine products, including cigarettes, pipe tobacco, chew or Nicotine patch. Nicotine interferes with healthy circulation and may affect the result of your breast augmentation surgery. It also places you at higher risk of complication when receiving anesthesia.

ONE WEEK BEFORE BREAST AUGMENTATION SURGERY:

• Do not drink alcohol for 1 week before and after breast augmentation surgery.
• Please ensure that all laboratory tests and/or blood work has been completed by this time as ordered by the plastic surgeon/nurse practitioner. Our fax number is 585-271-4786.

THE DAY BEFORE BREAST AUGMENTATION SURGERY:

• Call 267-8200 to obtain your arrival time for the day of your breast augmentation surgery.
• DO NOT EAT OR DRINK ANYTHING AFTER MIDNIGHT (This includes water and gum chewing). Breast augmentation surgery may be cancelled if this is not followed. A fasting state is required in order to receive sedation for surgery. The only exception is medication, which we instruct you to take with a sip of water the morning of breast augmentation surgery.

DAY OF BREAST AUGMENTATION SURGERY:

• Go to suite 101 (Lindsay House Surgery Center).
• You may shower and shampoo the morning of breast augmentation surgery. Do not wear makeup, hair sprays or gels, or nail polish. You may leave acrylic nails on.
• Avoid clothing that must be pulled over the head. Please wear loose fitting clothing.
• Do not wear jewelry, including body jewelry or bring valuables to breast augmentation surgery.
• Do not use underarm deodorant.
• If you have your menstrual cycle, please wear a feminine napkin. Do not wear a tampon.

POST-OPERATIVE INSTRUCTIONS:

COMMON INSTRUCTIONS AFTER BREAST AUGMENTATION (Breast Implant) SURGERY:

• A responsible adult must provide transportation for you after breast augmentation surgery (public transportation is not permissible).
• A responsible adult must stay with you overnight and after your breast augmentation surgery until the morning following the procedure. If you are having several plastic surgery procedures, you may need or prefer assistance for 1-2 days following your breast augmentation procedure.
• Avoid making major decisions or participating in activities that require judgment for 24 hours after breast augmentation surgery.
• Do not drive for 24 hours after surgery or while you are taking pain medication. Do not drive for approximately 5-7 days after breast augmentation surgery.
• Avoid any activities that cause pain or discomfort.
• You are encouraged to walk around the house on the day of breast augmentation surgery and thereafter. This helps to prevent blood clots from developing in the legs.
• Move/pump your legs frequently while lying down. This also helps in preventing blood clots from developing. Wear the support stockings for at least 5 days after breast augmentation surgery or until fully active.
• Use your incentive spirometer 10 every hour while awake for 5 days after breast augmentation surgery or until fully active. This is necessary to prevent post operative pneumonia or atelactasis.
• Resume activities slowly. You may feel tired for the first few days. Avoid heavy lifting, bending, and straining for 3 weeks. You may resume all activity after six weeks.
• Drink plenty of fluids (8-10 glasses/day) for the first week to keep well hydrated.
• If you have not urinated after 6 hours of being home from breast augmentation surgery, please contact our office.
• Expect to have some incisional discomfort for the first 24 hours after breast augmentation surgery. Take your pain medication before your pain becomes severe.
• Take all medications as instructed post operatively.
• You may resume all of your medications after one week from the time of breast augmentation surgery.
• Some bruising and swelling is normal. It is expected to take between 3-6 months after breast augmentation surgery to see your final results.
• Avoid direct sunlight to the incision for at least 1 year. Use a sunscreen with zinc oxide with an SPF of 20 or greater to help decrease the visibility of the scar.

POST OPERATIVE INSTRUCTIONS FOR BREAST AUGMENTATION (Breast Implant) SURGERY:

BREAST AUGMENTATION (BREAST IMPLANTS)

• You may or may not have a gauze dressing over your breasts after your breast augmentation surgery. You will have steri strips (adhesive bandage) in place over your incision. Please keep your dressing clean and dry. On post operative Day 3, you may take a shower, it is okay to get the steri strips wet, do not remove them. You can gently pat yourself dry with a towel or use a blow dryer (cool setting) to dry the steri strips. You may not wear a bra for a total of 3 weeks post operatively; this allows the breasts to fall naturally. Two days after breast augmentation surgery, you can apply Dr. Koenig's Post Breast Enhancement Oil on breasts but avoid incision line for at least 2 weeks. Apply 1-2 times daily with gentle massaging. This helps to ease pain, increase lymphatic circulation and nourish the skin.

CALL OUR OFFICE IF YOU DEVELOP ANY OF THE FOLLOWING AFTER BREAST AUGMENTATION SURGERY:

• Fever of 101 degrees F or greater.
• Pain not relieved with pain medication.
• Swelling, redness, bleeding, and/or foul drainage from an incision site.
• Persistent nausea and/or vomiting.
• Any other concerns.

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