What surgery is available, and what techniques are involved?
Breast enlargement involves the placement of an implant under the patient’s breast tissue to enhance the size and shape of the breast. The implants are usually inserted using an incision placed under the breast at the crease, but can also be put in via an incision in the armpit or around the nipple. Implants can be placed either directly behind the breast (known as sub-glandular placement), or behind the breast and chest wall muscle (known as sub-muscular placement). Your surgeon will advise which is appropriate for you.
Behind the breast
The insertion of implants behind the breast is considered to be the simplest of the available enlargement procedures, and less likely to cause significant discomfort. This route is also effective for patients with slightly drooping breasts.
Behind the muscle
The insertion of implants behind the breast key consideration for slender patients and those with very little breast tissue where the edge of an implant may be detectable through the skin. The muscle provides extra cover and helps to hide the upper half of the implant, and so is often recommended for those who have very little breast tissue and whose ribs may be visible through the skin.
Dual plane augmentation
When slender women with slightly drooping breasts seek enlargement surgery, surgeons often combine these two routes, placing the implants partly behind the breast and partly behind the muscle. Through this combined approach surgeons techniques. This is called a dual plane augmentation.
What type of implants should I have?
The outer layer, or shell, of all implants is made of silicone. Some implants have an additional polyurethane coating. The shell can be filled with either silicone gel or saline. Implants have been used for breast augmentation since the 1960’s and, when made to appropriate specifications, the evidence suggests they are safe to use. You should ask your surgeon exactly which type and manufacturer of implant will be used and why. In general, wise surgeons will use tried and tested implants made by reputable manufacturers. Most patients will be offered silicone gel filled implants. They tend to feel the most natural, can readily be made teardrop-shaped and are durable. Saline filled implants tend to feel less natural, folds and ripples may be more visible and they have a risk of deflation.
All other filler materials have been withdrawn for use in the UK. The two most important decisions to make about your implants are their size and shape.
Implants are supplied by volume in millilitres or weight in grams. It is not possible to just pick a cup size and ask your surgeon to supply that. At your preoperative consultation your surgeon will assess your chest wall, your existing volume of breast tissue and how much skin is available to accommodate the implant. Your surgeon will be able to give you an idea of what implant size is appropriate for you.
Your own view is also important since in most patients a range of possible implant sizes could be used and it is helpful if the surgeon knows if you would tend towards the larger or smaller end of that range. Your surgeon will not be able to guarantee you a cup size. In general the larger the implants that are used and the slimmer you are the less natural-looking your breast augmentation will be. The implant will be less obvious if it is not oversized and if you have a reasonable amount of your own tissue to cover the implant.
Implants can either be round or teardrop shaped (otherwise known as anatomical). Round implants provide a bigger volume at the top of the breast, and by design are the same width as they are tall. With teardrop shaped implants, it is possible for the surgeon to choose the width and height separately thus enabling more control of the eventual shape. With either of these options, there are varying degrees of projection, depending on whether the desired effect is to look subtle or more noticeably pert. In general your surgeon will advise the best shape option to fit your frame and your desired outcome
Are silicone implants safe?
Breast implants are made from medical grade silicone. This is a polymer that has been tried and tested and is used in a number of other medical devices. Silicone is also used in frequently occurring household items such as shoe polish, hair conditioner, and kitchen implements. As far as we can tell this material is safe. All of us already will have small quantities in our bodies, apparently without affecting us. If you have breast implants, small quantities of silicone come off the surface of your implants and will be taken up in the lymph glands in your armpit and will end up in your liver.
Silicone is inert in the body, you cannot react to it or reject it. There is no association between breast augmentation and breast cancer or cancer of any other part of the body. Neither is there any proven association with any other illness. There have been recent reports of an illness called anaplastic large cell lymphoma (ALCL) in association with breast implants, but it is sporadic and extremely rare, it does not seem to be as serious as ALCL occurring elsewhere.
Over time the implant shell may fail and the silicone gel may leak out. Whilst this may cause symptoms and will result in re-operation to remove and replace the implants there is no evidence that a ruptured breast implant causes ill health.
What does the operation involve?
Breast enlargement surgery takes about one-and-a-half hours, and is usually done under general anaesthetic. The operation itself involves accessing and creating the pocket into which the implant will be placed, using one of the insertion routes mentioned above: breast-crease, armpit or nipple. Once the pocket has been created, the surgeon may insert a trial implant to check that the size chosen is appropriate. The implant inserted and the incision wounds are stitched. You may be able to go home the same day, but many patients will spend one night in hospital.
Postoperative pain in these procedures is easily controlled. Your chest will feel tight. Your breasts and ribs below your breasts will be tender. Patients will be mobile from day one and should be back to full exercise within six weeks. Patients are recommended to take around one to two weeks off work immediately recuperate fully.
At first your breasts may look too high and the skin appear tight. This tends to settle down over the first six weeks or so after the operation as a more natural shape emerges. Most patients are delighted with the change that has been achieved, but some find their new shape is difficult to get used to. You should be prepared for this possibility.
The nature of the scars will depend on the technique that has been used. Scars tend to six weeks, changing to purple over next three months and then fading to white. Most patients will form good quality scars over time. Abnormal scarring is rare in breast augmentation surgery.
Introduction to breast augmentation
What complications can occur?