When there is a small amount of droop to the breast and good skin quality the breast can be given a "virtual" lift with implants alone. This is often necessary when there has been deflation of the breasts after a pregnancy or deflation with weight loss. We call this the dual plane breast augmentation. Dual plane refers to the location of the implant, the upper part of the implant is in the submuscular plane while the lower part is in the subglandular plane of dissection. This is adjusted intraoperatively so that the best breast shape can be obtained.

The concept behind dual plane breast augmentation is that when the muscular attachments of the pectoralis major at the inframammary fold are completely released, the upper pectoralis muscle is able to lift the unattached gland to a higher position. The breast implant than fills in the volume needed to maintain this. Dual plane breast augmentation procedures result in a mature shaped breast rather than a more rounded shape. The major advantage is that there are no significant extra scars on the breast. All patients who undergo dual plane breast augmentation are counseled that a breast lift may be necessary in the near or distant future if the breast shape is not desirable. We have only had to perform breast lifts in less than 10% or our dual plane breast augmentation patients in the first year.

Other risks and complications for dual plane breast augmentation are the same as for a conventional breast augmentation.

PRE-OPERATIVE INSTRUCTIONS: DUAL PLANE BREAST AUGMENTATION

THREE WEEKS BEFORE DUAL PLANE 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 your dual plane breast augmentation surgery (our fax number is 585-271-4786).
• DUAL PLANE 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 DUAL PLANE 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 dual plane breast augmentation surgery. It also places you at higher risk of complication when receiving anesthesia.

ONE WEEK BEFORE DUAL PLANE BREAST AUGMENTATION SURGERY:

• Do not drink alcohol for 1 week before and after dual plane 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 DUAL PLANE 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). Dual plane 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 your dual plane breast augmentation surgery.

DAY OF DUAL PLANE BREAST AUGMENTATION SURGERY:

• Go to suite 101 (Lindsay House Surgery Center).
• You may shower and shampoo the morning of your dual plane 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 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 DUAL PLANE BREAST AUGMENTATION SURGERY:

• A responsible adult must provide transportation for you after dual plane breast augmentation surgery (public transportation is not permissible).
• A responsible adult must stay with you overnight and after your surgery until the morning following the breast augmentation procedure. If you are having several procedures, you may need or prefer assistance for 1-2 days following your procedure.
• Avoid making major decisions or participating in activities that require judgment for 24 hours after dual plane breast augmentation surgery.
• Do not drive for 24 hours after dual plane breast augmentation surgery or while you are taking pain medication. Do not drive for approximately 5-7 days after dual plane breast augmentation surgery.
• Avoid any activities that cause pain or discomfort.
• You are encouraged to walk around the house on the day of your 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 surgery or until fully active.
• Use your incentive spirometer 10 every hour while awake for 5 days after 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 dual plane breast augmentation surgery, please contact our office.
• Expect to have some incisional discomfort for the first 24 hours after dual plane 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 your dual plane breast augmentation surgery.
• Some bruising and swelling is normal. It is expected to take between 3-6 months 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 DUAL PLANE BREAST AUGMENTATION SURGERY:

• 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 dual plane 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 DUAL PLANE 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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