Incision Choices

Incisions for breast augmentation can also differ, based on the type of implant used and the preference of the patient and surgeon. Locations for the incisions might include:

• Inside the armpit (transaxillary) which eliminates all visible scarring on the breast. However, this approach can increase the risk of infection and may not provide the most precise positioning of the implants. Implants tend to fall laterally, and the scar is noticeable in the axilla. Sensitivity can be affected more often by this approach because many of the nerves enter the breast laterally.
• In the crease on the underside of the breast (inframammary). This is a common incision position, allowing the surgeon ample access to place implants accurately and accommodating nearly any implant type and size. One drawback of this incision is that it may be seen in swimwear when raising the arms. It is also very likely to get hyperpigmented in Asian breast augmentation patients. Lastly, the rate of implant bottoming-out is higher with this incision. Some claim that there is a slightly decreased risks of capsular contracture with this approach.
• Around the areola (periareolar). The areola is the pigmented skin surrounding the nipple. This placement may be used for both saline and silicone implants.  Combined with the use of a keller funnel, this incision is perhaps the most advantageous of all incisions. It is the most discreet location on the breast or body as one would have to be completely naked to see the incision. There is less risk of bottoming out for this incision. It is ideal for Asian and Hispanic breast augmentation because any hyperpigmentation that would occur would blend into the areola skin. New fashion trends that reveal the under-breast has increased the popularity of this choice.

No matter which incision you choose for your breast augmentation surgery, Dr. Gana will take care to optimize your healing to help minimize the appearance of the scar. He closes all his incisions in five discreet layers to minimize the tension on the incisions and allow your body to heal more naturally. He also does not use absorbable sutures to decrease the inflammation in the healing incision. He only uses non-reactive sutures and removes them when they need to come out.

Placement Choices

There are two locations in which to place breast implants. The first is beneath the chest (pectoralis) muscle, known as submuscular placement. With this technique, the implant may be placed under just a portion of the muscle or the muscle will be used to completely cover the implant. The second is above the chest muscle and underneath the natural breast tissue, known as subglandular placement.

Submuscular placement offers many advantages over subglandular placement, including a reduced risk of capsular contracture, a longer lasting result, and less interference during mammogram examinations. Possible disadvantages of submuscular placement might include increased pain during the first few days following surgery. Active women may also find the chest becomes distorted during strength training and other activities with this placement. However, some women do not have sufficient breast tissue for subglandular placement, making the submuscular position the only viable option.

Subglandular placement also features both benefits and drawbacks. This positioning may be more likely to lead to sagging breasts in the future. In women with less natural breast tissue, the edges of the implant may be visible on the outside of the breast as well. Dr. Gana will discuss both options and help you decide which placement will be best for you.

Every woman is unique in both her desires and her body shape. Keeping this in mind, Dr. Gana will take the time during the pre-operative consultation to discover your specific concerns and desires for breast augmentation surgery. The time taken at this appointment ensures you enjoy a completely customized treatment plan with your specific needs in mind.

During your consultation, you and Dr. Gana will discuss the differences between the two options in implants. Both saline and silicone implants have a long track record of safety and each offer their own set of advantages. Numerous measurements are taken, and detailed discussions ensue to determine the right implant for you. Other decisions will also be made, such as implant placement and surgical technique. When your surgery is personally tailored in this fashion, you enjoy more natural results and a higher rate of satisfaction in your outcome.

Preparing for Your Surgery

What you do before your breast augmentation surgery is just as critical to the success of your procedure as the operation and recovery process afterward. Our goal is to make sure you go into your surgery confident of your choice and comfortable with the choices discussed for your personal breast augmentation. Dr. Gana will ask you to bring 3 nude breast photos from the front that represents your goals in terms of size to your consultation. We will also give you list of pre-operative instructions to prepare you for your procedure and ensure your safety throughout. Those instructions might include:

• Stop smoking six weeks or more before your surgery to prevent nicotine-related complications
• Do not take medications or supplements that work as blood thinners, such as aspirin, anti-inflammatory medications, vitamin E and fish oil
• Stay hydrated before and after surgery as this will ensure a safe recovery process
• Line up someone to take you home from your procedure and stay with you for the first 24 to 48 hours
• Schedule help with the house, children and pets for the first week so you can focus on resting and recovering after surgery
• Fill prescriptions, stock up on food and quiet activities to make your recovery time more comfortable and pleasant

The better your preparation before surgery, the easier it will be to rest after the procedure without worry over fulfilling obligations or taking care of tasks.

Procedure Overview

Dr. Gana recommends general anesthesia for your surgery, which will be done on an outpatient basis. He also injects long acting pain medication, similar to what one would get at the dentist office to numb the breast and performs local nerve blocks. You will be comfortable throughout the process and most importantly, when you wake up. Incisions will be placed as discussed during your consultation and through the incisions, Dr. Gana will place the implants into the breast pocket using any of the best surgical methods.

If the implants will be positioned underneath the muscle, an incision will be required internally as well to create a space for them. If you have chosen saline implants for your surgery, they will be filled once they are in the proper position in the breast pocket. Each pocket dissection is performed very carefully, making sure to avoid any bleeding. Each pocket is also irrigated three times with triple antibiotic solution to further reduce the risk of capsular contracture.

Dr. Gana incorporates a no-touch technique and re-preps the surgical area before the permanent implants are opened. Dr. Gana will take between one and two hours to complete your breast augmentation surgery. At the end of the procedure, Dr. Gana will meticulously suture the incisions closed in five specific layers to minimize post-operative scarring. He will then place glue and external tapes to hold the surrounding skin in place to protect them as they begin to heal. Dr. Gana does not recommend surgical bras or any tight fitting clothing on the breasts after augmentation. The new pressure from the implants on the inside may cause wound ischemia if the breasts are compressed additionally from the outside.

After Your Breast Augmentation

You will be swollen and sore for the first few days after breast augmentation. This is not your final look. It takes six weeks for your implants to drop and fluff. You will be provided with detailed post-operative instructions to make your recovery smooth and comfortable. Dr. Gana will prescribe oral medication to manage pain and antibiotics to prevent infection. He also encourages the use of ibuprofen and arnica after surgery to provide the best swelling reduction and pain relief. Patients are pleased to find that this stage of recovery typically only lasts a few days and they begin to feel better much faster than they expect, typically within 3 days.

Most of our patients return to work within the week if their job is not overly strenuous. Pain, swelling and sensitivity will linger for a few weeks, but subside enough to allow you to return to most of your activities without significant discomfort. Rigorous exercise should be restricted for two weeks to give the breasts ample time to heal. Patients are encouraged to walk immediately after surgery and then 3 times daily to prevent blood clots and to improve circulation. Dr. Gana will monitor your progress at your follow-up appointments and advise you as to when you can resume your workouts or other strenuous activities.

Patients typically return at one week, two weeks, three weeks, six weeks, three months, and six months for postoperative visits. Patients may resume cardio or lower body activity that does not involve bouncing up and down nor the upper body at two weeks. At four weeks they can do light jogging, and at six weeks they can resume upper body activity and heavy lifting (greater than eight pounds).

While you will begin to see your scars fade within a couple of months, it can take up to a year before you will see their final effect. Dr. Gana starts all his patients on a 12-week silicone scar gel program. It is important to avoid direct sun exposure in the area during this time, since UV rays can make scars more prominent. With proper care and patience, you will likely find your scars are not very noticeable once healing is complete.

Results that Last

Breast implants are designed to last for many years, making them an excellent investment of time and money over the long run. The US FDA and implant manufacturers around the world recommend replacing implants after 10 years. Regular monitoring of breast implants after breast augmentation is also recommended.

Some women may decide to change up their implants years after their initial augmentation because they would like to modify their size or shape. Dr. Gana performs revision breast surgery for patients that would like to exchange or remove previous implants. He also works with women that are unhappy with their initial breast augmentation due to the size of the implants or complications they experienced after surgery.

Taking the Next Step

Breast augmentation is a decision that should be made between a woman and her plastic surgeon. You are not one size fits all and you should not be treated that way. Find a surgeon that you connect with in terms of your goals and make sure he or she is giving you the look that you want. Ask plenty of questions, come prepared with photos, and do your research to make sure your plastic surgeon is a breast expert and board-certified by the American Board of Plastic Surgery.

This may be your first procedure or your tenth. You are making surgical changes to your body and you want to make sure you feel comfortable and not rushed. Dr. Gana is known for spending as much time as you need to make sure you understand all the components of the process. His bedside manner is exemplary, and he truly cares about his patients. He prefers to do fewer surgeries so that he can focus on making each of his results the absolute best. He is an artist that truly loves what he does. To schedule your consultation with Dr. Gana today, contact SoulPlace Surgery at 310-598-2648.

The information about breast augmentation with implants was reviewed by Dr. Josiah Gana. If you have any questions, please don’t hesitate to contact us using our contact form below.