Northern Virginia- Fairfax and Manassas
When Should a Breast lift with an Augmentation Be Performed Simultaneously?
If a woman desires bigger breasts and feels that her breasts are sagging, then she may be a candidate for a breast lift and augmentation. Depending on the degree of lift desired, skin will have to be removed from the breast to achieve the lift. Although a lift will reposition the breast to a more elevated and youthful position, nevertheless, the breast may lose about 10%-15% of its volume because of skin removal. In this situation, you have a choice to try on implants and see whether you would like an implant to be done at the same time as the lift, or have the procedures done separately. An augmentation/ lift procedure is a more involved procedure than either a lift or an augmentation alone. It also carries a higher risk of complications, but it is usually an extremely satisfactory surgery.
Breast Augmentation / Lift Procedure
The way that I prefer to perform breast augmentations through an underarm approach has been described in detail in a previous section. Also, options of breast lift procedures has been described in detailed previously. I perform a breast augmentation/lift procedure by combining both procedures as described. First I perform the breast augmentation from an under-arm approach and then I perform the lift. In this method, the breast muscle, or pectoralis major is not cut, and the healing process is faster, and the pain is less.
How We Minimize Complications of Breast Implants:
At the Bitar Cosmetic Surgery Institute, our Northern Virginia breast lift specialists take pride in making sure we provide for our patients the best surgical experience possible. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
Bleeding after breast implants/ lift can be traumatic to a patient. It usually happens in the hours ensuing the breast augmentation, and usually happens on one side. Sometimes, a small amount of bleeding can be observed, but if the bleeding in a breast after a breast augmentation becomes significant, then the patient needs to have the bleeding removed in the operating room in a usually straight-forward procedure. The rate of hematomas, or bleeding after a breast augmentation is reported to be about 2%. Before surgery, our patients are tested to make sure they don’t have any common bleeding disorders by their own physicians, and by lab tests. I use tumescent solution, similar to that used in liposuction, before starting a breast augmentation procedure to decrease the amount of bleeding. That technique plus minimal dissection, handling of the muscle during the procedure and creating the appropriate pocket size for the implant are all techniques that decrease the chances of post-operative bleeding. In my practice the rate of hematomas in breast augmentation/lift is less than 1%.
Breast implant infections occurs in general in about 1-2% of cases. The most important step in avoiding infections, in my opinion, is to perform the surgery at a first-rate surgical facility such as INOVA Fairfax Hospital. Patients are given the appropriate intravenous antibiotics coverage throughout the actual surgery. During the surgery, the skin surface of the patient is cleaned properly. Next, I change gloves multiple times during the operation, and I am the only one who handles the implant in the operating room to ensure total sterility and avoidance of infection. After the procedure, my patients are prescribed a one-week course of antibiotics to minimize infection. As a result of these extra precautions, my implant infection rate is significantly lower than the national average at less than 1%.
Capsular contracture is the hardening of the scar tissue around the implant, and occurs in 10%-15% of women with breast implants. It can also be a factor of time elapsed since the implant placement. Every implant will have scar tissue around it; that is totally natural. What is undesirable is for the scar tissue to harden and cause the patient pain or unnaturally-looking breasts. The theories behind the cause of capsular contractures vary. Capsular contractures may be caused by a sub-clinical infection, by significant bleeding during the operation, or by time alone. In the previous section, I discussed how to minimize the risk of infection. In order to minimize the risk of bleeding, I inject the breasts with a tumescent solution, similar to that used in liposuction. The reason for the tumescent solution is to decrease the bleeding during and after the operation and to provide for local anesthesia to decrease post-operative pain. As a result, my rate of capsular contracture has been less than 1%.
Rippling is the formation of small waves or folds of the breast surface due to a breast implant. Sometimes rippling is visible, other times it is palpable, or both. In the case of breast augmentations, especially with saline implants, this potential result can lead to patient dissatisfaction in up to 10% of breast augmentation patients. In order to avoid rippling, one must understand what causes it. The chest muscle, or pectoralis major, does not cover the chest totally; the lateral edge of the breast is not covered by that muscle, which is used as coverage for a breast implant. Rippling can be avoided or minimized by giving the breast implant maximum coverage with breast tissue and muscle. For that specific reason, rippling is minimized by placing an implant under the pectoralis major muscle and by selecting an implant size that would be covered almost completely by the muscle. As a result, the implant cannot be felt from the lateral edge of the breast. Because of these two guidelines, the rate of rippling among my patients is less than 2%.
Deflation or Rupture
Breast implants are devices. Their lifespan of “looking good” varies between different types, the patient’s conditions, and the technique used, but that lifetime is not indefinite. The younger the age of a woman seeking breast implants, the higher the probability that they may have to be adjusted or replaced at some point in the future. The good news is that newer breast implants are made of better material than the old ones and have a longer lifespan, with less complications. It is difficult to quote rates of breast implant rupture or deflation because it is a function of time. The best way to minimize this risk is by paying attention to each step in the pre-operative evaluation of a patient, the actual surgical procedure, and the follow-up care. If an implant ruptures or deflates, it needs to be exchanged. Saline implants ruptures are easier to diagnose, but silicone implant ruptures may need MRI imaging to make that diagnosis.
Ability to Breastfeed Women are sometimes concerned that if they get a breast augmentation, they will not be able to breastfeed afterwards. The likelihood of losing the ability to breastfeed after a breast augmentation is very small, since the dissection occurs away from where the milk ducts are located. With the breast augmentation operation described above, inability to breastfeed after a breast augmentation that I have performed has not occurred with any of our patients to my knowledge.
Loss of Nipple Sensation or nipple / Areolar skin
Similar to what has been said about ability to breastfeed, loss of nipple sensation is a potential complication that due to the technique with which I perform this procedure is a minimal complication, with less than 1% occurrence. However, there is theoretically a higher chance of losing the nipple in a breast lift/ augmentation procedure than in either a lift or an augmentation alone due to changes in blood supply to the nipple. Temporary loss of sensation from a “stunned” nerve or a bruised nerve may occur in the time period after surgery, but sensation in the vast majority of cases returns within a few weeks.
For more information about this procedure call our office and speak to our friendly staff member 703-206-0506(MD, DC, and VA).
Information on this web site is for information only. Do not use the information to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.