You may visit your surgeon as many times as you wish, to have all of your questions answered. At your final preoperative visit, your final questions will be answered and you will confirm that you have understood the procedure to be performed, that this material has been explained to you, that you have read and understood these information sheets, and that you accept the risks by signing the informed consent forms. You will be given prescriptions for pain pills and nasal sprays, along with instructions for their use. Certain laboratory tests will also be required within two weeks of surgery. If you are over the age of 50, you will have to obtain a cardiogram at your doctor’s office or any licensed laboratory. You may have blood drawn by our office nurse during your final preoperative visit, or, if you prefer, at your family doctor’s office or any laboratory (e.g. Kaiser Hospital, etc.).

As with all other elective procedures, the patient should avoid ibuprofen (Advil®), all Aspirin® products and excessive amounts of vitamin E (the small amount contained in most multi-vitamin preparations is not harmful) for two weeks before surgery, as these inhibit the clotting mechanism and increase your chances of unnecessary operative bleeding. All patients will be asked to stop smoking at least a month prior to surgery in an effort to maximize your body’s ability to heal the incisions following the operation.

Patients will be given a prescription for Hibiclens® soap. It will be necessary to scrub the surgical site (from the neck to the belly button, and from one armpit to the other) for ten minutes the evening prior to surgery and for one final time on the morning of surgery before leaving for the surgical suite. Scrubbing the skin with Hibiclens® these two times will decrease the number of bacteria on your skin and minimize the chance of developing an infection after surgery.

Your anesthesiologist will discuss the available options for accomplishing your surgery comfortably and safely. Ordinarily, your anesthesiologist will call you the night before surgery to discuss the anesthetic care plan with you. But if you miss the call or your anesthesiologist does not call you, do not worry as you will be able to discuss your anesthesia and have all your questions answered in the morning, at the Laguna Hills Surgery Center, prior to your procedure. It is absolutely imperative that you make arrangements in advance to have someone drive you to and from the Surgery Center on the day of your operation and that a responsible adult spend the first day with you at home after surgery.

A deep sedative or light general anesthetic will be used. An anesthesiologist will be available at all times to insure your comfort and safety. The operative time is approximately an hour and a half. A small incision is placed in the fold beneath the breast, around the areola or in the armpit. A pocket, which will accommodate the implant, is created beneath the breast tissue, either above or below your chest muscles. The location of your incision, as well as options relating to implant types, sizes and location of the pocket will be discussed with you at length pre-operatively. Implants vary greatly in type (and cost!), but basically all have a silicone rubber shell. Implants used today are filled with either silicone gel or saline (salt water) solution. Implant surfaces may consist of traditional smooth rubber or a textured rubber surface. In addition to the traditional implants, your surgeon has the option of choosing high profile or anatomic shaped implants for you. With so many implants available, it is obvious that no single implant is ideal for all circumstances. Your surgeon will review the latest controversies regarding breast implants, FDA regulations and your options.

The manufacturer of your breast implants expects the implants to last a long time, but everything man-made does break or wear down eventually. The life span of all types of implants can be shortened by trauma or mechanical failures. Such a rupture may be clinically undetectable to you or your surgeon if you have silicone gel filled implants, but could be picked up during mammography or other specialized tests. Rupture or leakage of the older gel implants often led to gel migration or formation of lumps within your breast as a result of scar tissue developing around the free silicone, necessitating future breast biopsies and implant replacement. Today’s gel-filled implants contain a “cohesive” gel that stays intake even with shell rupture and will be less likely to migrate. However, rupture of a saline filled implant, will generally be obvious because the breast will resume its previous size and shape over a short period. Unfortunately, no one can predict in advance when an individual implant will fail. Replacing an implant will become necessary if a leak is detected. It is strongly suggested that you return to see your plastic surgeon at least once a year for a breast examination. These examinations are provided by our office without cost to you.

You may choose to have a catheter inserted which is connected to a “pain pump” which infuses local anesthetics into the surgical field for the fist few days. Such pumps will greatly enhance your comfort during the early postoperative phase. A loose circumferential wrap is fitted at the completion of your operation, mainly to hold your dressings in place. You will be instructed when to remove this wrap and to begin implant manipulations (“massages”).

Keeping Breasts Soft:
The human body’s natural reaction to implants, regardless of type, is to surround them with a layer of scar tissue. This happens each and every time. Scar tissue has a natural tendency to contract and compress the implant, which may cause the external breast to appear unnaturally firm (such scar tissue may cause one or both breasts to be painful and to look uneven). In addition, particularly in patients with a small volume of breast tissue initially, surface wrinkling may be evident, especially in patients who choose to have textured surface, saline filled implants, and in those with implants placed above the pectoral muscles.

The surgeon always places each breast implant in a pocket or space, which is larger than the implant itself; as long as this pocket stays larger than the implant, your breasts should remain soft and look natural.

In order to minimize the degree of scar contracture that your body develops around the implant we recommend active exercise and daily implant manipulation (i.e. “breast massage”) as will be described to you by the surgeon or the office staff. These exercises must be continued on a daily basis. Should breast hardness develop, a corrective operation may be required to remove or release the scar tissue in order to soften the breast; such secondary operations are not always successful.

Every activity in life, whether driving automobiles or having surgery, is associated with risk. The following inherent risks must be understood and assumed by the patient if we are to proceed with this operation. Although most patients have a very satisfactory result, complications may occur following any surgical procedure. Complications requiring reoperation are probably higher following breast implant surgery than any other type of aesthetic operation, and when including implant replacement, close to 100% of patients end up requiring at least one more operation during their life times. Problems which can arise include those already mentioned associated with the implants (including ruptures and capsular contractures) and the following: infection, hemorrhage into the breast pocket, chronic pain, increased breast asymmetry, an abnormal “double fold” along the bottom part of your breast, an abnormal lowering of the breast fold, breast flattening or indentation upon tightening of the pectoral muscles, unsightly scars at the site of the incision or untoward reactions to anesthetic administration.

A moderate amount of discomfort is normal with every procedure, but breast augmentations, particularly with implants placed beneath the muscles, results in significant discomfort, perhaps analogous to that felt after a C-section. You will be given ample pain medication to help control the discomfort. In addition, at the time of your procedure, your surgeon can insert a pain relief pump, a tiny catheter through which local anesthetic can be infused during the first few days after surgery.

Should unusual bleeding occur after the procedure, your breast will immediately become noticeably asymmetrical (the one with the bleeding will be much larger), painful and swollen. This will necessitate a return to the operating room to stop the bleeding and to remove the blood clot, and result in additional fees to the patient.

Infection, a rare complication, usually cannot be cleared unless the implant is temporarily removed to allow complete obliteration of the infection before the implant can be replaced. This can take up to six months before it is safe to reinsert the implant.

Other problems, which occur but are usually of transient nature, include allergic reactions to medications, postoperative nausea or vomiting, hypersensitivity of the nipples, tightness in the chest wall and shooting or burning pains at the sides of the breasts. Frequently one or both nipples or other areas of the breasts may become numb temporarily, but occasionally this may prove to be permanent.

A rare and unsubstantiated, but possible, relationship between the silicone gel and connective tissue disorders such as arthritis and lupus has been alleged. There are other very rare potential complications from this operation in addition to the ones that have been mentioned, but it is not possible to advise you of every conceivable complication. Serious complications, even death, after any type of cosmetic surgery are relatively rare. The need for reoperation after breast augmentation, as has been mentioned, is common, but most patients end up with a very satisfactory result.

There are also other very rare potential complications from this operation in addition to the ones that have been mentioned, but it is not possible to advise you of every conceivable complication.

The foregoing was not intended to frighten or upset you, but to insure that your decision to have this operation is made with your awareness of the possible risks.

All fees will be discussed freely in advance by the office staff. Not only do insurance companies not cover the cost of such cosmetic surgery, but they may place exclusion for breast disease on your future policies. In compliance with suggestions adopted by the American Society of Plastic Surgeons, it is customary for the patient to pay all fees for cosmetic surgery prior to the desired operation. This insures that the patient is sincere in her motivation and can afford the surgery, thus creating a better patient/physician relationship. A non-refundable deposit will be required to secure your desired surgery date. The remainder of the fees must be paid prior to the surgery, usually at the time of the preoperative visit, but no later than one week before surgery. Additional fees are also required for laboratory tests, surgical facility fees, the anesthesiologist, and if necessary, mammography.

If additional surgical procedures become necessary, additional facility, laboratory, anesthesia, implant costs and professional fees will be incurred. The surgical facility and anesthesiologist fees quoted will be based on our best faith estimate; the final fee may vary as these fees are based on surgical time, and it is not always possible to predict.