Breast Augmentation

Breast augmentation is one of the commonest aesthetic surgery procedures carried out worldwide. In my own practice, women seeking breast augmentation fall into two groups, young women who have not begun family life and older women who have been through pregnancies and are seeking to reverse changes to their breasts that have naturally occurred as a result of the hormonal changes associated with pregnancy. For many women considering breast augmentation, the intention is to make a significant and pleasing difference to the size of their breasts whilst maintaining as natural an appearance as possible.

I most commonly use a short incision placed in or just above the inframammary crease of the breast. I have many times used an incision that skirts the lower part of the areola margin. Some surgeons prefer to use an incision in the axilla/armpit, but this is not a technique I use personally. The implant that is used to augment the breast can be placed either behind the breast tissue and on top of the chest wall muscle or behind the breast and underneath the muscle (pectoralis, the muscle that gives athletes definition to the front of the chest). Wherever possible, I prefer to place implants in a submuscular pocket because I believe that this softens the contour of the upper part of the breast and also helps to hide the implant, in other words, to make it less detectable.

Modern implants are available in a variety of shapes and sizes. The decision for which to use will be based partly on the wishes and shape of the patient and partly on surgical recommendation. This is something that is discussed during pre-operative consultation. It is important that women seeking breast augmentation discuss with their surgeon the sort of change they are expecting to make to their breast size and what their personal aims are in undertaking such surgery. It should always be remembered that no guarantee can be given about a specific cup size for the breast following surgery since there is no clear way of measuring the breast volume and translating this to change in breast size according to the volume of implant selected surgically.

Complications and Other Factors for Consideration

Bleeding can complicate breast augmentation, just as with any surgical procedure. This commonly occurs in the first 24 hours and affects approximately 1 in 20 women. The signs of haematoma are swelling and discomfort in the affected breast and the treatment is to return to the operating theatre where, under general anaesthesia, the blood is removed and bleeding stopped before replacing the implant and closing the wound once more. This should not cause long-term problems.

Infection is a rare occurrence (2-3%) but can be a real problem. Patients who develop an abscess around the implant itself, will present with swelling, pain and redness of their breasts, will feel very unwell and will be running a fever. In the end, pus will appear through the surgical scar. Infection that involves the implant pocket itself can only be managed effectively by surgically removing the old implant and by administration of antibiotics. Once the wounds have fully settled and time has been allowed for the infection to be totally eliminated, it is possible to re-insert a fresh implant. It is typical for a period of 4-6 months to elapse before this attempted. During this time, it is normal to leave the contralateral unaffected implant entirely alone.

It is said that approximately 15% of patients will have some permanent alteration to sensation in the nipple areola complex. This could affect both breasts. More commonly, patients complain of an uncomfortable increase in sensation but my experience is that this always settles with time.

For slim women in particular, I warn that the implant may be palpable. Particularly in the lower part of the breast where there is less tissue covering the implant. Unless this were particularly troublesome to the patient, it is not something that demands further treatment.

Just as there is a scar on the skin, then so the body encapsulates the implant in its own scar behind the breast. In 5-10% of patients, this scar, which is often referred to as the capsule, has a tendency to contract on the implant and as it does so, creates distortion (a change in the shape of the breast), pain and a feeling of hardness. Capsular contracture can occur years after surgery and there is no clear way we can predict who will suffer this problem. The typical treatment is to release the scar or remove to allow the implant to lie within an unrestricted pocket. It is typical during this surgery to replace the implant with a fresh one.

General complications can occur as with other procedures carried out under general anaesthesia and include deep vein thrombosis and pulmonary embolism.

Pregnancy and breast-feeding are not contraindicated after breast augmentation.

There is no clear guidance from any implant manufacturer that their product should be replaced surgically after any given period of time. Provide

For some patients, a secondary procedure may be helpful in order to achieve a satisfactory outcome.

Key Points - Breast Augmentation

  • Many different types of implant are available to suit individual needs
  • Surgery is performed under general anaesthesia with a single night in hospital
  • I recommend the use of a sports bra for 4-6 weeks post-operatively
  • Appearances tend to settle and improve over the first 8-12 weeks
  • Office workers should be fit to return to work after one week | Tel: 01342 330303