Primary Breast Augmentation (Ep 43)

This show is all about primary (or first time) breast augmentation - the most popular plastic surgery procedure in the United States year after year!  
Here, we will discuss the procedure itself, the operation, recovery and risks.  Like with any plastic surgery procedure, the most important aspect of the process is having a goal - what you are looking to accomplish with respect to the "look" you would like to have when surgery is over.  I discuss the various choices and decisions that need to be made, such as incision location, implant size, shape, and type.

We have done a bad job as plastic surgeons making breast augmentation seem complex - it's NOT.  Based on what you want to achieve, the decisions - such as implant size, type, projection, location, incision, etc - really make themselves.
Please note - I got caught up talking about the risk of infections at the end, and left out the small (<1%) risk of hematoma as one of the risks that I discuss. Keep that in mind when you listen to that section.

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One of the most common plastic surgery procedures in the United States year over year is a primary breast augmentation. And if you're listening to this or watching this, then you are undoubtedly one of the women who is interested in this procedure. And so in this show, what we're going to do is really talk about how to approach a consultation for a primary breast augmentation, some of the ins and outs of the procedure, recovery, and the risks that are involved in having a primary breast augmentation.

It's interesting that us as plastic surgeons have made the process of primary breast augmentation so complicated. It really is fairly easy. In my practice, the main focus is what you want after it's all said and done.

At the end of the day, what do you want to look like when we're done? And that really, if you have that goal in mind, very similar to any other procedure in plastic surgery, if you know where you want to end up, working backwards to get you to where you want to be isn't that difficult. What we have to remember, and I think one of the most important things in breast augmentation, especially when you're in the research stage, is to understand that your body is largely going to dictate the final result.

You can, between your chest wall, so your ribs, your rib cage, muscles, your breast tissue, and your skin, and how your breast is shaped, a lot of that we can tweak to get to your final result, but there are certain things that we just can't change. Rib cage, asymmetries, differences in sizes and shapes, some of those can be tweaked, but they can't all necessarily be changed to make a kind of perfect breast augmentation. Perfect final outcome.

And that's something that is really important to discuss during the consultation, during the examination, that we can talk about where you want to end up, and the difference between the one picture that you bring in that you say, okay, this is what I'm looking for, and where you're starting, we can kind of bridge that gap. Understand that where you're starting is going to determine where you want to end up, or where you're going to end up, and that knowing where you want to end up is probably the most important decision that you can make before coming in to see me or any other plastic surgeon. A lot has been made with breast augmentation about making different choices.

Incision location, implant size, implant shape, implant type. Do you go saline or silicone? Do you go textured or smooth?

Do you go high profile or moderate plus or ultra higher? And those decisions largely all make themselves when we decide where you want to be, and we know where you're starting. A lot of those decisions are just going to make themselves.

So it's important to know the terms, but a lot of times we'll talk in the consultation about the implant profile and the implant type that is going to get you the result that you want based on where you're starting. Breast augmentation from a procedure, from a surgery standpoint, really is not terribly involved from a time perspective. So most breast augmentations can be completed.

The primary breast augmentation, we're not doing anything else, can be completed within 30 minutes to an hour. My preferred approach is through the inframammary crease, so your breast crease. You have an incision that's about this long in your breast crease that we can use to place that implant where we want to place it.

Nine times out of ten, that is going to be a smooth implant under your muscle, but there are instances and there are patients where an above the muscle implant with a textured device as opposed to a smooth implant is going to get you the best result and the result that works right for you. Now, there are trade-offs to the smooth versus the textured, the over versus the under the muscle, and those are things, depending on where you want to be, that we can talk about during your consultation. Like I said, the procedure takes about half an hour.

It's an outpatient surgery. In my practice, you're completely asleep. You are in and out of the surgery center typically within about two hours.

Your total time in our surgery center here in my office is about two to two and a half hours. You're drowsy most of the day. You get up, kind of once you're walking around doing normal things, you can go and sit down at a restaurant and be totally a zombie on pain medicine or hurting.

Breast augmentation really does not hurt that bad or shouldn't hurt that bad if it's done correctly. You'll see on the internet all sorts of terms, the quick recovery, the flash recovery, the 24-hour recovery. What these are are all everybody's little pet name for doing a breast augmentation largely in the way that Dr.

John Tebbets from Dallas described doing an augmentation kind of step-by-step, very clean, no bleeding, and it allows you, the patient, to get back to a normal life without a lot of discomfort. That's the way that I was trained. That's the way my implants are selected and the technique that we use to put the implants in.

In terms of the rest of your recovery after that first day, I don't like implant patients to be lifting anything over about 10 pounds or bouncing. Whatever bouncing means to you, typically running, elliptical, if you're into trampolines and things like that, don't do it for about six weeks. Things like a peloton bike, walking, things like that are fine.

I just don't want that chest muscle pushing on our implants or our implants to get pushed around for those first six weeks while that early capsule is forming. For that reason, six weeks, no lifting, no bouncing. The other point that I wanted to make is time off of work.

Now, if you have a job that requires a lot of heavy lifting, then you're really going to want to minimize that for about six weeks. You're not going to want to have to go pick up boxes. You have patients who work for the Postal Service or work for UPS or as delivery women for different companies, and I don't want you carrying 25- and 30-pound boxes for eight hours a day a week after your breast augmentation.

Likewise, nurses, don't go trying to pull people down the hall. Don't move people around the hospital or in the operating room a couple of weeks after surgery because you could cause a problem with your surgery. Typically, though, for most people, if you have a computer job, a desk job, or something that doesn't require a lot of use of your arms, then you can get back to work typically after a long weekend.

Wednesday or Thursday surgery, you're back to work on a Monday. You'll still be a little bit sore, but it is manageable with Motrin and Tylenol, if that. So, time off of work from this really isn't significant.

We can have an entire podcast talking about risks, but typically with primary augmentation, your risks are capsular contracture, implant malposition, which means the implants don't stay where we want them to, infections, which fortunately are very rare, but when they happen, they often result in the loss of your implant. We essentially have to take it out, let you heal, and start over. That risk is less than 1%, and so is not something that needs to be front of mind, but you have to know any implant we place can get infected.

That's why we are very carefully operating with sterile technique. We're very careful not to touch the implants. We use antibiotics in an appropriate manner to keep you from getting an infection, but that doesn't mean we're going to completely eliminate the possibility, so just know that that's out there.

Other things that can happen, scars cannot heal well. Implants can end up shifting over time. Some of those things are due to your own genetics.

We try and eliminate the surgical variables there by doing things very precisely, doing things the same way every time, but the human body is the human body, and we can't predict healing for a lot of people, so know that when we elect to have surgery, you kind of buy the potential for the complications, even though they are fortunately, in this instance, are very low. So I hope this gives you good, solid information about primary breast augmentation, which is one of the most common plastic surgery procedures in the United States year over year. A lot of this is individual surgeon to surgeon, especially the recovery, the limitations, and things like that.

I'm telling you what I do for my patients. If you're not having surgery with me, you'll want to make sure that you discuss with your surgeon exactly what he or she would like you to do in the recovery phase, how much time they recommend you taking off of work based on their technique and how they plan and execute their operation. This should give you a broad overview, but do discuss with your surgeon before you start exercising or before you go back to work.

I hope you've enjoyed this. Please let me know. You can drop us an email, info at drjasonhall.com or reach out to me, Dr. Jason Hall on Instagram DMs. Thanks y'all.