Prepping for Patient Ed Consult: Breast Augmentation Choices
Preoperative Planning – Surgical Choices in Breast Augmentation
How to Choose Breast Implant Size and the Look You Want
How to choose the breast implant size for each patient is probably the most heated debate for surgeons and most worried about option/choice for patients. The most common methods are all subjective and mean nothing when it actually comes down to walking into the operating room – ie – putting sizers in your bra, talking cup size, looking at photos of other people, 3-D imaging, and we can’t forget one of my personal favorites, the rice test! Let’s face it, patients are either worried that they will be too big or not big enough. Although talking “full C” with your surgeon or bringing him or her a photo of what you want to look like may make you feel all warm and fuzzy at the time, I guarantee you, when you leave your consult, you will be wondering if they actually understood what you want.
Dr. Tebbetts makes all surgical decisions about how to change a breast – whether it needs augmenting, lifting or reducing – based on a scientifically proven and published measurement system called, The High Five System®. It is so simple to use – even patients can measure themselves at home to get an idea of what their body – their breast is calling for. It is five measurements that are applied to a formula – the answer gives you the CORRECT amount of fill for each individual breast…. every time.
By simply filling the empty breast envelope, the High Five System® produces beautiful, natural appearing breasts that are least likely to cause you more operations in the future. So if you want to change your breasts – after time, babies, nursing, weight gain and loss – and yet you don’t want a “boob job”, the way Dr. Tebbetts approaches how to determine size – The High Five System® – is just the ticket for you!
Choosing the Type of Breast Implant
We have learned a lot about breast implant devices over the years and they just keep changing. In fact, since we went to press with TBB2 and now, everything has changed, making Chapter 5 in TBB2 out of date. After careful review of the data available, at this time, Dr. Tebbetts prefers the safety and longevity characteristics of round, smooth cohesive silicone gel breast implants. These implants have been approved by the FDA since 2006 – for both American manufacturers, Mentor and Allergan.
Each company has slightly different sizes to offer, so Dr. Tebbetts prefers to use your measurements to determine which manufacturer will be the best fit for your breasts. Each company offers long term warranties as well – we provide each patient with manufacturer’s handout material, implant serial number cards and warranty information after surgery.
We are happy to discuss all the implant questions that you may have, like: “Isn’t saline safer?”, “What happened to textured implants?”, “What about shaped implants?” Ask away and we will be happy to discuss what we know, given the data available, at the time. It is very important to remember that what makes a pretty, natural breast is NOT the type of implant that is used, but HOW the breast implant is used – the size chosen and pocket location chosen. In other words, if the breast implant size simply fills the breast envelope (not pushing it) and the proper pocket location is used to give adequate soft tissue coverage over the implant, it could be any shape, fill, or shell type and it will look natural on you. It is not the implant – but how the implant is used that makes you a pretty result!
How to Choose Breast Implant Pocket Location – Over vs. Under vs. Dual Plane
Again, this very important decision in planning your breast augmentation with Dr. Tebbetts, goes back to the measurements. If you have 2 cm or less of pinch thickness in the upper portion of the breast, the breast implant needs to be placed under more of YOU to camouflage it over time – make it age better with you and make your mammograms the best they can be over time.
Dr. Tebbetts developed and published the Dual Plane method in 2005. I hope the illustrations below help you understand the difference between over, under and dual plane. We would be happy to discuss any specific questions you have about pocket location. P.S… nobody’s implants are completely “Under” no matter what your buddies told you – it’s just a phrase that is very commonly used amongst patients and surgeons. The breast implant is usually place partially under the pectoralis muscle covering the upper third of the implant.
Choosing Breast Implant Incision Location
Boy, have times changed in this department! When the FDA took the old silicone gels off the market in the 1990’s, we were forced into using nothing but saline implants for over 16 years. Saline implants come to the surgeon empty and are filled through a valve after they are placed (one of the reasons they have such a high failure rate) in the pocket. Placing an empty implant left us with a lot of incision options – endoscopic axillary, peri areolar and inframammary – were all incision options.
Now, with the advent and use of thicker silicone gel implants, we are limited to mainly the inframammary (under breast, crease) incision. This incision option provides maximal accessibility without compromising the implant shell or filler. The inframammary incision has always been the leader in fewer risks – it is always hidden in the crease under the breast, the surgeon only has to pass through minimal tissue and he is in the pocket, it does not increase risk of infection or sensation loss (like PA incisions do).
All of Dr. Tebbetts incisions are closed from underneath the skins surface, avoiding track marks on the skin that might be visible later. The stitches dissolve on their own and require only a small piece of brown, paper tape to cover them. This piece of tape is your only “bandage” and it comes off on its own in about two weeks.
How to Prepare for Breast Augmentation – Preoperative Planning and Putting It All Together…
I know on the surface, it seems like a lot of stuff to consider, but when you boil it down – here is what has to be decided before you go into that operating room:
The Day of Surgery
Although a breast augmentation with Dr. Tebbetts is predictably only 30 minutes of OR time, the entire process takes half a day. Usually arriving at 8:15 am and leaving the surgery center around lunch time. For the best possible experience, choose a buddy/caregiver for the day who is naturally bossy!! That person will be a tremendous help to you right after surgery when you are still in your anesthesia fog.
Once home you get to sleep 2 hours, then you must get up, eat, take your Ibuprofen, start your arm raises , shower and wash your hair and dry it. After that your evening is yours, but you must be busy – if you are taking care of the kids – great! If you are shopping and going out to dinner – great!! We don’t expect you to run a marathon the night of surgery, but we expect you to fully participate in your 24 Hour Recovery® and move normally. The only thing you cannot do the day of surgery is drive. 24 Hour Recovery® is a team effort – Dr. Tebbetts will do his part, and we know you will do yours because no one has time to be down! Your recovery time becomes part of the expense of having this surgery – the longer you are down and can’t function (hiring baby sitters, days off work, husband’s time off work – it all adds up!), the more this costs you in the long run!
What to Expect Immediately After with Breast Augmentation with 24 Hour Recovery® Techniques
We always like to prepare our patients for what to expect during the first few days, weeks, and months after surgery, because although you can return to normal activity immediately, the healing process takes time. If you know what to expect and can plan around it, it is not usually a problem. When you don’t know what to expect – and it’s a surprise… well, now, that can be a BIG problem!
For the first 4-6 weeks – expect your new breasts to be too high, shiny, big and tight. Here’s an example of a patient before, one day post op and 6 weeks post op. Look at the degree of change from day one to six weeks! Please note that there is no bruising, no bras, no bandages, no drains in this patient at one day post op! With Dr. Tebbetts’ technique, you can wear anything you want to wear immediately post op – but in general – things like stretchy tanks and camisoles with shelf bras work best during this time.
At 3 months – your new breasts will feel more like they are part of you and I think it is reasonable to buy pretty, expensive bras at that point and finally get a good idea of what new cup size you will be (keep in mind that it will be different if you go to VS or to Target!).
For 6 – 9 months – expect to have shooting pains and tingles and weirdness – it takes that long for sensation to normalize. At 1 year post op – your incision is considered completely healed and you are pretty much passed your greatest risk of capsular contracture.
Why Would You Choose Dr. Tebbetts and 24 Hour Recovery®?
If you want to change your breasts but don’t want to destroy them, then trust your body to make the size and pocket location decisions. If you want to resume normal activity the afternoon of surgery and cause the least amount of disruption to your family and your career, then choose 24 Hour Recovery®.
The number one reason for reoperation in breast augmentation is size exchange – they are always either too little or too big – eliminate that risk by using objective, clinical decision making – by using The High Five System®. The second biggest reason for reoperation in breast augmentation is capsular contracture. Dr. Tebbetts has the lowest, published rate of capsular contracture in the literature. 24 Hour Recovery® patients experience a 1.5% capsular contracture risk. So by returning to normal immediately, you reduce your second biggest risk!
Choose Dr. Tebbetts because he is an excellent technical surgeon who has devoted his surgical career to redefining the patient’s experience in breast augmentation surgery – not just for the first 24 hours, but for your life time.
John B. Tebbetts, M.D., Dallas Plastic Surgeon