Breast Augmentation Guide with female cosmetic surgeon, Dr Victoria Karlinsky
Usually I tell my patients, leave the zipper part out of the bra cup so that it doesn’t distort and take a look and see, does that amount of rice fill in the bra cup nicely or do you feel like it still has space? Then you take out the bag, you put in more rice and you put the bag back in the bra. You do that until the point where the bra cup is nicely filled out. There’s really no more space to put the rice in, but it’s also not pouring out of the bra itself. Once you get to that point, I’d like you to try on your clothing, things that you wear to work, clothing that you hang out at home with, a cocktail dress that you would wear to somebody’s wedding and take a look and see, does that amount of rice give you the look that you would like?
Once you get to the point where you see that this is exactly what you’re looking for, I’d like you to take that rice that’s in the bag in the Ziploc bag and put it in the measuring cup, a Pyrex cup that you would use for cooking that typically has milliliters in it and ounces. Take a look, how many ounces of rice did it take to fill the bra cup to a point where no more rice can be filled? That is approximately the volume of an implant that you would need to make you happy. Usually, you can consider that each ounce of rice is approximately 30 CCs of volume of an implant. It’s not exactly that, but it’s very, very close. This way, you are able to really know what size implant will make you happy, so by the time you and I meet, I can certainly direct you and help you and solidify your decision, but it’ll give you a peace of mind that you know exactly what you’re getting, that it’s not a surprise.
Now, if you are somebody who is under 35, then typically other than the normal lab work, which you can can get from the Preoperative video with pre-op testing, you do not need to have mammography or ultrasound unless you have history of breast cancer in your family. If you do have history of breast cancer in your family, even if you’re way younger than 35, I think it would be safer if you get at least an ultrasound to confirm that everything is normal. So I do ask my patients to get either an ultrasound or mammography typically for women who are much younger because the breasts are very dense, mammography alone is not enough and usually the radiologist will ask for you to get additional imaging, and the ultrasound typically is what helps the radiologist to determine that the mammography is normal. Now, if you’re 35 or older, I ask all of my patients to get mammography and, or ultrasound, and the reason why I say and, or ultrasound is because, again, not infrequently, my patients will go to get mammography.
If you are still young, if you’re 35, 38, 40 and you happen to be very thin, you’ll have very dense breasts, and not infrequently, the mammography will come back as BI-RADS zero, which means that you need additional imaging. Now, that means you have to make another appointment for an ultrasound, take the time that you need to get an ultrasound, and so to save my patient’s time, I always request mammography and ultrasound at the same time. I just want you to understand the reasoning behind it so that you can then make a choice. If you’ve already had mammography and the ultrasound was never required, certainly mammography alone is perfectly fine, so that’s the part for the breast augmentation. Later on in a different video that talks about a lift with augmentation or any other breast surgery, I will ask the same kind of requirements for any type of breast operation.
Now, to prepare for your surgery, you’ll do your sizing, you’ll do your lab work, you’ll do the mammography and, or ultrasound if you are 35 or older or if you’ve had breast cancer history in the family. The surgery itself is fairly fast, typically is done through the inframammary incision, which is underneath the breast. The reason why I like that particular approach for my breast augmentation patients is number one, because we do not go through the breast tissue itself. When we cut through the skin, we go directly onto the muscle and underneath the muscle. Most always, that’s how we position the implant and I will discuss the implant position in a second. But the potential ability to breastfeed for somebody who is younger is higher if we do not go through the ductal system, which is if we have to go through the peri-areolar or around the areola approach.
It is also a cleaner approach because we know statistically that potential for infection or capsular contracture, which is scar tissue around the implant is higher when we go through the peri-areolar approach or through the areola tissue. Now, remember that even though breast augmentation is a very common operation, it’s wonderful, it has very high satisfaction rate, it is still a real surgery, and I always remind my patients that there’s always a potential for infection, bleeding, poor scarring, potential for implant not settling well into its pocket, requiring additional surgery, potential for encapsulation or formation of scar tissue around the implant. This is really one of the most common potential complications that we see with breast augmentation. It’s still very rare. Depending on the studies that you look at, it’s only a few percent for primary breast augmentation if you’re getting breast augmentation for the first time, three to 5% of the time, but it still exists, which means that if somebody does get breast augmentation and they have an encapsulation, they may require additional surgery to have it addressed.
And remember that there’s never a hundred percent guarantee that an encapsulation will not happen again, so you do have to keep that in the back of your mind even though it’s a very rare complication it does exist. Now, in terms of having your implants replaced every 10 years, as a medical legal statement, I do inform my patients that the implants are not meant to be lifetime devices and the companies that manufacture them ask that the implants are changed every 10 years. Now, realistically speaking, of course, you’re not obligated to change them every 10 years, but from the standpoint of legal aspects and warranties that the companies that make them give you, it’s really within every 10 years they ask that patients replace their implants.
The new implants that have been in the market now for quite a few years, what patients know as gummy bear implants, these are all highly cohesive gel implants and, of course, there are many different projections and anatomical, not an anatomical, which I won’t get into in this video, but certainly one thing I can tell you is that the silicone implants are much, much safer than they used to be many, many years ago. The highly cohesive gel if you were to cut through the implant is very dense. It no longer goes into the tissues and creates the problems that women used to have with the old implants, so silicone implants are very safe. I always prefer silicone implants to saline implants because certainly feel wise, it feels much better. After surgery, I always tell my patients that I want you to get back to normal life as quickly as you can, and the only thing I ask is that you don’t do any heavy lifting or running for about two weeks after surgery. The incisions are very small, they’re closed with absorbable suture. There’s nothing that needs to be removed.
There’s typically a little sticky tape that covers that incision, which I allow my patients to simply remove about seven days after surgery. You are able to shower the day after surgery, normal, regular shower. I do ask that you don’t go into the bathtub, you don’t soak in a pool. Of course, no beach for about a week to 10 days, but a shower is perfectly okay. And I don’t put any restrictions on any kind of bras for my patients after surgery other than no pushup bras for a few weeks after. You want to allow the implant to settle properly into its pocket so you don’t want to have anything pushing it up. These are really the only things that I ask of my patients, and then you just get back to normal life. The faster you get back to your normal life, the easier the recovery tends to be.
After surgery, my patients get typically three prescriptions. One is for antibiotics, which I’ll ask you to take for seven days after surgery twice a day typically. Usually if somebody is not penicillin allergic, they’ll get an amoxicillin with clavulanate or augmentin, and you would take it twice a day starting with the day after surgery. Remember, you’re going to get IV antibiotics on the day of surgery, so you do not need to take it the day of your operation. You’re also going to have pain medicine. Typically, it’s either Percocet or Vicodin. Sometimes patients can be allergic to one or the other and, of course, that gets customized to an individual patient, and that you can take the day of surgery. Patients can take one to two tablets every four hours. Remember that prior to your operation, you cannot take any Advil, Aleve, aspirin, ibuprofen, any medication that falls into the non-steroidal anti-inflammatory class.
However, after surgery, I’m perfectly okay with you taking ibuprofen, Advil in between with Percocet because sometimes ibuprofen will actually help substantially better with pain control than Percocet can. So for two weeks prior to surgery, no NSAIDs. Immediately after surgery, there’s no problem to take Advil between your Percocet. And the third prescription I will give you will be for Zofran or Ondansetron, and that’s actually an antinausea medication because sometimes patients do get very nauseous with general anesthesia or with a pain medicine, and then you can preemptively take it prior to taking your pain medication or you can take it after. If you do feel nauseous, you take it. If you don’t feel nauseous, you don’t have to take it. There’s always a 24-hour follow- up from my patients after your surgery and then a one-week follow-up as well. Now, you will have my private cell phone number. This number is available to all my surgery patients, either I, my private nurse or my fellow are there at the end of the line if you have any questions, any concerns or any issues, so you will always have direct contact with me or my team.
Yet again, another thing that gives you a little bit of a peace of mind to know that if something worries you, we’re always there to help and make sure that you’re doing okay. I believe this is all the information that you need for breast augmentation. Please remember, whether you’re out of town or you’re local here in Miami, it is important that somebody comes to pick you up after your surgery and you cannot be alone for the first 24 to 48 hours. Somebody has to be there to help you if there’s any problem or any issue, but even if there is no problem, there has to be somebody there because it is general anesthesia and it’s a safety concern.
I hope this helps. I hope this alleviates some of your worries, and as I have mentioned before, if you have any questions or if you’re not clear about something, you can find a cell phone number on Instagram. My Instagram page, DrKarlinsky, you can always send the WhatsApp to that number and just let me know who you are, if you’re planning to have surgery or if you already scheduled for surgery and what your question is and I and my team will answer any questions you have immediately. Thank you so much for watching. See you soon.