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Plastic Surgery FAQ Provided by Dr. Fred Hackney

Frequently Asked Questions

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Breast Augmentation is a cosmetic procedure that uses implants to enlarge and shape the breasts.

You may be a good candidate for breast augmentation if you feel your breasts are too small, weight loss has changed the size and shape of your breasts, or your breasts have become smaller and lost their firmness following pregnancy. A young woman must have reached full breast development, be emotionally mature, and have realistic expectations concerning the procedure. Your goal should be improvement but not perfection.

Breast augmentation is a day surgery and is done at one of several local hospitals or surgery centers. There will be no stitches to remove and usually no drains. Most patients resume their normal daily activities during the first week following surgery.

Dr. Hackney will discuss the following important aspects of breast augmentation during your consult.

Incision Placement:

Three different incision locations are commonly used to place the breast implants. The inframammary incision is made under the breast just above the natural crease. The periareolar incision is made around the lower edge of the areola (the darker area around the nipple). The transaxillary incision is made within the armpit (axilla). There are several factors to consider when choosing the location of the incision such as the visibility of the scar, potential of numbness of the nipple, or the need to have a breast lift at the same time. Dr. Hackney will help you decide which is the best option for you.

Breast Implant Location:

The breast implants can be placed either behind your breast tissue (sub glandular) or under the chest muscle (sub muscualar). The choice of location depends on how much breast tissue you have. If you have enough thickness of breast tissue over the muscle, then the implant can placed behind the breast tissue. If not the implant is best placed under the muscle.

A pocket is made either behind the breast tissue or under the chest muscle and the implant is inserted.

Types of Breast Implants:

Saline Breast Implants - A saline breast implant is filled with a salt-water solution. This breast implant is filled by the surgeon in the operating room. Saline is a natural solution and if the implant is ruptured the body will safely absorb the fluid.

Silicone Implants - A silicone implant is pre filled by the manufacturer with silicone gel. Silicone was the first substance used for breast implants because of its natural feel and movement.

Shape of Implant:

Breast implants may be either round or anatomic (tear drop shape). No single implant is right for everybody. Dr. Hackney will discuss the pros and cons of round and anatomic implants, examine you, and recommend which implant would be best for you.

Implant Shell:

The shell of both types of breast implants is made of hard silicone. The FDA never restricted hard silicone, as it is much different than silicone gel. The shells can have a textured surface or a smooth surface. The textured surface was originally designed to decrease scarring, also called capsular contracture, around silicone gel implants. However, saline implants have a low incidence of scarring so the textured surface is less benefical with these implants.

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Am I a good candidate for breast augmentation?

One or more of the following feelings or conditions may indicate that you are a good candidate for breast augmentation:

  • You are bothered by the feeling that your breasts are too small
  • Clothes that fit well around your hips are often too large at the bustline
  • You feel self-conscious wearing a swimsuit or form-fitting top
  • Your breasts have become smaller and lost their firmness after having children
  • Weight loss has changed the size and shape of your breasts
  • One of your breasts is noticeably smaller than the other

How will my plastic surgeon evaluate me for breast augmentation surgery?

Your plastic surgeon will examine your breasts and perhaps take photographs for your medical record. He or she will consider such factors as the size and shape of your breasts, the quality of your skin and the placement of your nipples and areolas (the pigmented skin surrounding the nipples). If your breasts are sagging, a breast lift may be recommended in conjunction with augmentation. You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries including breast biopsies, and medications that you currently take. You will be asked whether you have a family history of breast cancer and about results of any mammograms. It is important for you to provide complete information.

How should I prepare for surgery?

In some instances, your plastic surgeon may recommend a baseline mammogram before surgery and another mammographic examination some months after surgery. This will help to detect any future changes in your breast tissue. Following breast augmentation, you will still be able to perform breast self-examination. If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions. Breast augmentation is usually performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.

What will the day of surgery be like?

Your breast augmentation surgery may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite. Medications are administered for your comfort during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing breast augmentation, although general anesthesia may be desirable in some instances. When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. Your breasts will be wrapped in gauze dressings or a surgical bra. You may be permitted to go home after a few hours, unless you and your plastic surgeon have determined that you will stay in the hospital or surgical facility overnight.

When can I resume my normal activities?

After breast augmentation surgery, it is often possible to return to work within just a few days or a week, depending on your job. Vigorous activities, especially arm movement, may be restricted for two to three weeks. Sexual activity should be avoided for at least the first week following surgery. After that, care must be taken to be extremely gentle with your breasts for at least the next month.

What type of implants will be used?

Board Certified Plastic Surgeons and their patients work together to decide between Saline and Silicone Gel Breast Implants. Patient age, desired incision type and other factors help inform surgeons and patients which type of implant is best in a particular situation.

The outer shell of both Silicone and saline implants are made of solid Silicone material. This same material is widely used in a variety of medical devices, and is the same in both implants.

Saline filled implants are filled with the same kind of salt water that is used in IV fluids. Saline implants can be inserted prior to inflation with the saline fluid.

Silicone Gel implants are filled with Silicone Gel, which is a semi-solid. Silicone Gel has a texture similar to that of breast tissue. Silicone implants may require a larger incision than Saline implants as Silicone implants can not be inserted in a deflated state as Saline implants can.

The availability of Silicone Gel Implants offers new options for women considering breast surgery for the first time, as well as for those who have had previous breast augmentation and are now seeking new breast implant replacement or revision.

Where are the incisions placed?

One of the advantages of a saline-filled implant is that, because it is filled with saltwater after being inserted, only a small incision is needed. Often, an incision of less than one inch is made underneath the breast, just above the crease, where it is usually quite inconspicuous.

Another possible location for the incision is around the lower edge of the areola. A third alternative is to make a small incision within the armpit. Once the incision is made, the surgeon creates a pocket into which the implant will be inserted. This pocket is made either directly behind the breast tissue or underneath the pectoral muscle which is located between the breast tissue and chest wall.

An incision can be made either underneath the breast, just above the crease, around the lower edge of the areola or within the armpit.

How long will the results last?

Except in the event of implant deflation requiring surgical replacement with a new implant, the results of your breast augmentation surgery will be long-lasting. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman's breasts. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast "lifting" to restore their more youthful contour.

Is it Necessary to Keep in Contact with my Plastic Surgeon?

You should return to your plastic surgeon's office for follow-up care at prescribed intervals, at which time your progress will be evaluated. Your surgeon will encourage you to schedule routine mammographic evaluations at the frequency recommended for your age group.

Please remember that the relationship with your plastic surgeon does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your surgeon.


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Fred L. Hackney, M.D.
Hackney Plastic Surgery Clinic
Office Address:
8315 Walnut Hill Ln.
Suite 225
Dallas, TX 75231
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Dr. Hackney has 21 patients available for view in the Before and After Photo Gallery. Click here to visit.
Dr. Hackney has 4 videos available in the Video Gallery. Click here to view.

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