Breast Enlargement / Augmentation

Breast Enlargement procedure

Breast augmentation is a well established procedure that has been performed on more than three million women worldwide over the last three decades. The majority of women who have had the procedure report that they are very pleased with the result.

Through the use of implants, this surgery can increase the size of your breasts and correct uneven breasts. It may also be used to correct drooping breasts but may require an additional uplift procedure. To learn more, please see the Uplift (mastopexy) section of this web site.

The implants used in breast augmentation surgery are filled with either silicone or saline solution. Each has its benefits and drawbacks. Briefly stated, these considerations are:

• Saline implants are as safe as possible and can be inserted such that the scar is minimized. However, should they leak, they need to be replaced. In addition, they may cause a rippling of the skin of the breast, particularly in slim women with little breast tissue.
• Silicone gel-filled implants provide a more natural feel to the breast and are less likely to cause rippling. At present, most surgeons use cohesive gel silicone implants, which do not leak if the shell is damaged. Silicone implants however need a slightly longer access incision to place them.

Over the years, the media have raised various questions regarding the safety of the silicone implants. If you have concerns, please click here to read a detailed discussion of the topic we hope will answer many of your questions. You should also feel free to discuss this issue with your surgeon during your consultation.

The breast enlargement consultation: discussing your goals

Successful breast augmentation surgery begins with careful planning to meet your particular goals. There are several decisions to be made. One, the choice between saline and silicone implants is discussed above.

A second, involves the choice between round and anatomical (teardrop-shaped) implants. The goal of this decision is to give you the most natural looking breast possible.

• Some people feel round implants have a tendency to show an upper edge, creating a "stuck-on" appearance. In some cases this may be a valid concern. However if you have a sufficient amount of breast tissue and seek a moderate amount of augmentation, this should not be a problem.
• Patients who are very slim, and have very little breast tissue to cover the implant may be advised to choose the anatomical implant to create a more natural contour.
• For patients who seek a very large augmentation, disproportionate to their bodies, neither type of implant will look natural or attractive. In addition, it is very likely that there will be undulation in the skin of the lateral part of the breast, a condition called traction rippling.
• You'll also want to discuss the size of your implant. This can be a confusing decision as a particular cup size will look quite different of two women of different stature.
• One way your surgeon will help you decide is by having you try on various size bras with bra fillers to get a sense of how large an implant would be appropriate.
• You can try something similar at home using rice in a stocking as a filler.
• Remember you goal is a size that looks both natural and pleasing.

You and your surgeon will also discuss whether your implant should be placed behind your breast tissue or behind the pectoral muscle as well, and where your scars will be located.

Finally you'll discuss the risks related to breast augmentation and what you should expect during your recovery.

What to expect from breast enlargement operation

There are three main approaches used for breast augmentation:

• The implant may be inserted through the crease under the breast (sub-mammary crease) using an incision approximately 5cm long. This is the most popular technique today.
• Access may also be gained through an incision on the inside of the nipple-areola, in the lower half, and this is suitable only when the areola as a least 3.5-4 cm in diameter.
• A third method uses an incision in the armpit. The implant can be placed placed above for under the pectoral muscles, but this approach is only suitable for round implants.

Your surgeon will discuss these techniques with you and describe the benefits and disadvantages.

Whatever technique you and your surgeon decide on, your surgery will usually be done under general anaesthesic.

If your surgeon is using the first technique, he will make his incision in the breast crease and create a pocket under the breast tissue either in front of or behind the pectoral muscle. Bleeding points will be sealed and the implant inserted into the pocket. The incision will then be closed with dissolving sutures and covered with a light dressing.

At this point, a supporting bra, which you will have been instructed to bring with you, will be put on unless your surgeon chooses to use adhesive tape on your breasts. If a bra is used, you'll be advised to wear it day and night for the first six weeks except while showering or bathing.

After breast enlargement surgery

Although considerable effort has gone into making breast augmentation more comfortable, you should expect that after your surgery your breasts will be tender and swollen for a few days. During this time there are a number of things you'll be advised to do.

• Because you will have had a general anaesthesic, you may experience some nausea in the hours after your surgery. If so, please let your nurse know so you can be given appropriate medication. It also helps to avoid drinking too much fluid early after your operation. Try taking small sips at intervals of several minutes to see if you tolerate them comfortably.
• The initial tapes placed during your surgery should be left undisturbed for the first week, by which time your wound will normally be healed. After this time, it is advisable to apply Micropore tape to the scars for another four to six weeks. This often leads to a better quality scar.
• Be sure to take the painkillers that will be prescribed for you and to limit arm movement.
• You will have been advised to take Arnica for a week before your surgery to help decrease swelling and bruising. Please continue taking it for two weeks after your procedure.
• Postoperative haematoma (a collection of blood under the breast) may occur in the first 24 hours, which is why you are advised to limit your arm movements. Should you develop haematoma it may be necessary for you to return to the operating theatre but it should not affect your long-term outcome.

Recovering after breast enlargement

The day after your surgery you may be able to go home, depending on the degree of pain you are experiencing. If you do leave the hospital that day it is very important that you have a responsible adult who is wiling to stay with you through the day and your first night at home.

During the early weeks of your recovery there are certain things you should expect:

• Many people are able to drive after two to four days, depending on their level of discomfort. One consideration is that wearing a seat belt may be uncomfortable. For your own safety, it is far better to delay driving until you can wear a set belt than to rush into driving and not wear your belt.
• It is usually recommended that air travel be postponed for a month after surgery. For more on why this is advised, please see the Frequently Asked Questions page on this web site.
• As with any surgery, pain may occur in the area for some time. Most commonly this resolves in a few months but it can last longer in some instances and may require special treatment.
• Even if your discomfort is limited, you should not assume that you are healing faster than normal or ready to exercise. Exercising too early can cause seroma, a collection of clear fluid around your implant, which may require drainage. Most surgeons recommend you refrain from upper body exercise for the first three weeks. After this time you can start exercising gradually, with the goal of being back to your normal activity level after six weeks.
• There may also be changes in nipple and breast sensation. These are usually temporary.
• It is also fairly common for the skin above the incision to feel a bit numb for some months, but this rarely extends to the nipple.
• Complete loss of sensation is more common in large volume augmentation because severely stretched nerves have more difficulty recovering. Some patients experience increased sensation, which can last for as long as three months.
• The most common complication following breast augmentation is capsular contraction, a condition in which the scar tissue around the implant shrinks, squeezing it so it feels firm or even quite hard.
• Most capsular contracture stems from the use of smooth shell implants. With modern textured surface implants the incidence is low, probably around 5%. It is not known why this condition develops in some cases and not others.
• Extreme athletic activity, such as marathon running, is definitely a factor, however normal activities such as aerobics or badminton do not appear to cause this problem.
• If it is necessary to relieve the firmness of a contracture, it may be appropriate to surgically release the capsule under general anaesthetic. Several medications that have shown positive effects on capsular contraction are currently under trial.
• Infection is fortunately very rare after breast augmentation. Should it occur, it will exhibit itself by swelling and redness appearing up to three weeks after surgery. Should this occur, the implant will be removed and the infection allowed to clear before the re-insertion of a new prosthesis.

More to consider

Only you can decide whether breast augmentation will improve your appearance and quality of life. It is our job to give you the facts and guidance to make a sound decision. As you think about breast augmentation surgery, you should also consider the following information:

• Scaring is a consideration. Scars are noticeable initially but will fade to a more normal skin colour in time depending your healing characteristics. Thick and lumpy scars (keloids) are fortunately very rare but may require special treatment.
• Regular breast self-examination is important for every woman and it still possible after breast augmentation surgery. If you find a lump you should inform your GP or your plastic surgeon immediately.
• The Royal College of Radiologists have stated that any device inserted into the breasts leads to some reduction in the ability of investigators to detect a malignancy early. This decrease, which is from about 90% to 70%, seems to be relatively similar for all types of breast implants.
• Despite this situation, mammography can still be performed by an experienced radiographer. It is recommended that women with breast implants should have their screenings only at dedicated centres.
• There is no known link between silicone implants and increased risk of breast cancer or autoimmune disease. You can learn more on the web page of the Independent Review Group on Silicon Breast implants, commissioned by the UK government.
• It is logical to assume that breast implants will not last forever and may need to be changed. This, however, would be many years in the future.