Breast Augmentation
Artwork by Dr. BYUN
A breast augmentation is a surgical procedure performed to enhance the size, shape and or positioning of one’s breasts. This procedure involves inserting an implant behind each breast to increase the bust size by one or more bra cup sizes. Prospective patients should know not to expect perfection, per se, but to most definitely expect improvement.
Dr. BYUN’s Compression Test For Breast Augmentation
What Makes Leading Plastic Surgeon Dr. BYUN’s Incision and Implant Placement Technique Different?
Dr. BYUN wants the outcome of breast augmentation surgery to look natural, not artificial. He uses one of three sites for incisions: the axillary, the areola, and the inframammary fold. Between the breast tissue and the skin is a pocket where the implant will be placed. The implant itself will be inserted either behind the breast tissue or the muscle of the chest wall, though Dr. BYUN often opts to inserts the implants beneath the muscle because he believes it makes the look breasts more youthful and natural. The implants are then centered beneath the nipples to conclude the surgical procedure.
Breast Augmentation Procedure
We have provided a sample copy of an Operative Report. The procedure is subject to change per the patients needs.
ANESTHESIA: GENERAL
OPERATIVE PROCEDURE
After induction of general anesthesia the patient will be prepped and draped in the usual sterile fashion. Often an incision of less than one inch is made underneath the breast, just above the crease, where it is usually inconspicuous. Another possible location for the incision is around the lower edge of the areola (the pigmented skin surrounding the nipple). A third alternative is to make a small incision within the armpit. Once the incision is made, Dr. BYUN will create a pocket into which the implant will be inserted. This pocket is made underneath the pectoral muscle which is located between the breast tissue and chest wall.
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Breast Augmentation Recovery
Right after surgery you will need to refrain from heavy lifting and straining your chest or arms by pushing or pulling heavy objects. You should not lift your arms above your shoulders prior to your first per-operative visit. At your first visit, Dr. BYUN will determine which activities you will be allowed to resume. Everyone heals at a different pace, and asymmetry and swelling are part of the healing process.
Keep all bandages, dressings, and tapes intact for 48 hours. This time is crucial in creating the desired results. After 48 hours you may take your first shower. Remove and discard external bandages not applied directly to the skin (ace wraps and gauze) and do not replace. Do not remove the Micro-foam sponge tape that supports the breasts. You must wait until your first follow-up appointment with Dr. Byun where he will further instruct you. Also, as stated before, do not remove any bandages/tapes that are applied directly to the skin to cover incisions. If any tape or part of the tape loses adhesiveness, it is acceptable to trim the edges. Do not remove tape completely. Cleanse any uncovered incisions 3-4 times a day using clean gauze soaked in saline water (found at your local pharmacy) and follow the instructions from the first page about showering and cleansing incisions.
It is not uncommon if you experience discomfort for several weeks after surgery, especially while you open doors and pull or push objects. This is all normal. Expect asymmetry, size differences, and folds at different levels. All of these concerns will be addressed by Dr. BYUN at the follow up appointments in the weeks to come.
You must take a shower prior to and on the same day as each follow up appointment to clean the incisions and prepare them for suture removal.
Breast Augmentation FAQs
How Do I Decide Which Implant Is Right For Me?
Hundreds of thousands of women in America choose breast augmentation surgery each year, and its popularity continues to steadily increase. Plastic surgeons have responded to the demand with a variety of new options and innovations, including new choices for implants. It is important to remember that implants are not one-size-fits-all. There is a wide range of sizes and shapes to match your individual body type and your own expectations. The key to choosing the right material, shape, and size for your procedure is to share your goals with your surgeon. Ask plenty of questions, review your surgeon’s before-and-after albums to help visualize in your mind, or practice with bras to see how you would like to look after your breast augmentation.
What Is The Difference Between Breast Augmentation And Breast Lift?
Breast lift focuses on restoring a youthful profile to the upper body by raising the breasts and reversing sagging. By elevating the position of the breasts on the chest, the procedure can create the appearance of larger volume, even though a small amount of tissue is normally removed during the surgery. In addition, by improving symmetry and restoring a “perky” look by returning low or downward-pointing nipples to a natural appearance, breast lifts create a profile that is more dramatic in its projection, shape, and proportion.
How Long Does The Recovery Take? When Can I Go Back To Work & Exercise?
Depending on both the surgery and your own physiology (your body’s healing), most patients have a downtime of two (2) to three (3) weeks before returning to daily activities such as exercising. During the first ten (10) days, we ask that you do not do any activity that increases your heart rate. This is to help the healing process, since the blood clot that has stopped the bleeding from the surgery dissolves in about seven (7) days. After ten (10) days, increase activity by ten percent (10%) each week as tolerated. Stop activity if you see a dramatic increase in swelling when you wake up the following day. At the one (1) week post-op visit you will be provided with healing instructions and what specific activities are allowed. Patients can usually return to work after one (1) week.
What Does The Healing Process Look Like?
Bruising, Swelling, and Stitches (which can pucker) are all NORMAL. Tissue firmness is NORMAL. Your body may not heal symmetrically, meaning one side may take longer to heal than the other, this is NORMAL. Any previous asymmetry may remain.
Will I Be In Pain?
You will not feel anything during the procedure, since anesthesia will be used. However, after the anesthesia wears off, you will feel some pain and discomfort. It is highly recommended that you start off taking Extra Strength Tylenol, every six (6) to eight (8) hours, alternating with Motrin. Please DO NOT MIX pain relief medications together at the same time. If you are experiencing a higher level of pain, please take the prescribed pain medication (Norco, or other prescribed pain medication).
How Will The Feel And Firmness Of My Breasts Change?
Silicone gel implants provide the most natural feel. However, Dr. BYUN may achieve a similar consistency with saline implants by inserting them behind the chest muscle and stretching the implant shell by filling it with additional saline. Implants will add strength and firmness to your breasts, which may actually help them resist sagging. But, the extra weight of a large implant can increase the likelihood of sagging as the body ages and skin loses elasticity.
How Soon Can I Take A Shower?
We recommend waiting forty-eight (48) hours to shower. Make sure you are steady on your feet. Do not soak the incisions and pat them dry when done.
Can I Get My Sutures Wet?
After forty-eight (48) hours, stitches can get wet. It is highly recommended, however, that only normal saline (over-the-counter medical cleaning solution) is used to clean the stitches. DO NOT use any cleansers or alcohol products on the suture site. Picking or pulling at the sutures is not approved and can cause damage. Pat the sutures dry if need be.
Can Breast Augmentation Be Performed In Conjunction With Other Procedures?
Yes, this is commonly done, especially as an element of a suite of surgical procedures known as a mommy makeover. These procedures target the changes the body often undergoes as a result of pregnancy. A mommy makeover may also include liposuction to shrink specific areas of stubborn fat, a tummy tuck to repair the abdominal wall and remove excess folds of skin, and a breast lift, as described above.
What Should I Expect With Swelling?
Pain, soreness and swelling are the natural result when an implant is inserted into a sensitive area of your body, especially if it has been placed beneath chest muscles. Swelling crests within 48 hours, but won’t completely subside for months. Because of swelling, your breasts will appear elevated on your chest; it will take time for them to drop into their final position.
One of the best ways to manage swelling is to give your body time and space to recover fully and efficiently. Avoid physical stresses that tax the muscles, ligaments, and skin that are attempting to heal. Walking, however, is recommended as a practical way to reduce your risk of developing a blood clot. Walking and increasing fluid consumption help reduce swelling of the breasts, as well.
Why Is My Swelling Lasting Longer On One Side?
This is very common. The function of your Lymphatic System (which acts as a highway of Arteries, Veins, and Lymphatic Channels) is to filter out fluid from particular areas of the body. Lymph Nodes, Bone Structure & Tissue Shape are different from right to left, so when it comes to draining, the “clearance rate” of the swelling is also entirely different on each side. The heart is located on the left side of the body and distributes blood throughout the body using different paths & pressures. The drainage of the heart is not completely linear; thus, another reason why Lymphatic Clearance is different on each side.
Why Are My Results Uneven?
Post-op asymmetry is NORMAL. Pre-existing asymmetry will continue since the human anatomy of left vs. right does not always match. Human tissue is naturally asymmetric. This applies to Breasts, Face, Eyes, and even the Nose.
How Often Can I Apply Heat And Cold Packs?
Hot packs are NOT recommended due to a side effect of increased inflammation which can further delay the healing process. However, cold packs are recommended with frequent usage in fifteen (15) minute intervals.
What To Do If I Become Constipated?
Reduce Norco usage, walk around, and take an over-the-counter medication like Colace or MiraLAX. It is recommended that you start using an over-the-counter stool softening medication one (1) day before surgery and continue taking it until you no longer need to be taking Norco for pain.
How Soon Can I Get On A Plane?
Every case is unique. Typically, short distances (short domestic flights) are okay. However, we recommend that you wait until you see Dr. BYUN’s team at the one (1) week follow-up appointment for final approval. Please keep in mind that extra swelling can occur due to pressure changes in the plane.
Can A Breast Augmentation Be Performed In Conjunction With Other Procedures?
Yes, a Breast Augmentation is often a key part of a “Mommy Makeover” – a group of procedures that may also include:
- LIPOSUCTION – to shrink specific areas of stubborn fat
- TUMMY TUCK – to repair the abdominal wall and remove excess folds of skin
- BREAST LIFT – (with or without implants) to restore shape, perkiness and volume
This suite of surgeries targets the changes the body often undergoes as a result of one or more pregnancies, or for a patient interested in the combination of multiple procedures, as listed above. The goal is to restore a youthful, firmer profile, while fortifying self-confidence
How Do I Maintain The Best Breast Implant Results?
Most patients feel soreness and pain for several days following surgery. However, forty-eight (48) hours after surgery, gauze dressings may be removed, and you may shower. Ten (10) days after the conclusion of surgery, Dr. BYUN and Nurses will conduct follow-up appointments, where sutures will be removed, and you will be provided with massage techniques to perform at home to help expedite the recovery process. We recommend purchasing a sports bra with a zipper in front to wear for the weeks of healing – this can be discussed at your follow-up appointments. Swelling may need three (3) to five (5) weeks in order to fully dissipate. Though you may return to work in about three (3) to four (4) weeks, excessive work or lifting should be avoided for a few months.
BYUN Post Operative Information & Care Instructions for Breast Augmentation
MEDICATIONS TO HELP WITH NAUSEA
ZOFRAN (or OTHER ANTI-NAUSEA MEDICATION): Take one (1) Zofran tablet (or other anti-nausea medication) as prescribed on your way home from surgery.
MEDICATIONS TO HELP WITH INFECTION
KEFLEX (or OTHER ANTIBIOTIC MEDICATION): Start the antibiotics as prescribed (make sure to consume food when taking any antibiotics as it can cause nausea). It is crucial to complete the ENTIRE course of antibiotics.
MEDICATIONS TO HELP WITH PAIN
TYLENOL & MOTRIN: Start with two (2) extra strength Tylenol (take every 6-8 hours). You may take Motrin instead of Tylenol if preferred. Do not take Tylenol and Norco within the same 6-8 hour window. Taper off medications as tolerated.
NORCO (or OTHER PRESCRIBED PAIN MEDICATION): If pain is not controlled with extra strength Tylenol or Motrin, take one-two (1-2) tablets of Norco instead (take every 6-8 hours). DO NOT DRIVE if you’re taking Norco as it can cause drowsiness and other side effects. Norco has Tylenol in its composition – AVOID TAKING NORCO WITH TYLENOL and/or MOTRIN in the same 6-8 hour window.
METHODS & MEDICATIONS TO MINIMIZE BRUISING AND SWELLING
ARNICA TABLETS & BROMELAIN (over the counter): Take one (1) week before and continue for one (1) week after surgery.
ICE THERAPY: Fifteen (15) minutes on, fifteen (15) minutes off. Icing is most important in the first forty-eight (48) hours post-surgery. Icing will still be effective after that forty-eight (48) hour period and is still recommended.
COMPRESSION: Firm but gentle wrapping with ace bandages.
METHODS TO ENHANCE RECOVERY
PROTEIN INTAKE: Protein can be ingested in any form; powder, shakes, bars or foods high in protein.
HYDRATION: Increase water intake (i.e., Pedialyte hydration packets to put in water) & Electrolyte drinks (i.e., Vitamin Water).
CLEANING WOUNDS TWO (2) to THREE (3) TIMES A DAY: Not cleaning enough can cause infection while cleaning too much can take away good, healing tissue and prolong recovery.
MINIMIZE STRESS: Stress leads to inflammation and can delay healing.
METHODS TO DECREASE NAUSEA
HYDRATION: Hydrate the day before with clear fluids. NO FOOD or WATER 8 hours prior to surgery, but you may hydrate before the 8 hours.
MEDICATIONS, CHEWS & FOODS
Take anti-nausea medications (Zofran, or other prescribed anti-nausea medication).
Try ginger candy or a flat ginger ale drink.
Avoid strong scents and smells, or food odors.
Eat slowly and in small portions.
Do not lie down flat after your meal for two (2) hours.
Return to normal foods slowly (please refer to the steps below):
- Start with CLEAR LIQUIDS (water)
- Move into a SOFT DIET (applesauce, pudding, etc.)
- Return to a REGULAR DIET
IMPORTANT: A full diet can be introduced ONLY when the others are successfully tolerated.
IMPORTANT: Start with room temp food – the hot temperature of the food may cause nausea.
ACTIONS TO AVOID AFTER SURGERY
AVOID HEAT THERAPY: Heat expands the tissue and can ruin the surgical work.
AVOID TOO MUCH ACTIVITY: Increasing heart rate and blood pressure can worsen swelling and fluid build-up.
AVOID MASSAGING THE SURGICAL SITE unless told to do so by our medical team.
AVOID TAKING BANDAGES / ACE WRAP(S) OFF: DO NOT remove bandages until after forty-eight (48) hours, or as instructed by our medical team. If ACE wraps are not worn correctly, original surgical results may not be maintained
AVOID LAYING ON ONE SIDE: Laying on one particular side can cause an increase in swelling on one side of the body, can worsen asymmetrical appearances, and delay the healing process.
THE SPECIFICS
ON THE WAY HOME: Take anti-nausea medication.
UNTIL ONE (1) WEEK FOLLOW UP: Start antibiotics (take with food like yogurt, applesauce, or crackers) and start pain management.
PAIN MANAGEMENT OPTIONS:
Tylenol Extra-Strength & Motrin: one (1) to two (2) tablets / capsules, alternating every six (6) to eight (8) hours.
For Intolerable Pain: Norco, or other prescribed pain medication (take with food and as directed).
DO NOT drive and DO NOT mix Norco with Tylenol and Motrin.
If taking Norco, take with stool softener, as Norco can slow down digestion.
AFTER SURGERY: Start stool softener as directed: Colace, Miralax, or fiber supplements. Apply Ice to and around the surgical area.
MONITOR SWELLING: The first three (3) days are the worst, the majority of swelling subsides in three (3) weeks.
Elevate legs above heart level.
Start foot exercises – ten (10) times every hour (60 min), this helps to prevent clots.
Start breathing exercises – ten (10) times every hour (60 min), take a deep breath in, hold for ten (10) seconds and exhale.
Perform these exercises at your own pace, helps prevent lung collapse and pneumonia from general anesthesia.
WOUND CARE: To be done two (2) days after surgery – at your forty-eight (48) hour postoperative visit.
BANDAGES & DRESSING:
- Remove gauze and ACE bandage. DO NOT remove anything directly on the skin.
- Apply Bacitracin / Neosporin to incisions three (3) to (4) times daily to prevent infection and scar depression.
- Once bleeding or oozing has stopped, stop application of ointment.
- Keep the incision clean and dry – use saline and gauze to clean, NO RUBBING.
It is OK to touch the dressing and adjust if it causes any discomfort.
If the dressing is soiled before the two (2) day mark, replace it with a new, clean gauze / ACE bandage.
IMPORTANT: If you have the urge to vomit, sneeze, or cough let it out
IMPORTANT: If you’re continuously vomiting, call the office.
WHAT TO AVOID AFTER SURGERY
AVOID Lifting Arms Above Head or Behind Back
AVOID Sleeping on your Stomach
AVOID Chest or Arm Exercises
AVOID Strenuous Activity for at least two (2) weeks
DO NOT Lift Objects over 10lbs
EXTRA CREDIT
Be Kind to Yourself and Trust the Healing Process!
BE PATIENT – swelling can take a few weeks to months to decrease.
SORE THROAT feeling from the Endotracheal Tube placed by the Anesthesiologist, resolves within in one (1) to two (2) days, using ice chips or hot tea will help to soothe sore throat.
PLEASE NOTE – If surgery is more than five (5) hours, the anesthesia team may insert a catheter to monitor your body fluid during surgery, the catheter is removed at the end of surgery, discomfort is normal and present for twenty-four (24) hours.
SENSATION, NUMBNESS and TINGLING is NORMAL – new nerves awaken and grow after muscle repair, it may take up to six (6) months to one (1) full year for normal sensation to return.
BLEEDING within the first twenty-four (24) to forty-eight (48) hours is NORMAL.
BRUISING can appear away from the incision, this is NORMAL – bruising will change colors as it heals.
PUCKERING after surgery is NORMAL and a great sign – this shows that your muscles are adhering to the tissues, do not massage the puckered areas! .
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Dr. Michael BYUN is a serious doctor with seriously comprehensive experience unlike many of his peers, setting him heads and shoulders above the rest.
