Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation and general anesthesia. After initiation of anesthesia in the operating room, Dr. Agha will inject a solution of local anesthetics around the nipple-areola complex. This injection solution consists of a combination of lidocaine, marcaine, and epinephrine. The lidocaine and marcaine will numb the surgical site for several hours after the surgery and decrease your sensation of post-operative pain. The epinephrine causes constriction of the blood vessels at the surgical site, reducing the potential for bleeding and bruising.
Step 2 – The Incision
After marking the diameter of the new nipple-areola complex, Dr. Agha will make an incision over the marking. The excess areola skin is then excised. The incision is extended through the breast tissue to underneath the breast. The inframammary fold is then lowered, and the constricted lower pole breast tissue is internally released by scoring the tissue to allow it to expand. A pocket is then created by gently and meticulously dissecting beneath the muscle. The pocket for the implant is centered beneath your nipple-areola complex. The pocket is then washed with irrigation fluid containing three different types of antibiotics to minimize potential infection.
Step 3 – Implant Preparation
The implant will be soaked in irrigation fluid containing three different types of antibiotics to minimize potential infection. The implant will then be prepared under sterile conditions for insertion into its corresponding pocket. For saline implants, the implants are first checked for integrity. Then the air within the implant is removed completely and replaced with a small volume of sterile saline. The implant is then rolled and inserted into the pocket. Silicone gel implants come pre-filled and do not require filling in the operating room. Dr. Agha uses a “no touch” technique when placing the implants into the pocket. This includes using new sterile towels to drape around the breasts, changing his gloves, washing the outer surface of the new gloves and the breast with a solution containing antibiotics, and minimizing the implant contact with the adjacent breast skin around the incision. This minimizes the possibility of any foreign material coming into contact with the implant and potentially causing infection.
Step 4 – Implant Fill
During the filling process of saline implants, Dr. Agha uses a “closed-fill system” to inflate the implants with sterile saline. The saline flows from a sterile bag through sterile tubing directly into the implant. Dr. Agha feels that this additional precaution prevents contamination of the saline by bacteria.
For silicone implants, this step is not needed.
After the implants have been filled, Dr. Agha will temporarily close your incision and will sit you up on the operating table to check symmetry of breast shape, form, and volume. Once the desired outcome is obtained, the incisions are long-lastingly closed. Drains are rare.
Step 5- Closing the Incisions
The procedure is completed by circumferential tightening and repositioning of the nipple-areola complex in a higher position. Over time the incision lines will fade. A sterile dressing is applied to the incisions, and a soft surgical bra is placed over your breasts.