Breast Enlargement (Augmentation)
Breast augmentation is an operation designed not only to increase the size of the breasts, but to improve the shape at the same time. This is done with the insertion of implants under the breast tissue. Women requesting this sort of surgery may either have naturally small breast, or the breast volume may have reduced after pregnancy and breastfeeding or weight loss. Breast augmentation may also be combined with a breast lifting operation (mastopexy) to lift the breast up higher if they have ‘dropped' with time. A well planned and executed breast augmentation procedure makes for a very happy patient and many new patients have come following a recommendation from previous breast augmentation patients.
You may already know something about modern day breast implants. They have an outer shell and are filled with silicone gel. I only use ‘cohesive gel' implants which are semi-solid. This means that even if the implant is cut in half with a scalpel, it will hold its shape and no leakage occurs. I also believe that it is essential to obtain a completely natural look and advise the use of implants which are ‘anatomical' or tear-drop shape, as these produce a more natural and attractive looking breast. ‘Round’ implants are also appropriate for some patients and we will discuss this together at the time of your consultation.
There are a number of factors to consider when choosing the size of your implants. I will take detailed measurements of your chest wall and current breasts and you will have an opportunity to trial a range of implants at your consultation so you can have a fairly accurate idea of your ‘final’ size after surgery. I always recommend staying within appropriate limits for your body size to achieve a natural and attractive augmentation.
Types of Implants
Breast implants have in fact been in use since the early 1960's and much publicity has surrounded them. The original implants had a silicone shell with a liquid silicone filling. The concern around these was the possibility of rupture and leakage of the silicone and how this may affect the patient. After much study and debate, no increased risk of breast cancer or other diseases has been found with silicone implants.
Modern implants have a “cohesive semi-solid silicone gel” which does not leak even if the implant is fully ruptured. Another major recent advance has been the introduction of polyurethane coated implants which have reduced the rate of capsular contracture (the most common long-term problem associated with silicone implants) to an impressive 0-3%. I have been very pleased with the aesthetic shape that they are able to achieve. I recommend using only reputable top-of-the-range implants from Silimed or Allergan if you are at all considering having implants. These companies provide a lifetime guarantee against rupture.
What shape of Implant is Best?
One of the options to consider in your choice of implants is the use of either “anatomical teardrop” or “round” shape implants. Generally speaking the anatomical teardrop shape provides a more natural and aesthetic augmentation for patients who are slim or have very little breast tissue of their own. They provide for a smooth upper pole transition area that is visible if you are wearing a low cut top and can provide for a small degree of lift to the breast tissue.
I use round implants much less frequently and recommend them only for patients who have no droop and have a reasonable amount of breast tissue to start with (at least a B cup).
The other consideration is the surface of the implant which can be ‘textured’ or ‘smooth’. I would almost always recommend textured implants as have been proven to have a much lower rate of long term problems with capsular contracture.
Behind or In Front of the Muscle?
Breast implants can be placed either directly behind the existing breast tissue and on top of the chest muscle (the ‘pectoralis major’ muscle) OR behind the chest muscle. The first approach is also referred to as ‘sub-glandular’ placement as opposed to the ‘sub-muscular’ placement which is behind the muscle.
Generally speaking the subglandular approach suits patients that have a reasonable amount of breast tissue particularly in the upper pole area so that the implant does not become visible in this area. It provides the most aesthetic and durable augmentation in this situation. However for patients that are very slim and have little tissue in the upper pole, the submuscular approach is preferred so that good soft tissue coverage of the upper pole can be achieved. In this situation I in fact recommend a dual-plane approach that combines the benefits of both approaches and I will discuss this with you fully during your consultation.
Choice of Surgical Incisions
The inframammary incision (under the breast crease) is almost always the best choice for surgical access. It gives the best access for preparing surgical pockets for implant placement and ensuring that symmetry is achieved between the two sides. The scar is usually of excellent quality and well hidden.
Occasionally a peri-aereolar incision (through the areola) may be recommended if certain breast deformities exist that need correction at the same time as the augmentation surgery.
Achieving a Natural Look
Achieving an aesthetic and natural appearing augmentation is something that I believe is worth spending a large amount of effort on. Surgical experience and artistic sense is essential in this regard. There are a number of options to consider from the style of implant to the surgical technique of placement which must be custom designed for each patient to achieve the ultimate goal of an augmentation that the patient is proud of.
Implants and Breast Cancer
It is well accepted through exhaustive international research that silicone breast implants do not cause breast cancer. In fact breast cancer rates are lower in women with implants than the general population although this is likely to be a reflection of the smaller breast size in women having implants.
Routine breast screening with mammography can be performed after augmentation surgery. You will need to inform the radiographer at the time of your x-ray about your implants so that a modified x-ray technique can be used.
Implants and Pregnancy
Breast implants do not interfere with your ability to breast feed as they are placed behind the breast gland tissue. You should take care to wear a very supportive bra during pregnancy and breastfeeding to ensure that your breast shape is maintained in the long term.
The sutures around the aereola are removed in 7 to 10 days. I routinely use dissolving sutures for the main incisions to minimise postoperative discomfort and obtain the finest possible scar in the long term.
Preparation for Surgery
It is advisable to stop taking Aspirin and other non-steroidal anti-inflammatory medications (such as Voltaren, Brufen, or Neurofen) two weeks prior to surgery as these mediations can all increase bleeding and bruising following surgery. Paracetamol is absolutely safe to take should you need it prior to surgery.
A number of nutritional supplements such as garlic, fish oils, and Vitamin E can also increase bleeding and should be stopped. The oral contraceptive pill should also ideally be stopped prior to surgery. Needless to say, smoking does increase the potential for several complications such as wound infection and healing problems and should ideally be stopped at least 4 weeks prior to and 2 weeks after surgery.
It is advisable to purchase a pair of supportive elasticated ‘sports’ bras pre-operatively for use after the surgery. My practice nurse will advise you regarding what sort of bra to buy.
The Operation and Postoperative Care
The operation is performed under general anaesthesia and takes 60-90 mintues. A 24-hour hospital stay is generally advisable although the surgery can be performed as a day-case operation in some cases. Surgical drains (if required) are removed the morning after surgery.
Postoperative progress is usually straightforward although the breasts are natural somewhat swollen and tender. Oral antibiotics and painkillers will be prescribed to you and the breasts are supported by well-padded and supportive dressings after surgery. These remain in place for one week. Most of the swelling and bruising will have settled by 7-10 days, and you will be able to get back to work after this period.
I will advise you about wearing a supportive well fitting bra night and day for four weeks after surgery to support the breasts as healing is completed and the breasts take on their new shape. Underwire bras should be avoided for this period to avoid pressure on the implants. You can safely start gentle exercise at 3-4 weeks and more vigorous exercise at 6 weeks.
Complications following a well-designed and executed breast augmentation procedure are fortunately rare. These may include:
It is not uncommon to have some minor change in the sensation of the nipples which gradually returns to normal over 2-3 months.
Haematoma or bleeding around the implant may require removal of some sutures and washing out the haematoma (<1%). This has no long term effect on the outcome of surgery.
Infection very rarely occurs around breast implants. Every care is taken during and after surgery to minimize this risk including the administration of appropriate antibiotics and meticulous surgical technique.
Minor asymmetry is possible particularly if there is asymmetry between your two breasts preoperatively. It is often possible to adjust the position of the implants during surgery to correct small degrees of asymmetry.
Capsular contracture is the formation of scar tissue and hardening around breast implants. This may occur in up to 5% of patients with modern breast implants. Modern polyurethane coated implants keep this rate down even further (probably around 1-2%). The hardening usually occurs gradually over some years and may require treatment.
Breast augmentation in my experience produces very happy patients who have a large boost in confidence. That is the ultimate aim of any aesthetic surgery, and breast augmentation patients often comment that they feel much more "feminine". The principle aim of this surgery is to produce natural looking, fuller and more youthful breasts that are also appropriate to the individual patient's anatomy.
Procedure Time 60-90 mins
Anaesthetic General anaesthesia
Nights in Hospital 1 night
Time off Work 7-10 days
Time to daily activities including driving 7-10 days
Time to sport and exercise 4-6 weeks