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Dr. Horton Outlines Breast Augmentation From Consultation to Recovery

We recently sat down with our Board-Certified Plastic Surgeon, Dr. Karen Horton, to discuss one of the most popular procedures she performs at our practice: The Breast Augmentation. Below is our Q&A with Dr. Horton detailing the ins and outs of the popular breast enhancement surgery, as well as how she approaches the procedure from pre-surgical consultation to postoperative care.

Question: What percentage of your patients receive breast augmentation surgeries?

Dr. Horton: Approximately one half of the patients I see in my office each day are seeking some form of breast augmentation. Many of these are Moms who would like to rejuvenate their tummy and breasts after they have completed childbearing. They notice permanent changes to their breasts such as deflation, loss of breast volume, and breast sagging that a breast augmentation can help to correct.

The two main patient populations I see most often are women who have finished having their children, are healthy and relatively fit, and are ready to focus on themselves and welcome an improved body image; or women who are seeking breast cancer reconstruction after breast cancer treatment. My aesthetic goals for both of these patient populations – be they cosmetic or reconstructive – are exactly the same! I strive for women facing breast cancer to feel as if their results are the best cosmetic outcome possible, regardless of the reason for their surgery.

I encourage women who are seeking a “mommy makeover” not to feel guilt about considering doing something for themselves as a woman, a mother, or a wife. I emphasize to Moms that it is not vain or selfish to consider a breast augmentation; rather, it can be an empowering and positive experience when done for the right reasons and by a Board-Certified Plastic Surgeon with extensive experience. Additionally, I generally recommend that surgery is also scheduled at a time when Moms will have help with their postoperative recovery.

Q: What are the main reasons your patients give for wanting the procedure?

DH: Breast augmentation surgery has many perks. It can help a woman improve her body image, self esteem, fit her bras and clothing better, and to enable her to feel comfortable and natural in her own skin. Women who come to see me for a possible breast augmentation often strive for at least one of three common goals: One, to achieve greater breast fullness that will enable her to be more proportional to the rest of her body curves or body shape; two, to regain breast fullness or volume that was lost after she has had children; or three, to achieve better symmetry than her current appearance.

Many women are born with one breast that is significantly larger or smaller than the other, with more droop, a different shape, or other asymmetries that a breast augmentation can help to correct. Other women have a particular breast condition such as “tubular breasts” or rare conditions such as Poland’s Syndrome in which breast augmentation is used as a reconstructive tool.

Q: What techniques do you use that set you apart from other Plastic Surgeons?

DH: As a female Plastic Surgeon who shares the same anatomy as the great majority of individuals I see in the office, most of my patients confide that they feel comfortable sharing their thoughts and concerns with me not only as their surgeon, but as a woman. I treat each of my patients with the same thought process, attention, and care that I would provide to my sister, a close friend, or family member. I only recommend procedures that I would have done to my own body, as a mother of twins, a slender and athletic person, a wife, and a full-time professional career woman.

For most of my patients, I recommend silicone gel implants that have a “gummy bear” consistency and feel. My patients and I tend to share the same aesthetic goals: a natural, proportional, teardrop shape; one that looks youthful, but avoids a “fake” and obvious augmented look. Many of my patients are fit and athletic, and they want to avoid sacrificing the muscles in their chests. This is one of the things we discuss at our initial consultation, which lasts about 45-60 minutes, along with each woman’s specific goals for her body and individual situation, her recovery time, potential risks and complications, and considerations after surgery such as breastfeeding and nipple sensation, mammograms, and breast cancer screening.

Q: What type of care do you provide patients before their procedures?

DH: Following our extensive, initial consultation, I give each of my patients “homework.” This includes speaking to two to three of my patients who have had the exact same procedure she is seeking. I carefully match patients by age, body type, personality, and aesthetic goals. I allow women who have had a breast augmentation procedure to educate one another in an informal setting, such as a phone call, so that a woman who is considering this procedure can learn all about it, including potential risks and complications. This is part of the “informed consent” process, and it serves to further educate and empower women.

I also ask patients to find online images that correspond with the result they are seeking, including size, shape, projection, details of the nipple and areola, and other factors that we consider when planning surgery. “Wish pictures” help me, as a surgeon, to understand what is in the “mind’s eye” for each of my patients on an individual basis. We then use these images during surgery to ensure we come as close as possible to her specific desires. I also welcome women to find “don’t pictures,” which illustrate what features are undesirable, such as too big, too small, too wide apart, an unnatural look, etc.

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To view our breast augmentation before-and-after picture gallery, click here.

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When a woman decides she is ready to schedule surgery, I meet with her a second time in my office for about 90 minutes. Along with our second meeting, patients also spend time with Nurse Mari, our Registered Nurse, who further educates them about how to prepare for surgery and postoperative restrictions, as well as when activities such as driving, work, exercise, and sex can be resumed. We provide our patients with all the information they will need for their recovery at this visit, including prescriptions for pain medication, antibiotics, and an anti-anxiety pill that is extremely helpful for most women the night before their procedure!

Q: How do you help patients decide which size and type of implants are best for them?

DH: After patients have found their “wish pictures” and “don’t pictures” that help to illustrate the results they desire, we generally meet once more to discuss surgery further, or meet again at their preoperative visit. Together – using preoperative images typically taken at their initial consultation – we determine a range of breast implant volumes, styles, and projections that are appropriate in consideration of their goals.

However, the final determination of which size and type of breast implants are most appropriate for each patient is actually determined during surgery, while she is asleep. I perform meticulous intraoperative “sizing” of the breast so the best match of implant size, shape, and projection is selected on the operating room table. Each breast is sized independently, as many individuals have chest wall asymmetries, mild scoliosis, or differences in breast shape or size preoperatively that need to be considered in achieving a symmetric, natural, and long-lasting breast augmentation result.

Q: What type of care do you provide patients after their surgeries?

DH: On the day of surgery, I meet with my patients again to review the plan and perform markings on their skin. We also confirm their personal goals and review any additional “wish pictures” they may have found since their preoperative visit. I stand with each and every one of my patients as they drift off to sleep, and I am usually the first person they see in the recovery room after surgery.

Patients can generally go home a few hours after their procedure. I will then see them a few days after surgery, and then weekly for the first month to ensure they are healing well with a beautiful and natural result, free of any complications. In the long term, I like to see my patients every year to ensure they are still looking good and feeling fabulous, even many years after their breast augmentation!

For more information regarding breast augmentation surgery, or to schedule a one-on-one consultation with Dr. Horton, please contact our office today.



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Dr. Karen M. Horton, M.D. - Plastic Surgery, Physicians & Surgeons - Medical-M.D., San Francisco, CA