The areola is the colored skin, which surrounds the nipple. The periareolar incision is placed along the edge of the areola from about 4 to 8 o'clock. The advantage is that the scar can hide well here.

Scars in this area are usually thin.

If the scar ends up a little dark, it can hide in the pigmentation of the areola.

If the scar is a little light, it can hide in the skin.

Since we expect to see a color change along the areola, the resultant scar is usually difficult to detect.

• Advantages: Best disguised incision, and just about any implant problem can be fixed via this incision. Scar is covered by clothing.
• Disadvantages: May be too small for silicone gel breast implant placement. May cause injury to the milk ducts in the lower breast.

The inframammary fold (IMF)incision is made just above the crease under the breast, and is centered just lateral to a line dropped from the nipple.

When the areola is too small, this is the preferred incision. The most common situation is for the placement of a silicone gel filled implant.

• Advantages: Any size implant can be placed via the IMF approach, and just about any implant problem can be fixed via this incision. Scar covered by minimal clothing. No injury to milk ducts.
• Disadvantages: More noticeable than the periareolar incision.

These incisions are made in the armpits. The location is discrete, but removed from the breast.

Being farther away can make it more difficult to place the implants. Specialized instruments must be used to reach the lowest portion of the implant pocket.

Since the bottom of the pocket cannot be felt through the axillary incision, there is a slightly increased risk of asymmetry.

• Advantages: Scar in armpit.
• Disadvantages: Sensory nerve to the nipple crosses between this incision and the pocket for the implant putting it at risk.More exposed scar location. Higher risk of damage to silicone gel implants during placement. Less control over the implant pocket creation at the IMF. Cannot treat capsular contracture through this incision.

Breast Implants can either be placed in front of or behind the pectoralis major muscle or "dual-plane" technique.

Placing breast implants behind the pectoralis major muscle has several advantages. The overall shape of the breast is more aesthetically pleasing. Muscle compression at the top of the breast gives a more tapered look.

The result is a full, natural, teardrop shaped breast. The muscle also adds thickness to the soft tissue covering the implant.

This not only helps to better disguise the breast implant, but also protects the implant.

The advantage of placing the implant in front of the muscle is that the breast implant is not likely to move with forceful flexion of the pectoralis major muscle.

So if you are a body builder, and you are posing, breast implants in front of the muscle will not move like implants placed behind the muscle. Also, small amounts of sagging can be disguised, by placing the implants in front of the muscle.

The dual plane technique attempts to combine aspects of breast implant placement in front of and behind the pectoralis muscle.

For carefully selected patients, this technique maintains the tapered appearance of the upper pole, while allowing for better filling in the lower pole.

This can be helpful when there is some laxity in the lower breast, but cannot replace a breast lift.

What happens before, during and after your Breast Augmentation Surgery can directly affect your results. Below are some general rules.

Your instructions may vary depending on the details of your surgery, your surgeon and your overall health.

Preparation for surgery includes a few simple steps that are necessary to improve the safety and predictability of your breast augmentation.

Some are true of any surgery, and some are specific to breast augmentation.

Dr. Ahmed will tailor your care specifically to you, so be certain to follow the instructions given at your pre-op visit.

Here are a few things that are usually necessary:

• DO NOT eat before your surgery. In general, you should take nothing by mouth after midnight, the night before your surgery in general 8 hours before your surgery. Certain prescription medications may be taken with a small sip of water, but be certain to review these with Dr. Ahmed.
• AVOID aspirin ibuprofen, or other over the counter pain medications that may lead to excess bleeding.
• DIETARY SUPPLEMENTS should be stopped 1 to 2 weeks before surgery to avoid complications. This includes Vitamin E, Fish Oil, Ginseng, Gingko, Echinacea and many others. Be certain to bring a list of all medications, dietary supplements and herbs you are taking to your pre-op visit to avoid potential problems.
• If you are taking Arnica Montana to decrease post-operative bruising and swelling, take the first tablet, the night before surgery.

• You will need a friend to drive you home.
• WEAR loosing fitting clothes. A shirt that buttons or zips down the front will be easier to get on and off.
• Bring a good support brassiere (no underwire or push-up bras) with you the day of your operation. The band size (the number) should be the same as before surgery. The cup size (the letter) should be the planned size after surgery. In other words, if you are a 34A before surgery, and the goal is to be a C-cup, you should bring a 34C bra, without an underwire, with you on the day of surgery.

CALL DR. Ahmed IF:

• You are bleeding excessively (a small amount on the dressings or bra is normal).
• You have discomfort not relieved by your pain medication.
• You have any signs of infection: redness, swelling of incision, drainage from incision, or fever.
• You have persistent (more than 24 hours) vomiting. In this case, you should also discontinue pain and antibiotic medications.

A small percentage of patients may experience nausea after anesthesia; this may continue for 24 hours. After your breast augmentation, take liquids only until your stomach has settled.

You may have a soft diet in the evening, if you are not nauseated.

Resume your regular diet the next day, as tolerated. Pain medications and antibiotics can also induce nausea.

If your nausea is persisting longer than 24 hours, contact the office.

• LIMIT your activity to the house for the first 24 to 48 hours.
• ABSOLUTELY NO strenuous sports (aerobics, tennis, skiing, or jogging) for six (6) weeks.
• DO NOT reach above shoulder height, nor bend below waist level, for two (2) weeks after the surgery.
• DO NOT lift weights exceeding twenty (10) Kilograms for six (6) weeks.
• YOU MAY drive your car in three (3) days with caution, wearing lap and shoulder seat belts.
• YOU SHOULD sleep on your back for one (1) week.
• DO wear a bra. If you remove the bra to wash it, replace it with another. If the bra is comfortable, you may leave it on until your first postoperative office visit. Sleep in your brassiere for two weeks. You should not make a habit of going braless during the day unless you have been specifically instructed to do so. Unless instructed otherwise, you must wear your bra for 24 hours/day, for the first two weeks, following your surgery (DO NOT remove it when you sleep). Dr. Ahmed strongly recommends that you continue to wear a bra for 12 hours/day for the first six months after surgery.

Swelling of the breasts is normal postoperatively, and will gradually decrease over a two to three-week period.

The incisions are sutured with dissolvable sutures.

These will be trimmed at your postoperative visit.

Keep your dressing dry at all times.

The dressing will be removed in the office after surgery. You may remove the dressing sooner, if directed to do so.

The Steri-Strips (tapes) on the skin should not be removed at home.

They are helping to keep the incision closed, and will be removed in the office.

If the drain catheters (not used in about 98%) are in place, take sponge baths only until your first postoperative visit.

After the catheters are removed you may shower.

If you do not have drains in place, and you are cleared to shower, allow the water to hit your back.

It is okay if a little water runs down the front, but avoid blasting your breast with the shower spray.

Do not remove the tapes (Steri-Strips) over your incisions.

They may be pat-dried or air-dried after showering.

These will be removed in the office. Replace your bra once you are dry.

There may be a feeling of tightness and discomfort throughout the chest area for which pain medication will be prescribed.

Each day will be an improvement.

You may not drive or operate heavy machinery while taking your pain medication.

It may cause drowsiness, and impair your judgment.

The effect of anesthesia can persist for 24 to 48 hours.

Therefore, you should limit your activity to the house for that period.

Resume your monthly self-breast examinations.

Your personal physician should resume routine breast examinations annually.

Breast feeding after breast augmentation is encouraged.

The current recommendation for women who have breast implants, is the same as for women without breast implants.

Breast implants take up space in, or behind the breasts, and this may lower the volume of milk produced