Dr. Wilder's Philosophy on Breast Procedures

As far as breast augmentations, Dr. Wilder says if he could have his preference, no one would even know his patients have had surgery. They would just look like they have a great figure, but look “in proportion”. 


Dr. Wilder also believes “less is more”. What he means by this is if he can do less surgery for a patient and the patient be happy, it is a win! He educates them on their options. For example, if a patient could do a mastopexy (breast lift) alone and lift their own tissue without adding volume (augmentation) he gives them that option. Even though that is less surgery now and in the future for him, he is thinking what is best for the patient.

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Breast Augmentation

Breast Augmentation surgery refers to the enhancement of the breasts with an implant. Some women have breasts that never developed satisfactorily, while others have lost fullness as the result of pregnancy or weight loss. The procedure increases the fullness and projection of the breasts providing a more proportional figure. It can also help correct breast asymmetry. It is usually done on an outpatient basis under general anesthesia. Dr. Wilder performs-his procedures at Austin Surgical Hospital, a very private award winning hospital for outstanding medical care. 

There are four decisions that the patient will be involved in making: 

  • Type of implant (silicone vs. saline)

  • Incision site (under the breast, around the areola, or in the axilla)

  • Placement of implant (under the pectoral muscle or directly behind the breast tissue, over the pectoral muscle)

  • Size

At your consultation, Dr. Wilder will make recommendations based on his examination, and will help you decide on the best approach for you.

Mastopexy (Breast Lift)  

A Breast Lift, also called a Mastopexy, is a surgery that lifts sagging breasts either with or without breast implants. Those who choose to undergo a breast lift are usually those who are noticing that gravity has taken over their breasts due to aging, pregnancy, breastfeeding or other factors that may cause your breasts to sag. This procedure will restore the breasts to their original perky position and size. 

A breast lift raises and reshapes sagging breasts by removing excess fat/skin and repositioning the remaining tissue and nipples to improve its appearance. A breast lift can also reduce the size of the areola, which is the darker skin surrounding the nipple. If a patient's breasts are small or have lost volume it can be added. 

Breast Lift With or Without Implants: When deciding if an implant is necessary, the doctor will examine how much breast tissue you have and what you would like your desired result to be. A breast implant not only increase the size but also the firmness of the breast.

Breast Implant Exchange 

Breast Implant Exchange, which involves replacement of saline or silicone breast implants, is performed to change the size or type of your implants and to correct any complications from your primary breast augmentation. The overall goal is to restore a youthful breast contour and appearance. (The American Society for Aesthetic Plastic Surgery) 

Breast implants are not lifelong devices, but every patient will have a different experince. If there is a change in your breast implant with the look or feel that you are unhappy with, you should consider consulting with Dr. Wilder. 

In some cases, the outside shell of the implant breaks down causing silicone to leak and the scar tissue around the implant to harden. This can only be fully detected through an MRI or an implant removal. During the time of the removal, the surgeon can safely replace the implant. 

Breast Reduction 

Breast Reduction, also known as reduction mammaplasty, is a procedure to remove excess breast fat, glandular tissue and skin to achieve a breast size more in proportion with your body and to alleviate the discomfort associated with excessively large breasts (macromastia). 

Disproportionately large breasts can cause both physical and emotional distress for patients. Patients with macromastia may experience physical discomfort resulting from the weight of their breasts. Although breast reduction is often performed to address medical issues, patients who do not have the symptoms of macromastia but are unhappy with the size of their breasts can still pursue breast reduction as an aesthetic procedure. (American Society of Plastic Surgeons) 

Breast Implant Removal 

The goal of Breast Implant Removal surgery is to remove breast implants from breast augmentation or breast reconstruction patients. During these procedures, the surgeon may also remove silicone material from implant leaks and the breast capsule, which is the scar tissue that forms after the placement of a breast implant. 

Often, the scar tissue that forms after the placement of an implant is soft and does not need to be removed, but it may harden, causing pain and discomfort. This is often a reason to have the implants and scar tissue removed. 


Breast Procedure FAQ

How do I know what incision is right for me?

Unless you are having a breast lift at the time of your implant placement, Dr. Wilder usually recommends an incision hidden in the crease under your breast. This incision allows the most direct access to the implant space, avoids scars on the breast itself, allows for revisions in the future, and is visible only to someone with whom you are intimate.

How do I choose the size of implant?

Dr. Wilder chooses implant sizes and styles based on a patient’s preoperative appearance combined with “wish” photographs of what the patient would like to look like after the surgery. This is done by looking at the before -and-after gallery of photos and finding women who have a similar appearance to the patient in the “before” picture and selecting one that most closely resembles what they would like to see as their own “after” picture. Trying implants on in a bra for size may come close, but it doesn’t give you any idea of what your breasts will actually look like with those implants inside of you.

What is the difference between silicone and saline breast implants?

All implants currently are made entirely of silicone. The saline implants are an empty shell of silicone rubber that are filled with saline (salt water) during the actual operation. The silicone gel implants have a similar silicone rubber shell, but are pre-filled at the factory with additional silicone in the form of a gel designed to approximate the feel of normal breasts. The gel-filled implants therefore have a more natural feel which is especially noticeable in thinner patients.

How long do I have to wait until I can exercise again?

While you can go for walks and use your arms immediately after surgery, Dr. Wilder recommends avoiding any exercise that elevates your heart rate, causes you to sweat, or involves lifting more than 10 pounds for three weeks following surgery.




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