Breast Augmentation & Under Wire Bras

We generally avoid using under wire bras for six to eight weeks following breast augmentation. There are two reasons for this approach. First, when patients undergo sub muscular placement of breast implants, the pectoral major muscle may undergo spasm in the early post-operative period. This may force the implant in an upward direction and lead to malposition. When this situation arises, we utilize compression to force the implant in a downward direction. An under wire bra would have the opposite effect.

Another reason for avoiding under wire bras in the immediate post-operative period is the potential for the bra to irritate a fresh surgical incision.  An infamammary incision would be directly beneath the under wire bra and this might lead to irritation of the incision.

Exercise Following Breast Augmentation

Recovery times following breast augmentation surgery vary from patient to patient. These times are significantly impacted by the nature of the procedure, the patient’s employment, and the patient’s social situation. It’s important to realize that even though breast augmentation is a cosmetic procedure, it’s still a significant operation with associated risk. For this reason, premature return to normal activity can result in an increased incidence of complications.
  
We generally recommend light activity for the first week following the procedure. After one week, patients are allowed to gradually resume normal non- strenuous activities. Strenuous activities and heavy lifting are not allowed for at least six weeks in most cases. At six weeks, most patients are able to resume all of their normal activities.

Insurance Coverage for Blepharoplasty?

When redundant upper eyelid skin results in obstruction of vision, it’s more than a cosmetic issue.  Patients often have excess skin, which obstructs vision superiorly and laterally.  Under these circumstances, excess upper eyelid skin can actually cause significant functional problems.  For instance, this can create problems when driving a motor vehicle and this can be potentially dangerous.  When this happens insurance carriers will occasionally view upper lid blepharoplasty as
medically necessary and cover its expense.

Before insurance carriers cover the expense of blepharoplasty they require that certain criteria be met.  These include documentation of symptoms and physical findings associated with visual field obstruction.  In addition, visual field studies that demonstrate visual field obstruction are critical to insurance approval.

Visual field studies are typically performed by an ophthalmologist or optometrist. The study is performed by measuring the patient’s response to a series of flashing lights. The patient’s responses are recorded and a computer- generated report is made. This report will demonstrate any visual field defects that the patient may have. The initial study is followed by a secondary study in which the upper eyelids are taped in an upward direction.  Improvements in the results of visual field studies with the upper lids taped as opposed to untaped would indicate that blepharoplasty would benefit the patient.

Signs of Breast Implant Leakage

In the majority of patients undergoing breast augmentation, implants last a lifetime. Occasionally, implants deflate and need to be replaced.

Current data suggests that implants deflate at a rate of 1% at one year and 3% at three years. Over time, this number can be expected to grow. Implants may deflate with no apparent cause or may deflate secondary to trauma.

When saline implants deflate, the diagnosis is relatively easy to make. These implants lose volume and flatten quickly. Silicone implants present a much more difficult problem when they deflate. Rupture of silicone implants may not be apparent for years.

Signs of deflation include soreness, redness, loss of volume, change in shape, and sometimes, capsular contracture. These signs may be subtle and a history of trauma may be the only early indicator.