A Best Friend's Guide to Breast Augmentation

1. A Best Friend’s Guide to Breast Augmentation Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com

2. What you need to know before having a breast augmentation. Considering a breast augmentation is a big deal. Have you always thought about a breast augmentation, but had limited opportunities to learn about the options, benefits and risks? Well.. we’ve got you covered. With this guide, we’ll introduce you to the everything else you need to know about breast augmentation: How To Choose a Plastic Surgeon, Breast Implant Sizes and Types, Breast Incision Placement, Risks, Recovery and more. We’re here to guide you through this journey. Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com

3. Who are we exactly? We are a board-certified female plastic surgeon team located in Nashville, Tennessee. Our goal is to be both attentive to the needs of our patients and to help each patient realize their dreams. We want to ensure that each patient’s experience, from the initial consultation through surgical recovery, is as pleasant and smooth as possible. We want to facilitate the best education and support for all women interested in plastic surgery, whether you become a patient of ours or not. If you’d like to learn a little more about us, feel free to check us out here! We are, Dr. Mary Gingrassand Dr. Melinda Haws Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com

4. A Breast Augmentation is one of the most popular plastic surgery procedures in the United States. Having breast implants can help accentuate the feminine figure and bolster a woman’s self–confidence. It is our goal to answer any/all of your questions and create a comfortable atmosphere for you. THE BASICS A breast augmentation is a surgical procedure that enhances the shape and size of a woman’s breasts using breast implants. Women choose to have breast augmentation surgery to enhance the contours of their body, to correct loss of breast volume following pregnancy, to make their breasts symmetrical, and for other individual reasons. Breast augmentation surgery requires research, careful consideration, and a basic understanding of what will be involved – even before your first consultation. Being prepared is the best way to ensure a successful procedure and a happier you. Now that you have some background, its time to move forward and dive deeper into what you need to consider when having a breast augmentation. Keep in mind throughout your research, expectations must be realistic to avoid disappointment and should be carefully discussed with your surgeon. This leads us to the first and most important part of your journey – Choosing the Right Surgeon. Well.. we’ve got you covered. We’re here to guide you through this journey. Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com

5. SELECTING A PHYSICIAN • The single most important factor in achieving the results you desire is selecting the best physician for your surgery. Choosing the right surgeon is a responsibility that should not be taken lightly. Never let yourself be pressured into making uneducated decisions. Instead, do your own research and check your surgeon’s training and experience prior to your first consultation. • You’ll want to research and verify your surgeon’s: • Plastic surgery specialty • Plastic surgery board-certification • Years of experience and training • Hospital privileges • Surgical facility/office and ensure they are accredited by a national or state agency Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com

6. PLASTIC SURGERYCERTIFICATION There are many ways to find a qualified physician. Referrals from friends or family members who’ve had a breast augmentation is always a great place to start. • In addition you may also contact a number of respected professional organizations, such as: • The American Society of Plastic Surgeons (ASPS) • The American Society for Aesthetic Plastic Surgery (ASAPS) • Your local medical society Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com

7. REALSELF.COM Since its founding in 2006, RealSelf has created the world's largest community for learning and sharing information about cosmetic surgery, dermatology, dentistry, and other elective treatments. Their extensive collections of reviews, photos, and doctor Q&A make RealSelf the most trusted resource for those who are looking for help beyond the beauty counter. Dr. Gingrass and Dr. Haws are proud to be Top Doctors on RealSelf, which is a recognition awarded to less than 10% of doctors on RealSelf. This status is earned by achieving high patient satisfaction, getting favorable feedback on their expert answers, and investing time in answering patient questions. They are also honored within the RealSelf 100. These 100 doctors of RealSelf are recognized as the most influential board-certified aesthetic doctors on social media and are recognized for providing valuable insight for consumers who are looking to make informed and confident decisions about their health and beauty. We recommend browsing and interacting with the community on RealSelf as an additional resource when considering a breast augmentation. Dr. Mary Gingrass | Dr. Melinda Haws Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com

8. QUESTIONS FOR YOUR PLASTIC SURGEON • In addition to learning about your plastic surgeon’s certification and experience, the following are questions you should ask your plastic surgeon during your initial consultation: • What are the risks and complications associated with having breast implants? • How many operations should I anticipate over a lifetime after having a breast augmentation? • How will my breasts look if I choose to have the implants removed without replacement? • What shape, size, surface texturing, incision site and placement site are recommended for me? • How will my ability to breast-feed be affected? • How can I expect my breasts to look over time? • What are my options if I’m dissatisfied with the cosmetic outcome of my breast augmentation? • What alternate procedures or products are available if I choose not to have breast implants? • Do you have before and after photos I can look at for each procedure, and what results are reasonable for me? • We recommend bringing pictures of breasts that you like the day of your consultation so we can have a better idea of your expected outcome. These questions and your initial consultation will help you assess your plastic surgeon and ensure that you feel comfortable with him or her. You’ll want to make sure that your surgeon takes time to answer your questions and that they speak to you in a patient, respectful manner. Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com

9. THE BREAST AUGMENTATION PROCEDURE From start to finish, we’ll discuss exactly what happens during your breast augmentation procedure. It is important to understand the process and have a realistic expectation of how long the procedure takes as well as what is involved in the surgery, recovery, and potential risks. Though it is always important to continue to ask your plastic surgeon questions about your procedure, understanding the process beforehand will help guide you and give you peace of mind. Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com

10. At The Plastic Surgery Center of Nashville, each breast augmentation patient is unique. It is important for us to make personalized recommendations based on each patient’s vision and goals. To learn about the process of the breast augmentation procedure, follow the steps! Step 1: Anesthesia In a hospital setting, breast augmentation surgery is performed with general anesthesia for your comfort. Step 2: Incisions Your plastic surgeon will begin making the surgical incision along the crease on the underside of the breast or around the areola. An incision made underneath the breast is called an Inframammary Incision, while an incision made around the areola is called a Periareolar Incision. Incisions vary based on the type and size of breast implant, the individual’s anatomy and recommendations made by your plastic surgeon. BREAST AUGMENTATION SURGERY *Image provided by ASPS Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com

11. BREAST AUGMENTATION SURGERY Step 3: Inserting and Placing the Breast Implant After the incisions are made, your plastic surgeon works through the incision, creating a pocket either A) behind the breast tissue, over the pectoral muscle (a submammary/subglandular placement) or B) under the pectoral muscle (a submuscular placement) to accommodate the breast implant. The method for inserting breast implants depends on the type and size of the breast implant, your particular body type, and your plastic surgeon’s recommendations. *Image provided by ASPS Step 4: Closing the Incisions Once the breast implants are inserted, the incisions will be closed using sutures, bandages, tape, and/or gauze for support and to assist with healing. Over time, the incision lines will mature and become less noticeable. The breast augmentation surgery will require an hour to two hours to complete. Step 5: After Surgery Your plastic surgeon and attending staff will strictly monitor your progress. You may feel tired and sore for a few days after breast augmentation surgery, but you should be mobile in one to two days. Gauze and surgical dressing will be removed within 24 hours, at which time you may change to a sports bra. Any sutures that do not dissolve on their own will be removed in 7 days. During the first two weeks, your nipples may experience a burning sensation. This will subside as swelling decreases. Swelling after breast augmentation surgery may persist for three to five weeks with implants placed under the breast gland. In breast augmentation where the implants are placed under the muscle, swelling may persist significantly longer, approximately three to five months. Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com

12. BREAST AUGMENTATION RECOVERY It is vitally important that you follow all patient care instructions provided by your plastic surgeon. This will include information about wearing compression garments, taking an antibiotic if prescribed, and the level and type of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. You should be able to walk without assistance immediately after breast augmentation surgery. It is important to walk a few minutes every few hours to reduce the risk of blood clot formation in your legs. Most patients will be able to return to work a few days after breast augmentation surgery, depending on the amount of activity their job requires. During the first two to three weeks, your breasts will be very sensitive to direct stimulation. If your breasts are no longer sore after three to four weeks, breast contact should be fine. No heavy lifting, pushing, or pulling with the upper body is recommended for at least two weeks after breast augmentation surgery. We discourage any activity that causes an increase in your heart rate or blood pressure for the first two weeks. After breast augmentation surgery, the surgical scars will appear pink and firm for six weeks. The surgical scars may appear to widen or remain the same size for several months. They will eventually fade, though they will not disappear completely. View our Recovery Timeline next. Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com

13. RECOVERY TIMELINE • The First Week: • Any surgical dressings will be removed within 24 hours. You may be instructed to wear a sports bra. • You will be permitted to shower 24 hours later after surgery. • If you have external sutures, they will be removed in about a week. If your surgeon used tissue glue or tape, it will be removed in 7 days. • You may be able to return to work within a few days to a week, depending on the nature of your job. • You should refrain from lifting, pulling, or pushing anything that causes pain and limit strenuous activity. • Two – Three Weeks: • You should minimize excessive physical activity for at least the first two weeks after surgery. After that, take care to be extremely gentle with your breasts for the next month or two. Your breasts will also be sensitive to touch for the first two to three weeks. • Long-term: • To promote a safe and healthy outcome, it’s important to return to your plastic surgeon's office for follow-up evaluation at prescribed times and whenever you notice any changes in your breasts. Do not hesitate to contact your plastic surgeon when you have any questions or concerns. Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com

14. POTENTIAL RISKS • At our cosmetic surgery practice we perform breast augmentation surgery often, and usually achieve excellent results. Yet, as with other types of surgery, there are a number of potential risks. • Capsular Contracture: One of the more common complications following breast augmentation surgery is called capsular contracture, which occurs when the capsule or scar around a breast implant tightens, causing a woman’s breast to feel abnormally hard. The condition is treatable. • Excessive bleeding or infection • Oversensitive, under sensitive, or numb nipples are infrequent but possible complications. • Leaking breast implants: If a saline breast implant leaks or breaks, the implant will drain completely within a few hours and your body will absorb the salt water harmlessly. If a silicone gel-filled implant breaks, you may not detect the leak if the scar tissue around the breast implant remains intact. If the scar tissue does break or tear, however, the silicone gel may migrate into the surrounding tissue. If a saline or silicone implant breaks, you will require a second operation to replace the leaking implant. If your implant breaks, contact your plastic surgeon. • Mammography complications: Though current evidence does not show a link between breast augmentation surgery and breast cancer, breast implants can alter the way a mammography is performed in order to detect breast cancer. Trained radiologists will need to perform special displacement techniques as breast implants may obscure breast tissue on some views. Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com

15. FORGET THE CUP SIZE Are you hoping for large or small implants? Do you want a little boost or a dramatic change in your bust size? When choosing implant size there are a few factors you want to consider, and cup size is not one of them. First we’ll take into consideration the amount of natural breast tissue you have. Women with more breast tissue can use a smaller implant to achieve a larger result. Your body shape and size is another factor that will help us determine the best sized implant for your augmentation. Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com 15

16. TRYING ON SIZERS Once you figure out your desired results, the next step, to best visualize what the end result will look like, is to try on sizers. Implant sizes depend on how much fluid or gel is in the implant. The smallest size available is 125cc, which is often used to correct asymmetry. Patients typically choose a size between 300cc and 400cc for breast enlargement. While trying on sizers, your plastic surgeon will be able to help you with your decision and fit you with the best implant size for you. Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com 16

17. LIFT OR AUGMENTATION OR BOTH? • What you need to remember is that “augment” means to add to, or make bigger. • A breast augmentation will make your breast bigger. • A mastopexy is a breast lift or breast tightening procedure that tightens up a breast that has a loose skin envelope. • The two procedures are by no means mutually exclusive; in fact, we perform combined breast augmentation with a mastopexy or lift quite frequently. • During your consultation, we will first assess your goals; do you want a larger breast or a higher, tighter, firmer breast? Second, we will recommend what we believe is the best way to proceed in order to achieve your specific goals. The use of other patient’s before and after pictures will be used to give you an idea about what can be reasonably achieved on our part as well as help us better understand your expectations. Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com 17

18. SILICONE VS. SALINE SILICONE • Available to ages 22 and higher • $900-1,200; more expensive than saline • More natural feel, because it has a closer consistency to normal breast tissue • Larger incisions and scars, because it is inserted full size • Difficult to detect rupture; requires medical imaging (MRI or ultrasound) SALINE • Available to ages 18 and higher • $900-1,200; less expensive than silicone • More unique look and feel in some patients, but in others, there is no noticeable difference • Smaller incisions and scars, because it is filled once inside the breast • Easy to detect rupture, because it develops a flat tire look; body will absorb the harmless solution Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com 18

19. SHAPES & TEXTURES Many patients are surprised to learn that implants are available in different shapes. Two main shapes are available: round and teardrop. Round is the most common type used and is a popular choice since it provides optimal lift and plenty of cleavage. Some women prefer teardrop however since this implant shape tends to have a more natural look. With round implants smooth or textured can be used since the implant can rotate in its pocket without changing the shape of the breast. With teardrop implants we generally recommend a textured implant to keep the implant from repositioning or moving inside of the capsule. One of the biggest complications from breast augmentation surgery is a condition called capsular contracture. This occurs when the thin tissue capsule surrounding the implant becomes hard and tightens. This can cause the breast to feel hard and in extreme cases even distorts the shape of the implant. Rather than having a smooth outer surface, textured implants have an outer layer that is textured (kind of like a rubbery sand paper). This textured surface clings to the capsule, reducing the rate of capsular contracture especially in subglandular augmentations. In patients with sufficient breast tissue and with a submuscular placement, you can’t feel the difference between a textured and a smooth implant. In patients with less breast tissue, you may notice the thicker shell of the textured implant. Talk with your surgeon about whether textured or smooth implants will be most beneficial for you. Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com 19

20. GUMMY BEAR IMPLANTS We also offer the highly cohesive gel implants (also known as gummy bear implants). While they do have many advantages, there are a few potential drawbacks to this popular implant choice. Gummy bear implants are more expensive than silicone and saline implants, but they have the following benefits: In the event of a rupture, these implants will keep their shape The integrity of shape minimizes the chance of gel leakage They pass the “feel” test because they squish when pressed against another person (as in a hug) as opposed to providing resistance like saline implants They seem to hold their shape for a much longer time than other implants The gel is so thick that it won't run or slosh around inside the implant The folds and rippling associated with saline and silicone implants are less likely to occur Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com 20

21. HOW MUCH DOES IT COST? At the Plastic Surgery Center of Nashville, breast augmentation pricing ranges from $5,500 - $6,700, and breast lift pricing ranges from $5,700 - $7,000. A breast augmentation with a lift ranges from $7,700 - $9,300. These are all-inclusive prices that cover the surgical and anesthesia fees, the implants and all follow-up office visits. HOW DO I AFFORDIT? • We aim to make plastic surgery accessible to all patients and accept the following financing options: • CareCredit • Alphaeon Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com 21

22. ARE YOU READY? • Consider the following points when deciding whether or not to undergo a breast augmentation: • I am doing this for myself, not for anyone else. • My family and friends are supporting me, not pressuring me. • I understand and accept all potential risks associated with cosmetic surgery. • I recognize that there are no guarantees and that additional procedures may be necessary. • I am physically and mentally fit to experience this change in appearance. • I am financially able to afford the costs of surgery. • I will be able to give myself the proper time to recover. • I trust my surgeon, and I am comfortable with office staff. Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com 22

23. SMART RECOVERY Our care and compassion does not end with your surgery. We work to serve you through a comfortable recovery as well. Breast augmentation is about an hour-long surgery and involves a short one-to-two-week recovery. Breast augmentation does not require an overnight hospital stay, but you should avoid work and other normal activities for at least one week. After your surgery, we will provide you with in-depth post-operative care instructions that you are responsible for following. You will be advised to book a follow-up appointment with your doctor, but if you have any other questions or concerns, do not hesitate to contact us immediately. Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com 23

24. THAT’S ABOUT IT We hope you’ve enjoyed reading A Best Friend’s Guide to Breast Augmentation! We hope you will share it with anyone you know thinking about breast augmentation so they are well educated about the procedure. Again, we want to facilitate the best education and support for all women interested in plastic surgery, whether you become a patient of ours or not. Please give us a call if you have any further questions or comments, we’d love to be of assistance. And good luck on your journey! CONTACT US: The Plastic Surgery Center of Nashville Dr. Mary Gingrass & Dr. Melinda Haws 1915 State Street Nashville, Tennessee 37203 Phone: 615-467-6777 www.nashvillesurgery.com ©2016 The Plastic Surgery Center of Nashville Mary Gingrass, MD | Melinda Haws, MD www.nashvillesurgery.com 24