Breast Surgery
Every breast enhancement patient is different, and we pay close attention to the specific needs of each patient we see. Our goal is to understand what will work best for you.
Visit our procedure pages listed below for specific info for each type of surgery, or read on for detailed descriptions of our process and patient care.
The Consultation
The pursuit cosmetic improvement begins with the first consultation. All cosmetic consultations are with Dr. Frank, not a patient coordinator. Yes, it takes more time for the doctor but, it’s our belief that you want and need to hear about the surgery from the person who’ll be doing the surgery. Few practices do this, but we don’t feel we can get to know our patients in the five-minutes of face time some surgeons give their patients in what they call “a consultation”.
We believe it’s essential to listen to the patient – not only to discuss the procedure and its inherent risks, but to tailor the discussion to the factors that make each of us different and challenging. A careful examination is also directed toward explaining to the patient what positives and negatives her unique anatomy brings to the table.
At the end of the consultation, you will receive a price quote. This quote is for everything except your postoperative medications. Again, not to criticize our colleagues, but giving a patient the “surgeon’s fee” without the cost of surgical bras, anesthesia, operating rooms, postoperative visits, etc. has become far too common and unfairly reflects a price far less than your final cost. When you leave our office, you’ll know the bottom line.
Sizing
At a second visit is needed by virtually all cosmetic patients. At that visit consent forms are reviewed, a detailed description of the anticipated recovery is discussed and preoperative photographs are taken. For breast augmentation patients, a sizing is also done.
In talking to patients who have undergone surgery elsewhere, the single most common complaint was: “I was told I’d be a particular cup size, and I’m not that size.” When we asked these women how they selected their implants, some said they asked for a particular cup size and were told not to worry the implant would be picked for them. Others were told to put rice in bags and to calculate their preferred implant size based on the volume of rice. Others were shown computer simulations which supposedly showed what they could expect postoperatively.
In this practice, we do sizings by putting patients in their postoperative bra and letting them try sizer implants in the bra with a top and in the bra alone. While we won’t claim this is a perfect means of selections, it does give patients the opportunity to see the difference 50 or 100 ccs makes in their final appearance. We offer our advice when it comes to the final decision but, firmly believe that the patient not the spouse, significant other, or doctor is the one who needs to be happy with the ultimate choice. We offer all patients the opportunity to come back in before surgery a second time, if they wish to confirm their decisions.
Implants
We use saline implants made by Mentor and Inamed (formerly McGhan). While some plastic surgeons use one brand exclusively, it has been our experience that some women “fit” better in one brand or the other. Both manufacturers stand behind their products with generous warranties and both have proven time and again their safety. We do not use “lesser” brands such as PIP or Silimed which are cheaper but do not have the track record of Mentor or Inamed. In more petite patients who desire larger implant sizes, high profile implants may be an alternative. In most cases, when implants get larger they also get wider.
In more petite patients this can lead to the implant extending into the armpit. High profile implants offer more implant volume with a narrower base giving the desired volume without the negative effects of traditional implants.
We strongly believe in overfilling of saline implants. The tendency of saline implants to ripple is well known and in some patients it can be not just felt but seen when the patient bends forward. Placing the implant below the muscle is certainly a consideration to minimize rippling but, overfilling the implant by 10% can turn a good result with palpable rippling to a great result without it.
Occasionally patients ask about anatomic (teardrop shaped) implants. The plastic surgical literature is replete with cases in which these implants have rotated within the pocket resulting in a “strange” looking result which often needs to be corrected surgically. For this reason, we, and 86% of plastic surgeons nationally, prefer round implants.
Incisions
Dr. Frank has extensive experience with each of the three standard implant incisions: inframammary, periareolar and transaxillary. Each has its advantages and disadvantages. The incisions are typically small, well concealed and closed with dissolving sutures which do not need to be removed. To date, we have not seen the advantage of the TUBA technique when considered with its limited exposure and the inability to make revisions using the original incision.
Implant placement
Subglandular implants (over the muscle)
When implants were first introduced, most were placed under the breast but over the chest wall muscles. In patients who are small breasted, we place the implant over the muscle, which results in a very round appearance to the upper portion of the breast. Some patients complain of a “fake” or “Baywatch” appearance and others can have visible rippling over the cleavage. For these reasons, we generally prefer subglandular implants only in patients with enough of their own breast tissue to minimize these negatives.
Submuscular implants (under the muscle)
Most of the patients we see prefer a more natural postoperative appearance. In these patients, we often recommend submuscular implant placement. Placing the implant under the muscle not only improves the postoperative appearance. Capsular contracture (scar tissue formation around the implant which can distort the shape of the breast) is much more common in implants over the muscle. Mammograms are easier to read when the implants are under the muscle and the likelihood of being able to breastfeed postoperatively is increased. The benefits must be weighed against more pain in the immediate postoperative period.
Stryker Pain Pump
In an attempt to make the postoperative recovery more comfortable for our patients, we are now pleased to offer the Stryer Pain Pump as an option for patients having breast augmentation. The pump is designed to supplement pills for pain control, not replace them. The pump was developed for pain control in total joint replacement patients and has been used for cosmetic surgery patients for several years.
The pump consists of a thin tube (similar to an epidural catheter) placed in the implant pocket at the time of surgery. This catheter is attached to a reservoir which is filled with a long acting local anesthetic. Over the course of the first two days after surgery the pain medications is delivered to the place where it is most needed resulting in a significant decrease in oral narcotic use. A regulatory valve prevents overdose. The catheters are typically removed by the patients once the reservoirs are empty.