Breast Enlargement (Augmentation)
Breast augmentation or mammaplasty is an operation used to increase the size and/or shape of the breasts. This is usually achieved with artificial medical implants placed behind the breast tissue. It is effective at increasing breast size, may be used to improve breast shape, but is not usually successful on its own for treating breast droop or emptiness. It is also useful in cases of underdevelopment of the breast or in some cases of inequality between the breasts.
The decision to undergo breast augmentation should always be a personal one. You should not consider this procedure to please someone else. Like all aesthetic plastic surgery procedures, breast augmentation will not resolve any of life's major problems and cannot be expected to do so.
There has in the past been much controversy, especially during the early 1980s and 1990s about the safety of breast implants. Please refer to the Department of Health link below, to the MHRA link or to my own article "Is silicone safe?". I and most other surgeons are now convinced that silicone gel filled implants are not only safe but are the best implants available, and a huge body of evidence now supports this view.
I do not favour saline implants because of their consistency and propensity to deflate, and I point out to patients that in any case the saline in such implants is contained within silicone membranes!
I would be happy to discuss in greater detail the safety of these various implants at consultation.
Breast augmentation is carried out under general anaesthesia. There are a number of techniques of breast augmentation. The most popular is insertion of the prosthesis through the crease under the breast, via an incision approximately 5cm long.
After making a 5cm incision in the breast crease, the surgeon creates a pocket under the breast tissue in front of the pectoral muscle. Meticulous attention is given to stopping any bleeding as I believe this is one cause of compromised results following this surgery. The incision is closed with dissolving sutures and covered with a light dressing. Usually a compressing tube dressing is used at first, which is later changed to a sports bra which should be selected on advice from our nurses.
After Your Operation
After surgery the breasts will be tender and swollen for a few days and it is advisable to limit the arms movements and take the painkillers prescribed. Most women can drive on the third day.
Postoperative haematoma (a collection of blood under the breast) may occur in the post operative period. Should this happen, it may necessitate a return to the operating theatre but this would not affect the long-term outcome.
There may be changes in nipple and breast sensation, which are usually temporary. It is fairly common for the skin above the incision to feel somewhat numb for some months but this rarely extends to the nipple. Complete loss of sensation is more common in large volume augmentation as the severely stretched nerves have more difficulty recovering. Some patients describe heightened sensation, which can last for two or three months.
Infection with breast augmentation is fortunately very rare and will exhibit itself by swelling and redness appearing up to three weeks after surgery. Should this complication occur, it would mean the removal of the implant and the infection allowed to clear before the re-insertion of a new implant.
The most common complication following breast augmentation is capsular contracture. This is when the scar tissue shrinks around the implant squeezing it so that it feels firm or in some cases quite hard. Most capsular contracture stems from using smooth shell implants but with modern textured surface implants the incidence of encapsulation is low, probably around 5%. It is not known why this condition develops in some cases and not others. If it is necessary to relieve the firmness of a contracture it may be appropriate to surgically release the capsule under general anaesthetic. My own experience is that surgery for this condition is now extremely rare, possibly since the advent of the new generation of textured implants and adoption of a meticulous technique to prevent blood accumulating around the implant. This is however speculation, although the fact remains that this complication is rarely serious in my own practice.
Other complications include wrinkles or ripples in the surface of the implant being visible or palpable in thin women, and this may necessitate a change in implant type or location. Adverse scarring is rare, and significant asymmetry of position may occur but is again very unusual.
Follow up after breast augmentation is not of proven benefit but all patients are expected to report any problems with their breasts and to conduct regular breast examinations as normal. Mammograms are still possible although they may have a very slight reduction in sensitivity. Problems related to breast augmentation are rare indeed. There are long-term implications of a breast augmentation procedure. This is because it is only sensible to assume that breast implants will not last forever and may need changing. This however would be many years in the future.
Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL) and Breast Implants: latest news as of Summer 2017.
latest news as of Summer 2017
Medicines and Healthcare Regulatory Agency:
Breast Augmentation Procedure: What Happens in Surgery Step by Step
Article written by Prof. Simon kay for the sofeminine.co.uk website
Before and After Photos:
The following are photographs of Simon Kay´s actual patient, taken before before and after the procedure.
Whilst these photographs represent typical results, not everyone who undergoes plastic surgery will achieve the same.