Your breast augmentation result depends on many factors, but chiefly, the standards your surgeon has for his or her own performance, for your outcome, and his or her concept of beauty. Dr. Laverson produces problem free predictable attractive and proportionate breasts consistently. This doesn’t just “happen” by the insertion of implants, but happens only by an obsessive attention to many details. Not all breast augmentation procedures are alike. Most patients are unaware of huge differences in planning, technique, and quality. Decisions made with you before the procedure affect many facets of your result. Technical details of the procedure performed while you are asleep influence final appearance and longevity of your implants.
What steps will your surgeon take before and during surgery to be sure your implants stay together toward your mid-line, preventing visible and un-natural separation between your breasts? What steps are taken to prevent implants from dropping off to your sides when you lay down? What steps (if any) are taken to be sure your implants remain high on the chest with the natural slope and fullness across the upper breasts you desire? How will your surgeon minimize the chance of capsular contracture, which causes implants to become hard and mis-shapen, usually requiring re-operation? How will implant malposition (implants improperly positioned) be prevented? What about rippling and wrinkling at the implant edges? Are special steps taken to prevent infection, implant perforation, bleeding, and “animation” (movement) of the breasts with chest muscle contraction?? These are all problems that occur frequently after breast augmentation. Many surgeons routinely re-operate to improve or correct such troublesome issues. Although they may occur despite efforts to prevent them, unlike many surgeons, Dr. Laverson takes extra time and makes special effort before, during, and after your breast augmentation to minimize the chance of problems in the following ways:
1. Size selection. Our approach is dimensional, NOT volumetric. Your implant is selected based on the dimensions of your breast and chest before surgery, and the dimensions you want to have after surgery. Implants are available in many sizes and shapes. The shape of your implant and the width, height, and projection are carefully chosen by Dr. Laverson who considers your presenting chest and breast anatomy, your skin characteristics, and your desired result. You will try these implants on in the office and decide which is best. We also offer 3D Portrait Surgical Simulation with various sizes in the office.
2. Implant surface, implant fill, implant positioning, and approach for implant placement. There are choices to be made before surgery that affect your outcome. Dr. Laverson discusses these with you, and will help you select the device and procedure with the best chance of success for you. Your lifestyle, personal preferences, body habitus, breast size, age, and other individual factors influence these choices. Many surgeons only order implants from one of the three major manufacturers of FDA approved breast implants, but Dr. Laverson orders from all three (Allergan (Natrelle), Mentor, and Sientra), depending on which implant is best for your situation.
3. Capsular contracture. This problem causes breasts to become firm and un-natural in texture. Sometimes, fluid around breast implants is produced, causing the breast to enlarge spontaneously. Evidence suggests that contracture is a response to bacterial biofilms, produced by organisms that naturally live in breast ductal tissue. Dr. Laverson avoids breast ducts, and provides pre-surgical anti-bacterial scrub for you to shower with before breast augmentation. At the start of your procedure, a polyurethane barrier is applied to seal your ducts from the surgical field, and you are dosed with intravenous antibiotics. During the operation, your breast implant pocket is kept absolutely blood free, and irrigated copiously with four different antibiotics, effective against ductal bacteria. Your skin is thoroughly scrubbed by nursing staff before surgery, and again by Dr. Laverson during surgery. Antiseptic is also used to coat the breast implant pocket. Your implant is removed from its sterile packaging, bathed in antibiotic, inserted, and the deep connective tissue closed over the device after proper positioning all within 1-2 minutes, minimizing the likelihood of exposure to bacterial contamination. New manufacturer warranty provisions provide financial assistance for patients needing implant replacement for capsular contracture.
4. Wound failure with implant exposure. Dr. Laverson reconstructs muscle, deep connective tissue, superficial connective tissue, and several layers of skin closure to be sure your implant is protected, concealed, and securely covered as much as possible, with restoration of normal appearing skin surface and a scar that is fine, well positioned, and minimally detectable. This extra time, energy, effort, and care diminishes the possibility of implant exposure and other poor outcomes.
5. Breast implant malposition and “bottoming out.” Selection and placement of the implant are important to prevent these problems, but also taking time to reconstruct the lower curvature of the breast before inserting the implant help to keep it in position. Dr. Laverson secures your connective tissue to the chest wall to prevent implant descent with loss of fullness in the upper breast. Few surgeons will take the time while you are asleep to anchor edges of the implant pocket in this way to stabilize implants in their proper position.
6. Check the result. Many surgeons perform the entire breast augmentation procedure without seeing how you look in the upright position. Breast tissue is soft and mobile over the implant, and shifts with your posture. Often, the result looks perfect when you are laying flat on the operating room table but breasts drop down below the implant when you are standing. This problem (and others) can only be corrected if discovered during surgery by sitting you up while asleep to check your appearance in the upright position. Dr. Laverson secures you safely and comfortably to the operating room table in anticipation of sitting you up to check the result and to be certain that your breasts look right before your procedure is concluded.
7. Long acting anesthetic. To minimize early post surgical pain, Dr. Laverson treats the area of your augmentation with anesthetic solution to relieve pain for hours to days following your operation. Either regular bupivacaine or long acting bupivacaine (Exparel®) will be used. Either way, you are unlikely to be in excruciating discomfort upon awakening from anesthesia. This minimizes your need for nausea inducing narcotics.
8. Highest Quality Post Surgical Bra and/or Stabilizing Garments. Dr. Laverson doesn’t skimp or save on your post surgical bra. He applies the highest quality latex free Marena® and/or Design Veronique® bra with a two inch supporting band to maintain your implants in their proper location. If necessary (and at no extra charge to you), a three inch stabilizing band will be provided as well. Implant position during the early period of healing must be properly maintained to improve your long term result. This also means no running or jumping for several weeks after your breast augmentation procedure. If you have a breast lift with your augmentation, post-surgical support for several months is recommended. Dr. Laverson understands that if you don’t like your post-surgical bra or if it is not comfortable, you won’t wear it.
9. Follow Up Appointments. Because your breast augmentation result progressively matures for several months after surgery, problems may not become apparent until some later time by which many surgeons have no scheduled follow up. Implant influenced tissue expansion, gravitational settling, resolution of swelling, and pocket expansion related to dynamic musculoskeletal forces change your appearance. Sometimes, early detection and treatment of developing problems can improve your long term outcome. Dr. Laverson always wants to know if there is deterioration of your result in any way, and wants to see final results six months to one year after your breast augmentation surgery. There is never any charge for follow up visits. Although rarely indicated, minor office revisions and/or treatment of problems are included as well.
Depending on your situation, additional and/or alternative elements of preparation, technique, and post-surgical care will be added to improve your result, prevent complications, and increase longevity of your implants. These measures may increase the cost of your surgery slightly, but if effective, additional surgery to manage problems is avoided. Your breast augmentation outcome and experience will more likely be the best possible.