What is Breast Augmentation
Since our practice’s inception in 1998, breast augmentation has been a cornerstone procedure. Dr. Kirn, along with Dr. Al Bayati, continuously refines our techniques to minimize scarring and recovery time while ensuring high-quality results. Each procedure is customized to fit the unique needs and goals of our patients.
The Incision
Patients have their choice of incision: in the armpit, at the nipple, or under the breast. Sometimes, the patient’s anatomy makes one of these options more favorable than the other. Based on these factors, and the patient’s preference, the planned incision is determined during the consultation in advance of surgery. The armpit incision is advantageous since it avoids a visible scar on the breast. Both saline and gel implants can be placed through the armpit although a larger incision is required for a gel implant. Technological advancements over time have made this possible. For saline implants, Dr. Kirn developed a smaller surgical instrument to create the implant pocket thereby minimizing incision size. A larger incision is always necessary for silicone implants. But here again, technology has come to the rescue. The Keller Funnel was developed by one of Dr. Kirn’s closest professional colleagues. Dr. Kirn participated in some of the early research on the device, as well as subsequent laboratory testing. The Funnel allows a gel implant to be safely inserted through a smaller incision than would otherwise be possible with a gel implant. Further, this device enhances performance of a “No Touch” technique.
Joining Dr. Kirn, Dr. Al Bayati brings a fresh perspective combined with a foundation of strong training from the University of Kentucky, where he worked closely with Dr. Kirn and other esteemed plastic surgeons. As a chief resident, Dr. Al Bayati independently performed breast augmentations, achieving excellent results. He employs techniques that mirror those of Dr. Kirn, ensuring continuity in the high standards of care and successful outcomes our patients expect.
Implant Selection
Our practice uses both saline-filled and silicone gel-filled implants. Most commonly, implants from the Mentor Corporation (www.mentorwwllc.com) are used, although other options are available as desired. Gel implants were re-approved by the FDA in 2006. Dr. Kirn participated in one of the FDA clinical trials on gel implants giving him years of experience with them before their general re-approval. There are certain circumstances where saline or gel implants may have a particular advantage. Therefore, the choice of saline or gel implant is a decision made jointly between you and your surgeon.
Implant size selection is one of the most important aspects of a successful breast augmentation procedure. The choice is highly personal but must remain within accepted safe surgical technology. During the consultation, you will try on actual implants to provide a simulation of breast volume. While there is no exact method to precisely select an implant size, this method has proven valuable over time in our practice and has minimized the need for size change operations.
The Operation
Nearly all of our breast augmentation procedures are performed at the outpatient surgery center. The Surgery Center is an AAASF accredited outpatient operating room. Patients benefit from attentive care by the staff and the safety advantages of an accredited facility. For patient comfort and safety, general anesthesia is provided by a Board-Certified Anesthesiology group.
The day of surgery includes arrival at the Surgery Center roughly one hour before the operation. The procedure usually takes one and a half to two hours to complete, but surgical times can vary depending on many factors. After the procedure, patients will typically spend 30 minutes to 1 hour in the recovery room before leaving the facility.
A “No Touch” technique is utilized for all breast augmentation procedures. This designation, “no touch” is somewhat of a misnomer and a more accurate statement would be “one touch” or “limited touch.” The technique involves keeping the implant away from any potential source of microscopic contamination. When Dr. Kirn or Dr. Al Bayati perform the procedure, they are the only person in the operating room who will touch the implant if at all. Further, the implant is only opened when it is ready to be inserted. If a gel implant is used, the implant is inserted through the Keller Funnel directly into the pocket and may truly not be touched by anyone including the surgeon. Saline implants are inserted before filling. Then, they are inflated using sterile IV saline running through tubing connected directly to the implant. The saline is never exposed to air, just as would occur with an IV placed into a vein.
All patients are raised into a sitting position after the implants are in to confirm proper positioning and, for saline implants, make any fill volume adjustments to maximize symmetry.
Dr. Kirn and Dr. Al Bayati offer the long-acting numbing medication, Exparel, to breast augmentation patients. This medication has been used safely at the practice since 2015. The medication is injected while the patient is under general anesthesia, just prior to start of the operation. It provides significantly improved patient comfort for the first 72 hours or so. Although the use of Exparel is an optional choice for patients, most patients find it to be extremely helpful and decrease the need for narcotic pain medication after surgery.
Recovery
After surgery, most patients can expect soreness for a few days. This will be more significant when the implants are placed under the muscle. Dr. Kirn and Dr. Al Bayati take every precaution to minimize trauma to the tissues intraoperatively, so there are no movement restrictions immediately following surgery. Patients are advised to avoid activity which elevates the heart rate or blood pressure for at least five days after the procedure to minimize the possible risk of bleeding.
Patients are usually placed into an ACE wrap dressing in the operating room and will change to a sports bra on the third day after surgery. We do not routinely use special surgical bras. Patients should avoid the use of underwire bras for six weeks after surgery. Following that, patients may wear whatever they choose. If the implants are placed under the muscle, it usually takes several weeks for the muscle to stretch out over the implant and the breast shape to mature. The process is gradual. Dr. Kirn, Dr. Al Bayati and their staff will guide the patient regarding use of any exercises to expedite breast shaping.
More general information about breast augmentation may be obtained at the American Society of Plastic Surgeons website: www.plasticsurgery.org or the American Society for Aesthetic Plastic Surgery website: www.surgery.org.
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Dr. Kirn and Dr. Al Bayati are Plastic Surgeons devoted to advanced techniques in Cosmetic Surgery of the Face, Breast, and Body.
Breast Augmentation
Frequently Asked Questions
How much weight will I gain from breast implants?
What size implant will give me a C cup bra?
Will I lose sensation if I have a breast augmentation?
Which breast augmentation incision is best?
Does one breast augmentation incision hurt more than the others?
What happens if I get pregnant after breast augmentation?
During pregnancy, your breasts will undergo the typical changes expected as the glandular tissue enlarges, regardless of whether you have implants. The implants themselves generally do not impact your ability to breastfeed, though their effect can vary based on several factors:
Implants placed below the chest muscles are less likely to interfere with breastfeeding capabilities. The incision location for inserting the implants can influence breastfeeding. Periareolar incisions (around the areola) may disrupt milk ducts and nerves, possibly affecting milk supply. Inframammary (under the breast) or transaxillary (through the armpit) incisions are less likely to cause such issues.
The surgeon’s technique and the timing of the surgery relative to when you plan to become pregnant can also play significant roles. Having surgery well before pregnancy can help minimize potential breastfeeding problems.
After pregnancy and nursing, the breast tissue typically reduces to its pre-pregnancy size, but the implant remains unaffected. However, the stretching of the breast skin and tissue during this time may lead to shape changes. If these changes are significant and troubling, a breast lift may be considered to restore the desired breast contour.
What happens if there is a leak / deflation of the breast implant?
If a saline implant leaks, it will deflate, causing a noticeable decrease in breast size. This can occur rapidly, within a few hours, or more gradually over several days. Slow leaks over months are rare. The saline solution used inside these implants is the same as intravenous fluid, which the body can safely absorb without causing harm.
Detecting a leak in silicone gel implants is less straightforward, as they may not show obvious signs of deflation. Diagnostic imaging such as an ultrasound, mammogram, or MRI is often required to determine if there is a leak. The current FDA recommendation for patients with gel implants is an ultrasound or MRI 5-6 years after implant placement and every 2-3 years thereafter. Our practice has ultrasound technology to allow us to monitor gel implants as needed and according to the FDA recommendations. If a leak is confirmed, the implant should be replaced. We provide the recommended screening for the implants we place at no cost to our patients at our clinic.
For both types of implants, it is recommended to replace a leaking implant to maintain aesthetic results and ensure safety. Prompt consultation with your surgeon is advised if you suspect an implant leak.
Are breast implants safe?
Breast implants are among the most thoroughly tested medical devices in history, having been safely used in millions of women since the 1960s. There is no increased risk of breast cancer with the use of breast implants. However, like any medical procedure, they can come with some risks. These include potential complications such as implant leakage and capsular contracture (scar tissue that forms around the implant).
It's important to note that a very rare type of cancer known as Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) has been linked to the use of textured breast implants. However, our practice does not use textured implants, significantly reducing the risk of this condition. For more comprehensive information, we encourage consulting the American Society of Plastic Surgeons’ resources.
Do I need to replace my breast implants?
There is no set requirement for replacing breast implants at any specific interval. Replacement is generally only necessary if you experience a complication or wish to alter the size or type of your implants for personal reasons. Both saline and silicone gel breast implants are designed to be long-lasting, and there is no mandatory replacement timeline for them.
The FDA recommends monitoring gel breast implants starting at 5-6 years after surgery and every 2-3 years thereafter with ultrasound or MRI to detect silent leaks. Our practice offers ultrasound monitoring as a complimentary service to our patients. If a leak is detected, the implant(s) should be replaced.
Should I use a gel or a saline breast implant?
Can I break a breast implant?
Do breast implants wrinkle?
Both saline and silicone gel breast implants can exhibit visible wrinkling, though this tends to be more noticeable with saline implants, particularly in slender individuals. The likelihood of seeing visible wrinkling increases if you have less body fat and breast tissue. Additionally, larger implants can also have a higher risk of wrinkling.
Placing implants under the muscle can help reduce the appearance of wrinkling compared to placement above the muscle, especially in individuals with minimal natural breast tissue.
Will I have cleavage after breast augmentation?
Will I look like natural after breast augmentation?
Which type of breast implant weighs more - saline or gel?
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Meet Dr. David Kirn
Dr. David Kirn is an American Board of Plastic Surgery Certified Plastic Surgeon who is devoted to advanced techniques in Cosmetic Surgery of the Face, Breast, and Body. In private practice since 1998, he is located in a state-of-the-art facility which includes a full service skin care center. The practice is focused on personalized patient care and attention to detail. Where possible, Dr. Kirn utilizes minimally invasive procedures.
Meet Dr. Ahmed Al Bayati
Having completed his training in plastic surgery and serving as Chief Resident at the University of Kentucky, Dr. Al Bayati brings a wealth of expertise and dedication to his practice. His commitment to advancing patient care and achieving exceptional outcomes reflects his unwavering passion for plastic surgery.
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