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Breast Augmentation / Breast Implants : An Informed Consent Presentation
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Breast Augmentation / Breast Implants : An Informed Consent Presentation

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This is a powerpoint presentaiton given by W. Thomas McClellan, MD FACS, a Board Certified Plastic Surgeon who specializes in breast augmentation. This presentation is unique and critical because it ...

This is a powerpoint presentaiton given by W. Thomas McClellan, MD FACS, a Board Certified Plastic Surgeon who specializes in breast augmentation. This presentation is unique and critical because it gives patients detailed information about what is important regarding breast augmentation. For example: How to choose a surgeon, what is important in the operating room, postoperative care, how to pick a size, type of breast implant.

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Breast Augmentation / Breast Implants : An Informed Consent Presentation Presentation Transcript

  • 1. Breast Augmentation: Making an informed decision W. Thomas McClellan, MD FACS Board Certified, American Board of Plastic Surgery www.mtpsa.com Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 2. Why is this presentation important? • I want you to be an informed consumer. • Create an outline to discuss procedure with your plastic surgeon. • Better understand the surgery, implants, risks, complications, and post-op care. • Help you to generate questions. Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 3. Introduction • Statistics • 316,948 breast augmentations in 2011 • #1 cosmetic procedure performed for women between 22 and 40 • American Society of Aesthetic Plastic Surgery 2011 Statistics www.surgery.org Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 4. Discussion Points • Choosing a Plastic Surgeon • Selecting an Implant Size • Type of Implant (Memory Gel or Saline) • Breast Cancer and Implants • Incision Location Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 5. Discussion Points • Above / Below Muscle • Surgical Facility and Anesthesia • Intra-Op Technical Caveats • Post-Op Care • Your Medical History / Risks / Complications Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 6. Choosing a Plastic Surgeon • Board Certified in Plastic Surgery • Look for the ASPS logo - Minimum 6 years of focused Surgical Training after Medical School - Unparalleled written and oral examinations - Extensive experience with breast augmentation evaluation, surgery, post-op care, and complications. - Operate in accredited surgical facilities. • Don’t permit an Ob/GYN, ENT, or other non- qualified doctor perform your breast augmentation. Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 7. Choosing a Plastic Surgeon • Questions to consider: - How many does your plastic surgeon perform yearly? - Photo Examples? - Does a PA, Nurse, or Trainee operate on you during surgery? - Can you talk to a few of their former patients? - Complications? • Make sure you feel comfortable with the physician and staff. Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 8. Selecting Implant Size • Choosing proper size important for a lasting result. • Review pictures of similar sized women. • Try on the implants with a sports bra. • Bring a friend or partner to offer advice. • Multiple visits help make best decision. • Size chosen is size you receive in OR. Hvilsom, Gitte B. et al. Local Complications after Cosmetic Breast Augmentation Plastic & Reconstructive Surgery. 124(3):919-925, September 2009. Araco, A et al. Sesitivity of the Nipple Areola Complex Following Breast Augmentation. Plastic & Reconstructive Surgery. 128(4):984-989, October 2011. Adams, W. Breast Augmentation. Plastic and Reconstructive Surgery. 130(4):597e-611e, October 2012 Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 9. Selecting Implant Size • Important Anatomy - Width of the breast and distance between breast - Current breast size - Tissue thickness and elasticity - Sternal notch to nipple distance - Patient height, weight, hip shape - Your current breast asymmetry Hvilsom, Gitte B. et al. Local Complications after Cosmetic Breast Augmentation Plastic & Reconstructive Surgery. 124(3):919-925, September 2009. Araco, A et al. Sesitivity of the Nipple Areola Complex Following Breast Augmentation. Plastic & Reconstructive Surgery. 128(4):984-989, October 2011. Adams, W. Breast Augmentation. Plastic and Reconstructive Surgery. 130(4):597e-611e, October 2012 Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 10. Selecting Implant Type Memory Gel Saline Age minimum >22 18+ Size fixed (pre-filled silicone) adjustable (saltwater) Feel softer firmer Visibility less rippling more rippling Weight lighter heavier Incision length 4.5 3cm Rupture silent (MRI to detect) immediate deflation Capsular Contracture greater less Cost $$ $ Every patient is different. Please consult with your surgeon to determine the best implant choice for you. Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 11. Breast Cancer and Implants • Risk of breast cancer is not increased with implant • Can’t see all breast tissue on mammogram - requires extra view (Eklund displacement technique) to improve visualization • Palpable tumors are more easily detected with implant • Implant doesn’t delay diagnosis of breast cancer • If diagnosed with breast cancer survival rate is the same Handel, N, The Effect of Silicone Implants on the Diagnosis, Prognosis, and Treatment of Breast Cancer. Plastic & Reconstructive Surgery. 120(7);81s-93s, December 2007. Wood, Spear. What do women need to know and when do they need to know it. Plastic & Reconstructive Surgery. 120(7);135s-139s, December 2007 Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 12. Incision • Inframammary - hidden in the lateral breast fold - 4.5 - 5cm long - 9x less capsular contracture = longer lasting result - > retained nipple sensation - < bleeding - precise + gentler on the tissue - incision used in future to exchange implants Weiner, TC Relationship of Incision Choice to Capsular Contracture. Aesthetic Plastic Surgery. 2008 Mar; 32 (2): 303-6. McClellan WT. et Al. The Inframammary Crease. Breast Augmentation Principles and Practice. Ch 5; 2009: 51-6. *I prefer the inframammary incision when appropriate. Please consult your plastic surgeon for the best incision for you. Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 13. Inframammary incision @ 3 months Text Text well hidden in lateral breast fold Scar Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 14. Above or Below Muscle (+/-) Sub-Glandular Sub-Muscular Capsular Contracture higher lower Impact on mammography more less Implant Visibility more rippling less rippling Implant Palpability greater palpability less palpability of edges Implant Location lower higher Pain of Procedure same same Implant Movement no movement + with activity Every patient is different. Please consult with your surgeon to determine the best position for your implant. Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 15. Surgical Facility and Anesthesia • Hospital or Certified Surgery Center - Board Certified Anesthesiologist • General anesthesia with LMA (laryngeal mask airway) - Protected airway with easier recovery - Stable blood pressure reduces hematoma risk - Medications help prevent PNOV and reduce post-op pain - If intra-op difficult, drug reaction, or event arises you are already in the safest setting possible. McClellan, W. et. al. Peri-Operative Blood Pressure Changes Associated with Hematoma and Mammaplasty. Presented ASAPS 2006. Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 16. Intra-operative Technical Caveats • Attention to detail makes the difference • Surgeon does entire procedure. (no PA or student) • Pre-operative antibiotics • Nipple-Areola covered • Precise tissue dissection • Strict Hemostasis (normotensive anesthesia) Adams, W. Breast Augmentation. Plastic and Reconstructive Surgery. 130(4):597e-611e, October 2012 McClellan, W. et. al. Peri-Operative Blood Pressure Changes Associated with Hematoma and Mammaplasty. Presented ASAPS 2006. Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 17. Intra-operative Technical Caveats • Implant and Pocket washed with antibiotic fluid • “No Touch Technique” for the implant + glove change • Sit up to examine size, shape, and symmetry • Three layered closure + Dermabond™ • Early removal of airway (prevents coughing) Adams, W. Breast Augmentation. Plastic and Reconstructive Surgery. 130(4):597e-611e, October 2012 McClellan, W. et. al. Peri-Operative Blood Pressure Changes Associated with Hematoma and Mammaplasty. Presented ASAPS 2006. Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 18. Post Operative Care • Follow-up Schedule - Post-Op day 1, 5, 3 weeks, 3 months • Breast Massage - Important to maintain soft, natural, long lasting result - Start Post Operative Day 1 - Up, In, Down (hold for 5 sec) 5x daily for one week - 3x day for 2 weeks - 1x day for life *This is my preferred postoperative visit schedule and massage regimen.Your treatment plan may vary. Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 19. Post Operative Care • Post-Operative Bra - Cotton Support Bra (hooks in front) - 5 days - No Bra - 1-2 week (patient dependent) - Underwire Bra - Once implant descent is optimal • Activity Level - No lifting > 10 lbs for one week - No working out for 4 weeks *Individual treatment plans varies based on surgery. Make sure to discuss your care plan with your plastic surgeon. Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 20. Your Medical History • Smoking - increased infection and diminished wound healing - quit 2 months prior to surgery and 1 month following • Weight - should be a stable base weight prior to augmentation • Medications - no aspirin, ibuprofen, NSAID, herbal supplements one week before Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 21. Your Medical History • Delayed candidate: - UTI, sinus infection, breast feeding (in last 10 months), weight changes • Not a candidate: (in my practice) - diabetes, heart disease, vascular insufficiency, prior radiation, clotting disorder, autoimmune disease, psychological illness, unrealistic expectations, or other major medical condition Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 22. Risks and Considerations • A small % of women can’t breastfeed after pregnancy • As with any surgery, there is a very small general risk such as: blood clot, heart attack, stroke, and death. - your risk for blood clot is higher if taking birth control pills and/or smoking. • Implants don’t last forever. In time implants will harden, and may become asymmetric; requiring removal or exchange. - change or removal at some point is necessary and another cost. Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 23. Risks and Considerations • If you have a complication related to cosmetic surgery, who would pay for facility charges? • Traditional insurance is unlikely to provide coverage. • CosmetAssure is a cosmetic insurance included in your surgical quote. • Make sure your plastic surgeon offers this option in the very small chance you may need it. Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 24. Possible Complications @ 5 years Capsular Contracture 5.9% Asymmetry 5.2% Sensation Changes 2.7% Infection 1.9% Hematoma 1.5% Palpable Folds 1.3% Rupture 0.5% Others <1% Hvilsom, Gitte B. et al. Local Complications after Cosmetic Breast Augmentation Plastic & Reconstructive Surgery. 124(3):919-925, September 2009. Araco, A et al. Sesitivity of the Nipple Areola Complex Following Breast Augmentation. Plastic & Reconstructive Surgery. 128(4):984-989, October 2011. Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13
  • 25. Questions? www.mtpsa.com Copyright © 2012 W. Thomas McClellan, MD FACS All rights reserved.Tuesday, February 19, 13