Breast augmentation

Breast augmentation is the single most commonly performed procedure in North Texas. So if you live in Dallas, Plano or Frisco, the odds are that you know someone who has breast implants. Choosing the right surgeon and the best surgery is not as simple as selecting how large an implant you want. The decision to pursue breast augmentation is personal, and the decision-making around the surgical plan has to be equally personalized. There are several questions that must be answered when planning a breast augmentation –

  1. What type of implant should you use – saline, regular silicone, or highly cohesive silicone?
  2. Should the implant be smooth or rough textured?
  3. How wide should the implant be? How tall? Should it be round or oval shaped?
  4. What volume (i.e. how many cubic centimeters) should the implant be?
  5. Where should the implant be placed – above the pectoralis muscle or below it?
  6. Where should the incision be placed – underneath the breast, around the areola, or the in the armpit?
  7. Is it necessary to perform a breast lift at the same time?
  8. Is there any obvious or hidden asymmetry that will need to be adjusted for during the surgery?

The answers to these questions depend on your specific goals, but also on you. Your anatomy, body type, age, and other physical characteristics drive the plan. A large smooth saline implant above the muscle may not be ideal if you have thin crepey skin with very little fat. On the other hand, for a different patient, this choice may be perfectly safe and appropriate.

During your consultation, you should expect to discuss all the details of your medical history. This includes breast health history (e.g., prior mammograms, family history of breast disease), prior surgeries, and medications and supplements you use. After meeting Dr. Nagarkar and his nurse, you will also have medical photographs taken in the office to assist with the surgical planning.

Dr. Purushottam Nagarkar, University of Texas Southwestern Medical Center, Dallas, Plano and Frisco
Dr. Nagarkar on his philosophy of breast surgery:

I like to have an in-depth discussion with each new patient to really understand her specific goals. I’ve found that a patient will usually have a clear idea in her mind about where she wants to end up, and my job is to understand that idea and make it concrete and tangible so that we can both agree on the plan. A focused history and physical examination, as well as detailed measurements and photographic analysis will help us winnow our options, and to create the surgical plan as a doctor-patient team. The goal is to produce a reliable and long-lasting result that you will be just as happy with in ten years as you are the day after surgery.

Who is a good candidate for breast augmentation:

Most patients without any major medical problems can be good candidates for breast augmentation. However, making sure that your expectations and goals are clear is critical in making sure that you will be happy with your result. During your consultation with Dr. Nagarkar he will spend the time to truly understand your desires to determine whether breast augmentation is the right surgery for you.

How to prepare for surgery:

Dr. Nagarkar will let you know if any laboratory tests are required prior to your surgery. In some patients, a pre-operative mammogram may be needed to obtain baseline information and help detect any changes in your breast tissue. If you are a smoker, you must completely stop smoking and refrain from any nicotine-containing smoking cessation aids (such as patches or gums) for 6 weeks prior to surgery. This is critical as smoking increases the risk of significant complications. Finally, you will discuss with Dr. Nagarkar which medications and supplements you should stop taking before surgery, and which ones you can continue. You will get detailed written instructions for pre- and post-operative care. In addition, you will receive any postoperative prescriptions you might need so that you can have them filled by the pharmacy in advance.

What to expect on the day of surgery:

Breast augmentation is generally an outpatient surgery that lasts around an hour, depending on the complexity of the case, and whether you have chosen to have other procedures performed at the same time. You should plan on having nothing to eat or drink after midnight the night before surgery. You will need to have someone drive you to and from the surgery, and to stay with you for 24 hours afterwards. A licensed and certified anesthesiology provider will be present during your procedure to provide anesthesia and monitor you at all times during the surgery. After surgery, you will return to the recovery room where a nurse will monitor you until you are awake and alert and ready to go home.

What to expect after surgery:


Your surgery is designed and performed to achieve the best possible result and as close to 100% symmetry as possible on the operating table. In the first 48 hours after surgery, you will have some swelling, which can take several weeks to resolve completely. Your scars may appear raised and inflamed at first, but will fade, soften, and flatten, over the course of 6 months to a year after surgery.

The first few days

Recovery after breast augmentation is usually quite rapid. You will be able to go home after surgery, and you should be able to be up and about by that evening. Dr. Nagarkar will call you the next day to make sure you are doing well, and to answer any questions you might have.


Narcotic pain medications are usually only needed for a day or two, and often are not required at all. Often, anti-inflammatory over the counter medications like Tylenol and Ibuprofen are adequate.

Incision care

Your incisions will all be closed with internal absorbable sutures, and surgical glue, so you can generally start showering the day after surgery, although bathing, swimming, or getting in a jacuzzi should not be done until at least 3 weeks after surgery. You should protect your fresh scars from sun exposure for at least 6 months after surgery, because they are extra sensitive to sunlight during this period. Dr. Nagarkar may discuss special scar care techniques such as silicone sheeting or moisturizers with you. If you are prone to forming keloids, it is very important that you discuss this with him prior to your surgery.


Most patients do not require surgical drains.


You can return to your regular diet after surgery, but for the first day or two, stick with lighter meals. Anesthesia can make your digestive system a bit sensitive – a double cheeseburger the evening after surgery is not recommended. You should refrain from high-sodium foods. Salt may increase swelling or prolong the time required for your swelling to resolve.


Recovery after breast augmentation is usually quite rapid. Most patients only need to take a few days off work.


You will be able to go back to non-strenuous activities such as walking, using a computer, writing, and so on, immediately after surgery. You should not lift anything over 10 pounds (or a gallon of milk), for 2-3 weeks after your surgery to allow your tissues to heal.


You can resume driving once you are no longer taking narcotic medications, and when you feel that you are in full control of your car. This often takes a week or two.


Aerobic exercise such as yoga, running, cycling, barre, etc., must be stopped for three weeks to allow the tissues to heal. Strenuous activity too early in the recovery brings a high risk of bleeding, which can cause significant complications.

Follow-up visits

You will see Dr. Nagarkar usually 7 – 10 days after surgery to examine your incisions and healing progress. We will see you again at 4-6 weeks, when Dr. Nagarkar may clear you from activity restrictions if you are healing appropriately. Finally you will have appointments around 3 months, 6 months and 1 year after surgery.

To meet Dr. Nagarkar in person, schedule your consultation or call us.