Breast Augmentation using saline filled breast implants
Breast Augmentation w/ Saline
This plastic surgery is about a breast augmentation. You just saw the patient in a seated position. You could tell from that seated position that she actually has a nice breast shape to begin with, and a nice amount of breast tissue. That's always good because there's more tissue to hide the implant. The implant will be less palpable. Because of her beautiful breast shape, she's really going to have a fabulous result.
What you're seeing here is me putting a little bit of numbing medicine in the tissues to make her more comfortable during the operation as well as postoperatively. The pencil-looking device you see is actually called an electrocautery, and it uses electricity to cauterize the tissues and control the bleeding. The nice thing about this device is it also has the ability to cut the tissue, so I can use it in two different modalities to perform this surgery.
Through this real small incision, I will dissect down through her breast tissue. For the most part, this is actually under her breast tissue through her subcutaneous fat down to her breast tissue edge until I see the edge of the muscle. After I expose the edge of the muscle, I will start to divide the muscle and create a pocket under the muscle where I can put the implant in. This special retractor does a great job of holding the muscle up in the air and allow me to perform the surgery.
Because the saline-filled implants are placed in when they're deflated, I can use a very small incision, and this is a real bonus for the patient so that she doesn't have to have a larger incision. When I use silicone gel, my incision's only a little bit bigger, but it is bigger. But I'm not a surgeon that puts a real big incision on the patients.
You can see here that I have a headlight on, and I wear special glasses that allow me to see two and a half times greater than my normal vision. I use the electrocautery to release the muscle and cut it where I need to as well as control the bleeding.
I'll stick my finger in throughout the surgery to get a better sense of how big the pocket is and what her tissues feel like, and that's really important is to get a great sense of the feel of the tissues so that it helps me design the right size pocket. I take into account what her natural tissues are, the weight of her implant's going to be, what her activity level is, as well as what her planned lifestyle is. All those things are taken into account when I'm doing a breast augmentation, and I will cater and specialize the operation just for this patient's request.
After I've created the pocket, I will go ahead and put a little bit of numbing medicine into the pocket. This will last for about 12 hours, and that will make the patient very comfortable after the surgery.
After I've created both pockets in a similar fashion, I'll put on a second pair of gloves and take the implant. It will have been prepared while I was doing the surgery. Then I will insert it into the pocket. Preparing the implant is a specialized task which I have done thousands of times, and basically what happens is is the implant is opened and inspected for any manufacturer's defects. If I see any, I will not use the implant. Luckily in 15 years, I have not seen any of the implants have defects.
At this point what's happening is my assistant is using a large syringe, and he is filling it up and infusing it into the tissues. This is called a closed system, and there is no saline being exposed to the air. It's going directly from a sterile bag and being placed into the implant. The screen in the above left-hand corner is actually a demonstration of how the implants are prepared. The implants are opened from their container, and they're inspected. All the air is taken out. Then the implant is filled with saline. Then all the air and saline are taken out, and then it's brought back up to the table, and I put it into the patient.
As my assistant continues to fill the implant, I'm actually feeling her pocket with my finger and making sure I like how everything feels. There's no bands or restrictions. This will allow her to have a beautiful shape that will last a long time. All the implants come with recommended fill volumes, and it's usually about 25-30 cc's per implant. I typically will fill my implants to the max recommended fill volume. I think it gives a better result, and it helps the implant perform better. We are very careful in how many cc's we put in. We like to match the volumes and give them a good look.
So she's in a seated position now. I'm happy with how she looks. The fill tubes will be removed, and I'll make sure that the fill cap is seated correctly. Then she'll be returned to a laying down position and her wounds will be closed, but you can get a nice sense for how she looks for her after.
I will always check the pockets and make sure that there's no areas of bleeding. I really don't want there to be any bleeding whatsoever. You can see that there's nothing coming out, which is exactly what happens normally. I feel the pocket and make sure I'm happy with the shape. If I feel a band or anything, I will go ahead and release it because if you don't get all those bands, sometimes the implants don't come down as much as you would like them to, and she'll be left with some type of an asymmetry.
You see here there's one area that I want to just kind of improve upon a little bit. You'll see it just takes a few seconds to do that, and then I'm very happy with the rest of the shape. This type of attention to detail is what separates my work, and allows the types of before and after photographs that I can create.
What you see here is now I'm taking her tissue planes, or the tissues themselves, and this is basically the fascial tissue and a little bit of fat. I sew this fascial tissue together, and that's just like a connective tissue in the body. That tissue's brought together. What that does is that adds a layer of protection around the implant. Then I'll go ahead and close the skin edge in three different layers. What that does is that allows the small wound to heal without any tension. That's key because that will allow the incision to heal in a very thin line that will fade away over time. This incision will basically sit right in the crease of her breast.
As a plastic surgeon, I like to make sure that the incision will heal very well, so I take a lot of time and make sure that there are plenty of sutures places. These all dissolve on their own, so she won't have to have any of these taken out. It will give her just a very, very impressive, thin scar. That scar is very tiny, and it will heal very well.
I do put one more layer in, and this will just give her perfect skin edge approximation. This stitch will come out in about four days. As far as her postoperative experience will be, the first two days are kind of the roughest. After that, it tends to get a lot better relatively quickly. She'll be back at work within about four days, and her activity level will be back to normal by about three weeks.
I do not tape them down. I do not put them in any special type of bra. I have found that to be unnecessary and uncomfortable for the patient.