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Frequently Asked Questions About Breast Augmentation

Philadelphia, Pennsylvania

What is Breast Augmentation?
Breast augmentation is a cosmetic surgery procedure that increases the size of a woman’s breasts. A saline or silicone gel filled breast implant with a silicone shell is placed under the breast, increasing the breast size. Breast augmentation is indicated for women who are not satisfied with their final developmental size after puberty and in women who have lost size and developed unfavorable shape after pregnancies and with aging. It is also indicated in some cases where the breasts have developed unevenly and there is a significant size discrepancy or asymmetry.

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Who is the Best Candidate for Breast Augmentation?
In many cases, a woman considering a breast augmentation procedure feels her current breast size is too small or disproportionate to her particular body size. Women who have lost a significant amount of weight or have had pregnancies may find their breast size has shrunken and they wish to restore their breast size through breast augmentation. According to Philadelphia plastic surgeon Dr. David Bottger, a good candidate is a woman who is at least 18 years of age and is healthy.

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My Breasts Sag but are not Large. What Can Be Done?
If sagging is minimal, a breast augmentation alone may provide adequate improvement in shape and size.

In cases of more severe sagging, a procedure called a breast lift (or mastopexy) may be performed by removing skin only to tighten the breast envelope and can be performed with and without an implant depending on size and shape goals.

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What are the Risks of Having Breast Augmentation Surgery?
Risks and complications may occur but are not limited to unfavorable scarring, infection, hematoma (bleeding), capsular contraction (excessive firmness), visible or palpable rippling, implant deflation, sub-optimal shape, asymmetry and alteration of nipple sensation. Although they can occur, significant complications are uncommon.

Current scientific evidence shows no increased risk of breast cancer or any systemic disease in women who have breast implant surgery. Breast augmentation has one of the highest satisfaction rates of any plastic surgery procedure.

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How is a Breast Augmentation Surgery Performed?
The procedure is performed on an outpatient basis in the hospital operating room. Usually it is performed under general anesthetic. One of the three incisions (axillary, areolar or inframammary) is made and a pocket is created usually under the pectoral or chest wall muscle. A saline filled implant or a pre filled silicone gel implant is placed and inflated and the incision closed with absorbable sutures. An elastic compression dressing is placed. Discharge to home occurs after several hours in the recovery room.

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Is Breast Augmentation Surgery Painful?
Each patient will tolerate pain post-operatively in a different way. While some patients may describe the pain as an ache, others experience greater levels of discomfort. In either case, appropriate pain medications are prescribed and these help minimize pain. Operations that require elevation of the muscles, such as a breast augmentation, have discomfort similar to that of a C-section.

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How Long Does the Breast Augmentation Procedure Take?
It usually takes approximately one to two hours for Dr. Bottger to perform a routine breast augmentation procedure.

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What Types of Incisions are Used for Breast Augmentation?
Dr. Bottger offers his patients choices regarding incisions for the insertion of implants. Although any of the three major incisions can be used in most patients, certain anatomic characteristics or implant types may favor one approach over another.

Inframammary (in the fold under the breast): An incision, one to two inches long, is made in the fold in the shadow under the breast. Through this incision, a pocket is made usually under the pectoral muscle. The implant is inserted into the pocket and inflated.
This is a very direct approach and is the most requested incision. It can be used in virtually any patient although it may be less optimal in the extremely flat patient with no defined fold. The vast majority of these incisions heal with excellent scars.

Periareolar (around the lower border of the nipple/areola): This incision is made at the margin of the pigmented portion of the areola and the skin of the breast. Pockets for the implant are then usually made under the pectoral muscle. The implants are inserted, inflated, and adjusted for symmetry. This incision produces almost universally excellent scars. The periareolar approach may be less optimal in the patient with a very small diameter areola.

Axillary (armpit): The axillary incision is made through a crease in the armpit. The pocket for the breast implant is usually made under the pectoral muscle. The advantage of this approach is that there are no scars on the breasts. A fiberoptic endoscopic system is used to dissect the pockets under direct vision with a high degree of accuracy.

Umbilical (belly button): An incision is made in the belly button. With a special instrument, a tunnel is made from the incision to behind each breast. The breast implants are rolled up like cigars and passed up these tunnels. They are inflated, checked for symmetry, and the incision is closed. Dr. Bottger does not favor this incision for a number of reasons. Mainly, the dissection is done bluntly with no visualization, which creates a greater chance for asymmetric pockets and subsequent implant asymmetry. In addition, lack of visualization interferes with adequate control of bleeding, which can also lead to post-operative problems.

The correct incision depends on each patient’s own anatomy and implant type. Dr. Bottger will discuss each option with you during your breast augmentation consultation.

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What Type of Implants are Available for Breast Augmentation?
Saline implants are the current breast implants used in the United States. They consist of a silicone rubber outer shell and are filled with saline or salt water at the time of surgery.

Saline implants are available in several shapes and surface textures including the textured anatomic or teardrop shaped implant the smooth round implant and the textured round implant. Dr. Bottger has extensive experience with both types of implants and chooses a device based on the patients’ individual anatomic characteristics. In most cases, the smooth round implant gives the most natural result with less chance of visible or palpable rippling or shape abnormalities.

Silicone gel implants are also available in certain patients who have problems that cannot be adequately corrected with saline implants.

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How Long is the Recovery Period?
The length of time it takes to recuperate after breast augmentation surgery varies. Most patients will require assistance for the first several days, particularly patients that have small children to care for. Breast augmentation patients usually return to work at five to seven days if not required to lift more than 15 pounds. Patients can return to full exercise, including weight lifting, in three weeks.

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When can I Resume Regular Exercise?
Most breast augmentation patients are encouraged to start a slow walking routine on the second postoperative day. Regular aerobic and more vigorous activities are not allowed during the first 2 weeks in order to decrease the risks of bleeding, swelling, and bruising. Weight lifting, sports, and aerobics are allowed at three weeks in most patients.

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Will Breast Augmentation Affect my Ability to Breast Feed?
The ability to successfully breast feed varies for all women with or without breast implants. The breast augmentation procedure should not significantly affect a woman’s ability to breast feed.

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What if the Breast Implant Ruptures?
Today’s saline implants are more durable than ever. Deflation rates are estimated at 1% per year. If this should happen, the implant deflates as your body absorbs the saline. There is absolutely no health hazard should this happen and the implant can be easily replaced. A warranty exists for the implants Dr. Bottger uses, which includes both replacement implants and a portion of operating room costs.

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What is the Cost of Breast Augmentation?
Dr. Bottger’s staff will review the cost of breast augmentation at the time of your consultation. A number of affordable financing plans are available for surgery.

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Why Should I Choose Dr. Bottger for my Breast Augmentation Procedure?
Finding a qualified, experienced board certified plastic surgeon for your breast augmentation is extremely important. Every surgical procedure, including breast augmentation surgery, carries risks and uncertainties that a board certified plastic surgeon such as Dr. Bottger has proven knowledge and experience in managing with the highest level of care. Dr. Bottger has extensive experience and expertise in breast augmentation surgery and has demonstrated his abilities through hundreds of successful breast augmentation procedures.

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What is the Best Implant, Saline or Silicone?
Both saline and silicone gel implants give excellent results, yet each has its own advantages and disadvantages. Neither is associated with increased risk of any systemic disease.

Saline implants have the advantage of a slightly smaller incision required for placement. This allows more options for incision placement. Also, because the implants are filled at time of surgery, breast asymmetries can be potentially better addressed by saline implants. Saline implants are also less expensive than silicone gel implants. One disadvantage of saline implants is a firmer feel to the breast. Another disadvantage is a higher incidence of visible palpable rippling. This is more of a problem in the thinner patient.

Silicone gel implants have the advantage of a softer feel and potentially a more natural appearance. Also silicone gel filled implants have a smaller incidence of visible rippling. This is more significant in thinner patients who have less soft tissue coverage.

One disadvantage of silicone implants is the need for a slightly longer incision. This may limit the option for incision location. Silicone gel implants are also somewhat more expensive.

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If you have more questions about breast augmentation surgery or would like to set up your confidential consultation with Dr. Bottger, please call or e-mail us today.