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Vijay Moradia, MD, FACS Your Friendly Plastic Surgeon Cosmetic Plastic Surgery 386-756-9009 Breast Augmentation Page 1 of 48 A fun way to learn about Breast Augmentation Having well proportioned and well placed breasts makes adolescent girls and women happy and confident. It provides for better dress up, ..

    Vijay Moradia, MD, FACS

    Your Friendly Plastic Surgeon

    Cosmetic Plastic Surgery

    386-756-9009

    A fun way to learn about

    Breast Augmentation

    Having well proportioned and well placed breasts makes adolescent girls and women happy and confident. It provides for better dress up, better social image and better personal relationship.

Making breasts look bigger and better - than they are - is an age old art practiced by

    women of all origins. Long before the Plastic Surgeons decided to cash in!!!!

    Before you read on, please know that despite a few jokes and silly quotes in the following pages,

the information and its serious nature is for real.

    And don‟t drink or drive while you read. Take a regular pen and a highlighter or a red pen. Mark what you like in regular pen. Mark what you have questions on or don‟t understand in red or highlight. Not liking something in this information packet is not allowed.

    You can also save this to your computer and adjust the fonts, size and colors to your liking.

Let us start:

    The big secret is padding. Starting from bathroom tissues, socks, napkins, sponges, and silicone gel pads and padded or water bras they all work. (Except when you are in a pool,

    some may swim next to you.)

Breast implants basically- are internal padding. Guaranteed water-proof.

Making the breasts larger is a very commonly performed cosmetic surgery.

It is usually done by using an implant.

    Breast Augmentation Page 1 of 48

    Vijay Moradia, MD, FACS

    Your Friendly Plastic Surgeon

    Cosmetic Plastic Surgery

    386-756-9009

    It is also possible to enlarge the breasts by using body‟s own tissues; however, the complexity, risks, donor site scars and complications make this method not practical for cosmetic reasons.

We will talk about the implants first.

SALINE AND SILICONE GEL FILLED BREAST IMPLANTS

    Saline filled breast implants are approved for the augmentations and reconstruction of breasts by the FDA. Silicone gel filled implants are placed under study protocol guide lines by the FDA and the manufacturers - and are limited to certain group of patients only. They may be available to all patients in near future the FDA full clearance is being

    awaited eagerly by all of us.

    I use the Inamed or the Mentor breast implants. They are made in the USA and carry good applicable warranties and support. I use both saline and silicone gel filled implants.

    Breast implants have been around for decades. There were many different types. Different type of shells and different types of inside filler materials have been tried. The only ones staying on the market are the ones where the outer shell is made of solid silicone and the inside contents can be either salt water (saline) or silicone gel.

The “Saline” implants come empty in the box. They are inserted fully folded and thus the

    surgical incision scars are smaller. They are filled with „Sterile Normal saline‟ solution

    during the operation. Saline means salty (water). The term „Normal‟ simply means that the saline solution is matched to human body‟s fluid concentration. (It is “Normal” in relation to human body. It may not be so normal for ocean fish, turtles or plants etc. It is probably not so normal for aliens from the outer space as well!!) Sterile means, every thing alive (or half dead) in the water has been killed by the company that makes the saline bags.

    In the regular kind saline implants, the filling tube is disconnected and removed after the saline implant is filled up. There is also another adjustable variety, where the filling tube is connected to a small filling metal/plastic chamber; it is left attached and placed under the skin.

    Breast Augmentation Page 2 of 48

    Vijay Moradia, MD, FACS

    Your Friendly Plastic Surgeon

    Cosmetic Plastic Surgery

    386-756-9009

    These implants can be adjusted in volume through the skin for up to a few months and then the filling port and tube are removed with a second small operation in the office. Don‟t dream of using this feature to make the breasts bigger for a party and then let it down. Tissue that stretch, don‟t come back to normal afterwards.

    And the additional bump of the filling port is not cosmetic!! The filling port must be removed by approximately 6 months after the original surgery.

    The “Silicone” implants are filled at the factory with silicone GEL material. These implants need larger incisions to insert. They are not adjustable in the operating room or later. You can check out the silicone gel stuff in the Home Depot too. The kind we use is just a little cleaner and a lot more expensive.

    Several other fillings have been tried and none have become practical yet.

    The implant shell can be of either smooth or textured surface. The textured surface is considered to create less of a thick/tight scar capsule compared to the smooth one. However, the textured implants are MORE likely to be felt through the skin in MOST of the remaining patients, because they are thicker and less soft shells. I prefer the smooth variety.

    The shapes of the implants include round and tear drop oval (or „anatomic‟, „contoured‟ etc). Implants do tend to spin in a circle and even flip over - inside the breast pocket; early on, if the pocket is large enough. This means that a tear drop shaped implant can end up making one or both breasts looking odd and tilted. The round implant shape is more uniform. Also, the oval implants are placed symmetric in the operating room in semi-sitting position. After the healing, different body positions tilt them differently and the two sides may not look symmetrical. The oval implants stay oval, whether standing up or lying down. Normal breasts change shape. The round implants also change shape somewhat.

    Also, the round implants have an advantage of becoming more tear drop shaped when you stand by the effects of gravity and pressure from the muscle on the upper pole of the implants. Obviously, I am a fan of the round ones. But, if you want to talk about the oval ones in details, you are welcome to our office. Remember, we don‟t charge for talking to you. (AKA a Complimentary Consultation to be politically correct.) Listening to you may

    be a different ball game.

    Breast Augmentation Page 3 of 48

    Vijay Moradia, MD, FACS

    Your Friendly Plastic Surgeon

    Cosmetic Plastic Surgery

    386-756-9009

    The round implants are available in different projection heights (HIGH, MODERATE AND REGULAR) for the same base diameters. This means that a 300 cc round REGULAR profile implant will have a broader base diameter and a shorter projection height, where as a 300 cc HIGH profile implant will be narrower and taller.

    Or, in other words, for the same 300 cc volume, you get a higher breast projection with the high profile implants and the sides of the implants don‟t spill over on to the sides of

    the chest.

    Most patients will benefit from the high profile. Some may prefer a MODERATE profile implant. Few may actually need the broader Regular profile implants. One Other advantage of the High profile design is that because the slope of the implant is steeper, the edge of the implant is much closer to the base than the other profiles. This leads to less formation of the edge ripples and makes them less obvious.

    All Implants, including the silicone gel; show edge ripples to some degree when filled. Think of it this way if you fill the implants with air, the shell can form most obvious ripples, the air allows the „plastic‟ to fold in where ever it wants to. Fill the implant with Saline (salt water), the water will be able to resist the shell folds better, reducing the depth and size of the ripples. Silicone gel provides the most resistance to the fold formation and is generally the best implant to minimize or even eliminate the ripples.

    Ultimately, the amount of the breast/muscle and skin/fat over the implant decides the visibility of the implant ripples. The high profile saline implants have their edges near the bottom and steep slope on the sides - they tend to ripple less than the regular profile ones, and the ripples tend to be better hidden.

Saline implants are perceived as being „safe‟ by most lay persons. If the saline leaks out,

    it is the same salt water that you get intravenous during any medical/surgical encounters. It will simply be absorbed by body with no adverse effects. The leak can happen possibly through the filling port valve. The valve is similar to a basket ball valve. It is located inside the implant and tends to close tighter when pressure is applied to the implant. Leak can also happen through a shell defect. Usually the leak is slow, drop by drop and may take several days or even weeks to become obvious. It may also be intermittent. The best way to appreciate a partial leak is to have some one look at the breasts when you lie down. You can also feel the difference in the weight of the implant and the implant may feel floppy in side.

    Breast Augmentation Page 4 of 48

    Vijay Moradia, MD, FACS

    Your Friendly Plastic Surgeon

    Cosmetic Plastic Surgery

    386-756-9009

    A leaked implant when removed may have some yellowish fluid rather than the clear saline solution this is probably due to transfer of body proteins through the defect into the implant. The body proteins generally can not cross an intact silicone shell membrane. A saline implant by itself does not have much exchange of water or salt with the body.

    Any air bubbles left inside the implant at the time of surgery are absorbed into the body across the shell. By the same token, implants filled completely with water and left for several days in a room, will collect air inside the shell the air out side the implant gets in.

    In side the body, the air left between the implant and the breast tissue at the time of surgery may make funny noises in side when you squeeze the breast tissue, it gets absorbed and then any air bubbles inside the implant will disappear too.

    Both Inamed and Mentor provide a life time free replacement pair of implants in case of leak and they have limited financial assistance warranties too. Please remember, the warranties are between you and the implant company. I have no business interest in that. You can get your warranty services ANYWHERE in the USA and by ANY PLASTIC SURGEON. If you see a Plastic surgeon, always ask what company implants does he/she use, what is the warranty and who is giving the warranty. Implants made outside the USA may be cheaper to buy for the surgeon; you may not get any warranty at all. Also, you may not get the recall notices!!! (Yikes).

    Generally a simple implant exchange operation can be done under local anesthesia and may not be expensive.

    Reshaping the internal cavity and reshaping the breasts is done under general anesthesia and takes two to three hours to complete. It is more expensive.

    Silicone gel implants have the best soft - natural breast like - feel at the body temperature. The current silicone gel implants are made of more cohesive (sticky) gel than those of the past. Some of the Inamed and Mentor (Cohesive II) implants can actually be cut in two pieces without having the gel spill or run. Sometimes they are also called the Gummy Bear Implants. Don‟t let your friend have any chewy ideas though.

    The technology of breast implant design, development and manufacture will continue to progress and improve. Newer or future generations of implants may be better in some way from those currently available.

    Breast Augmentation Page 5 of 48

    Vijay Moradia, MD, FACS

    Your Friendly Plastic Surgeon

    Cosmetic Plastic Surgery

    386-756-9009

    Once the FDA clears the silicone gel implants for free market, it will be open to all cosmetic breast augmentation patients. Presently, only new reconstructive cases, congenital absence of breast and patients with very thin / loose breast tissues undergoing a breast lift qualify. Patients who already have an old silicone gel implant and want to replace them with new silicone gel implants are also qualified.

    Patients with saline implants showing a lot of wrinkling/rippling and having very thin soft tissue cover also can exchange them for silicone gel implants.

    For the last decade, there has been a lot of concern over the possible systemic effects of the leaking silicone gel from the old implants. No definite conclusive lab test proven connection has been demonstrated yet. Also, the shell material of a breast implant is always silicone. There are silicone solid implants for small joints, silicone catheters, silicone covered heart pacemakers, silicone face and body augmentation/reconstruction implants etc. being routinely used in human body. The implant manufacturer and FDA web sites may carry the latest information about silicone research.

    Just for curiosity, there may have been a double decked implant; manufactured in the past. Also, there are anecdotal reports of doctors placing two stacked implants in one breast!

Web sites for your knowledge:

    www.inamed.com

    The Inamed Corporation 1 800 624 4261

www.mentorcorp.com

    The Mentor Corporation

    1 800 MENTOR 8

www.fda.gov/cdrh/breastimplants/

    The Food and Drug Administration

    1 888 INFO FDA

www.plasticsurgery.org

    THE American Society of Plastic Surgeons

    1 800 635 0635

    Breast Augmentation Page 6 of 48

    Vijay Moradia, MD, FACS

    Your Friendly Plastic Surgeon

    Cosmetic Plastic Surgery

    386-756-9009

www.nap.edu/catalog/9618.htm

    The Institute of Medicine Findings

    1 888 624 8373

    WebMD and similar medical knowledge sites can be a good source of information. Be aware that many of these sites will charge you per article from medical journals and the

    information you get may be all Greek or worse (statistics) to you.

    And there are a lot of private cosmetic surgery sites on the internet too. What you are reading now is most likely the most informative web page you are going to run into.

WHO CAN HAVE BREAST IMPLANTS

    Any female who wishes to have breast enhanced by implants must be a healthy and a happy person to start with.

Tran-sexual Males can have this done too just not in my place. I have elected not to

    practice any trans-sexual work. I don‟t think I am good enough to address the complex

    psychological need and issues of these patients. Sorry.

Also, the answer definitely is NOT everyone who can afford it.

    And the reason for that is I love my integrity and license far more than some one who wants to muscle in with a lot of cash.

    This is serious business - just look into the reports of patients who have been hurt getting this surgery done. If you call the medical board of your state or the American Society of Plastic Surgeons, or just surf the web you will find a lot of not so happy

    stories around.

Take the decision to undergo surgery seriously.

    DO IT ONLY AND ONLY FOR YOUR SELF.

    Your significant other may have a good time with your breasts and your personal relationship with him may improve substantially. However, in the event of a complication or an otherwise good result that he does not like, you become the ultimate loser.

    Breast Augmentation Page 7 of 48

    Vijay Moradia, MD, FACS

    Your Friendly Plastic Surgeon

    Cosmetic Plastic Surgery

    386-756-9009

    As to you being Happy - That is the goal of the surgeon as well. But having large breasts will not solve all your life issues. Better find other simple solutions for those.

    Breast augmentation has been and will most likely be performed hundreds of thousands of times a year in the USA.

    You must be at least 18 years of age for cosmetic breast augmentation according to the FDA. (Ha! The famous last words you have always heard, since you were born! Also, funny that they let you drive before 18! ).

    Any one under 18 must come with her parents to my office. Individual exceptions must be well discussed and documented. If you are under 18 and already a teenage mother, I suggest you explore all legal issues for surgery consent beforehand. And you can still almost count on waiting till you are 18.

Under 18, you should spend more time on learning to drive better always keeping a space

    between you and all other cars and people around you, whatever your speed may be.

    Staying away from concrete barriers, light poles, trees and shopping mall entrances is healthy too.

    18 and up to 65 (healthy and active) is a good range for me. As long as, you are actually going to enjoy the results of my labor and your torture, it will be worthwhile. Beyond 65 we need to talk.

    Younger than 18 if there is a congenital absence of breast or other development problems, it may be OK. Once again, please bring your parents.

WHO CAN NOT OR SHOULD NOT GET BREAST IMPLANTS

    First of all - If you are an unhappy person before the surgery, chances are that you will still be the same cranky person afterwards - may be even more so.

    I prefer to spend my time with people who smile spontaneously, rather than demand that I make them smile.

    Breast Augmentation Page 8 of 48

    Vijay Moradia, MD, FACS

    Your Friendly Plastic Surgeon

    Cosmetic Plastic Surgery

    386-756-9009

    To understand why this is so important, we will go through a lot of details.

Don‟t even think about a breast implant if you have any infection anywhere in the body,

    untreated breast cancer or pre-malignant breast disorders or other conditions likely to cause cancer elsewhere in the body. Also if you are currently pregnant or nursing, get that over first.

    Any damage to tissue be it surgery, injury, infection, burns, radiation, chemical damage, immunological damage…. the dog barking next door, etc. - will be repaired by the body

    using a marvelous process called scar formation. This happens both inside the tissue and outside on the skin. The healing by scar formation is supposed to happen to the best of the body‟s capacity.

    So, if you have a condition that reduces the healing process (medical conditions, connective tissue disorders, Autoimmune diseases such as Lupus, Scleroderma, Rheumatoid conditions and some inherited disorders with abnormal healing and weak connective tissues etc. Also, a weakened immune system (e.g. on a chemotherapy or drugs to suppress the immune system), HIV, poor nutrition… etc.), you are possibly in trouble -

    before you even begin.

    And if you have smoked tobacco away to no end, that may stop you from starting the renovation project in the first place. Smoking makes the microcirculation poor and also adds some poisonous carbon monoxide to your blood. You may have a lot of hemoglobin in your blood; some of it may be just useless functionally.

    At the least, you must not have other on-going problems that can make your and my lives miserable.

    By that, I mean, a bad heart, uncontrolled high blood pressure, bad diabetes, tendency to bleed, bad back, spine, knees and hips; poor healing, crappy lungs, life long friendship with the Camels (also called a life time of smoking), active infections anywhere in the body (this includes uncontrolled HIV too), connective tissue disorders, unexplained anemia, blood dyscrasias, untreated cancers, regular use of steroids, chemotherapy, old damage to the breast such as radiation therapy, previous surgical tic tac toe marks, too much weight gain, any tendency to psychiatric problems, unrealistic expectations, uncontrolled endocrine problems, previous blood clots in the leg muscles and/or in the lungs or other body organs, significant stroke, chronic fatigue syndrome etc.

    Breast Augmentation Page 9 of 48

    Vijay Moradia, MD, FACS

    Your Friendly Plastic Surgeon

    Cosmetic Plastic Surgery

    386-756-9009

    Also, no help at home for after care, some one pushing you to get the Breast Augmentation, no spare money in the bank account to feed you while you can not work………… you get the idea.

Trust me; I did not repeat these warnings for „no good reasons‟. Pay attention to them.

    Either - these bad conditions can make the Breast Augmentation a nightmare and a bad day-dream combined.

Or - the Breast Augmentation can make the bad conditions much worse.

And don‟t forget the ultimate complication, much as I hate to mention it, life and death

    are facts.

THE ANATOMY

    Breasts are sitting on top of the Pec Muscles. You can visualize your Pec muscles in the mirror by following the maneuvers done by body builders. (You may have to try hard!) (Some girls are born without the Pec muscle and the breast it is called the Poland

    syndrome and it does not happen in Poland alone).

    The Breasts get their life (blood supply) from one big artery coming from the arm pit and passing through the Pec muscle. It also gets several smaller arteries from inside your chest, coming through the rib spaces near the sternum and a few small arteries coming from your back, around the sides.

    And the breast has a nipple (Genius!), about 15 to 20 milk ducts going towards the base with more mini ducts and a lot of milk sacs (alveoli). And when you make milk, you can feed a hungry little one. Make sure that you have stopped making milk before doing an augmentation! (Also, if you make milk without having had a pregnancy, talk to your Gyn first. Something in your brain or the body (such as a hormone producing tumor) is causing the milk production.

    Breast Augmentation Page 10 of 48

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