1 IS BREAST AUGMENTATION RIGHT FOR YOU? (816)
2 For many women, having shapely, full breasts is an important part of feeling feminine. The breasts give the body proportion, shape, and curves. Unfortunately, many factors may lead a woman to feel less than satisfied with her breasts, such as post-pregnancy changes, natural asymmetry, injury, or the natural effects of aging and gravity. However, breast augmentation is an option that helps women improve the appearance of the breasts and cleavage, improve self-esteem, and help regain a feeling of femininity. Whatever your reasons for considering breast augmentation surgery, Dr. Hlavacek and everyone at Kansas City Surgical Arts want to support you in your journey. We understand that breast augmentation is a highly individualized decision, with many different options available to help you achieve your goals. In order to help you understand your breast augmentation options, we have created this breast augmentation e-book, covering all of your options from start to finish. We encourage you to print this e-book and make notes as you read. After reading about breast augmentation and your different options, we would love to see you at Kansas City Surgical Arts for a consultation with Dr. Hlavacek. Bring along your notes and the e-book to help guide your discussion with Dr. Hlavacek and to ensure that all of your questions and concerns are answered during your appointment. 2 At Kansas City Surgical Arts, we believe that a well-informed patient is a happy patient. During your consultation, before surgery, or during recovery, no question or concern is too small Dr. Hlavacek wants to ensure that you have all of the information you need to make informed decisions about what is a highly individualized and personal surgery.
3 Common reasons for breast augmentation surgery Breast augmentation is one of the most popular cosmetic surgeries in the United States with a long track record of safety and patient satisfaction. Your reasons for seeking breast augmentation are personal and specific to your own needs, desires, and goals. Some common reasons that women cite for seeking breast augmentation include: Correct sagging or loss of fullness after pregnancy or weight loss Improve body proportion and create a balanced appearance Correct asymmetry when one breast is noticeably larger than the other Increase breast size or shape Improve appearance of cleavage Reconstruct breasts after mastectomy Correct age-related changes to the breasts 3
4 Am I a good candidate for breast augmentation? Many factors must be considered in determining if you are a good candidate for breast augmentation. Perhaps the most important factor is your goals and reasons for seeking breast augmentation surgery. Having realistic expectations will greatly increase your likelihood of satisfaction with your surgery results. During your consultation with Dr. Hlavacek, you will discuss your reasons for seeking breast augmentation, your goals, and the several options available to you. To be a good candidate for breast augmentation surgery, you should be in good overall health, and at or near your ideal weight. If you have a significant amount of weight to lose, you may find that your breasts change as you continue to work toward your weight goals. Healthy breast augmentation candidates are also non-smokers. If you smoke, make a plan to quit well before surgery. Smokers are at higher risk of complications during surgery of any kind, and may find recovery takes longer. In order to determine if you are healthy enough for breast augmentation surgery, you will need to bring the following information to your consultation: A list of current or prior health problems, including any previous surgeries. If you have had prior surgeries, it will help Dr. Hlavacek to understand how your body coped with the surgery and recovery. A complete list of all medications, vitamins, and supplements you take. Should you schedule surgery, you may be asked to temporarily stop taking some of these, or to change your dosage. It is imperative that you let Dr. Hlavacek know if you use any blood thinning medications or supplements, as these increase your risk of bleeding during surgical procedures. A list of any family health problems, including but not limited to heart disease, diabetes, or hypertension. A list of any allergies to medications, surgical or medical supplies, or anesthetics. 4
5 Consultation One of the most important steps in your breast augmentation journey is the consultation. During your consultation with Dr. Hlavacek, you will discuss a number of topics. The consultation is a time for you to discuss your breast augmentation goals, any concerns you may have about surgery, and the different choices available to you. During your consultation, please bring up any concerns or worries you may have. Dr. Hlavacek and everyone at Kansas City Surgical Arts is committed to ensuring that you have all of the information you need to feel comfortable and confident with your choices before going into surgery. If you think that you may not remember all of your questions and concerns, write them down prior to your consultation and bring the list with you. Some patients also find it helpful to bring a trusted family member or friend for moral support and to act as a second set of eyes when trying on sample implants. In addition to discussing your goals and concerns, Dr. Hlavacek will discuss your options for implant size, shape, and type, as well as different incision locations and implant placement. You will have the opportunity to feel and try on several types of implants during your consultation. Dr. Hlavacek will also take measurements of your breasts and body, and take before pictures to provide guidance when making surgical decisions. You will be able to see before and after photos of previous patients as well. In addition, Dr. Hlavacek will discuss your health history, medications, and any risk factors you may have, and he will also discuss the surgery itself, recovery, and possible risks. 5
6 Your breast augmentation options Breast augmentation is not a one-size-fits-all surgery. This is your body, and you have specific goals for how you want to look and feel after breast augmentation. You will have a number of choices to make regarding your surgery, and Dr. Hlavacek will provide guidance during your consultation and pre-operative appointments. The choices you will be making include the size and shape or your implants, incision locations, silicone or saline-filled implants, and implant placement. 6
7 Choosing the ideal size for your frame The first decision you will make will be about the size of your implants. Consider selecting an implant size that will be in proportion with your body frame. Dr. Hlavacek will offer guidance during your consultation, but there are many advantages to being conservative when considering implant size. Larger implants, particularly if they are disproportionately large in relation to your body frame, have risks including capsular contracture (narrowing of the pocket around the implant causing the implant to be squeezed), visible rippling of the skin, numbness, and eventual sagging. Selecting an appropriate shape The shape of your breasts after augmentation will depend on a combination of factors, including your natural breast size and shape, and the size and shape of the implants you select. If you are seeking to increase your cleavage, the natural position of your nipples, shape of your chest, and natural shape of your breasts will be taken into consideration as they will all impact the appearance of your breasts after augmentation. Keep in mind that two patients may select the same size and shape of implants but have dramatically different appearances. Your body is unique to you. Although before-and-after photos of other patients with similar body shapes or frames may be useful guides, rely on your own feelings and appearance in making your final decisions. During your consultation, you will have the opportunity to try on and handle different sizes, shapes, and types of implants. Some patients find it useful to bring a few extra tops in different styles to try on with sample implants. Silicone or saline Perhaps one of the most important decisions to make regarding your breast augmentation is whether to choose silicone or saline implants. Both are FDA-approved and safe, but each has its own advantages and disadvantages. Silicone Silicone breast implants are prefilled with a silicone gel and are designed to feel like your natural breast tissue. Silicone implants come in a variety of shapes and sizes, and provide uniformity. Silicone implants have a low risk of breast rippling as well. These implants are FDA-approved for patients 22 years of age and older. Silicone implants do not leak into the surrounding area if they are ruptured, and it is important to have regular screening examinations, possibly including MRI exams, in order to monitor for ruptures. Silicone implants carry a higher risk of capsular contracture and are typically more expensive than saline implants. 7
8 Saline Saline implants are filled with a saltwater solution that is similar to the natural fluids found in your body. With Dr. Hlavacek s guidance, you will be able to select a size that is ideal for you, but these implants do not come pre-filled. During your surgery, Dr. Hlavacek will fill the implants with saline after they are in place. This allows Dr. Hlavacek to make fine adjustments to the size of the implants in order to ensure symmetry. Saline implants have few health risks should they rupture and leak into the body. Saline implants are FDA-approved for patients 18 years of age and older. While saline implants have many benefits, the downside to saline is that they tend to have a firmer, less natural feel than silicone implants. Saline implants also have a higher likelihood of visible rippling. Incision options Breast augmentation surgery may be performed through any of three types of incisions. During your consultation, Dr. Hlavacek will offer advice about which type of incision is best for you. Your incision options are in the fold below the breast (inframammary), in the armpit (transaxillary), or along the lower edge of the areola (peri-areolar). Inframammary An inframammary incision is made in the natural fold under the breast and is the most common approach to breast augmentation. It has been practiced in the United States for many decades and carries very low risk of complications. This incision location is best for larger pre-filled (silicone) implants. Although incisions under the breast are usually discreet, the natural crease may be altered by the size or shape of your implants and thus the incision scar may be visible after surgery. This may be of particular concern if you have a tendency toward thick scars when healing. Inframammary incisions are also much closer to the actual implant. If the incision becomes infected, the implant may be at risk. Peri-areolar A peri-areolar incision follows the bottom edge of the areola, and is discreet, often indistinguishable from the natural edge of the areola after the incision is completely healed. The incision is typically four to five centimeters in length, and allows good access to the pocket where the implant will be placed. The incision is also relatively far from the implant, reducing risk of complications should an infection develop at the incision site. Women who are considering having children in the future and plan to breastfeed should discuss the possible risks of a peri-areolar incision with Dr. Hlavacek during consultation, as this incision carries the risk of loss of nipple sensation, as well as possible changes in the ability to breastfeed. 8
9 Transaxillary A transaxillary incision is made in the armpit and is the least visible of the possible incision sites, leaving no scars on the breasts. Transaxillary incisions typically heal very well and are usually much smaller than inframammary or peri-areolar incisions. An added benefit of transaxillary incisions is that breast augmentation performed through this incision is done with the assistance of an endoscope. An endoscope is a tool that allows Dr. Hlavacek to use video monitoring throughout the entire procedure. By directly visualizing every step of the breast augmentation surgery, Dr. Hlavacek is able to make the most precise placement and surgical decisions possible. Endoscopic transaxillary incisions also have a significantly reduced risk of excess bleeding. Implant placement You have two choices for the placement of your breast implants. Implants may be positioned either above (subglandular) or below (submuscular) the pectoral muscles. The ideal placement will be discussed during your consultation, but the decision is typically guided by your existing breast tissue, the natural shape of your breasts, and your augmentation goals. Submuscular With submuscular placement, you will not feel the breast implants as easily, and the final results will look and feel more natural. This position makes breast imaging, including mammography, easier. However, recovery from submuscular placement tends to take a bit longer, and if there is need for re-operation, this placement may make such a surgery more difficult. Subglandular Subglandular implant placement is above the muscle but below the natural breast tissue. Surgery is typically shorter with faster recovery. Above-the-muscle placement also allows easier access should future surgery be necessary. The downside to subglandular placement, however, is that the implants will be more easily felt through the skin, mammography may be slightly more difficult, and there is increased risk of capsular contracture. 9
10 The day of your breast augmentation surgery Be sure to get plenty of rest the night before your breast augmentation surgery, and follow Dr. Hlavacek s pre-operative instructions. You may have limitations on what you can eat or drink the night before and morning of surgery, and may also need to start or stop medications prior to surgery. The morning of surgery, have a friend or family member drive you to our surgical facility. Dr. Hlavacek will meet with you prior to surgery to review and confirm your choices. He will also mark your body to confirm your selections and guide your surgery. You will have the opportunity to ask any last-minute questions or address any additional concerns. Your surgery will take from one to several hours depending on the options you have chosen. Your surgery will take place under general anesthesia, meaning you will be asleep for the entire procedure. If you have had a negative reaction to anesthesia in the past, be sure to let Dr. Hlavacek know during your consultation. Dr. Hlavacek will perform your breast augmentation using the decisions you specified during your consultation. If you chose saline implants, Dr. Hlavacek will fill the implants as closely as possible to the size you chose, and he will make fine adjustments to ensure symmetry. After Dr. Hlavacek has finished placing your implants, he will close the incisions and apply sutures, dressings, and a compression garment or bra. After surgery you will be very sleepy from receiving general anesthesia and will require someone to drive you home. Prior to going home, you will be monitored following surgery to ensure that you are on the path to healing and are stable enough to go home. 10
11 Breast augmentation recovery Recovery from breast augmentation takes time, although you will have a good idea of your overall results right away. In order to ensure that your recovery goes smoothly, plan ahead. You will need a trusted friend or family member to drive you home from surgery and to stay with you for at least the first night after surgery. Ideally, arrange for help for the first week or two following surgery, especially if you have young children. Your activities will be limited for the first several weeks. You will be unable to lift more than five to ten pounds right away, and will not be able to lift your arms above shoulder height for several days. In addition to planning for help during your recovery, consider the timing of your procedure. If you plan to undergo breast augmentation before a significant event, perhaps a wedding, reunion, or vacation, schedule your surgery as far in advance as possible in order to give yourself adequate time to heal so you can look and feel your best. Immediately after surgery Breast augmentation surgery is done on an outpatient basis, meaning you will go home the same day as your surgery. Your chest will be wrapped with surgical dressings, you will be wearing a surgical bra or compression garment, and you may have temporary drains in place. These will help to reduce swelling and bruising and allow any fluid accumulation to drain away from the surgical sites. 11 You will see results right away, but your final appearance will be somewhat obscured by bruising and swelling. You should also expect to have discomfort and some pain, but these are usually well controlled with oral pain medications. Although you will be able to walk immediately after surgery, you should rest as much as possible for the first few days.
12 The first few weeks after surgery In the first few weeks following your breast augmentation, you will have post-operative appointments with Dr. Hlavacek to monitor your healing and recovery. Your dressings will be removed a few days after surgery, and your stitches will come out approximately one week later. You will continue to wear a compression garment or support bra for several weeks as you heal, and will need to limit your activity. Dr. Hlavacek will gradually release you to more and more activity, but you should avoid anything intense or with a bouncing motion for at least six weeks for example, you will need to refrain from activities such as jogging, running, or horseback riding. Recovery times vary from patient to patient, but by following Dr. Hlavacek s instructions as closely as possible, and protecting your breasts from possible injury or impact, you will help speed along your recovery. Your swelling and bruising will last for several weeks, and the incisions will heal and fade over the course of a year s time. Your full results will be visible after several months. 12
13 Risks of breast augmentation surgery Breast augmentation is considered to be major surgery, but if you follow your recovery plan and keep all post-operative appointments, you can reduce your risks. However, despite the track record of safety with breast augmentation, risks do exist. Your level of risk will depend on your overall health, whether or not you smoke, how well you follow your recovery plan, and how your body has reacted to prior surgeries. Breast augmentation risks include: Discomfort, bruising, and swelling Infection Asymmetry Changes in skin or nipple sensitivity Adverse anesthesia or medication reaction Excess scarring Capsular contracture Hardening of the breast Leakage or rupture of the implant Although leakage and rupture are real risks, most patients never experience a leak or rupture, or need to have their implants replaced. Should a leak or rupture occur, Mentor Corporation guarantees all implants, and additional warranties are available depending on whether you select saline or silicone implants. A leak or rupture will require removal of the leaking implants with the option to have the implants replaced. 13
14 A note about performing your monthly self-breast exam after breast augmentation Although implants have been proven to have no increased risk for breast cancer, they also do not protect you from breast cancer. Be sure to continue performing your monthly self-breast exams. Dr. Hlavacek will provide you with specific instructions on how to perform a proper exam with breast implants. This will include learning to recognize the margins of your implants and being able to differentiate between your natural breast tissue and the implant. When you have your routine mammogram screenings, you will need to let the mammographer know that you have implants in order to ensure an accurate examination. Report any abnormalities right away to Dr. Hlavacek, your OB/GYN, or your primary care doctor. While most abnormalities turn out to be harmless, your health is of the utmost importance and no concern is too small to be taken seriously. 14
15 Take the next step If you would like to learn more about breast augmentation and your options, call Kansas City Surgical Arts today to schedule a consultation with Dr. Hlavacek. We want to ensure that you have all of the information and support you need to make informed decisions every step of the way. Call us today at We look forward to hearing from you. 15