The Best Breast

By Terrye Tebbetts

The periareolar incision

This incision is placed around the edge (or just within) the areola, the pigmented skin surrounding the nipple. In most instances, the skin around the areola is thinner than the skin in the fold beneath the breast. There is some evidence that, all other things equal, thinner skin forms better scars than thicker skin. Some surgeons tout a periareolar (around the nipple-areola) scar as less visible than a scar beneath the breast. Is that true? Not necessarily. It depends on the quality of the scars in the two places, and that’s not totally predictable.

The greatest advantage of an incision around the areola is that it’s located in thinner skin that usually heals well.

The greatest trade-offs of a periareolar incision are increased trauma to breast tissue, increased exposure of the implant to bacteria normally found in the breast, and if you develop a bad scar, the scar is located in the most visible location on the breast.

A periareolar scar is located on the most visible area of the breast. As long as the scar is good—great. But if it’s not so good, and we don’t know who may form a bad scar, it’s not so great. It’s true that the skin of the areola area usually heals well, but if it does not, the less than optimal scar is noticeable every time you look at the nipple or areola.

Another stated advantage of the periareolar incision is that it’s easier for the surgeon to reach all parts of the breast from a central incision.

Truth is, a skilled surgeon can reach all parts of the breast under direct vision by all incisions (with the exception of the belly button incision where a portion of the dissection is usually “blind”). Trade-offs of the periareolar approach? If you have a very small areola, incision length can be inadequate without extending the incision onto breast skin which forms less optimal scars. When you cut skin, you cut nerves. When you cut nerves, most grow back, but not all, and not predictably. You might think that an incision around the areola would always make patients lose more sensation compared to other incisions, but it doesn’t! Why not? We don’t know! Probably because sensory loss is very unpredictable and may be more related to how the surgery is done (more about that later) or the size of the implant (the larger, the more stretch on nerves and potential sensory loss).

Every woman’s breast tissue contains bacteria. These bacteria live on the skin of healthy women and enter the breast through the nipple.

They don’t usually cause infection because the body is accustomed to their presence in the breast. But put a large foreign object, your breast implant, in the area, and the bacteria can sometimes produce problems. When an implant is inserted through a periareolar incision, the breast implant is more directly exposed to breast tissue compared to other approaches. With more exposure to bacteria, you might think that infection rates would definitely be higher with this approach, but increased infection risk has not been scientifically documented. Even if an implant doesn’t get infected, bacteria around the implant are probably a major factor contributing to capsular contracture, so you might expect a higher risk of capsular contracture with a periareolar incision.

Again, not scientifically confirmed, but in our practice, we’ve seen a slightly higher incidence of capsular contracture in patients who select the periareolar approach.

If you happen to form bad scars (and this can happen, regardless of your history of scars), the areola would not be an ideal place to have a bad scar. Bad scars are very rare in any location, but to date, we have no way of reliably predicting which patients will develop bad scars.

by Terrye Tebbetts

Wednesday evening from 6- 8 pm Central time, I will be hosting a live question and answer session on www.implantinfo.com  – you will find the event under the Discussion section of their site.  This is a very imformative and helpful sight to women who are thinking about getting implants or who already have them – you will find great support and assistance there.  There is “wisdom” to be had and a great new family to join. 

We will discuss 24 Hour Recovery, High Five Measurement System, Form Stable – Gummy Bear implants – you name it – we will talk about it.  I don’t always say what the ladies want to hear, but you can always count on me to be honest with them!  Let the debate and the discussions begin!

So if you are near your computer Wednesday night – please log in and ask questions – anyone who asks a question will recieve a free copy of The Best Breast 2 book – see the instructions on the site for how to get your free book!  Don’t miss it!

By Terrye Tebbetts

The inframammary incision

Located in the fold beneath the breast, the inframammary incision is the most widely used incision in augmentation and is the standard against which all other incision locations must be judged. The reasons?

It gives the surgeon excellent access for augmentation in a wide range of breast types, offers better control of the operation in many instances, places the incision closest to the pocket compared to any other incision, requires the surgeon to go through less normal tissue compared to any other incision, has no critical adjacent structures (nerves or blood vessels), and is a “gold standard” that most surgeons learned during their residency training. More women have had (and continue to have) augmentation through an inframammary incision compared to all other incision locations combined.

The greatest advantage of an incision beneath the breast is the degree of control it allows the surgeon in a wide range of breast types and the fact that it minimizes damage to normal tissues and potential damage to adjacent critical structures.

More augmentation patients have had this incision location than all other incision locations combined.

The only trade-off of an inframammary incision is the presence of a scar in the fold beneath the breast.

The trade-off of the inframammary incision is the scar beneath the breast. Properly placed in a patient with normal healing, after the scar matures, the scar is less noticeable than the imprint of your bra on your skin when you remove your bra.  A very small percentage of patients form less than optimal scars (more about that later). If you have formed very heavy scars on your chest area in the past (that did not improve with time), you may want to consider another incision location. No test can predict the quality of scar you will form. But for the vast majority of patients (well over 90 percent) , the inframammary scar location is an excellent choice.

So why would patients consider other incisions? In our experience, two main reasons:

1. If a patient has a “head trip” or preconceived negative ideas or concepts about an inframammary scar without understanding the trade-offs of other scar locations, or

2. If a patient has a personal friend or acquaintance who has had another incision approach and is happy with it. It’s human nature to think that if your friend is happy with a certain incision approach, you should choose that approach. In fact, that’s not true at all once you’re really informed.

By  Terrye Tebbetts

  There is much debate and discussion about incision location preferences, but just like a lot of other issues in breast augmentation – most decisions are based on an opinion instead of truly understanding the pros and cons of each option.  Here is some insight about incision locations and tradeoffs from The Best Breast 2.  Each day this week we will go into more detail on each incision location:  Inframammary, Periareolar, Axillary and Transumbilical.

Based on twenty years of experience with all incision locations, I am convinced of the following:

 Most patients worry far more about incision location before the surgery than they care after the surgery (provided they have a good result).

If an incision is on you, you will notice it!

If you have a beautiful breast, neither you nor anyone else will care where the incision is located.

Every patient thinks that the incision location she has is best.

Incision location is a common way that surgeons use to market their augmentation practice. If a surgeon touts the ‘X incision’” as unquestionably the best, and states,

“I am the expert at the “X incision,” run the other way.

No incision is best, and the likely message is that the surgeon doesn’t know how to do it any other way.

If a surgeon is experienced with all incision locations, the surgeon will offer you all options.

If you hear negative comments about an incision location from another patient or surgeon, it’s usually because neither has much experience with that incision location.

No incision location is always best. Each location has advantages and trade-offs.

Every woman’s breasts, at some time in her life, are likely to acquire a blemish, a stretch mark or a biopsy scar. A well-executed incision scar is usually no more noticeable than these other blemishes, and if the breast is beautiful, who notices? Who cares?

Just because your friend had a certain incision doesn’t mean that incision location is best for you. In most cases, it doesn’t matter. A few, very rare breast deformities are best addressed through a certain incision, and when these deformities occur, we don’t hesitate to tell a patient, “With this specific breast deformity, a specific incision location gives us better control over your operation, and, hopefully, we’ll get a better result.” But in over 90 percent of patients that we see, we offer the patient a choice of incision locations. If a surgeon is experienced in all incisional approaches, the surgeon is less likely to recommend one location over another. Instead, the surgeon will give you a full range of options.

What’s really most important about incision location?

• How much control it gives your surgeon over your operation.

• How much it allows your surgeon to minimize trauma to your tissues.

• How far the incision location is from the implant pocket.

• How much normal tissue your surgeon must go through before getting to the implant pocket. The greater amount of normal tissue your surgeon has to go through, the more trauma, bleeding, pain, length of your recovery, and possible other complications you should expect.

• How many critical structures (mostly nerves and blood vessels) are located near the incision or on a path from the incision to the pocket.

Don’t form an opinion about incision location until you know about all the alternatives! Incision location is one of the LEAST important decisions you’ll make in augmentation. Each incision location has relative advantages and trade-offs.

What about Scars?

We’ve said it once, and we’ll say it again. No scar location is necessarily always better than another. Let’s examine some myths about scars:

Myth 1

For patients with minimal or no breast tissue, a scar under the breast isn’t a good choice.

Not necessarily. If the scar is properly positioned exactly in or very slightly above the crease beneath the breast, it will be minimally noticeable.

We’ve heard from more than one patient, “My boyfriend (a medical student on a medical fact finding mission, I’m sure ) said that he saw a scar on a topless dancer that was up on the breast, and it was terrible.

I don’t want that incision.” The facts? Topless dancers have more inframammary incisions than any other incision. The reason the scar was more noticeable was that it was improperly located. If the scar is placed too high above the fold, it’s in an area where it is maximally stretched by the pressure of the implant. If it were kept exactly in the fold or very slightly above the fold, there’s less stretch, and the scar would be narrower. A popular misconception I’ve heard from surgeons is that inframammary scars should be placed well above the fold “so that it won’t show when she raises her arms in a bikini.” Fact is, less than 1 percent of a woman’s life is spent in a bikini. Fact is, a good scar exactly in the fold is far better than a widened scar that occurred because it was placed too far above the fold. If a surgeon is experienced in all incision locations, you can just choose! If you don’t like one (incision or surgeon), choose another!

Myth 2

One incision location is less noticeable than another.

Not true. It depends on the patient’s body position, who is looking, how long after the surgery (whether the scar is mature and faded), and the quality of the scar (largely dependent on each patient’s healing tendencies). What is always less noticeable is a better quality scar, regardless of its location.

Myth 3

A shorter scar is always better than a longer scar.

Not true. The quality of a scar is much more important than its length.

A short, ugly scar is always more noticeable than a slightly longer, thin, faded scar. Experience has taught many surgeons that when you make an incision too short to minimize scar length, you often stretch that incision and “traumatize” the incision edges excessively during surgery. The scar does not heal as well, often stays redder longer and becomes wider. The result is a shorter scar, but also an uglier scar. A better quality scar, even if it is slightly longer, is far better than a short, ugly scar.

Myth 4

If you can put the incision off the breast in the armpit or the belly button, it’s always better.

Not true. We’ll cover specific advantages and trade-offs of each incision location later in this chapter, but there are definite trade-offs for both the axillary (armpit) and umbilical (belly button) approaches that may not appeal to some patients. Fact is, after surgery, scar location usually becomes a nonissue if the patient has an excellent result.

Myth 5

One scar location or another always preserves breast sensation better.

Not true. We formerly believed the axillary (armpit) incision preserved sensation better than other approaches, but after many more years’ experience, we don’t think that is necessarily true. The factors that most affect sensation are 1) surgical technique—the more the surgeon directly visualizes the anatomy and the less bleeding, the less risk of nerve compromise, and 2) the size of the implant—the larger the implant, the larger the pocket required, the more nerves are likely to be cut, and the more stretch the implant places on nerves; hence, the greater the chance you’ll lose more sensation.

Myth 6

Surgeons pick scar locations because they think one is best.

Not necessarily true. Surgeons usually pick scar locations based on their experience. If they have a lot of experience with different scar locations, they’ll offer you all options and discuss the trade-offs. If they’ve only done augmentations one way (or even the majority one way), that’s the scar location they will most likely suggest.

by John B. Tebbetts, M.D.

One of the most common questions we are asked by patients (and some surgeons) is, “If you have published the processes and techniques that enable patients to go to dinner the evening of surgery and have the lowest reoperation rates in the scientific literature, why don’t more surgeons offer patients these same advancements?”

We ask ourselves the same question, especially since all of the processes and techniques have been published in the most prestigious journal in plastic surgery for more than 5 years.  Today, we still don’t know the answer.  A relatively small percentage of plastic surgeons worldwide have truly implemented most of our processes to deliver augmentation patients a much more optimal level of care.

Surgeons respond to the demands of their patient market. The current market of breast augmentation patients simply does not demand the highest level of care.  A staggering statement, but it’s a fact.  Until more patients become more educated about the choices available to them, become more responsible for their requests and decisions, and demand a higher level of recovery and outcome, surgeons are unlikely to change.

Surgeons want to deliver patients what the patient wants, in the most expeditious manner possible.  I have actually heard more than one board certified plastic surgeon say, “ I get paid to operate, not educate.  I want to give patients what they want, not try to talk them out of what they want.” 

Sometimes patients’ wishes are not in the best interests of their tissues.  Some patients request implants sizes or types (such as high or extra high projecting implants) that are more likely to negatively impact their tissues in the future.  How?  The weight of an excessively large implant or the pressure of an excessively projecting implant is likely to cause much more stretch of the breast skin, allowing sagging and thinning.  Pressure also causes shrinkage or loss (atrophy) of the milk producing tissue of  the breast over time—a  downside rarely mentioned by most surgeons.

Changing a patient’s mind about what she wants requires education.  Helping her make the best decisions to minimize reoperations and uncorrectable damage to her tissues requires education and a significant time commitment by her surgeon and the surgeon’s personnel.  Currently, surgeons do not get paid more to educate more.  Some surgeons fear that telling a patient what she may not want to hear will cause her to go to another surgeon, resulting in lost business and lost revenue.

Simply put, more surgeons don’t deliver out to dinner augmentation and 24 hour recovery because their patient market does not demand it.  Learning and implementing the processes and techniques to deliver that level of care requires that surgeons commit more time, effort, and resources to achieve much higher levels of patient education, surgeon education, and personnel training.  Surgeons don’t get paid more for all that extra time; patients don’t demand it; therefore most surgeons don’t do it.

Changing surgeons’ habits requires incentives and the most powerful incentives are financial.  Currently, the demands of the patient market in breast augmentation do not provide a financial incentive for surgeons to change.  Regrettably, no change means few improvements for patient– fewer patients will experience out to dinner augmentation and 24 hour recovery, and more patients will continue to experience excessively high risks of reoperation and irreversible damage to their tissues.

We know that better for patients is a reality.  We know the processes and techniques that are required to deliver better, and we have shared that knowledge with colleagues worldwide.  It’s time for patients to become more educated, learn to distinguish marketing hype from scientific reality, and demand an opportunity to choose a higher level of outcome with fewer risks.

As my dad told me at an early age…”I can’t help you if you don’t help yourself.”

by Terrye Tebbetts

I just thought you might like to know what our day was like today.  Dr. Tebbetts only operates on Wednesdays and Fridays – we try to make Fridays our big breast augmentation days so that patients can miss only one day of work and not interfere with their children’s schedules very much.

We started at 8 am today – did 8 breast augmentation surgeries  – the surgery center was closed at 2 pm.  I called to check on all 8 patients at 6 pm – they were ALL out and either shopping or going to dinner.  All had eaten and showered and raised their arms above their heads in sets of ten every 30 minutes! 

It is so nice to check in with patients the afternoon of surgery and hear the joy, the excitement and the thrill of knowing that they fell and look fantastic – yet they had surgery today!!  Congratualtions Ladies!  You are truly amazing!!

Just an FYI – 6 today were Allergan Style 410 “gummy bear” implants, 2 were Round Smooth conventional silicone gel – just for the record!

by Terrye Tebbetts  

It is hard to imagine that 8 years ago this fall, I decided to have my breast augmentation surgery…my how time does fly!  My little one was just three years old and we knew we weren’t going to add to our family anymore and the Allergan Style 410 form stable implant study had just begun in the United States ~ I couldn’t wait to sign up!  You see, Dr. Tebbetts and I had introduced them to European surgeons in 1993 – well, he introduced them and taught surgeons how to use them and did live surgeries in 8 different countries in 2 weeks, I did a lot of sightseeing – but I was there, nonetheless, and still remember the excitement of all the surgeons at the prospect of this new form stable breast implant and the possibilities it brought with it!

Being able to offer this revolutionary technology to patients in the US has been a blessing over the last eight years.  There has not been a new breast implant product in plastic surgery for 30 years!  Since every woman is different – having multiple breast implant options is critical to being able to treat each patient as she needs to be treated!  We are limited in the number of patients we can enroll in the study each month – so yes, that part is frustrating as we would like to be able to offer it to more women.  But each 6 months, the FDA only allows the company to enroll 460 more new patients – this allocation is spread out over 150 surgeons in the US.  So it is a very special treat to be a good candidate for this implant and this study and to find a surgeon who knows how to use them and is participating in this study.  So far, to the best of my knowledge there are a little over 7000 women that are currently enrolled in the study in the United States.  I know we personally have over 300 in our practice and some up to eight year follow up!

But in the end, we have to remember that the device, the breast implant, is just part of the picture – the process of achieving a good, long term result.  The decisions we make ahead of surgery with our plastic surgeon about implant size selection, pocket location, incision location and of course the breast implant will all affect the outcome both short and long term.  When choosing to do something elective – to change your body because you WANT to, not because you need to – you owe it to yourself and those that love you to make the very best, educated decisions you can possibly make.  So in the end, it all goes back to education.  I was lucky….I married into the best education anyone could possibly have on breast augmentation.  But since not all of you can be “so lucky”, LOL, we wrote the book – just for you!  If you are going to spend $6000 – $8000 changing your body – you need to do some solid research first.  Our goal and the mission is to improve, redefine the overall patient experience in breast augmentation so we see more 8, 10, 20 year results and fewer revisions and reoperations! 

Kudos to the Gummy Bear – form stable 410 – thanks for 8 great years (and counting!)!!

by John B. Tebbetts, M.D.

Throughout our clinical practice, we have tried to help patients find the best possible surgical options in breast augmentation that is most convenient to where they live or work.  We communicate with patients in the United States and internationally who contact us and ask us to recommend surgeons in their area who predictably deliver what we do— out to dinner augmentation, 24 hour recovery and low reoperation rates.

We constantly deal with a common question: If you are a prospective patient searching for a surgeon who delivers or claims to deliver out to dinner augmentation and 24 hour recovery…..or if you contact us for help in finding a surgeon in your area that delivers that level of care…how do you or we really know whether the surgeon claims to deliver 24 hour recovery or really delivers it? And what are the chances that by using part but not all of the defined processes, that a surgeon can predictable deliver out to dinner and 24 hour?  I’ll just answer that one briefly—it “ain’t gonna’ happen”.

Are a majority of surgeons claiming to deliver out to dinner and 24 hour recovery and only using parts of the system (stepping on the coattails and using the buzzwords), or do a majority of surgeons actually deliver 24 hour recovery using every process in the system (jumping on the bandwagon)?  At the present time, a majority of surgeons are on the coattails, not on the bandwagon.  As a patient, we want to help you identify the surgeons that are on the bandwagon so that you can experience a state-of-the-art recovery and outcome.

The Internet has provided more patients the opportunity to become aware of what is currently available in breast augmentation—implants, surgical techniques,  recovery, and lower reoperation rates.  Understandably, patients considering breast augmentation would like to have it done locally to minimize disruptions to their lives and families.  When patients frequently contact us to recommend surgeons in their area, we are happy to help, provided we have personal knowledge of the clinical practices of a surgeon—specifically, how the surgeon educates and evaluates patients, plans the operation, selects the implants, executes the operation, and cares for the patient afterward.  Obviously, we can’t have this knowledge about large numbers of surgeons, but we know and have learned about a surprising number of surgeons nationally an internationally to whom we can refer patients.

One of our greatest challenges is responding appropriately to patients who contact us and say:

“ I saw Dr. X, and he says that he’s read your articles and does everything the way you do.”  Maybe, but if so, you’ll find out as you by simply asking if you’ll have any bandages or special bras and what is the chance that you’ll be able to go out to dinner the night of your augmentation?

“ I saw Dr. X and he took a couple of measurements and then had me stuff implants in a bra to pick the size implant I wanted.”  If a surgeon had you stuff implants in a bra, the surgeon isn’t even close to using a quantitative measuring system.  The surgeon is encouraging you to make a decision about implant size based on something that neither of you can define (cup size) and something (a bra material) that has absolutely no correlation with your personal tissue characteristics.

“I saw Dr. X and he took measurements and then we looked at before and after pictures and pictures that I brought to pick my implant size.”  If the surgeon really uses and understands the High Five Measuring System, the surgeon will also understand that it is impossible to correlate anything in a picture with actual tissue measurements.  Pictures may be interesting, but they are not part of a quantitative system of breast implant selection.

“I saw Dr. X, and when I asked about the High Five System, he said he uses it, and used a tape measurement to take one measurement on my breasts.”  The most basic, reliable, and predictable measuring and decision system that is scientifically verified (the High Five System) requires a minimum of five simple measurements—four with a caliper and one with a tape measure.  One or two measurements just won’t provide enough information to make the best decisions.

“Dr. X’s website advertises rapid recovery, but when I saw him, he didn’t take any measurements and his nurse said that they would prescribe narcotics for me following surgery to keep me comfortable and that I shouldn’t raise my arms or drive for two weeks.”  If any surgeon prescribes narcotic strength pain medications for any length of time following augmentation, the surgeon is not even on the coattails and is doing the opposite of what offers you the opportunity for the most optimal recovery.  If a surgeon is prescribing narcotic strength pain medications, the surgeon is causing excessive bleeding and tissue trauma during the operation that produce excessive and unnecessary pain that requires stronger medication.

All of these comments from patients, and many more like them, are what we affectionately term “stepping on the coattails but not jumping on the bandwagon”—our way of saying that advertising or doing part of the set of processes we do isn’t likely to deliver what we deliver.   Worst of all, each of these approaches deprives patients of the opportunity for an optimal recovery and outcome.

So now, you know that saying or doing only part of what we do is “stepping on the coattails”, and is not likely to predictably deliver out to diner augmentation and 24 hour recovery.  “Jumping on the bandwagon” requires that 1) a surgeon understand that all of the processes we have published, not an arbitrary few, or a few modified processes are essential to predictably deliver what we deliver, and 2) the surgeon is willing to commit the time, effort, and resources to implement all of the processes that are required (more about what exactly those processes are later), and 3) that the surgeon is willing to supply independent verification of the actual times and conditions of recovery.

In subsequent posts, I’ll go into more detail about what’s special about each of the processes that combine to predictably deliver out to dinner augmentation and 24 hour recovery.  But just so you know that it’s a combination of things, here are the categories of processes that must be used in their entirety, not selectively, to achieve optimal recovery and outcome:

Patient Education- Content and processes of providing you information and helping guide you through scientifically verified decision processes to arrive at optimal decisions.

Informed Consent- Assuring that you thoroughly understand the potential consequences of the decisions you make so that you are more comfortable assuming responsibility for those decisions.)

Tissue Based Clinical Evaluation with Objective Measurements (The High Five System)- defining your personal tissue characteristics that make you different from every other patient…using quantifiable measurements, not opinions or visual impressions.

Implant Selection Based on Objective Measurements (the High Five System)- using objective measurements and the only system that has been shown in peer reviewed and published scientific studies to deliver the fastest recovery and lowest reoperation rates in the medical literature.

Operative Planning Based on Objective Measurements (the High Five System)- selecting the implant pocket location and defining other factors that maximize soft tissue coverage over your implants for your entire lifetime—to minimize risks of uncorrectable deformities and tissue compromises.

Surgical Techniques and Instrumentation- Applying techniques that virtually eliminate bleeding and minimize trauma to your tissues—the two most essential requirements to achieve the most rapid recovery and the least risk of reoperations in the future.

Anesthesia and Recovery Management Protocols- defined methods, drugs, and doses that minimize total amounts of drugs that you receive and reduce unnecessary potential drug side effects that make recovery more difficult—while optimizing the safety and accuracy of the surgeon’s environment.

Postoperative Care- our Recipe for Recovery, a simple but essential series of activities immediately postoperatively that have been proved unequivocally to optimize your chances for optimal recovery and outcome.

That’s it for now.  If you want to get to the party of out-to-dinner and 24-hour recovery, it’s not likely to happen by stepping on the coattails. Ya gotta’ jump on the bandwagon, and it’s all right there for you and your surgeon to use.

by Terrye Tebbetts

Often, once the kids go back to school and the fall schedules settle down or in, we tend to start thinking about ourselves again.  We start to plan and think about things we might just want to do for us – but when it comes to breast augmentation, often we don’t allow ourselves enough time.  Optimal planning is the key.

Our patients have been predictably up and out to dinner the day of surgery for over 10 years now – 24 Hour Recovery is a reality for Dr. Tebbetts, our practice and our patients.  But sometimes in the excitement of getting up and out and going again, patients forget that it takes time to realize optimal healing and acceptance of the implants – it’s a process.

First, there is education.  You have to know and understand what your choices and options are – pocket location, incision location, how to determine size, which implant (shaped or round, saline or silicone, smooth or textured) and then how in the world do you find the right surgeon?  Why is it important to learn about your recovery ahead of time?  The Internet is helpful but really can only be as good as your knowledge – since anyone can put anything on a website – whether it is personal opinion or science – if you don’t educate yourself – how can you tell the difference?  The Best Breast 2 is an incredible resource for every woman considering this operation.  Yes – it’s a big 500 page plus book – but you can read it for what you need to get out of it – it is worth the time and effort you will put into getting facts – not just opinions from friends and message boards (not that those aren’t valuable resources too – but they have to be tempered with fact, science and objectivity).  Plus – you can tell a lot about the plastic surgeons you call – just by how much the staff really knows and shares with you and what kind of written information they send to you.  You don’t want to use a surgeon that does not specialize in this procedure – there is too much at stake.  So to get ready for spring, you need to start learning about breast implants and breast augmentation now!

Second, interviewing and consulting with surgeons.  This process can take up to 6- 8 weeks – so once again, if you are planning to look good pool side in the spring of 2010, consulting in the fall of 2009 is key.

Third, scheduling surgery – Most plastic surgeons will require a 4-6 week lead time to get your procedure on the surgeon’s schedule and assist you with all the preoperative requirements.

Fourth, Recovery – I cannot stress to you how important it is to learn about this preoperatively – even before your consults.  Why waste your time on a consult with a ps who’s routine recovery is 3 weeks long in a strap with drains and pain pills if you can use a ps who can have you up and out and returning to normal activity in a matter of days (let alone 24 Hours!)?  We know now, that true 24 Hour Recovery yields lower incidence of developing Capsular Contracture – so it’s not just about feeling good right away, but reducing risk of reop and revision long term (there are TWO chapters on Recovery in the The Best Breast 2 that fully explain all the ramifications of a better post op experience).  Ask the hard recovery questions right off the bat – to save time in the end. 

                Standard 24 Hour Recovery time line ~

arms up and showered and out to dinner or shopping the night of surgery (no bras, bandages, drains, straps, pain pills or bruising)

approximately 2 days before full energy level returns

 if surgery on Friday, back to work on Monday

no cardio for 2 weeks, no lifting more than 35 lbs for three weeks

no SOAKING in still water for 6 weeks (Planning for spring and summer – this has to be factored in your time line!  Getting in still water too soon increases your risk of infection!)

Fifth, The Stages of Recovery – often referred to as “dropping and fluffing” or “settling” – generally you have about 4-6 weeks where your implants will feel permanently pushed up, 3 months before you can really try to buy bras, 6-9 months when sensation is normalizing and 9-12 months for the incision to be considered “healed” – your greatest risk period for developing capsular contracture is within the first 12 months.  You will have nuisances during all of these periods – explained in detail in the book.  I have had so many patients tell me they refer to the book even more post op than preop  – it is so nice to reassure yourself that what you are feeling and experiencing is normal and that the “story” you were told to begin with did not change – very comforting!

In order to be ready to debut your new additions in the spring of 2010, start your breast augmentation journey NOW!  Educate yourself, go on your consults, find your surgeon, make your choices – have surgery by mid – to late January at the very latest to be fully ready with no restrictions on your outdoor activities or travels to places tropical in early spring (March). 

Just remember, we can have you feeling great in 24 Hours, but for the implants to soften and settle and for you to feel good about being in lighter, more revealing clothing and bathing suits and to be in the water safely, a good 3 month lead time is your best time line for the best result!