Breast Augmentation (Breast Enlargement) Surgery by Jan Stanek at Surgical Aesthetics
Woman’s breasts are associated with femininity and consequently women who possess little or no breast tissue may feel unfeminine, lack self-esteem, and their personal relationships may consequently suffer.
Breasts may fail to develop, or following pregnancy, they may lose volume and shape. The primary reason for doing breast augmentation is to increase the breast size. Secondarily, in some cases, it may be possible to improve the shape and symmetry. Some breasts may appear to be droopy due to the fact that the distance between the nipple and the breast fold is very short; in such cases the droop may be corrected by increasing the breast size and lowering the position of the fold. In mild cases of nipple inversion the nipples may become everted.
Prior to breast augmentation it is necessary to ascertain that there is no breast disease and this is done by examination and in older women by mammography and/or ultrasound. For women who have a strong family history of breast cancer, the decision whether to go ahead with the surgery is much more complex and would be explained by the surgeon.
There is a choice of implants for augmentation and this will be determined by the surgeon and by patient’s preference.
In essence, breast implants are bags made of silicone either smooth or rough (textured) on the surface, filled with liquid or gel. The nature of the filling material and the thickness of the shell will determine the “feel” of the implant.
There are differences between these implants and consequently they have their advantages and disadvantages.
Shape of Implants
Recently implant companies introduced “so-called” anatomical implants. These implants are usually pear-shaped in profile and are meant to mimic natural breast shape. However, recent work has shown that “standard” oval or dome-shaped implants produce a much more natural result. The choice of implant shape will be discussed by the surgeon because in some circumstances one type of implant may be preferable over another.
Implants can be inserted through incisions placed in the fold of the breast, in the areola of the nipple, or in the armpit. The choice of the approach will depend on the surgeon’s choice as well as experience. In most circumstances the armpit approach produces the most inconspicuous scar, but technically it is also the most difficult from the surgical point of view.
The implants are placed in a pocket made either in front of the chest muscle, the pectoralis, or behind. If possible, it is better to place the implants behind the muscle because it provides an extra cover and with aging the implant is less likely to produce visible wrinkling, especially in the lower and inner part of the breast. There is also some evidence that, if implant is placed behind the muscle, the likelihood of hardening (capsule/contracture) is lessened.
Breast augmentation is usually carried out under general anaesthesia and requires a one-night stay in hospital. It may be painful especially when implants are inserted under the chest muscle. The pain is due to stretching of the muscle. Drains are left in the breast pocket overnight and removed the following day. Sutures are removed 7-10 days post-operatively. Swelling will last for two to three weeks and softening of breasts may take up to six months, depending on the implant used.
Breast augmentation is a good operation if carried out by an experienced surgeon. However, as in all surgery it is subject to complications:
- Bleeding: this is uncommon and occurs in approximately 1% of patients. The most critical time is immediately after surgery when excess blood may accumulate in the breast pocket and needs to be evacuated. There should be no long-term problems arising from this complication if treated correctly.
- Infection: surprisingly it is very rare and occurs in less than 0.5% of patients. In some cases it may be treatable with antibiotics but it may necessitate implant removal for a period of six to twelve weeks before the implants is re-inserted.
- Implant rejection: this is very unusual if it ever occurs.
- Scar: Some individuals form unfavourable scars and these may have to be revised at some stage or may require injections of steroids, or silicone sheeting to improve them. Keloid scars may be difficult to improve with any form of treatment.
- Asymmetry: most breasts are of different size and this may become more apparent after surgery. If there is visible difference before surgery most surgeons will try and correct this by using implants of different sizes. However, it is not possible to make breasts completely symmetrical; asymmetry is “normal”
- Encapsulation: sometimes also called hardening is the commonest problem that may arise following surgery either early or many years later. It still occurs in between 0.3% and 10% of patients and is due to the behaviour of scar tissue that surrounds the implants. When this capsule of scar tissue tightens around the implant breast feels firm or hard. In extreme cases, when the capsule shrinks and becomes very thick, the breast may become painful and its shape distorted. In most cases the capsule can be treated by further surgery and only few individuals present with an intractable problem necessitating implant removal.
- Malposition of implant: implants settle too high or too low necessitating re-positioning by further surgery.
- Loss of nipple sensation: This occurs in less than 5% of patients. Sensation can be lost partially or completely. Occasionally, sensation can be temporarily increased. Whether the change in sensation will be permanent will not be known for at least one year post-operatively.
- Implant failure: All implants will eventually fail and currently implants are expected to last for at least 10 years. How long implants will survive will depend on many factors and these will be discussed by your surgeon. If implants fail they will have to be replaced. Currently, implants are the subject of a warranty, guaranteed by the manufacturer. The causes of implant rupture or deflation are: trauma of surgical insertion, damage by surgical; instruments, capsular contracture, trauma of physical activity and excessive compression during mammographic examination.
Rare complication: Breast implant related Anaplastic Large Cell Lymphoma has been diagnosed in 250 patients world-wide. It is estimated that there are more than 100 million women in the world with breast implants. To date there have been 13 cases identified in the UK. The incidence has been calculated as 1: 400,000 with a mortality of 1: 12,500,000.
As in all surgery it is essential to see a surgeon who will be able to tell you whether your problem can be remedied by surgery, and what the risks are. Only then are you in a position to decide whether you want to go ahead or not.