Guidetobreastaugmentation Knoxville

7/31/2019 Guidetobreastaugmentation Knoxville

1/34

A Girlfriends Guide

toBreast Augmentation


2/34

4 First Things First

6 Breast Augmentation Basics

7 What to Look or in Beore and

Ater Photographs

8 Forget Cup Size

9 The Fun Part: Trying on Sizers

10 8 Important Tips to Getting

Your Size Right

11 The Great Cleavage Conusion:

Its Not About Size

12 How to Know I You Might Need a Lit

14 How Much Will it Cost?

15 All About Implants

20 Why the Best Thing About Gummy

Bear Implants Could Be Their Name

25 10 Questions to Ask Your Plastic Surgeon

27 Are You Ready? Questions to Ask Yoursel

28 How to Recover Well

32 Medical Insurance May Not Be Enough: Thats Why We Have CosmetAssure.

33 Other Helpul Stu

2

WHATS

INSIDE

A G I R L F R I E N D S G U I D E T O B R E A S T A U G M E NT A T I O N


3/34

A G I R L F R I E N D S G U I D E T O B R E A S T A U G M E N T A T I O N

3

TheresaPatient Care Coordinator

MandiMedical Assistant

JillNurse Injector

HeatherLicensed Aesthetician

NatashaPatient Care Assistant

KatiePatient Care Assistant

OK LADIES, i youre like most women considering a breast augmentation,you probably have lots o questions. More than likely youve talked to some r iends or done

research online. We know how quickly the inormation and opinions can get pretty over-

whelming so we thought you would appreciate some straight talk rom girlriends in the

knowus.

Sure, we work at Dr. David Reaths oce. Yes, were more than a little biased when it comes to

recommending a great plastic surgeon, but you must know that we wouldnt say anything

in this guide i we didnt believe it. Whether you end up choosing Dr. Reath, another board-

certied plastic surgeon, or decide a breast augmentation isnt or you, we think the pages in

this guide will be super helpul. I they are please pass this along to another girlriend. I not,

well...lets just keep that between us!


4/34


4

FIRST THINGS FIRSTSee that logo right there? You may not know it yet, but thatlogo is a sign o protection. Heres why: whenever you see that

logo, you know the doctor behind it is certied by the American

Board o Plastic Surgery. Believe it or not, there are doctors with-

out surgical training who market cosmetic surgery procedures

to the unsuspecting public. Its happening right here in Knox-

ville and as long as there is no law against it, its buyer beware.

So this logo helps give you an idea about the credentials o the doctor youre considering.

The credentials dont guarantee a successul outcome, but at least when you choose anASPS member surgeon, you can be sure o these things:

So now you know to look or that logo.I you cant nd it easily, the doctor probably

doesnt have it.

P.S. Dr. Reath is Board-certied and serves as

Chairman o the Public Education Committee o

the American Society o Plastic Surgeons.

Has at least six years o surgical training,

with 3 years specically in plastic surgery.

Is certied by the American Board o

Plastic Surgery.

Operates only in accredited

medical acilities.

Adheres to a strict code o ethics.

Fullls continuing education requirements,

including patient-saety techniques.

This is all you have to remember,

four letters:

ASPS.


5/34


5

VERY INTERESTING...Most women have one breast that is slightly larger than the other.A saline breast implant saved a womans lie during an otherwise tragic

shooting in Caliornia this year.

The Hong Kong Polytechnic University oers courses in manuacturing push-up bras.

Breast Augmentation is the most popular plastic surgery procedure perormed.*

Over 376,000 women had breast augmentation or breast lit surgery in the US last year.*

Most women who have breast augmentation are between 30 and 39 years old.*

Surprisingly, almost as many women over 40 had breast augmentations as did

women in their 20s.*

Breast Implants, even silicone ones, do not interere with breast eeding.

In act a recent study showed higher levels o silicone in canned ormula, than in

breast milk o women with silicone implants.

The FDA approves saline implants or cosmetic breast augmentation in women over 18,

and silicone breast implants or women over 22. There is no age-limit on breast implants

or reconstructive reasons.

China ranks #1 in breast augmentation surgeries, surpassing the US, Brazil, India and Mexico.

*Source: American Society o Plastic Surgeons 2009 procedural statistics

**Source: ISAPS.org


6/34


6

BREAST

AUGMENTATIONBASICS:There are lots o reasons why women consider having breast

augmentation surgery.

Many tell us they just want to be able to buy a bathing suit that

ts! Despite some Hollywood stereotypes, the majority o women

increase rom one to two cup sizes to obtain that fattering gure

they always wanted. Some come to us ater they have had children

and lost their breast size ater breast-eeding. Others need to have a

breast lit along with the enlargement. Well tell you how to know i

youll need a lit later on.

From what weve seen in our oce, were right in line with the

national statistics that say breast augmentation is one o the

astest growing plastic surgery procedures. We suspect its growing

because o the great results and the quick recovery time. A recent

study revealed that 96% o women who had a breast enlargementsurgery were either satised or highly satised with their results.

We guess thats why over 200 o our patients chose breast

augmentation last year alone!


7/34


7

Have you ever looked in a magazine and ound a hair style you liked

only to be told by your hairdresser that it wont work or you because

your hair is too ne, curly, straight etc.? That can happen with what

you see in plastic surgery beore and ater pictures as well.

The important thing to do is to nd BEFORE photos which resemble

your own appearance. Be honest with yoursel about what you aretrying to change and be realistic i your pre-operation breast shape

is not ideal.

How To Look At Beore And Ater Pictures

Heres where to begin: Start with beore photos that look like your

body type and breast shape and then, and only then, nd pictures o

results you like.

Be sure that you are looking at pictures o women who are aboutyour same height, weight, chest width and breast size.

Beore and ater pictures can tell you a lot about the surgeons taste,

so be sure it matches your own idea o beauty. Its clear rom looking

at his photo collection that Dr. Reaths ideal is a more natural looking

breast size and shape, but that may not be what you want.

Technically Speaking

From a technical standpoint, the photos should be uniorm in

appearance and ormatting (and the beore and ater pictures shouldbe o the same patient! Look or telltale signs like moles and reckles

i you are in doubt.)

Understandably, the photos you see are the results that the doc-

tor and the patient particularly proud o, so it shouldnt be the only

reason to pick your surgeon (although it can be reassuring to see a

lot o pictures with good results rather than just one or two.) Think o

the photos as more o a

guideline to communi-

cate the look you want

and understand that you

cant exactly reproduce

the results you see in

pictures.

It is good to have a

collection o several

pictures to look at

so you know thesurgeon perorms

breast augmenta-

tions oten and well. Its even better i they are nice enough to

include the patients height, weight and choice o implants.

WHAT TO LOOK FOR IN

BEFORE AND AFTERPHOTOGRAPHS:

Click here to see Dr. Reaths breastaugmentation photo gallery.


8/34

FORGET CUP SIZEYou might not want to hear this but were going to tell you

anyway: you need to orget thinking about cup size. As women,

we tend to think in cup sizes because that is how we buy our

bras. The most common comment we hear is, Id like to be a

C-cup. When we hear that we translate it to mean, She wants

her breasts to look like they t the rest o her body.

This is because cup size or patients having breast augmenta-

tion is a very subjective measurement. Everyone wears their

bras dierently and every bra manuacturer makes them dier-

ently. You may be a 36C in one bra and a 34D in another.

And when you check out all the dierent styles at your local

Victorias Secret, you can understand why we say think

proportion and shape, not cup size.


8


9/34


9

THE FUN PART: TRYING ON SIZERSAll right, so weve realized that cup size isnt really a good way togure out whats right or you. What you really want to do is try out

our collection o silicone implant sizers when you come or your o-

ce consultation. This is always the best part o the visit because you

really get to visualize what the end result will look like.

Youll want to consider your body rame, height, weight, shoulderwidth, hip width and current breast volume when youre choosing an

implant. As you increase in size you will need to use a larger implant

to maintain proportion (with the exception o starting breast volume

o course.) So i you are 5 tall and petite, you will typically need a

much smaller implant than i you are 59 with broad shoulders and

wide hips.

Implant sizes are based on the amount o fuid or gel in the implant

itsel. Theyre available as small as 125cc (great or correcting asym-metry) and can go way up rom there. Dr. Reaths patients are gener-

ally in the 300cc to 400cc range.

The Sizer Sisters Mandi and Jill


10/34


10

7 IMPORTANT TIPS TO GETTING YOUR SIZE RIGHT

1 Wardrobe: Bring in dierent types o outts to try on with your sizers.You want to make sure that you are comortable in your casual dress as well

as your cocktail dress. Plain baby-doll t-shirts work best. We have some in

the oce you can use as well.

2 Personality:Think about your personality (outgoing or shy) and howyou want to be perceived by the public. Then, make sure that you convey

this to your surgeon. Breasts that are larger than what what would be pro-

portionate may suit your style. On the other hand, you may lean towards

looking great in a cocktail dress without attracting unwanted attention at

work.

3 Fitness: Factor in your exercise routine. I you are a runner or seriousathlete, you will want to choose implants that wont interere with your t-

ness routine.

4 Youre In Charge: Although your surgeon should be your guide, heshouldnt dictate what size you should be. Its a collaboration. However,

there may be a situation when your surgeon doesnt recommend going

with the size you want. I thats the case, you may want to have urther

discussions to make sure you understand the reasoning behind this. Its im-

portant or you to be comortable that your prospective plastic surgeon has

spent the proper time with you and is not dismissing your input. I youre

eeling let out o the decision-making process, nd another plastic surgeon

(Board-certied o course!).

5 You Be You: Dont pick your implant size based on how it looks on ariend. Even though you and your riend may seem similar in terms o body

size, there are other actors that must be considered. Its natural to think My

girlriend has 350s so I should get the same size because they look perect

on her. But the important words are on her. I you are open to dierent

implant options, its more likely that youll nd the one that is just right

or you.

6 Bring A Friend: You may nd that you would enjoy bringing a riend orspouse with you when you try on sizers. Our sta is great at guiding you in

this process but sometimes its un to have someone else there who knows

you well. Also, there is a large quantity o inormation discussed during your

consultation so its nice to have an extra set o ears. (Speaking o ears, its

best not to bring the kids.)

7 Know When Enough is Enough: Remember that you are picking thesize o your breasts not just or this year but or many years to come. I you

choose an implant that is too big, you may have issues with back pain and

sagging later on. Ask any o our breast reduction patients and they will tell

you that much bigger isnt always better!


11/34


11

THE GREAT CLEAVAGE CONFUSION

ITS NOT ABOUT SIZEWhen it comes to conusion, cleavage is right up there with cup size. Its important to

understand beore your surgery that increasing the size o your breasts is not what gives

you cleavage. Rather, cleavage is a unction o the shape and width o your chest and how

close your breasts are together.

When you were little, do you remember looking down and crossing your arms to pretend

you had cleavage? Its the same principal here.

I your breasts are set wide on your chest, you will have more ullness ater your augmen-tation, but not more cleavage. Conversely, i your body is narrow below your shoulders

and your breasts are close together, youll have great cleavage even with a small implant.

I cleavage is important to you, be sure to talk about it beore you have your surgery so

you wont be disappointed. And remember, you can buy a bra that will help too.


12/34


12

HOW TO KNOW IF YOU NEED A LIFT:Women who are unhappy with sagging in their breasts oten choose to have a breast lit.Usually this sagging is a result o pregnancy and breast-eeding or weight-loss, but not

always. Frequently a modest implant is used in conjunction with the lit to restore ullness in

the upper part o the breast. Using an implant is completely optional and depends on the

goal o the individual patient.

During a breast lit, also known as a mastopexy, the breast is lited by removing the excess

skin and restructuring the breast tissue. In many women a delicate incision around the

nipple area (areola) is all that is needed. In others, who have a large amount o excess skin,

the incision will need to be extended.

The Lit Test You Can Do Yoursel

It can be a disappointment i you come to our oce or breast augmentation and Dr. Reath

explains that to achieve a pleasing shape and perkiness, youll need a breast lit as well.

So heres a good way you can tell. Standing in ront o a mirror, look at your nipples in rela-

tion to the natural crease beneath your breasts. I your nipples are lower than your breast

crease beore surgery, adding implants without removing excess skin will make them more

saggy. And it will just get worse with gravity over time. Sad, but true. You will probably need

a lit. I your surgeon tells you to just use bigger implants, dont go there girlriend!


13/34


13

NO, YOURE NOT CRAZY.

ONE IS BIGGER THAN THE OTHER.Most women have one breast thats bigger than the other just like they might have a leg

or arm that s slightly longer than the other. (And by the way, when you have your next

pedicure, look and see i your toes exactly match.) The point is that its rare or the human

body to be symmetrical.

However, in some women the dierence in breast size and shape is more noticeable,

and this is where a breast augmentation and/or a breast lit can be a big help.

It is very common to use two dierent implantsizes to adjust or the dierence in natural breast

tissue. Sometimes, one breast may need a lit

while the other one does not. (Interestingly,

breasts oten heal rom surgery dierently too.)

PODCAST ALERT: Youll never guess the doctor whom theThe American Society o Plastic Surgeons chose to interview when

they decided to produce a podcast on breast augmentation?

Dr. Reath and one o his patients!

It is very inormative and answers many questions about breast augmentation that

patients across the country requently ask. The 20-minute podcast is perect to listen to

while you are looking at beore and ater photos.

Click here to listen to it.


14/34

14


Our breast augmentation price is $4,865

This includes surgical and anesthesia ees, saline breast implants, the bra

you wear ater your surgery and all ollow-up visits. It also includes our ex-

clusive recovery kit and a CosmetAssure policy*.

Cash Discount: Great news! For our patients who would like to pay with

cash or check we oer a 5% discount. ($4,465 with cash discount)

I you want silicone breast implants, the price is $5,865

($5,465 with cash discount)

Breast lit pricing varies rom around $6,200 to around $8,600 beore the

cash discount. The dierence in price depends on the incision site, the

amount o skin to be removed and whether or not implants are used.

*Included in the price o your surgery is a CosmetAssure policy,

which protects you in the unlikely event o a complication within thirty days

ater your surgery. We are the only plastic surgeons oce in Knoxville to

provide this important insurance. When you read more about CosmetAs-

sure later on, youll understand why Dr. Reath eels so strongly about oer-

ing this extra saety net to his patients.

GET THE PROCEDURES

YOU WANT WHEN YOU

WANT THEM.CareCredit providers can oer a variety o

no-interest and low monthly payment plans.

And, CareCredit works just like a credit card so

its easy to use again without having to

reapply.

NO INTEREST PLANS

Featuring plans with no interest i paid within

3, 6 or 12 months.

LOW FIXED INTEREST PLANS

Featuring plans with a low interest rate start-

ing at just 13.9% i paid within 24, 36, 48, or 60

months.

HOW MUCH WILL IT COST?


15/34


15

ALL ABOUTIMPLANTS

NEW KID ON THE BLOCK:SIENTRA

Implant Brands: Do They Matter to You?

Ok, so lets talk about the

details on implant brands. Dr.

Reath preers both saline and

silicone implants made by

Mentor, a company owned by Johnson and Johnson. He also has

considerable experience with Mentors competitor in the implant

business, Allergan (ormerly Inamed, which was ormerly McGhan).

As both implant brands are excellent, his preerence is mainlybecause o the excellent service Mentor provides and the compli-

cated sizes that Allergan uses.

Although implant brands matter a lot to your surgeon, they prob-

ably wont mean that much to you unless you need to have your

implants replaced. I they are covered under the manuacturers

warranty, then you will need to use the same brand as the ones

you are replacing. Thats why most good plastic surgeons will have

a good relationship with both companies in order to best take care

o their patients. Sientra received FDA-clearance or their silicone breast implants in March2012. Their entire catalog is comprised o high strength cohesive gel

implants also known as highly cohesive gel, orm stable, or simply gummy

bear implants. Mentor and Allergans similar implants are still in phase two

studies and have yet to be similarly approved by the FDA.


16/34


16

QUESTION: WHY IS YOUR

PLASTIC SURGEON NOT LIKE JIFFY-LUBE?ANSWER: YOU DONT HAVE TOREPLACE YOUR IMPLANTS EVERY 3,000 MILES!

Many people are under the mistaken impression that breast implants

need to be replaced every ve years, seven years, ten years etc. This

is not true. Basically, i you are not having any problems with your

implants, there is no need to replace them. In case youre wondering,

the most common reason implants are replaced is when a woman

wants to change her breast size.


17/34


17

SALINE VS. SILICONE

Over the next couple o pages, we are going to walk you throughsome choices you are going to make i you decide to have a breast

augmentation. Were going to do this in a very straightorward way;

laying out the pros and cons or you while avoiding complicated

medical jargon, (hopeully!). So here goes..

Saline vs. Silicone

First lets talk saline. Saline implants were rst introduced in 1965

as an alternative to silicone implants. Their outer shell is the same as

silicone implants, but they are lled with saline at the time o surgery,which allows a smaller incision to be used (about 1.5 inches).

Over the years there have been many improvements in the shell

integrity to decrease the chances o defation, and in the valve to

prevent leaks.

Here are the advantages to saline implants:

There is a smaller incision, and therefore you have a smaller scar.

They cost less.

There is greater variability in size, because the ll level is adjustable.

Its obvious if you have a deation.

They have a physiologic ller (salt water).

The disadvantages with saline implants are:

They are rmer implants so they dont feel as natural.

They can cause rippling.

They require a submuscular placement unless you

have a lot o natural breast tissue.


18/34


18

SILICONE IMPLANTS

The Facts about Silicone ImplantsAlmost hal o the women we see decide to use silicone implants

rather than saline since the recent FDA approval. In the early 1990s,

silicone breast implants were removed rom the market due to saety

concerns. However, data that has been gathered since that time

has proven these implants to be sae. This data was gathered over

14 years through an adjunct study that allowed the use o silicone

implants or only very select patients. Dr. Reath was one o the plastic

surgeons who participated in this study, and has been using silicone

cohesive gel breast implants since that time.

Now we can oer silicone breasts implants as long as you are over

the age o 22. (The reason or this is that the FDA eels that in some

women breast development may not be complete until age 22.) Sili-

cone implants can also be used in women o any age seeking breast

reconstruction, or the correction o developmental abnormalities,

including breast asymmetry.

The History o Silicone Implants

Silicone implants were rst introduced in 1962 (rst produced by

Dow Corning). Both the outer shell and the silicone used to ll the

implants have been much improved over generations.

For example, changes in the shell have proven to decrease thesilicone bleed, (the amount o silicone that is shed by the implant)

while the silicone ll has become more cohesive during the develop-

ment and generations o implants. These changes explain why in a

recent study, scientists ound more traces o silicone in canned inant

ormula than in breast milk rom augmented patients with silicone

implants!

We currently use Mentor Memo-

ryGel implants, which are Fourth

Generation silicone implants

(1993 to present). They contain

a cohesive silicone gel in a thick,

low bleed shell. Although the FDA

approval or cosmetic breast augmentation is recent, dont be con-

cerned that the Fourth Generation implants are new to us. They are

the same ones we have been using in the study patients. So you can

be condent that they are sae. Further, Dr. Reath has been using

silicone implants since 1986 (even longer than this i you considerhis training).

There is now a th generation o silicone breast implants that be-

came available in March 2012. These are the highly cohesive orm

stable gel implants also known as gummy bear implants.


19/34


19

SILICONE IMPLANTSPROS AND CONS

Here are the advantages o silicone implants: They are softer and have a more natural feel.

They have a slightly lower defation rate.

They dont ripple.

They are more easily used above the muscle

(subglandular) position.

The disadvantages o silicone implants are:

It is harder to detect when they rupture.

They require a longer incision.

They cost more.

The ller could be considered less physiologic.

Now that you know the dierences in the implants themselves,

you can understand that they are not inserted the same way and

they behave dierently ater the surgery too. Especially i you are

considering silicone implants, make sure your doctor has experi-

ence working with them.

The best way to illustrate the properties o a silicone cohesive

gel implant is by watching this brie video. The video shows

a Mentor MemoryGel silicone breast implant cut in hal.

You can see how the material holds together uniormly (noleaking) while still retaining the natural give o breast tissue.

It does this because o a cohesive, gelatin-like substance that

acts as a solid rather than a liquid.


20/34


20

WHY THE BEST THING ABOUT

GUMMY BEAR IMPLANTSCOULD BE THEIR NAME

particularly when youre standing up. But i you want your breast

implant to act like normal breast tissue, you dont want excessive ull-

ness in the upper part o the breast when youre upright. Sientra also

says highly cohesive gel implants have less olds, or scalloping. I dont

nd this to be a problem with our current cohesive gel implants, but

sometimes it can be a problem with saline implants.

Sotness & Incision: Everyone agrees that these implants are a little

rmer and may not eel as natural as less cohesive silicone implants.Also, they do require a slightly longer incision.

So, or me the bottom line is that these implants give women

another choice, however, I dont think any o us can say that these

are better or worse than our current implants.

Now that anyone who wants these implants can have them, the

question on everyones mind (Dr. Reaths included) is: are these better

implants? Here are his thoughts:

Lets compare these to our current MemoryGel cohesive silicone gel

implants in terms o longevity, shape, sotness, incision size and cost.

Perhaps the easiest o these questions to answer is the last.

Cost: Sientra has very competitively priced their implants to be

about the same cost o the cohesive gel implants we are now using.

Longevity: What a lot o people like about these implants is that

they cannot leak since they have the consistency o the gummy bear

candies. However, what we dont know is how age will aect these

implants over the course o many years. It may be another 10 to 15

years beore we have answer to this, but many people do like thatact that they are more or less solid.

Shape:There does tend to be less change in the shape o the im-

plants with positional changes. I see this as both good and bad. I you

want more ullness in the upper part o your breast, this may be good


21/34


21

IMPLANT SHAPES: ROUND VS. ANATOMIC

Our pick? Round

SURFACE TEXTURE: SMOOTH VS. TEXTUREDOur pick? Smooth

Round: Dr. Reath primarily uses round implants or cosmetic

breast augmentation. He explains why, Because round implants are

totally symmetric, their orientation, when placed, is never problem-

atic. Their advantages are that they are the most commonly used

implants, probably look more natural in both the upright and lying

positions, and they are not textured. They are also less expensive.

Anatomic: Anatomic or tear dropped implants are asymmetric.

There is greater projection at the bottom o the implants than at the

top. Shaped implants provide shape when there isnt any but have

the potential to rotate causing problems. They must be properly

oriented or they will have the greater projection in the wrong place.

They are textured and more expensive.

Smooth: The surace o your implants can be either smooth or

textured. Dr. Reath explains why they came up with the idea to add

texture to the implants,

It was originally thought that texturing implants would lead to asoter result with less capsular ormation. However, this has not been

borne out clinically. Textured implants do adhere to the surrounding

tissues and do not move as well with massage. Additionally, rippling

is much more common with texturing. So I denitely preer smooth

implants.


22/34


22

PLACEMENT PLANE:

SUBMUSCULAR VS.SUBGLANDULARAlso known as Under the Muscle or Over the muscle

Implants can be placed either beneath the pectoralis major mus-

clesubmuscular (or subpectoral), or on top o the muscle, beneath

the breast (glandular) tissuesubglandular. There are several con-

siderations that determine what may look best or you, and in some

women either placement is a good option.

Submuscular (Under the Muscle)

Heres our recommendation: Choose the submusular (under the mus-

cle) placement i you have saline implants, a small amount o natural

breast tissue or a strong amily history o breast cancer.

Placing the implants under the muscle has the advantage o having

more o your tissue over the implants, and may make the implants

look more natural and less obvious. For this reason, Dr. Reath recom-mends that most saline implants be placed beneath the muscle.

Saline implants are slightly rmer or stier, and may require the

pressure o the muscle to give a better shape to the upper part o the

breast. Implants may remain a little soter under the muscle and may

be less easily elt, particularly with saline implants. Rippling, which is

more common with saline implants, will be less obvious under

the muscle.

However, all implants beneath the muscle are subject to animationdistortion. As the muscle contracts over the implant, it can temporar-

ily change or deorm the shape o the breast. While this is not a per-

manent situation (it goes away once the muscle is not fexed), it can

be a concern to some patients, particularly body-builders. There will

be a decrease in chest muscle strength ater the surgery, but this will

recover. Submuscular placement is more uncomortable initially, and

may always have a slightly dierent sensation to the patient. There

may also be a slightly greater risk o bottoming out with submuscu-

lar placement than with subglandular placement.

Here are advantages to placing the implants under the muscle:

The implant is less visible and looks more natural.

Its harder to feel the implant and therefore it feels more natural.

There is less rippling if you decide on saline implants.

Possibly there is better breast imaging with mammography.

The disadvantages to placing the implants underneath

the muscle are:

It is more uncomfortable and involves a longer recovery.

There is animation distortion when the chest muscles are exed.

There is a possible increased risk of bottoming out.


23/34


23

PLACEMENT PLANE:

SUBMUSCULAR VS.SUBGLANDULAR

Subglandular (Over the Muscle)

Heres our recommendation: Choose the subglandular (over the mus-

cle) placement i you want silicone implants, have a large amount o

natural tissue and want saline implants or require a breast lit.

The subglandular placement is more common with silicone implantsbecause they are soter and do not require as much tissue coverage

or a good shape. The above the muscle placement is also or women

with greater amounts o natural breast tissue. I you already have a

moderate amount o breast tissue, you may achieve a more natural

shape with the implant in the above the muscle position, particu-

larly with silicone implants, because there is no muscle between the

implant and the breast tissue. Women with greater amounts o breast

tissue, using a smaller (relatively speaking), saline implant, can also

use the subglandular position.

There is no animation distortion o implants in the subglandular

plane. The operation is less painul, the recovery a little shorter, and

there may be a more natural sensation or the patient. However, rip-

pling can be more visible which is why saline implants should not be

placed over the muscle in women with very little breast tissue.

Dr. Reath also notes that, In breast lits, it is more commonwith the

technique I useto place the implants in the subglandular position.

This allows a better ability to mold the shape o the breast and the

implant as a single unit.

Here are the advantages o placing implants over the muscle:

There could be a more natural-looking shape of the breast

(particularly with silicone).

The recovery is less painful with a shorter recovery time.

There is no distortion when the chest muscles are exed.

The disadvantages o placing the implants over the muscle are:

The implants are more visible and palpable, especially

with saline implants.

There is a greater chance of r ippling when using saline implants..


24/34


24

GET READY.

DR. REATH EXPLAINSIMPLANT PROFILE.Youre probably going to hear something about implant proles i you get

serious about choosing implants so we asked Dr. Reath to give some

perspective on what proles are and his recommendations about them:

Round implants come in dierent proles. The prole relates to

the relative projection o the implant or a given diameter, or basewidth. Proles may be moderate, moderate prole plus, or high prole.

The dimensions are dierent with silicone than they are with saline.

Generally speaking the lower prole implants tend to give a more natural look.

In choosing an implant, I recommend the lowest prole or the size the patient

wants, without having the implant diameter exceed the base width o the pa-

tients breast.

Usually this will be moderate, or moderate plus with saline, and moderate plus or

high with silicone. High prole saline implants can give too much ullness in thesuperior (upper) breast and tend to look unnatural. (The dimensions o the high

prole silicone are equal to the dimensions o the moderate plus saline.)

GOT THAT? OUR ADVICE: LET YOURSURGEON PICK YOUR IMPLANT PROFILE.


25/34


25

TEN QUESTIONS YOU

SHOULD ASK YOUR PLASTIC SURGEON.1 What are your credentials and training experience?Patients are oten reerred to a surgeon by their primary care physi-

cian or a riend; however, it is important to know what qualies the

surgeon to perorm your procedure. Ask your surgeon i he/she is

Board-certied in plastic surgery. ASPS member surgeons are certi-

ed by the American Board o Plastic Surgery and are trained speci-

cally in plastic surgery. They operate only in accredited medical acili-

ties, adhere to a strict code o ethics and ulll continuing educationrequirements, including patient saety techniques.

2 How many procedures o this type have you perormed?In addition to knowing your surgeons credentials, it is important

to know the level o experience he/she has in perorming your proce-

dure. Choosing an experienced surgeon is one way to

ensure good results.

3 What do I need to do to prepare or surgery? Certain surgeries require that you stop smoking, lose weight or ollow

a specic diet limiting the ood you eat. Make sure that you speak to

your surgeon and your anesthesiologist about any allergies or about

any conditions or which you are taking medication. You should

mention any vitamins, supplements or over-the-counter medications

as well.

4What are the risks?Every surgery has some associated risk. Weigh the benets o the pro-

cedure against the risks o side eects and complications (e.g. nausea,

vomiting, pain, inection, or bleeding) beore making your decision.

5 How can I better manage post-surgical side eectsand complications such as nausea, vomiting, pain, inectionor bleeding?

Some post-surgical side eects and complications are more manage-able than others. Make sure you speak to your surgeon about your

risk o experiencing side eects and complications, and about any

medications he/she may prescribe to minimize these symptoms. For

example, your surgeon may prescribe a medication beore surgery to

minimize nausea and vomiting or prescribe something or pain.

6 How long o a recovery period can I expect?What kind o help will I need during my recovery?

Some surgeries take longer to recover rom than others. Make sureyou speak to your surgeon about how long it will take to heal, as well

as how you might physically eel immediately ollowing your surgery.

Your surgeon will be able to inorm you o the arrangements neces-

sary to ease your recovery.


26/34


27/34


27

ARE YOUREADY?

QUESTIONS TO ASK YOURSELFAm I choosing to enhance myappearance or me?

I know that others may support me, but no

one is pressuring me.

Am I realistic about the resultso the surgery?

I understand that cosmetic surgery can im-

prove my appearance, but it cannot changemy lie.

Do I ully understand and accept thepotential risks associated with myprocedure?

I know that there are no guarantees and

realize that additional procedures may be

necessary. I have been (or will soon be) given

inormed consent documents and pre- and

post-procedure instructions.

Am I in good shape physicallyand emotionally?

There are no underlying health disorders or

mental health conditions I have not dis-

closed to my surgeon.

Can I aord this?

I can aord all the costs o surgery, includ-

ing non-monetary costs such as the time to

recover.

Why is now the right time or mysurgery, rather than a month or a yearago, or, conversely, a month or a yearrom now?

The timing ts my schedule. I have not

been oered special incentives to schedule

surgery and I am not eeling pressured to

commit to a plan beore I am ready.

Am I completely comortable with mysurgeon and the sta in his ofce?

My surgeon spent time with me, answered

my questions and recommended a surgical

plan that is designed to achieve my statedgoals. The sta is riendly, helpul and sup-

portive. I dont eel like just a number.

Once youve worked through the questions, youmay want to talk about them with a trusted riend

or amily member and certainly with your plas-

tic surgeon. Ater all, you and your physician will

make the nal decision about your surgical plan.

Realistic expectations will better prepareyou or surgery, and a prepared patient has

the best recovery.


28/34


28

HOW TO RECOVER WELL

Helping you manage a speedy recovery is one o our primary mis-sions. One o the reasons breast augmentations surgery is so popular

is because o the quick recovery time. Breast augmentation takes

about an hour and is done as an outpatient procedure under general

anesthesia (you will be put to sleep). It does not involve an overnight

stay in the hospital.

Whether you choose to have your implants over or under the muscle

may impact your recovery by a day or so. Either way, most women

are able to return to normal activities in 7 to 10 days and usually needno more than a week o rom work.

One idea that typically works well is to have your surgery on a Thurs-

day and take the next week o work. That way, you can easily go

back early i youre eeling up to it, but you dont eel pressured to go

back beore youre ready.

Another thing to keep in mind is how physical your job and normal

activities are. A good guideline is not to lit anything, and certainly

nothing heavier than a gallon o milk, or the rst week ater surgery.I you have small children running around or your work involves

heavy liting, you may need to have more help during your recovery

or more time o.

Our Surgical Recovery Kits: A Great Personal TouchWe hear rave reviews about the kits we put together or all o our

patients. Everyone tells us that they are a big help during recovery.

Our goal is to put together everything you need ater surgery so you

dont have to.

One o the most important things we include is silicone sheeting

shapes (say that three times ast!) Silicone sheets put direct pressure

on the incision site, which is the best way to minimize the appear-

ance o scarring. In contrast to scar creams which dont apply pres-sure, silicone sheets are easier to use because they are not greasy,

dont stain, and wont stick to your clothes. Oh! And did we mention

the kits come ree with your surgery?!

TO PATIENTS FROM, PATIENTSWhen you are in the oce, be sure to look through our To

patients From, Patients book. It can usually be ound in our

waiting room. We asked some o our previous patients to write

down their thoughts and advice about the surgery process and

share things they ound helpul during their recovery.


29/34


29

HOW TO RECOVER WELL continued

Taking the Girls or a RunMany people ask us how soon they can get back into their exercise routine. A good general

guideline is that you can start slowly (walking) ater a week and work up to more aerobic ac-

tivity as you eel comortable. For chest presses and weight liting, you should give it at least

two weeks (you wont eel like doing it anyway!) It will be longer i your implants are under

the muscle.

No Tanning Beds...

Speaking o taking care o your new investment, dont be going

to the tanning bed ater your breast augmentation or at least

6-8 weeks. Besides being horrible or your skin, it makes the inci-

sions more visible. You wouldnt drive your brand new Mercedes

through the mud now, would ya?

For those o you who are set on all-over color with no tan lines,

we have a better idea. Its called Fake Bake. We carry it in our store

and highly recommend it.


30/34


30

ALMOST TIME FOR BRA SHOPPING...ALMOST

Its inevitable. Once you have your surgery, the rst thing you aregoing to want to do is go out and buy a bunch o pretty new bras to

celebrate the change in your gure. We understand completely. Its

just that you are going to hate us when we tell you that its better to

wait a month or two. (Sorry. Sorry. Sorry.) Heres why:

The nal results o your breast augmentation surgery take a while, es-

pecially i you have saline implants or you have your implants placed

under the muscle. Saline implants are heavier than silicone implants

and they will continue to settle in over the rst two months. I yougo under the muscle your chest muscles will need some time to

accommodate the new implants. In addition, you may have some

swelling which you want resolved beore you invest in a bunch o

new bras.

Obviously your old bras wont t anymore.

So whats a girl to do?

You will probably be very comortable in the bra we provide you

ater your surgery because it will give you the support you are goingto need. We ondly call it the granny bra so that gives you an idea o

how sexy it is. From there, buy one or two sports-type bras that will

be comortable and are able to expand and contract as your breasts

change. During your ollow-up visits, we will tell you when you get

the green-light to head to Victorias Secret.

P.S. no underwires or at least a month!(Funny story, we recently had a patient who thought we said no un-

derwear or at least a month. She was quite relieved when we cleared

up the conusion that we meant underwire bras NOT underwear!)

What can you do with all o your nice (clean) brasthat no longer t? Dont throw them away!

Bring them into our ofce.

We are now a collection center or Breast Oasis, a charitable organi-

zation that provides clean, gently-used bras to women who need

them. We were surprised to learn that bras are one o the most need-

ed, least donated items to womens shelters. We are excited about

the opportunity to give back in such a positive way. I you know o a

group who is in need o our bras, please let us know!


31/34


31

VITAMINS

Most people take some sort o multivitamin or herbal supplement, but very ew think todisclose their vitamins to their doctor and anesthesiologist prior to surgery. Ater all, theyre

just vitamins, they dont count as a medication, right? Wrong!

Many people acing surgery ail to disclose their herbal supplement use out o ear o being

ridiculed by their doctor. (Who would think that licorice could be dangerous?) The act is,

your doctors want and need to know what you are taking to ensure your sae recovery.

Why? Some vitamins cause post-surgical bleeding, worsen Infammation, raise blood pres-

sure or alter your sugar levels. The best advice is to quit all herbal supplements three weeks

prior to your surgery.

DO TAKE ITWe now carry multi-vitamins in our store that

are specically designed or patients pre-and

post-surgery. They contain nutrients that aid in

healing and reduce bruising while excluding

supplements that can cause problems.

You should start these two to three weeks

beore surgery.

VitaMedica Clinical Support or Surgery

AM/PM Vitamins $44

Aspirin, Advil or Motrin

Any diet pills or herb blendsdesigned to control appetite

Vitamin E

Chromium

Garlic Ginger

Ginkgo

Goldenseal

Flaxseed

Fish oil

Echinacea

Licorice

Saw Palmetto

Ephedra

Ginseng

Feverfew

Kava-Kava

St. Johns Wort

Valerian Root

DONT TAKE IT


32/34


32

MEDICAL INSURANCE MAY NOT BE ENOUGH:

THATS WHY WE HAVE COSMETASSUREAnother way we care or our patients: CosmetAssure

Complications ater cosmetic surgery are rare, thankully, but they can occur

as with any type o surgery. You may think that your insurance will cover this.

Surprise! The majority o major medical health insurance policies now or will

soon exclude treatment o medical complications i those complications are

a result o an elective aesthetic surgical procedure.

Complications can be stressul enough without the additional worry about

who is going to pay the bill. Thats why we enroll all o our patients in the

CosmetAssure program (except i you have reconstructive surgery, revisional

surgery or surgery done under local anesthesia because CosmetAssure does

not oer policies to cover those.) CosmetAssure is endorsed by the Ameri-

can Society o Plastic Surgeons and covers the cost o caring or complica-

tions within the rst 30 days ater cosmetic surgery. Best o all, your policy is

included with all eligible surgeries Dr. Reath perorms.

PS. We are the only plastic surgeons oce in the Knoxville area to provide

this important insurance to cosmetic surgery patientsand it aint cheap.But, to quote our riends at LOreal, Youre worth it.


33/34


33

PlasticSurgery.org

This is the ocial website o the American Society o Plastic

Surgeons and the most comprehensive source o plastic

surgery inormation online.

LoveYourLook.com

Learn more about cohesive gel implants and research breast

augmentation on this site powered by Mentor.

Realsel.com

Read comments about breast augmentation rom women

around the country and check out their popular Was it

worth it? eature.

Still have Questions? Click here to Ask Dr. Reath

Facebook.com/plasticsurgeryknoxville

Visit our active acebook page. It has lots o patient

comments and lively discussions about all-things plastic

surgery. We love to have you like it.

Click here to get Dr. Reaths blog

directly into your inbox.

BreastOasis.com

Read all about the non-prot program to deliver

gently-used bras to women in need.

Get your ree copyo our 80-page glossy

magazine called

Your Beauty.

It has all kinds o

good stu including

interviews with beauty

pioneers, quizzes,

recipes and more.

STILL IN YOUR

RESEARCH STAGE?CHECK OUT THESEOTHER USEFULRESOURCES:


34/34


34

CONTACT US

David B. Reath, M.D. Plastic Surgery

109 Northshore Drive, Suite 101, Knoxville, TN 37919

phone: 865.450.9253 fax: 865.450.9949toll-ree: 866.reath.01 (866.732.8401)

www.breastaugmentationknoxville.com

This publication provides general inormation about plastic surgery.

David B. Reath, MD PLLC is not responsible, and expressly disclaims,

all liability or damages o any kind arising out o your use, reerence

to, or reliance on, the contents o this publication, I you need medical

assistance please seek the help o your doctor.

Copyright 2012 David B. Reath, M.D., PLLC

THATS ABOUT IT

We hope youve enjoyed reading A Girlriends Guide to Breast Augmentation asmuch as weve enjoyed putting it together or you. Again, eel ree to link to it and

orward it to anyone you know thinking about breast augmentation.

We welcome your suggestions! Shoot us an email at [email protected].

Please tell us what you liked and let us know i we missed anything.

Documents

Guidetobreastaugmentation Knoxville