Pregnancy, breast feeding, weight gain and subsequent weightloss can loosen the soft tissues of the breast. Breast augmentation can predicatably refil and reshape empty or sagging soft tissues and improve your confidence.
Types of Breast Augmentation
Breast Augmentation with Implants
Under general anaesthesia, silicone breast implants are inserted into a surgically created pocket either:
- immediately behind the natural breast tissue (sub-glandular or sub-mammary pocket)
- behind the pectoralis major muscle, the chest “pecs” muscle (sub-pectoral, sub-muscular pocket or dual plane)
- under the layer of fibrous tissue that is immediately in front of the pectoral muscle. The subfascial pocket represents a compromise between sub-glandular and sub-muscular.
The choice of pocket is largely decided by the amount of soft tissue cover that is available to disguise the upper edge of the implant and slimmer patients usually are best suited to placement of the implant under the muscle. Your surgeon will discuss which is best suited to your anatomy.
Implants are usually inserted through an incision in the crease under the breast (the inframammary fold). They can also be inserted through a cut in the armpit or around the areola. The inframammary fold or the peri-areola are the most commonly used in our practice.
Breast Augmentation with Breast Lift
If the breasts have a mild degree of droop, this can be improved by breast augmentation surgery alone. If the breasts are droopy but at a size that suits your body shape, you could have a breast lift operation without an implant (mastopexy).
In a breast lift, the nipple is raised and the breast tissue and skin is tightened using incisions around the areola and under the breasts. In some cases, both implants and lifting are needed. This can be done at the same time or in two separate operations.
Breast Augmentation with Fat Transplant
The only alternative surgical technique to enlarge the breast is lipofilling. This is where fat removed by liposuction from another part of the body (such as the hips or thighs) is injected into the breast area. Because only a relatively small amount of fat can be injected at a time, and some of the fat is reabsorbed into the body, you would need several injections to get a permanent enlargement.
Your own fat is the only substance that can be safely injected into the breast. Other materials have been tried, and then banned. Do not allow anyone to inject anything other than your own fat into your breasts.
Breast Augmentation to Correct Asymmetry
An implant is made of a silicone gel enclosed in a silicone or polyurethane casing and comes in a variety of shapes and sizes. In your consultation, your surgeon will examine your breasts and to see the size of your ribcage and the firmness of your skin. They will discuss with you what size and shape of implant would best achieve your desired outcome. It is not possible to determine exactly what cup size your breasts will be after the augmentation, however your surgeon will be able to indicate a range.
Implants can be round or anatomical (teardrop shaped). With both types of implant, it is possible to determine the projection. The projection determines how much the implant will stick out. Lower projection implants will be more subtle than higher projection. With anatomical implants, the width and the height can be detemined seperately which helps tailor the implant to the existing anatomy of the patient.
Is silicone safe?
Medical silicone is used safely in many medical devices, including breast implants. Your body will form a layer, called a capsule, around the implant. Sometimes, the capsule can thicken and tighten around the implant. This is called capsular contracture and it can change the shape or feel of the breast. If this happens, you might need further surgery to remove the capsule.
Breast augmentation is not linked with breast cancer or other cancers. There have been reports of a condition called anaplastic large cell lymphoma (ALCL) occurring with breast implants, but this is extremely rare and does not seem to be as serious as ALCL occurring in other places.
Over time, some silicone may leak out of the implant. This does not cause ill health, but it might cause lumpiness or pain, and you might need surgery to remove and replace the implant. Over time, the implant may become more noticeable, particularly if it is large.
What are the scars like?
The latest dissolving stitches are used to close the wounds as they provoke almost no inflammatory reaction as they are dissolved and therefore minimise any scarring. In a breast augmentation, the scars run along the skin crease under the breast. If the breast is also being lifted, an additional scar runs vertically from this fold to the areola (ring of colour around the nipple) and then curve around it.
They usually heal nicely with little redness and start to fade within a few weeks, but as with any scar it may take several months to look its best. In an absolute minority of patients the scars may become red and itchy and form hypertrophic (enlarged) or keloid (fibrous) scars. This may require treatment with silicone patches or steroid injections.
How painful is it?
The majority of the discomfort settles within 24 hours, during this time patients are in hospital and can have very powerful painkillers if necessary. Patients are offered a short course of painkiller tablets on discharge from hospital.
What happens after surgery?
Breast augmentations can be done as a day case or with a one night stay. More complex procedures involving mastopexy or reduction can require a two night stay. The wounds are protected with a soft dressing for two weeks after which time the dressings are removed in the clinic and patients can usually return to bathing or showering normally. At three months post-operatively a further routine follow up appointment is made to check that everything is healing well and post-operative photographs are taken.