Breast Augmentation in St. Louise
Conveniently located to serve St. Louis

Typical candidates for breast enlargement are physically healthy, have fully developed breasts, and have reasonable expectations for the outcome of the surgery. Looking at breast augmentation before and after photos helps patients understand the results that can be achieved.

Ideal candidates seek out this procedure for the following reasons:

• Dissatisfaction with breast size
• Dissatisfaction with loss of breast volume and shape after pregnancy, aging, or weight loss
• Dissatisfaction with the upper area of the breast seeming “empty”
• Asymmetrical breasts
• Elongated breast shape
• One or both breasts failing to develop normally

This procedure is not recommended for women who plan to lose a large amount of weight or become pregnant in the near future. Dr. Rottler and Dr. Hulsey may recommend that you stabilize your weight prior to surgery.

Many patients benefit from a combination surgery called breast augmentation with lift. Technically referred to as augmentation mastopexy, this combines a breast lift and implants to enlarge the breasts while eliminating sag. When a patient desires elimination of sagging but has no interest in larger breasts, a breast lift without implants is the better option.

The technology used in breast augmentation has come a long way from the first procedures. Today, there are three main implant options. Each implant type has properties which are unique to the device and may make one more favorable than others in certain circumstances.

Saline-filled breast implants: These implants are filled with sterile salt water (normal saline). They are unique in that they are the least expensive breast implants and when they eventually wear out it is easy to make the diagnosis of an implant failure. In selected cases, they can be placed through the armpit for a smaller and less noticeable scar.

Saline breast implants are filled at the time of placement during surgery. This allows for minor modifications in implant size once the surgeon can actually see them in the body. The downside to saline implants is that they are slightly heavier, denser devices that have more rippling. They also have a valve that can leak (normal saline), and they generally feel firmer, much like the bag of salt water they are!

Silicone-filled breast implants: These implants are filled with soft silicone gel. This gel feels more like natural breast tissue. Gel devices are softer, slightly lighter, and have no valves. As such, they come pre-filled and cannot be added or subtracted to. They ripple less and generally feel more like a bag of jelly.

Today’s third and fourth-generation silicone breast implants are cohesive, which means the silicone gel is more rubberized, a thicker gel maintains the shape of the implant better, and leakage is less of a problem. On the other hand, when gel implants wear out, it is more difficult to make the diagnosis of an implant malfunction.

Implants also come in many different sizes. Small breast implants are ideal for some patients, and large breast implants are ideal for others. The best breast implants for a patient are the ones that fit best with the patient’s frame.

Additionally, implants come in different profiles. Low, moderate, and high-profile breast implants are all available depending on the patient’s needs and goals.

There are two placement sites and three incision locations. Breast implants can be placed below the major pectoral muscle (submuscular or subpectoral), or the implant can be placed on top of the muscle (subglandular or subfascial). Placing the implant beneath the pectoral muscle may be useful for patients with minimal soft tissue coverage thereby hiding the rippling of the implant.

Dr. Rottler or Dr. Hulsey will help you determine which option is best for you during your breast enlargement consultation. They will also explain and help you decide on an incision location. The three main choices are:

• Inframammary: The incision is made underneath the breasts, right above the crease
• Transaxillary: The incision is made near the armpits.
• Periareolar: The incision is made around the lower area of the areola.

Although all surgical procedures carry certain risks, there is no evidence showing that breast implants impair breast health. Minor complications sometimes occur during breast augmentations, but they are not very common.

It is possible for breast implants to rupture and leak. If a saline implant leaks, the solution will be safely absorbed into the body. If a silicone implant ruptures or breaks, it is more difficult to make the diagnosis.

This is why MRIs are recommended by the FDA for women with silicone implants– to detect any leaks that may not have symptoms, which are known as “silent ruptures.” These ruptures are not very common, and scientific advancements have been made in implant shells to further improve them. Both saline and silicone breast implants are considered to be safe in humans.

Once you are of the age that requires regular mammograms, it is important to find a radiology technician with experience in taking x-rays of augmented breasts. Dr. Rottler and Dr. Hulsey may recommend that you undergo different types of examinations, such as ultrasounds or MRIs.

Some believe the presence of breast implants can make it more technically difficult to take and read mammograms. Fortunately, this can be minimized by utilizing the Eckland technique of implant displacement mammography.

Breast augmentation procedures require proper preparation for these surgeries to be safe and achieve optimal results. Preparation is customized according to each patient’s personal details and their surgical plan. The following are some general preparation directions to follow before breast augmentation surgery.

• Prepare your home for the recovery process – You will be physically limited while healing. Because of this, it is important to make all recovery essentials easily accessible in advance.
• Clear your schedule – Arrange for time off from work in advance. Additionally, cancel any plans for strenuous physical activities like sports or heavy lifting.
• Arrange for assistance – You will need someone to help you with your daily needs at the start of recovery, along with the needs of your children and pets. Ask a friend, family member, or healthcare professional to provide you with assistance.
• Avoid smoking and alcohol – Do not smoke for several weeks before the date of your surgery. Additionally, do not drink alcohol several days before the procedure. These activities can increase the risk of surgical complications.

Prior to your consultation, you will be sent a password for an Internet program called Emmi Solutions which is designed to prepare and educate you on your upcoming visit. When you come to your consultation with Dr. Rottler or Dr. Hulsey, be prepared to discuss your desires and expectations, as well as your medical and family history. Dr. Rottler and Dr. Hulsey will take all of these things into consideration when determining how to best meet your goals.

Our nurse will then take photos of your breasts for medical records, as well as examine and measure your breasts, nipples, and areolas. Examining the size, shape, skin quality, and placement will allow for the best recommendations for your procedure. This is the time to ask all of your questions and state your concerns. Dr. Rottler and Dr. Hulsey will make sure to discuss the likely outcomes of your breast augmentation, as well as any risks or potential complications.

The procedure itself takes between one and two hours, during which time you will be under general anesthesia. The anesthesia will be performed by a Board Certified Anesthesiologist who will call you the night before your surgery to have a pre-consultation with you. General anesthesia means that you will be “asleep” and not feel anything.

Dr. Rottler or Dr. Hulsey will then make an incision under your breasts, around your areolas, or in the armpit, depending on the decision made during your consultation. They will then create a pocket in the chest or breast area and place the implant in that pocket. After the implant has been placed, Dr. Rottler or Dr. Hulsey will then close the incision with dissolvable sutures.

Immediately following your surgery, you will be taken into a recovery room to be closely monitored. Your breast incisions will be dressed in surgical gauze and you will be placed in a bra that will support the breasts as they heal, as well as minimize swelling. You may have to wear this bra for the first month following surgery.

Most of your discomfort or pain will be experienced during the first 48 hours immediately after surgery. Your breasts may feel sensitive or tight and there will be some swelling and discoloration or bruising, but it will disappear quickly within the first couple of weeks. You will have pain medication to deal with your discomfort. It is also crucial to follow our doctors instructions regarding applying topical antibiotic ointments and cleaning the incision sites.

Our doctors will advise you on when you can return to your normal activities. You should be able to walk immediately after surgery, which is crucial for preventing blood clots as you stay in bed to heal. You should refrain from any lifting, pushing, or pulling during the two weeks after your breast augmentation. You should be extremely careful with your breasts for at least the first month.

Do’s:

• Get plenty of rest.
• Sleep on your back or in the fetal position.
• Eat properly.
• Take prescribed medications for pain as directed.
• Stay patient.
• Contact your surgeon if you have concerns.

Don’ts:

• Don’t wear bras with underwire.
• Don’t perform any heavy lifting.
• Don’t take a bath or swim in swimming pools, bathtubs, jacuzzis, lakes, rivers, or seas.
• Don’t smoke.
• Don’t sleep on your stomach.

Implants are man-made devices that will eventually wear out over time. Although the results of breast implants are typically long-lasting, it is generally recommended that they be replaced if and when they leak or wear out. It is crucial to schedule routine follow-ups with Dr. Rottler or Dr. Hulsey to ensure that your implants have maintained their placement and to discuss any questions you may have.

Your implants may need to be replaced if the shape or size of your breasts changes over time. Some women choose to undergo a breast lift if they have become dissatisfied with the appearance of their breasts after years of aging.