Breast Augmentation Repair

Delayed wound healing is not very common after breast enlargement surgery. Because the incisions are relatively small, and with proper technique the breast tissue is not devascularized the problem is rarely seen in healthy patients. Nicotine use, poorly controlled diabetes, chemotherapy, radiation therapy, vascular disease, immunosuppressive therapy or disease, use of corticosteroids may all lead to delayed wound healing.

Breast augmentation surgery should not affect breast feeding. Because breasts gain more projection and substance after enlargement, they are typically easier to hold. Because they protrude more, and are easier to hold, breast feeding becomes much easier. Paradoxically breast feeding is actually less difficult for some women, after breast augmentation surgery. Given all of this, however, there are studies showing that women with breast implants report an inability to feed in up to 2/3’s of the implanted population, compared to 7 in 100 for women without breast implants. It is doubtful, however, that matching for size and age such results would ever hold up.

The Keller Funnel is a cone-shaped device that helps Dr. Gerzenshtein position breast implants. The tip is inserted through the breast implant incision, and the implant is put into the slick funnel. Dr. Gerzenshtein uses a gentle push/squeeze motion to coax the implant into the correct position. One advantage to using the Keller Funnel is its no-touch sterile approach that reduces the risk of infection. Also, the device allows Dr. Gerzenshtein to use minimal amount of force when positioning the implants, putting less stress on the implant shell and decreasing the risk of the implant weakening or rupturing. This can reduce the chance of the implants needing to be removed and replaced again. A surgery using the Keller Funnel is shorter and requires smaller incisions and less tissue trauma than traditional breast augmentation repair.

Any surgery, in any discipline carries a risk of infection. The risk is calculated based on the degree of contamination for a particular operation. Breast augmentation is considered a “clean” surgery, and carries an overall infection rate of less than two percent. If infection should take place, it will most often affect one or more of three patterns, assuming there is no disseminated spread, and the infection remains localized. Infection can occur in the skin, in the soft tissue surrounding the implant, and in the form of a pus pocket. Skin infection will usually respond to oral antibiotics. Soft tissue infections surrounding the breast implant may respond to oral antibiotics, will sometimes require intravenous antibiotics, and in other cases need to be treated with implant removal. If the infection should progress to, or start out as an abscess (pus-pocket), the only treatment that will be effective in treating the infection and preventing more serious systemic complications is drainage of pus and breast implant removal. Toxic Shock Syndrome (TSS) may result from the presence of a foreign body (breast implant in this case) in the setting of an infection, and is a truly life-threatening condition that needs to be addressed immediately. It is marked by high fever, nausea and vomiting, diarrhea, light-headedness and possibly loss of consciousness, and a diffuse rash. The treatment is timely institution of IV antibiotics, and breast implant removal. If the breast implant is removed, the infection should be treated, the inflammation allowed to resolve, and a new implant placed weeks down the road.

The breast enlargement surgery itself should be painless, whether performed under sedation with local anesthetic, or general anesthesia. It is the postoperative period that some may find brings discomfort. Assuming the postoperative course is without complication, pain from breast augmentation surgery peaks the day after surgery, and diminishes over the course of the following three to four days to be tolerable enough without the use of narcotics. Of course, pain tolerance varies significantly from patient to patient. The 72-96 hrs time frame is a “ballpark” figure, and a reflection of personal experience. Several other important factors are crucial to consider in breast enlargement surgery. Pre-incisional administration of local or dilute local (called tumescent) anesthetic greatly diminishes postoperative breast enlargement surgery pain. Postoperative pain and tenderness can be further affected by breast implant placement position. Sub-muscular placement or “dual plane” placement may cause substantially more discomfort than sub-glandular placement because of muscle dissection. If a skin excision is necessary, pain may be more pronounced. The injection of local anesthetic at the conclusion of breast augmentation surgery greatly diminishes postoperative discomfort. In addition, a more effective multiple intercostal nerve block may be performed. Finally, a small catheter may be placed, within the breast implant pocket, for the purpose of delivering local anesthetic in the post breast enlargement surgery period. This has been shown in studies to help significantly with postoperative discomfort. In short, breast enlargement surgery is very well tolerated in most patients.

A breast implant is more likely to be noted on manipulation of the breast when they are too big for the breast and soft tissue present, when they are over, rather than under the muscle, and when they are textured. Ensuring a small enough base width, good soft tissue cover with a submuscular or dual-plane placement, and using smooth breast implants will decrease the risk for this.