Breast Augmentation By Implant for Beginners

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  • #92882
    Michelle Larsen
    Ambassador

    ALL:

    I converted this topic by Michelle Larson to a Sticky as it often comes up and has broad application for the transgender community. It’s a great starting point for folks beginning to consider this option.

    Thanks,

    DeeAnn Hopings

    Okay; maybe that isn’t the best title, but I’ve been mulling this over for awhile, and it is what I came up with. I’m hoping that this will be a forum where we can all post information we have found helpful in getting breast augmentation or questions we have wrestled with in getting it done. For me, this is just about the actual process of getting from ‘I’m needing to have breast augmentation’ to ‘wow, I can now check that off my list’. So I guess I will start posting snippets and chunks of what I have so far. As it is a work in progress (at least until I have my surgery), I will be posting updates as I get new, more, or better information. I do hope any of you reading this, find it helpful. And if you have a question, or comment, and you don’t want to post it here in the Forum, please feel free to message me. Hugs, Michelle

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    • #96296
      Michelle Larsen
      AMBASSADOR

      Okie dokie. So, I apologize for how long this has taken, but I have been doing a lot of research and digging to get this all together. I hope it helps someone in the future. So where does this go forward? I am going to start digging through the comments, and doing the research to be able to answer each comment. And, as I go through my consultations, surgery (Fall 2021), post surgical recovery, and my life going forward; I will be updating this Forum post. So, we are not done ladies… Have a good, safe, and happy life. Michelle

    • #96294
      Michelle Larsen
      AMBASSADOR

      Addendum B:

      <u>Breast Augmentation Recovery Stages: What to Expect, Week by Week</u>

      https://www.zwivel.com/blog/breast-augmentation-recovery-what-to-expect-week-by-week/

      Before undergoing breast augmentation, it’s important to know that the procedure itself is only the start. The surgical procedure is relatively straightforward, but full recovery does take several weeks.

      Breast augmentation surgery can be performed on an outpatient basis by a qualified plastic surgeon, but requires careful attention during recovery to ensure the best possible outcome.

      Depending on various factors, such as the size of the implant and its placement, it typically takes between two and three weeks before a person can resume all of their regular daily activities.

      In this article, we go over your breast augmentation recovery timeline, and take a look at how you can get ready for your post-op journey.

      The surgical process

      Your plastic surgeon will begin by administering either general anesthesia or intravenous sedation to numb the area so that you’re comfortable during the procedure. Together with your doctor, you will decide which type of anesthesia is best suited to your specific needs.

      Next, your surgeon will make an incision, usually in an inconspicuous area in order to minimize the appearance of scarring. There are three common incision points: around the nipple area, at the base of the breast, or above the armpit.

      Your doctor will then insert the implant beneath the pectoral muscle (submuscular placement) or directly behind the breast tissue (subglandular placement) depending on the type of implant being used, the size of the breast, and your personal preferences.

      Finally, your doctor will close the incisions using sutures, adhesives, or surgical tape so that your skin heals properly. A good surgeon will know how to close the incisions properly to minimize scarring.

      Following surgery you will be taken to a recovery room where you will be monitored by medical professionals. At this time, you will be required to wear a surgical bra and gauze to protect your breasts and aid in the healing process.

      In general, breast surgery takes between 60 and 90 minutes from start to finish. However, the procedure may take longer depending on the surgical technique used, and whether you’ve opted to have a breast lift performed simultaneously.

      If you are having breast reconstruction surgery following breast cancer or trauma, the procedure may be more in-depth and require a longer recovery period.

      Contrary to popular belief, those who opt for larger implants will not experience a longer recovery period following cosmetic breast augmentation. They may, however, have more difficulty adjusting to their new breast size than those who opt for a subtler increase.

      Breast augmentation recovery timeline

      Total recovery is a slow process that takes place over the course of several weeks. Remember, everyone’s recovery experience is different.

      24 hours following surgery

      In the first day following surgery you will most likely experience moderate discomfort, which can be alleviated using prescription or over-the-counter pain medication, depending on what your surgeon recommends. Some swelling, bruising, and nausea is also likely.

      Your arm movements will be restricted for the first 24 to 48 hours following the procedure. This will, among other things, prohibit you from driving. Make sure you have easily removable shirts ready for the first few weeks of recovery. Button-down tops and tops that zip up in the front are ideal.

      You will be required to restrict all physical activity during this period. Avoiding nicotine, alcohol, and blood-thinning medications is also highly recommended.

      During the first days of your recovery, you will need help moving around, getting dressed, and preparing meals.

      Two to ten days post augmentation

      You will be instructed to begin displacement exercises. These at-home massage techniques will help you achieve natural-looking results and prevent common breast augmentation complications such as capsular contracture.

      Breast augmentation patients who have had submuscular placement of either saline or silicone implants are typically required to do these exercises.

      Following the 48 hour mark, you should be cleared to drive as long as you are not taking any pain medications that seriously impair your motor skills. It is important to check with your doctor before getting behind the wheel.

      You will likely need to go for one or two follow-up visits over the first ten days of recovery.

      Ten to 14 days after augmentation

      Most patients are able to resume some light activities. Light lower body exercises can resume around the two week mark with your doctor’s approval.

      Your doctor will likely recommend that you get back to your regular daily activities and return to work.

      Patients are still required to avoid any heavy lifting, and refrain from engaging in any intense aerobic activity while the breasts recover from surgery in this early period.

      Two to three weeks post surgery

      Your doctor will probably advise you to continue your displacement exercises during this period, likely encouraging you to gradually resume some of your daily activities.

      However, most doctors typically still restrict their patients from doing upper body exercises, such as push-ups and weightlifting until roughly one month after surgery.

      Four to six weeks following augmentation

      Approximately one month following your procedure you will begin to see some of the final breast augmentation results come to fruition. Your breasts will begin to settle into their natural position, and you shouldn’t require any painkillers or medications during this period.

      You can also slowly transition from your surgical bras back to wearing your support, sports, or push-up bras at this time and resume your normal exercise routine.

      After being cleared by your doctor, you should be able to slowly resume upper body exercises around the four week mark. Running can typically be resumed around the six week mark as well.

      Several months after surgery

      You will now be able to see if the results meet your expectations.

      Ten to 12 weeks following the procedure, you should be cleared for all lower body exercises. You’ll be able to resume heavy lifting and upper body exercises around the three month mark.

      Scar tissue will begin to heal, and will continue to gradually fade over time and blend in with your surrounding skin. These scars should be virtually invisible by the two year mark if properly cared for.

      It’s widely recommended that you schedule one or two follow-up appointments in the month following your procedure to consult with your doctor about your results. They will observe the incision site and breast fold to ensure proper healing, and to confirm that you’re happy with the implant size and shape.

      After breast augmentation: post-op tips

      In order to recover as quickly as possible, follow the in-depth post-op guidelines supplied to you by your doctor. Here are a few more tips you can follow to speed up recovery:

      • Avoid taking certain medications; Aspirin and other blood-thinners are off-limits.
      • When your doctor gives the okay, moisturize the area regularly to avoid stretch marks.
      • Suppress the urge to open your bandages and look at your progress. This could reopen your wounds and cause infection.
      • Give your implants time to settle. At first they will appear in a higher position but they will gradually lower to their natural state.
      • Make sure to get lots of sleep as this will speed up the process.
      • Avoid wearing tight-fitting clothing and choose tops that don’t require you to raise your arms to put them on.
      • Make sure to have plenty of nausea medication on hand. Nausea is common following breast augmentation surgery.
      • Avoid sleeping on your sides. Rest upright, with pillows positioned behind your back.
      • If you are in extreme pain or experience excessive bleeding or swelling, don’t hesitate — call your doctor immediately.

      Don’t be alarmed if you experience either hypersensitivity or a lack of sensation in the nipples after surgery; this is normal and to be expected.

    • #96293
      Michelle Larsen
      AMBASSADOR

      Addendum A:

      <u>What’s It Like to Recover from Breast Augmentation Surgery?</u>

      https://www.healthline.com/health/breast-augmentation-recovery

      Breast augmentation is a surgery that increases the size of a person’s breasts. It’s also known as augmentation mammoplasty.

      In most surgeries, implants are used to enhance breast size. Fat from another part of the body can also be used, but this method is less common.

      People typically get this surgery to:

      • enhance physical appearance
      • reconstruct the breast after a mastectomy or another breast surgery
      • adjust uneven breasts due to surgery or another condition
      • increase breast size after pregnancy or breastfeeding

      People seeking male-to-female or male-to-nonbinary top surgery might also get breast augmentation.

      Generally, recovery takes about 6 to 8 weeks. It may take more time depending on how you heal and your overall health. Every person is different, so it’s best to talk to a surgeon if you’re concerned about the recovery process.

      In most cases, recovery lasts about 6 to 8 weeks. Here’s what the timeline may look like:

      Immediately after surgery

      Most breast augmentation surgeries involve general anesthesia. This means you’re asleep during the procedure.

      Once the surgery is done, you’ll be transferred to a recovery room. You’ll slowly wake up as a team of medical professionals monitors you. You’ll likely feel achy and groggy.

      If the implants were placed under the pectoralis muscle, you may experience tightness or muscle aches in the area. As the muscles stretches and relaxes, the pain will decrease.

      Hours after surgery

      After a few hours, you’ll feel less sore and sleepy.

      You can usually go home after several hours, but you’ll need someone to drive you.

      Before you leave, your surgeon will wrap your breasts with a bra or elastic band. This will support your breasts during recovery. Your surgeon will also explain how to care for your incision sites.

      3 to 5 days

      During the first 3 to 5 days, you’ll likely experience the most discomfort. Your doctor will have prescribed medication to help control the pain.

      You might have minor bleeding at the incision sites. This is normal. But if you’re concerned about any bleeding, talk to your surgeon.

      1 week

      As you approach 1 week, you may be able to manage the pain with over-the-counter pain medications.

      The pain should be minimal after the first week.

      With your surgeon’s approval, you can gradually return to light daily activities.

      Next few weeks

      During this time, you’ll still have some soreness and swelling. But it should slowly get better.

      If you have a physically demanding job, you’ll need to be out of work for 3 weeks or more. You’ll also need to avoid heavy lifting and intense physical activities, like running.

      2 months

      After about 2 months, you should be nearing full recovery, though this depends on how well your body heals.

      Your doctor will let you know if you can resume normal activities.

      Possible complications

      As with all types of surgery, breast augmentation poses potential complications.

      General surgery complications include scarring, wound infections, and bleeding problems, like blood loss. It’s also possible to go into shock or develop issues related to blood clots.

      Anesthesia can also trigger an allergic reaction, but this is rare.

      Complications specific to breast augmentation include:

      • scarring that changes the breast shape
      • asymmetrical breasts
      • breast pain
      • breast numbness
      • undesired or poor cosmetic results
      • nipple changes in appearance
      • breast or nipple sensation changes
      • breast cellulitis
      • breasts appear to merge (symmastia)
      • incorrect position of implant
      • implant is seen or felt through the skin
      • skin wrinkling over the implant
      • fluid accumulation (seroma)
      • scarring around the implant (capsular contracture)
      • implant leak or break
      • breastfeeding problems
      • breast implant-associated anaplastic large cell lymphoma
      • breast implant illness

      To heal some of these complications, you may need surgery to replace or remove the implants.

      On average, breast implants last about 10 years before the shell ruptures or leaks. You’ll eventually need surgery to replace or remove them.

      Tips for a healthy recovery

      Successful breast augmentation depends on how well you heal. To increase the chances of a smooth recovery, you can:

      • Wear recovery bras. Follow your doctor’s instructions. Recovery bras provide support and manage pain and swelling.
      • Care for your incisions. Depending on your surgeon’s preference, you may have to wear a bandage or apply ointment. Always follow the directions.
      • Take your medication. During the first week, pain medication will help you feel more comfortable. If your doctor prescribed antibiotics, take the entire course.
      • Prepare your home before surgery. Before the procedure, finish any housework and meal prep. You’ll need to rest when you’re back home in recovery.
      • Wear loose clothes. Loose-fitting, breathable clothes will help you feel more comfortable.
      • Avoid intense activity. Strenuous movement can delay the healing process.
      • Eat nutritious foods. A healthy diet will help your body recover. Consume lots of lean protein, fruits, and vegetables.
    • #96292
      Michelle Larsen
      AMBASSADOR

      Side Effects:

      This isn’t going into the ‘good’ side effects that we have come to know and love; increased self-confidence, increased intimacy, increased feeling of attractiveness, etc., but rather the unforeseen, outlier, odd ball type of side effects.

      Dental Work: I have read several postings where the discussion has centered on the required use of antibiotics before and after dental procedures subsequent to breast augmentation. From what I can find, there is nothing definitive to supports this one way or another. The best, most concise, information I can find is from ImplantInfo: “The bottom line on this issue, according to some doctors is that there is no bottom line.

      Certain doctors feel that, intuitively, surgeons should obviously treat their patients with prophylactic oral antibiotics in the period directly after the placement of the breast implants. This should be done for any procedure which causes a transient bacteria, such as dental surgery, colonoscopy, urological treatment (cystoscopy), and gynecological treatment. Probably 1 dose, 1 hour prior to the treatment followed by 1 dose after the treatment should be sufficient, as long as the patient is not immunocompromised.

      This should be done for the first 6 months to 1 year after the breast implant placement. There is no data to support this – in that a study was never done in this country. However intuitively surgeons should treat breast implants like any foreign body implantable medical device, like pacemakers and total joint replacements.

      Concerning general dental cleaning, the issue is even more vague. We cause a bacteremia every time we brush our teeth. And a dental cleaning is only a more mechanical “brushing of the teeth”. Although superficial dental cleaning should not require antibiotics, deep cleaning and periodontal treatment should get antibiotics therapy. There however have been anecdotal reports of increased capsular contracture after infections from dental treatment. Certain doctors make it a point to not prescribe oral antibiotics prior to the above outlined treatment except for superficial cleanings or routine dental treatment (fillings), as long as the patient does not have evidence of an immunocompromised state.

      Other doctors recommend antibiotic pre-medication prior to all dental work. Best bet is to follow your particular surgeon’s advice. If you wish to be more conservative, most doctors will agree that pre-medication prior to dental treatment is not going to hurtful. Call your dentist or your plastic surgeon, as you feel comfortable with, and ask for a prescription to be called in for you on the day before your treatment.

      http://www.implantinfo.com/faqs/1.6.aspx

      http://www.breastimplants.org/everyday-living/pros-cons-of-antibiotics-for-dental-work-after-breast-augmentation

      https://www.breastaugmentation101.com/dental-work-after-breast-augmentation/

      Temperature: At first glance one would assume, as I did in the beginning that implants would adjust to normal body temperature. But apparently not! The question would be, ‘what is the underlying cause’? Is it based on the type of implant product? Or is it based on how and where the implant is positioned?

      Comment1: I’m over a yr post op and mine are almost always cold to the touch! Even through out summer when it was 110 out, I’d touch em and they were cold lol

      Comment2: Same here, I’m almost 1.5 years post op and they are cold most of the time. I think it really depends on how much preexisting breast tissue you had, I had very little, and so I really have nothing to insulate them with hence the boobie icicles

      Comment3: When I had saline they weren’t cold, when I switched to silicone they were cold all the time!

      Comment 4: I know that no one wants to talk about it BUT at only 2 days PO I am so so DONE with being constipated. I’m pretty petite and I get extremely uncomfortable as soon as I bloat even a little bit (and this morning I got woken up from my stomach doing the “groaning”noises and feeling like it was about to explode), so I went and got Dulcolax suppositories and within minutes it worked, and I’ve felt so much better since. So for anyone needing quick, easy relief….try these

      Allergic Reactions: Any type of allergic reaction that may be caused by anything related to the surgery, medication, or products used as part of the surgery.

      Comment1: I had a reaction and it was horrible! I had giant tub of cortisone prescribed and a medication for itching. Also Tagamet can be used to help block with histamines. There is a Benadryl clear that helped, Dermaplast spray, and Rhuligel. I switched to only cotton surgical bras and that helped a lot. The bra was the biggest culprit for me.

      Comment2: Take off the bra. Load up your chest with the best anti itch cream you have. See if your Dr. will call in Atarax it helps with itching – it also made me sleepy. Ask surgeon to get you a cotton bra! I know it’s the fabric in the bra, at least it was for me. Also ice bags wrapped in towel helped take the edge off the itching.

      Comment 3: I had burning in my sternum but it’s almost gone at 1.5 weeks PO. My nipples are SO sensitive though! It’s incredibly annoying. I’ve been using Jenny Eden’s booby butter morning and night to prevent stretch marks – love it so far. Check the top of the October or November groups for a link to purchase.

      Squeaking: weird! Yes, apparently, some women mention that in the short time after surgery, there seem to be squeaking noises coming from their chest. Are they more prone if over, or under, the muscle? Or are they more from being textured, or smooth? Or more based on size? Given that these comments are just off the cuff comments with no medical explanation; this will be a topic for discussion with the surgeon.

    • #95610
      Michelle Larsen
      AMBASSADOR

      <u>Surgical Concerns:</u>

      Pain: From the information I have gathered, a few days of moderate pain is to be expected, requiring the use of prescription pain medications. Afterwards, OTC pain medications may be required. It is extremely important that you and your surgeon understand what your history is with pain medications, and what is planned for your pain and swelling after surgery. For example, certain narcotic pain medicines have little to no effect on me, while others do. Your surgeon needs to hear this, and more importantly ‘understand it’. Conversely, you will need to fully understand what medications the surgeon is planning to prescribe, when they should begin and end, and the dosages. And you both need to develop a mitigation plan in case pain, swelling, or inflammation gets too much to bear. Remember, this surgery occurred on you, not the surgeon, you are the patient, and you need to understand how to control that discussion and plan. After surgery is no time to start figuring out what to do.

      <u>Comment 1</u>: as far as pain management.. if your surgeon offers exparel injections it is worth it 100%. I had next to no pain my entire recovery. Only ever took Tylenol and barely needed that. Also my surgeon advised me to avoid ibuprofen and only use Tylenol/acetaminophen both pre and post op. Not sure the reasoning behind that though.

      <u>Comment 2</u>: So this really sucks! I was just posting on here last night about how great I was feeling, that I had been able to go back to work and all these positive things. So last night, after what I considered to be an incredible day and not going overboard, being careful, etc – I lay down to go to bed, and suddenly my chest muscles started to slowly constrict and have been clenched ever since. I took some Tylenol (1500mg) because I’ve been off Vicodin since day 3 and then was taking Toradol after until day 5, but am also off that now. Tylenol didn’t do anything, which I kind of expected because it’s not an NSAID, but my surgeon firmly instructed me to not take OTC NSAIDs until 2 weeks DPO. I tried slowly stretching my chest with a yoga block under my back, lay there for a good 15 mins, did some arm stretches. Nothing would help loosen me up, so I was up until 2am just staring at the ceiling. This morning, I said screw it – I don’t have any bruising and I don’t really think I’m going to have a hematoma so I took Motrin, still nothing.

      …… I called my surgeon and told the patient coordinator what was happening, they were very resistant to prescribing me any sort of muscle relaxant and kept recommending more yoga. I got pretty annoyed because I see that muscle relaxants are a very common medication that many women take after BA, including from what I’ve seen here. Initially before my surgery, my doctor did not want to prescribe me narcotic pain meds either, which I expressed concerns about and I was really made to feel that I had to almost insist or complain to her in order to get prescribed 10 Vicodin pills for the first couple of days. I called them back again and said that while I truly admire their continuous holistic approach, I can’t handle the aching from being so constricted. So, I now have 10 Valium pills, but as a result had to leave work for the day as I cannot work on the inside of computers and their electrical components while on a controlled narcotic.

      <u>Comment 3</u>: The first few days were as expected. It’s hard to get up and down without using your arms to push. Lots of pressure in the boobs, and just feeling tired/wore out after being under for surgery. The incisions were fine for me. I had some lipo in the underarm, side boob area as well, and that was where I was the most sore. I went off the pain meds on day three and were able to get by on just OTC pain meds. I am allergic to the suture glue it turns out, so that caused me to get some pretty awful blisters, and those were much worse to deal with than the incisions. And then as predicted I developed hives from the antibiotic. So if we discount those two issues, which were the worst, the surgery recovery was fine. I found that gently shaking the skin helped with the nerve tingles/zings that were annoying. I am now having them in my right boob, which I hope means some of the nerves are awaking there. I am fairly numb on that breast which is odd as it had the least of tissue removed. Guess you never know….. Again, I don’t regret having the work done, I just regret the money spent on it, if that makes sense…..

      • #95611
        Michelle Larsen
        AMBASSADOR

        Surgical Concerns (pt 2)

        Bruising & Hematoma: a hematoma is just blood that collects outside of the blood vessels; as in a bruise. Breast hematomas can occur after breast surgery. Small hematomas usually begin to clear up in a few days. Larger one’s can lead to inflammation or fibrosis. From Wikipedia: “Breast hematomas can sometimes lead to skin discoloration, inflammation, or fever. When a hematoma resolves, it may become fibrotic, leaving behind scar tissue. A resolving hematoma may liquefy to form a seroma.

        Post-surgical breast hematomas can also impede wound healing and therefore impact the cosmetic outcome. Hematomas are furthermore one of the risk factors for breast surgical site infections. There is preliminary evidence that, after breast implant surgery, the presence of hematoma increases the risk of developing capsular contracture.”

        Blood Flow:  I have read of situations where the tightness of the implant can cause a restriction in the blood flow to the surrounding tissue. Issues surrounding restricted blood flow do not seem to be clearly defined or articulated from what I have found. I have not found this issue listed as a recognized complication. However, observance of this should be added to the list of items to be aware of in your post operative monitoring.

        Drop & Fluff: As the post-operative process continues, the implants will drop into their final position and begin to fill out the breast area. It appears that this process commonly takes many months to complete. As no two people are the same, given the different sizes, types, and shapes of the implants, no two rates of drop and fluff are the same. There seems to be an accepted rule of thumb that this will take many months for this to complete. And if you are fitted with an ‘internal bra’ this timeframe would be different. And your two breasts may not drop & fluff at the same rate. These are things that you must be aware of, and monitor, and communicate with your surgeon about.

        PostOp Massage: as part of your post-operative recovery, your surgeon will provide you with some exercises to help in the healing process. This will help the muscles get back in shape, help with inflammation, support the process of drop and fluff, among others. Your surgeon with outlines different aspects such as the frequency, duration, and type would be discussed. Both you and your surgeon should also discuss any types of creams, salves, etc. that can be used to soften the tissue, reduce the visibility of the incision scars, promote incision healing, relaxing the muscles, etc. A couple of the products I have seen discussed are Booby Butter and BioFreeze.

        <u>Comment 1</u>: I was instructed to do “downward” massages at first after my 2 week appointment. Basically, lightly push down on the top part of the implant, so you can feel it at the bottom of your breast……. He also instructed me to walk my hands up a wall, so my hands were high above my head and stretch the pec muscles… I do this several times a day and whenever I think of it. I’m sort of tight in the mornings, so I usually do my first round of massaging in the shower.

        <u>Comment2</u>: To my understanding it really depends on your doctor. I am 6DPO and my doctor said he wanted to go over massage techniques at my 1WPO appointment. I’ve talked to some people whose doctors did not want them doing any massages.

        <u>Comment3</u>: I was told not to massage and honestly I couldn’t anyways because I felt so sore.  I’m a month post-op and they already feel soft.

        1 user thanked author for this post.
        • #95612
          Michelle Larsen
          AMBASSADOR

          Surgical Concerns (pt 3)

          PostOp Clothing:  after your recovery from surgery, your breasts and torso will be wrapped properly in order for you to return home and begin the healing process. Ensure that you have had a complete and detailed discussion with your surgical team so you know exactly which clothes you can transition to, and at what times. For example, you will probably want loose fitting tops with button down fronts so you do not have to raise your arms to get the top on or off. And if the tops are tight, that too may not be comfortable.

          Bras are especially important. Some doctors do not want underwire bras used, while others are okay with it. You will need to have a size and style that provides the support your surgeon recommends, and that feels good on you. Your surgeon may recommend changing styles and sizes as the healing process progresses. The idea of being able to wear cute, sexy bras, is going to have to wait a bit I’m afraid.

          <u>Comment1</u>: I was given 2 post op bras to wear 24/7 absolutely no underwire bra until the 6 week mark. I’m close to 5 months post op and still wear my post op bras most days just because I find them comfy.

          <u>Comment2</u>: My surgeon actually says I have to wear underwire 24/7 at 3 weeks post op, which is in a week for me.

          Cleaning: It is important to keep the incision area, and your body clean following surgery as you heal. But you are not going to be able to soak in a nice hot, bubble bath, filled tub. You will also need to have discussed in detail, what your surgeon recommends about showering and keeping the incision clean and dry. There may be specific soaps, lotions, and cleaning solutions the surgeon recommends. And how to properly wash your breasts as well should be fully understood. And as with the bath, you are probably not going to be able to stand under the hot water until you run the hot water heater to cold.

          Incision: proper care and protection of the incision is vital to ensure infections do not occur. Be mindful of what things you should watch out for, and signs that your healing is progressing. No one like a scar, but be careful, and discuss the use of any over the counter creams or medications that you think will help either healing or lessen the appearance of scarring. And depending on what is placed on the incision before you leave the hospital or surgical suite, ensure that you fully understand how to take care of the tape or bandage that was used. And know what to look for in case there are issues with the tape or bandage.

          Anesthesia: from what I have found, general anesthesia is used for breast augmentation surgery. While it is not for me, I won’t rule out that some surgeons, somewhere on the planet, use a local anesthetic. If you have ever been operated on, you should make sure you discuss with the surgeon any side effects  you encountered, and what was done to mitigate their risks. You should also discuss what may be needed for constipation after surgery, as this is common post-surgery, and as a result of any pain medications that may be prescribed.

          1 user thanked author for this post.
    • #94905
      Michelle Larsen
      AMBASSADOR

      <u>Size:</u>

      The intended result is to provide an augmentation increase from the size prior to surgery, to a ‘C’ cup breast size. It is desired that this is also in line with what the surgeon feels is appropriate for my body size and build, as well as the existing composition of my breasts and surrounding support structure. Size, being both fullness and projection, must be understood in order to obtain the size you desire. Also, the amount of existing breast tissue may dictate whether or not you can obtain the desired look with just a single surgery, or would require multiple. If, for example your desire is for a final look that cannot be supported by your current shape, you may need to have an initial surgery to allow for more skin and tissue to for before you can take the next step to larger implants.

    • #94904
      Michelle Larsen
      AMBASSADOR

      <u>Look and Feel:</u>

      Having breast augmentation that produces to as close to a natural look and feel that most closely resembles natural breasts is important. This is not limited to size and shape, but also breast and nipple position. As for nipple position, the typical male chest has nipples faced further to the outside of center of the breast, so there is a possibility that the nipples my not be properly centered, but rather pointing away from the center of the chest. It appears this effect can be somewhat mitigated with implants that provide for a fuller and rounder shape, as opposed to a more outward projection. Many breast augmentation surgeons can create 3D images of what will closely resemble your breasts after surgery. Remember that these are estimated images, and not something that will be exact.

    • #94851
      Michelle Larsen
      AMBASSADOR

      <u>Longevity:</u>

      Breast implants do not have an expiration date; nor do they have a ‘best if used by’ date. But they probably will not last a lifetime. Obviously the ‘lifetime’ part will depend on how old you are when you get them. I have heard of a woman that got implants who was in her 70s. Less than 20% of women with implants will have them removed or replaced in the first 8 to 10 years. Eric Culbertson, MD on the The American Society of Plastic Surgeons website states breast implants “to last more than a decade, with the chance of rupture increasing about one percent each year. That means after a decade, there is a 90 percent chance that the implant will still be fully intact.”

      And what about longevity as it relates to the implant type, saline or silicone, texture, or fill? From one website:

      Saline breast implants will last longer if they are at their maximum fill amount as recommended by the manufacturer. Underfilled saline shells may fold and wrinkle before meeting their potential fate: a rupture. Continuously folding the implant shell creates friction and friction often equates to failure, explicitly causing the implant(s) to deflate over time as the saline solution leaks out. Underfilled saline implants have one of the highest rates of failure. The rupture rate for saline in a 2014 study was 5.6 years. Of the 48 ruptured saline implants studied, 26 implants were underfilled.

      Just as an implant can fail due to underfilling, it can fail if overfilled. Manufacturers suggest overfilling a saline implant no more than 10-15% of the maximum fill amount to maintain shell integrity. Overfilling is filling above the maximum fill amount. Some surgeons have been able to expand the saline implant shell 20% more than the manufacturer recommends. While that may give some patients the look they are after, going more than 15% over can result in implant failure in the future.

      The saline implants that have a textured shell and reach the manufacturer’s recommended maximum fill have the highest chance of survival. In the same 2014 study, surgeons found that of the 45 ruptured saline implants, only 16 were textured implants.

      With silicone implants, surgeons are unable to add silicone to the implant to give the patient the benefits of the correctly filled saline implant. However, silicone implants have a vast advantage over saline implants in that the silicone gel acts as a solid instead of a fluid. If a silicone implant were to rupture, the gel will remain intact and is more likely to retain its form. Being form-stable and having the ability to remain contained, means silicone implants will have a longer life. In the same 2014 study, the mean duration of implantation until rupture was 12 years. In the 49 silicone implant failure cases studied, 11 implants were textured shells and only four were smooth.

      In fact, one company has developed a silicone implant that may outlive traditional silicone implants–Allergan has introduced the Inspira line. Inspira implants have been available in Canada for some time, and now they are available to U.S. patients. The Inspiras have a slightly overfilled shell, preventing the implant from folding inside the breast.

      Breast implants could last a short time, or many decades, depending on what you choose as the implant, how your body reacts to the implants, and your lifestyle. This is definitely a topic worth serious discussion with your surgeon.

      1 user thanked author for this post.
    • #94830
      Michelle Larsen
      AMBASSADOR

      <u>Maintenance:</u>

      This pertains to the maintenance of the actual product to help maximize the safety and longevity, and not for the surgical after care process. If not, there could be issues with warranty validadtion down the road. For example, Sientra offers a 20 year warranty and seems to have a lower rate of Capsular Contracture. https://en.wikipedia.org/wiki/Capsular_contracture

      Early on maintenance would include not only what the manufacturer recommends, but what the surgeon indicates, and your own personal observations. Being mindful of changes in size, shape, placement, and symmetry should be reported to your doctor as soon as practical. Also, changes in color, firmness, or smoothness, or feeling and sensitivity of the breast should be noted.

      Periodic testing

      Make sure, once the implant manufacturer, implant size and style, are decided on, that the manufacturer’s recommendation are understood and followed.

      Comment 1: I had mine (silicone) for 18 years. The only thing i had to do was a screening every couple of years, then every year after the 10th year. You don’t have to do an mri, but the ultrasound type. In Europe it’s cheap. There seemed to be a rupture last year, but It was well past time to replace them, so I didn’t go ahead with the mri and decided to replace them. At the end there was no rupture. So there’s no rule.

      Comment 2: Does anyone else have concerns about the maintenance required for implants? My PS told me they don’t have to be replaced every ten years if there isn’t an issue, but I’ve read the risk of a rupture goes up the longer you have them and its recommended to get screenings every few years which adds onto the cost.

      Mammogram

      Traditional mammograms may not be possible with breast implants. You need to alert the facility performing the mammogram that you have implants. So you can ensure they have experience performing mammograms with implants. There is a risk of rupture with both saline and silicone implants during a mammogram.

      This if from Cohen/Winters Aesthetic & Reconstructive Surgeons:

      Getting a mammogram with implants is safe overall and is still considered the best preventative measure. But you do have to be aware of a few things. First off, when you call to make your appointment at the screening center, let them know that you are getting a mammogram with implants. This way you will know if they have experience performing mammograms on women with implants, which differs slightly from a mammogram without implants.

      It is a possibility for both saline and silicone implants to rupture during a mammogram, which is one of the reasons you want to make sure the mammographer is familiar with performing mammograms with breast implants, because mammograms with implants require special procedures. The older the implant, the more likely it is to rupture. Because women often get implants placed at a younger age, by the time you have a first mammogram, your implants are likely to already be older. Mammograms don’t always detect ruptures, which is why routine MRI scans are recommended for silicone implants. If your mammogram does detect a rupture, you will be notified so that you can let your plastic surgeon know immediately.

      Another caution when undergoing mammogram with implants is capsular contracture. Capsular contracture is scar tissue forming around the implant. It is hard tissue and can crack when the breast is compressed during a mammogram. As a result, after a mammogram you may notice that your breasts have a slightly different look and feel, and each breast may react to the mammogram differently.

      Despite the possible risks, current medical guidelines advise to continue getting mammograms with implants.

      Comment 1: Had my 2nd mammogram today since my June 2016 BA. My first one was a breeze, this one was awful. Curious others experiences….my first one the tech did a really goid job ‘pulling’ my natural forward and pushing my implant back. At first I thought ‘what the heck’ but after today, I appreciated it so much more.  (375 silicone under)

      Comment 2: Yes I did traditional/3D….an MRI is suggested every so many years I believe…

      Dental Work

      Recently I have learned of surgeons advising implant recipients to take antibiotics both before and after any dental procedures. I can’t determine if this is a new protocol, or if it is isolated to certain types of implants, or areas, or for certain types of dental procedures, or is it based on how close to when the implant surgery was performed. This is another concern you should address with both your surgeon and your dentist.

      1 user thanked author for this post.
      • #95736
        Emily Alt
        UNITY

        This is just a quick comment about dental work.  Surgeons and dentists may recommend taking antibiotics before dental work to reduce the chance of infection.  Dental work (especially cleaning) releases bacteria that can get into your bloodstream and infect the surgical site.  I had knee surgery a while ago and had to take amoxicillin every time I went to the dentist for a year after the surgery.

    • #94760

      I am new here, and thanks for the information. While augmentation is desirable, I have trouble finding about hormone therapy for mtf breast development. Are there forums here that I might be direct to?

      • #94763
        Michelle Larsen
        AMBASSADOR

        Debbie, wow, that is a big request…. LOL You will find there are lots of HRT related postings on this site. Just spend some quality time with your electronic device of choice and go searching. And look in Places -> Local Places to see what places & resources there are close to where you live. Oh, and then there is the ChatRoom. HRT is a big topic of discussion there as well. Happy searching and researching, Michelle

    • #94072
      Emily Alt
      UNITY

      Hi Michelle,

      Thanks for taking the time to research and post this valuable info.

      Sorry if I missed it, but I didn’t see anything about having existing breast tissue before getting implants.  Of course this isn’t a requirement.  However, implants do look more natural when there’s already some tissue to work with.  I think it’s important for new girls to understand that.

      Emily

      1 user thanked author for this post.
      • #94082
        Michelle Larsen
        AMBASSADOR

        Thanks Emily. So far, all I have posted are section I and II… I have lot’s more to go…. Thanks, Michelle

        1 user thanked author for this post.
    • #93768
      Holly
      SILVER

      Wow  Good Job Lots if info here  Thank you

      • #94764
        Michelle Larsen
        AMBASSADOR

        Holly, in the words of the great Naval hero, John Paul Jones, “I have not yet begun to post”; I have a whole lot more of my research to post. I have barely scratched the surface. So check things out from time to time. I plan on posting more this weekend. Michelle

        1 user thanked author for this post.
    • #93235
      Michelle Larsen
      AMBASSADOR

      <u>Safety:</u>

      This does not pertain to the surgical procedure, or after care, but rather for the safety of the actual product. There are three implant safety issues that seem to be predominant from my research; Capsular Contracture, BIA-ALCL (cancer), and physical failure.

      From Wikipedia – Capsular Contracture is a response of the immune system to foreign materials in the human body. Medically, it occurs mostly in context of the complications from breast implants and artificial joint prosthetics.

      The occurrence of Capsular Contraction follows the formation of capsules of tightly-woven collagen fibers, created by the immune response to the presence of foreign objects surgically installed to the human body, e.g. breast implants, artificial pacemakers, orthopedic prostheses; biological protection by isolation and toleration. Capsular Contracture occurs when the collagen-fiber capsule shrinks, tightens and compresses the breast implant, much like the collapse of a bubble gum bubble.<sup>[1]</sup> It is a medical complication that can be painful and discomforting, and might distort the aesthetics of the breast implant and the breast. Although the cause of Capsular Contracture is unknown, factors common to its incidence include bacterial contamination, rupture of the breast-implant shell, leakage of the silicone-gel filling, and hematoma.

      The placement of the implant under the muscle, as opposed to above the muscle, or the use of textured implants seems to lessen the likelihood of Capsular Contracture.

      2 users thanked author for this post.
      • #93236
        Michelle Larsen
        AMBASSADOR

        Safety (pt 2):

        The second safety issue of note is Breast Implant Associated-Anaplastic Large Cell Lymphoma (BIA-ALCL). While numerous articles have been written on this subject, an article from CHH Health, dated February 7, 2019, was one I found helpful. In the article it mentions that “at least 457 women in the US” have been diagnosed with this condition. And the consensus seems to lean to the condition being more predominant with textured implants. According to the NIH; “Although rare, all cases with adequate history have involved a textured breast implant.” Indications I have seen are that ‘between 1 and 3 million women in the US have breast implants’, but without a valid number of women with textured implants as a basis to calculate risk, I have not been able to determine a risk level.

        The risk of breast implant related cancer has been something I have been aware of for many, many years, so it is nothing new.

        https://www.cnn.com/2019/02/07/health/fda-lymphoma-linked-to-breast-implants/index.html

        https://www.fda.gov/medical-devices/letters-health-care-providers/breast-implant-associated-anaplastic-large-cell-lymphoma-bia-alcl-letter-health-care-providers

        https://pubmed.ncbi.nlm.nih.gov/28157769/

        https://journals.lww.com/plasreconsurg/Fulltext/2000/03000/Characteristics_of_a_Population_of_Women_with.14.aspx

        https://www.quora.com/How-many-women-get-breast-implants?share=1

        2 users thanked author for this post.
        • #93470
          Michelle Larsen
          AMBASSADOR

          Safety (pt 3):

          The third issue centers on the physical failure of the implant. This seems to be primarily from a physical defect in the implant, although there could be outside reasons for an implant to rupture. With saline implants, any rupture would result in the sterile saline solution quickly being released into the body, and absorbed, and ultimately discharged. There would also be a quite obvious deflation of the breast containing the ruptured implant. Silicone would more slowly leak into the body, but seems to be more contained in the cavity where the implant is positioned; although there has been cases, and concern, of silicone particles migrating to other parts of the body and causing health problems. The best, in the event of a rupture seems to be ‘gummies’. From several articles, and demonstration videos, these seem provide for the silicone to not leave the implant upon rupture. In fact, it appears that the silicone will retract back into the implant in the event any is expelled at the site of the rupture.

          There are undoubtedly other safety issues related to breast implants, but these three seem to be the most predominant. So the bottom line is that, safety issues surrounding breast implants is something to be seriously discussed with your doctor and surgeon.

          2 users thanked author for this post.
    • #92933
      Michelle Larsen
      AMBASSADOR

      Outline:

      This should have come before I posted about Construction Type; but oh well, here it is. This Outline is just a list of topics I put in my research document. If anyone else has any suggestions, I would love to include them. I have probably overlooked a few…..

      I. Construction Type

      II. Safety

      III. Maintenance

      IV. Longevity

      V. Look and Feel

      VI. Size

      VII. Surgical Concerns

      VIIa. Pain

      VIIb. Bruising

      VIIc. Blood Flow

      VIId. Drop & Fluff

      VIIe. PostOp Massage

      VIIf. PostOp Clothing

      VIIg. Cleaning

      VIIh. Incision

      VIIi. Anethesia

      VIII. Side Effects

      VIIIa. Temperature

      VIIIb. Allergic Reactions

       

      1 user thanked author for this post.
      • #93809
        Anonymous

        im concerned about the type and size i want silicone and the largest implant that i can safely get

        1 user thanked author for this post.
        • #94083
          Michelle Larsen
          AMBASSADOR

          KristiAnn, I know you will, but get what you and your doctor and surgeon feel are best. You will have them for a long time, so everything needs to be considered and done correctly. Michelle

           

          1 user thanked author for this post.
    • #92884
      Michelle Larsen
      AMBASSADOR

      Disclaimer:

      First off, I am NOT a doctor, nor am I any sort of medical professional. This is just from the research I have done, and nothing more. You may find information that is different, and I encourage you to share it.

      Resources: Now, I have not vetted most of these. In fact the only one I have had personal experience with is the last one, West End Plastic Surgery, because they did my orchiectomy. They were great. I have also talked with Amelia Aesthetics (Jen Eden) via their online video resources and online blog.
      Amelia Academy – https://tv.askamelia.com/

      Amelia Aesthetics – https://askamelia.com/

      American Society of Plastic Surgeons – https://www.plasticsurgery.org/

      The Cosmetic Concierge – https://www.cosmeticconciergemd.com/

      Wendy Gottlieb, MD – https://wendygottlieb.com/

      GrS Montréal – https://www.grsmontreal.com/en/home.html

      The Philadelphia Center For Transgender Surgery – http://thetransgendercenter.com/

      Kotis Plastic Surgery – https://www.drkotis.com/

      RxBra – https://www.rxbra.com/

      West End Plastic Surgery – https://www.westendplasticsurgery.com/

    • #92883
      Michelle Larsen
      AMBASSADOR

      <u>Construction Type:</u>

      The three types are Saline, Silicone, and ‘Gummy Bear’. From what I have seen, the ‘Gummies’ seem to be the preferred type. Now, that is based on what research I have done, so you may be finding something different. As most of you know, saline has been around the longest, followed by silicone, and finally the ‘gummies’. And of the three types, I have seen smooth surfaced implants and textured surface implants. One thing I found interesting about the ‘gummies’ is that if there is a puncture of a cut/tear, the ‘gummy’ part might come out, but will get pulled back in so it stays in place…..

      • #92937
        Michelle Larsen
        AMBASSADOR

        This is from another comment posted by Dr. Michelle Roughton at Amelia Aesthetics: This is a tough decision.  I have placed Sientra textured implants and I think there’s good reasoning behind doing so.  Essentially the risk of a second surgery is higher than the known risk of the ALCL (lymphoma occurring in capsules around textured devices).  Here’s the rub though and how I’m leaning at present…more and more cases of ALCL are arising.  We didn’t know to look for it until the last few years.  So more cases are being diagnosed which means the risk is ‘increasing’.  I think you’ll have to make the decision that helps you feel the most comfortable.  Risk a second surgery or risk a rare lymphoma.  I’m favoring smooth only implants these days myself.

        As for me personally, I will have all of this information with me when I talk to my surgeon. She/he, will be the one that sees me specifically, and will be better situated to discuss the best path for me.

      • #92934
        Michelle Larsen
        AMBASSADOR

        This is from a comment posted by Dr. Michelle Roughton at Amelia Aesthetics: So under the muscle I don’t see a lot of benefit from textured implants.  Over the muscle is a different story.  Textured implants, as I am sure you know, are associated with a rare form of lymphoma (which is a cancer).  It’s super rare and even more rare to die from it, but you can.  Most of my patients freak out (and I would too, no shade!) about that and I’ve just switched to smooth all the time except for very specific cases.  The rate of capsular contracture with a smooth implant OVER the muscle is 6 x higher than when placed UNDER.  So I talk to most of my over patients about considering texture devices.  Time changes every woman’s body, breasts, etc with or without surgery so I don’t think anyone can claim that textured devices STOP drooping.  I’d just be really informed and know what to look for for the ALCL (lymphoma), which is late onset (think over 1 year later) seroma or fluid collection.  I hope this was helpful and not too scary.

        More on the cancer and capsular contracture in the Safety (II) section, so stay tuned…..

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