Breast Augmentation Recovery-Breast Augmentation in Athletes

Breast augmentation is common in female athletes who perform high volumes of cardiovascular exercise such as running, swimming, biking, etc. It is also common to see atrophy of the breast with competitive bodybuilders who are consistently lean for competitions. It is quite common for these women to come into our office and say, "Dr. D. I want to be able to return to my previous cup-volume.....or......Dr. D. I just want to be able to wear a strapless dress again."

The next question to follow is......."How soon can I return to working out after my breast augmentation?"

This is the simple 4 week rule.

Week 1: Walking is O.K.

Week 2: OK to return to the gym. Low impact cardio is fine such as exercise bike. Isolated arm exercises are O.K.

Week 3: OK to return to running. Patients should wear two support bras while running.

Week 4: Unrestricted gym activity is OK. Pilates and Yoga OK at week 4 as well.

Tuberous Breast Surgery. Breast Augmentation

Breast augmentation can be a very effective tool to correc the tuberous breast deformity. Tuberous breasts are not simply underdeveloped breasts. Tuberous breast characteristics iclude a widened, enlarged, puffy areola unusually wide spacing between the breasts, minimal breast tissue, higher than normal breast fold, and narrow base at the chest wall.

Correction of the tuberous breast often involve placement of a breast implant, lowering of the inframmary fold, and often scorring of the breast parenchyma below the areola.

The photo above demonstrates an approximately six month follow-up for surgery for tuberous breasts.

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Breast Augmentation. Bra Sizing.

The breast augmentation consultation can often bring anxiety to the patient as there are many questions to be addressed or discussed. These variables can range from topics pertaining to the patient (medical conditions, height & weight, bra size, pre-operative breast shape); surgeon (preference for above vs. below the muscle, incision choice); or implant (saline vs. silicone, smooth vs. textured, profile).

Determining bra size in breast augmentation consultations creates a common frame of reference for the physician and patient to discuss post operative bra size. The first step in the physical examination is observation. In the observation step, both the patient and I stand in front of the mirror and with the same perspective identify any asymmetries between the breasts.

Breasts are more often than not asymmetric with either a discrepancy in breast volume, breast fold position, nipple position, shoulder height, and chest wall asymmetry. After this step of the physical examination we proceed to pre-operative bra sizing.

Bra Sizing: The BasicsThe size of a bra is determined by two factors: 1) The Band Size & 2) The Cup Size.

The Band Size

Step 1. The band size of the bra is relatively a fixed number determined by the circumference of a woman’s chest. This number can be measured with a measuring tape in inches, just beneath the breasts, in the crease where the band of the bra would be placed.
Step 2. Add five to the number of inches determined from this measurement. For example, if the measured number is 27” then if you add the number 5, the result is 32. Therefore the band size of the bra necessary is 32. If the measured number were 28” adding 5 would result in a 33 band. One quickly realizes when bra shopping that there are no odd number band sizes, so one would try on a 32 or 34 band bra to see which fit best. In this scenario, the 32 bra would be worn on the last of three clasps and a 34 bra would be worn on the first of three clasps.The band size is relatively consistent in women of adult age as the bony ribcage has completed growing. This number will change to a small degree if a woman gains or looses weight around the chest where the band of the bra would normally be placed. The so called “bra fat”.2)

The Cup Size

I have found the “Size Me Up” system designed by Edward Pechter in Valencia, CA to be the best system for determining cup size. In the “Size Me Up” system, the dome of the breast is measured by starting the measurement from where the breast begins on the side of the chest, passing over the nipple and finishing towards the sternum where the breast ends. The resulting measurement is then compared on the “Size Me Up” chart to determine the cup and bra size.One point I have learned is that the “cup volume” or “measured breast dome” increases depending upon the band width. That is, a “C” cup represents a smaller volume breastfor a woman with a small ribcage (i.e.32 band size bra, C-cup) than a woman with a larger ribcage (i.e. 36 band size bra, C-cup).

In my experience, the best manner in which to predict the post-operative cup size is to determine the pre-operative bra size measurements and base diameter of the patient. The post-operative cup size can be predicted by using these measurements with the volume per base diameter of the breast implant.While the prediction of post-operative cup size is not exact, I find this step to be helpful, as it facilitates a common frame of reference between the patient and surgeon.

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Capsular Contracture Surgery

Correction of capsular contracture and revision breast surgery are challenging cases. This patient had painful capsular contracture and left breast double-bubble deformity. Correction of this asymmetry was done with bilateral "en bloc" capsulectomy, re-set of the inframammary fold, and change of implant profile.

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Breast Augmentation. Incision Selection

During the initial consultation for breast augmentation patients often ask questions regarding which approach is best to place the breast implant. There are advantages to each incisional approach. Which incision the patient decides upon depends upon their preference as well as surgeon input regarding pre-existing anatomical limitations.

Typically for silicone breast augmentation one of three incision choices is selected. The three possibilities are:

1. Peri-areolar
2. Inframammary
3. Transaxillary

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Breast Augmentation. Recovery from Surgery

The typical breast augmentation patient in our practice is an athletic professional woman who wants to return to work or exercise soon after surgery. Frequently patients have questions in consultation regarding recovery following breast augmentation.

I have found that our patients recover very quickly and with minimal pain and discomfort. Often I find that I have to slow my patients down.
Below I have included the post-operative medication and exercise schedule.
1. Emend 40 mg by mouth mourning of surgery to prevent nausea.2. Percocet 5/325 by mouth every 4-6 hours as needed for pain.
3. Valium 5 mg by mouth every 8 hours as needed for spasms or sleep.
4. Keflex 500 mg by mouth four times per day. (Antibiotic)
Post-Operative Exercise Regimen:
1. First week post-operatively. Walking and Exercise Bicycle.
2. Second week post-operatively. Exercise Bicycle. O.K. to add machine Leg Exercises.3. Third week post-operatively. O.K. to add Arm Exercises.4. Fourth week post-operatively. O.K. to add Chest Exercises.
5. After six weeks patients have unrestricted return to exercise such as Pilates, Yoga, Contac Sports, etc.

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Breast Augmentation. Breast Implant Proportion

Women often present to the office in consultation mentioning that they want to maintain a natural breast augmentation look. Patients will say, "I want to look better in my bikini or in my strapless dress and I don't want anyone to know I have had a breast augmentation."

One of the more challenging aspects of breast augmentation surgery is to make sure that the surgeon and the patient are on the same page with regard to breast volume goals. Typically, we have patients bring in photographs of breast sizes and shapes that they like so that we can first determine if the patient's goals can be easily obtained.

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