FAQS

What is the best size of breast implants for my surgery?

Every person’s body is different and there are many things to consider when you are having a breast implant or breast lift surgery.  At Cosmetic Surgery Affiliates we will have you try on different sizes of breast implants in your consultation in order to ensure that you are happy with your sizing.  We encourage you to bring a favorite shirt with you so you can see how clothes will look with your new size.  When you are trying on different sizes we allow you, not the doctor, to choose your size of implant.  This method of implant selection has proven nearly perfect in over 7,000 cases to date in achieving 100% patient satisfaction.  In over 7,000 breast implant related cases, we have had only 3 patients desire a different size other than what they received.  Dr. Nuveen will interject to give his opinion when necessary to prevent you from selecting a size that is either too small to justify the expense or too large for your frame and to minimize droop over time.  Our entire staff  is committed to making sure you are completely and totally satisfied with your results and we will take every step necessary to make that happen for you. 

Silicone or Saline? 

 Apart from the decision to actually have the procedure, choosing which type of implant to use will be your most significant decision.  When you come into our office for your consultation you will be given the opportunity to hold both a saline implant as well as a silicone gel implant which generally serves as a major determining factor in deciding which implant type is right for you.  

Saline- It is a salt water solution, very close to the saline found naturally throughout the body.

1. Feels less like natural breast tissue due to the liquid filling.
2. May feel more firm if fully filled
3. A higher risk of wrinkling and rippling especially in patients with thin skin and tissue.
4. Allows the smallest incision possible because the implant is filled after it has been put in place.

Silicone- A safe, cohesive gel that is soft to the touch.

1. Feels more like natural breast tissue.
2. Require a longer incision because the silicone gel implants go in pre-filled.
3. The thinnest patients are commonly recommended for silicone gel implants due to thin tissue coverage.
4. Longer life span than saline implants.

Should my breast implant be placed above or below the muscle?

This question can only be answered after a physical breast examination.  There are advantages and disadvantages to either breast implant technique.  There is no difference in the speed of the breast augmentation surgery and there is no significant difference in the techniques used to place the breast implant in either plane.  The fee is the same for each type of placement.

The under the muscle placement clearly provides the most breast implant coverage.  The muscle covers over 60-85% of the implant and provides another barrier of coverage which will help with a more natural look.  In thin-chested patients, this is a significant advantage and should be considered heavily.  The trade off is a minor increase in discomfort, recovery usually requiring pain medications for about 2-3 days and then 600-800 mg of ibuprofen only.  Another benefit is that in 7,000 implants placed, we have found a very slight decrease in capsular contraction (breast firmness around the implants from scar tissue) when placed below the muscle.  There is additional research that has been done internationally which also supports this reduction in scar tissue formation with sub muscular placement.  Radiologically, detection of minor abnormalities is more commonly and easily detected with the implant placement below the muscle.  Patients with family histories of breast cancer may consider this as an indication for under the muscle placement.  About 95% of our breast implants are currently placed under the muscle.

Placing the implant above the muscle often provides a quicker recovery, but this minimal decrease in pain is often outweighed by the advantages of below the muscle placement.  Putting the implant above the muscle provides less coverage of the breast implant and a significantly increased risk of breast capsular contraction, and you can also feel the implant more easily with this method of placement.  For all of these reasons we will very rarely ever place implants completely above the muscle.  Generally, the only time we will recommend this location for implant placement is when we are correcting severe conditions or abnormal breast form.
Perhaps the most ideal placement for breast augmentation surgery is termed as “muscle sandwich” or partial muscle coverage.  This is when there is a thin layer of fascia or outer layer of muscle above the breast implant and a majority of muscle below the breast implant.  This technique provides for slightly improved coverage of the implant.

What breast augmentation incision is the right one to choose?

Dr. Nuveen has personally performed over 7,000 breast implant related cases and he has used ach technique  imaginable incision location hundreds of times.  This experience has taught us that each incision has its own unique qualities, benefits, as well as disadvantages.  The armpit incision is a good one for patients who begin with smaller breasts and very little droop.  Other patients benefit from the incision being on the fold beneath the breast which helps to elevate the nipple position best.  Some patients choose to have their incision around the areola (nipple area), however this area tends to leave the most noticeable incision scar when used with larger breast implant sizes due to stretch.  Another disadvantage to the areola incision is there is an increased risk of loss of sensation, which can be very important to some women.

What risks and symptoms will go with having cosmetic surgery?

We want you to fully understand the risks involved in any surgery so that you can make an informed decision.  Although complications are very infrequent, all surgeries will have some degree of risk.  At Cosmetic Surgery Affiliates we will use our expertise, knowledge, and surgical resources to avoid any complications that could arise with your procedure.  If a complication does occur, we will use those same skills to solve the problem quickly for you.  Because of our highly specialized medical team and state-of-the-art medical facility we are fully capable of handing any situation that may arise.  Taking these factors into consideration cannot be overestimated when considering surgery.

If a complication does arise, you, Dr. Nuveen, and the nursing staff will all cooperate together to resolve the problem.  Most complications involve an extension of the recovery period rather than any permanent effect on your final result.  This may involve an unplanned admission to a hospital or an overnight stay within our facility for evaluation the next day.

Normal symptoms post-operatively include:

Swelling and bruising:  Moderate swelling and bruising are normal after any surgery.  Severe swelling and bruising may indicate bleeding or possible infection.

Discomfort and pain:  Mild to moderate discomfort is normal after any surgery.  If the pain becomes severe and you cannot get relief from pain medication, please call us at 405-842-6677.

Crusting along the incision lines:  Daily soap and water washes will ensure cleanliness.  We usually treat this with antibiotic ointment.

Numbness:  Small sensory nerves to the skin surface are occasionally cut when your incision is made.  The sensation in those areas gradually returns within 3-6 months as those nerve endings heal spontaneously.
Itching:  Itching and occasional small shooting electrical sensations within your skin frequently occur as the nerve ending heal.  Ice, skin moisturizers, and massages can be very helpful with alleviating that.

Redness of Scars:  all new scars are red, dark pink, or purple.  Scars on the face usually fade within 3 to 6 months.  But, scars on the breast and body can take as long as a year to fade completely.

Rare risks post operatively:

Hematoma:  This is a small collection of blood under that will usually absorb spontaneously.  Larger hematomas may require aspiration, drainage, or even surgical removal to achieve the best result.

Inflammation and infection:  A superficial infection can usually be easily fixed with an antibiotic ointment.  However, deeper infections may require antibiotics but will be determined upon evaluation by the physician.  In the event that you develop an abscess, usually drainage is required.

Thick, wide, or depressed scars:  Abnormal scars may occur even though we use the most advanced cosmetic surgery techniques for your procedure.  If you have issues with your scars there are many options to address those concerns.  Injection of steroids into the scars, placement of silicone sheeting onto the scars, or further surgery to correct the scars is occasionally necessary.  Some areas on the body scar more than others and some people scar more than others do.  Your own history of scarring should give you some indication of what you can expect.

Wound separation or delayed healing:  Any incision, during the healing phase may separate or heal unusually slow for a number of reasons.  These include inflammation, infection, wound tension, decreased circulation, smoking, or excess external pressure.  If delayed healing occurs, the final outcome is usually not significantly affected, but secondary revision of the scar may be indicated.

Sensitivity or allergy to dressing or tape:  Occasionally, allergic reactions or sensitivity may occur from soaps, ointments, tape, or sutures that we use during your procedure.  Such problems are unusual and are usually mild and can be very easily treated.  In extremely rare circumstances, allergic reactions can be severe and require aggressive treatment or even hospitalization.

Injury to Deeper Structure:  In very rare instances damage to blood vessels, nerves, and muscles can occur.

When can I exercise again?

If you have a breast augmentation/reduction/lift you may return to low impact exercises as your body will allow. This is generally around 2-3 but it does vary from patient to the next.  There is no heavy lifting or straining allowed for 4-6 weeks.  Ideally, we don’t want you to lift anything over 20 lbs for the first two weeks and then nothing over 10 lbs for the next four weeks. Use common sense and listen to your body

If you have a tummy tuck we want you to wait 12 weeks before doing any core/abdominal exercises.  You can walk within one week of your procedure, you can use a stationary bicycle in two weeks, and within three-four weeks you can return to light jogging.  As with any procedure please use common sense and listen to your body.

If you have a brachioplasty we advise you to nothing with a heavier impact than walking for at least two weeks.  You will want to have clearance from the physician to return to any heavier working out than that.
If you have liposuction you will be up and walking immediately following the procedure and can progress to light exercise as tolerated.

How often will I need to be seen for follow-ups?

Our recommended follow up schedule is to either be seen, or to send follow up pictures at:

One week
One Month
Three Months
Six Months

There is no additional charge for your follow up care and we are always happy to address any questions or concerns you may have.

When can I shower after my procedure?

If you undergo breast augmentation/reduction/lift you may shower any time just do not scrub the area where your incisions are. However, stay out of the bathtub, pool, ocean, and any other form of soaking for at least 2 weeks.

If you undergo a tummy tuck you can shower 24 hours after your procedure.  You shower with soap and water, and then blot dry.  You may also use a hairdryer, set on the cool setting, to dry the bandages.  Never use the heat setting!

If you undergo brachioplasty you may shower 24 hours after your surgery with warm soap and water, do not scrub the incision site.

If you undergo liposuction you can shower 24 hours following the procedure just remember to put your compression garment back on as soon as you get out of the shower.   

How long will I need to take off of work?

If you undergo a breast augmentation we recommend giving yourself 3-5 days off work, but this varies patient to patient depending on how you tolerate pain and you recovery.

If you undergo a breast lift/breast reduction we recommend taking 6-8 days off work.  If you are adding an augmentation with the lift or reduction you should expect 8-10 days.  With all cosmetic procedures this will vary patient to patient.

If you undergo a tummy tuck you can anticipate needing 7-10 days off of work.

If you undergo brachioplasty varies depending on your occupation and that can be established at the time of your consultation.