In your initial consultation, Dr. Manuel Gutierrez 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 him. He will 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.

Dr. Manuel Gutierrez 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.

Your surgeon may prefer to perform the operation in an office facility, a freestanding surgery center, or a hospital outpatient facility. Occasionally, the surgery may be done as an inpatient in a hospital, in which case you can plan on staying for a day or two.

Breast augmentation can be performed with a general anesthesia, so you’ll sleep through the entire operation. Some surgeons may use a local anesthesia, combined with a sedative to make you drowsy, so you’ll be relaxed but awake, and may feel some discomfort. Most patients decide on incision based upon where they want the scar. But each incision sets up an entirely different operation. Risks and complications are different, and those issues are more profound than the scar. The armpit incision tends to be more painful and less accurate than the other approaches. If a revision is necessary, another incision usually must be made. The nipple incision yields a scar that is barely visible on most but not all Caucasians, but on patients of other races it very frequently gets pigmented and thick. It often results in a reduction of muscle coverage over implants due to technical issues, which means the implant can be more seen and felt. By cutting through the breast tissue, there is more pain, swelling, and changes in nipple sensation. Most important of all, is the fact that this incision requires pushing the implant through the breast. Though we do not really think about it, the ducts within the breast have bacteria within them. When the implant goes through the ducts, those bacteria get on the implant. And it is exactly those bacteria that cause the inflammation that causes capsular contracture. This remains the leading cause of revision surgery after breast augmentation, and it should be a priority to do everything possible to reduce this possibility. Significant experimental data demonstrate this to be true. The best published results are with the under the breast – the inframammary – incision. The incision is hidden in the crease under the breast; there is less contamination with bacteria in the breast; more nerves are avoided; the breast tissue itself is not cut so there is less pain; the same incision is the ideal incision for any kind of future revision; and the list goes on. Most important of all is that the very best published data is with this incision. Plastic surgeons and plastic surgery patients too often make decisions based upon undocumented personal experience, and this is inaccurate. If we just look at the facts, the results are best with this incision, which is why I encourage all patients to select it.

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. Within several days, the gauze dressings, if you have them, will be removed, and you may be given a surgical bra. 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.

You should be able to return to work within a few 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. (see All breast surgery carries some uncertainty and risk.)

For many women, the result of breast augmentation can be satisfying, even exhilarating, as they learn to appreciate their fuller appearance. Regular examination by your plastic surgeon and routine mammograms for those in the appropriate age groups at prescribed intervals will help assure that any complications, if they occur, can be detected early and treated. Your decision to have breast augmentation is a highly personal one that not everyone will understand. The important thing is how you feel about it. If you’ve met your goals, then your surgery is a success.