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Breast Enlargement

Breast enlargement or augmentation is one of the most common cosmetic surgery procedures.

The reasons people request breast augmentation include:

Naturally small breasts or ‘smaller’ than the person would like.
Breasts that have lost volume & sag or droop after pregnancy.
Breast asymmetry (unequal size &/or shape of breasts).
As part of breast reconstruction following cancer operations.

To enlarge the breasts, breast implants are used. All breast implants have an outer silicone shell but what is contained inside differ.

The most commonly used in the United Kingdom contains silicone. Other contents that have been used in breast implants include saline (salty water), triglycerides (fat), etc.

Silicone filled breast implants despite the furore about implants, have stood the test of time & tend to give the best feel to the breast implant.

The most commonly used incision is one underneath the breasts called a submammary incision. It can also be introduced from incisions around the ‘brown or pink’ area surrounding the nipple (areola) or through the armpit. It has even been introduced using an endoscope passed through the navel (umbilicus).

The submammary incision has the advantage that it can easily be opened up if there is a complication & is the most favoured.

Technique: Once the incision has been made, a pocket is created for the insertion of the implant. Sometimes drains are used. Absorbable sutures are used to close the wounds. Breast implants can either be put directly underneath the breast tissue itself or underneath the muscle. Each plane has its own advantages. Putting underneath the breast tissue is a simpler dissection, may cause less bleeding and is definitely less painful in the early period following surgery but depending on the amount of breast tissue, this may not hide the silhouette of the implant as well as when it is put underneath the muscle. Some people argue, however, that this may give a better cleavage. Underneath the breast also has an advantage of lifting the nipple better, especially in patients who have lost volume & have saggy breasts after pregnancy.

Putting the implants underneath the muscle has the advantage that the silhouette of the implant is hidden better & it may reduce one of the most common problems with breast implants called adverse capsular contracture (bad capsule). It however has its disadvantages of being more painful in the early period, may have an increased incidence of bleeding & twitching of the muscle & movement of the implant may be embarrassing especially for people who are athletic. For very saggy breasts, if there is no added mastopexy (breast lift) operation, it may cause a double bubble appearance where the breast implant appears higher than the normal breast tissue which appears lower.

Duration of operation: Operation usually lasts 1 - 1 ½ hours.

Duration of admission: Depends on whether the implant is under the muscle (couple of days) or under the breast tissue (same day or overnight).

Post-Op Care: When the implant has been put underneath the breast tissue, a number of surgeons do not use drains, which means the person can leave the hospital later on that evening or after an overnight stay. When the implant has been put underneath the muscle usually drains are used & they may drain for a couple of days or more before being removed. Some patients find removal of the drains quite uncomfortable.

Usually antibiotics are started during the operation & for a short period afterwards to reduce the risk of infection.

Following the operation the person will be fitted with a support bra which helps take the weight of the breasts & reduce discomfort & rapid sagging because of the increased swelling of the breasts that will occur following an operation.

Painkillers are also administered both orally & intramuscularly if need be.

Following discharge the support bra should be worn for a period of six weeks. Heavy lifting is generally not advised for a good 4 – 6 weeks especially if it has been a submuscular implantation.

Time off work: There may be period of pain in the first few days but after about a week most people should be able to go back to work.

Complications: Most patients who have this operation are usually very pleased but occasionally they have problems.

The problems that can arise include:

Haematoma which is a collection of blood following the surgery. This will usually be in the first 24 hours & will require a visit back to the theatre for evacuation.
Infection. This may not be manifest for a few weeks. If infection is confirmed, the breast implants need to be removed & an interval period of three months will need to elapse before reimplantation. This is because once implants get infected the antibiotics do not get to them well as implants are not living tissue.
Adverse capsular contracture. This is what is commonly known as capsule or bad capsule. This is the most common complication of breast implantation & is a result of the way the person heals. It is more common when there has been a haematoma or the patient has had radiotherapy. Most commonly used implants now have a textured or rough surface to reduce the incidence of this bad capsule formation. The capsule can distort the shape of the breast & become firm &/or painful. In severe cases replacement of the implant is required.
Rupture. As implants are manmade they can rupture for a variety of reasons. When ruptured they will need to be removed & replaced. The patient may not be aware until a scan is done unless there is a distortion of shape of the breast.
Sensory disturbance in the nipple areola complex. A small proportion of people (15%) may lose the feeling around their nipple because of the operation. For others it is either decreased or even increased.
Wrinkling of implants. There may be wrinkling of the implants which can be seen through the skin. This is more common for very thin patients or patients with very little breast tissue with large implants.
The scars are usually nice & supple though occasionally can become raised or lumpy.

The average life of breast implants is usually 10 – 15 years.

Concerns & Controversies: In the United Kingdom, an 'Independent Review Group' was set up by the government to assess the concerns & controversies over the safety of silicone breast implants. They did not find sufficient scientific evidence to support the concerns held in the USA over their safety. (In the USA there has been a ban in the use of silicone breast implants for cosmetic breast augmentation since 1992.) More information can be found at www.silicone-review.gov.uk.