Breast Augmentation is one of the more common procedures performed by Plastic surgeons. Breast implants were first developed in 1963 with the production of the silicone gel filled implant. Since then, multiple companies, each with various implants, have come and gone. Currently there are two primary implant companies based in the U.S. named Mentor and Allergan. Both companies produce implants with a silicone shell. These implants are filled with either saline (salt water) at the time of surgery or are pre-filled with silicone. Multiple studies have confirmed the fact that silicone implants do not cause and are not directly associated with any immunologic diseases or with cancer. Just as there is a tremendous amount of variability in the size and shape of women's breasts, there are multiple options that must be considered when having a breast augmentation. The primary issues when having a breast augmentation are the following: shape of implant, size of implant, location of implant placement, access incision, type (Mentor vs. Allergan), and whether the implants are smooth or textured.

Who is a candidate for breast augmentation?
Women who would like to enlarge their breasts to improve the overall balance and proportions of their body are ideal candidates. Women may wish to "fill out" their clothes better. Commonly, women may feel that their breast have gotten smaller after pregnancy and would like to return to their pre-pregnancy size. Lastly, some women are very asymmetric in size and would like to be more even.

How long does the surgery take?
Dr Wigoda generally performs a breast augmentation in 60 to 75 minutes.

What type of anesthesia is used?
Dr Wigoda performs this procedure under general anesthesia with a board certified anesthesiologist present at all times during the procedure. This procedure is performed in a fully equipped and accredited operating room. You will be placed on the operating room table in a supine position (on your back). After the anesthetic is given, your skin will be cleaned with a disinfectant and sterile drapes will be placed over you. An intravenous antibiotic is administered. Dr Wigoda will make an incision, create the pocket (space) for the implant, place the implant, fill it with saline (unless using a silicone gel implant), and suture the incision closed. Only a minimal amount of blood is lost. Blood transfusions are not required. After surgery you will go to a recovery room until you are fully awake and comfortable. You will be discharged to home. Someone else will need to drive you home. You will be given pain pills, a steroid pack for swelling, muscle relaxants, and antibiotics. Dr Wigoda will typically want to see you back within 1 to 2 days for a quick check and then at one week after surgery for suture removal. Dr Wigoda will continue to see you periodically over the next 3 months. You will follow-up with Dr Wigoda on a yearly basis.

Are there any women who should not have breast augmentation (i.e., Contraindications)?
1) Women who are at very high risk for breast cancer based on their own past history or their family history should be discouraged from BA. 2) Women who are not willing to take a chance on losing some of their nipple sensation or their ability to breast feed. 3) Women with significant ptosis (sagging of the breast)- see breast lift/mastopexy 4) Women who have had radiation to their chest for cancer

What are the potential risks with this type of surgery?
There are many potential risks with this procedure but overall, they are not common. In addition, there is only a very small risk of a serious complication. Complications include capsular contracture, rupture of implants, asymmetry of breast mound, asymmetry of nipple/areola, loss of all or a portion of nipple sensation, loss of or decreased ability to breast feed, wide scar, extrusion of implant, palpable implant, malpositioned implant (too high or too low), numbness on breast, upper arm numbness with axillary approach, infected implant requiring removal, pneumothorax (collapsed lung), rotated anatomic implant, skin rippling, pain, nipple hypersensitivity

Can breast implants cause cancer?
There have been countless studies that have researched this very topic and the answer has been no. There has never been a proven link between breast implants and cancer.

What effect do breast implants have on breast mammograms?
Breast implants will obscure some breast tissue on mammograms. Special views have to be taken to try to see as much tissue as possible. You should let your mammographer know that you have implants so that they can take these special views. Studies have found, however, that women with implants who develop cancer are not diagnosed any later than women without implants.

Will I be able to breast feed after breast augmentation? Will silicone leak into my milk?
Breast augmentation may affect your ability to breast feed. Many women with implants, however, have successfully breast fed. There is no risk to your child with breast feeding if you have saline or silicone gel breast implants.

What are the different shapes that implants come in?
Implants primarily come in two shapes, round or anatomic. The anatomic implants are tear drop shaped. They are similar to the shape of a breast with more projection inferiorly and less superiorly. Round implants are perfectly round. Some surgeons feel more comfortable with one type over the other and will almost universally use one type. Other surgeons will vary the shape of the implant based on their perception of the needs and goals of the individual patient. With anatomic implants there is less room for error when dissecting the pocket where the implant will lie. The surgeon must be more precise. If the pocket is made too large, the implant may rotate. While it is O.K. for a round implant to rotate, it is not for an anatomic. The shape of implant used is frequently at the discretion of the surgeon. There is no universal opinion on whether one shape is better than the other. There are also variations in projection with round implants (“high profile”, “mid-profile”, etc)

Are there different size implants?
Yes, there are many sizes. The size of the implant used will depend on how much breast tissue is present and the goals of the patient and surgeon. The majority of women undergoing breast augmentation would like their breasts to be fuller while not having the appearance of being obviously augmented. There is a limit to how large an implant can be and the breast still have a natural appearance. It is possible to place very large implants in almost any patient but at the cost of having breasts that do not appear natural. It is important that patients discuss their desires with respect to size very carefully with their surgeon. The easiest way to communicate to your surgeon regarding this issue is to show him/her photos of topless women, showing women who in your opinion are too large, just right, and too small. If your goal is for a natural look, one key variable in deciding on the size of the implant is the width of your chest. Look for women in the photos that have a similar chest size (not breast size) to you. Remember, however, that your breasts are different from anyone else's. They will be different in size, shape, feel, elasticity, nipple/areola size and position, distance from each other, symmetry, etc. The photos are simply to allow for better communication. Do not expect that your breast will look exactly like someone else's no matter how similar you might think you are to them.

Where exactly are the implants placed?
Implants may be placed in one of two locations. They may be placed above the pectoralis muscle, deep to the breast tissue ("subglandular") or under the pectoralis muscle just above the chest wall/ribs ("subpectoral"). Women who have a moderate amount of breast tissue are candidates for a subglandular placement. The majority of women, however, do not have sufficient breast tissue and are better off with a subpectorally placed implant. In order to place the implant deep to the muscle, the lower portion of the muscle is sometimes partially cut during surgery. The advantages of a subpectorally placed implant are a decreased rate of capsular contracture and a decreased incidence of implant wrinkling. In addition, less breast tissue is obscured on a mammogram.

Where is the incision made to place the implant?
There are generally three different incisions which can be made for placement of a breast implant. Implants can be placed above or below the pectoralis muscle from any of these incisions. The three options are 1) below the breast in the fold ("inframammary"); 2) around the lower half of the areola ("periareolar"); 3) In the armpit ("transaxillary"). Some patients may be better candidates for using one incision over the other but most patients are good candidates for at least two if not all three of the incisions. The patient should decide where they would prefer to have their scar. The good news is that in the vast majority of cases the scars heal well and eventually, will be minimally noticeable. The most common incision used at the present time is the inframammary. With the patient sitting straight up or standing, the scar is often not visible as it is blocked from view by the breast. It is more noticeable when the patient lies down. The periareolar scar, if placed correctly, heals very nicely and is often difficult to find even by a trained eye! In order to use this incision the areola has to be a minimum size (Usually 3.4-4.0 centimeters across). The transaxillary approach has become more popular with the introduction of endoscopic surgery. The disadvantages to this access site are that for women who enjoy wearing sleeveless shirts during exercise (ie, during aerobics, lifting weights, etc) or bathing suits during the warm months, the scar will be noticeable initially when they raise their arms. Finally, all patients must realize that if their breast implants need to be removed for capsular contracture in the future, most surgeons will do this through an inframammary incision as this is the best way to remove the capsule that has formed around the implant. If their original implants were placed through a different incision, they will now have scars in two locations.

How long is the incision? Will it be noticeable?
The incision, regardless of location is usually 3.5-4.5 centimeters long. The incisions usually heal very nicely and may be difficult to detect after 6 months. Because silicone gel implants are pre-filled, the incision used to insert them may be larger than a similar size saline implant.

What is the difference between a Smooth and Textured implant?
Implants may be smooth or have a textured surface. The textured implant surface feels almost like sandpaper. The textured surface has been shown to decrease capsular contracture. In addition, it minimizes the amount of movement of the implant. This is a particular advantage if one is having implants replaced. One disadvantage of texturing is an increased incidence of wrinkling of the implants and a slightly higher deflation rate. The textured surface is not palpable through the skin.

Which company's implants should I use (Allergan vs. Mentor)?
Both companies are large companies with a relatively long experience in the breast implant business. Both produce reliable products and have warranties on their products. Their current policy is to replace implants that rupture within 10 years for free. The companies also will pay a set amount toward additional surgery.

Are drains placed?
Dr Wigoda does not place drains in straightforward (first time) breast augmentations. Dr Wigoda may place one drain in each breast implant pocket if he is removing and replacing an implant and there is a risk of fluid accumulation. (like when removing a hard capsule) The fluid will drain into a collection device that can easily be emptied. The drains will usually be removed 1 to 3 days after surgery. Drains are placed and removed at the discretion of the surgeon. Removal of the drains is not painful.

What happens before I have the surgery?
You will first have a consultation with Dr. Wigoda to discuss your particular case. Once you have decided to proceed with the surgery and have scheduled a date, you will return for a second visit at which time Dr. Wigoda will review the surgery with you, photos will be taken, consent forms will be signed, and further instructions and prescriptions will be provided. Full payment is made prior to surgery (or financing is arranged). You will have lab tests drawn and an electrocardiogram done by your primary care physician (or we will recommend where to do this) one to two weeks prior to the surgery.

What happens on the day of surgery?
You will arrive at the office surgery center. You will not have eaten or drank anything since midnight the night before. You will be checked in and your vital signs will be taken. You will put on a gown. An intravenous line will be started. Dr Wigoda will mark your breasts with a marker. You may be given a sedative in your I.V. to help you relax before you are taken back to the operating room.

What happens after surgery?
Bandages will be placed and your chest will be wrapped in an ace bandage. You will recover for 1 to 2 hours in the recovery room. You will then be driven home by a friend or family member. Your activities will be limited for the first few days. It is advisable that you not drive for at least 3 to 5 days after surgery. As the pain and swelling decreases you will be able to resume normal activities. Dr Wigoda will allow you to resume strenuous exercise with your arms after 4 to 6 weeks. You may be able to resume exercise with your legs (walking, jogging, bicycling, etc) slightly sooner.

How much bruising, swelling, and pain is there?
After surgery, it is expected that the breasts will have a moderate amount of swelling. Most of the swelling will resolve over 2 to 4 weeks. The breasts will appear slightly larger than they will ultimately be because of this swelling. Both breasts may have some bruising although it is generally mild and resolves over 1 to 2 weeks. The amount of pain post-operatively is very patient dependent. Some patients will experience mild discomfort, particularly with raising the arms and with increased activity. It is unusual to have significant pain. The vast majority of patients report the pain as tolerable. Some patients have reported difficulty getting comfortable when going to sleep for the first 1 to 2 weeks. Patients may also experience hypersensitivity of their nipples. For the most part, all of the pain and discomfort resolves completely with time, generally 2 to 4 weeks.

When can I get back to work? When can I drive a car?
For sedentary work with minimal physical activity you can expect to go back after 3 days. For moderate activity, it will take about 7-10 days to be comfortable. For manual type labor with heavy lifting, you will need to wait 2 to 3 weeks. It will take 3 to 7 days to be able to drive safely, depending on your pain tolerance, how much pain medication you are taking (if any), and whether you drive an automatic or manual transmission automobile.

Will there be stitches that have to come out?
Dr Wigoda will remove the sutures after approximately 7 days.

When can I resume sexual relations?
You may want to wait at least one to two weeks until your incisions are well on their way toward healing. Early sexual activity may prolong your soreness and discomfort.

When will I see the final results?
It will take 3 to 4 weeks for most of the swelling to resolve and probably 3 months for all if it to resolve. After this you should have a reasonably good idea of what the final look will be. Your breasts may still be a little firmer than they will ultimately be, however. It often takes months before the breasts and the implants feel very soft and natural. It also takes about 3 months on average for the implants to drop to their final position if they are placed under the muscle.

What is different about the way Dr. Wigoda does the surgery?
Dr. Wigoda was fortunate to train with the pioneer of a new technique for breast augmentation in Dallas. The technique he learned and uses causes minimal bleeding, minimal swelling and bruising, and minimal pain. The vast majority of patients are quite surprised afterward at how little discomfort they have and how quickly they return to normal activity. Most patients return to work within a few days. Most patients have no or very minimal bruising. Patients are instructed to raise their arms straight up on the evening of surgery. Often times, patients report that their friends (who had surgery elsewhere) suffered for a month or more with significant pain, were not allowed to raise their arms, had significant bruising, etc. This is not the case with the technique used by Dr. Wigoda. Finally, with Dr. Wigoda’s technique for skin closure, scars are typically minimal and are often difficult to see once they have fully matured.

Please take a moment to contact Dr. Wigoda with any question you may have