Baltimore, Maryland Breast Augmentation Surgery
Dr. Adam Summers

Sometimes, Dr. Summers will recommend a minor breast lift operation at the same time as your breast implant procedure.  This is typically done to correct uneven breasts or nipple/areola.  Major breast lift procedures are usually not performed at the same time as the implant procedure due to the increased risks associated with combining these procedures.

Occassionally, patients request that other procedures be combined with their breast augmentation surgery.  At the Maryland Plastic Surgery Center, procedures which Dr. Summers has combined safely with breast implant surgery include liposuction and tummy-tuck (abdominoplasty).

At the Maryland Plastic Surgery Center, Dr. Summers has performed corrective breast surgery (reduction, reconstruction, and symmetry procedures) on women of all ages, ranging from teen-agers to those in their 80's.

However, cosmetic breast enhancement with implants is typically reserved for women who have completed growing and are emotionally mature.  The youngest patient accepted for routine breast implant surgery is 18 years old.

Breast implants are "mechanical" devices which have been approved by the FDA as safe for general use.  This means that breast implants have met stringent safety and efficacy criteria.  All breast implants have a silicone shell.  The inside of the implants is filled with either saline or silicone gel.

Silicone-gel filled implants were re-approved for use in 2006.  There has been no evidence based research that demonstrates a link between silicone gel-filled implants and autoimmune diseases (lupus, arthritis, etc.) or breast cancer.  And, because silicone-gel filled implants are softer than saline-filled implants, many patients at the Maryland Plastic Surgery Center elect to have their breast augmentation procedure performed with silicone gel-filled implants.

Rarely, an implant will rupture or leak.  With saline implants, the saline is safely absorbed into the body.  If the leak is significant, a deflation of the affected breast is noted immediately.

With silicone gel-filled implants, the silicone typically remains in the implant pocket, so a deflation is usually not noticed immediately.  Over time, some patients develop an inflammatory response and the implant pocket will shrink around the silicone gel.  An MRI may be obtained to verify that a leak has occurred.

In either case, the deflated/ruptured implant may be removed and replaced with a new implant.  The implant manufacturer will provide the new implant at no charge to the patient.  Additionally, the implant warranty will cover the cost of surgery to have the implant replaced, so (aside from medications and laboratory/radiology studies, if needed) there are no additional out-of-pocket expense for replacing a deflated/ruptured breast implant.

Dr. Summers has significant experience working with both saline-filled breast implants and silicone-gel filled breast implants.  In fact, Dr. Summers was the very first plastic surgeon in Maryland to be certified by both Allergan/Inamed and Mentor Corporation (the two companies which manufacture breast implants for use in patients in the United States) to implant silicone gel-filled breast implants.

Contraction of the pocket around the implant may be reduced with massage of the implants.  Dr. Summers will instruct you in massage techniques after surgery if he believes it will be helpful.  If Dr. Summers asks for you to perform the breast massage, you would typically start two weeks after surgery and continue for several months.  The massage should be performed at least five times daily for five minutes on each affected side.

You may drive when you are not having significant pain and you are not taking narcotics for pain control.  Please do not drive if you are taking narcotic pain medication – this is just as risky as drinking alcohol and driving.  Typically, patients operated on by Dr. Summers at the Maryland Plastic Surgery Center are feeling good with ibuprofen alone about 3 days after surgery.

In general, we caution all patients that exposure to ultraviolet light can damage the elasticity of the skin, cause pigmentation changes and result in skin cancer.  However, you must be particularly careful to avoid direct UV light on any healing incision because permanent discoloration may result.  To be safe, avoid UV light exposure over the incision for six months.  Please note that, because the skin in the cleavage area is stretched, it is more susceptible to sunburn – apply extra sunscreen frequently if you are going to have your upper chest exposed.

Although it may take more than six months to see the final results of your surgery, most patients are able to appreciate a relatively “normal” appearance in clothing within the first month following surgery.  Typically, your breasts will appear swollen for a couple of months following surgery.  As the swelling diminishes, you will loose some of the fullness in the cleavage area.  As the skin adapts to the weight of the implant, you will develop more fullness at the bottom of the breast.  Occasionally, we ask patients to wear a “bra strap” for several weeks to help speed this process.  Some patients have a skin fold at the base of the breast that takes several months to resolve – in rare cases the fold persists and can only be eliminated with additional surgery.

You will need to wear your bra night and day for the first week following surgery.  The bottom of the bra should be against your ribcage, not against the breasts.  The bra should only be removed for a brief shower.  After the first week, you may sleep without the bra.  We do recommend that you wear the bra whenever you are engaging in any strenuous activity for the first month following surgery.  Avoid wearing a bra with an underwire for the first month after surgery to reduce irritation.

During the breast augmentation procedure, air is trapped in the surgical pocket around the implant. This excess air will be absorbed within several days and is nothing to be concerned about.  This is more commonly noticed with saline implants.

Itching is NOT a sign of healing.  You may have an allergic reaction to the tape or adhesive.  Please come into the office and we will examine you to see if the tape should be removed and if you need any other treatment to protect your incision.

Give us a call.  We will have you come in as soon as possible to have the tape replaced.

To help you obtain the best possible scar, we recommend that the surgical tape over the incision remains intact for the next three weeks.  We will replace the surgical tape for you approximately every 10 days or as needed. After this time, you may rub Vitamin E oil, Mederma, or ScareFade cream into the scar twice daily to help reduce the appearance of the scar.

Please do not attempt to look at your incision – pulling on the breast may stretch your scar.  You may see your incision with a mirror in the office when your surgical tapes are changed.

You may shower after the ACE wrap has been removed following your first post-operative visit.  When you shower, do NOT soak your incisions - try to keep your incisions as dry as possible. We recommend that you shower with your back to the shower stream.  Absolutely NO bathtub, Jacuzzi, whirlpool or swimming.

During pregnancy, breast enlargement occurs and this stretches the skin envelope of the breast. When pregnancy and nursing are over, the tissue within the breast involutes or shrinks, usually to a smaller size than it was originally. However, the skin remains slightly stretched and the smaller amount of breast tissue falls to the bottom of the stretched skin envelope. The result is usually a breast with somewhat loose skin, and a lack of fullness in the upper portion. A breast lift and/or a breast implant procedure can correct this situation.

How much your breasts can be enlarged depends on your tissues and your desires regarding breast size. For example, if you have never been pregnant, and have a very small 'A' cup breast, your skin may be very tight. This may limit the size that can be achieved. Also, it is important for your breasts to be in proportion to the rest of your body, so we typically will discourage overly large implants in women with a small stature.

Breast implants do not cause breast cancer. Breast cancer occurs in slightly more than ten percent of women.  Excellent scientific reviews indicate that the rates of breast cancer are actually lower in women who have had a breast augmentation procedure - this is thought to be due to the fact that women seeking breast enhancement actually have less breast tissue, thus reducing their overall risk for breast cancer.

The rates of autoimmune diseases (lupus, rheumatoid arthritis, etc.) among breast implant patients are the same as the rates of autoimmune diseases in the general population.  Many studies have reviewed the presence of autoimmune diseases, and it has been established that neither saline breast implants nor silicone gel filled breast implants cause autoimmune diseases.

Differences will always exist between your two breasts - they may be different sizes, or the nipple locations may be different. A routine breast augmentation procedure does not "control" the position of the nipples. In fact, pre-existing off-center nipples may be more obvious after an augmentation. To better align the nipples, Dr. Summers may recommend a minor breast lift type of procedure.

Drains are usually not used with breast augmentation or breast lift procedures performed by Dr. Summers.

Breast implants are mechanical devices with a failure rate of approximately 1% per year. Some patients have had breast implants in place for over 25 years, but no one can specify the life of a breast implant. At some point you may choose or need to have your breast implants replaced.

The act of replacing an implant which was otherwise intact and doing well can expose the patient to new problems. Your body is not an automobile and does not require an "oil change" every 5,000 miles.  Therefore, Dr. Summers does not recommend breast implant replacement unless there is a problem with the breast or the implant.

When any object is implanted in a person, the body naturally forms a lining or capsule around the implant.  This capsule is similar in to scar tissue and it can shrink or contract.  If the capsule contracts markedly it can squeeze your implant, resulting in distortion of the implant or make the breast feel firm (this is called "capsular contracture").  It is important to note that the implant itself has not changed - rather it is the scar capsule squeezing the implant that changes the size, shape and feel of the implant.  If the capsule is removed, the implant will feel soft again. Unfortunately, the capsule can recur. Maneuvers which Dr. Summers believes to help reduce the formation of a thick/tight capsule are routinely followed at the Maryland Plastic Surgery Center.

Rarely, the outer shell of a breast implant can break. Usually, this is due to folds occurring with abrasion of the outer shell, and is more likely to follow the development of firmness due to capsular contracture.

In the event of saline-filled implants, harmless salt water will be absorbed by the surrounding tissues - in this case the leak is easily noticed and the defective implant would be replaced with a new implant.

In the event of silicone gel-filled implants, the silicone typically remains in the implant pocket and is not absorbed by the body nor will it migrate into any other part of the body. If an implant rupture is confirmed (usually with an MRI), or is strongly suspected (due to concurrent capsular contracture), the implant can be inspected, removed if necessary, and replaced with a new implant.

This depends on the type of work you perform. Women who have a "desk job" can typically have their surgery on a Thursday and return to work the following Monday, thus only missing two work days. Women who engage in mildly strenuous activity should schedule one week off of work. Women who engage in heavy lifting and more stenuous activity may need to take two weeks off of work. The extra time off of work for women with mildly-to-more strenuous activity is necessary to help prevent problems such as swelling and bleeding which may result in other complications such as capsular contracture or necessitate a return to the operating room.

We encourage an immediate return to full, normal activity as soon as you can - many patients have enjoyed walking around the mall or outside the day after surgery. Just don't do any type of strenuous or jarring exercise that would push your pulse over 100 for about two weeks. Any aerobic activity that increases your pulse over 100 will also increase your blood pressure, and could make you bleed.

Similar to the answer about resuming exercise routines, we ask that you avoid strenuous activity which can increase your pulse over 100 beats/minute for two weeks following surgery.

Also, for the first month after surgery, you should avoid any activity that pulls, pushes or stretches the breasts, including placing pressure on the chest.  This will help to ensure that your incision has adequate strength before it is placed under any stress.

Most of our patients desire to have their breasts enlarged to a “C+” or “D” cup size.  However, the actual implant size and the actual amount of fluid put into the implant is dependent on your personal desires and your body habits.  To help us determine the fill volume, we ask that you return for a second visit with a Bali Downtime or Haynes Style G400 bra in your desired cup size.  We will have you place pre-filled implants into the bra while wearing a white tee-shirt so you can see how you might look after your breast augmentation procedure.

You can find pictures of other women who have your body type (shoulder width, height) and who have the breast size and shape you desire to obtain.  Most patients print pictures from the Internet or cut out pictures from magazines.  You can also bring in pictures of women who have a result you would not like to obtain.  In this way, we can review your desires and more closely address the possibility of meeting your expectations.  Also, please review our pre-operative instruction sheet and follow all of our instructions – especially with respect to avoiding aspirin or aspirin containing products for at least 3 weeks prior to surgery.

We perform all routine breast enhancement procedures at the Maryland Plastic Surgery Center - our state-of-the-art operating facility. The facility is Medicare certified and licensed by the State of Maryland as an out-patient surgery center.  The Maryland Plastic Surgery Center has passed rigorous on-site OSHA inspections and the Center is compliant with the most recent Life-Safety Codes.

Typically, the actual procedure takes between one and two hours.  However, you will be at the Maryland Plastic Surgery Center for approximately 3-4 hours.

In order to document your progress, we will take photographs of you prior to surgery and after surgery.  These photos will be kept in your file and are available for your review on request.  Rest assured that your privacy will be protected and that your face will not be in the photos.

Your implants come with a standard warranty that provides you with a free lifetime replacement if an implant leaks.  The implant company will also pay for the cost of your procedure to have the implant replaced during the first 10 years following surgery. 

Note: Saline breast implant patients have an option to "upgrade" their warranty.  We recommend that you take advantage of this additional valuable warranty coverage as described in the warranty booklet – please review the implant company’s literature we provide to you on your first post-operative visit for more information.

Please call us at any time if you have any questions.  However, we definitely need to hear from you as soon as possible if you notice any of the following: 

• Fever over 101-degrees
• Increased swelling in one breast
• Pain not controlled by pain pills
• Persistent nausea or vomiting
• Drainage from your incision

The pain medication should be taken at the first sign of pain...do NOT wait for the pain to become severe.  Dr. Summers usually recommends that patients take only half of one pain pill at a time.  After waiting about 30 minutes, another half of a pill may be taken if the pain is still present.  Do not exceed two full tablets in a four hour period.  Please refer to the “Avoiding Postoperative Nausea” instruction sheet for instructions on appropriate use of the pain medication.

There are no restrictions on your diet.  We do recommend that you review the “Avoiding Postoperative Nausea” instruction sheet for diet recommendations the first 24 hours following surgery.

You are seen according to the following schedule:  One day after surgery for removal of the ACE wrap, a review of the surgical results, and post-operative instructions.  Six days after surgery for removal of the stitches (this does not hurt) and new tape application.  One week later for your second tape change.  One week later for your third and final tape change.

The amount of swelling and bruising is quite variable.  Some patients have almost no bruising, while others have significant bruising that persists for several weeks.  This is related to the amount of work performed and your own body’s natural response to trauma.  In general, most patients notice complete resolution of bruising within 2 weeks.  The swelling can persist for several months.

Please note, most patients have minor abdominal swelling for the first two days after their procedure.  This is normal and is nothing to be concerned about.

Avoid strenuous activities for three weeks after surgery. Specifically: