Breast augmentation surgery is beginning to pop up in the strangest places!  This includes your ear/nose/throat doctors, family doctors, general surgeons, emergency room doctors, and… just about everybody else who has an MD after his or her name.  Lots of doctors are trying their hand at the procedure as a way of supplementing their bottom line.  And why not?  Constantly in demand, breast augmentation is the number one cosmetic procedure.

There’s even a $7,000 entry-level course being taught for anyone with an M.D. degree to learn how to perform breast augmentation. At the end of this weekend course, someone with only modest surgical skills could learn how to balloon up the breast tissue as you would for liposuction, and do a very limited pocket under the breast and over the muscle for a large incision in the breast fold and then put an implant in and sew it up.

What does surgical judgment, experience and aesthetic judgment count for?  By the time I had started my cosmetic breast practice, I had performed hundreds of a much more difficult procedure: breast reconstruction. This gave me a great deal of experience with the sub muscular pocket and the beginnings of the concept of the muscle brassiere. In addition, with breast reconstruction, you are usually trying to match and adjust the opposite side.

So is judgment and experience important?  Just this last week, among the other cases cited were breast cases: bilateral and augmentation, unilateral augmentation, and then a mastopexy bilateral Salt removal and replacement bilateral implant removal incised exchange.

Just as an outline of the process of breast augmentation and lift:

1. Preoperative marking
2. General anesthesia
3. Incisions
4. Making the sub muscular pocket with muscle support
5. Placement of a sizer to expand the pocket to fit the breast implant
6. Sit the patient up for visual assessment for shape and volume
7. Make necessary adjustments to the size
8. Temporary sutur breast lift
9. Sit up for assessment
10. Remove sutures
11. Second temporary breast lift
12. Sit patient up for assessment
13. 3rd Temporary breast lift
14. Set up okay just markings
15. Remove skin
16. Suture closures
17. Set up for final check of finished lift and augmentation to make sure it is aesthetically correct.

These steps were for a complicated major breast lift and augmentation with asymmetry.  There are many different surgical steps with a lot of decisions to be made at every step. The reason you can’t just throw some markings and then cut on the dotted line is for every change in volume, there are changes in dimension according to the skin tension. This is different according to every person.

There’s a lot more to cosmetic breast augmentation, breast lifts and breast surgery than just putting a little bag under the skin. Cosmetic breast surgery has a steep learning curve that takes years to master.  This is especially true if one is performing symmetry surgery or revision surgery, which is complicated three-dimensional surgery.  It is definitely not for the gynecologist with time on his hands who has just taken a weekend course.