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Breast Augmentation

Enhance the Volume and Symmetry of Your Breasts with a Breast Augmentation

Breast augmentation is the enhancement of breast size and shape most commonly with the use of implants. This procedure can also help increase the fullness and projection of breasts that have decreased volume due to pregnancy, weight loss, or aging.

Breast augmentation can also be done with the transfer of fat from one area, such as the abdomen or thighs, to the breasts, but the results are more subtle than with an implant.

Breast augmentation is best for people that would like fuller and larger breasts and do not have a lot of drooping of the breasts. Over time, the breast may droop and the top of the breast becomes less full. Breast augmentation can also help fill out the top of the breast, also called the “superior pole”. Drooping of the breasts is treated with a breast lift, also known as a mastopexy. A mastopexy (breast lift) can be combined with a breast augmentation to achieve fuller and lifted breasts. During your consultation, we will develop a plan that is customized to your body shape and desired look.

Schedule with Amita Shah, M.D.

Schedule with Scott Farber, M.D.

Implant choices:

  • Fill: Silicone or Saline?

    The choice of saline versus silicone implants is usually left up to the patient unless there are specific reasons we recommend one over another. Silicone implants are used more frequently since being re-approved by the FDA in 2006 for patients older than 22 years old. There is no association found between silicone and rheumatologic disorders. Silicone implants are softer, lighter, and have less tissue rippling issue than saline implants. The largest size of silicone implant available is 800mL at this time, whereas saline implants can be larger. Leak detection is more difficult with silicone implants. The FDA recommends monitoring of silicone implants with MRI 3 years after implantation and every 2 years thereafter. The MRI is usually not covered by insurance. Another consideration is the price of implants, as saline implants are typically less than silicone implants.

  • Shell: Smooth or Textured?

    The outer shell of all silicone and saline implants is made of silicone. Implants used to be offered in smooth or textured surfaces but the textured implants have been taken off the market due to association with Anaplastic Large Cell Lymphoma (ALCL). We do not use any textured implants.

  • Shape: Round or Anatomic?

    The shape of the implant that is most commonly used is the round implant. When laying on a table, it looks like a circle, but when upright against the chest wall, the implant has a more natural shape with the lower aspect of the implant being larger than the top. Historically, there are also shaped silicone implants, also known as the “gummy bear”, or anatomic implants. The shape is designed to mimic the natural breast so the area of highest projection is in the lower pole. Anatomic implants are good for ptotic breasts and patients where we need to “create” a shape such as for tuberous breast deformities. The pocket must be precise since the implant has to be implanted in a specific orientation and there cannot be a lot of movement of the implant. The pocket is usually subpectoral since the edges of the implant can be palpable, especially in thin patients. Texturing was used to help keep the implant in place, but due to the concerns of ALCL, we do not use these implants. If a patient wants a more “augmented” look with high and round medial upper aspects of the breast with lots of cleavage, a round implant should be used. In our experience, most patients have been happier with round implants since it makes the breasts appear fuller. There is also less risk of rotation of the implant since they are round.

  • Profile: Low, Medium, or High?

    This is based on the patient’s desired outcome. First, the width of the breast is measured. This is known as the “base diameter” Next, the amount of augmentation desired by the patient and the patient’s breast tissue and shape are evaluated. The amount of projection is more dependent on the measurements of the implant than the overall fill. For example, an implant with a smaller base and 300cc fill will have more projection than an implant with a wider base and 300cc fill.   If using an anatomic implant, the patient’s breast height has to be evaluated since the implants also come in different heights.

What kind of incision do I want to use?

The choices for incisions are Inframammary (IMF), Periareolar (around the areola), Transaxillary (incision in the axilla), and Transumbilical (through a belly button incision). At HCPS we perform the IMF or Periareolar incisions.

  • Silicone implants: can use IMF, periareolar, and transaxillary approaches. Because the implants cannot be deflated prior to insertion like a saline implant can, the incisions for silicone implants are larger than that for saline.
  • Saline implants: can use IMF, periareolar, transaxillary, and transumbilical
  • IMF

    Advantages: can hide the scar in the breast fold, less risk of infection and capsular contracture, and the surgeon can do all pocket approaches. Disadvantages: not a good choice for patients with a poorly defined inframammary fold (such as tuberous breast deformity) since the scar can be seen due to the lack of droop of the breast.

  • Periareolar

    Advantages: can perform subglandular and subpectoral pockets through this incision, can lower the fold, good for tuberous breast deformities and poor inframammary folds, can hide scar around (not in) the areola. Disadvantages: increased risk of capsular contracture, distortion or widening of the nipple-areolar complex.

What kind of pocket do I want to use?

The options for pockets are subglandular, subpectoral, subfascial, and dual plane 1, 2, or 3.

  • Subglandular

    The implant goes under the breast tissue and over the muscle; Advantages: good for patients who are also getting their breasts lifted, no animation movement of implant, recovery is easier. Disadvantages: not good for patients with thin or little breast tissue on the top due to visible implant and superior pole hollowing.

  • Submuscular

    Implant goes under the pectoral muscle; Advantages: lower capsular contracture rate, good for patients with poor overlying tissue, less rippling, easier for mammograms to visualize breast tissue; Disadvantages – displacement of the implant to the side of the chest, animation movement of the implant (implant moves with activation of pectoralis muscle), higher risk of snoopy deformity (breast tissue hang below implant).

  • Dual Plane

    Pocket is dissected under the muscle and the breast gland. This approach is good for poor overlying tissue on the top, narrow breasts, and droopy breasts.

Why Should You Choose the Surgeons at Hill Country Plastic Surgery?

Both Dr. Farber and Dr. Shah were fellowship-trained at the most prestigious institutions and their techniques for delivering patient results and satisfaction set the standard for plastic surgeons in the field. They use the most advanced techniques and consistently achieve superior results. Their warm demeanor, genuine care, and dedication to their patients are second to none. Ultimately however, patients choose Dr. Farber and Dr. Shah for the results. Their patients look and feel their best, and so can you. Discover the difference here in San Antonio!

Limitation, Risks, and Complications

The risks of breast augmentation surgery are bleeding, infection, changes in nipple or breast sensation, poor scarring of the skin, implant leakage or rupture, wrong position of the implant, formation of tight scar tissue around the implant, fluid around the implant, discomfort near or around the breast implant, wrinkling or rippling of the skin over the implant. If any of these complications occur, you may need surgery to fix it.

What to Expect During Your Consultation Visit

During the initial consultation with your surgeon at Hill Country Plastic Surgery, we will discuss your concerns and goals before recommending treatment options that are tailored specifically to your needs. Prior to your consultation, we recommend that you review the procedures on our website so you are familiar with the terms we will be using during our discussion.

Once we identify your concerns and surgical goals, we will discuss all of the treatment options that are available to you. Every patient is unique and we will develop a tailored surgical plan that addresses your specific goals. In addition, we will thoroughly review your medical history, surgical history, medications, allergies, family medical history, and other important details. It is very important that we obtain accurate information in all of these areas as it may impact the outcome of your surgery.

While discussing different treatment options, we will perform a physical exam and take measurements that are necessary for planning for your surgery. Pre-operative (before surgery) photos will be taken either at your initial consultation, or during your pre-operative visit.

After your consultation, you will receive access to your notes on the patient portal in addition to information about your specific surgery. If you have not activated your patient portal, this can be done at your appointment by asking any of our staff to assist you. If you have questions after your appointment, you can contact our office or message us through the patient portal. Some patients will require medical clearance from their primary care physician or a specialist or additional tests before undergoing surgery.

Once you have determined that you would like to have surgery and have completed any clearances and tests that were requested, contact our office at (210) 658-3555 to schedule a pre-operative appointment with one of our surgeons.

Pre-operative Appointment

On the day of your pre-operative appointment, we will review your procedure in detail and go over the surgical plan with you. We will also address any questions and concerns you may have. Please read over the procedure consent prior to this appointment and have any questions ready so we can discuss them.

During your pre-operative visit, we will provide you with all of the after-care instructions as well as necessary medication prescriptions. You will also be provided with a post-operative appointment for follow up after your surgery.

Before the Day of Surgery

Please do not smoke (cigarettes, vape, or pipe) or use any nicotine products 4 weeks prior to and after your surgery. Smoking and nicotine greatly impair healing, which can cause increased risk for infection and complications, such as delayed incisional healing or wound opening which lead to worse scarring. Please stay away from second hand smoke as well, as this can also cause wound healing problems. If you use nicotine products, you will need to stop 4 weeks prior to surgery and then you will need to undergo a cotinine test prior to surgery to ensure that the nicotine is out of your system.

Please do not drink alcohol before or after your surgery (until cleared by your surgeon). In addition, please do not drink alcohol while taking pain medication, as this can have serious, and life threatening side effects.

Please leave all valuables at home. If you have body piercings, kindly remove them prior to surgery.

Please have someone available to drive you home. Due to the lasting effects of the general anesthesia, you will be unable to operate a car after surgery. A taxi or car service is not adequate either. You will need a family member or friend who can assist you.

You may have been asked to obtain pre-operative tests at a lab facility or your primary care physician. Your pre-operative tests (labs, X-rays, EKG, etc) need to be completed at least three days before your surgery. If you have them done at your doctor’s office, the results will need to be faxed to (210) 362-1582.

The surgery facility will call you the day before your surgery to let you know what time and where you should arrive.

Shower the morning of or the night before your surgery with your normal soap and water. Do not use deodorant, lotion, cream, perfume, aftershave, oils, or makeup after bathing.

Do not take Advil, Aleve, Naproxen, Fish Oil, Garlic, CoQ10, Omega 3,6, Motrin, Excedrin, Ibuprofen, Aspirin, medications for arthritis or any medication that contains these medications for ten days prior to your surgery and two weeks after.

Do not eat or drink anything after midnight the night before your surgery.

Please call our office if you have an infection of any kind prior to your surgery.

Day of Surgery

On the day of surgery do not take the following blood pressure medications before your surgery:

Medications with generic names that end in “-pril”, “-sartan”. If you are on metformin, you will be asked to not take it on the day of surgery.

On the day of surgery, your plastic surgeon will meet you in the pre-operative area to go over any last minute questions or concerns you may have. Your plastic surgeon will make some preoperative markings and will perform extensive checks with careful attention to detail, ensuring high quality care and safety. You will meet the anesthesiologist and their team, as well as the members of our plastic surgery operative team.

During the plastic surgery procedure, our plastic surgeons pay meticulous attention to detail and work as a highly experienced team to ensure a great result. Your family will be updated of your status periodically and will be able to talk with the plastic surgeon in person after the procedure is completed. The incisions will be placed in a dressing or a compression bandage. Instructions for care on these will be given to you in your preoperative paperwork.

Aftercare

In order to make your recovery faster and more comfortable, we recommend that you prepare before your surgery. Things you can do are:

  • Prepare a sleeping area that is easy to get to. For example, set up a couch downstairs instead having to walk up to an upstairs bedroom. Keep your toiletries close by and prepare food ahead of time. Arrange for someone to be with you the first night after surgery.
  • You may receive your post-operative medications at your pre-operative appointment. You should pick up these medications prior to your surgery.
  • If you’re having an outpatient same-day procedure you will be released to go home the same day and will need someone to drive you home.
  • Review your post-surgery instructions given to you at your pre-operative appointment

If you have a history of nausea or vomiting after anesthesia, please let us and your anesthesia provider know. We can prescribe anti-nausea medications and take extra steps to prevent nausea and vomiting after surgery.

When undergoing general anesthesia, you will need to have someone drive you home. You will not be allowed to undergo surgery if there is no confirmed designated driver.

Medications:

After surgery you will have discomfort and the goal of pain medications is to reduce pain, but it will not completely remove all pain. A good measure for if you need more pain control is that you should be able to take a deep breath without severe pain. Do not wait until your pain is unbearable to take the next dose of pain medication because it will take longer to get your pain under control again.

You may resume your home medications after surgery except blood thinners and as determined by your surgeon. We will give you a prescription for a pain medication. If you are prescribed medications that contain acetaminophen (tylenol) it is important that you not exceed 3500 milligrams of acetaminophen (tylenol) per day.. Do not drive, operate heavy machinery or make important decisions while taking narcotic pain medications.

Narcotic medications may cause constipation. Ensure you have adequate (>25 grams/day) of fiber in your diet and drink at least 64 oz. of water daily. You may also wish to take an over the counter stool softener such as Miralax or Colace once or twice daily.

You can alternate your narcotic medication with Ibuprofen 600mg every 6 hours and/or Gabapentin 300mg three times a day. Take ibuprofen with food to protect your stomach from irritation.

If you have a history of nausea or vomiting after anesthesia, you may be prescribed an anti-nausea medication (Ondansetron) which can be taken as needed.

Before prescribing any narcotic medications, we are required to check the Texas controlled substance history database (Texas Prescription Monitoring Program). If you currently have a pain medication contract with another physician or are currently on narcotic medications, we will have to coordinate your medications with that physician.

We will prescribe pain medications for recovery after surgery, but do not prescribe long-term pain medications and do not do more than one refill for any pain medications. If you have pain that is beyond what is usually anticipated for your surgery and there is no surgical reason that can be found, we will help by referring you to one of the many pain management specialists that we work with.

Surgical Site Care:

You may shower 48 hours after your surgery. Do not scrub the incisions, just let the water run over them and gently dab them dry afterwards. Apply gauze or ointment over the surgical site daily as needed for light drainage. Do not immerse your incisions in baths or hot tubs until at least 2 weeks after surgery. More specific instructions will be provided during your pre-operative visit.

Drain Care:

Sometimes it is necessary to place a drain after surgery. The purpose of a drain is to remove excess fluid from the surgical area. Empty the bulbs and measure the output whenever the bulbs are half full or at least twice a day. You will be given a sheet to record how much is coming out of the drains. Bring this sheet to your follow-up appointment. In general, drains remain in place until there is less than 30mL (1oz) out of the drain for two days in a row.

Please Call Immediately if:

Please call if you have the following signs/symptoms:

  • temperature greater than 100.5 F
  • bleeding or pus draining from the wound site. If you have bleeding, apply direct pressure to the area for 20 minutes
  • increasing pain that is not controlled on oral pain medications
  • increasing redness or size at the surgical site
  • your drain is not holding suction
  • if your incisions come apart
  • Any other concerns

For non-emergency questions:

During business hours (8 AM – 4:30 PM): call (210) 658-3555.

After hours and on weekends/holidays: call (210) 658-3555 and you will be forwarded to the on call surgeon.

If you are having any serious problems or symptoms such as difficulty breathing or chest pain, call 911 or proceed to your nearest emergency room.

Activity restrictions:

No vigorous activity: no pushing, pulling, bouncing, housecleaning, yoga, running, heavy lifting greater than 5 lbs until your follow up appointment. Avoid activities that raise your blood pressure or heart rate. You are encouraged to walk around and you can climb stairs after surgery. You should not lay in bed and not move.

Clinic appointment:

Your clinic appointment will be scheduled at your pre-operative appointment before surgery. If you need to change your appointment time or date, please contact our clinic at (210) 658-3555.

The surgeon may adjust any of the above guidelines and instructions based on the patient and type of surgery performed.

Breast Augmentation FAQs

Breast implants do not have to be changed out after a period of time. They are removed because of leakage, improper positioning, or patient request.

If you have a leak in a saline implant, you will be able to tell since there will be visible deflation of the implants. Silicone implant rupture is more difficult to detect and imaging is needed to determine if you have a leak. MRI and Ultrasounds are the usual imaging techniques used.

Capsular contracture is thickened scar tissue around the implant. This scar tissue can cause changes in shape and position of the implant, pain, and cause the implants to become hard. If this happens, the implant and scar tissue needs to be removed and replaced with a new implant.

During your consultation, your surgeon will discuss your goals, lifestyle, medical history and also evaluate your body to determine the best type for you.

It’s up to you. Limitations on size will be determined by your body shape and tissue quality. Your surgeon will give you recommendations for sizing to achieve the best result over a long period of time.

Breast augmentation is typically not covered by insurance until it is part of a breast reconstruction or reconstruction matching procedure.

The cost of a breast augmentation varies from patient to patient and depends on size and material of the implant. Coming in for a consultation with one of our surgeons will give you a better idea about pricing.

Interested?

Are you interested in learning more about this procedure? To schedule a consultation, please contact us. Hill Country Plastic Surgery is the premier plastic surgery center in the San Antonio and Austin area, and our friendly team members are here to help you and will reach out promptly.

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