A Best Friend's Guide to Breast Augmentation

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A Best Friends Guide
Breast Augmentation
to
WWW.LEWISPLASTICSURGERY.COMDR. GORDON
LEWIS(804) 267-6009 RICHMOND, VA
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Have you always considered increasing the size of
your breasts, but you werent sure who to ask or
what to do?
Thats why were here.
Weve created this guide to inform you about
everything you should know about breast
augmentation. From How To Choose a Plastic
Surgeon, Breast Implant Sizes and Types, Breast
Incision Placement, Risks, Recovery and more.
Were here to guide you through this
life-changing journey.
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Who are we?
Dr. Gordon Lewis has been a plastic surgeon in
Richmond, Virginia for almost 9 years. He is a
native of Richmond and is happy to offer the
highest quality care and most personalized
service available to thousands of patients in the
area and beyond. He obtained an undergraduate
degree at the University of Virginia and medical
degree from the Medical College of Virginia. He
trained with a plastic surgery residency at the
Medical College of Virginia, completed fellowship
training at the Duke University Medical
Center. He is affiliated with several
professional organizations, including the
American Society of Plastic Surgeons, the
Richmond Academy of Medicine and the Medical
Society of Virginia. Im also an associate member
of the American College of Surgeons and a
candidate member of the American Society for
Aesthetic Plastic Surgery.
He and his team are truly passionate about their
patients, about helping them to realize natural
and beautiful results from cosmetic and
reconstructive surgery. Their goal is to offer
the best possible care and to bring experience,
talent, artistry and an unequaled attention to
detail to every unique patient.
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What is breast augmentation?

• Breast augmentation surgery involves the
  placement of custom-fitted saline breast implants
  or pre-filled silicone implants. This procedure
  allows women of all ages to select the bust line
  they have always desired or restore the youthful
  contour of the breasts they once had. In addition
  to enhancing the size and shape of the breasts,
  this procedure improves firmness. Most of our
  patients undergo breast augmentation to
• Increase the size of naturally small breasts
• Increase the projection of the breast by
  restoring breast volume
• Correct asymmetry (uneven breasts)
• Lift sagging breasts after pregnancy or weight
  gain or loss.
• Breasts may require an additional procedure
  called mastopexy (breast lift surgery), which
  repositions the breasts to a higher position on
  the chest.

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Selecting Your Plastic Surgeon

• The best thing you can do for yourself and your
  breasts is selecting the right plastic surgeon
  for the procedure. Take your time to make an
  educated decision, and do not feel rushed or
  pressured to make a decision without being
  well-informed. Before a consultation, research
  the surgeons training and experience. Being
  knowledgeable will result in your comfort and
  confidence throughout the process and procedure.
• What to research and verify about your surgeon
• Plastic surgery specialty
• Plastic surgery board-certification
• Years of experience and training
• Hospital privileges
• Surgical facility/office and accreditation by a
  national or state agency

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Plastic Surgery Certification

• There are several ways you can identify a
  qualified plastic surgeon. First, you can ask for
  referrals from friends or family members whove
  had breast augmentations. Second, you can try to
  find plastic surgeons in your area, and on their
  website, you can read testimonials from their
  past patients.
• You can also contact either of the following
  highly respected professional organizations
• The American Society of Plastic Surgeons (ASPS)
• American College of Surgeons
• The American Society for Aesthetic Plastic
  Surgery, Inc.

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Questions for Your Plastic Surgeon

• After researching your plastic surgeon, the
  following questions will clarify more specific
  issues you may be concerned about. You should
  assess your surgeons response as a
  representation of his or her bedside manner and
  determine how comfortable you feel with him or
  her.
• What percentage of the doctors practice is
  cosmetic versus reconstructive plastic surgery?
• How long has the doctor been performing the
  procedures you are considering?
• Does the doctor have hospital privileges to
  perform the procedures you are considering?
• Can you receive a copy of the doctors
  professional biography that summarizes his
  training, qualifications and credentials?
• Does the office provide, at the consultation, an
  itemized fee quotation sheet, listing all
  proposed services and charges?
• Who will administer the anesthetic- an
  anesthesiologist (physician specialist), or will
  it be a nurse, a nurse anesthetist, or the
  surgeon?
• Is the surgery performed entirely by your
  surgeon? Or is a part-delegated
  surgeon-in-training or associate?
• Will the operating surgeon and the staff perform
  all of the postoperative care?
• Is the outpatient surgical facility located in a
  medical building or immediately adjacent to a
  major hospital?
• Asking questions during your initial consultation
  will help you better get to know your plastic
  surgeon in order for you to feel at ease with him
  or her throughout the process. Your surgeon
  should listen well and answer your questions in a
  patient, respectful manner.

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The Breast Augmentation Procedure

• During a comprehensive one-on-one consultation at
  Lewis Plastic Surgery, you will learn about
• The difference between saline and silicone breast
  implants and actually touch both types of implant
• Breast implant sizes and shapes
• Breast implant placement behind, in front of or
  partially behind the pectoral muscle
• Incision types under the breast, around the
  nipple or in the axilla (arm pit)
• Surgical facility and anesthesia
• Breast augmentation cost and financing options

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Step 1 Anesthesia Most people have a general
anesthetic for their surgery, but the surgery can
be done with Iv sedation if there is a desire or
reason to avoid a general anesthetic.
Step 2 Incisions The decision where to place the
incision is made at your preoperative visit and
depends on your wishes and goals for the surgery.
There are advantages and disadvantages to each of
these incision locations
Image provided by ASPS

• Periareolar (under the nipple) direct and close
  access for accurate placement, nearly invisible
  scar, higher incidence of decreased sensation in
  the nipple, higher rate of capsular contracture
• Inframammary (bottom of breast) most direct
  access to chest wall for most predictable
  results, very faint scar, not visible in bikini
  tops, most sterile for lowest rate of capsular
  contracture
• Transaxillary (crease of armpit) least likely
  to be seen, higher probability of implant
  malposition, cannot accommodate silicone
  implants, higher rate of capsular contracture

Breast Augmentation Surgery
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Step 3 Placement of the Implant The vast
majority of implants are placed underneath the
pectoralis muscle (submuscular) while some are
placed underneath the breast tissue
(subglandular). Whether they are fully under the
muscle or partially under the muscle (dual plane
approach) depends on each patients personal
anatomy.
Breast Augmentation Surgery

• SUBGLANDULAR
• Not recommended for thin tissues
• More visible and palpable implants
• Higher risk of capsular contracture
• More difficult mammograms

• SUBMUSCULAR
• Appropriate for thin tissues
• Less visible and palpable implants
• Lower risk of capsular contracture
• Less difficult mammograms

Step 4 Following the Procedure Once the
incisions are closed with sutures, surgical
garments are wrapped around the chest to protect
the treatment area. Our breast augmentation
patients initially recover in the recovery room,
observed by our licensed nurses. After a short
period when they are awake and comfortable, they
will be able to go home to rest.
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Breast Augmentation Recovery
We suggest taking a week off of work, but some
patients will return to work faster assuming that
they do not have to perform any heavy lifting.
Full recovery takes two to four weeks. Your first
post-operative visit will be scheduled about two
to four days after the procedure and you are then
seen a few more times during the recovery period.
In the first few days you may experience mild
discomfort, bruising and swelling, all of which
are considered normal and treated with
prescription medicine. You should wear a special
supportive garment for five to seven days after
which you may resume wearing normal bras.
Detailed instructions on how to care for the
incisions, when to resume exercise and other
pertinent facts are provided prior to
surgery. Your relationship with us will not end
after the surgery. We will see you frequently in
the next weeks and months and will want to see
you back one year after surgery as well. We will
continue to advise you on activity, exercise,
breast self-examination and the future need for
mammography, as you require.
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Recovery Timeline

• 1st Week
• You are allowed to shower the day after surgery.
• Light activity, including walking, is permitted
  and encouraged immediately following surgery.
• You may be able to return to work 3-4 days after
  surgery, depending on the nature of your job.
• You should not lift, pull or push anything that
  causes pain and limit strenuous activity for 2
  weeks.
• You will need to set up an appointment with your
  surgeon to check on your recovery process.
• 2nd and 3rd Weeks
• You should not lift more than 15 pounds or do any
  strenuous activities for 6 weeks.
• Most swelling will resolve within 1 month.
• Long-term
• Return to your surgeons office for follow-ups at
  the recommended times and if you notice any
  abnormal changes in your breasts.
• Contact your plastic surgeon with any questions
  or concerns.

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Potential Risks

• During your initial consultation, we will discuss
  every possible outcome of your procedure
  including possible complications. Swelling and
  bruising may be present for up to two weeks. The
  final shape and feel of your breasts will not be
  seen for two to three months after the breast
  augmentation surgery. Although infrequent,
  breast implant surgery risks may include (but are
  not limited to)
• Desire for a different size
• Numbness of the breast
• Swelling
• Bleeding
• Rupture and leakage
• Poor aesthetic scar healing
• Assymetry
• Capsular contracture (scar tissue around the
  implant)
• Changes in nipple / breast sensation

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Before After
Here are a few real images of Lewis Plastic
Surgerys past patients, so you can see the
satisfactory results of breast augmentations done
by Dr. Gordon Lewis. Before and after photographs
serve as a helpful tool that enables you to
visualize the end product of the procedure. If
you are interested in viewing more and finding
something similar to your desired breasts, please
see our Breast Augmentation Photo Gallery.
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Helpful Resources

• To help you begin this journey with personal
  research on surgery and recovery, please visit
  the websites listed below. These valuable
  resources will help you connect with the plastic
  surgery community, so you can find more
  information and ask more questions about breast
  augmentation.
• American Society of Plastic Surgeons (ASPS)
• www.plasticsurgery.org
• RealSelf
• www.realself.com
• American Society of Aesthetic Plastic Surgery
• www.surgery.org
• Lewis Plastic Surgery Breast Implants 101
• Dr. Lewis Breast Augmentation Podcast
• Breast Surgeries Infographic