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Breast Augmentation

Before & After Gallery | Patient 5

Patient 05 - Wants Fullness and Roundness


Patient Details

Case 5 – Bilateral Breast Augmentation

Reason for consulting with OC Breast Surgery specialist
This 38 year old patient from Orange County was ready to reclaim her body after breastfeeding her two children. She was a 34 A/B cup and desired to be a 36 C/D cup. She did have a history of rheumatoid arthritis when she was younger that was in remission. Before consulting with OC Breast Surgery center she spoke to her doctor about breast implants and was cleared by her physician for surgery. She had no previous breast surgeries.

In the exam, the surgeon measured an equal distance of 18.5 cm for each breast from her sternal notch to her nipple areolar complex. The patient and surgeon discussed size, shape, and incision placement in order to set realistic expectations. She indicated that she preferred to have fullness in the upper pole and would not mind a little “side boob”. She did not want “ski slopes” and preferred a little roundness over the natural slope. She was not sure if she wanted her incision to be in the upper areolar edge or along the inframammary fold. The IMF incision is the one most patients choose because it bypasses the risks of breast tissue contamination, visibly retracted scars, potentially changing the imaging of a mammogram and possibly changing future breastfeeding possibilities.

Surgical Plan – Bilateral Breast Augmentation

Pre-Op Sizing
The patient was instructed to follow the Breast Implant Sizing Guide at home before her pre-op sizing appointment in our Newport Beach office. This home exercise involves purchasing one or several bras of your desired post surgery size and stuffing them with nylon, flax seed filled sacks. Patients are encouraged to fill the bra until reaching a desired volume then go bigger until reaching a volume considered too big. Her preferred flax seed size was 300 cc to 350 cc.

On the day of the pre-op sizing appointment in our Newport Beach office, the patient brought along her bra(s) and a tight fitting garment. With the help of our Clinical Coordinator, she placed several tapered gel sizers into her bra to find the proper range of implants. She decided on a range of 300 cc to 350 cc, which was consistent with her at home exercises. She also provided photos of naked breasts in a natural position to depict the size and shape she desired along with photos of breasts that were too big and too small.

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Pre-Op Labs
Blood Test
All breast surgery patients are required to have had a Mammogram or Ultrasound within 1 year of the surgery date. All patients must have a CBC and Basic Metabolic blood test to be cleared for surgery. Patients over the age of 50 must have had an EKG within 1 year of the surgery date.

Day of Surgery
Breast Augmentation is done under General Anesthesia. Surgical time is 2 hrs.
The day of surgery, the patient and doctor discussed again using the infra-areolar incisions versus IMF (inframammary fold incisions). She and her husband chose the latter, which the surgeon thought was the best choice as well. Skin marks were then placed with the patient in the sitting position prior to surgery. In surgery, the breasts were prepped and draped in the sterile fashion. The 3.5 to 4 cm incisions were located in symmetric fashion along the inframammary fold on each side. Dissection carried down to the muscle. Tissues removed off of the inferior aspect of muscle and muscle divided. A generous submuscular pocket was created. Same thing was carried on the opposite side without deviation. The 345 cc sizers were placed. The various sizers were tried, but we have elected to use the 345 cc. After the patient had been placed in the sitting position, the patient was placed supine (lying flat on her back), and the sizers removed. The pockets were irrigated with Triple Antibiotic solution and instilled with 0.25% Marcaine with epinephrine and Exparel. Exparel is a long-acting numbing medication that is time released. It helps to control the pain for the first few days after surgery by keeping the area numb. It alleviates the “elephant sitting on my chest” pain that women typically report after a breast augmentation. The 345 cc Allergan Natrelle Inspira smooth, moderate profile implants were then placed in the submuscular space with the use of Keller Funnel. Deep tissues were closed with suture, and the skin closed with Monocryl sutures. The wounds were cleaned with saline and alcohol and covered with paper tape, gauze, and ACE bandage with the bra.

Post Op
The next day at her first post-op appointment, the patient was instructed to follow the Breast Implant Moving Exercises several times a day for the first several weeks as the implants settled into place. Post-op photos are taken at 10 weeks. The implants were moving well and the patient had no problems. She was very happy with the size and shape of her breasts.