How do I choose the best Plastic Surgeon for me?
2. How do I compare surgeons?"
3. What is best for me?
4. What about tear drop or anatomic implants?
5. What about silicone?
6. What about size?
7. What is cup size and what does it mean?
8. What about drains and dressings?
9. How long until they fall and decrease in size with
10. Why Dr. Shamoun?
11. What determines the final result?
12. How long do the implants last?
13. What is responsible for most of the catastrophic
events related to implants?
14. Your surgical experience?
FAQs NUMBER 1
Q: How do I choose the best Plastic Surgeon for me?
A: To protect yourself from complications arising from inadequately
trained, incompetent, and unethical physicians, Dr. Shamoun recommends:
ASK IF THE SURGEON IS BOARD CERTIFIED BY THE AMERICAN BOARD OF
PLASTIC SURGERY. This is the only Board Certification that guarantees
formalized training in both General Surgery and Plastic Surgery. Beware
of "gimmicks" and misleading advertising from any other physician
claiming Board Certification. Beware of those who tell you they are
Board Certified but neglect to say in what discipline. Beware of the
"bogus Boards." Such Boards are not recognized by the Board of Medical
Specialties. Some of these Boards often simply require payment of
a fee to join and provide no assurance of training. Always ask to
see Certificates, verifying Board Certification by the American Board
of Plastic Surgery (or call 1-888-425-2785, or download www.plasticsurgery.org).
Ask if your surgeon has hospital privileges to perform the particular
surgery you are considering and call the hospital to make sure.
Anyone can attempt to perform plastic surgery anywhere in the United
States, but as a patient, you want someone qualified and competent
to take care of you if something goes wrong. If you are not diligent
and educated in your search, you may find you have had major plastic
surgery performed by a dentist, oral surgeon, dermatologist, or ear,
nose, and throat physician with no formalized plastic surgical training.
I do not state the above to be critical of my non-plastic surgical
colleagues, but only to assure yourself of adequately trained physicians
who are competent and qualified to take care of you.
to FAQ List
Q: How do I compare surgeons?
A: In your search for a plastic surgeon, you must begin to find a
surgeon who is Board Certified by the American Board of Plastic Surgery
first. You must then consult with several surgeons and decide if you
like that individual and feels he/she is competent enough to perform
the procedure in question. Be careful and be critical. The more skills
a surgeon develops, the more choices the surgeon can offer and the
more surgical alternatives are available for optimizing the result
for any given patient.
I have several rules that patients may utilize when making choices
about breast augmentation:
A. Review breast augmentation before-and-after photographs carefully.
Remember that all photographs are different. It is important for surgeons
to show patients before-and-after photographs reflecting accurate
breast tissue and chest wall characteristics that are similar to a
particular patient. Patients must be matched for frame, age, height,
and weight, as well as soft tissue and hard tissue characteristics
in order to gain any knowledge from looking at before-and-after photos.
In other words, patients must have similar breasts and chest wall
dimensions in order to make comparisons.
B. Ask the
surgeon to show you his more difficult cases. Ask to see many
different types of breasts. This will help you gain knowledge as to
his expertise in dealing with problems. Remember that patients with
small, beautiful breasts often have large beautiful breasts afterwards.
The more difficult cases are cases that involve patients with no breast
tissue, severe asymmetries, droopy breasts, congenital deformities
and breast reconstruction. It is paramount for patients to see
particularly difficult cases in order to gain knowledge of a surgeon's
C. It is important to see if the post-operative and pre- operative
photographs are of good quality and well controlled.
D. Ask the surgeon to show you close-up photography of all
types of incisions. If pre and post-operative photographs are at different
angles and different depths, with different Lighting, then attention
to detail is lacking and one should look elsewhere.
One should also be sure and ask to see many different matched views
of the same patients' before-and-after pictures. Sometimes, the side
views may look great when the front views may not look so great, or
vise versa. Be sure and visualize as many different views (of the
same patient) as possible in order not to be fooled or misled. (usually
see front, three-quarter, and side views of the same patient.
to FAQ List
Q: What is best for me?
A: It is important to find out what incisional approach, what type
of implant, and what position the implants should be placed in, that
serves your best interest as a patient.
Remember, it is the soft tissue and hard tissue characteristics relative
to the size of the implant that determines where the implant is best
positioned (that is, usually either submuscular or subglandular).
It is also very important to ask your surgeon if he places implants
above and below the muscle. It is my opinion that most senior plastic
surgeons and non-plastic surgeons do not offer patients choices. Often
the absence of choices usually dictates the result. It is my opinion
that frequently surgeons cut corners in order to achieve a quick result
without proper concern for the long term benefits of any individual
patient. Some surgeons try to talk patients into the procedure they,
as surgeons, feel more comfortable with (I believe this is wrong).
One must keep in mind that a submuscular breast augmentation procedure
must be performed precisely using sharp dissection and must be performed
by a true surgeon. If your surgeon always places an implant in
one position, my recommendations are to look elsewhere. He/she
is usually a cookie cutter surgeon who knows only one way to deal
with one problem. It is my opinion that there is one best way for
any particular patient, given pre-operative soft tissue characteristics
and patient concerns. Remember that all choices of implant, all
incisional approaches, all anatomic positions of the implant have
advantages and disadvantages, and must be explained in detail in order
for you to be well informed.
(70%) that present to my office for augmentation mammoplasty have
very little breast tissue and benefit the most from partial
retropectoral placement of either a saline or silicone implant.
In most of these patients, the pectoral muscle is gently lifted and
30% of patients in my practice benefit from a subglandular
approach, given their soft tissue characteristics.
your friend or relative had an implant placed in a certain position
does not mean that you should have an implant also placed in this
of factors: based on soft tissue and hard tissue characteristics,
breast cancer risk, scarring, athleticism, sensory disturbances, as
well as the ability to breast feed all impact on the choices and eventual
decision concerning the correct position. I can assure you that
there is one best approach for any given woman,depending on her needs,
and it is the surgeons' responsibility to determine what combination
of choices is best. The one best approach cannot be determined by
looking at a photo- graph of a patient, without a close examination,
or without discussing what is important to the patient.
one can make has both advantages and disadvantages. The only way to
make informed decisions is to understand all the facts about all the
choices. A competent Plastic Surgeon must be able to reliably give
every patient, every incisional approach option, every currently manufactured
breast implant option, and both pocket location options, in order
to fulfill their needs and deliver a State of the Art breast augmentation
to FAQ List
FAQs NUMBER 4
Q: What about tear drop or anatomic implants?
A: Anatomic implants are tear drop shaped and are only available in
a textured shell. It is my opinion that they look best in women who
are tall and have a long torso. Women who have a stature of greater
than 5'5" may be candidates for this implant. These implants are textured
and, therefore, more palpable and somewhat firmer in consistency (they
do not move very well). They are also taller than they are wide and
more rectangular in shape. It is my opinion they do not look any more
natural than a round implant for any given woman. Proponents who encourage
tear drop or anatomic implants often receive royalties from implant
companies and, thus, promote their products. In summary one cannot
often tell from a photo whether the patient has round or anatomic
implants, unless she is very small and very thin.
to FAQ List
Q: What about silicone?
A: Silicone implants are the most commonly available implants world
wide. With the exception of Japan and the United States, they are
widely used in Europe, South America and other major countries. Several
major epidemiological, immunological, toxicological, and rheumatological
studies have concluded that silicone breast implants do not cause
any autoimmune disease, connective tissue disease, or immune system
dysfunctions. A panel of unbiased experts unequivocally concluded
that silicone breast implants do not cause any diseases. It is unfortunate
that the FDA and Plaintiff lawyers have deprived the American women
of their rights to valid information and valid choices with regard
to breast implants. A full two-hundred page report by a select panel
of medical experts is available through the Federal Breast Implant
Multidistrict Litigation Web Site.
Silicone implants are available on an adjunct study protocol. I am
an investigator and frequently perform silicone implants when needed.
Remember, that saline vs silicone gel filler is a choice, like all
other choices in augmentation. There is no such thing as any perfect
option or set of options, but there is a best option that can be
tailored for any given patient. Every option comes with a set
of trade offs that patients must be willing to accept.
It is my opinion that the major draw back to silicone is the greater
risk of capsular contracture that can develop, as well as the inability
to know exactly when and if this implant leaks. Remember we as surgeons
and healthcare providers do not know everything about anything. I
also feel we will continue to learn more about silicone with time.
It is difficult to compare a 1970 silicone implant with a 1980 or
1990 implant. Through the years, these implants have changed in quality
and their risk of rupture or leakage has also changed. Silicone and
saline implants look the same and feel different. It is interesting
that the slightly firmer feel of saline is usually of no concern to
women who have never ever experienced silicone implants. Silicone
implants can often be placed in a subglandular position due to their
softness and less need for soft tissue coverage. Ideal patients for
a silicone filler include those women with very little tissue and
moderately droopy breasts who desire no scars from a lift (see
patient #29 in breast augmentation photo gallery). If we could
predict with accuracy who would form scar tissue around a silicone
implant, we, as Plastic Surgeons, would choose silicone as our first
choice for most all women. Unfortunately, the unpredictable nature
of capsular contracture precludes the use of silicone for most women
to FAQ List
FAQs NUMBER 6
Q: What about size?
A: I cannot produce a breast of any size without untoward events occurring.
It is my job to educate any given patient about the long term consequences
of breast augmentation surgery. Sometimes patients do not fully realize
the consequences of what they do for at least two to five years following
the surgery. Remember that precise chest wall shapes and measurements,
height and weight charts, and soft tissue characteristics relative
to any given breast implant determine how large a woman can safely
augment her breasts without great risk.
After revising numerous breast augmentations operated upon elsewhere,
it is my opinion that the number one cause of complications
related to breast implants (i.e.,
bottoming out, thinning
out of tissues,
rippling) is directly related to over- sized implants relative
to a woman's frame, chest wall characteristics, and soft tissue envelope.
Patients must use common sense when it comes to size. It is impossible
to make a decision on what size you should be, based on a friend,
a photo, or a chat room on the Internet. It is also virtually impossible
for any given women to have a similar woman's exact breast tissue
characteristics, even if they are the same height and weight. It is
most important to consult with a physician who understands soft tissue
principles in order to prevent future complications from developing.
to FAQ List
Q: What is cup size and what does it mean?
A: It is important for patients to understand what cup size really
means. A 300 cc. implant for one patient may achieve a B cup, and
for another patient a D cup. How is this possible? It is because the
breast tissue characteristics relative to the chest wall characteristics
are different for any given patient.
Cup size is determined by measuring the chest wall circumference and
then the breast circumference. If the breast circumference is 5" greater
than the chest wall circumference, then the patient has an A cup breast;
6" greater than the chest wall circumference, a B cup; 7" greater
than the chest wall circumference, a C cup, and 8" greater than the
chest wall circumference, a D cup. Chest wall circumference is measured
from the bottom of the breast (at the inframammary crease) and breast
circumference is measured at the most projecting point of the breast
(over the nipple). Please see helpful links to determine your cup
It is my personal belief that cup size is not important, and one should
basically forget about it. It is the actual look that becomes important.
My ultimate goal is for a women to look just as good nude as in clothing.
It is my bias that patients who frequently have a round/hard ball/fake/"shock
value" type look in clothing often look ridiculous in the absence
of clothing. "If you can spot a womans' breast from the back, then
they are too big and unattractive."
During the consultation, I will determine a size range for any given
patient. The actual cc. volume is not important as I will tailor the
operation for any given patient based on their soft tissue characteristics.
At the time of surgery, I will use sizers and determine the exact
volume necessary in order to achieve the look desired. It is important
to realize the operation is tailored for any given patient, and no
specific volume is determined pre-operatively (only a range is chosen
before the procedure).
I feel very strongly that when a physician (regardless of the number
of years in practice) decides on the exact volume of an implant
prior to the surgery, he/she may over-estimate or under-estimate the
exact implant that needs to be utilized by 20%. This would be like
visiting a shoe store, finding your size, and buying the first pair.
Of course, some fit better than others.
At the time of
surgery, after the prostheses are inserted, you will be changed to
a sitting position on the operating room table. I carefully inspect
both sides to assure symmetry and make additional adjustments if necessary.
Precise adjustments of the pocket size, implant size, and implant
position will be made with any given patient in an upright position
on the operating room table when they are asleep. I use several trial
sizers before committing to a specific size implant, much like trying
on a pair of shoes. This enables me to give a more exact look and
assure the most accurate, refined and aesthetic result in all body
to FAQ List
FAQs NUMBER 8
Q: What about drains and dressings?
A: Drainage tubes and compression dressings are unnecessary after
the procedure. It is my personal philosophy that drains are utilized
by surgeons who use blunt technique to create an implant pocket which,
therefore, causes more tissue trauma and bleeding compared to other
techniques. Drains are often necessary to remove fluid produced by
the tissues in response to the tissue trauma of dissection when blunt
dissection is utilized. It is my belief that utilization of a meticulous
technique with precise control of all bleeding vessels is far superior
to any blunt dissection. I find that drains are totally unnecessary
in first time augmentation operations. I also feel that compression
post-operative dressings are also unnecessary. .
Back to FAQ List
Q: How long until they fall and decrease in size with time?
A: It is unnecessary for implants to fall into a proper position over
three weeks to three months post-operatively. In most routine breast
augmentation procedures, the implants are placed in a proper position.
This will result in an excellent position of the breast implants in
an early post-operative time interval. It is usually unnecessary to
use axillary straps or heavy Ace wraps in order to move the implants
into a lower position. In only very unusual selected cases are implants
placed in a relatively high position (on purpose) in order to prevent
bottoming out. One must remember that a Plastic and Reconstructive
Surgeon must be able to predict what will happen to the implant and
the soft tissue over the first two to three weeks to years later for
any given patient. This is determined by the chest wall and soft
tissue characteristics, as well as experience in dealing with all
types of breasts. This decision involves how much muscle to elevate
or cut, what type of implant to utilize, and how much dissection is
necessary. It is the ability to plan the procedure pre-operatively
and fine tune the particulars intra-operatively that determine a far
superior result from an average result.
When a particular size is chosen, the breast size should be compensated
for swelling, atrophy of tissues, and weight changes in the post-operative
period. In general, any given woman can expect a 10-15% smaller size
in 6 months to one year after the procedure (especially if implants
are placed in a submuscular position). Subglandular implants will
change size less with time (5-10%). This is due to atrophy of the
tissues and swelling. One should be aware, however, that any weight
gain may enlarge the breasts and negate the decrease in size in the
post-operative period. I encourage all women with large breasts after
augmentation (greater than C cup) to wear support as much as possible
to preserve the new look and soft tissue characteristics as long as
possible. These decisions are of utmost importance and precisely why
your choice of a surgeon becomes critical.
to FAQ List
Q: Why Dr. Shamoun?
A: I frequently use every implant made through every incision and
in every location (above and below the muscle). I can also assure
you that your breasts will absolutely look the best they can look.
I will determine the best approach for you with the most advantages
and least disadvantages to suit your needs and satisfy your goals
long term. Some simple generalities based on my experience are as
1. What are the choices? Augmentation mammoplasty procedures
involve choices. The choices of incision approaches include inframammary,
periareolar, axillary, or umbilical. The choices of currently manufactured
breast implants include silicone or saline implants. The choices of
the types of implants include textured surface implants vs smooth
surfaced implants. The choices concerning the shape of the implant
involve anatomical or tear drop vs round implants (round implants
may be high profile, moderate profile, or low profile). The choices
of the pocket locations are either partial retropectoral, total retropectoral
There appears to be anywhere from two to four hundred ways to perform
the procedure given the above variables. Which is best depends on
the type and thickness of tissues the patient brings the surgeon to
work with. They all have trade offs. More are perfect. The most important
thing is to provide adequate soft tissue cover over any implant so
that implant edges are not visible. One must choose implant size carefully
so that one does not progressively make tissues thinner, the coverage
poorer and risk visible edges and wrinkling associated with other
It is my opinion that the majority (70%) of patients that present
to me requesting saline implants over silicone are better served with
implants placed in a partial retropectoral position. The partial retropectoral
placement of most saline implants is best suited for those patients
who present with an A cup and very little breast tissue. The advantages
of this approach include a lower risk of capsular contracture, lower
risk of movement of the implant, and lower risk of ripples. In addition,
more breast tissue is visualized on mammogram and more internal support
exists to control the droop over time.
30% of my patients
will benefit from implants placed in a sub- glandular position, and
these are patients that have adequate soft tissue coverage (with thick
fibrous breast tissue) or a slight droop to their breast appearance.
Other candidates are patients who have very scant amounts of tissue
but very dense tissue with thick skin. Saline implants in all of these
patients can often be implanted in a subglandular position with excellent
It is important to realize that capsular contracture rates (the most
common unpredictable complication) vary with the type of filler material
in the implant, the location of the implant, characteristics of the
implant shell (silicone is more likely to become encapsulated than
saline), as well as your choice of surgeon.
With silicone gel-filled implants, smooth shell implants have a higher
incidence of capsular contracture compared to textured surface implants.
The risk of capsular contracture with saline implants is the same
whether they are textured or smooth surfaced. Textured implants, however,
are firmer and more palpable. Therefore, I do not believe that textured
saline implants provide any benefit (except perhaps to prevent a teardrop
implant from changing positions). (In short, texturizing the shell
appears to offer an advantage against capsule contracture only
for silicone implants).
Overall, submuscular placement of any implant appears to provide a
lower risk of capsular contracture than above the muscle. Overall,
my capsular contracture rates are less than 1% when implants are placed
in a partial retropectoral position. I attribute this very low capsular
contracture rate due to a meticulous bloodless technique, massage
exercises, and appropriate implant choices. Remember, if you are thin,
adequate soft tissue coverage should be your number one priority and
your implant should be placed in a partial retropectoral, under the
muscle position. Once again, there are no guarantees with any elective
surgery, but I can assure you that your breast enhancement surgery
will be a most pleasant experience and your new look will be the absolute
to FAQ List
Q: What determines the final result?
A: Outside of the experience and talent of the surgeon, it is the
combination of choices available that determine the final result for
any given woman.
There are four different incisions, two different types of implant
fillers, two different types of shells, four to six different shapes
of implants, and fifteen to twenty different volume sizes. It is the
correct combination of these variables that determines the final result.
The experience, judgment, and artistic ability of the surgeon using
these combination of variables will determine the final result.
1. How does a surgeon use the different variables for any given
I am often asked what incision and what implant is best for me? I
feel very strongly that patients should not have a fixed idea of what
they want prior to their consultation. There are indications and specific
limitations of every approach and every style and shape of implant.
Any given patient must realize that any 300cc. implant may look totally
different, even in the same patient.
A 300cc. implant may be a high profile implant, moderate profile implant,
low profile implant, smooth-walled implant, textured implant, anatomical
or round implant, inflatable implant, or pre-filled implant. Individual
breast implants may look totally different but have exactly the same
fill volume (the shapes and profiles may be different when the volumes
may be the same). How do we use these different variables as Plastic
Surgeons? It is my opinion that the different shapes of implants should
be utilized based on chest wall and breast tissue characteristics
for any given woman. The location of the nipple areolar complex, skin
and breast soft tissue characteristics as well as chest wall characteristics
are of great importance in determining what type of implant to utilize:
A) For example, a woman who presents with very
high positioned breasts on her chest wall (nipple areolar complex
is positioned very high near the collar bone and nipples are close
to one another) frequently are difficult to augment with standard
implants. These particular patients benefit from a high profile implant
that has greater projection than base width. see
patient #3 Standard low profile implants in these patients
with small breasts, close together nipple areolar complexes and high
positioned breasts, look ridiculous. The standard round implants (which
are moderate or low profile) are as wide as they are tall and would
have to be positioned too high, too low, or too wide in these particular
patients. It is precisely this group of patients that need a high
profile implant where most of the volume is projected anteriorly and
the base is relatively small in order to successfully achieve an aesthetically
pleasing augmentation of adequate size.
B) Other choices involve which type of incision
is best for any given woman? This may involve choices of preserving
nipple sensation as much as possible or preserving the ability to
breast feed. Frequently young patients, younger than twenty-one, would
like to preserve the ability to breast feed over the appearance of
any scar. Based on my experience and the mid wife literature, the
incision should not be placed at the border of the areola if a woman
wishes to preserve 100% the ability to breast feed (due the 10-20%
risk of interfering with the ability to breast feed). The breast tissue
ducts are violated as the approach goes through the breast tissue,
resulting in interruption of ductal flow when attempting to breast
feed. When pregnancy occurs and a patient desires to breast feed,
the ducts frequently become engorged and are unable to empty milk
due to ductal scar tissue developing. Approximately 10-20% of these
women will have to resort to other means of breast feeding.
It is my personal philosophy that all of the risks and benefits need
to be made available to any given woman in order for them to make
educated decisions. One must remember the quality of life is different
for different people, and, therefore, the incision choices, implant
location, implant sizes, and styles must be different also. It
is my job to determine what is important and help any woman choose
the approach that offers the most advantages and least disadvantages
for them. Remember this should be different for different patients.
to FAQ List
Q: How long do implants last?
must remember that implants are mechanical devices that eventually
will fail. Failure may become manifest as a capsular contracture or
leakage. With silicone implants, it is difficult to determine if leakage
occurs given the thickness of the implant gel. The only specific way
to determine if a silicone implant is leaking is to obtain an MRI,
ultrasound, or mammogram. Saline implants, on the other hand, are
obvious when leaking, given the fact that the water is resorbed by
the body. It is my philosophy to not adopt a routine standard of implant
removal and replacement. I do not believe it is necessary to remove
a standard saline implant just because it has been in place a number
of years. Statistics prove that the saline within the shell of an
implant can remain for years problem-free.
All women must realize that just as their face ages, their breast
tissue will also age and their implants will not look the same in
five years, ten years, or twenty years. Frequently the overall look
of the breast will necessitate removal and replacement along with
some other type of procedure if necessary. Remember that routine replacement
of saline implants, in my opinion, is not necessary (even a deflated
silicone shell could remain in the body long term with no problems
if need be).
The removal and
replacement of a saline implant that is ruptured or leaking is a very
safe and straightforward procedure. The implant leak will become obvious
over two-three weeks as the tissue reverts to its original size. The
procedure is performed electively (and not as an emergency) and will
take approximately twenty-five minutes to remove and replace. The
implant pocket has already been dissected and the same original incision
and approach is utilized. The recovery time is one day. Frequently
all implant manufacturers will guarantee their product for five to
ten years and they will reimburse the patient for some of the anesthesia
and facility costs. It is my general policy to remove and replace
any implant that I have implanted at a significantly reduced cost
if it has leaked or deflated over any woman's life time.
to FAQ List
Q: What is responsible for most of the catastrophic events related
A: I am frequently asked by attorneys involved in litigation to review
cases and serve as an Expert when breast implants have been utilized
and unfavorable results develop. I have also specialized in restoring
many womens breasts after multiple unsuccessful previous surgeries.
It is my opinion that the most common cause of litigation related
to breast implants involve incompetent/ untrained surgeons or poor
judgment on behalf of the surgeon in utilizing the different choices
Patients frequently will shop price, creating a catastrophe with numerous
long term problems in order to save $500-1,000. Problems related to
implants include extrusion, malposition, bottoming out, synmastia,
capsular contracture, double bubble phenomena, infection, and bleeding
(see photo gallery: Breast
Many of the problems are predictable and unfortunately irreversible.
Sadly, many of these patients who sought breast enhancement are now
delegated to breast reconstruction candidates.
It is my opinion the most common incisional approaches resulting in
litigation are the transumbilical approach and the transaxillary approach.
Although I utilize these approaches, there are certain limitations
of these approaches which must be recognized and discussed pre-operatively
(I frequently compare the transumbilical approach for breast augmentation
to changing one's oil in their car through the exhaust pipe. It doesn't
make much sense). Problem patients with dents, malposition, implant
failures, distortion of the abdomen, capsular contractures and asymmetry
have all been referred to me with the transumbilical approach. The
most common problems referred to me with the axillary approach include
asymmetries, restricted pockets, and inframammary crease problems
such as bottoming out and high riding implants.
detail usually results in excellent incisions regardless of the location,
and, therefore, it is my prejudice that the shape, size, and overall
appearance of the breast takes precedence over the scarring from the
incision. I invite you to schedule an appointment and look at the
scars up close, regardless of their location in any individual patient.
I invite you to see the breast implant revision section of this Web
site to see the difficult restorative nature of secondary breast surgery.
REMEMBER: It is best to do it right the first time!
Limiting reoperations requires optional decisions and precise surgery
at the first procedure.
to FAQ List
Q: Your surgical experience?
A: Your surgery will more than likely be performed under general anesthesia.
I feel that you should be relaxed and should remain pain-free throughout
the procedure. This is accomplished by way of general anesthesia in
an Accredited facility setting. I take pride in working with the very
best healthcare professionals in order to provide excellent anesthesia
and nursing care.
Your post-operative course, unlike what you have heard, will not be
difficult at all. Patients frequently require a one to two day recovery
for subglandular placement of implants and a three to four day recovery
for submuscular placement of implants. Immediately after your surgery,
you will be in a light bra with small steri-strips covering the incision
location. NO heavy garments, Ace wraps or drains are utilized.
I encourage you to resume your physical activity as you see fit.
It is my personal feelings that you will not damage anything by resuming
activity early. You may be a bit uncomfortable, and, therefore, need
to restrict your activity in the first one to two days after the surgery.
Meticulous technique with sharp dissection is utilized intra-operatively
with coagulation of all small blood vessels. Only approximately one
teaspoon or tablespoon of blood is lost throughout the surgery. I
feel very strongly that this is why my patients frequently do not
bruise, have minimal swelling after the procedure, and have less than
a 1% risk of encapsulation.
Patients are followed twenty-four to forty-eight hours after the procedure,
primarily for reassurance. Their small steri-strips are changed and
it is perfectly acceptable to take a shower shortly after surgery.
I encourage you to wear your bra to prevent swelling in the immediate
Your second visit
will be approximately one week after surgery, at which time the sutures,
if necessary, will be removed and specialized treatment in scar care
will be given (in order to allow the scar to heal without noticeability).
It is also at the one week visit that I will massage or displace your
breast. It is my feeling that with smooth-walled saline implants placed
either subglandular or submuscular, that massage and displacement
may help your breast stay as soft as possible. The literature suggests
that it may or may not help in maintaining the softness of the breast.
It is my opinion that massage has no negative effect, and, therefore,
should be utilized if possible. I do not recommend massage in the
immediate post-operative period due to discomfort.
Many women may find that it takes approximately one to six weeks to
develop a bond between their new breasts. Their implants will feel
hard and artificial and one breast will always heal quicker than the
other. After this bonding phase, you will feel that your implants
are a part of you and you will enjoy them forever.
It is important for you to realize that I wish you the very best throughout
this surgical procedure. I will spend an inordinate amount of time
pre-operatively discussing the risks, benefits, alternatives, and
complications and deciding on what is best for you. I will not push
you into any given situation unless I feel very strongly about it.
I will walk you through the procedure personally and will call you
the evening of your surgery to check your condition. Please do not
hesitate to ask anything pre- operatively or post-operatively regarding
your breast implant surgery.
My office has, and always will, make accommodations for patients traveling
a great distance from around the country and from international locations.
to FAQ List
hope this information has been helpful. If any questions arise, please
do not hesitate to e-mail Dr. Shamoun at JMShamoun@aol.com,
or call 949-759-3077.
Congenital Deformities I
and Lifts I Lifts I Reduction I Reconstruction I
©Copyright 2001, Dr. John M. Shamoun, M.D. All rights reserved.