What is Mondor’s Cord or Mondor’s Disease?
Mondor’s Cord or Mondor’s /Disease is a spontaneous thrombophlebitis of the superficial veins of the breast, anterior chest wall, and abdomen. It occurs in 1 to 2 percent of breast augment patients, and is self limiting. It usually involves a vein extending from the inframammary breast crease to the upper abdomen. It looks and feels like a cord. It poses no danger of systemic embolization. It will resolve without treatment in several weeks. Warm compresses and non-steriodal anti-inflammatory agents can be used for symptomatic relief.

What is the “Rice Test”?
One of the most miscommunicated aspects of breast enlargement surgery between the patient and the surgeon is the size of the implant. Implants are based on cubic centimeters (cc). In order to perform the Rice Test, the patient purchases a sports bra the size she desires to wear. She then fills a plastic bag with rice and places it in the bra. The rice will mold to the contour of the breasts. Rice is added or removed until the desired size is achieved. The rice is then measured. One cup equals 250cc and two cups equals 500cc. It is wise to add 10 to 15% to the final figure to allow for the changes seen with surgery. Thus, if one liked the look achieved with 300cc of rice, then one should ask for a 330-345cc implant.

How do I pick an implant size?
One can use the rice test as described above. Another option is to use a zip-lock bag and water. One fills the bag with water and places it in the sports bra. Water is added or removed until the desired size is achieved. The water is measured in a measuring cup. One ounce of water is equal to 30cc of water. It is wise to add 10 to the final volume to allow for changes that take place after surgery.

During the preop consultation, the patient can ‘try on’ different size implants by placing them in a sports bra. This is done in the doctor’s office with any style implant until the desired result is achieved.

Also, pictures can give a surgeon a rough estimate to the size implant desired. Lastly, the Allergan Bio-Dimensional Planning System uses measurements of the breast and chest wall to determine the ideal implant for one’s body contour.

How are saline implants filled?
After the incision is made, all air is removed from the implant and it is rolled up like a cigar. This breast implant augment fill kitsignificantly decreases the size of the implant, thus allowing the use of a smaller incision as compared to the incision used for a gel implant. It is then placed through the incision into the new breast pocket and unrolled. A silicone sleeve may be used to protect the implant during insertion. A hollow fill tube has been connected to the valve of the implant. The other end is connected to a syringe or Fill Kit. The syringe is then disconnected from the tube, filled with saline, reconnected to the tube, and the saline is injected into the implant. This step is repeated until the desired volume is achieved. This is considered an ‘open technique’ since the saline comes in contact with air. This may increase the risk of implant contamination or infection. The fill tube is removed from the implant and the valve is closed.

The Fill Kit technique is a ‘closed system’. The Fill Kit is connected directly to the saline bag with IV tubing and the kit has a special one way valve. This allows the saline to be injected directly from the saline bag into the implant without being exposed to air. This may have the theoretical benefit of decreasing the risk of implant contamination or infection.

What are the effects of pregnancy after breast augmentation?
The breasts will initially engorge or swell as they normally do with any pregnancy. They will become more firm as they fill with milk. The areola complex will also get larger and become darker. One may be able to visualize more vessels in the skin, especially veins, as well as stretch marks. Breast feeding may also contribute to these changes. After the pregnancy and/or breast feeding, the breasts will loose their volume. They may return to their pre-pregnancy state. However, if they loose a significant amount of volume, the breast tissue and skin may stretch and sag. This may make the implants also sag and rest too low on the chest wall. If the implants remain in their original position, then only the nipples and breast tissue may sag down over the implant. This causes the nipple to be too low in relation to the implant causing a ‘snoopy dog’ deformity. These situations may require either replacement with a larger implant or a breast lift procedure.

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