Are you certified by the American Board of Plastic Surgery?
Yes, I am certified by the American Board of Plastic Surgery. Certification means that I have undergone the rigorous process of oral and written examinations that cover all plastic surgery procedures. I am also a member of the American Society of Plastic Surgeons.
Were you trained specifically in the field of plastic and reconstructive surgery?
I was trained specifically in the field of plastic and reconstructive surgery. I was trained at the integrated plastic surgery residency at the University of Washington in Seattle. My training encompassed all aspects of plastic surgery including general reconstruction, cosmetic surgery, pediatric surgery (cleft lip, cleft palate), trauma, burns and hand surgery.
How many years of plastic surgery training have you had?
An integrated plastic surgery residency is typically 6-7 years long. The University of Washington program is six years. After my residency I went on to complete an additional year of hand surgery fellowship at The Curtis National Hand Center, followed by several months dedicated specifically to cosmetic surgery training.
Do you have hospital privileges to perform this procedure? If so, at which hospitals?
I have surgical privileges at multiple locations throughout Portland, Seattle, and Hood River. I have credentials at The Surgery Center at Tanasbourne, Providence St. Vincent, Legacy Good Samaritan, Legacy Meridian Park, Swedish Medical Center, The Seattle Facial Plastic Surgery Center, The Columbia Gorge Surgery Center, and Providence Hood River.
Is the office-based surgical facility accredited by a nationally-or state-recognized accrediting agency, or is it state-licensed or Medicare-certified?
All of the operating facilities that I use for my surgical procedures are fully accredited.
Am I a good candidate for breast enhancement or breast enlargement?
Good candidates for breast augmentation surgery are healthy women who desire larger breasts. For women over 40, a mammogram before surgery is recommended. After pregnancy or nursing, I recommend waiting 3-6 months before having cosmetic breast surgery. This gives your breasts time to complete the process of changing completely after pregnancy or nursing.
What will be expected of me to get the best results?
Best results are obtained when in appropriately sized implant are used. I use "tissue-based planning," which relies on breast measurements, and your goal look, to size the implants. An implant that is too large for your breasts can cause rapid sagging and thinning of breast tissues. An implant that is too small may not adequately fill the skin envelope of your breasts. Sizing implants is a key part of the consultation process. I spend a full hour each patient during the initial consultation. This gives plenty of time to talk about the procedure and choose your implants.
Where and how will you perform my breast augmentation surgery?
I perform breast augmentation surgery in a fully accredited operating room. A board-certified anesthesiologist puts my patients completely to sleep (general anesthesia). I find that general anesthesia gives the most comfortable experience. A breast implant is placed under the pectoralis muscle. Placing the implant "under the muscle" gives an additional layer of camouflage for the implant. This extra layer of cover helps hide the implant, decrease the potential for visible rippling, and also helps decrease the risk of developing a capsular contracture. After the surgery, many patients take only ibuprofen and are back to most day-to-day activities within one day.
For a detailed example of one woman's recovery experience, see my 24 hour breast augmentation recovery page.
Which implant shape, size, surface texturing, incision site and placement site are recommended for me?
This is a good question, and varies with each patient. Sizing is based on your goal look and your measurements. For most first-time breast augmentations I use smooth, round implants. If a woman has very little breast tissue, I will use a shaped implant. A shaped implant has a teardrop shape. There is a natural taper at the top of the implant. This helps smooth the transition between the chest wall and the breast. It can give a more natural appearance. I typically use an incision within the crease below the breast. The incision is about 2 inches long and heals very nicely. Implants are typically placed under the muscle.
How long of a recovery period can I expect, and what kind of help will I need during my recovery?
Most women are back to day-to-day activities within one to two days. Soreness is most noticeable in the first week, but improves significantly each day. My recommendations include increasing activities slowly, while listening to your body. I ask women to not participate in cardiovascular exercise for four weeks and to not perform any chest exercises for six weeks.
What are the risks and complications associated with my procedure?
Complications after breast augmentation surgery can include having a collection of blood, or fluid, form around the implant, developing a superficial or deep infection, developing a capsular contracture, improper positioning of the implant, asymmetry, poor cosmetic outcome, being unhappy with the size, developing an animation deformity (with implants under the muscle), visible rippling, a palpable implant, implant rupture, or developing BIA-ALCL (breast implant associated anaplastic large cell lymphoma). Each complication is dealt with in a different way. During the consultation I discuss the risks and possible complications.
How are complications handled?
I try to avoid complications whenever possible. This starts with appropriately sized implants. In the operating room I use meticulous surgical technique, and use multiple different strategies to avoid infection, and capsular contracture. These include a "no touch" technique for implant handling. The nipples are covered with an impervious dressing (tegaderm), the implant is inserted with a Keller funnel, and the implant is washed in triple antibiotic solution. I purchase CosmetAssure (cosmetic surgery insurance) for all of my patients. This extra insurance helps defray the costs of possible complications, if they do occur.
How many additional implant-related operations can I expect over my lifetime?
An implant typically lasts 10-15 years. It should be assumed that the implants will be replaced every 10-15 years. Many women do have implants longer than 10-15 years, however. The number of additional operations depends on your age, and how long you hope to have your breast implants.
How will my ability to breastfeed be affected?
I use an incision placed in the crease. This incision gives me the most direct approach to the implant pocket, which is placed under the pectoralis major muscle. The ducts between the breast tissue and nipple are not divided during the procedure. Breast-feeding should not be affected by the surgery.
How can I expect my implanted breasts to look over time? After pregnancy? After breastfeeding?
Breast implants tend to settle with time. Any additional weight within the breast can make breast sagging occur more quickly. Breast sagging is called ptosis. Overly large implants speed the natural rate that breast ptosis occurs. I work hard to size implants conservatively, so as not to drastically increase the rate of breast sagging.
During pregnancy or breast-feeding your natural breast tissue will increase in size, causing your breasts to become larger. After pregnancy, or nursing, is completed your breasts will decrease in size. Sometimes, women find that the fluctuation in size has now caused breast ptosis. Sometimes they may benefit from a breast lift procedure. A breast lift re-elevates the nipple and reshapes the breast.
What are my options if I am dissatisfied with the cosmetic outcome of my implanted breasts?
The answer depends on the cause of the dissatisfaction. If someone is unhappy with the size, I ask them to wait six months before considering having another surgery. An implant malposition issue is addressed with additional surgery. If someone was on the border of needing a lift (mastopexy), but elected not to undergo a lifting procedure during their initial augmentation procedure, they may decide to have a lift performed during a second procedure.
How will my breasts look if I choose to have the implants removed in the future without replacement?
After implant removal, it takes six months for the breasts to change. The tissues reshape and the skin will tighten. If after six months ptosis is present, some women may benefit from a breast lift. Additional size can be obtained by performing fat transfer to the breasts. This is a technique of breast augmentation that uses your own tissues to make the breasts larger.
Do you have breast augmentation before-and-after photos I can look at for this procedure and what results are reasonable for me?
When evaluating any surgeon, it's a good idea to look at before-and-after photos. This will give you a chance to evaluate the work that they have performed. When looking at before-and-after photos, it's important to find women with similar anatomy. This gives you the best sense of how you may look after the surgical procedure.
To schedule a consultation, call our office or see our contact page.
Dr. Austin Hayes is a Board-Certified Plastic Surgeon with offices in Portland, Seattle, and Hood River.