In terms of selecting the location of the incision and resulting scar. There are several type of incisions through which the breast implants are inserted. This is the armpit incision, areolar incision and breast fold incision. In my practice, I prefer to do armpit incision in inserting breast implants, because we are able to avoid any direct incisions and thus scarring or scar formation directly at the breast skin and gland thus there will be no visible scar at the breast mound or surface. On addition to this, the result scar at the armpit area is hardly noticeable since its fine and linear.
On the other hand, incisions at the areolar area results to a scar that is very visible or noticeable specially for asian and black african patients which scar poorly and may hypo-pigment. In addition to this, significant number of patients with areolar incision complain that their scar widens thus needs revision. Also, risk for loosing or affecting nipple sensation after areolar incision is significantly high. Because of this, I rarely perform this unless patient request it or they would need breast lift surgery as well. 
But for patients with well formed breast fold before surgery, breast fold incision is as good option. With this type of incision, nipple sensation is rarely affected. Resulting scar can be concealed with in the breast fold. For me, this is the second best incision. But as much as I could and like, I perform my breast augmentation surgery with an armpit incision. For transgender, the ideal incision would be through the breast fold, for better dissection to facilitate creation of the pocket for the implants and also for ease of muscle dissection.
Breast augmentation procedure will take 1 to 2 hours to complete and this is performed under sedation with intercostal block. Pain is one of the most common concerns that patients for breast augmentation think of. Because of this, we have give this pain issue a lot of attention. We have formed a pain management protocol to address this in which patients are give intercostal blocks to numb their chest before surgery and immediately after surgery. This will help us control the pain. On top of this, patients are started on single IV pain medications combined with oral pain meds so that the effect of these medications would overlap each other.
To be honest with you, majority of my patients does not complain of pain but more of the discomfort due to swelling of the breast after surgery. But swelling is temporary and will eventually resolve through time. After surgery, as I said there will be swelling and some bruising that peaks on the 3rd day and start to subside on the 4th day onwards. You will be instructed to wear special bra used by breastaugmented patient during the first 2 to 3 weeks to help control the swelling and also give you more comfort. Sutures are removed on the 7th day after surgery and wounds are healed by the 10th day after surgery.
For your activity this is gradually increase after surgery since you need to rest for a day or two, you will be allowed to do some light cardio activity on the 3rd week after surgery like walking, and then you may resume regular gym exercise after 4 to 5 weeks. Patients are advise to refrain from sexual activity for 3 weeks after surgery since this may causes hematoma formation and pain.
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