Silke’s Story

The proof is in!!!

Posted by Silke on Monday, 11 January, at 4:05 p.m.

Just got my before & after pics today (Thank you Dr.Pechter 🙂 ).

I looked at them, and believe it or not, I couldn't even remember what my old boobs looked like, had something different in memory!!! I do have to say they do look smashing even in photo (hope y'all don't mind my bragging *g*).

Just shows you (especially those of you still fairly early in the recovery process) that they do grow on you and become part of you, both physically and in your mind. Which, btw, might explain why some women want to go larger after a while.

Well, gotta go, just thought to share that titbit (pun intended 🙂 ).

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I feel guilty...

Posted by Silke on Thursday, 10 December, at 1:23 p.m.

...for not writing in soo long. It's just that there isn't all that much to say any more. Life is back to pre-BA normalcy with the exception of bigger bras lining my lingerie drawer *bigGRIN*.

Didn't even realize that I hadn't posted about my last check-up yet. And actually there isn't much to report anyway, especially since Dr. P already beat me to it :-).

Well, it's hard to believe and I had never even imagined it, but these new and improved babies feel like I've always had them (well atleast since puberty)! I had always imagined them to feel somewhat foreign for the rest of my life but not so.

Sure, I can feel ripples when I touch them but otherwise can't feel the implant at all. I'm so glad I did this and no, I don't wish I had done it sooner. I'm glad I waited as long as I have. It gave me a chance to really think long and hard, to try to accept myself the way I was (which I failed to be able to do). I don't have to feel guilty because the implants might interfere with nursing since I waited til after (also no need to worry about harming the implants by doing so). It also helped me figure out exactly what size I wanted to be, and that in turn saved me from disappointment after my BA.

I want to thank Dr. Pechter again for doing such a great job, you truly are a gifted plastic surgeon. Another big thank you goes out to his staff for being so caring, nice and patient. Last but not least, thanks to Nicole and all the ladies on the forum. You all helped me make an informed decision and calmed my fears. People can be so wonderful.

As Dr. Pechter said in his post: This story, my story truly is a success!

I hope with it I can help some of you pre-BA women turn yours into a success as well and I promise, should the need arise, I will update it.

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Post-op photos

Posted by Ed Pechter, MD on Friday, 27 November, at 6:13 p.m.

Silke came by the office the other day for her "after" photos. She looks great for two months post-op and I expect her to to look even better in another few months as the tissues relax and the implants really settle in. She is happy with the outcome and her decision to have breast augmentation so it has been a successful venture from my point of view. I hope this on-line saga has been helpful to those who have kept up with it. Good luck to you all.

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Almost there

Posted by Ed Pechter, MD on Tuesday, 3 November, at 8:55 p.m.

Silke isn't due back in the office for a couple of weeks but I've been following her posts on the main board. Yesterday, for the first time since her surgery six weeks ago, she sounded unreservedly enthusiastic. Here is what she had to say:

NEW: Re: SILKE How are you doing? Silke -- Monday, 2 November, at 10:48 a.m.

I'm doing great! Started exercising again last Monday and ran my first 'after BA' 5K last Wednesday. Am still a bit on the slow side but that was expected after 5weeks of no training at all. Reached another milestone yesterday, bought my very first Victoria's Secret bra EVER! My hubby's birthday is coming up and that's part of his present ;-). The 34C I bought fits perfectly though I have to get used to being able to wear these demi bras! (only full coverage heavily padded bras prior to BA) My size hasn't changed at all since the BA. They are starting to drop a bit and are getting softer all the time, I even have some bounce. I went with the areola incision and couldn't be happier, it's virtually invisible! You said you are thinking about the navel incision, wow, that just freaked me out too much. I couldn't imagine having the implant pushed all the way up from there but that's a personal preference I guess. Just make sure the PS you choose is VERY qualified in that procedure. Dr Pechter did a great job, I couldn't be happier with his work and care, as well as his staff's. CU, Silke

When I see Silke in person and she tells me that she is happy not only with my work but also her decision to have breast augmentation I will consider the procedure a true success.

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Almost there

Posted by Ed Pechter, MD on Tuesday, 3 November, at 8:55 p.m.

Silke isn't due back in the office for a couple of weeks but I've been following her posts on the main board. Yesterday, for the first time since her surgery six weeks ago, she sounded unreservedly enthusiastic. Here is what she had to say:

NEW: Re: SILKE How are you doing? Silke -- Monday, 2 November, at 10:48 a.m.

I'm doing great! Started exercising again last Monday and ran my first 'after BA' 5K last Wednesday. Am still a bit on the slow side but that was expected after 5weeks of no training at all. Reached another milestone yesterday, bought my very first Victoria's Secret bra EVER! My hubby's birthday is coming up and that's part of his present ;-). The 34C I bought fits perfectly though I have to get used to being able to wear these demi bras! (only full coverage heavily padded bras prior to BA) My size hasn't changed at all since the BA. They are starting to drop a bit and are getting softer all the time, I even have some bounce. I went with the areola incision and couldn't be happier, it's virtually invisible! You said you are thinking about the navel incision, wow, that just freaked me out too much. I couldn't imagine having the implant pushed all the way up from there but that's a personal preference I guess. Just make sure the PS you choose is VERY qualified in that procedure. Dr Pechter did a great job, I couldn't be happier with his work and care, as well as his staff's. CU, Silke

When I see Silke in person and she tells me that she is happy not only with my work but also her decision to have breast augmentation I will consider the procedure a true success.

====================
VS here I come

Posted by Silke on Monday, 2 November, at 11:09 a.m.

Hi all,

yes, at almost 6 weeks post-op I finally dared to shop at Victoria's Secret. Though I was pretty sure I needed a 34C I let the nice sales lady do her job and measure me and indeed (even by VS standards) I'm still the same size.

I ended up buying their newest addition, a very pretty lace underwire demi bra and matching panties. It sure was the most expensive underwear I ever bought! But well worth it, Tyra eat your heart out (no offense intended) :-).

Well, just thought to share that little tid bit with you guys. I have my next post-op on the 12th, will let you know how it goes.

Til then, Silke

======================

Another milestone reached

Posted by Silke on Monday, 26 October, at 11:33 a.m.

Well, I've done it, went back to exercising today! Tomorrow will mark 5 weeks post-op for me and so I thought it was time to get on the treadmill again. So off to the gym I went this morning!

I did start easy though, altered my usual work out to a slower pace and a tad shorter duration. Good thing too, I tell you after 5 weeks of doing nothing strenous it sure takes some easing back into things. But the run went pretty good and I plan on uping to my normal routine in a couple of sessions.

I didn't work on my arms or upper body either today, just legs and a few abs. The abs did feel a little uncomfortable so I stopped after 30 (usually I do 100+). Especially the side to side ones gave me trouble, so I decided to work lower abs instead. Just another thing to ease back into. I did look good in my sports bra though *g*.

Have my next post-op in a couple of weeks and will let you all know what the doc says.

Til later.

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Let's try this again...

Posted by Silke on Monday, 12 October, at 9:09 p.m.

Well, let's see if the server will let me post today.

Unfortunately, I can't exactly remember what I wrote last night, sorry.

Anyway, as far as milestones go, I mowed and edged the yard yesterday, NOW life is definately back to normal! I also went and bought a new sports bra for the occasion. Boy, do I fill that puppy out nicely :-).

Oh yeah, the day before I went to pick out a couple of dresses that I'll be modeling at a charity fashion show on Thursday. The first one is a very form fitting cocktail dress with a deeep V-neck front and a criss cross back (won't be able to wear a bra with that one). It was the first time ever that I was able to wear that kind of dress! No more need for safety pins to pin together the plunging neck line. The other dress is a formal floorlength off-the-shoulder gown. Also a first, never had enough of a chest to keep those kind of dresses up. Everybody said I looked stunning in it (now if I can just figure out what to do with my hair 🙂 ).

The real test will be the back stage huzzle and buzzle. I guess everyone will get a good look at what a nice job Dr. Pechter did! That's ok, I'm not shy.

Talking about Dr. Pechter, I had another post-op today. Got to see the incisions for the first time and boy was I pleasantly surprised! They're virtually invisible already, I really had to look close and hard to find them! The stitches have dissolved nicely as well, now if they just drop everything would be back to normal (just bigger *g*).

I did show him though were I could feel some folds and yes indeedy peety, I do have some rippling but luckily it's not visible (atleast so far, everyone cross your fingers!).

I also got to meet with one of the ladies here from the forum and another one of his prospective BA patients. I hope our little chat was atleast somewhat informative. I didn't mind showing them my 'results' either (as I said, I'm not shy) and hope that gave them somewhat an idea of what to expect and maybe helped a little with the size dilemma as well.

All in all I thought it was a very 'productive' check-up and it was fun to meet one of the people behind the many posts here.

Oh, one more thing before I forget. A great big apology to Dr. Pechter and his staff for keeping them after office hours (but you know how it goes when you have fun, time just flies!). Hope we didn't make you too late for dinner. And thank you so much for your caring, patient attitude (even towards my kids who had a field day in the waiting room).

Ok, enough for tonight. Cu all, Silke

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Transition

Posted by Ed Pechter, MD on Thursday, 8 October, at 10:13 p.m.

I'm please with Silke's recovery to date. Right now she seems to be in that transition stage of gradually incorporating the change in breast size into her body image. Initially after augmentation most women view the implants as being foreign, almost as if they are separate entities being worn outside of their own body. Unlike gaining or losing weight, the change in body image from breast implants is sudden and takes some getting used to. This process usually takes a few months but once it has occurred the implants seem a natural part of the body. In fact, at that stage many women look at their before photos in mild disbelief, remarking "Was that really me? I don't remember looking like that." When Silke reaches that plane I'll know her operation was a complete success.

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Sleepless in Ca...

Posted by Silke on Wednesday, 7 October, at 11:27 p.m.

...but no big deal :-).

It's just one of those days, I'm too wound up to go to bed, there's nothing decent on TV, so what to do? Well, hit the forum of course!!!

Since I hadn't been around for a few days I thought I'd give you gals a quick update.

As I mentioned in my last post, I've moved on to the 'show-off' stage which means more and more people are noticing that I've changed. I can't help but notice the admiring stares of the opposite sex (sorry if I'm bragging 🙂 ) and am loving it! Looking at my reflection I can see what they're staring at - hihi.

Still, when I look in the mirror at my naked self, I still don't see my new additions as part of me, they still seem so alien. They are still (and I know, I know it's way early in the game) pretty high, sort of like wearing a push-up bra and seem just huge. Sometimes I wonder if I ever will get used to that.

Don't get me wrong, I don't regret having done this, especially since everyone is telling me how great I look, but to those of you who are still in the pre-BA stage, realize that it might take some time afterwards to adjust.

I do go braless as much as I can so gravity can aid in the 'settling' process (just wish I had a time machine *g*). I guess I'm just not so good at this waiting game.

I'm also counting the days til I can finally get back to my fitness routine, I miss my morning runs.

Well, I guess I better get to bed, only 7 more hours til I have to get the kids up for school. And I do have to attend a meeting in the morning as well, let's see how that goes. I have to present a report, the question is will anybody be able to concentrate on the issue or be too distracted by my 'material' for gossip *lol*.

Good night all.

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My 1week post-op

Posted by Silke on Sunday, 4 October, at 8:02 a.m.

Had my 1week post-op on Thursday and everything was just the way it's supposed to be. The nurse was commenting on how remarkable quick and easy my recovery is and I have to agree. I feel really good. I drove myself to the appointment (it's an 1 1/2 hrs drive) and had no problems with that, LA rat race 😉 and all.

I am still not too happy about the highness and fullness on top but as Dr.P reassured me that will change as time goes on. He thinks I'll be quite happy with the results.

I started showing my new 'additions' off a bit already, tight shirts and V-necks look great now!

Just in case you all were wondering why I'm writing just now, I've simply been too busy! After my post-op it was straight to the LA airport to pick up my sister who'll be staying with me for the whole month.

We have a busy schedule ahead of us but I'll promise to write as much as I can.

By the way before I forget, I remember reading some posts on the forum concerning the loss of nipple sensation after a BA. Well, I don't seem to have that problem. They react just as before to temperature changes and under stimulation if you know what I mean :-).

Cu you all later, Silke

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One week, two days, and counting

Posted by Ed Pechter, MD on Thursday, 1 October, at 10:44 p.m.

Silke is now 9 days post-op. Her bruising is gone and she has only mild swelling. The breasts are starting to "drop," meaning that the tissues in the lower half of the breast are relaxing, allowing the implants to become fuller in this area so they don't appear so high. This is a gradual process which will cause the breasts to change and improve in appearance over several month's time. Silke seems more comfortable with the size, which I still measure as a "C" cup. With a blouse on they don't seem too remarkable but I'm sure she'll fill out a bra or bikini quite well.

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The road to recovery

Posted by Silke on Saturday, 26 September, at 4:59 p.m.

Well, I had my first post-op Thursday as Dr.Pechter mentioned. Since we stayed down in Beverly Hills overnight though I'm just now getting a chance to post.

I went in to the post-op all tight and with my boobs feeling rock hard, not a great feeling but easily tolerable. So far I've only needed 4 pain pills since the BA and truthfully I could have done with 2 but since they were there it was just more comfortable. I did feel I needed all the sleep I could get and the pain killers got me through the nights more easily.

As I mentioned before I sleep in my bed, not in a recliner as a lot of women seem to do, with just one additional pillow to make it easier to get up in the morning.

But back to my post-op, I was not too happy about the appearance of my breasts going in. Dr. Pechter's nurse made me feel a little better after saying how great I already looked.

I did tell Dr.Pechter that I was concerned about the high- and tightness of my breasts, and that I did not like that at all. He replied that the appearance was quite normal for this stage of recovery and not to worry it would get better as time went on.

He measured each breast to get an idea of what my cup size is and determined it to be a C. After the swelling goes down it should turn out to be an average C just as I wanted.

He then showed me how to manipulate each implant to keep the implant pocket from contracting. THAT was definately NOT a pleasant thing especially on the left side as that side seems to be more tender then the right. He did assure me though that it would get easier and more comfortable as healing progresses.

After taking a first 'after' photo I was all done.

My hubby and I went out to dinner that night to celebrate that first milestone.

Friday was a day of shopping for me. No, no, definately not for lingerie yet but fun nevertheless. And that afternoon it was back home to pick up the kids.

That night laying in bed I did break down a bit. My breasts were still so tight and it just didn't look like they would ever be able to look normal. I felt like I would be disfigured for the rest of my life! All the dreams of being able to wear sexy lingerie and bikinis went right out the window. I thought I'd forever have to wear baggy clothes so only my husband and I would know the terrible secret.

I did talk to my husband for a long time and he made me feel a lot better but I just can't banish those thoughts from my mind entirely.

I do know it's still way too early to draw any sort of conclusion, I just wish I could know for sure that everything will turn out to my satisfaction. It seems so unfair not to have come out of puberty with a decent sized chest.

Anyway, I can't wait for the day when I look in the mirror and see nice soft breasts just hanging from my chest, and actually will be needing a bra again.

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Silke's first postop visit

Posted by Ed Pechter, MD aka drP on Thursday, 24 September, at 8:12 p.m.

Silke returned to the office this afternoon, 48 hours after her breast augmentation. Her breasts look just like they should at this stage: high, tight, and squished flat by the muscle! She has mild bruising and moderate swelling but very little pain.

I showed her how to do breast massage exercises, or, more technically, implant displacement exercises. Now that the implants are in place her body will begin forming a lining around them, what we call the capsule. Capsule formation is normal and happens in everyone with every kind of implant. In some ladies, though, for reasons we don't understand completely, the capsule shrinks and squeezes the implant. This process, called capsular contracture, is what can make the breasts feel too firm.

Pushing the implants around forces the body to form a larger, roomier capsule, counteracting the tendency for the capsule to shrink. By pressing firmly on the lower, outer part of each breast I forced the implant to move upward, toward her collarbone. As soon as the pressure was released gravity brought the implant back into place. I told Silke to do this for a minute or so twice a day for as long as she has the implants, but especially for the next couple of months while the capsule is forming.

Due to the swelling it was hard to get an accurate measure of the breasts but even with implants filled to 420 cc I think Silke will just be a mid-C cup, which is what we were shooting for. She said her appearance is a bit shocking but this is generally a good reaction. If a woman thinks her breasts are large initially she usually is happy with the size in a couple of months. If she thinks the size is perfect right after surgery she often later wishes they were larger.

Unless Silke has some problem I won't see her again for a week, but I know she will be keeping us posted on her recovery.

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Silke has boobs!

Posted by Silke on Wednesday, 23 September, at 10:12 a.m.

Well, where to begin!?

I guess I'll just tell the whole story. After writing my 'final thoughts' yesterday I got the kids ready and dropped them off at a friends house. My husband and I then went on our way to Dr. Pechter's office. After batteling with heavy traffic we arrived there at 7am.

After giving my hubby one last quick kiss it was off to the back of the office. Rosanne, Dr. Pechter's nurse, showed me to the restroom and gave me a hospital gown to change into. After changing into the gown (why do they call those flimsy ugly things gowns?) I went to an examinig room to proceed with the final preparations before surgery.

Sitting there waiting for Dr.Pechter to come in, the nerves hit. Luckily there were a few magazines to occupy my time with and keep my nerves in check.

Standing infront of Dr.Pechter with my chest exposed and him taking measurements and drawing on me with a marker was just a tad awkward but what needs to be done needs to be done.

After I was marked, one last before picture was taken and then Dennis came in to go over the anesthesia check list. I find him very sympatic and reassuring, he explained everything very well and could answer all my questions satisfactorially.

I was then escorted to the operating suite and asked to lay done on the operating 'table'. Everybody was very thorough in explaining everything that was done to me and I really appreciated that, there is just no worse feeling to me then not being well informed. And I think a lot of times the doctors make you feel so inferior which was definately not the case here.

Dennis used a local anesthetic before putting in the IV and I thought that was great since I hate the feeling of the IV going in, it usually feels like they're trying to jam it all the way through. Not so yesterday, I didn't feel the IV going in at all. I also liked that Dennis kept talking to me, just small talk but it kept my mind calm and off the procedure about to happen.

I remember still just chatting away and then the next thing I remember is opening my eyes and asking when we'll be going to start. Was I pleasantly surprised to hear that it was all done!

Eventhough I still felt drowsy I didn't feel bad at all. There was some discomfort getting up from the bed but that was it. I don't remember at all how long I was in recovery and can only base that fact on everybody else's information.

My hubby took great care to strap me in the car as gently as possible with just the lap belt across and the shoulder strap behind me. I did not need the pillow I'd brought in preparation for the trip home. Our 1 1/2 hour drive home was rather uneventful with the exception of a rail road crossing and a couple of other bumps.

Once home I went straight to bed to rest. I decided to just add an extra pillow but otherwise just lay on my back as usual. I awoke around 3 o'clock, still not in pain just discomfort. I did however decide to take one of my painkillers just in case. At ca 4 o'clock I felt awake enough to go join the kids infront of the TV. Getting out of bed was a little awkward but not unmanageable.

My whole family was so supportive especially my husband. He tended to the kids, the house and ofcourse me the whole day, I couldn't have asked for more. A very dear friend of mine dropped by dinner that afternoon and I had a small portion of it since I didn't feel all too hungry anyway.

I never got nauseous at all even after taking the pain meds (knock on wood, I think I threaded that more than anything).

After a while I started getting up myself to get a drink of water, answer the phone or whatever. I decided to watch some more TV after the kids went to bed and then went to sleep at 10pm, taking another pain killer just in case.

Sleep was not really comfortable since I couldn't shift around much but have slept worse under normal conditions.

I was up at 7 this morning and helped get the kids ready for school. The discomfort this morning was much less but I took a pill nevertheless, I figured that way I'd be able to function a little more normal.

My breasts seem to be getting a little softer already though they're still quite hard. I haven't taken the bra or the strap off yet but plan on doing so in a little while to take a shower. I have to say though that even with the high- and tightness of my breasts I already am quite pleased and am pretty sure that they will be simply smashing after all that goes away. I do think Dr. Pechter and Rosanne did a great job with the size.

Well, I guess that's it for today. I plan on being a little more active today (I already swept the floor in the kitchen!) though I'm still taking it easy.

My next post might be a couple of days since we're heading out of town tomorrow and I won't be back til Friday. By then I should have had my first post-op as well.

Til then, Silke

P.S. Thanks for all the well wishing!

===========================

Silke's surgery from the head of the bed: the anesthetist's point of view

Posted by Dennis O'Leary on Wednesday, 23 September, at 8:51 a.m.

I encourage the office staff and surgeons to let the patients know that I am always available to talk with their patients. Several weeks ago I was asked by Dr. Pechter to contact Silke to answer her anesthesia questions related to her sensitivity (allergy) to carrageenan. Carrageenan is a suspension - emulsifier and thickening agent found in meats, dairy products, many health and beauty aids and medications. Exposure to this agent would cause her to suffer swelling, primarily in the oral pharynx and hives. I told Silke that I was pretty sure that carrageenan was not in my usual anesthetic armamentarium but I would research to confirm and call her back. I was concerned about my primary anesthetic induction agent, Diprivan (propofol), which has a soybean base and an egg phosphatide emulsifier.

On my initial Internet search, I was surprised by the widespread use of carrageenan. I then contacted the drug manufacturer and after several days I was able to speak with a pharmacology analyst who confirmed that carrageenan was not used in the manufacturing of Diprivan. I telephoned Silke with my findings.

This morning (9-22) I reviewed Silke's chart to confirm her laboratory studies, medical/surgical history, preop consultation notes, consent forms and preop checklist. These items have been checked and noted by Dr. Pechter and his surgical nurse but I am the last one to check them again (another reason why they call me the anesthesia police). I met Silke in the exam room after Dr. Pechter finished "marking" or "mapping" her chest. As Silke is in excellent health with a limited medical/surgical history my preanesthesia evaluation and review of her respiratory, cardiovascular, hepatic, gastrointestinal, neuro/musculoskeletal, renal and endocrine systems took less than fifteen minutes.

Once patients have been informed and accepted their anesthetic course their main concerns are usually directed toward pain management and postoperative nausea and vomiting (PONV). Silke confirmed that she had picked up her pain relief medication and it was at home. She did not have a history of motion illness i.e. nausea and vomiting with winding roads and boating. She also did not experience PONV with three previous general anesthetics. I give all patients intravenous antiemetic medication before emergence from anesthesia so I considered her a very low risk for PONV.

Silke had no further questions so I then gave her a review of the expected events of her morning: one last trip to the bathroom, Rosanne and Susan would help her onto the operating room bed with a pillow under her knees and a cervical pillow for her neck, they would place the electrocardiogram pads on her back, noninvasive blood pressure cuff on her left arm, pulse oximeter probe on her fingertip and deep vein thrombosis (DVT) boots on her lower legs - while I started an IV in her right arm. I would use a local anesthetic so she would not feel it. I would then give the medications through the IV for her to drift off to sleep. I told her I would place a small tube down her throat while she was asleep and remove it before she woke up. I added that she might have a scratchy and dry throat post op but it will go away with voice rest, liquids, popsicles etc. I reminded her that since we are not the hospital, she could stay here as long as she would like but she had to stay at least an hour after the surgery (she left after 1 1/2 hours in recovery). At this point she seemed a little nervous (as many patients do). I am not concerned that she remembers this sequence - most patients do not. I offer this information and encourage the patients to interrupt me if they have any questions about what we are about to do to them. Most patients understand that anesthesia involves vigilance and high tech monitoring and are reassured that we do it all.

The anesthetic induction went well. Dr. Pechter injected local anesthetic around her breasts and intercostal nerve blocks. Intercostal nerve blocks are a tremendous adjunct as they allow me to otherwise decrease the amount of general anesthetic and they provide prolonged analgesia in the recovery room and throughout the rest of the patient's day. Silke had a smooth anesthetic course (read Dr. Pechter's entry) and emerged quickly. Her first comment was, "I'm still waiting for you to start." She did not require pain relief medication in the recovery room nor did she experience PONV. She was discharged to her husband 1 ½ hours after completion of surgery.

As I call all patients postoperatively, I spoke with Silke's husband at 6:30pm to answer any questions and to check on her status. I also spoke with Silke. She had slept most of the day, did not suffer PONV and had required very little pain relief medication. She also did not have a sore throat - an event that she suffered with a previous anesthetic. I encouraged them to call Dr. Pechter's office number, at any time, should they have any questions or problems.

Silke did her research well. She asked very intelligent questions and seemed comfortable with her decisions. I suspect her expectations will be met with very few, if any surprises. We'll have to wait for her comments…..

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Silke's Breast Augmentation

Posted by Ed Pechter, MD aka DrP on Tuesday, 22 September, at 8:06 p.m.

Well, Silke had her breast augmentation this morning. She was already wearing a hospital gown provided by my nurse when I got to the office at 7:15 AM. After changing into surgical scrubs I went over our presurgical checklist with her, making sure I had her phone number, that she had picked up her pain medication, that I had reviewed her preoperative blood count, and checking other routine but important matters. Silke commented that she felt nervous, and I explained that this was a good thing. In preparation for the stress of surgery the body starts pumping out steroids, endorphins, and hormones. All of these natural chemicals can create a jittery feeling but they indicate that the body is doing its job. Silke was just beginning her ride on the "emotional rollercoaster," like when your heart starts pounding on a real rollercoaster as the car goes clackety-clack up the first hill in anticipation of the rush of that first drop.

With Silke standing in front of me I did the "markings" for the surgery, drawing lines under each breast and from the center of each collarbone to the nipple, marking the lines in 2 cm increments. These markings made it obvious that her left breast was a bit higher on her chest than her right breast. Minor degrees of asymmetry such as this are very common but I pointed it out to her because sometimes ladies will comment after their augmentation that I made their nipples uneven when it was like that their entire life without being noticed. Although the left breast was just a tiny bit larger, each breast measured six inches across, corresponding to a "AA" cup size. Silke reiterated that she wanted to be a "C" cup at most, and that she would rather be a little smaller than any larger. With the markings completed the anesthetist came into the room to interview Silke. Then, after one last trip to the lady's room, she was escorted into the operating room.

Besides the surgeon, there were three other people in the O.R. Dennis, a CRNA (certified registered nurse anesthetist), provided the anesthesia. Silke had general anesthesia, meaning that she was totally asleep throughout the operation with a breathing tube down her windpipe to deliver oxygen and anesthetic gases. Sue, an LVN, was the circulator, or "gopher," meaning that if we needed some suture material, saline, or other supplies she would "go for" it and hand it over to us in sterile fashion. Rosanne, an R.N., acted as first assistant, meaning that she "scrubbed in" with me, helping by handing over instruments, holding retractors, and being alert to any problems that might arise -- which proved to be a good thing today.

As soon as Dennis had Silke asleep I injected some local anesthetic around her breasts, to diminish the need for general anesthetic, cut down on bleeding during surgery (because the local anesthetic contains epinephrine/adrenalin which causes blood vessels to constrict), and to diminish her postoperative pain. Then Sue washed her breasts with an antiseptic solution and Rosanne and I covered her with sterile towels and drapes, leaving only her chest exposed.

At 8:15 AM I made an incision one-third of the way around the lower edge of the right areola. Because she had so little breast tissue, one or two spreads of a scissors brought me to the pectoralis major muscle. The muscle is oriented in parallel fibers and rather than cut it I opened it along the plane of the fibers, like the spreading of a curtain. I then lifted the muscle and bluntly opened up a space beneath it and above the rib cage, separating some of the muscle fibers from their attachment to breast bone to allow proper positioning of the implant. There was virtually no bleeding.

I then placed into the space I had just created a sizing implant, a temporary implant used to judge the adequacy of the pocket dissection and to help determine the size. With the sizer filled to 300 cc the breast had a circumference of 8.5 inches, which I knew would give Silke only a "full B" cup. Although she carries only 116 lb. on her 5'6" frame I had to fill the sizer to 420 cc to reach the 9 inch circumference necessary to make her a "C" cup. I was tempted to go even a bit larger but because of her admonition not to exceed a "C" cup I decided to stick to a 390 cc implant. With the sizer still in place Rosanne and I switched sides and an identical procedure was begun on the left breast.

It was at this time that Rosanne noticed a problem. The skin around the right breast, where she was now standing, felt puffy and spongy. I put my hand on it and immediately realized there was air in the tissues, a condition called subcutaneous emphysema, creating a sensation like human bubble wrap. My first thought was that I might have punctured her pleura, the lining around the lung, while injecting the local anesthetic. Pressure from the anesthetic gases could force air out the hole in the lung and into the tissues. We pointed the finding out to Dennis who noted that Silke's vital signs were stable but took the precaution of turning off the nitrous oxide, one of the components of the anesthetic mixture, to keep the subcutaneous air from expanding. In the few seconds it took to accomplish this we noticed that the sizing implant, which we had filled with air rather than saline, was shrinking. Upon removing it we confirmed that it had developed a pin hole leak. This solved the problem, allowing my pulse to return to normal, as Silke's had been throughout.

After completing the dissection of the pocket on the left side I checked both sides to make sure there was no bleeding and squirted in an additional small amount of local anesthetic to reduce postoperative pain. For this procedure we selected McGhan style 68, smooth, round implants. I evacuated the air in each implant and inserted it into the pocket that had been created under the muscle. The size, position, and placement of the implants was checked by me and my two nurses with our asleep patient lying down and sitting up. Size and shape were optimal with the right implant filled to 430 cc and the left implant filled to 420 cc. A few stitches closed the muscle and the skin was approximated with several small dissolving sutures beneath the surface so that no stitches would have to be removed later. We placed tapes on the skin over the incisions to support the closure and help give a nice scar. Rosanne and Sue placed a surgical bra on Silke as well as an elastic strap over the top of the breasts. The bra helps to keep the new folds beneath the breast at an even level and the strap keeps the muscle from pushing the implants up. At 9:30 AM Dennis awakened Silke from the anesthetic, we transferred her onto a bed which was wheeled into the recovery room, and her breast augmentation was over.

Silke had very little pain afterward, which I attribute to the fact that she is pretty tough, not a complainer at all. We monitored her in the recovery room for about an hour and a half then discharged her to the care of her husband. I called her this evening and when she answered the phone she sounded as if she hadn't had surgery at all. But that doesn't mean she isn't going to suffer some. We'll see tomorrow what the experience was like from Silke's point of view.

=====================

Final thoughts

Posted by Silke on Tuesday, 22 September, at 5:10 a.m.

Here we go. It's 5 a.m. and about time for me to hit the road to drive the 1 1/2 to surgery.

I just have a couple of minutes to give you my last thoughts before 'going under the knife'.

As expected I didn't sleep well at all last night. I kept tossing and turning, and had the oddest dream. In it the plastic surgeons office was a futuristic sort of operating factory straight out of the mind of Robin Cook! So things can only get better :-).

I did take one last long look in the mirrot this morning to farewell the old me. I wonder what that first look at the new me will be like.

Anyhow, it's time for me to get the kids ready and go.

So, wish me luck again and I'll hope to be back soon.

==========================

20hrs to 'C'-day

Posted by Silke on Monday, 21 September, at 11:33 a.m.

I expect this to be my last post before my surgery tomorrow morning and to tell you the truth, there's not much left for me to say anyway.

The issue saline versus silicone has been resolved by the fact that there is no way of getting the silicone ones in time. I guess it's just as well.

Talked to my friend again this morning and she brought up a good point: with silicone I might constantly worry about rupture and leakage of the silicone into my body and thus not enjoy the new me. I definately plan on enjoying every new inch and with saline there's just less to worry about.

I'm trying to stay as busy as possible today so I won't have much of a chance to fret about the surgery tomorrow. I got some help there this morning when trying to do some laundry. Our pipes backed up and dirty water came out everywhere and flooded the kitchen, what a mess!!!

I did get a last minute work-out in as well and I'm really glad since I won't be able to much in that respect for a few weeks. I do hope to be back to running the end of October and aim for a couple of 5k runs the beginning of November.

I think that will be one of the hardest things for me, the wait til I can exercise again! Also am curious as to the effect my new 'additions' will have on my fitness routine. I know I'll be shopping for good sports bras for sure and my triathlon routine will never be the same again. I used to just climb out the water, slip into some bike shorts, socks and shoes and off I went. Instead I might actually have to run to the locker room to change into a support bra before I get on the bike. But I'll take that little inconvenience gladly!

Well, I guess that's it for today. I'll be back on the forum as soon as I can to let you all know how it went.

Boy, I'm not looking forward to starting my day tomorrow without a cup of coffee, that's for sure! But I figure I won't be needing it anyway, I'm expecting to have enough adrenaline floating through me to run a whole army on :-).

CU all on the flip side!!!

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saline v. silicone

Posted by Ed Pechter, MD aka DrP on Monday, 21 September, at 9:43 a.m.

My office manager came in early this Monday morning to see about getting silicone implants for Silke's surgery tomorrow morning but as a practical matter there is no way we can get them in time. So I guess fate is telling us that saline is the right choice after all. I tend to be the eternal pessimist ("There is no such thing as simple surgery, only simple surgeons") yet I feel very confident that she will be pleased with the outcome of the surgery.

Silke made a comment about silicone implants not providing flexibility as far as being able to fill them as desired, as is possible with saline implants. This is true, but I address this problem by having several different sizes available. Once again, my particular practice is to agree on a cup size with my patients, not a particular implant size. Silke wants to be a standard "C" cup so I will use whatever size implant is necessary to achieve that for her, whether saline or silicone.

I keep a full stock of saline implants in my office but I have to specifically order silicone when I am going to use those. If I estimate that Silke would need, say, a 390 cc implant to make her a "C" cup then I usually order one size above and below that as well. And since we always like to have "a pair and a spare" in case something happens to one of the implants we would be looking at ordering nine silicone implants. I would be happy to do this if she wanted to wait for silicone but she has said she wants to go ahead with surgery tomorrow as planned even if we don't have time to get the silicone.

BTW, if you're wondering why she could even get silicone, she would qualify under the Clinical Study category of having tissue characteristics (i.e. being thin) that might make silicone an appropriate choice.

Silke has been off of aspirin products for a couple of weeks (actually she doesn't usually take anything anyway) because they can interfere with the blood clotting process and increase the risk of bleeding problems from surgery. I have reminded her to be "NPO" (nothing by mouth) after midnight tonight (including gum, candy, juice, water, coffee, etc) in anticipation of tomorrow morning's surgery.

Each patient is unique and in Silke's case one special thing I have to keep in mind is that she is allergic to carrageenen, a seaweed derivative used in manufacturing some pharmaceuticals. My very conscientious nurse anesthetist, Dennis O'Leary, CRNA, took the lead by contacting the manufacturer of one drug in particular, Propofol, to make sure it contains no carrageenen. It does not and we can't think of anything else we would use that would contain seaweed. Let's get ready to rumble!!!

======================

T minus 1 1/2

Posted by Silke on Sunday, 20 September, at 5:38 p.m.

Well, it's getting close! Only a little more than a day and I'll be going in for surgery. It hasn't really sunk in yet, I think, am still way to calm eventhough I keep coming up with additional concerns every day.

The newest one is whether I should have tried to get silicone implants instead. The idea came up at my initial consult but I dismissed it after talking to a friend who had silicone implants put in 10 years ago and needs to have them removed. I just thought it wasn't worth the hassle.

Then all of a sudden, well admittetly with a little help from my hubby :-), the subject came up again on Friday.

I ended up sending Dr.Pechter an e-mail asking for his thoughts on silicone for my implants. He called the same evening, bless his soul! Unfortunately, the timing was off a bit and to tell the truth, I felt bad about bothering him with my whims on a Friday evening.

He called back today and we talked about the silicone, it's somewhat higher incidence of capsular contracture but lower risk of rippling.

I hate having to make a decision between saline and silicone implants! I feel like just holding a lottery!

It seems to me that both types have their advantages, so how does one choose?

Anyway, the choice might be taken out of my hands anyway, should the silicone implants not be available in the short time left. I do not want to move my surgery date, no matter how silly THAT might sound. I guess if I was told that the silicone would definately give me better results I'd be willing to wait for them, but as it stands I don't know why I should. Of course my husband thinks I'm crazy not to move the surgery date to wait for silicone, go figure.

Well, I guess enough for today. I'll find out tomorrow if they can get the silicone implants by Tuesday, otherwise I think I will stick with the saline.

Oh yeah, one more thing. I do see one big diadvantage of the silicone implants in that they are pre-filled and are not adjustable as far as cc's are concerned and that makes me nervous.

====================

Dear Diary

Posted by Ed Pechter, MD aka DrP on Friday, 18 September, at 11:47 p.m.

Even though Silke lives in an area from where I occasionally draw patients she became aware of my practice on Nicole's implant site. She has decided to have me perform her breast augmentation and we have agreed to share our thoughts with you, the breast implant public. I undertake this with some trepidation since it inevitably must alter in some way the usual doctor/patient relationship.

Physically, I think Silke is an excellent candidate for breast augmentation. She is healthy and has a fit, slender figure with very small breasts but an adequate "skin envelope." She is also very intelligent, having researched her options thoroughly. The downside is that she seems to have some anxiety about the conflicting information she has received from various sources. In particular, she is worried whether she is choosing the right type of implant. Ultimately she could not decided between textured, anatomical implants and smooth, round implants so she left it up to me. I do not think there is an absolute right or wrong answer. My experience is that there is not a great deal of difference in the appearance with one or the other. My choice, though, is for smooth implants because she is so thin I think visible and palpable rippling would be a greater risk with the anatomicals (all anatomical implants are textured). I don't think she has to worry about having "grapefruits" on her chest because she is going for a relatively modest "C" cup (not "full C", just "C"). We looked at pictures to make sure we agree on what a "C" cup is and I went over my sizing system with her. I estimate that saline implants in the high 300s will be necessary to achieve that size. I expect her to think they look like her worst nightmare as far as size for the first few days so I have already encouraged her to give it a couple of months before she makes up her mind as to whether she likes the size.

I haven't met Silke's husband so it is hard to put his comments in perspective. Perhaps he has looked at the manufacturer's brochure about anatomical implants. I find that to be quite misleading. The women with anatomicals in the brochure all look great and those with round implants all have the high, grapefruit look. There are no pictures of women with round implants and great looking breasts nor of bad rippling or excess upper pole fullness with anatomical implants. Probably his comment about her possibly making the wrong decision is his way of saying, "I don't want to be responsible if something goes wrong or if you are unhappy." I have had the experience of a husband/boyfriend coming with a patient to a postoperative visit and saying something to the effect of, "We paid you all this money and the breasts are ripply (or firm or whatever)." But the husband never came to any of the preoperative visits where I discussed these risks over and over again. Oh well, that's why they pay me the big bucks. The chances are very good that even if Silke's husband doesn't care much one way or the other about the size of her breasts he will benefit as much as her from the increased self-esteem and improved body image that Silke likely will exhibit after her surgery.

============================

Dear Diary

Posted by Silke on Friday, 18 September, at 8:06 p.m.

I had my pre-op appointment with Dr. Pechter yesterday. All went well I thought.

I had brought in some pictures to show what kind of result I desire. I was also pretty sure that I want to be an average C, so that's what we decided on.

The incision site was never a concern and neither was the submuscular placement. I definately didn't know which implant type (anatomical or round) to go with. So I put my "life" in Dr.P's hands, so to speak, and went with his suggestion of the round implants.

Boy, I sure hope I made the right choice! I'm going for a natural look, no grapefruits on the chest for this girl :-). Took a quick look at his operating suite as well, looks nice. Then after paying for the procedure, I went back home to rehash the whole thing with hubby.

First let me tell you that he's supportive of my decision to go ahead with a BA because he knows it's an important step for me and he wants me to be happy. He says that he likes my breasts the way they are, AA and all, so why change them. Anyway, he thinks I'm making a huge mistake going with the round implants and just hopes that I won't be disappointed and hate them. That put somewhat of a damper on my spirits. He had initially told me to trust my PS's judgement and so I thought he went 180 against his own advise. I guess, maybe he's a little scared as well and who could blame him.

For some reason I'm totally calm, though I was a nervous wreck on the way to the pre-op. Well, nothing much left to do now, the waiting game is on, 4 days and counting down!

Tonight we will have a nice dinner a good bottle of wine and relax. Hope not to get in too much of a panic til atleast Monday :-).

Enough for today.

Silke
- Silke