Risk Information
Post-Op Information

Implant Size Acknowledgement
(PDF Format)

Pre-Op		Post-Op
Pre-Op		Post-Op

Breast augmentation is particularly useful for obtaining symmetry between both breasts. Many women have asymmetrical breast size and form, some as much as a cup size or two in difference. Breast augmentation surgery, if properly chosen, can lead to an increase in symmetry between the two asymmetric breasts. Breast augmentation can also be used as an adjuvant following breast surgery for the treatment of cancer.

Breast augmentation surgery is done in two ways. Breast augmentation surgery is done by placing an implant either underneath the breast tissue or underneath the patient's muscle in order to augment the overall breast mound. Through this method the surgeon is able to increase the woman's bustline by one or more cup sizes.

When consulting with our office a variety of issues will come into play. These will include the placement of incision, the size of the augmentation desired, the type of implant desired, the location of the implant, and how it affects your overall appearance.  One of the best ways to pick your implant size is to bring in photos of women you have seen in magazines who have a breast size & shape you like.  The doctor will then discuss the feasibility of creating this form on your personal physique.  In addition, several websites have HIPPA privacy compliant photos of a variety of pre and post op augmentation patients.  One site, www.breastimplants411.com is particularly helpful.  Feel free to browse these sites to find the size you desire.

The doctors get into specifics about the breast augmentation health related concerns must first be addressed. We will obtain a detailed history regarding breast cancer, abnormal masses or discharge from your breasts, and perform a thorough breast exam in order to insure healthy breast tissue. One in eight women in the United States throughout the course of their life will develop breast cancer and it is important first to insure that prior to any breast enhancement surgery that the underlying risk of malignancy has been ruled out. It is very important to know that breast implants do not cause cancer or do not prevent the detection of breast cancer as long as the patient commits to performing the recommended breast self-examination and follows the mammography screening protocols as recommended by the American Cancer Society.

INCISION CHOICES


There are many places that incisions can be placed in order to place a breast implant. Classically, incisions have been placed below the breast along what is called the inframammary fold. This is a natural crease that occurs at the junction between the lower part of the breast and the chest wall. This incision is completely hidden when the patient is standing and is an excellent incision for a placement of a variety of different types of implants.

A second incision which is routinely used is the periareolar incision. This incision is made at the junction between the dark part of the nipple areolar complex and the lighter part of the skin. Because this is a natural transition zone it is an excellent place for hiding scars.

A third incision choice is the axillary incision. Using endoscopic techniques, Dr. Stelnicki is able to perform a safe dissection of the underlying breast pocket and underlying muscle with excellent visualization of the entire area. This allows accurate placement of the implant and decreases the risk of any postoperative bleeding or infection. This incision is an excellent choice for women who do not want any scars on the breast itself, as the incision is in the axilla and all the surgery is done underneath the skin.

The last incision that is being used today is the incision around the belly button or the periumbilical incision. Our office does not routinely perform this surgery, as in its current state Our staff considers it to be experimental and possibly dangerous. This incision choice is mentioned here only to educate the reader about the options available on the market today.

IMPLANT TYPE


There are many types and varieties of implants available today. For primary augmentation the preferred implant is a saline implant. This implant is filled with the same saltwater that is present in our blood stream and produces an excellent contour of the breast. It can be adjusted at the time of the operation to improve symmetry between the right and left side of the breast and comes in a variety of shapes, including round and a natural teardrop shape that can be used to optimize the outcomes and achieve the desired results for the breast.

Silicone implants are available for some patients on a study protocol. Silicone offers the advantage of a slightly more natural feel, but does not give any enhancement in terms of the overall look of the breast. In 1992 there was concern that silicone was causing various collagen vascular diseases, such as a lupus-like condition in certain patients. However, this has not, to date, been found to be validated by a multitude of scientific studies. Still, patients who are concerned about the silicone gel which is used in these implants, should decline placement of these implants. If you do desire silicone, we can work with you to enroll you in certain study protocols that would allow you to have silicone, but this type of implant is recommended for only selected patients.

PLACEMENT


The placement of the implants is also important. Implants can be placed either under the skin or under the muscle. Placement under the skin is a faster operation that involves less bruising postoperatively and a quicker recovery. However, the implants are more palpable and are more prone to wrinkling. There is also a higher risk of abnormal scarring around the implant with the subcutaneous placements and increasing the risk of long-term deformity of the breast, called capsular contraction. Dr. Stelnicki's preferred method in most patients is to place the implant below the muscle. Placing it below the muscle significantly decreases the risk of 1) abnormal contour around the implant, 2) palpability of the implant, 3) the risk of wrinkling, and 4) the risk of capsular contraction. However, in some patients who have had previous implants placed in a subcutaneous position, replacement of the implant into the same pocket may be beneficial and warranted.

GENERAL SURGICAL RISKS


We want you to understand fully the risks involved in surgery so that you can make an informed decision. Although complications are infrequent, all surgeries have some degree of risk. All of us at our office will use our expertise and knowledge to avoid complications in so far as we are able. If a complication does occur, we will use those same skills in an attempt to solve the problem quickly. The importance of having a highly qualified medical team and the use of an accredited facility cannot be overestimated.

NORMAL SYMPTOMS

1. SWELLING AND BRUISING: Moderate swelling and bruising are normal after any surgery. Severe swelling and bruising may indicate bleeding or possible infection.
2. DISCOMFORT and PAIN: Mild to moderate discomfort or pain is normal after any surgery. If the pain becomes severe and is not relieved by pain medication, please call us at (954) 983-1899
3. CRUSTING ALONG THE INCISION LINES: We usually treat this with antibiotic ointment.
4. NUMBNESS: Small sensory nerves to the skin surface are occasionally cut when the incision is made or interrupted by undermining of the skin during surgery. The sensation in those areas gradually returns – usually within 2 or 3 months as the nerve endings heal spontaneously. 
5. ITCHING: Itching and occasional small shooting electrical sensations within the skin frequently occur as the nerve endings heal. Ice, skin moisturizers, and massages are frequently helpful. These symptoms are common during the recovery period.
6. REDNESS OF SCARS: All new scars are red, dark pink, or purple. Scars on the face usually fade within 3 to 6 months. Scars on the breasts or body may take a year or longer to fade completely.

COMMON RISKS

1. HEMATOMA: Small collections of blood under the skin are usually allowed to absorb spontaneously. Larger hematomas may require aspiration, drainage or even surgical removal to achieve the best results.
2. INFLAMMATION AND INFECTION: A superficial infection may require antibiotic ointment. Deeper infections are treated with antibiotics. Development of an abscess usually requires drainage.
3. THICK, WIDE OR DEPRESSED SCARS: Abnormal scars are uncommon and may occur even though we have used the most modern plastic surgery techniques. Injection of steroids into the scars, placement of silicone sheeting onto the scars, the use of Mederma or Scar Guard or further surgery to correct the scars is occasionally necessary. Some areas on the body scar more than others, and some people scar more than others do. Your own history of scarring should give you some indication of what you can expect.
4. WOUND SEPERATION OR DELAYED HEALING: Any incision, during the healing phase, may separate or heal unusually slow for a number or reasons. These include inflammation, infection, wound tension, decreased circulation, smoking or excess external pressure. If delayed healing occurs, the final outcome is usually not significantly affected, but secondary revision of the scar may be indicated.
5. SENSITIVITY OR ALLERGY TO DRESSING OR TAPE: Occasionally, allergic or sensitivity reactions may occur from soaps, ointments, tape (eg. Blisters) or sutures used during or after surgery. Such problems are unusual and are usually mild and easily treated.
6. INCREASED RISKS FOR SMOKERS: Smokers have a greater chance of skin loss and poor healing because of decreased skin circulation.
7. INJURY TO DEEPER STRUCTURES: Blood vessels, nerves and muscles may be injured during surgery. The incidence of such injuries is rare.

RARER COMPLICATIONS

1. If they are severe, any of the problems mentioned under Common Risks may significantly delay healing or necessitate further surgical procedures. 
2. Medical complications such as pulmonary embolism, severe allergic reactions to medications, cardiac arrhythmias, heart attack, and hyperthermia are rare but serious and life-threatening problems. Having a certified anesthetist present at your surgery reduces these risks as much as possible. (Failure to disclose all pertinent medical data before surgery may cause serious problems for you and for the medical team during surgery.)

UNSATISFACTORY RESULT & NEED FOR REVISIONAL SURGERY

1. All plastic surgery treatments and operations are performed to improve a condition, a problem or appearance. While the procedures are performed with a very high probability of success, disappointments occur and results are not always acceptable to patients or the surgeon. Secondary procedures or treatments may be indicated. Rarely, problems may occur that are permanent.
2. POOR RESULTS: Asymmetry, unhappiness with the result, poor healing, etc. may occur. Minimal differences are usually acceptable. Larger differences frequently require revisional surgery.
   

SPECIFIC RISKS FOLLOWING AUGMENTATION

1. CAPSULAR CONTRACTION: Capsular contraction is the most common “complication” or side effect of breast implant surgery. During surgery, a pocket is created for the implant that is somewhat larger than the implant itself. During healing, a fibrous membrane called a capsule forms around the device. Under ideal circumstances, the pocket maintains its original dimensions and the implant “rests inside, remaining soft and natural. For reasons still largely unknown, however, the scar capsule shrinks or contracts in some women and squeezes the implant, resulting in various degrees of firmness and make the breast round. This contraction, if it occurs, can occur soon after surgery or many years later can appear in one or both breasts.
   Capsular construction is not a “ health” risk, but it can detract from the quality of the result and cause discomfort, pain, or distortion of the breast contour. In cases of minor contraction, we usually will not suggest surgical correction. Cases of very firm contraction may require surgical intervention. Capsular contracture may reoccur after surgical procedures to treat this condition. Rarely, if the contraction recurs and cannot be eliminated, the occasional patient may choose to have the implants permanently removed.
2. HEMATOMA: Some postoperative bleeding into the pocket containing the breast implant may occur. If the bleeding is minimal, the body will absorb it with time. Should post-operative bleeding occur, it mat require surgical intervention. This is not dangerous and should not affect the results of surgery. Please refer to medications to avoid before and after surgery.
3. INFECTION: Post-operative infection is very uncommon, but possible. It may occur in the immediate post-operative period or at any time following insertion of a breast implant. Subacute or chronic infections may be difficult to diagnose. We reduce this to a minimum by giving intravenous antibiotics during surgery and oral antibiotics after surgery. Most infections are mild and resolve without incident. If a serious infection develops and does not respond to antibiotics, the implant may have to be removed for about 3 months. After the infection is treated, the implant can usually be safely replaced. It is extremely rare that an infection would occur around an implant from a bacterial infection elsewhere in the body, however, prophylactic antibiotics may be considered for subsequent dental procedures, dental cleaning or other surgical procedures.
4. LOSS OF SENSATION TO SKIN OR NIPPLES: Nerves that supply skin or nipple sensation may be cut or damaged while the pocket or space for the implant is being created. Although this does not happen routinely, it can happen no matter how carefully the surgery is performed. If sensory loss occurs, the nerves slowly recover over a period of 1-2 years in about 95% of cases. It is the same risk with any of the surgical incisions, i.e. around the nipple, under the breast or in the armpit.
5. EXPOSURE OR EXTRUSION OF IMPLANT: Thin skin, inadequate tissue coverage, capsule formation, infection or severe wrinkling may all contribute to the erosion of an implant through the skin or scar. Should this very rare complication occur, temporary implant removal may be indicated, however the implant should be able to be replaced at a later time.
6. WRINKLING: Wrinkling is possible with saline implants. Some wrinkling is normal and expected. With the use if saline implants, visible wrinkling under the skin has been more noticeable. This is more common in women with thin breast tissue. All contoured implants are textured. Textured implants have a greater tendency to wrinkle Occasionally, the edge of the implant or the valve of the implant can br felt. These problems are usually mild and require no treatment. Sometimes the palpable valve, wrinkling and/or folds may be confused with palpable tumors and questionable cases must be investigated. Experience has shown that the wrinkles frequently improve or even disappear within a year. (See Subpectoral Placement below.)
7. ASYMMETRY: Although having both breast match is the surgical objective, perfect symmetry if the breast cannot always be achieved. If your breasts had slightly different shapes before surgery, they may remain slightly different after surgery. In spite of careful attention to detail, the dissected pockets may end up slightly different in shape or height due to the healing process. If this becomes a problem after healing, you may later need additional surgery. There are no guarantees as to the shape, size, or results of the breasts. Good results are expected but not guaranteed.
8. SUBPECTORAL PLACEMENT IF THE IMPLANT (UNDER THE MUSCLE): If the implants are under the pectoralis muscle, a unique set of risks apply. Occasionally during construction of the muscle, the implants will temporarily be flattened amd/or pulled upward. Occasionally, the implants may “ride” higher than their original position because of the muscular construction. Implants are placed under the muscle to reduce the frequency of capsular contraction. Implants are usually placed under the muscle in thin, small-breasted women to provide mor “cover” over the implant. Placing the implants under the muscle may reduce visible wrinkling.
   Your mammograms will be easier to read if the implants are placed behind the muscle as compared to behind the breast tissue.
9. DEFLATION: If for any reason the valve or implant covering fails, the saline will leak out, be absorbed and then be excreted by your body. Ruptured or deflated implants can not be repaired. Rupture can occur as a result of injury, for no apparent cause, or during a mammography. This causes no medical harm, but the implant will need the be replaced in a secondary procedure. Breast implants can not be expected to last forever. The rate of saline implant leakage is quoted at about 1-2% over many years. The implants are guaranteed for life. There would be no charge for a new implant itself.
10. LOSS OF SKIN, BREAST TISSUE, OR NIPPLE: This is an extremely rare complication of breast enlargement. It usually develops from an infection that has gotten out of control and results in the death of the involved tissues. This very rare complication will usually involve only small areas that will eventually heal with good wound care. Secondary surgery is a remote possibility.
11. INTERFERENCE WITH BREAST FEEDING: Most women with breast implants have nursed their babies successfully. At times there is no scientific evidence that breast feeding is a problem, however there is a very limited research that has been done in this area. Nevertheless, any breast surgery can theoretically interfere with your ability to breast feed, although this would be uncommon.
12. CALCIUM DEPOSIT IN THE TISSUE AROUND THE IMPLANT: In some patients, a thin layer of calcium will develop within the scar capsule surrounding the implant. This usually occurs several or more years after the implant has been inserted. In these patients the added density of the scar may reduce the detectability of lesions close the scar on mammograms. Breast cancers may still be visible and detectable when specialized techniques arte used. Should this occur additional surgery may be necessary to remove and examined the calcifications.
13. BREAST CANCER: There is no evidence linking implants to increased breast disease and breast cancer. The only clinical studies available show that the prevalence of breast cancer in women with implants is the same or even slightly lower than that in women without breast implants! Furthermore, two studies have shown, to date that the stage of breast cancer detection in women with implants appear to be identical to that found in the overall population.
14. INTERFERENCE WITH MAMMOGRAPHY: You should alert the technician to the fact that you have implants. Special techniques will be used and extra views may be needed in order to see as much of the breast tissue as possible. Even under the most ideal circumstances some breast tissue may remain unseen and a suspicious lesion missed. Because the breast is compressed during mammography, it is possible, but rare, for an implant to rupture. On occasion, specialized mammography, ultrasound or MRI studies may be of benefit to evaluate breast lumps and the condition of the implant.
15. SYNMASTIA (LOSS OF CLEAVAGE): This is a unusual problem that can develop after normal augmentation either above or below the muscle. The skin over the lower sternum (breastbone) pulls away from the bone, and normal cleavage is reduced or eliminated. In its more serious form, the pockets on either side merge to form a single pocket. In the more minor form, the pockets remain separate, but the skin tents upward. Reduced fibrous or elastic “strength” in the subcutaneous tissue may be contributory but is difficult to predict. If the problem develops, correction will require secondary surgery.
16. IMMUNE DISORDER: Some women have claimed that gel prostheses have contributed to or stimulated connective tissue disorder such as systemic lupus erythematosis, scleroderma, rheumatoid arthritis etc. Other complications involving the nervous system, skin and immune systems have been reported. Reports claiming a causal relationship between silicone gel and such symptoms have been published in the medical literature and widely reported in the press. To the present time, no such relationship has been established scientiftically. Gel implants are not available for routine use because of the concerns of the Food and Drug Agency. The saline (salt water) used to fill saline implants is harmless and is excreted in the urine should the implants leak or rupture.
17. PRESENCE OF SILICONE RUBBER: Saline-filled implants are made of silicone rubber. Although silicone rubber has not been implicated in any diseases, and has been used in many types of implants, its use is under investigation. It is possible and rare, that small pieces of implant material may separate from the implant. This should be of no consequence.
18. THROMBOSED VEINS: Thrombosed Veins, which resemble cords occasionally develop in the area of the breast and resolve without medical or surgical treatment.
19. No guarantee has been given to me as to the shape, size, or results of the breasts. Good results are expected but not guaranteed.
    
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MAMMOGRAMS


When performing a mammogram following breast augmentation, a special technique called the Eklund Technique should be used, which displaces the breast tissue away from the implant. Using this technique significantly improves mammography and allows excellent visualization of the surrounding breast tissue. This, combined with breast screening and self-exam, leads to no increased risk of breast cancer in patients who have undergone augmentation mammoplasty.

Dr. Stelnicki will perform breast augmentation in a certified surgery center. It can be done with either general anesthesia or sedation which is given in the vein, as well as some local anesthetic. A certified anesthesiologist of anesthetist will be used for the operation to insure a safe surgical procedure.

In preparation for the surgery you should make sure that you have not been lactating within at least 6 months prior to the surgery and that there is no current discharge from your nipples. This decreases the risk of any infection of the implant. You should also stop any smoking at least 2 weeks prior to surgery and you should discuss with your doctor any concerns you have about loss of nipple sensitivity. On the day of surgery you should have someone come with you to drive you home that day. You will not be able to do any heavy lifting for several weeks.


SPECIFIC POST-OP INSTRUCTIONS

1. ACTIVITY: Avoid exercise, heavy lifting and straining for three weeks minimum. You may however do normal activities at any time if they cause no pain or discomfort. Let your body tell you what you can do or not do.
2. DRESSINGS: Do not get the dressings wet in the first week after surgery. You may bathe in a small amount of water. After the first week the dressings will be removed and you will be able to go in the shower.
3. SHOWERING AND BATHING: You may shower after 72 hours. If you prefer to bathe you may do so.
4. SUTURES: The Dr. or the nurse will remove the sutures 10-20 days after surgery.
5. EXPOSURE TO SUNLIGHT: Scars take at least one year to fade completely. During this time, you must protect them from the sun especially if naked. Even through a bathing suit, a good deal of sunlight can reach the skin and cause damage. Wear a sunscreen with a skin – protection factor (SPF 30) at all times when in the sunshine. Be extremely careful if areas of your breast skin have reduced sensitivity.
6. EXERCISE: You may take gentle walks within a few days. DO not return to exercise (or heavy lifting) for 3 weeks. That includes leg exercise, stationary bicycle or fast walking. No swimming, golf or tennis for 6 weeks. 
7. DRIVING: You may drive 5 days after surgery if you have a car with power steering. 7 days with stick.
8. After your first post-operative visit you must wear an underwire bra for 6 weeks. This bra will be worn continuously for the first 3 weeks, then at night for the second 3 weeks. Please bring 1-2 bras with you to your 1 week post-op visit for fitting.

AS YOU HEAL INFORMATION

1. ACTIVITIES: It is important that you not engage in strenuous activities in the first 3 weeks after surgery. Aerobic exercise will raise your blood pressure, which could cause late bleeding and harm your result. If your job keeps you sedentary, you may return to work when you feel comfortable, usually five days after surgery. 
2. HEALING OF SENSORY NERVES: Regeneration of the sensory nerves is accompanied by tingling, burning or shooting pains, which all disappear with time and are nothing to be alarmed about. If, however this is accompanied by swelling or redness, infection or bleeding, then you will need to come to the office.
3. ASYMMETRY: It is quite common for the two breasts to heal differently. One may swell more, one may feel more uncomfortable, or the shapes may differ initially. After complete healing, they should look remarkably similar and natural. If you are concerned, ask questions.
4. “SLOSHING” SENSATION: You may hear and feel “sloshing” in your breast after surgery. This is not the implant! It is the air that is trapped in the space around the implant and the natural fluid that accumulates after an operation. It will be absorbed by the body within a few weeks.
5. SHINY SKIN: The skin of your breasts may become shiny. This is a result of the swelling that occurs after surgery. Within a few weeks, the edema and swelling will subside and the skin will look more normal.
6. SENSITIVITY: As the nerves regenerate, the nipples commonly become hypersensitive. This will subside with time. You may find that gentle massaging helps.

POST-OP CARE FOR OUTPATIENTS

1. VERY IMPORTANT: If you have EXCESSIVE bleeding, pain, nausea, vomiting, fever, sudden enlargement of your breasts, rashes or difficulty breathing call the office at (954) 565-7575
2. Your first 24 hours: When you go home, a family member or a responsible adult must drive you because you have been sedated. A responsible adult should remain with you for 24 hours. If you have any questions about these matters, please ask one or our nursing staff. Under no circumstances are you to drive for 24 hours.
3. When in bed lie on your back with two or three pillows under your head and shoulders for 72 hours.
4. After discharge GO DIRECTLY HOME TO BED.
5. You may get up and go to the bathroom only with the help of a family member or friend. If you feel dizzy or faint when walking or on the toilet you must lie on the floor until you feel better. Otherwise you will faint which could cause serious injury.
6. DRESSINGS: Wear your surgical gown at all times for the first 7 days.
7. BLISTERS: If you feel itching, pulling or redness under the dressing paper tapes, you must lift the tape from the skin otherwise it may develop a blister. If a blister develops it must be covered with an antibiotic ointment at all times preferably Bacitracin. DO NOT apply hydrogen peroxide to the blister. Even though this area will look red for quite a while it will usually heal without residual. This area must be covered with a sunscreen 30 SPF for three moths otherwise it could result in a pigmented area.
8. ACTIVITY: Take it easy and pamper yourself. Try to avoid any straining. You may go to the bathroom, sit and watch TV, etc., but no matter how good you feel, DO NOT clean the house, rearrange the attic, etc!!! DN NOT do any form of exercise. We do not want you to bleed and cause any more swelling and bruising this is unavoidable. Do not lift anything heavier than 5 pounds including children.
9. DIET: If you have any post-operative nausea, carbonated sodas and dry crackers may settle your stomach. If nausea is severe, call your doctor. If you feel normal, start with clear liquids and bland foods, and if those are well tolerated, progress to a regular diet. Try to drink as much fluid as you can in the first 48 hours as will alleviate a lot of nausea. Gatorade is excellent for this purpose. Eat before taking pain medications and antibiotics. Avoid heavy, greasy and spicy foods for 24 hours after the surgery.
10. NARCOTICS: The pain medications you have been prescribed are narcotics. These medications can make you extremely nauseated. If you cannot tolerate these medications, take extra strength Tylenol, two at a time, but no more than eight a day. Also use the muscle relaxant given to you. This will significantly decrease your pain. 
11. CONSTIPATION: The narcotic pain medications can make you constipated. You may take any mild laxatives.
12. SMOKING: Smoking reduces capillary flow in your skin. We advise you not to smoke at all during the first 14 days after surgery.
13. ALCOHOL: Alcohol dilates the blood vessels and could increase post-operative bleeding. Please do not drink until you have stopped taking the prescription pain pills, as the combination of pain pills and alcohol can be dangerous.
14. DRIVING: Please don’t drive for at least 5 days after general anesthesia or intravenous sedation or while taking prescription pain pills.
15. POST OPERATIVE APPOINTMENTS: It is very important that you follow the schedule of appointments we establish after surgery.
16. DO NOT take Asprin, Motrin, or similar products.
    
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