Most routine breast augmentation consultations include a thorough discussion of breast size, cosmetic preference, and implant type. There are several other issues that can become very relevant to selecting the appropriate operation for a given patient, and to prepare her for the postoperative recovery and the resulting lifestyle changes. Here are a few other questions that should be asked and answered to optimize your functional and cosmetic outcomes.
How much exercise do you do, and what kind?
Many of my patients who undergo breast augmentation are slim and fit. They usually work out quite often, including activities that require a lot of upper body strength and use of the pectoralis muscles of the chest. Breast augmentation usually involves placing an implant either above or below the muscle layer, therefore physical activity is extremely relevant to recovery and postoperative lifestyle.
The exercise issue is particularly relevant for patients considering a procedure that would place the implant under the muscle. In order to fit the implant under the pectoralis muscle, space has to be made for it. Although part of the muscle is cut to accommodate the implant, the bulk of it still works normally, contracting while performing upper body exercises. In some cases, this can cause “animation,” or movement of the implant, up and down during exercise. Implant animation can look a little strange, but more importantly, it can feel awkward. For patients who are slim and have little native breast tissue, and for those who regularly perform strenuous exercise, sub-pectoral augmentation may be more challenging long-term. If this sounds like you, you may be better served with an implant under the breast rather than under the muscle.
How soon do you have to be back at work, and what exactly do you do?
Most patients will ask how long the recovery is after this operation. Recovery is a relative term, as it depends a lot on lifestyle. For patients who sit at a desk and use a computer, return to work may be as short as a week or even less. For those who have more physically demanding jobs like home health aide or police officer, return to work may be three weeks or more. Lifting a heavy patient or wearing a bullet proof vest may not be possible or advisable for more than a month after breast surgery, and strenuous physical exercise using the upper body and arms can take up to six weeks to allow. For patients undergoing sub-pectoral augmentation, the recovery period can last much longer. Pain levels alone are far greater with this approach, and it can take several months for something like a pushup to feel comfortable.
How well do you tolerate pain?
While any surgical wound produces pain, different types of tissue produce different kinds and quantities of discomfort. Skin incisions usually feel achy the first postoperative day, while the anesthesia is still wearing off and other pains feel more present. The incisional pain becomes more noticeable the second day, and usually feels like a slight burning sensation. This tends to fade after the first three or four days, as the wound settles in. Breast tissue can also cause pain, but this is more of a dull ache, and it usually is not that significant unless pressure is placed on the tissue itself.
Muscle wounds, on the other hand, can be very uncomfortable for long periods of time.
If you have ever sprained or bruised a muscle, you know that it hurts like crazy, and can take a long time to get better, because muscle tissue contains extensive blood vessels and nerves. The pectoralis muscle sits on the chest wall, underneath the breast tissue and against the rib cage. It normally lies flat, with no space underneath it. When it is lifted up to make room for a sub-pectoral implant, part of it has to be divided, or cut, to make it looser. Furthermore, in order to make space for the implant, the muscle needs to stretch, both during the surgery and slowly over time afterwards. This causes significant pain, more than many patients realize.
Do you have small children or small pets at home?
When it comes to postoperative instructions, it is common to be advised not to perform any heavy lifting nor straining. Patients usually understand this to mean no strenuous exercise and no carrying heavy package. But heavy lifting also includes small children and pets, especially if they are over 15 pounds in weight.
The other issue with small children and pets is that, even if they are not extremely heavy, the sheer amount of movement of which they are capable means that handling them requires more force and can be more challenging. This limitation usually surprises patients, especially moms, who worry about not carrying their babies for weeks on end. The bad news is that these limitations are real and sometimes do last several weeks. The good news is that there are lots of ways to work around the no picking up rule, and baby or puppy snuggling need not be compromised to do so.
Do you take any herbal or homeopathic medications?
A patient’s medical history always includes a survey of the medications they take. Most people understand this to mean prescription drugs they get from the pharmacy; but they often disregard the many other supplements and “medications” that they take on a regular basis.
Many of the herbal, homeopathic, and over-the-counter substances that people take not only qualify as medications, but can also have profound effects on surgery. Some of them can cause bleeding, others can cause clotting, and others still can interact to various degrees with the anesthetics used during the procedure. Some avoidable surgical complications occur because patients do not realize that the supplements they take with breakfast actually put them at risk for postoperative problems, and the discussion about them never comes up in the first place. Always be sure to mention any and all pills, powders, and potions that you use in addition to your regular diet, just to be sure that none of them are at high risk of complicating your surgery. Avoiding those problems can be as simple as stopping those products a few weeks before your operation.
Have you ever had a scar complication, like a keloid?
One of the main factors in the way a scar ultimately turns out is genetics. Even with a fabulous repair, some incisions will turn out better than others just based on the patient’s ability to heal well. By the same token, some scars will turn out poorly because the patient does not heal well.
One of the more problematic scar related problems is the keloid. Keloids are big, thick, chunky overgrowths of scar tissue that occur in some patients for reasons that are still poorly understood. While it is impossible to predict who will get a keloid and who won’t, the best predictor of future behavior is past behavior. If you’ve had a keloid in the past, you could get another one. This is particularly relevant if you are planning an incision around the areola, where a thick scar would be more obvious than one under the breast; and it would also be more difficult to treat with injections or excisions both because of sensitivity and because of the irreplaceability of the areolar skin. You may also require a longer or more frequent follow-up regimen to manage and treat any scar related problems after your surgery. Always mention to your surgeon if you have any history of poor scarring, and better decisions can be made to optimize your outcome.
Breast augmentation is one of the most commonly performed cosmetic procedures in the United States, with an overall high rate of patient satisfaction. That being said, there is always room for improvement, and fantastic, complication-free results are the ultimate goal. A good cosmetic appearance is only one part of the objective. Having the right size and shape implant, in the right pocket is the next step in toward success. A surgical approach that is tailored to your personal history and lifestyle will further contribute to your looking and feeling your best in your new body.
As with any relationship, the patient-surgeon interaction depends on honest and complete communication. Let your surgeon get to know you, so that she can guide a surgical plan that optimizes your outcome. These questions should help complete that picture and lead you both to ultimate success.
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