Breast Augmentation

Cosmetic breast augmentation is a surgical procedure to enhance the size and shape a breast and is used for a number of reasons:

• To enhance the body contour of a woman who, for personal reasons, feels her breast size is too small.
• To restore breast volume lost due to weight loss or following pregnancy .
• To achieve better symmetry when breasts are moderately disproportionate in size and shape .
• To improve the shape of breasts that are sagging or have lost firmness, often used with a breast lift procedure.

By inserting an implant behind each breast, it is possible to increase a woman's breasts by one or more bra cup sizes. There are many ways to undertake breast augmentation. All of the procedures involve making an incision to insert the implant, creating a pocket under the breast tissue in which to insert the implant and selecting the ideal implant to give the most natural augmentation of the breast.

Incisions.

The method of inserting and positioning your implant will depend on your personal wishes and body shape. The incision can be made either in the crease where the breast meets the chest, around the areola (the dark skin surrounding the nipple), or in the axilla (armpit). Incisions in the axilla are only suitable for a limited number of people.

Breast implants can be placed in a pocket either in front of the chest muscle (referred to as the subglandular pocket as it lies directly under the breast itself) or behind the chest muscle (referred to as submuscular).

In the U.K. the subglandular placement (in front of the muscle) is the most common method as it allows accurate placement of the implants with the ability to produce a natural looking cleavage. However in some very thin women with little or no breast tissue if the implant is placed in front of the muscle it would only be covered by skin and not much else. In this instance to place the implant behind the muscle (submuscular pocket) will look better.

Types of Implants

The choice of implant filler, implant size, shape and other features will be determined based on your breast anatomy, body type and your desired increase in size. Your lifestyle, goals and personal preferences, and surgical judgment are also determining factors. Implant manufacturers occasionally introduce new styles and types of implants, and therefore there may be additional options available to you.
Breast implants are medical devices with a solid silicone, rubber shell. The implant shell is usually filled with silicone gel. The are several different types of silicone gel, but in general a cohesive silicone gel is used which prevents or reduces the risk of leakage. The size of a breast implant is measured in cubic centimetres (ccs) based on the volume of silicone filler. Breast implants also vary in other ways:

• Shape: the implant may have a round profile or one that is anatomic (teardrop or tapered shape)
• Texture: the implant shell may be smooth or textured
• Profile: the implant may have a low, medium or high projection (the depth of the implant from the base to the highest point of the implant curve)
• Diameter: the width of the implant measured across it's base (the side of the implant that will be positioned over the chest wall)

Breast implants are not guaranteed to last a lifetime and future surgery may be required to replace one or both implants. Regular examinations for breast health and to evaluate the condition of your implants are important.

Planning your Surgery

In your initial consultation, your health will be noted and it will be explained to you which surgical techniques are most appropriate for you, based on the condition of your breasts and skin tone. If your breasts are sagging, a breast lift may also be recommended. The surgery and anaesthesia will be discussed, and the costs involved. Because most insurance companies do not consider breast augmentation to be medically necessary, they generally do not cover the cost of this procedure.

Preparation for Surgery

It is important to avoid taking any Aspirin or products containing Aspirin for 2 weeks either side of the operation since Aspirin has an adverse effect on bruising. The same is true for non-steroidal anti-inflammatory drugs (such as Brufen and Nurofen). While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days at home, if needed.

The Risks

Breast augmentation is relatively straightforward. As with any operation, there are risks associated with surgery and specific complications associated with this procedure.

The most common problem, capsular contracture, occurs if the scar or capsule around the implant begins to tighten. This squeezing of the soft implant can cause the breast to feel hard. Capsular contracture can be treated in several ways, and sometimes requires either removal or "scoring" of the scar tissue, or perhaps removal or replacement of the implant.

As with any surgical procedure, excessive bleeding following the operation may cause some swelling and pain. If excessive bleeding continues, another operation may be needed to remove the accumulated blood.

Infection is rare because routine antibiotics are given following surgery. If infection occurs despite this, then the implant may have to be removed although after the infection is treated a new breast implant can usually be put in.

Some women report that their nipples become oversensitive, undersensitive, or even numb. You may also notice small patches of numbness near your incisions. These symptoms usually disappear within time, but may be permanent in some patients.

Breast implants do not generally interfere with a woman's ability to breast feed, or present a health hazard during pregnancy to a woman or her baby. However, pregnancy and the associated changes to a woman's body may alter the results of any breast surgery, including surgery to place breast implants. Therefore, it is important to discuss this if you are planning becoming pregnant and breast feed in the future.

Occasionally, breast implants may break or leak although this is avery rare problem with modern implants. Rupture can occur as a result of injury or even from the normal compression and movement of your breast and implant, causing the man-made shell to leak.

If a silicone-gel filled implant leak or break, the elastic silicone gel may remain within the implant shell, or may escape into the breast implant pocket (a capsule of tissue that surrounds the implant). A leaking implant filled with silicone gel may not deflate and may not be noticeable except through imaging techniques such as an MRI scan. For this reason, a woman with silicone breast implants is advised to attend for further consultation annually to assess that her implants are functioning well. An ultrasound exam or MRI screening can assess the condition of breast implants.

Following the placement of breast implants mammography is technically more difficult. Obtaining the best possible results requires specialized techniques and additional views. You must tell the radiology staff about your implants when undergoing any diagnostic breast examination. In many cases, an ultrasound exam or MRI may be recommended in addition to mammography.

The Surgery The surgery will be done as an inpatient in a hospital, and you will need to remain in hospital for a day or two.

Breast augmentation will be performed under general anaesthesia. The surgery usually takes one to two hours to complete The method of inserting and positioning your implant will depend on your wishes and body shape. Every effort will be made to assure that the incision is placed so resulting scars will be as inconspicuous as possible.

Through the incision, the breast tissue and skin is lifted to create a pocket. Once the implant is positioned within this pocket, the incisions are closed with dissolvable sutures and the wounds are covered with surgical tape and a light dressing. A post surgical or sports bra is placed as the final part of the dressing for comfort and to support the breasts.

After your surgery

After surgery the breasts will be tender and slightly swollen for a few days and it is advisable to limit arm movements and take the painkillers which you are prescribed.

Most women can drive by the fourth or fifth day after surgery and return to work after a week.

Your wounds will be checked one week after surgery. Although by that stage everything will be healed you will need to keep wearing the supportive bra day and night for a further four weeks.

As the implants settle in their new pocket it is best to avoid sports for the first 3 to 4 weeks and then build up gently.