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Tips for Reducing Your Risks of Complications
Following Breast Augmentation
There are a number of things that can be done before, during, and after breast augmentation surgery to ensure the lowest complication rate and the best results. Explained below are a number of the steps Dr. Loftus recommends. Ask your doctor if he or she takes these extra steps. If the answer is no, ask why.
Reducing Infection:
Reducing the risk of infection after surgery should be a primary concern. The following are steps that Dr. Loftus recommends to reduce the risk. If your doctor isn't taking the same precautions, ask why.
- To reduce the risk of infection, Dr. Loftus recommends two different antibiotics (Ciprofloxacin and Kefzol) at the time of your breast augmentation surgery. Together, they work to cover virtually every possible bacterial risk. Additionally, they each provide combined coverage for the most common cause of infection, which is Staph Aureus.
- Dr. Loftus recommends using vancomycin during surgery to rinse the implant pocket before your implants are placed. Vancomycin is extremely effective, even against resistant strains of staph, such as MRSA. It covers both staph aureus (which is often linked with implant infections) and staph epidermidis (which is often linked with capsular contracture).
- If you are prone to chest acne, Dr. Loftus recommends bactrim, an antibiotic, to be taken two weeks before surgery to help your acne clear up before the day of surgery. As acne harbors bacteria, especially staph, clearing it prior to surgery will reduce the likelihood of chest acne contributing to a breast implant infection or capsular contracture.
- Dr. Loftus recommends that you have your breast augmentation operation in a private accredited surgery center where the risk of infection may be lower than in a hospital (as hospitals may expose you to antibiotic-resistant bacteria).
- To ensure the highest degree of sterility, Dr. Loftus recommends sterilizing surgical instruments upon your arrival, rather than days or weeks ahead of time. The instruments may be transferred directly from the autoclave to the operating room table, as opposed to being stored between the time they are sterilized and used (which is done in many operating rooms).
- During your breast augmentation operation, Dr. Loftus recommends that the only person who handles your implants directly should be your plastic surgeon. And, before he or she handles them, they should change their gloves, thereby reducing the possibility of contamination.
- All of these steps have thus far enabled Dr. Loftus to have a zero rate of bacterial infection for breast augmentation in her private accredited surgery center. Given that she performs hundreds of breast augmentations each year, this record is favorable compared to the 1% rate of infection nationally.
No one knows exactly why capsular contractures form around saline implants, but most plastic surgeons think that they are related to bacterial contamination that occurs at the time of surgery.
Therefore, every step taken to reduce the risk of infection (see above) should translate into reduced risk of breast augmentation capsular contracture. Dr. Loftus has found that, indeed, all of the efforts she has made to reduce infection have resulted in a reduced risk of capsular contractures. In fact, while the national risk for capsular contracture is 10-50% (depending on which study you read), Dr. Loftus' own rate of capsular contracture is less than 1%.
Dr. Loftus recommends breast implant displacement exercises for keeping your breasts soft and natural. Your surgeon should provide instruction on these after your surgery and work with you until you are comfortable performing them.
Reducing Deflation (If you select Saline Implants):
Dr. Loftus recommends reducing the risk of saline implant deflation by overfilling your implants according to the manufacturer's recommendations for breast implant augmentation. This usually means 25-30 CCs, which is equivalent to an ounce of fluid. To accomplish this, Dr. Loftus recommends selecting an implant that is smaller than the size you chose and then overfilling it to the amount that you choose. By doing this, Dr. Loftus has had a less than 1% deflation rate over the last 10 years.
Dr. Loftus recommends reducing your risk of rippling by overfilling your implants if you select saline implants. She also recommends smooth implants, as textured implants have the distinct disadvantage of increased rippling. These two simple measures markedly reduce the risk of rippling for saline implants. If it is determined that rippling may be a high risk for you, consider silicone gel implants which have a much lower risk of this problem when you undergo breast augmentation .
Additionally, if you have a modest amount of breast tissue, Dr. Loftus will recommend that you consider placing the implant under the muscle to avoid rippling in the upper half of the breast.
Sloshing, quite simply, is reduced by overfilling your implants. There is no disadvantage to overfilling your implants. You should clarify this issue with your surgeon to ensure that your implants will be overfilled.
The national average of permanent nipple numbness occurs in 15% of all women who have breast augmentation. Numbness is due to damage to the nerve that provides sensation to the nipple (the 4th intercostal nerve). As this nerve is small, it is often not visible during the operation which makes damage more likely. To minimize the possibility of damage to this nerve, Dr. Loftus recommends avoidance of "cutting" or "cauterizing" anything in the area of the nerve, which is on the side of the breast nearest the armpit. She instead recommends gently stretching tissue apart to make room for the implant. By stretching rather than cutting, the nerve is stretched but not severed. Stretched nerves are less likely to result in permanent numbness. This is why Dr. Loftus has a less than 1% rate of permanent nipple numbness in her practice.
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