Breast Augmentation

For a lot of women in America, the size of your breasts is one of the most important factors in how good or bad you feel about yourself. Breast size plays such an important role in feeling desirable and normal as a woman it's no surprise that breast augmentation was the #1 choice for cosmetic surgery in 2009.  Increasing or restoring your self esteem is probably the most important reason to have breast implant surgery. Many times women don’t realize what a life-changing experience having a breast augmentation can be until they have the procedure and see their results. You do have a right to feel better about yourself, and if a breast augmentation can make you feel more empowered, feminine, and sexy then why not?

Questions you may have about breast surgery:

How big should my breasts be?

Obviously if you’re reading this information then you or someone you care about is interested in having bigger breasts.  The question is: how big? Or more importantly, how big is too big?  This is a question only you can decide for yourself. When making this big decision, it’s important that you are certain you are choosing a size that YOU can live with. I stress the YOU because they are going to be on your body not someone else’s.  You also want to make sure that you are choosing an enhancement that is worth your time and money, but no so large that you look awkward or that you have gained weight.  Since sizes vary, we can not guarantee a certain cup size but we will do our best to get you to your goal.  During your consultation we will give you implants to try on so you can see how a certain size will look once the implant is in place.  We want your main focus to be on what the end result will look like and to not be hung up on a cup size or implant size.

Will I have big scars from my breast surgery?

There are multiple options when choosing where you want to place your incisions. Dr. Nuveen has performed over 7,000 breast implant related cases, so he has used each incision location and technique hundreds of times. These experiences have taught him that each incision has its own unique qualities and benefits, as well as disadvantages.

The armpit incision is a good option if you begin with smaller breasts and have very little droop. Sometimes you may benefit most from the incision being on the fold beneath the breast which will help to elevate your nipple position best. You may choose to have your incision around your areola (nipple area), however this area tends to leave the most noticeable scar when used with a large breast implant due to stretching. Another disadvantage to the areola incision is there is an increased risk of loss of sensation in the area. The length of your incision will vary depending on the size and type of implant that you choose but on average you will have a 1 inch incision for a saline implant or approximately a 2 inch incision for silicone.

        • Breast augmentation is performed on an outpatient basis under IV sedation. Once your incision is made, a pocket is created under the breast tissue or beneath the chest wall muscle. The implant is securely positioned within the pocket made beneath your muscle and then small sutures are used to close the incision.

          Everyone is different in their recovery but most patients that have undergone breast implant surgery will take 3-5 days to return to normal daily living. After surgery we will send you home with a support bra that you have to wear for 4-6 weeks. You may take the bra off to launder it or we have bras that you can purchase for $20. You may increase your activity as tolerated with no heavy exercise or lifting for at least 2 weeks. If after 2 weeks you feel like you are ready to exercise it needs to involve very low-impact activities and you will need to wear two sports bras when you do exercise. The weight restriction is fairly simple to follow, nothing over 10 lbs for the first 2 weeks and then nothing over 20 lbs for the next 4 weeks.

      • What to Expect during recovery:

      As you heal:

      Healing: How quickly and easily you will heal depends on a number of factors such as your genetic background, your overall state of health and lifestyle (exercise, diet, smoking, drinking, etc…). Many people believe your doctor is solely responsible for the healing process, but no one person can make another heal. Dr. Nuveen can facilitate (but not accelerate) your healing but you must also take an active role in that process. Your cooperation and close attention is extremely important when it comes to your post-operative healing.

      Another important factor in the course of healing is how well you follow the instructions that are given to you by Dr. Nuveen. You will receive verbal instructions as well as written instructions after surgery and it is imperative that you follow those instructions. We set those guidelines for you to promote your healing process and to prevent the occurrence of any complications that can interfere with your recovery. It is crucial that you recognize that you are a partner in this process and have a responsibility to follow instructions carefully. The instructions we give you are designed to give you the best opportunity for healing without delay or surprise.

      Your first 48 hours:

      Bra: You will be sent home wearing a support bra and you will need to wear that bra for 4-6 weeks following your surgery. Your bra should be washed and dried daily to avoid infection. You may buy your own sports bra and wear that as well as long as it is snug-fitting or we have bras available for purchase for $20. It is imperative that you do not wear under wire bras during this time. 

      Dressing: There are self-dissolving sutures in your incisions that do not need to be removed. You should shower daily, but DO NOT SOAK IN THE BATHTUB, fully submerging your incisions in water will greatly increase your risk of infection. You will have skin glue on top of your incisions, it is purple and should not be scrubbed off or picked at, it will come off on its own in approximately 2 weeks.
      If you are going home, a family member or friend must drive you because you have been sedated. If you choose to stay overnight in our guest suite you must have an adult caregiver to stay with you or a caregiver can be provided for an additional fee. 

      Activity: Take it easy and pamper yourself. Try to avoid any straining. You may go to the bathroom, try to get up and move a little every hour, but take it easy. No matter how good you feel please do not do any strenuous activities or lifting. We do not want you to bleed and cause any more swelling and bruising that is unavoidable. Do not lift anything more than 10 pounds for the first two weeks, then nothing over 20 pounds for the next four weeks.

    • Ice packs: We recommend using cold or ice packs for the first 48 hours to help reduce swelling, bruising, and pain. Use frozen peas in the package or crush ice cubes and put the ice into a zip-lock bag. Using ice after your procedure should help, not hurt, so if the ice feels too uncomfortable don’t use it as often. Leave the ice in place no longer than 20 minutes per area. 

      Diet: If you have any post-operative nausea, carbonated sodas and dry crackers may help settle your stomach. If nausea is severe, use the Phenergan suppositories you were prescribed. If you feel normal, start with liquids and bland foods, and if those are well tolerated, progress slowly back to your regular diet. 

      Alcohol: Alcohol dilates the blood vessels and could increase post-operative bleeding. Please do not drink until you have stopped taking the prescription pain pills, as the combination of pain pills and alcohol can be dangerous. 

      Smoking: Nicotine causes blood vessels to constrict and may interfere with normal wound healing. When blood vessels constrict there is less blood supply that can get to the wound which means less oxygen for normal healing to take place. Smoking may adversely affect wound healing and cause loss of skin and tissue death. Smoking reduces arterial (blood) oxygen supply which is necessary for normal wound healing. Exposure to second hand smoke has also been implicated in delayed or abnormal wound healing. It is best to avoid smoking and/or exposure to second hand smoke in the post-operative period while your incisions are healing. You should also avoid cigarette replacements such as nicotine gum, patches or the inhaler during your post-operative period as these have similar effects as smoking and second hand smoke. 

      Driving:  Please do not drive while taking prescription pain pills. Please be advised that all medications may impair judgment and the ability to drive or operate heavy machinery

      How to Care for Your Scars After Surgery

      Our practice is dedicated to making your entire surgical experience enjoyable. Healing is the great variable! The same procedure can be performed on a thousand different patients using the same surgeon, tools, and approach. Even with these constants, some scars will heal better than others. Incision care post-operatively can increase the appearance of your scar. We are dedicated to utilizing evidence based practice in providing you with the most up-to-date information, to ensure you get the results you are looking for.

      What is a scar? Think of scarring as a visible healing act. In the beginning stages of recovery, usually the first two to three months, your scars may be very apparent and pronounced. This is normal healing. As time goes by the scars will slowly become smaller and less visible. It may take up to two years for skin to fully heal from surgery. By then, scars are considered "mature" and you will see their final outcome.

      What can you do to improve the appearance of your scars? In the initial stage post-operatively, do not pick at the area, or rub abrasively. There may be skin glue along your incision. This can last for two to several weeks post-operatively. It will begin to slowly come off on its own. Nearly all sutures are self dissolving. Keeping the self dissolving sutures moist with Vaseline will help them dissolve faster. After the skin glue is off and the area is fully closed, a scar cream needs to be applied to improve the color and appearance of the incision. Maintaining a well balanced diet with an emphasis of Vitamin E and C will prepare your body for healing.

      What scar cream to use? We recommend over the counter scar creams (Mederma, Scar Guard, etc.) and Dermatix, which we also sell in our office. Mederma is a good product for scars on the hands or face. Dermatix is recommended for larger incisions on the body, such as those from breast augmentations, breast lifts/reductions, tummy tucks, and brachioplasties. Dermatix, from Valeant Pharmaceuticals is a transparent, self-drying silicone gel that will significantly reduce the appearance of scars. Dermatix flattens, softens and smoothes scars, relieving the itching and discomfort, as well as reducing discoloration.

      Variation in healing? There are many factors that go into how a person will scar. A few examples include age, location, genetics, and lifestyle. Exercising, eating a well-balanced diet, and abstaining from smoking all assist in healthy blood flow, which ultimately plays a significant role in scar healing. Our practice would like to give you the information and products that you need to have the very best results possible.

      Family and Friends:  Support from your family and friends is very helpful during your recovery. But because they may not understand what is normal in your post-operative care, their comments may unintentionally create emotional turmoil for you. You can trust that we will tell you honestly how your progress is and what we expect your results to be. Please trust in our knowledge and experience when we evaluate your progress. We know it is difficult not to compare your recovery with other people you may know who also had cosmetic surgery, but it’s imperative to remember progress varies greatly patient to patient and everyone has a different recovery experience.

      Cosmetic surgery has certainly become less taboo in the past decade, but your friends may still be reluctant to bring it up and discuss it because they think it may be a private matter to you. Patients occasionally feel upset that “no one noticed” or “said anything.” If you are comfortable discussing your cosmetic procedure then you should do so openly. When people ask how you are, respond saying “I feel wonderful. I just had cosmetic surgery and I’m recovering.” This lets people know that they may talk freely with you. Often if you will open up about your procedure you will find that your friends and acquaintances are very interested in discussing it with you.

      One potential drawback after surgery that can take places is that quite frequently patients experience a very brief period of “let down” or depression after cosmetic surgery. Some may subconsciously have expected to instantly look and feel better, even though they rationally understand that this will not be the case. You will be told what to expect during your recovery but the incisions can still come as a shock sometimes to see the initial results. Patients commonly question their decision to have surgery during the first few days after surgery because it’s hard to imagine the incisions once they are healed and everything has settled into place. As the healing occurs, these thoughts usually disappear quickly. If you feel depressed, understanding that this is a “natural” phase of the healing process and that the final outcome will be much different than what it looks like right after your procedure may help you to cope with any emotional “let down” you may feel initially.