FREQUENTLY ASKED QUESTION-BREAST AUGMENTATION

Q: How long do I need to be off of work?
A: It is recommended that you take one week off of work after breast augmentation surgery and continue to avoid strenuous activity and heavy lifting for 4 weeks after the surgery. I also ask the patients to not drive for 2 weeks after the surgery.

Q: Who is too old to get a breast augmentation?
A: Breast augmentation can be performed from an age of 18 years old on up. You are NEVER too old to improve the appearance of your breasts.

Q: Should implants be placed under the muscle or over the muscle?
A: Every patient’s anatomy is different, therefore, the only way to know which procedure would give you the best cosmetic result is by having a board certified plastic surgeon examine you and discuss your options with you.

Q: Is it necessary to wait until after having children before having breast augmentation surgery?
A: No, it is a matter of choice for each woman. More than half of patients perform the surgery before having children and the majority of them have no problems breast feeding afterwards. The incisions used are small and the surgeon attempts to minimize the amount of disruption of the glands to the nipple/areola. The underlying breast implant does not harm the breast fed baby in any way.

Q: How do I decide what size to go?
A: The size that a patient decides to achieve is a very personal decision. Often time the patient wishes to achieve a “natural look” to simply improve the proportionality of the upper and lower body. Some patients, however, want a “round” look. For these patients a “natural look” is not a priority and they are not concerned if other people know that they have had a breast augmentation. In making this decision, it helps to discuss your goals with your surgeon. Pictures are often helpful as a form of communication between the patient and the surgeon. Often times, discussing “cup size” is useful but one must be careful since “cup size” depends on the manufacturer of the bra.

Q: Do breast implants interfere with mammography?
A: Yes. Breast implants, regardless of their location in the sub-muscular or sub-glandular location, can interfere with mammography. Generally, the breast implants placed in the sub-muscular position tend to interfere with mammography less than those placed below breast tissue. Mammography centers are well accustomed to performing mammography on patients who have had breast implants (using displacement techniques).

Q: Can sensation of the nipple/areola be lost after breast augmentation surgery?
A: Yes, a small percentage (<5%) of patients have permanent nipple/areola sensation loss after breast augmentation surgery. Many patients have temporary loss or hyper-sensitivity of the nipple/areola complex. The surgeon takes great care during the operation to avoid injury to the nerve supply to the nipple/areola complex.

Q: How do I decide on the incision (approach) to be used during breast augmentation?
A: Several approaches are available to perform the breast augmentation. These include the following: an incision under the areola, under the breast (just above the infra-mammary fold), and in the axilla (arm pit). The choice of incision is a decision made by the patient and the surgeon. In general, we try to use the incision which is best hidden and therefore less visible. Often times, this decision is made based on the patient’s anatomy. For example, if the patient has some amount of excess skin under the breast, an incision can be well hidden in this area (just above the infra-mammary fold) otherwise an incision around the areola tends to heal very nicely and becomes barely visible with time.

Q: How do I decide to go over or under the muscle with the breast implant?
A: The decision to do a sub-muscular (under the muscle) or sub-glandular (under the breast tissue) breast augmentation is based on several factors. Some of these factors include the patient’s preference and the patient’s anatomy. Each type of augmentation has its pro’s and con’s. In general, however, all things being equal, I prefer to do sub-muscular breast augmentations. This type of augmentation is associated with less chance of seeing or feeling the breast implant. This operation is also associated with a decreased risk of breast implant hardening (encapsulation or scar tissue formation). Sub-muscular breast augmentation interferes with the performance of mammography less so than does sub-glandular breast augmentation.

On the other hand, sub-muscular breast augmentation is generally associated with more patient discomfort and a longer period of time to achieve the final cosmetic results compared to the sub-glandular breast augmentation. Weighing the pro’s and con’s of each type of augmentation, whenever possible, I prefer to perform a sub-muscular augmentation to achieve an end result with fewer complications and a better aesthetic result.

Q: What is capsular contracture?
A: This is scar tissue that forms around the breast implants causing the breasts to harden. This hardening may be associated with tenderness and pain. This is the most common complication with breast augmentation. Sub-muscular breast augmentation helps to deter capsular contracture. Massage may be useful, especially for implants placed above the muscle. If severe capsular contracture occurs, it may be necessary to remove the scar tissue and replace the implant (preferably in a sub-muscular position).

Q: Who should perform my breast augmentation surgery?
A: The physicians most qualified to perform breast augmentation surgeries are board certified plastic surgeons. It is important to get information regarding the surgeon’s training. Can the surgeon perform this procedure in a major hospital in your city? What do other patients say about the surgeon’ s ability to communicate and his level of care post-operatively?

Q: What do the implants feel like?
A: In general, implants feel firmer than your own breast tissue. Also, the appearance and feel of augmented breasts depends on how much breast tissue the patient had pre-operatively. In general, the more tissue the patient the patient has pre-operatively, the more natural the look and feel post-operatively.

Q: What medications should I stop before surgery?
A: It is recommended not to take any aspirin containing medication, ibuprofen containing medication or any herbs or weight loss medications for at least 2 weeks before surgery.

Q: How do I reduce nausea post-operatively?
A: Unfortunately, nausea is a common problem after many surgical procedures. Many medications can be used intra-operatively in an attempt to reduce this problem. Post-operatively, nausea can be reduced by minimizing the use of narcotics and taking the medication with a small amount of food in the stomach. If nausea is not relieved by these measures, anti-nausea medication may be prescribed.

Q: How do I know if I need a breast lift?
A: A breast lift (mastopexy) is an operation used to treat ptotic (sagging) breasts. A consultation with a well qualified plastic surgeon can help answer this question for you. In general, evaluating the position of the nipple/areola complex in relation to the fold under the breast (infra-mammary fold) will help determine the need for lifting. Different types of breast lifting operations are available depending on the severity of the sagging. Reviewing pictures of patients with similar situations may be helpful in deciding how to proceed.

Q: What can I expect post-operatively?
A: Unfortunately, most patients experience a moderate to significant discomfort post-operatively. This seems to be increased with sub-muscular breast augmentation compared to sub-glandular breast augmentation. Many patients are unable to sleep because they are not used to sleeping on their backs. Soreness of the back and neck may be related to this difficulty finding a comfortable position. Some patients choose to use 2 pillows and sleep in a reclined position.

Q: What is symmastia?
A: This is when the two breasts communicate in the midline (cleavage area). This may be done to “increase cleavage” by dividing the soft tissue or muscle fibers at the medial edges of the breast. This can be seen with implants placed over or under the muscle. It is a correctable problem.

Q: What is the difference between textured and smooth implants?
A: Texturing refers to the surface of the breast implant. Textured implants have a rough surface in an attempt to prevent contracture formation (especially when the implants are placed above the muscle). This does not appear to be relevant in the sub-muscular position. Textured implants may be associated with rippling more than smooth implants.

Q: What is a “tubular breast”?
A: Tubular breasts, otherwise known as constricted breasts, are associated with some breast tissue deficiency especially medially (around the cleavage area). The appearance of the breasts can vary greatly from a very severe deficiency of breast tissue to mild deficiency. Often times, the patient will have different size and shape between the right and left breast. This is a correctable condition. Of ten, implants can be used to improve the size, shape and symmetry of the breasts.

Q: When do the stitches come out?
A: The stitches usually come out 5-7 days after surgery.

Q: When can one shower after this procedure?
A: After the stitches are removed, the patient is allowed to shower.

Q: If I have to have the surgery redone later in life, will the incision be made in the same place as the original?
A: Usually, yes, the incision would be made in the same area.

Q: Will I need expanders to achieve the size I want?
A: Usually, expanders are not necessary.

Q: Do you use sizers during surgery to best determine size?
A: Yes, I always use sizers.

Q: How many different sizes of implants do you take into the OR?
A: I always have all breast implant sizes available in the OR.

Q: Do you make over-sized pockets?
A: Pockets are slightly larger than the implants used. This will allow for some movement of the implants so as to resemble natural breasts as much as possible.

Q: If I develop a capsule and the implants have to be removed, will I be able to have them put back again?
A: Most of the time, patients wish to have implants replaced after removal of capsules (capsulotomy).

Q: What guarantees are offered with the implants?
A: Currently, the implants are warrantied for life by the implant manufacturer. They also provide a stipend to return to the OR if an implant leak occurs within the first 10 years.

Q: What is the best way for me to determine the size implant I will need to go from where I am to where I want to be?
A: Often, by looking at pictures, we can ascertain your goals of size and shape of breast desired.

Q: Will I be able to sleep on my stomach?
A: In general, approximately 2-3 months after surgery, one is able to sleep on their stomach.

Q: Who prescribes the painkillers and can we collect them prior to surgery?
A: All necessary prescriptions will be prescribed by the doctor several weeks prior to surgery (at the pre-op appointment).

Q: How long will I have to wear this special bra?
A: Normally, the bra will need to be worn for 2-4 weeks. There are reasons why the bra is important and following San Diego Cosmetic Surgeon's, Dr. Pousti, directions will give you the best possible results. Each patient is different and so the recovery will also be different.

TESTIMONIALS - BREAST AUGMENTATION

I had breast implants 2 1/2 months ago. Before the surgery, I had lost a lot of breast tissue from birth control. I went from a size 34 full C to a 34 small B. Because I had lost so much tissue, my breast became very saggy. I saw several plastic surgeons in the San Diego area, before meeting Dr. Pousti.

After leaving the other plastic surgeons offices, I had always felt like I was just another $$. Some of them made comments like "I can do the surgery in under an hour!" That scared me immensely. I wasn't interested in a race, I wanted someone who would take their time and give me the result I was looking for.

Then I finally met Dr. Pousti. The first trip to his office, I was rather nervous and skeptical based on my previous experiences. I was greeted with smiling faces and by name! After speaking with Dr. Pousti, I was able to meet some of his patients who had already had the surgery. This was extremely helpful because I didn't just get to look at pictures of his work but I was also able to get first hand information on the procedure from beginning to end.

I was very surprised when I left his office for the first time, they thanked me for coming in and told me to feel free to come back as many times as I liked. WOW! I was expecting the phrase that I had gotten from every other office, "sign here and pick a date". I didn't feel pressured for one second at Dr. Pousti's office; instead I was given information on how to look for a credible surgeon in case I didn't decide to have my surgery done there. The office didn't want anyone to make the mistake of going to an un-certified surgeon.

At that point, I knew I had found the office that cared about me and not the $.

Through the next 3 weeks, I visited Dr. Pousti's office regularly, not only getting to know him and his wonderful staff, but also being able to meet more patients and felt more comfortable about the big step I was going to take. I felt like part of the Pousti family, and it was nice to know that he was getting to know me well enough to know what I wanted. Dr. Pousti actually cared about how I would feel about my breasts after the surgery, this was a great comfort. I knew I was in good hands.

I finally had the surgery, and I couldn't be more pleased with the results. I went from a small 34 B to a 34 D.

My main message for women that are considering this surgery; Check each surgeon out thoroughly; ask to speak with previous patients. Be extremely cautious with any surgeon who won't provide you with references, because there must be a reason. Also when searching for a surgeon, don't just look at the price, make sure that the surgeon cares about each of his patients and cares about the result they receive. Dr. Pousti is that surgeon.

~Summer

I wanted to write you so other women doing their research could read how wonderful of a surgeon Dr. Tom Pousti, is.
I spent seven months doing research and interviewing other surgeons in the San Diego area. I had made up my mind about breast augmentation, but finding the right doctor is what it's all about. After meeting with Dr. Pousti a few times, and then having my mother meet with him, I new he was the one. Personable, professional, caring, are only some of the qualities this doctor has to offer. He and his staff are the cream of the crop here in San Diego. My surgery was at Grossmont Hospital, which is a fabulous facility. Dr. Pousti, the nurses, my anesthesiologist, made me feel so at ease that I was not nervous at all before surgery.

My end result... fantastic!

I am a runner, with not a lot of body fat, and I think my breast look and feel natural! I would highly recommend Dr. Pousti to any other intelligent women that is looking to make a life changing decision like this.

Thank you!

I think I have always been unhappy with the size of my breasts. Just in the past few years is when I started to seriously consider breast augmentation surgery. I was considering it because I felt there was something missing to
my body image. I’m a professional Polynesian dancer on the side, so I keep in good physical shape and feel good about my body, but there was something missing on top. I didn’t feel I had a womanly shape. My breasts were nice but small.

For about a year, I had been doing research and meeting with a few different doctors. Then a friend referred me to Dr. Pousti. It was amazing how different him and his staff where. Dr. P’s demeanor and professionalism really stood out for me. There was no pressure, and I felt so comfortable talking with him. Dr. P gave me all the time I needed, and I felt I could say or ask him and his staff anything. All in all I really feel that Dr. P cares about me and it showed before, during, and after my
surgery.

Dr. P spent a lot of time speaking with me and making sure he fully understood what I wanted and that this was right for me. I was very concerned about getting a natural look. I wanted people to question if I had had surgery or not. I have to say my breasts are near perfect. They are exactly what I wanted. I’m having a great time with my new body or the “Girls” as I refer to them now. If I remember correctly Dr. P let me visit his office 3 times before I set the date.

One of the best things he did was allowing me to speak with other patients. I was amazed at how enthused and happy they all were. I talked to a lot of women who were having the same and different surgeries. They answered all of my questions and I felt they were truly sincere. Now that I am 5 months out from my surgery, I know exactly how they feel, and have the opportunity to share my experiences with other women and answer their questions.

If there is one thing I can say, meeting Dr. P and his staff was a blessing, I truly felt sure and confident about my decision thanks to them. Even after my surgery they stay in touch and make sure I’m ok. I recommend everyone who is considering any cosmetic surgery to visit Dr. P. Two of the women in my Halau (Polynesian dance group) have already set dates to have breast augmentations done. These women are like my sisters and I wouldn’t trust them to anyone but Dr. P and his staff. I know he will do the best for them like he did for me.

~R.R.

I had a breast augmentation done three months ago by Dr. Tom J. Pousti in San Diego. I am so glad I got a chance to meet with this doctor. I am so happy with my result of the surgery. I have a small child and I breast fed and my breast became very "ugly" after. Dr. Pousti changed my look! I went from small saggy "A" cup to a full "C" cup. I am waiting for the summer to come along so I can really show them off.

I highly recommend Dr. Tom Pousti to anyone who is interested. I met with several other patients from his office that was willing to share there experiences with me and that helped a lot.

Ever since I can remember, I've been jealous of the women on the sunny beaches in San Diego wearing triangle top bikinis. I always suffered with those horrible padded swimsuits I had to wring out because they were water logged after a swim. Eventually, I had had enough and decided to research my options.

Unlike most people, I was lucky enough to have my first consultation with Dr. Pousti. I spent several hours on the internet looking at before and after pictures of various plastic surgeons and was most impressed with Dr. Pousti's website and pictures. So, I decided to call Dr. Pousti's office for a consultation. I clearly remember the first question he asked me: Why are you interested in a breast augmentation? After my response, he made it clear that he approved of my reason and would not perform the procedure on anyone if the only reason they were considering implants was to impress their significant other. This was what sealed my decision to choose Dr. Pousti. He clearly had my best interests in mind, not only physically but emotionally as well.

After my initial consultation, I came back to his office on three occasions, speaking to other patients and bringing pictures of results I did and did not want. He kept them in a folder to take into the operating room with him, which helped reassure me. He also invited me back to the office at any time to ask questions of him and/or other patients.
The morning of the surgery, I was very impressed with the nurses. They were comforting and reassuring. When I woke up from the surgery, I instantly had a nurse by my side, and that night at home, Dr. Pousti called to check on me. How rare is that!

I have been back to Dr. Pousti's office since the surgery for check-ups and have always been greeted with a smile. At each appointment, I was told what to expect to feel and experience, which helped when I actually couldn't lift my arms too high or sit up on my own.
Now five months later, I am so excited to be able to wear triangle top bikinis! My husband and I even went to the Caribbean and I absolutely love our sunny beach pictures! I can, without a doubt, say that my decision to have breast augmentation with Dr. Pousti, is one of the best decisions I have made.

~Krista

I would like to let you know what I think about Dr. Tom Pousti and his staff. I had my surgery 4 years ago and would do it again in a heartbeat. I actually wish that I had done it earlier (I had such a great experience). Dr. Pousti and his staff made me feel so comfortable. All of my questions were answered, I was well informed, and everything was very professional.

I would like to recommend Dr. Pousti to anyone wanting to do any cosmetic procedure. He is a real professional who cares about his patients.

~Kathy

The doctor and staff treat you as a friend instead of a patient. They remembered my name after just the first visit. I never wait long and yet I always get quality care.

~Sharon

Breast Augmentation and eyelid surgery:
He and his team are excellent. They go far beyond the call of duty to make everything pleasant pre-op. His attention to detail has made a tricky surgery work out beautifully. I couldn't be happier.

~Lynette

When I had the initial consultation with Dr. Pousti, I felt very comfortable with him. I felt that Dr. Pousti was not pushy and was very clear about giving me all the informations that I needed to know about the surgery. And also, he is a very easy Dr. to talk to. I'd never felt threaten or intimidate by him at all. Plus, his staffs was very helpful and nice.

~Uyen

Dr. Pousti was wonderful. He made me feel very relaxed and comfortable about my operation. The results are amazing!! I'm back to my size before I had my kids and my breasts look amazing. I highly recommed Dr. Pousti. My tiny scars are hardly noticeable and I am truely thrilled with my results. I wish I had done this sooner!!

~Karin