Rapid Recovery Breast Augmentation St. Louis - Breast Enhancement Missouri
A breast augmentation is a procedure in which either a prosthetic implant, such as a silicone or saline implant, or someone’s own fat, is used to augment the breast. This procedure usually takes anywhere from 1 ½-2 hours to perform and is generally done under general anesthesia. Dr. Cabbabe utilizes “Rapid Recovery” or “Flash recovery” techniques to minimize pain and down time after surgery. These involve use of anti-inflammatories and local anesthetics around the time of surgery, careful surgical technique to minimize bleeding and early range of motion after surgery.
When an implant is used, the implant is placed either through one of three different incisions: The incision can be around the areola, which is the pigmented area near the nipple, in the natural breast fold, or occasionally through the armpit. If a breast lift is being done those incisions that are used to make the breast lift will be utilized to insert the implant.
If fat is injected, very small incisions are made through which fat is inserted after liposuction is done.
Dr. Cabbabe performs hundreds of implant surgeries each year and he uses only FDA – approved breast implants. These come with various warranties in case of rupture/leaking or capsular contracture. The current choices for a breast implant are silicone and saline. A silicone implant has a silicone shell with silicone material inside. A saline implant is composed of a silicone shell with saline or salt water inside. Silicone implants are available as round or “shaped”/”gummy bear”. Newer round implants are attempting to incorporate the thicker/more cohesive silicone to provide better form stability in the breast.
A silicone implant tends to provide a more natural look and natural feel with less rippling than a saline implant. Current FDA recommendations state that women <22 years of age should have saline implants; otherwise, any woman can choose whichever is preferred. FDA recommendations are for MRI screening 2 years after augmentation then every 3 years thereafter. This is to detect silent ruptures of the implant which may require further surgery. These are recommendations, not requirements and Dr. Cabbabe will review his opinion on this recommendation with you at the time of your consultation. The expected life of an implant is approximately 15 years. If a saline implant ruptures and it will generally deflate the breast and one would be able to tell immediately. If it’s silicone the patient may feel a small bubble or some other sort of contour change or maybe some local irritation or discomfort. A rupture may produce a capsular contracture of the breast. Either way, it is recommended that the implants be replaced and generally, if this has been several years, both implants will be replaced at the same time. We purchase our implants with lifetime warranties so that if this occurs the company will pick up the cost for the implants themselves for the lifetime of the implants. They will even give money towards surgical fees if this occurs in the first 10 years after placement. Implant companies now warranty for capsular contracture as well.
Preparing for Surgery
Dr. Cabbabe will ask that you refrain from taking any aspirin, plavix, Coumadin, ibuprofen or any other type of blood thinner before surgery. If you are older than 40, a mammogram within one year prior to the procedure is recommended as part of normal health screening. You will have an opportunity to try implants of various sizes inside a bra which will help you determine which size implant is best for you. Dr. Cabbabe will also measure your chest width to help you determine the best fit and shape for you. Dr. Cabbabe excels at making recommendations based on a patients desires and tissue characteristics. He is not a “one size fits all” surgeon and uses all of the various types of implants including all of the manufacturers to provide the best result possible.
A good candidate for a breast augmentation procedure is anyone who desires to have more fullness or enhancement of their breasts. If the breast is significantly ptotic or droopy, a breast lift may be recommended as well.The realistic expectations for a patient undergoing this procedure would be enlargement of the breast, filling both the upper and lower poles of the breast. This procedure in and of itself does not lift the breast. A breast lift only will do that and requires additional scars. The common reasons why someone pursues this would be that they’re either very small to begin with or perhaps they have lost volume in their breasts, most commonly after having had children, breastfeeding, or weight loss.
Most silicone implants are generally placed through an incision in the breast fold. although they can be placed around the areola if desired. Placing them through the areola carries a higher risk of developing capsular contracture as this is not considered as “clean” as under the breast.
If a saline implant is used occasionally they can be inserted through the armpit if one doesn’t desire any incisions on their breast at all. Most of the time the implants are placed underneath the muscle on the chest in order to keep them where they belong on the breast, to provide some additional thickness, to reduce the risk of seeing visible rippling and to minimize the risk of capsular contracture. Capsular contracture is an abnormally tight scarring around the implant that can distort or potentially cause pain on the chest. Most implants placed in this manner are done in a “dual – plane” which allows the implant to sit in a more natural position under the muscle and breast with ideal nipple position. Most implant companies now offer warranties in case of capsular contracture in addition to rupture.
Breast augmentation surgery takes around 1 1/2 hours to complete. Using the “Rapid Recovery” or “Flash Recovery” Techniques patients are given anti-inflammatories and Tylenol to “block pain before it starts” prior to surgery. During surgery, local anesthetics/numbing medicine is used in the skin and muscle to reduce pain after surgery. Antibiotics are given before the procedure, generally no drains are used and no massaging is generally recommended for most patients. Patients are able to shower the next day and go home in a bra. Use of anti-inflammatories in encouraged after surgery. Early range of motion is done with the arms. Patients will generally follow-up within 1 day to 1 week and then approximately 3-4 weeks later and then in several months.
The implants will sit higher on the chest immediately after surgery and will then settle into the breast over the course of 3 months to 1 year. A bandau may be provided to help accelerate the natural settling of the implants that occurs after surgery.
Nipple sensation and the ability to lactate are usually preserved in these procedures. Women are able to get mammograms after surgery and implants do not interfere with breast cancer detection.
There is a rare form of breast – implant associated lymphoma which all patients need to be aware of. What we know at this time is that there have been approximately 300-400 reported cases in the world to date. This is believed to be related to bacteria/biofilm on the implants. Some believe there may be a higher incidence with textured implants; however, the most recent consensus statement in 2018 stated that no single type of implant or manufacturer was known to have a higher incidence. ALCL becomes visible 5-7 years after surgery, most commonly with fluid collecting around the implant. Although this can occur for non – cancerous reasons, fluid around the implant may need to be tested for cancer cells prior to performing implant replacement surgery. If ALCL is caught early, implant and capsule removal may be curative. If it is caught late, more aggressive treatment such as chemotherapy or radiation may be recommended by an oncologist. Dr. Cabbabe recommends routine follow up annually to examine the implants for any abnormalities and to contact him immediately if there are any changes or concerns.
Before and Afters
Recovery is approximately 1-2 weeks from a breast augmentation procedure depending on the size of the implant used and the type of work one does. Most women who have this procedure done will be up and about the next day, moving around although they may need pain medication occasionally, but most women state it was not as bad as they anticipated and most of them, if they’ve had it done on a Thursday or Friday, can usually return to work the following Monday.
Dr. Cabbabe strives to make the procedure as easy and comfortable as possible for his patients. Before surgery, patients usually receive anti-inflammatory pain medications that do not cause bleeding. At the time of surgery, local anesthesia numbing medicine is used that is long – lasting into the breast. After surgery, early range of motion is begun and pain medications are given. Dr. Cabbabe does not believe in the use of pain pumps for breast augmentation as studies have shown mixed results with their use, they are costly and they increase the risk of infections. Dr. Cabbabe has removed breast implants on patients from other practices that use pain pumps due to infection.
The complications that can occur are infections of the implant, rarely requiring the implant to be removed, or bleeding into the pocket around the implant requiring further surgery to evacuate blood or stop bleeding. Most women have some asymmetry to their breasts and most of the time the same sized implant is used on both sides but occasionally a different size implant will be used if needed. More significant asymmetries need to be addressed through further incisions on the breast in the form of a breast lift. Capsular contracture can occur although this has become less common in Dr. Cabbabe’s experience. An implant may rupture and further surgery would be needed during their lifetime. Finally, there are rare cancers, referred to ALCL, which have been linked to breast implants. Fortunately, these are rare and are still case reportable. They have been found in women who present with fluid around their implants after breast implant surgery.