“First of all, I cannot say enough about how many satisfied women I’ve seen. Breast augmentation is the most rewarding procedure in my practice. That being said, one has to separate between what it is to recover and what it is to heal. Recovery involves proceeding as mother nature sees fit. It is wise to forgo activities that may hamper your outcome; focus on compliance with the post instructions provided to you that will help prevent slowing down the wound healing process and will help optimize the outcome. Initial recovery may require a week, but you’ll want to avoid certain activities to keep swelling down. For example, you cannot exercise for at least three weeks following the procedure. In the end, you’ll most likely have a beautiful outcome, but you do need to take precautions to help support this goal. The patient’s desires are the most critical factor to evaluate when deciding on breast augmentation. However, there are many other factors that go into the decision for breast augmentation. There are various types of breast implants, incisions location choices and breast implant positioning, such as, above or below the muscle. Each of these decisions requires expertise with the goal to achieve the best result. The goal in surgery is to make you happy.” explained Dr. Gary Brownstein, M.D. P.C. Cherry Hill, N.J.
“One misunderstanding about breast augmentation is that the only choice is size. Today, women need to know that there is a wide variety of breast implants available today. While size is the most obvious difference, there are differences in the shapes, profiles and surface texture. We also have available silicone implants there are both 4th and 5th generation implants, which have different physical properties in how they feel. This allows a woman who desires a more subtle enhancement to have a more natural shape. Additionally since we have participated in clinical trials, we have access to some sizes and shapes that are not yet routinely available.The second common misunderstanding is that post-operative discomfort cannot be managed. The degree of discomfort following breast augmentation is highly individualized, but today we can stay ahead of discomfort with much better and longer acting anesthetic agents. We also have better medications to control nausea.” explained Robert A. Jacobs MD, FACS, Port Jefferson, N.Y.
“One misconception for many women in the 35 to 50 age range is that breast augmentation will improve the droopy appearance of the breasts. Of course, this also depends on other factors, but many times women who are 35 to 50 and those who have had children may be better served by a breast augmentation breast lift combination procedure. And women are on the go today so we usually perform this combination in one surgical session. It is important to note that this combination is complex because you are adding more weight with the implant, and lifting or raising the breasts. So, you are working with opposite driving forces during surgery. Generally, there are two types of women who have breast augmentation; the group of women before children and those after. The breast lift combination is more likely to apply in women who have had children or those who have relaxed skin. At our practice, the combination and simply breast augmentation both offer a good result.” explained Dr. Stephen Coccaro M.D. F.A.C.S., of East Setauket, New York.
“I think there are still a lot of misconceptions about breast augmentation. The number one concern we still see is about silicone implant safety. Both silicone implants and saline implants contain an outer silicone layer. Over the past 8 years, I have found that silicone gel implants are increasingly more popular. For 14 years, silicone gel implants were available almost exclusively to breast reconstruction patients. Follow up studies during that time has shown no evidence to suggest that silicone is unsafe. Both saline and silicone offer beautiful results at our practice. It’s nice to know that women over 22 today have a choice. ” explained Dr. Richard L. Zeff, M.D., Stratham, New Hampshire.
“The biggest misconception I see is that bigger is better .Breast implant surgery should augment what you naturally have, it should not distort or stretch your breast beyond its natural shape so that it looks fake. It is important to note that breast augmentation may be performed for one of three reasons, including: 1) born with disproportionate breasts when compared to the hips and shoulders with the desire to create balance for body contours; 2) women with children who lost breast volume due to pregnancy and the desire to restore volume; 3) social or work related reasons to improve self-image and build confidence. The idea that your fit will be the same as any other woman is a misconception. Your augmentation plan will be totally different than the plan for any other women. In breast augmentation, it’s always a totally different operation every time.” explained Dr. Anthony N. Dardano, D.O., F.A.C.S. Boca Raton, Florida.
“The most common misconception I see is that many patients request a specific bra cup size when they seek breast augmentation. It is difficult to predict bra cup size after placing a specific sized breast implant because different stores label the same bra different cup sizes. For example a bra labelled a C cup at Macy’s can be labelled a D cup at Victoria’s Secret. I ask patients to focus on the look that they want to achieve and not a specific bra cup size. I use the Mentor Breast Implant Sizing System during which specially shaped implants of various sizes are placed into a non-padded bra so the patient may look into a mirror to see how they will look with that size implant. This system works very well for my patients.” explained Brooke R. Seckel M.D. F.A.C.S., Boston Massachusetts.
Have There Been Any Recovery Advancements?
“Early mobilization, avoidance of tight restrictive dressings and bras and early institution of Breast Implant Displacement Exercises speed recovery and help reduce the chance of capsular contraction or hardening of the implant in my practice. I encourage my patients to go bra less after surgery and start gentle motion of the implant by 3 days after surgery. Today, with most implants placed under the Pectoralis Muscle I also start slow gentle arm lifts to stretch the Pectoralis Muscle to help avoid muscle spasm and pain. Muscle relaxants are also given.” explained Brooke R. Seckel M.D. F.A.C.S., Boston Massachusetts.
“We find that recovery is minimal due to the variety of techniques we use to prevent discomfort. We focus on precise, sharp dissection of the breast to create the pocket for the implant, not blunt dissection that tends to create more trauma to the treatment area, resulting in greater discomfort. The newer generation gel implants are more amenable to placement under muscle, offering less discomfort and a quicker recovery. We use a long acting anesthetic by injecting it into the chest area, breasts and rib cage. We advocate for proper nutrition and keeping well hydrated after surgery. We use Arnica to prevent bruising and recommend all sorts of vitamins. In fact, the garments we use are Spanx instead of constrictive garments that tend to be very uncomfortable. In the end, we find that the overall recovery is more pleasant and more comfortable.” explained Dr. Anthony N. Dardano, D.O., F.A.C.S. Boca Raton, Florida.
“There has been a significant advancement in the recovery from breast augmentation recently. Exparel offers tiny beads that encase Marcaine in a liposome carrier. This carrier can be injected into the rib cage where the nerves are located and then, the body breaks down the beads to release Marcaine in a timely fashion. This allows women to stay ahead of discomfort in the first 72 hours and prevents women from using more pain medication that is associated with nausea and constipation. With less pain, less nausea, less constipation, and a little movement, overall recovery tends to be faster and better. In the past, we used anti-pain pumps that had to be attached to the body, Exparel requires no management or awkwardness and is much cleaner. The injection is very good for women who require breast implant placement under the muscle because there is trauma to the muscle area during surgery, and thus more painful. Exparel blocks the nerves to go to that treatment area to prevent the sensation of pain or minimize discomfort. Anti-pain medication may be an adjunct, but less meds lead to side effects. In turn, recovery is usually much smoother.” explained Dr. Stephen Coccaro M.D. F.A.C.S., of East Setauket, New York.
“Five years ago, I changed my post-operative recovery instructions. My post operative regimen involves early aggressive stretching of the arms up to but not causing pain. We also recommend going out on the night of surgery. At the conclusion of the operation, I irrigate with Marcaine, which reduces early post operative discomfort. Pain medication is provided as needed. The above regimen allows for a much easier and faster recovery than in the past.” explained Dr. Richard L. Zeff, M.D., Stratham, New Hampshire.
What’s New in Breast Implants?
“We are using 4th generation breast implants today in which the inside gel has a gummy bear consistency when compared to more of a fluid like gel in the past. The 5th generation implants were just approved last year, offering a textured more cohesive gel (thicker gel) in a tear drop shape. The 5th generation implants may better serve women who desire more, lower pole projection; those who like a longer implant; or those who want a breast lift and need to fill in the lower pole area. The 5th generation may also work better for women who have a long torso.” explained Dr. Stephen Coccaro M.D. F.A.C.S., of East Setauket, New York.
What About Combining Procedures?
“In terms of combining procedures, many of our breast augmentation patients like to have additional plastic surgery procedures. Approximately, 50% of our breast augmentation breast lift combination candidates are border line in terms of requiring the breast lift for the best possible outcome. In view of the significantly greater amount of scarring that results from the breast lift procedure we don’t want to do it unless it is absolutely necessary. In this case, we often perform the breast augmentation first and evaluate the need for a breast lift six months later, and only do the lift when needed. Other surgeries can be combined as well. The Mommy Makeover often combines Tummy Tuck and Liposuction along with breast enhancement surgeries. While it may be safer to perform very large cosmetic procedures in separate sessions (staged procedures), many women prefer to have the more routine procedures of their choice performed simultaneously.” explained Robert A. Jacobs MD, FACS, Port Jefferson, N.Y.
What Separates Your Practice From The Rest?
“Experience. After 32 years in practice I have more experience with how to achieve my patient’s Breast Augmentation goals and more importantly, how to avoid problems. Plastic Surgery is half science and half art. Experience is the best teacher and I am still learning every day. I love what I do. It is a great privilege and an honor to have patients put their trust in me. I try very hard to deserve my patients’ confidence. I am a doctor first and a plastic surgeon second which means the health and safety of my patients is always my first priority.” explained Brooke R. Seckel M.D. F.A.C.S. Boston, Massachusetts.
“We built a fully integrated operating room from the start and it is state of the art; not retrofitted to meet guidelines. We use board certified anesthesiologists who we know and work with regularly. In fact, our board certified anesthesiologists are dedicated to the out-patient surgery approach when compared to in-patient hospital surgery so they know how to offer a speedy recovery from surgery out of the recovery room. Lisa Karras, our plastic surgical nurse, is one of 17 registered nurses in NY State that is a certified plastic surgical nurse. She is also a certified operating room nurse. Aside from the many precautions we take to ensure safe surgery, we warm patients before surgery and we use the Keller Funnel for implant insertion (smaller incision) to reduce the risk of infection and capsular contracture. We have four plastic surgeons to choose from, including one female plastic surgeon. We combine over 70 years of experience in cosmetic and reconstructive plastic surgery.” explained Dr. Stephen Coccaro M.D. F.A.C.S., of East Setauket, New York.
“The good news is that the procedure is a safe when performed under the right circumstances. Reading peer reviewed information and knowing not all plastic surgeons have equal training is the first step in the right direction to setting reasonable expectations. Then, you need to know there are many good plastic surgeons. Yet, you need to find one who will listen to your desires and let you know if they are obtainable. Buying breast augmentation requires a great deal of understanding. It’s like buying a dress; you need to make certain it is the style and fit you want. All of this and safety are a primary focus at our practice.” explained Dr. Gary Brownstein, M.D. P.C. Cherry Hill, N.J.
“Whatever makes me special trickles down to my staff. We care about obtaining good results. Patient expectations are paramount and my expectations are generally higher than my patients. I am there for my patients after surgery, just as much as before surgery.” explained Dr. Richard L. Zeff, M.D., Stratham, New Hampshire.
‘In general, I tailor each breast operation to fit an individual’s needs, because every woman’s breast is different, and each woman has a different lifestyle and participates in various types of activities. For example, a triathlon runner may be better served with a smaller implant placed above the muscle as opposed to a larger implant under the muscle. This is likely to assist with preventing interference during Triathlon running. We also have a state of art facility, 2 blocks away from the hospital. We perform all plastic surgery in the hospital through a private suite with a separate entrance. In this way, our patients do not have to mix with the general population. We offer a VIP Concierge approach to treatment. Women have this benefit plus all of the added safety precautions available at a hospital. We have our own dedicated hospital team and nurses to cater to women interested breast augmentation. We provide our patients with a card that has the name and number of their dedicated aftercare team member to handle any questions or problems, as well as, direct contact to me when necessary. I have been performing plastic surgery for 15 years and hold numerous titles in the medical community. Notably, I am the President of the Medical Staff at the hospital.” explained Dr. Anthony N. Dardano, D.O., F.A.C.S. Boca Raton, Florida.