What is Breast Augmentation?
Breast augmentation is also called breast enlargement or referred to as a “boob job”. This is usually performed using an implant and aims to enhance the size and shape of the breast. It can be combined with other procedures such as breast uplift / mastopexy.
What to expect during your consultation?
The success of the consultation depends on your openness and honesty in relation to what troubles you and your expectations of surgery. You will be asked questions about your health, desires and lifestyle. Different operations can be tailored to your needs and the potential outcomes and the risks and complications will be discussed with you.
Breast enlargement involves the placement of an implant under the breast to enhance the size and shape of the breast. Incisions are usually placed under the breast at the crease but can be placed around the areola or in the armpit. Implants can be placed under the breast gland (known as sub-glandular placement), or behind the muscle. Where the implant is part covered by muscle and part under the gland it is referred to as a dual plane breast augmentation. A consultation regarding the risks and limitations of surgery will help you to choose a procedure that will meet with your expectations.
What implants should I have?
There are many different types of implants. There are different sizes, different shapes and the covering and the content or fill of implants can vary.
The shell of all implants is made of silicone and can be filled with either silicone gel or saline. The shell may also be coated with polyurethane foam. Most implants have a rough appearance to the silicone shell known as ‘texturing’.
Most patients will choose silicone gel filled implants that tend to feel the most natural and also tend to perform better in the long term compared to saline filled implants. Saline filled implants tend to feel less natural and are more likely to develop folds and ripples and have an inherent risk of deflation. Occasionally you may be offered a saline implant that can be adjusted after surgery.
Implants come in a variety of sizes and the implants are designed to fit the width and height of your chest. A sizing kit will be used to help you determine an appropriate size.
Implants can either be round or anatomical / tear drop. Round implants tend to provide more volume in the upper half of the breast of the breast whereas teardrop-shaped implants are shaped in a more natural way and aim to give a more natural result with less upper fullness.
Are Silicone Implants Safe?
Breast implants are made from medical grade silicone. They have been around since the 1960’s and there has been a lot of debate internationally about the safety of breast implants. I tend to use implants that have FDA approval. 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.
Over time implants 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 itself causes ill health. Small quantities of silicone may leave your implants and will be taken up in the lymph glands and possibly elsewhere. If this were to occur it is usually does not cause any problems and removal is rarely necessary and needs to be balanced against risks of surgery.
Preparing for breast augmentation surgery
The majority of boob jobs require general anaesthetic. Your health is a prime importance and any cosmetic surgery should be postponed if you are unwell for any reason. It is important that if anything changes with your health that you make contact with us. You should ideally stop smoking 6 weeks prior to surgery and stop taking aspirin, anti-inflammatory drugs and herbal supplements before surgery. You may need preoperative tests prior to surgery, which we will arrange if required. You will generally experience discomfort following the surgery and should aim to be off work for at least 2 weeks depending on the type of work you do.
Boob jobs often take between 1 and 2 hours and is usually done under general anaesthetic. Incisions are usually placed under the breast at the crease but can be placed around the areola or in the armpit. Implants are then placed in the chosen pocket either under the gland, under the muscle or a combination of both. The wounds are then closed with dissolvable stitches.
You will usually return to the ward within an hour following surgery and you will be encouraged to mobilize. You will usually not have drains in place and you will be able to eat, drink and mobilize as soon as the anaesthetic wears off. You will feel swollen and have discomfort that will usually require analgesia. There is often a sense of pressure on the chest, a discomfort around the outside of the implant due to the pressure effect and the skin feels tight and swollen. You should wear a support bra and keep this in place day and night for at least 4 weeks. You may be able to go home on the same day and should keep the wounds dry for the next week. You should arrange for someone to pick you up following surgery and have some support at home on discharge. You will be reviewed in clinic and the wounds checked at a week. You should avoid any strenuous exercise in the first couple of weeks and should continue to wear a support bra for 4-6 weeks after surgery. You will be able to resume light exercises after a week and normal exercise by 2-3 weeks. You should be able to swim by 2 weeks and you should begin massage to the scar once healed. The imags 1-3 show the progression of a patient showing how the implants are more swollen initially and asymetry between the two sides and how they drop and soften over the course of 6 weeks when the final picture has been taken. It often can take weeks and months for the final results to become apparent and this is not unusual.
Risks and Complications
The vast majority of patients are delighted with the procedure although common early complaints include change in sensation, bruising, swelling and there is often a slight difference between the two sides. Uncommon early complications include infection, haematoma, delayed healing, extrusion of the implant, seroma formation and thickened scar. There are also uncommon risks of general anaesthesia such as respiratory / cardiac compromise and deep vein thrombosis. In terms of later complications the most problematic is infection. Often in these scenarios it is necessary to remove the implants and leave things to settle before considering reimplantation at a later date (often 3-6 months). This is extremely uncommon.
Implants do change over time and all implants develop a capsule. This is a scar that forms within 6 weeks of surgery, it is a protective layer but it can change over time and thicken and scar. If this occurs it is called capsular contracture and can cause change to the shape and can cause discomfort and pain. The chances of having a re-operation for any reason after a breast augmentation are about 1-3% a year. So, after 10 years about 10-30% of women will have had a re-operation. Aside change of size; capsular contracture is the most common reason for re-operation.
Sensation usually changes following breast augmentation and the nipples may be hyper or hypo sensitive. It is uncommon to have permanent changes in sensation but can take a number of months to return back to normal.
Although all implants can rotate within the pocket anatomical implants when they rotate can cause a change in shape. Often this is self-limiting but if this was to become troublesome it may be necessary to replace the implants. This is uncommon.
You may, especially if you are thin, be able to feel the edges of the implants. This is an inevitable consequence of the operation and will not improve with time. Over time ripples or folds may be palpable especially in certain positions.
Some patients can develop intermittent swelling following breast augmentation. This usually resolves but if it persists may warrant further investigation.
With time just as the implant ages so does the breast tissue. This is particularly an issue with childbirth. It may be that further surgery to tighten the skin is required at a later date and everyone undergoing breast augmentation should be aware of the need for further surgery for both the implants and also the skin / breast tissue. The attached photo 4-6 shows a patient before and
after breast augmentation and then 6 years later to show how the breast tissue has aged over the implants and dropped following the completion of this ladies family.
A combination of change to the breast and the implant can lead to the implant looking too high or too low and for the breast tissue to hang over the implant. Over time there may be a need for a breast augment revision.
Implications for mammograms and screening
Breast implants push your natural breasts forward and so do not make it any more difficult to examine your breasts for lumps. You need to be aware that 1 in 10 women do develop breast cancer and if you find a discrete lump you should consult with your GP. If you find a lump or you are at an age to enter a breast-screening programme you may be offered a mammogram. You need to tell the mammography service that you have breast implants as you may require special views or potentially a different type of scan.
Implications for breast feeding
The ability to breast-feed should not be affected by breast augmentation. If one is unable to breast feed after breast augmentation it may be that you would have been unable to breast-feed in any case.
Are there any alternatives to breast augmentation?
The only alternative surgical technique to enlarge the breast is autologous fat transfer. This is a complex technique where fat is removed by liposuction from one area of the body and transferred into the breast area. The increase in size is usually modest and smaller than can be achieved with an implant and often patients will require a number of treatments to achieve a noticeable result. It is thought that our own fat can be safely injected into the breast although longer term evaluation is required to determine its safety and you should remain under follow up with your surgeon.