Are you satisfied with the size and shape of your breasts?  Do you feel your body is out of proportion?  Would you feel more feminine with larger sized breasts?  Have the effects of aging and children stolen your youthful breasts?  Are your breasts droopy  and demand a push-up bra?  Maybe you are a breast cancer survivor and seek reconstruction for their disfigurement.

These are some of the common concerns women have for requesting breast enhancement surgery.

The two most common procedures are breast augmentation and breast lift which increase the volume and shape of the breast and correct the sagging respectively.

Dr. Wire can perform these rejuvenating procedures safely and comfortably at his office without general anesthesia.  In his experience, local anesthesia facilitates a faster recovery with enhanced safety combined with the convenience and privacy of his office rather than a hospital.

Breast Augmentation

Breast augmentation enhances the size and shape of your breasts.  Breast augmentation is achieved with the use of implants made from silicone.  Silicone, the material which implants are manufactured, is extremely safe for the use in humans and has a long established safety record.  However, implants themselves can exhibit signs of wear and aging.  This reality is extremely important for the patient to accept.  Dr. Wire is emphatic about informing his patients that they will most likely require more than one surgery in their lifetime if they proceed with breast augmentation with an implant.  However, it is fair to balance that reality with the well-established track record of safety and satisfaction of breast augmentation with silicone gel implants.  Please refer to the following links for FDA endorsed guidelines and prescribing resources for breast implants.

Click Here For FDA Guidelines

Next, Dr. Wire advises women to consider the effects of implants on breast feeding, nipple sensation, and breast cancer.

If a woman feels strongly about breast feeding then she may wish to delay breast augmentation until she is finished having children.  Here are some considerations.  First, breast surgery alters the breast by manipulating its tissue, glands, and nerves with the incision to insert the implant and the dissection and expansion of the breast for the placement of the silicone gel implant.  In many cases, there are no untoward effects with the ability of the woman to breast feed.  However, success with lactation after breast augmentation can not be guaranteed, therefore, for a woman who is highly motivated to breast feed Dr. Wire recommends that they hold off breast augmentation until finished having children.

Another relatively common question is how long after breast feeding do I have to wait until proceeding with breast augmentation?  Although there is no scientific result, clinical experience suggests that lactation should have ceased for approximately 1-2 months or longer if possible.  The risk of proceeding to soon would be unexpected changes in the breast such as reduction in size as well as infection due to the bacteria residing within the nipple, milk ducts, and glands.

In regards to nipple sensation, it can be altered or even lost with breast augmentation.  The surgical technique utilized to create a pocket or space to insert the implant can damage or destroy the nerves for nipple sensation resulting in permanent numbness.  The risk is small, around 1%.  More commonly, women will remark about a change in sensation with many claiming hypersensitivity.  This usually settles down over the first 6-12 months after the procedure but it can be alarming and concerning for the woman.

Finally, the risk and impact of breast cancer should be considered by the patient.  Dr. Wire in no way provides expert consulting regarding breast cancer, risk, or its treatment.  His expertise is consulting women regarding the impact of implants on the detection and treatment of the breast if the patient were to be afflicted by breast cancer or other disease.  Family history, age, and personal medical history are reviewed and recommendations to followup with the patients primary physician or oncologic breast expert are recommended.  It is not uncommon for a mammogram to be performed prior to breast augmentation surgery.

Next, let’s take a closer look at implants

Pictures Of Breast Implants

Figure 1
Figure 1
Figure 2
Figure 2

A breast implant is a medical device made from 100% silicone of a given dimension and volume.  It consists of a shell which is the external surface that the breast surrounds.  It can be filled with saline or silicone gel.  Dr. Wire discourages the use of saline breast implants (Ask him why!).  The silicone gel implants are available in different sizes and shapes as well as smooth or textured.

Probably the most important characteristic of the breast implant is its size, or volume.  Unfortunately, implants are not sized as A cup, B cup, or Cup. In fact, there is no standardized scale for bra cup size.  The size of the implant is determined by its volume in cubic centimeters (cc) and its height, width, and projection in centimeters (cm).  For perspective, a 355cc implant is equivalent in volume to a 12oz can of soda!  Implants range from 100 to 800cc (figure 1).

The next consideration in selecting an implant is its shape.  For an implant of a set volume, the shape can by adjusting the height, width, and projection.  Therefore, implants for a given volume can have a low, moderate, or high profile shape (figure 2).

Further advances in implant design have resulted in form stable, textured, shaped implants.  These implants are commonly referred to as “gummy bear” implants, in reference to the feel of the gummy bear candies.  These are the most natural looking and feeling implants.

Finally, the outer shell of the implant can be smooth or textured.  Smooth shelled implants are the most common but some surgeons and patients prefer a textured shell.  There is some evidence to suggest that a textured implant may reduce the rate of capsular contracture (more on that later).  Dr. Wire will sometimes select texturing for larger sized implants so as to help “hold” the implant and reduce the amount of “bottoming out.”

So, putting it all together, it becomes readily apparent that there are many implant choices available for the patient.  The eventual selection depends upon the patients’ desires and expectations which is not easily translated to dimensions of an implant.  And every woman is different!  Some women want to look big, full, and augmented.  Some women prefer a more modest, natural look.  Therefore, implant options and selections are extremely important.

At the time of consultation with Dr. Wire, the patient is examined and measurements of the breast including width, length from the neck to nipple, and characteristics such as the shape of the inframammary fold, asymmetries, quantity of breast tissue, and relative laxity or droopiness of the breast and tissue (ptosis) are noted.  Next, the patient is encouraged to “try on” different sizers.  This gives the woman a chance to see and feel her new body.  Finally, the patient and Dr. Wire compare notes. Hopefully, there is close agreement between what the patient selected and Dr. Wire’s measurements.  Finally, a range of implants is mutually agreed upon.

Day of Surgery

In preparation for surgery, the patient will need to be cleared by their primary physician with a preoperative history and physical.  A mammogram may be indicated depending upon the recommendation of that physician. You should pick up your prescriptions and prepare your home so that you don’t have any responsibilities for the first week such as cleaning.

The morning of surgery, please shower and wash with the Hibiclens scrub brush provided by the office.  Do not apply any lotions or perfumes and wear a comfortable button down blouse.  EAT BREAKFAST!  Yes, eat breakfast please because you will appreciate its benefit through the rest of your surgical experience.  When you get to the office you will be orally medicated so breakfast will help prevent nausea.  You will be left to rest in a comfortable bed with warm blankets, aroma therapy, and acupuncture.

Before surgery, Dr. Wire will meet with you to go over final questions and take pictures.  After that, you will stop at the bathroom and then walk into the operating room.  Next, you will be prepared for surgery with all the typical accoutrements such as scrubbing, monitors, and drapes.  Dr. Wire prefers listening to classical music so you may wish to bring along your own music and earbuds.

Next, Dr. Wire will inject the lidocaine anesthetic to numb up your breasts.  This takes about 15 minutes and you may feel a poke or stick which should quickly dissipate.  Surgery begins only after you are completely numb.   During the surgery you will still have the sensation of touch but you will feel no pain.  Often, there is a sense of excitement for the patient as the implants are inserted. Some patients become quite talkative while others rest and relax.  When surgery is completed, you will get up to the bathroom and then allowed to recover with a juice and protein bar and ice packs.  Your ride will be waiting to take you home to rest overnight.  The numbing medicine will slowly wear off through the afternoon and you will encounter some pain.  Everyone experiences pain differently so you will have access to the pain medicine as needed.  You can expect a phone call that evening from Dr. Wire checking up on you.

Typically, Dr. Wire prefers to see his patients in follow up the day after surgery, one week, one month, and six months.  Breast augmentation is a fairly straight-forward surgery and recovery so one post operative visit within the first week will suffice for those who are travelling from far away or out-of-state.

The patient can shower the next day.  There are no drains or sutures to remove.  The incision under the breast is covered with a clear plastic bandage which is removed one week after surgery.  You may wear a comfortable sports bra right away but Dr. Wire discourages the use of an underwire bra for the first month of healing.

Activity is restricted so as not to raise your blood pressure or pulse rate; Therefore, no exercise or vigorous activity; No vacuuming or cleaning; You may go for a walk, go shopping or to a movie or restaurant.  Keep it simple for the first week.  After the first week you may begin to resume more activities but it will take one month for you to reach 100%.  Your body needs time to heal and the implants need to settle into position so being too active can be detrimental.  After a month, you can resume activities such as golf, tennis, swimming, and weight lifting and generally all restrictions are lifted.