Breast augmentation

 

Introduction

A breast augmentation increases the size of the breasts by the insertion of an implant behind the breast. It is suitable for women who have naturally small breasts or where there has been drooping or reduction in size following a pregnancy or weight loss.

The procedure gives a youthful appearance to the breast and adds more shape to the profile. It adds confidence and appeal to the figure and personality.

Mr. Ayub-Khan uses cohesive gel implants. These are implants filled with silicone but in a jelly state. The advantage being, they are unlikely to leak. The final size of the breasts depends on personal choice but it is always recommended to stay within reasonable limits of height, build and body weight. The decision regarding the optimum size will be discussed at the time of the consultation.

 

Consultation

At the initial consultation, a general examination of health and assessment of breast and chest size is made. The most appropriate operation and implant size will be discussed. The procedure, the preparation for and aftercare will be discussed. A summary of the discussion will be offered and time given of couple of weeks to reflecting and deciding to proceed with the procedure.

 

Preparation for surgery

It is important to avoid taking any Aspirin or non-steroidal anti-inflammatory products (Brufen, Nurofen and voltarol) for one week before the operation as they can cause significant bruising, bleeding during and after surgery. Arrangements should be made for transport home after the procedure and for help for the following few days at home.

A soft, firm support, sports bra (without under wire) should be brought along on the day of the surgery. The proposed size would be discussed at time of the consultation. This is to provide additional support over the dressings after surgery. It is recommended to wear this all the time over the next 4-6 weeks.

 

The Operation

An incision is made in the crease below the breast where it meets the chest as it is well hidden here and allows accurate placement of the implant to create a fresher look.

A pocket is created behind the breast and the implant placed snugly in the space, centred behind the nipples. Working through the incision, the breast tissue and skin is lifted to create a pocket either in front of the chest muscle (the subglandular pocket), or underneath the muscle (the submuscular pocket). Following this, the incisions are stitched in layers to protect the implant. External strapping is applied which needs to be kept in place for one week. This provides extra support for the breasts during this period. A firm support sports bra is put on top of the dressings to add further support. The whole operation takes a little over an hour.

 

Anaesthesia

Breast enlargement is usually performed under a general anaesthesia.

 

Postoperative care

After surgery the breasts will be tender and slightly swollen for a few days. Regular painkillers are recommended to keep the discomfort minimum and it is advisable to limit arm movements. Driving can be started when comfortable and return to work is usually within 10-12 days. Most women can drive by a week after surgery and return to work after 10-12 days.

The strapping and dressings should be kept in place for a week. After this showering can be started but the support bra should be continued to be used at all time for 4-6 weeks. Any aggressive sports activity/exercises should be avoided for the first 3-4 weeks to let the implants settle in their pocket.

There may be some temporary changes to the sensation over the breast and nipples. This can be either hypersensitivity or reduced sensation. This may last up to 2-3 months. This is as a result of stretching of breast tissue and nerves. There may be changes in the sensation of the nipple and breast which are temporary. It is fairly common for the skin above the incision to feel somewhat numb for 2-3 months but this improves spontaneously.

 

Scars

The incision of breast augmentation is kept in the fold of the breast and is hidden from view. It’s about 5-7cms long. Initially this is pink and firm but settles in time to a paler and softer look over the next few months.

 

Is a breast lift needed?

Some lift of the breasts can be achieved through augmentation alone. In situations where the tissue has stretched too much, a mastopexy is also required. This increases the complexity and duration of the operation and involves more scars. These are usually around the areola, going down vertically to join a horizontal scar in the breast crease (inverted T shape). In most cases breast augmentation alone will improve the ptosis (drooping) of the breasts.

 

How long do implants last?

Despite being resistant to extreme pressures breast implants are still susceptible to daily wear and tear. There are however variations in wear and tear amongst different individuals depending on how much exercise you take and other lifestyle activities. The outer shell or coating of the implant may develop tiny microscopic cracks after 12 to 15 years. As the silicone in the implants have solid gel state any cracks would not leak. The body always produces a thin covering around all implants from an early stage. This acts as an additional protection. This covering may start developing scarring which will make the breast feel firmer. Depending on how much of a problem this is creating, the implants may need replacing. At the time an assessment would be required by a specialist and a decision made on the best way forward.

 

Capsule formation

The breast implant is a foreign substance. The body reacts by making a thin protective shell around it. This cannot be detected from outside. In a small number of women this reaction is excessive and can result in a much thicker capsule. This makes the breast very firm and rounder by squeezing on the implant. The whole process is unpredictable on who might develop this.

The incidence of this problem is between 4-5 % of women undergoing surgery and rarely occurs before 2 years. It initially starts as a firmness which is palpable but does not distort the appearance of the breast. Over the next year or two it continues to tighten so that eventually the breast does look rounder and occasionally be source of pain and discomfort. In case of development of these problems further surgery may be required to remove the capsule and the implants. This condition is more common in smooth implants and non-cohesive gel implants.

 

Risks

All surgical procedures carry a risk. Breast augmentation is quite a safe cosmetic procedure. However, in rare circumstances one can experience the following problems.

  • Excessive internal bruising (haematoma) occasionally occurs and may require removing some stitches and wash out the bruising from beneath the skin. This has no effect on the long term outcome of surgery.
  • 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.
  • Changes in the sensation of the nipple and the breast (either an increase or a decrease) can occur following breast augmentation, but these are usually temporary.
  • Capsule formation. Occasionally hardening of the implant may develop due to scar formation. This problem occurs in about 5% of women undergoing breast. The exact cause of this problem is not fully understood but may be due to the body's sensitivity to the otherwise inert breast implant. This hardening can occur months or even years after surgery. If this condition is severe more surgery may be needed in the future to remove the capsule and replace the implants but this is rare before 5 or 10 years.

 

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