Plastic Surgery
James A. Rieger MD
(316)-652-9333

Breast augmentation, technically known as augmentation mammoplasty, is a surgical procedure to enhance the size and shape of a woman’s breast for a number of reasons:

1. To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
2. To correct a reduction in breast volume after pregnancy.
3. To balance a difference in breast size.

By inserting an implant behind each breast, surgeons are able to increase a woman’s bust line by one or more bra cup sizes. If you’re considering breast augmentation, this will give you a basic understanding of the procedure–when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on your individual circumstances. Please ask your surgeon if there is anything you don’t understand about the procedure.

The best candidates for breast augmentation
Breast augmentation can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with your surgeon.

“Mommy Makeover” includes a wide array of cosmetic surgery options, including breast augmentation, breast lift, tummy tuck, body sculpting with liposuction and skin rejuvenation procedures. These procedures, which can dramatically improve how you look and feel.

The best candidates for breast augmentation are women who are looking for improvement, not perfection, in the way they look. If you’re physically healthy and realistic in your expectations, you may be a good candidate.

Breast augmentation is usually done to balance a difference in breast size, to improve body contour, or as a reconstructive technique following surgery.

Types of implants –  Saline versus Silicone gel breast implants
One of the most important choices you will make is whether to use saline or silicone breast implants. There is no right answer to the question, but there may be a right choice for you depending on what your goals are. Both saline and silicone gel filled implants are safe. The shell of both is a soft solid silicone. A breast implant may be filled with saline or silicone gel. There are pros and cons to both saline breast implants and silicone breast implants so one may be better for you than the other depending on your objectives. The paragraphs below and your consultation with Dr. Rieger will help in this decision. There is also a third type of breast implant noted below which is new and fda approved.

Types of implants –  Our practice uses smooth surface breast implants only.

Advantages of Silicone Gel Breast Implants

The primary advantage of silicone gel breast implants is that they feel more like natural breast tissue and are less likely to show an edge or have rippling. They are also likely longer-lasting. They are recommended for women with less breast tissue. Should a silicone implant develop a pinhole, the gel will most likely stay inside the implant due to the cohesive nature of the gel. Should a larger tear occur, there may be some movement of the gel out of the implant. However, the gel would be contained by the normal thin scar tissue “capsule” that forms around all breast implants including saline implants shortly after implantation. Sometimes a thick scar tissue “capsule” may form around the leaked silicone. A thick capsule however can occur with a saline or silicone implant whether leaked or not leaked. When the leaked implant is discovered, the silicone gel, implant and this thick scar capsule will need to be removed. Some women are concerned about the safety of silicone gel breast implants.  These implants were intensely studied and approved by the FDA. No connection was found between silicone breast implants and cancer, autoimmune disorders, or connective tissue disorders. They were also not found to cause adverse effects to breastfeeding infants. Convinced by the studies showing that they are safe, the FDA approved silicone breast implants in 2006. The The FDA does recommend screening MRI’s of the breast for silicone gel implants. However high resolution ultrasound may be even better for this screening.

Advantages of Saline Breast Implants

Saline breast implants can give good results for the right patient, especially women with sufficient natural breast tissue and when the implants are placed under the pectoral muscle. They are less expensive than silicone gel implants. If a saline breast implant ruptures, the filler is quickly and safely absorbed by the body. This will cause the breast to deflate, but is safe since it is saline (“salt water”).

Gummy Bear Breast Implants

This is just a way to describe the cohesiveness or gel nature of the implants currently on the market. So their is no implant which is named a gummy bear implant it is just a “nickname”.

 All surgery carries some uncertainty and risk
Breast augmentation is relatively straightforward. But as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or “scoring” of the scar tissue, or perhaps removal or replacement of the implant.

As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to control the bleeding and remove the accumulated blood.

A small percentage of women develop an infection around an implant. This may occur at any time, but is most often seen within a week after surgery. In some cases, the implant may need to be removed for several months until the infection clears. A new implant can then be inserted.

Some women report that their nipples become oversensitive, under sensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.

There is no evidence that breast implants will affect fertility, pregnancy, or your ability to nurse. If, however, you have nursed a baby within the year before augmentation, you may produce milk for a few days after surgery. This may cause some discomfort, but can be treated with medication prescribed by your doctor.

Occasionally, breast implants may break or leak. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak. If a saline-filled implant breaks, the implant will deflate in a few hours and the salt water will be harmlessly absorbed by the body.

If a break occurs in a gel-filled implant, however, one of two things may occur. If the shell breaks but the scar capsule around the implant does not, you may not detect any change. If the scar also breaks or tears, especially following extreme pressure, silicone gel may move into surrounding tissue. The gel may collect in the breast and cause a new scar to form around it, or it may migrate to another area of the body. There may be a change in the shape or firmness of the breast. Both types of breaks may require a second operation and replacement of the leaking implant. In some cases, it may not be possible to remove all of the silicone gel in the breast tissue if a rupture should occur.

A few women with breast implants have reported symptoms similar to diseases of the immune system, such as scleroderma and other arthritis-like conditions. These symptoms may include joint pain or swelling, fever, fatigue, or breast pain. Research has found no clear link between silicone breast implants and the symptoms of what doctors refer to as “connective-tissue disorders,” but the FDA has requested further study.

While there is no evidence that breast implants cause breast cancer, they may change the way mammography is done to detect cancer. When you request a routine mammogram, be sure to go to a radiology center where technicians are experienced in the special techniques required to get a reliable x-ray of a breast with an implant. Additional views will be required. Ultrasound examinations may be of benefit in some women with implants to detect breast lumps or to evaluate the implant.

While the majority of women do not experience these complications, you should discuss each of them with your physician to make sure you understand the risks and consequences of breast augmentation.

Planning your surgery
In your initial consultation, your surgeon will evaluate your health and explain which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, your doctor may also recommend a breast lift.

Be sure to discuss your expectations frankly with your surgeon. He or she should be equally frank with you, describing your alternatives and the risks and limitations of each. You may want to ask your surgeon for a copy of the manufacturer’s insert that comes with the implant he or she will use — just so you are fully informed about it. And, be sure to tell your surgeon if you smoke, and if you’re taking any medications, vitamins, or other drugs.

Your surgeon should also explain the type of anesthesia to be used, the type of facility where the surgery will be performed, and the costs involved. Because most insurance companies do not consider breast augmentation to be medically necessary, carriers generally do not cover the cost of this procedure.

Preparing for your surgery
Your surgeon will give you instructions to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications.

While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days, if needed.

Where your surgery will be performed
 Dr. Rieger prefers to perform the operation in a state-of-the art accredited outpatient surgery center.

Types of anesthesia
Breast augmentation can be performed with a general anesthesia, so you’ll sleep through the entire operation.

The surgery
The method of inserting and positioning your implant will depend on your anatomy and your surgeon’s recommendation. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the armpit. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible.

Incisions are made to keep scars as inconspicuous as possible, in the breast crease, around the nipple, or in the armpit. Breast tissue and skin is lifted to create a pocket for each implant.

Working through the incision, the surgeon will lift your breast tissue and skin to create a pocket, either directly behind the breast tissue or underneath your chest wall muscle (the pectoral muscle). The implants are then centered beneath your nipples.

Dr. Rieger generally places the implant behind the pectoralis muscle. This placement interferes less with breast examination by mammogram than if the implant is placed directly behind the breast tissue. Putting the implants behind your chest muscle may reduce the potential for capsular contracture also.

See the webpage on implant pocket placement  for more information

The breast implant may be inserted directly under the breast tissue or beneath the chest wall muscle.

You’ll want to discuss the pros and cons of these alternatives with your doctor before surgery to make sure you fully understand the implications of the procedure he or she recommends for you.

The surgery usually takes one to two hours to complete. Dr. Rieger places most of the stitches under the skin surface to improve the appearance of the incisions. In most cases only simple butterfly paper tapes or steristrips are placed on the skin and only two or three suture require removal.

After surgery, breasts appear fuller and more natural in tone and contour. Scars will fade with time.

After your surgery
You’re likely to feel tired and sore for a few days following your surgery, but you’ll be up and around in 24 to 48 hours. Most of your discomfort can be controlled by medication prescribed by your doctor.

You should wear a sports  bra for the first few weeks. You should wear it as directed by your surgeon. You may also experience a burning sensation in your nipples for about two weeks, but this will subside as bruising fades.

Your stitches will come out in a week to 10 days, but the swelling in your breasts may take three to five weeks to disappear.

Getting back to normal
You should be able to return to work within 5 to 7 days, depending on the level of activity required for your job.

Follow your surgeon’s advice on when to begin exercises and normal activities. Your breasts will probably be sensitive to direct stimulation for two to three weeks, so you should avoid much physical contact. After that, breast contact is fine once your breasts are no longer sore, usually three to four weeks after surgery.

Your scars will be firm and pink for at least six weeks. Then they may remain the same size for several months, or even appear to widen. After several months, your scars will begin to fade, although they will never disappear completely.

Routine mammograms should be continued after breast augmentation for women who are in the appropriate age group, although the mammographic technician should use a special technique to assure that you get a reliable reading, as discussed earlier.

Your new look

For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance. 

Our cost for breast augmentation with smooth round silicone or saline implants is $5,250 * which includes surgery center, anesthesia, plastic surgeon fees and implants. Please call our office at 316-652-9333 for information and to schedule a free appointment. *

* The cost for breast augmentation includes  breast implants, surgery center fees, anesthesia fees and surgeon fees. There are no extra routine costs. However, the cost does not include medications, saline implant company extra warranties, surgery complications, future surgery revisions or implant changes, implant complications not covered by the implant company, and/or  extended stays in the surgery center. Silicone gel implants come with a complimentary warranty from the breast implant company.The details will be explained at the time of your appointment.

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Brochure © 2003 American Society of Plastic Surgery.