Breast Augmentation

Breast augmentation is the most common cosmetic operation performed in the USA. It is often referred to as a “breast aug” or “boob job” by patients and involves using either Breast Implants or fat to increase the size of their breasts.

A patient may be a candidate for breast augmentation if:

• You are troubled by the feeling that your breasts are too small
• You are unhappy with your breasts losing shape and volume after pregnancy, weight loss or with ageing
• Your breasts are unequal
• You are dissatisfied with the upper part of your breast looking “empty.”
• You have realistic expectations
• You are physically well, and you are not pregnant or breastfeeding
• Your breasts are fully developed

Breast enlargement can increase breast fullness and projection,  improve natural breast size, correct asymmetry as well as restore the balance of breast to hip contour, restore breast volume lost after weight reduction or pregnancy and enhance self-image and self-confidence

What breast augmentation surgery cannot do is correct severely drooping breasts. In this case, a mastopexy or a breast lift combined with a breast augmentation may be needed for sagging breasts to look fuller and lifted. This can often be done concurrently at the time of augmentation.

The choice to have cosmetic surgery is extremely personal, and patients will have to weigh the potential benefits in reaching your goals with the risks and possible complications of breast augmentation. Only you can decide for yourself.

I often tell patients that it is not what they want but what they can have. It is similar to buying a pair of shoes, if a shoe is too small or large you will not buy it. With breast implants, the concept is the same. The breast has a specific size and base diameter, and only implants up to a particular base width can be inserted. By increasing the volume, one can then increase the projection but not the base diameter.

Implants are generally placed in a pocket under the pectoralis muscle to decrease the risk of capsular contracture – where the body forms a very hard capsule around a foreign body – the silicone implant.

Implants may be either saline or silicone. The former is filled with sterile saline. If the implant shell leaks, a saline implant will deflate, and the saline will be absorbed and naturally expelled by the body.

Silicone breast implants conversely are filled with medical grade silicone gel. The gel feels more like breast tissue. If the implant leaks, the gel remains in the silicone shell or may leak into the breast implant pocket. A leaking silicone gel implant will generally not collapse the breast.

Silicone implants can be Anatomical or Round shaped and smooth or textured. However, due to concerns with ALCL ( Anaplastic Large Cell Lymphoma), a rare form of cancer associated with textured implants, in my practice only, round, smooth implants are now exclusively being used. Furthermore, as round implants are the same shape irrespective of rotation, there is less worry about them rotating out of place. Smooth implants may have some rippling visibly under the skin. They can also move within the breast implant pocket, which may give more natural movement.

Possible early breast augmentation surgery risks include: hematoma, anaesthesia risks, infection, persistent pain

Late complications include: changes in nipple or breast sensation, poor scarring, incorrect positioning of the implant, implant leakage or rupture, the development of tight scar tissue around the implant (capsular contracture), liquid accumulation (seroma), folding of the skin over the implant, the possibility of revision surgery

These risks and others will be thoroughly discussed before your procedure. It is essential that you talk about all your concerns directly with your plastic surgeon. You will be requested to sign consent forms to ensure that you understand the procedure as well as any risks and potential complications.

A careful review of scientific studies by independent groups such as the Institute of Medicine has found no connection between breast implants and autoimmune or other systemic diseases.

Breast augmentation surgery should be performed in a hospital or suitably equipped day clinic by a specialist Plastic surgeon.

A breast augmentation procedure has the following steps:

Incisions are made in inconspicuous areas to lessen visible scarring. Incision choices include: along the areolar edge (peri-areolar incision), the fold under the breast (inframammary fold) and in the armpit (axillary incision). The inframammary incision is most commonly used due to the ease of access, low risk of incorrect implant placement and cosmetically acceptable scar.

After the cut is made, a breast implant is placed into a pocket either: under the pectoralis muscle (a submuscular placement) or directly behind the breast tissue, over the pectoralis muscle (a subglandular placement)

The technique for inserting and placing breast implants hinges on the amount of enlargement desired, the implant type to be inserted, your body type and your surgeon’s recommendations and expertise.

After surgery, patients are taken into a recovery area for close monitoring before being transferred to the ward. In my practice, Intercostal nerve blocks combined with a PCA (Patient Controlled Analgesia) is used to control postoperative pain overnight before discharge the next day.

To achieve ideal breast augmentation results, all post-operative instructions must be followed, and patients need to return for regular follow-up visits.

Breast implants are not lifetime devices, and they will need to be replaced at 10 – 15 years. My patients are seen yearly to evaluate their breast health and implant integrity.

All patients are counselled that over time, their breast shape will alter due to ageing, weight changes, gravity and hormonal factors. When the appearance of breasts changes over time, some patients may need a breast lift or an implant exchange to give back a more youthful contour.

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