McClellan Plastic Surgery Breast Augmentation Booklet
This is a booklet that discusses the risks and benefits of breast augmentation. It discusses choosing a surgeon, size selection, implant choice, over or under the muscle, and potential questions you may want to discuss with your surgeon. Feel free to download the booklet to prepare for your visit with a Board Certified Plastic Surgeon. Please visit our website at www.mtpsa.com for more information. Also visit my youtube channel at www.youtube.com/user/wtmcclellan/
McClellan Plastic Surgery Breast Augmentation Booklet
BREAST AUGMENTATION:Essentials for an Informed DecisionBy W. Thomas McClellan, MD FACS
WELCOMEThe decision to have breast augmentation surgery is both exciting and complex.Women choose breast augmentation for many reasons: to feel more confident,to match their inner self with their outward appearance, or to restore the volumeand shape of their youth. Some women have had a lifelong dissatisfaction withtheir body image, while others have noticed an unfavorable change after illnessor pregnancy that they would like to reverse. Wherever you fit on the spectrumof reasons, our goal is to help you make an informed decision by providingdetailed information in order to stimulate thought and conversation with yourplastic surgeon. While there is much to consider, here you will find answersto most of your questions, along with some information we would like you tocontemplate as you determine if breast augmentation is the right choice for you.
QUICK STATS AND FACTSQuickFacts1 Breast augmentation is the most popular cosmetic surgeryperformed in the U.S.2 Breast augmentation has held the #1 spot since 2006.3 316,948 women in the U.S. had breast augmentation surgery in 2011,up from 101,176 in 1997.4 Silicone gel implants were used in approximately 60% of the procedures.5 Breast augmentation is most commonly performed on women betweenthe ages of 30-39.6 Most women have breast asymmetry with one side commonly smaller than theother. Significant breast asymmetry may also require a mastopexy (breast lift).
• Has extensive experience with breast augmentationevaluation, surgical technique, post-op care, andcomplications • Adheres to a strict code of ethicsASPS members proudly display the ASPS logo. If you do not seethe logo on a physician’s website or printed materials, he or shemost likely isn’t a plastic surgeon. If you see the logo but stillhave questions, don’t hesitate to ask.You know you need an ASPS plastic surgeon, but howdo you choose from there?Here are a few questions to ask your potential surgeon: • How many surgeries do you perform each year? • Can I see photo examples or talk to former patients? • Does a PA, nurse, or trainee operate on patients duringsurgery?Your plastic surgeon should gladly go over all of your questions tomake sure you are well informed about the risks and benefits ofbreast augmentation. A good surgeon will place an emphasis onsafety, patient advocacy, and quality throughout the process.Choose the surgeon who makes you feel comfortable and withwhom you develop a good physician/patient relationship.CERTIFICATION MATTERSPlastic surgeons are the only doctors who arequalified to perform breast augmentationsurgery.Unfortunately, many physicians (and non-physicians)perform breast augmentation with little or no formaltraining. Even if they say they are “board-certified,”it may not be in plastic surgery. It is critical to yourhealth and satisfaction to choose a board-certifiedplastic surgeon.Look for this logo to identifya doctor as a member of theAmerican Society of PlasticSurgeons (ASPS), whichmeans the followingcriteria have been met: • At least six years of focused surgical trainingafter medical school • Certified by the American Board of PlasticSurgery • Operates only in accredited medical facilities • Fulfills continuing education requirements,including patient safety techniquesCHOOSING YOUR SURGEON
IMPLANT SIZEYou’ve probably been contemplating for sometime now what new size you would like to be.We want you to be thrilled with the results, so thereare a few things to keep in mind when choosing theimplant size.First, there is really no uniform “cup size.” Onebrand’s C-cup is another brand’s D-cup. When itcomes to choosing an implant size, try to forget allof your preconceived notions about cup sizes andgo with what looks and feels best for your specificlifestyle, personality, and body type. Are you athleticor sedentary? Shy or outgoing? Your height, weight,current breast asymmetry and the distance betweenyour natural breasts should all be considered. Youshould expect realistic results, so take into account thatif you have a wide chest and your breasts are far apart,a breast augmentation will give you more fullnessbut not necessarily more cleavage. If you have anarrow chest and your breasts are close together, yourcleavage will become more pronounced after surgery.Your plastic surgeon will help guide you into a sizerange of implants that is safe for your body based onyour individual anatomical measurements. You willhave the opportunity to “try on” different size implantsduring your breast augmentation consultation. Try onmultiple implants with a sports bra, and bring a friendor significant other with you for feedback and advice.Sometimes it’s helpful to walk away and think aboutimplant size before making a decision, so multiple visitsare often necessary and encouraged. You should beconfident in your choice.Certification,TheRightSurgeonImplantSize
SILICONE GEL SALINEAGE MINIMUM 22 18SIZE Fixed (pre-filled silicone) Adjustable (saltwater)FEEL Softer FirmerVISIBILITY Less rippling More ripplingWEIGHT Lighter HeavierINCISION LENGTH 4.5cm 3cmRUPTURE Silent (MRI to detect) Immediate deflationCAPSULAR CONTRACTURE Greater Chance Lesser ChanceAPPROXIMATE COST $900/implant $700/implantSALINE vs. SILICONEAs you may have heard or discovered inprevious research, there are two types ofbreast implants: saline and silicone.It’s normal to have questions about the two,and in the chart below we’ll compare andcontrast your options. Saline implants are filledwith a saltwater solution similar to the fluidthat makes up most of the human body, andsilicone gel implants are filled with a cohesive“memory” gel.
INCISIONOne of the goals of a successful breastaugmentation is to have minimal evidenceof the incision.As mentioned in the previous graph, the incision lengthvaries depending on the type of implant you choose. Aninframammary incision is the most common approach. Itis hidden in the lateral breast fold and generally 4-5cmin length. This incision is nine times less likely to have acapsular contracture, which equals a longer lasting result.You may retain greater nipple sensation and have lessbleeding by having this type of incision. The inframammaryincision allows for precise tissue dissection, is gentler on thetissue, and can be used in the futureto exchange implants, resulting inless scarring.In addition, the incision is repairedin three layers with sutures thatdissolve for a smoother healingprocess.SalinevsSiliconeIncisionInframammary incision, 4.5 cm, hidden in the natural fold
PLACEMENT SUB-GLANDULAR SUB-MUSCULARCAPSULAR CONTRACTURE Higher risk Lower riskIMPACT ON MAMMOGRAPHY More LessVISIBILITY More rippling Less ripplingPALPABILITY Greater LessLOCATION Lower HigherPAIN OF PROCEDURE Same SameIMPLANT MOVEMENT No movement Increases with activityBreast implants can be inserted in two ways: sub-glandular or sub-muscular.Based on a number of variables, your doctor can help you decide if sub-glandular (under the mammarygland) or sub-muscular (under the pectoral muscle) will be best for your body and goals. There arebenefits and drawbacks of each, and the chart below should help you begin to weigh your options.*Note: Capsular contracture refers to the natural scar-like tissue that slowly forms around and encapsulates the breast implant over time.
SURGICAL FACILITY ANESTHESIAPlacement,SurgicalFacilityAnesthesiaYour health and safety are of the utmostimportance.It is essential that plastic surgery be performed in ahospital or certified Ambulatory Surgery Center (ASC).An ASC is a facility in which outpatient surgery isperformed on patients who do not require overnighthospitalization. Because general anesthesia isadministered, you will need a friend or family memberto drive you home.Additionally, it’s important that a board-certifiedanesthesiologist is present to oversee your surgery.A laryngeal mask airway (LMA) is often used duringgeneral anesthesia to protect your airway. An LMA isgentler on your airway and requires less anesthesia,which may reduce your hematoma risk and post-operative pain. In the rare event that an anesthesiaissue would arise, you are already in the safest, mostcontrolled setting possible.The Operating RoomAlthough you’ll be asleep when you are visiting theoperating room, it is important to understand aspectsof the procedure that may improve your outcome. Allsurgeons approach breast augmentation differentlyfrom a technical standpoint. Discussing the operationduring your consult will help you determine the rightsurgeon for you.You’re looking for a detail-oriented surgeonwho is adept at precise tissue dissection.Blunt lateral dissection of the breast pocket mayprevent damaging sensory nerves to the nipple,while covering the nipple-areolar complex can reducecapsular contracture and infection. Maintaining aneven blood pressure throughout surgery can lessenhematoma risk. Precise feathered release of thepectoralis muscle inferiorly helps the implant appearmore natural on the chest.To maximize sterility and safety, the implant and pocketshould be washed with antibiotic fluid. Also the plasticsurgeon should change surgical gloves and use a “notouch technique” for implant placement. Sitting youup in the operating room to examine size, shape, andsymmetry, using a three-layered tissue closure, and closepost-operative observation are just a few of the highstandards you should expect when choosing a surgeonand medical team for your breast augmentation.
HEALTH MEDICAL HISTORYMost women who choose to undergo breastaugmentation have a good past medical historythat allows them to safely have the procedure.There are also some current health standards that mustbe met to ensure the best possible outcome: • Ideally no smoking two months prior to andone month following the surgery • Maintain a stable base weight prior toaugmentation • No aspirin, ibuprofen, NSAID, or herbalsupplements one week prior to surgeryA delay of surgery is necessary if you have a urinary tract infection, sinus infection, severe weight changes, or havebreastfed within the last six to eight months. Diabetes, heart disease, prior radiation, clotting disorders, autoimmunedisease, psychological illness, unrealistic expectations, or various other major medical conditions would disqualifysomeone from being a candidate for surgery. Your surgeon will gladly discuss any medical concerns you may have in aconsultation visit.In case you wondered or have heard misinformation, the risk of breast cancer does not increase with implants. Anextra view during mammograms is recommended so that the breast tissue is more visible.
A thorough recovery process is essential for the best results.Make sure you can take time off of work or have help around the house so that you can heal. Each plasticsurgeon may have unique post-operative orders. Make sure to check with your surgeon about specifics.Below are a few of Dr. McClellan’s post-operative instructions for your health and safety: • To help with swelling, use ice packs wrapped in a towel at 20-minute intervals for up to five days. • You may shower 72 hours after surgery unless otherwise instructed. • Take only quick showers with lukewarm water. No long, hot showers for one week. • No exercise until you are released to do so--generally four to six weeks post surgery. • No driving until you are off of pain medication. • Do not lift anything heavier than a gallon of milk for one week. • No pools, lakes, or hot tubs for six weeks. • Take short walks hourly after surgery to avoid blood clots. • Do not massage the incision without the doctor’s permission.As you heal, you may have slight bruising and hypersensitive breasts. This is completely normal and shouldsubside within three weeks. Your final bra size will not be determined for six weeks due to swelling.The implants will need to be massaged daily, and your doctor will give you a specific regimen.RECOVERYMedicalHistoryRecovery
W. THOMAS McCLELLAN, MD FACSDr. McClellan completed his plastic and reconstructive surgery training atthe world-renowned Lahey Clinic Foundation, a Harvard Medical Schooland Tufts Medical School affiliate in Boston, MA.Following the completion of his plastic surgery training he completed aHand and Microsurgery fellowship at Duke University and an AestheticSurgery fellowship at Emory University in Atlanta, which is considered tobe one of the best at focusing on eyelid and cosmetic breast surgery.Dr. McClellan is board certified by the American Board of Plastic Surgery,a member of Alpha Omega Alpha, the national medical honor society,and a Fellow in the American College of Surgeons. He has completedextensive training at some of our nation’s finest institutions and ishonored to have trained with many of the “masters” in cosmetic, hand,and reconstructive surgery.Currently, Dr. McClellan is Chief of Surgery at Monongalia GeneralHospital and also serves as the Vice Chief of the Medical Staff.His practice focuses on cosmetic breast surgery such as augmentationand mastopexy as well as breast reconstruction following cancer.MEET THE AUTHOR AND DOCTOR
You Might Want to Ask YourPlastic Surgeon:• How long have you been certified bythe American Board of Plastic Surgery?• Is the facility of surgery accredited?• Can you explain the incision area,placement, size, shape, type?• Will I need a mammogram prior tosurgery?• Approximately how many breast aug-mentations do you perform a year?• What’s the rate of complications foryour office? (Bottoming out, capsulecontracture, infection, leaking, etc.)• What’s the most common complicationyour patients experience?• What’s your financial policy on repairs?(Bottoming out, capsule contracture,infection, leaking, etc.)• Do you offer CosmetAssure or other“insurance” for cosmetic procedures?• Are all of your post-op appointmentsfree?• Will my consultation fee be appliedtoward the surgery fee?• After surgery, will I be seeing you orone of your assistants?• Do you use a certified anesthesiologistor a nurse?• What type of anesthesia will I receive:general, twilight, or local?• Will I receive anti-nausea medicineduring surgery and a prescriptionafter?• If I have a problem, will the sameincision be used?• Will implants lose shape or sag aftera period of time?• Will I get a device card about myimplants?• Do you fill saline implants only tomanufacturer’s recommendation ordo you overfill?• Do you prescribe antibiotics beforeand after surgery?• Do you recommend taking anythingprior to surgery for swelling andbruising?• Do you perform surgery on womenwho are menstruating?• Will I lose sensitivity to my nipples?• During surgery, do you use implantsizers? If so, how many?• Are there any medications I need tostop taking prior to surgery?• How long until I can resume normal ac-tivities? (Exercising, swimming, sexualactivities, etc.)• Do you use dissolvable stitches?• How long after surgery can I showerand bathe?• How long after the surgery can I driveor pick up an infant (15-25lbs)?• Do you release the medial portion ofthe pectoralis muscle to make the im-plant placement more balanced?• Do you make oversized pockets?• What type of bra should I wear to con-sultation and also after surgery?• Do you rinse the implant withantibiotic solution before inserting?• Do you inject pain meds into the pock-et before closing up the incision?• How long after surgery before I can liftmy arms above my head?• How many people will touch theimplants before placing them?• Will gloves be changed beforetouching the implants?• Do you prescribe muscle relaxantsafter?• If surgery lasts longer than expected,who pays for that?• f problems occur after hours, willyou or another doctor help me?BREAST AUGMENTATION QUESTIONSMeettheDoctorBreastAugmentationQuestions
CONCLUSIONI hope you feel better equipped to make a choice about breast augmentationafter reading through this booklet. If you decide that this procedure might befor you, I invite you to call my office to schedule a consultation. I look forwardto meeting you in person and helping you through this process. If you choose asurgeon in your area I wish you a safe surgery, fast recovery, and excellent results.
Phone: 304-777-4677 • Fax: 304-777-4679 • mtpsa.comMorgantown, West Virginia