The Big (and Small) Picture – Part 3

If you’re unhappy with your breast size, breast augmentation could be the answer to achieving the shape you want. In the final segment of our Breast Augmentation interview, Dr. McKee talks in-depth about the potential complications associated with the surgery. Plus, what you’ll need to do after your surgery to help protect your investment.

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What else can you tell me about complications associated with the surgery?

David E. McKee: Yes. First of all, you have to have an anesthetic. There are people who do this operation under local anesthesia, but the truth is, there is no anesthetic that’s 100% safe. And the amount of sedation that’s required to do this operation under local anesthesia probably makes it more unsafe to do it that way than just to put somebody to sleep. General anesthetic is incredibly safe today, but there’s always some risk. No matter what kind of anesthesia it is, you can get a medicine that can cause you some reaction that you could even die from, but that is incredibly rare. So that’s the first complication I always tell people about.
You could have a pulmonary embolism from a blood clot that forms in your leg- again incredibly rare, especially in an operation, like breast augmentation, that is so short (I do it in about an hour and fifteen minutes) that the chances of you having any blood clot problems is almost zero, but nothing is zero in medicine.
Then you get to the operation itself: you could get a wound infection. Wound infections in breast implants are very, very rare because we’re careful in every operation to keep things sterile, but we’re incredibly careful about any time we’re putting foreign bodies in because it doesn’t take many bacteria to cause an infection in the face of a foreign body. So if you get an infected implant, it’s very possible and even probable that we’re going to need to remove the implant to get the infection clear. So we are very careful about infection, but infected implants occur in the United States with some frequency. Not as high in breast augmentation as in breast reconstruction, but still.
Malposition: we work very hard to make the pockets exactly the same, perfectly smooth, how big they are on the sides, how tall they are at the top, but sometimes after you’ve fixed the pockets and they’re perfect, implants can move.
Implant failure is not a complication: it’s guaranteed, if you live long enough, because all implants fail. All implant manufacturers guarantee their implants for life and will provide you with a replacement implant, no matter when it occurs, whether it’s 20, 30, or 40 years later, they will supply you with a free implant to replace the one. But, they only give you money to help pay for the replacement of your implant in the first 10 years. Beyond 10 years you can buy an extended warranty from the company and, if you do that, they will provide you with money to help replace the implant no matter when the implant has to be replaced.
The single biggest complication in terms of frequency is capsular contraction. Every implant gets a scar around it because your body recognizes the implant as a foreign body. That is not a complication, but in some patients, that scar thickens and tightens down around the implant and it can make look and feel different and it can be uncomfortable. Probably the frequency of capsular contraction, either in one or both breasts, is as high across the board in the U.S. currently as about 35%. Most of those patients do not require surgery because it’s not severe enough that it bothers them that much. It doesn’t change the way the breasts look or feel and it’s not painful, but if you check the breasts for symmetry by feel, you’ll find that one is encapsulated and the other is not. That patient doesn’t have to have anything done, but she has a complication called capsular contraction. They are graded from 1-4, many of the complications of capsular contraction are mild and do not require surgery, but about 5% of patients who have breast implants will require treatment, surgery, for capsular contractions.

After Your Operation

DEM:  Let me talk about post-operative care a minute. There’s a thousand ways to take care of breast enlargement patients after surgery. Anything that’s been proven beneficial, everybody does, but the rest is magic, and every doctor has their own magic. Some doctors wrap patients up in Ace bandages, some use special surgical bras, some doctors make patients buy this or that special device. All of that is “magic”. My personal approach is, I use gauze dressings on the incisions only, let the patients take those off a day after surgery. I let patients shower after 24 hours, put a little vaseline on the incision and wear a t-shirt as a dressing. I do not wrap and I do not want patients in a bra at all, at least until they come back for their first visit. That’s my personal magic, and I’ve had good results with it.
Whether your implant is above or beneath the muscle, there are certainly activities you want to avoid: stooping, bending, straining, lots of things with vigorous arm motion, certainly lifting heavy weight, running, jumping, jogging. All of those things should be avoided for 3 weeks in my practice and with some doctors, even longer.

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If you think Breast Augmentation might be for you, schedule a consultation with Dr. McKee.  E-mail us using the form below or call us at 615-868-4091. All information is kept confidential.

This is provided for informational purposes only and is not intended to take the place of a personal consultation. Every patient has different needs.  As always, Dr. McKee would prefer to speak with you in person to discuss your specific situation.

The Big (and Small) Picture – Part 2

Welcome back! If you’ve got a lot of questions about breast augmentation, you’re not alone. In part 2 of our series, Dr. McKee addresses the “Before and After” of Breast Augmentation surgery- what makes a good or bad candidate? What about recovery? Then we’ll meet office manager Jeanie McKee to discuss pricing and payment options.

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Who is a good candidate for breast augmentation surgery? Or maybe conversely, who is NOT a good candidate?

David E. McKee: I would say that a patient who is at high risk for breast cancer is not a good patient. Breast implants don’t cause breast cancer, but they do make it more difficult to image the breast. and if you are at high risk, if you have several relatives (like your mother, your grandmother on your mother’s side, your sister) who have had breast cancer, I think it’s an unwise operation for that patient. Otherwise, I don’t know that there is a person that shoudn’t have an augmentation. I do believe that there are patients who are much more likely to get good results and have fewer problems. That would be older patients who have finished having their children, who have a little extra breast skin, and who don’t insist on pushing very big. The bigger you go, the higher the complication rate, particularly the smaller you are to start with. And 18-20 year old women who have never been pregnant, who have AA breasts and no extra skin and who come in and want to be Ds, that a very bad set-up for a high complication rate. That’s a lot of implant to put in a patient at one time and expect everything to come out nice without a revision.

Is  there anything I can do before surgery to help ensure a good result?

DEM: Yes- don’t smoke. All complications go up in smokers. Obesity increases the risk of complications of ALL surgeries. It increases the risk of wound infections, and other complications. So maintain a healthy weight and don’t smoke. And then, I would say, there are specific things that your doctor will ask you to do in the few days before surgery related to sterility- showering with special soaps and those sorts of things, so make sure to do those things exactly as instructed by your doctor.

Let’s say a woman does have a baby after having breast implants. Could she still breast feed?

DEM: Since I don’t know if a woman would have been able to breast feed before she got breast implants, I would never guarantee her ability to breast feed, but there’s no reason that a woman who has breast implants should not be able to breastfeed if she gets pregnant and has a baby. There’s nothing about the implants that would be worrisome for breast feeding, nor is there any change in the breast. I don’t cut any ducts, I don’t even cut through breast tissue, that’s why I like the incision under the breast. Unless you put such a large implant in that it pushed so hard against their remaining breast tissue that it caused it to atrophy, which is possible, I think most people with breast implants can breastfeed.

How long will it take me to recover after surgery?

DEM: If you have the implant placed under the breast but above the muscle, if you have a sedentary job, work at a desk, keyed in an computer, if you had your surgery on Friday, you could probably go back to work on Monday. If you had surgery with the implant placed under the muscle, you’re probably going to miss 3 to 4 days, maybe even a week of work. It just takes that much longer to get over the surgery under the muscle in terms of soreness.

Will there be activities I can’t do again after breast surgery?

DEM: No. There is nothing that a patient with implants can’t do that any other patient can do once they are healed. There are all sorts of rumors out there, things about skydiving and implants blowing up in scuba diving and patients getting into sunbeds and having explosions. All of those are old wives’ tales and urban legends. There’s nothing that a patient with implants cannot do that anybody else can do.

Will insurance pay for my augmentation?

DEM: No. I don’t know of any insurance that will pay for breast enlargement surgery. It’s even difficult in patients with a severe deformity, like asymmetry, a difference in the size of the breasts, and I’m talking several cup sizes. It is very difficult to get them to let me fix that by putting an implant in the smaller breast. Although insurance does often pay for breast implants in the opposite breast in patients who have mastectomies for breast cancer if it’s necessary to get a symmetrical appearance.

As you’ll find when you visit our office, you’ll meet with Dr. McKee for your initial consultation, then you will also have an opportunity to speak with Jeanie McKee, Dr. McKee’s office manager. With Jeanie, you will learn all about the cost and payment operations for the procedures you’re considering.

How much should I expect to pay for a breast augmentation?

Jeanie McKee: The total cost is $5647 or $6547. That variation depends on whether you choose saline or gel implants, which cost different amounts. The cost includes the surgeon’s fee, the hospital fee, anesthesia, and the cost of the implants, so that includes everything required for the surgery.

What payment options do I have?

JM: All cosmetic surgery has to be paid in full before the date of surgery. In addition to cash and check, we accept Visa, Mastercard and American Express. We do offer Care Credit, which is a nationally recognized company who handles financing for health issues, and is used a lot for cosmetic surgery. Our office can help you apply, if necessary.

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Please come back for part 3 of our discussion- Dr. McKee will talk about potential complications with the surgery and how to help take care of your investment after surgery.

This is provided for informational purposes only and is not intended to take the place of a personal consultation. Every patient has different needs.  As always, Dr. McKee would prefer to speak with you in person to discuss your specific situation.
To schedule a consultation with Dr. McKee, e-mail us using the form below or call us at 615-868-4091. All information is kept confidential.

The Big (and Small) Picture – Part 1 of 3

An Interview with Dr. McKee about Breast Augmentation Surgery

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If you are one of the increasing number of women who are considering getting breast implants, then you probably have many questions about the procedure. Am I a good candidate for the procedure? Will it look natural? What are the risks of complications? In Part 1 of this 3-part series, Dr. McKee speaks openly about implants, incisions, the problem of “going too big”.

David E. McKee:The first decision you have to make about breast augmentation is where are you going to put the incision? Where am I going to have permanent scars? It’s not a question of whether or not you’re going to have scars, it’s a question of where you’re going to have scars. There’s the belly button, very few people in the country are doing that operation. Nobody in Nashville as far as I’m aware is doing a belly button. So, if you eliminate the belly button, then you’re left with 3 basic places for a scar: the crease under the breast, around the areola on the front of the breast, or scars in the armpits. The armpit scar is a very nice scar, it’s off the breast, so it’s not very noticeable, but it requires you to do the operation as a blind surgeon, you can’t really see what you’re doing. So I reject that approach. I either use the incision under the breast or the incision around the areola, but the incision around the areola, to me, is just in a more noticeable place than the incision in the crease under the breast.

Will there always be a scar?

DEM: There’s always a scar. You cannot do any surgical procedure without a scar.

What kind of scar could I expect to have?

DEM: My standard approach, I use a 4-5 cm-long incision in the crease under the breast, which ends up about a centimeter or a centimeter and a half up on the bottom of the breast after the implants have settled just a little. 5 centimeters is 2 inches, so it’s just under 2 inches long. It heals as a thin white line scar. It can heal as a wider scar- if it does, we can always do a little revision in the office and see if we can’t get a thinner scar. I’ve never had a keloid scar on the breast, but I have had a few scars that I’ve revised in the office under local anesthesia.

After deciding where to make the incision, the next decision is where’s the implant going to be? Is it going to be under the breast or under the muscle and there are specific indications in my mind and advantages and disadvantages to each of those locations.

The third decision is what kind of implant are we going to use? Not only do we have to decide between gel and saline, but we also have to decide between textured and smooth, round and shaped, or tear-drop implant, so it’s a very complex choice. I will use pretty much any implant that a patient wants, but I have my own prejudices based on 30 years of doing augmentations.  My standard implant is a gel, round, smooth implant. That’s the implant I think will give the most consistently good result. But there are complications associated with all the implants.

What’s the difference between silicone and saline implants?

DEM: A saline implant is empty when you get it and you just fill it up with IV saline, which is just salt water. You have some flexibilty in terms of adjusting the volume on the operating table. The gel comes pre-filled, you cannot adjust the volume, but there are plenty of sizes of gel to accommodate different needs. The biggest difference for me, and the reason I prefer gel, is because it’s more natural to the hand. The gel is made with a consistency that is very much like natural breast. The saline is much firmer.

How long do implants last?

DEM: The average lifespan on the new generation of gel implants, I think, is going to be greater than 15 years. It’s probably going to be closer to 20 years. Probably on the latest generation of saline implants, it’s going to remain about 15 years. But there are no guarantees. I certainly have patients with 30-year old implants in, but I also have patients where I’ve put implants in who have had implant failure within the first year. So these numbers are averages of length of survival of implant, so for an individual all bets are off. But the average lifespan, I think, is going to be over 15 years for both types.

How do I decide what size is best for me?

DEM: There is no right or wrong answer about size, but I always tell people, ‘The harder you push, the bigger you go, particularly the smaller you are to start with, the higher the complication rate. Of all complications: implant displacement, getting the implants uneven in terms of their position on the chest, capsular contraction, infection, bleeding, nerve injury- injury to the nerve that goes to the nipple and gives you permanent feeling in your nipple. All of those complications go up the harder you push,the bigger the implant you try to put in. So I try to encourage pts to be realistic about their size, particularly the young women who have never been pregnant, who have A or AA breasts. We can certainly go to a C, C+ a little bit, but beyond that I think you are risking complications and I try to discourage that. Ultimately, it’s up to the patient, but if a patient asked for me to do something I wasn’t comfortable doing, I’d just suggest that they probably ought to go see somebody else.

We size patients in the office with a bra and different implants that are placed in the bra just to give an idea, a starting place. The office manager helps them work through that process. It’s not perfect, but it gives us a range, it gives them some idea.

(Click here to see what Dr. McKee has to say about the visibility of breast implants)

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In part 2 of our interview, Dr. McKee will discuss payment options, recovery times, and what you can do NOW to become a better candidate for the procedure. Stay tuned!

This is provided for informational purposes only and is not intended to take the place of a personal consultation. Every patient has different needs.  As always, Dr. McKee would prefer to speak with you in person to discuss your specific situation.

To schedule a consultation with Dr. McKee, e-mail us using the form below or call us at 615-868-4091. All information is kept confidential.