Breast Augmentation

Breast augmentation is the most popular cosmetic surgical procedure worldwide.

Breast augmentation, also known as an augmentation mammoplasty, is the most popular cosmetic surgery procedure.

It can be used as a pure cosmetic surgical procedure to enhance the appearance and/or size of your breasts or as part of a staged breast reconstruction following a mastectomy.

Breast augmentation is carried out under general anaesthesia and depending on the technique and implant used, usually takes around 2 hours.

Preoperative evaluation

Breast augmentation is far more than choosing a "B, C, or D" size. Your surgeon needs to ask you several health related questions including any history of family or personal breast disease and perform a physical examination including the breasts, chest and armpits.

Dimensions of the breasts need to be accurately measured to determine symmetry. A failure to recognize subtle differences may result in accentuating the asymmetry or deformity rather than improve the aesthetics of the breast. Preoperative photographs can also help in the identification of any potential dissimilarity between the two breasts.

If you are of child-bearing age and are planning to breast feed post surgery you need to thoroughly discuss it with your surgeon in order to help him or her decide upon the location of the incision and position of the implant that will least affect your breast tissue and the nerves of the nipple-areola complex. Please bear in mind that breast implants are biologically inert and therefore there are no absolute contraindications to breast-feeding provided that milk duct and nerve damage is minimal following a breast augmentation procedure.

If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for at least two weeks prior to your procedure. We will provide you with specific pre- and postoperative instructions.

Finally, your surgeon will advise on the right type and size of implant for you and discuss the impact of implants on cancer monitoring. There is no scientific evidence that breast augmentation increases the risk of breast cancer. However you should be aware that the presence of breast implants might interfere with the sensitivity of your mammogram due to the fact that part of breast tissue remains inadequately visualized. If you think you are at higher risk for breast cancer because of family history or other reasons then the surgeon may suggest alternative surgical approaches such as placement of the implant underneath the pectoral muscle which may interfere less with radiological investigations. A preoperative mammogram is recommended for every woman over 35 as a baseline examination.

Operative considerations

Type of implants

All breast implants include a solid silicone rubber outer shell called a lumen. The most commonly used breast implants are either filled with sterile saline solution or viscous silicone gel.

Silicone implants

Advances in manufacturing technology have produced silicone breast implants that contain a semi-solid gel that mostly eliminate leakage and have a low rate of complications such as rupture. Modern implants are made with multiple layers of elastomer surrounding the gel which give them a firmer feel. They remain much softer than saline implants.

Silicone implants have been controversial but there is no scientific proof that this type of breast implants is associated with autoimmune or connective tissue disease or cancer. They are now used more often than saline implants.

Silicone breast implants are pre-filled so your surgeon may need to make a longer incision to insert them.

 

Saline implants

A saline breast implant is a shell made of silicone elastomer filled with a saltwater solution.

Saline implants are more likely than silicone to cause visible rippling and are generally firmer to the touch and less natural in appearance than silicone gel implants.

Saline implants are filled during surgery and allow the surgeon to make adjustments in size. Adjustable saline implants allow the surgeon to adjust the size for up to six months after your breast augmentation surgery.

Position of the implant

  1. Submuscular placement: implant is less likely to be seen or felt. Obscures less of the gland on mammography.
  2. Subglandular placement: subglandular pocket creation may be used in very active, muscular women because their well developed pectoralis can squeeze the implant, producing rippling.

Incision Location

  • Inframammary
    • Underneath your breast in the natural crease.
  • Peri-areolar
    • Scarring is minimal
    • Recommended for relatively small volume augmentation
  • Transaxillary
    • Under your armpit
    • The scar is inconspicuous but it is associated with more trauma to the gland.
    • Not recommended for anatomic implants.

Postoperative care

Following an augmentation mammoplasty you will be expected to stay in hospital overnight.

Drains are rarely required in primary augmentation but may be necessary in "redo" surgery or if any oozing or bleeding is encountered.

Pain following breast augmentation is somewhat variable and generally relates to implant size (larger causes more stretch) and route of implant insertion (the transaxillary approach yields more pectoralis muscle spasm than inframammary). However postoperative pain is usually manageable with OTC painkillers.

You will be advised to wear a supportive bra day and night for the first six weeks except while showering or bathing.

Breast implants will not last forever and may need to be changed. This is usually required after 10-15 years.

Potential Complications:

  • Capsular contracture
  • Haematoma (accumulation of blood)
  • Seroma (a pocket of clear serous fluid that may develop after surgery due to ruptured small blood vessels)
  • Changes in nipple sensitivity
  • Infection
  • Asymmetry
  • Wrinkling
  • Implant rupture
  • Mammographic interference
  • Revision surgery

Should any complication arise you need to inform your surgeon as soon as possible. SFMedica surgeons are accessible around the clock for all their operated patients.

If you want to know more about breast augmentation contact us today to book an appointment with one of our specialist doctors who will be happy to answer any questions you may have.

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Breast Augmentation with Implants (PDF 253Kb)