Why would implants be placed below the muscle?

There are several reasons why breast implants may be placed under the muscle (sub-muscular placement) during breast augmentation surgery. Here are a few of the main reasons:

1. Natural Appearance: Placing the implant under the muscle can provide a more natural-looking result by creating a smooth transition between the implant and the breast tissue.

2. Implant Coverage: The muscle offers additional coverage and support for the implant, which can help reduce the risk of visible rippling or wrinkling of the implant.

3. Mammography: Placing the implant under the muscle can make it easier to perform and interpret mammograms as the muscle helps separate the implant from the breast tissue, allowing for better visualization of breast tissue during screening.

4. Reduced Capsular Contracture Risk: Sub-muscular placement has been associated with a potentially lower risk of capsular contracture, which is the formation of excessive scar tissue around the implant.

It's important to note that the choice of implant placement depends on various factors, including the patient's anatomy, and desired outcome. During your initial consultation I will provide personalized information and guidance based on your individual circumstance.

Cheat Sheet- Breast augmentation post-op

Carefully follow the postoperative instructions provided by myself, my surgical coordinator, and my nurse. These instructions include guidelines on medications and activity restrictions. Adhering to these instructions will help optimize your healing process.

I recommend wearing your supportive surgical bra or compression garment to provide gentle support to the breasts. We ask patients to wear the same bra for a minimum of 48 hours straight, and afterwards you can give yourself 1-2 hour breaks throughout the day. Compression is key. This helps minimize swelling, promote healing, and maintain proper implant positioning.

Proper care of your incisions is crucial. Keep the incision area clean/dry as possible and avoid submerging your incisions in water. You will take off the steri-strips placed two weeks after surgery. 

You may experience some discomfort or pain after surgery. If needed, take the prescribed pain medication to manage any discomfort. Patients typically report their pain to be well managed with extra strength Tylenol.

No strenuous activity for six weeks. You will need to limit activities such as heavy lifting and upper body movements. Gradually ease back into your regular routine and if any activity causes discomfort, do not continue to push yourself. 

You will have a post operative appointment one week after surgery day and another one 6 weeks post-op. It is imperative that you attend your scheduled follow up visits. I want to monitor your healing progress, address any concerns, and provide further guidance as needed.

Pay attention to any unusual changes or symptoms, such as excessive swelling, redness, persistent pain, or changes in breast appearance. If you notice any concerns, promptly contact my office for an evaluation.

Sterility protocol during your breast augmentation

1. Preoperative Preparation: Before the surgery, the operating room is thoroughly cleaned and sterilized. The surgical team adheres to strict hand hygiene protocols and wears sterile gloves and gowns.

2. Patient Preparation: Once you are in the operating room, your skin is cleaned with an antiseptic solution to reduce the risk of infection. Sterile drapes are placed to create a sterile field around the surgical site.

3. Surgical Instruments: All surgical instruments used during the procedure are sterilized beforehand through various methods, such as autoclaving or using sterile single-use instruments. This ensures that the instruments are free from microorganisms and other contaminants.

4. Sterile Gloves: Myself and the surgical team wear sterile gloves throughout the procedure to maintain a sterile environment and prevent the introduction of bacteria.

5. Implant Handling: The breast implants themselves come in sterile packaging. My nurse opens the packaging within the sterile field, ensuring that the implants remain sterile before placement.

6. Implant Placement: Once the surgical incision is made, the pocket for the implant is created. The implant is carefully inserted into the pocket while maintaining sterility. This is typically done using a "no-touch" technique, where the implant is never touched by non-sterile surfaces or hands.

7. Wound Closure: After the implant is securely in place, the incisions are closed using sterile sutures or adhesive strips. Sterile dressings may be applied to protect the incision site and promote healing.

Throughout the entire process, the surgical team follows strict protocols to maintain a sterile environment. These measures are in place to minimize the risk of infection and promote safe surgical outcomes.

What size breast implant should I go with?

One of the most commonly asked questions with our prospective breast augmentation patients. When it comes to choosing the size for a breast augmentation, several factors need to be considered. As a board-certified plastic surgeon, I can guide you through the process. Here's what you should consider

1. Body Proportions and Frame: Your body proportions and frame play a crucial role in determining the appropriate implant size. Factors such as height, weight, chest width, and existing breast tissue are considered to achieve a balanced and natural result.

2. Desired Outcome: Clearly communicate your goals and expectations to your surgeon. They will assess your desired cup size and shape to help guide you in choosing the appropriate implant size.

3. Tissue Characteristics: The quality and quantity of your existing breast tissue are important. Patients with minimal breast tissue may require larger implants to achieve their desired size, while those with ample tissue may achieve their desired results with smaller implants.

4. Lifestyle and Activities: Consider your lifestyle and the activities you engage in regularly. If you're involved in sports or physical activities that require significant chest movement, you may prefer a size that allows for comfortable participation without compromising your lifestyle.

5. Surgeon's Recommendation: Trust the expertise of your plastic surgeon. Based on their experience and knowledge, they will evaluate your individual factors and recommend a range of implant sizes that are suitable for your unique anatomy and goals.

During a consultation, I will take measurements, conduct a physical examination, and use inspiration images or sample sizers to simulate potential outcomes. This allows you to visualize different sizes and make a more informed decision. Remember, the ultimate goal is to achieve a result that enhances your overall proportions, looks natural, and aligns with your expectations. Our office encourages open communication to help ensure a satisfying outcome.

I'm getting a breast augmentation at Dr. Devgan's office, what should I expect?

It’s natural to feel some level of apprehension or concern about undergoing cosmetic surgery. However, you should not let fear deter you from making the decision to go ahead and do it! Here at our office, we want you to know what the sequence of events are leading up to, on, and after your breast augmentation.

First, we’ll meet for your initial consultation, whether that be in person or via Facetime. We’ll chat about your goals and concerns, and I’ll ask you to send some inspirational photos. If you’re a good candidate for a breast augmentation, you will then meet with my surgical coordinator, who will share all surgical details with you in an in-depth meeting. Our surgical coordinator and I will be readily available throughout the whole process. Leading up to surgery day, our coordinator will be communicating via phone call, making sure all questions are answered.

On surgery day, you will come to the office one hour before your case is scheduled to start. You will first meet with my nurse who will go through all the pre-operative information, which includes your medical/surgical history, post operative medication, and incision care. A pregnancy and nicotine test will be done. Our board-certified anesthesiologist will meet with you next. All patients who undergo a breast augmentation are required to be asleep for this procedure. You will be under light IV sedation or “twilight” anesthesia. This means you’ll be breathing on your own, but you will not remember anything from the operating room. Lastly, you will meet with me, where we will go over your inspiration photos and confirm sizing. Afterwards it’s go time! My nurse will walk you to the operating room where the surgery will take place. Breast augmentations typically take one hour. Afterwards, you will wake up in the recovery room. My nurse will be monitoring your vitals, fluid intake, and incisions post operatively. Usually, after one hour in the recovery room, patients feel comfortable walking out on their own. Your escort and our nurse will help assist you into your car to travel to your recovery destination.

What is the difference between silicone and saline breast implants?

When it comes to breast implants, saline and silicone are two different types of filling materials used. Here are some key differences between saline and silicone implants:

1. Filling Material: Saline implants are filled with a sterile saline solution (saltwater), while silicone implants are filled with a cohesive silicone gel.

2. Consistency: Saline implants have a firmer feel compared to silicone implants. Silicone implants are designed to closely resemble the feel of natural breast tissue.

3. Rupture Detection: If a saline implant ruptures, it deflates quickly, and the saline solution is harmlessly absorbed by the body, making the rupture noticeable. Silicone implant ruptures are often referred to as "silent ruptures" because they can go undetected without regular imaging, such as MRI scans.

4. Appearance: Silicone implants typically provide a more natural look and feel due to their gel consistency. Saline implants may have a slightly more noticeable "water balloon" appearance, especially in patients with less breast tissue.

5. Naturalness: In very thin patients, silicone implants are less likely to show rippling and fold flaws and may thus appear more natural.

6. FDA Approval: Both saline and silicone breast implants are FDA-approved for breast augmentation in the United States.

It's important to consult with a board-certified plastic surgeon, like myself, to discuss your specific goals, medical history, and individual factors that may influence the choice between saline and silicone implants.

What is the difference between a midface lift and a lower facelift?

A midface lift and a lower facelift are two different surgical procedures that address different areas of the face.

A midface lift focuses on rejuvenating the middle portion of the face, including the cheeks and the area around the nose and mouth. It targets sagging or drooping cheeks, deep nasolabial folds, and a tired or sunken appearance. The procedure involves repositioning and lifting the underlying tissues to restore volume and smooth out wrinkles in the midface area.

On the other hand, a lower facelift primarily targets the jawline, jowls, and the neck. It addresses sagging skin, excessive fat deposits, and muscle laxity in the lower face, resulting in a more defined jawline and a tighter, more youthful appearance. The procedure typically involves repositioning and tightening the underlying tissues, removing excess skin, and sometimes liposuction to enhance the contour of the jawline and neck.

Both procedures can be performed separately or in combination, depending on the patient's specific concerns and goals. It is important to consult with a board-certified plastic surgeon to determine the most suitable approach for achieving the desired results.

Dr. Devgan recognized by Goop as one of New York’s best cosmetic surgeons

Written by Jack Nicastro

Goop recently published a shortlist of their favorite physicians in an article entitled: “The goop Guide to Cosmetic Surgeons.” Given goop’s aesthetic preference for a natural, understated look, it is no wonder that Dr. Devgan, known for her “beauty is in the details” motto, ranks as one of their top picks.

Goop applauds Dr. Devgan for her signature facial procedures which accentuate her clients’ natural beauty without leaving distracting scars. Specifically, goop cites Dr. Devgan’s non-surgical injectable procedures as well as her minimally invasive surgical techniques such as suture suspension lifting and eyelid zip-stitch, both of which are visually seamless.