After breast augmentation, you want breasts that look and feel completely natural.  They must feel completely soft.  If the breasts feel firm, this is called capsular contracture.  We are now very good at preventing capsular contracture. 

Some of the ways to get soft breasts consistently are:

1. do the surgery very gently so the tissues don’t get bruised

2. control all the little blood vessels so there is absolutely no bleeding in the implant pocket

3. irrigate the wounds with antibiotic solution to prevent even the most minimal infection. 

We also sometimes prescribe two medicines that can help produce soft breasts.  The medicines are called Accolate and Singulair.  They are routinely used for the prevention and treatment of asthma.  But in 1998, it was discovered that Accolate and Singulair are also useful for capsular contracture.  Several scientific studies have shown that these two medicines help to get natural breasts after breast augmentation surgery.

We work very hard at preventing post operative nausea in own out patient surgical suite.  By using a combination of different techniques and medication, our anesthesiologists have managed to lower the incidence of nausea after surgery to less than 5% of patients.  One of the medications we use is Decadron, which is in the cortisone family.

Our successful experience has been confirmed and validated by scientific study presented at the annual meeting of the American Society of Plastic Surgeons in October, 2007.  Seventy cosmetic surgery patients were studied.  Half of them (35) received Decadron and the other half did not.  Of the 35 patients who received Decadson, only 2 (5%0 developed nausea after surgery.  Of the 35 patients who did not receive Decadron, 9 (25%) had nausea. 

 So the conclusion is that cosmetic surgery patients should receive Decadron to prevent post operative nausea.

Some studies have been reported about breast augmentation using the patient’s own fat. Although this sounds great, it is very controversial and I think that women should avoid it for the foreseeable future.

Both The American Society Of Plastic Surgeons (ASPS) and The American Society For Aesthetic Plastic Surgery (ASAPS) have issued statements declaring that they do not recommend fat injections for breast augmentation because of the lack of safety and efficacy information. The President of ASPS said: “Patients considering breast augmentation need to know that fat grafting for this indication is not recommended at this time, unless one is part of an ongoing clinical research study.”

Fat injections are now quite refined and we routinely use fat injections in the upper face, cheeks, and lips. For the face, fat injections are completely accepted, safe and effective.

But the breast is a different matter. Obviously, much larger amounts of fat injection are needed for breast augmentation, and some of this fat may not survive. This failure of some of the injected fat to survive may lead to the formation of cysts, scarring, and calcification. These calcifications in particular may be a real problem because they could be confused in a mammogram with calcifications associated with breast cancer. This might complicate the accurate early detection of breast cancer.

So, I am not using fat injections into the breast except in very exceptional situations. Both saline breast implants and silicone breast implants have been shown to be safe and effective over the long term. I am one of the clinical investigators for silicone breast implants, and I think that breast implants will remain the standard of care for breast augmentation for quite a while.