Breast Augmentation surgery is designed to enhance the size and shape of a woman’s breast. The surgery is effective in increasing the size of the breast whether the initial problem was a failure to develop or loss of size after child bearing or weight loss.
A mild degree of breast sag may also be masked and the appearance enhanced by breast augmentation.
However, where sag is severe a breast repositioning procedure may be advised. This may be performed at the same time or at a second stage. Breast prostheses can also be used to reconstruct a breast after mastectomy (breast reconstruction) or to achieve balance in women whose breasts are of different size.
An increase in breast size of one or more bra cup size is possible by inserting prostheses behind the breast itself or behind the breast and pectoral muscle.
The ASAPS was founded in 1967, is the leading professional organization of plastic surgeons certified by the American Board of Plastic Surgery who specialise in cosmetic plastic surgery. With 2,400 members in the U.S, Canada, and many other countries, ASAPS is at the forefront of innovation in aesthetic plastic surgery around the world.
Who is suitable?
If you are in good health and your expectations are realistic then you are probably a good candidate for breast augmentation. Breast augmentation will always increase the size of the breast. It will not however always give the perfect or desired shape. Much of the final shape of the breast is determined by the shape of the breast before surgery.
This means that a girl with a naturally pretty shape will probably end up with again a pretty and larger breast after surgery. Where the shape is undesirable, steps may be taken during the procedure to obtain a better breast shape. This will be discussed in detail at your consultation if it is pertinent to your situation.
Insertion of a breast implant naturally requires an incision which will leave a scar. Common incision locations are in the armpit (axilla), in the crease below the breast (infra-mammary) or at the border of the pale and dark skin below the nipples (peri-areolar). Scars in the armpits often stretch and are of course easily visible in many forms of clothing. When the incision is placed in the armpit, the procedure is often performed blindly with a blunt instrument to make the space (pocket) for the implant. This has some technical limitations. If re-operation is required for any reason, often the armpit scar is not suitable for the second procedure and therefore a second scar is required. Incisions in the fold below the breast will leave a scar which may be visible when wearing a bikini if the arms are raised. It is also easily visible when you are lying down without a top on. It can however be quite a fine scar. Usually it is concealed by the curve of the lower pole of the breast. It is usually approximately 5cm in length. Incisions around the lower part of the nipple use the natural transition of the pale to dark skin to hide the scar.While all three scars are undeniably visible, this is usually the least conspicuous. If breast sag is severe, then a repositioning procedure may be required to achieve a good cosmetic result. When the breasts are repositioned, scars are more extensive, running around the circumference of the nipple and then down to and along the fold below the breast.
By placing the breast prostheses behind the larger muscle of the chest (pectoralis major muscle), it is usually possible to obtain smooth natural contour to the upper portion of the breast. Breast prostheses below the muscle have been shown to be less prone to the complication of hardening (capsular contracture).
However in some patients (for example, bodybuilders) the implant may preferably be located in front of the pectoralis muscle and behind the breast. The most suitable pocket for you will be discussed at your consultation.
Types of breast prostheses
All breast prostheses have a wall made out of silicone. This is plasticised to form a material called silastic. The prosthesis shell can however be smooth or textured. Textured prostheses have a roughened external wall which is designed to achieve a similar appearance to the polyurethane coated implants of the 80′s.
It is believed by doing this that the risk of hardening of the prostheses (capsular contracture) is reduced. This however is controversial.
The aim with smooth or textured prostheses is to achieve a soft and natural result. With smooth prostheses a large pocket is made and after surgery you will be instructed on how to massage the prostheses to move it around and maintain that large space thus ensuring it stays soft. Failure to do so can result in hardening. With textured prostheses massage is not required. Tissue ingrowth to the roughened wall of the prostheses is encouraged as the texturing is believed to reduce the chances of the scar tissue becoming hard.
While undoubtedly the polyurethane-coated implants were associated with a decreased incidence of capsular contracture, the same cannot be said with certainty with textured implants. Current thinking is that textured implants do reduce the risk of hardening when implants are placed behind the muscle. When implants are placed behind the muscle the risk of hardening is reduced anyway and the difference does not seem to be statistically significant.There is also some question as to whether textured implants are more prone to infection. Textured implants are more difficult to slide in through the incision and usually a larger incision is required to insert them. The content of the implant may be saline or silicone gel. Each has its advantages and disadvantages. Saline-filled (salt water implants) are more prone to leaking. Approximately 1 % of saline-filled implants leak and deflate each year and require replacement.This is not harmful but is of course inconvenient and means further surgery is required. Saline-filled prostheses may also achieve a rippled feel, somewhat like the edges of a waterbed. This may feel unnatural especially in a slim girl where there is little overlying tissue to “camouflage” these ripples.This is much less common with silicone gel-filled implants. In general, saline-filled prostheses feel more firm than gel-filled prostheses and less life-like. However, if your overlying tissues are suitable then you may achieve a good result with saline-filled prostheses. Silicone gel-filled prostheses are generally favoured as they feel more life-like. The gel is soft and yielding somewhat like human breast tissue.In the 1970′s, the walls of these prostheses were very fine and fragile and the gel fairly watery in nature. Comparison with a modern gel- filled implant will show that these are now much stronger and thicker in the wall and the gel itself is more viscous. The gel is now quite dense (cohesive gel). Thus the risk of leakage has substantially been reduced. Some implants have a fixed anatomical shape (tear drop) which they maintain (“form-stable”).
These implants are made of a denser cohesive gel (“Turkish delight”). They can be cut in half and just remain in two pieces. They do feel somewhat more firm and usually require an incision of about 6cm in the inframammary fold for insertion. They are usually more expensive than other implants but are sometimes better for masking breast sag if it is mild or to avoid a round shape in a slim patient.
If you are slim and want minimal scarring and a softer feel, you may well choose to use a smooth-walled, gel-filled implant as only it will achieve the above desires. However, the choice in Dr. Scamp’s practice is entirely in your hands as all implant types and incisions are available. Implants behind the muscle may move with exercise but are less likely to go firm.
Also, the top edge of the implant is obscured which avoids a “fake” look. Strong flexion of the pectoralis (chest) muscles may distort the implant but this disappears when you relax.
Preparation for Surgery
You should avoid aspirin, vitamin E, smoking and red wine for at least two weeks prior to surgery. These things all increase the amount of bleeding at surgery. If a breast lift is required, it may be recommended that you cease smoking completely for six weeks prior to surgery.
This is because smoking interferes with the circulation of the skin and can lead to significant healing problems. It is wise to wait until your weight has stabilised and your body has recovered from childbirth before undertaking this surgery.This usually takes up to a year after birth.
Ensure that you will have the support that you need after surgery so that you may rest peacefully at home. You will need someone to drive you home after surgery and to be present with you constantly for the first twelve hours.
Site of Surgery and Type of Anaesthetic
Your surgery will be performed in an accredited day theatre or in hospital as you prefer. Many people prefer to avoid the additional cost of hospital admission, so most of our patients have their surgery done in the Day Theatre. However again, the choice is entirely up to you. If you have several small children at home, you may prefer the peace and quiet of a night in hospital.
The surgery is performed under general anaesthesia whether in the day theatre or in hospital. Once you are asleep, long-acting anaesthetic solutions are injected into the breast region to minimise your discomfort after surgery. A long-acting pain-relieving drug is also administered into your vein. We found this combination to be the best way to ensure your comfort.
Our various clients from Gold Coast, Sunshine Coast & Brisbane have found assurance in our methodical process. Prior to your surgery, Dr. Scamp will again talk to you. He will then mark the incision site as determined by your preference and outline the shape of the breast. Through a small incision a space (pocket) will be made for the prosthesis, either behind the breast itself or behind the pectoralis muscle as agreed upon. When the implant is placed behind the muscle, the lower border of the muscle is lifted to allow for a better breast shape.
When the pocket is completely shaped, the implants are inserted and the incisions closed with absorbable stitches. If necessary, a drain may be placed into the pocket to remove any moderate excessive bleeding. Drains are used in only a small percentage of patients. Although the surgery takes only 1-1.5 hours (depending upon your individual requirements), you will spend approximately half the day in the day theatre, mostly in the recovery ward. When you are comfortable you may be collected and taken home.
The Post-Operative Period
Expect some discomfort particularly where the prostheses are placed behind the muscle. The long-acting anaesthetic injections help to minimise this and you will also have some pills to take for pain. There will also be some antibiotic pills for you to take. The biggest doses of antibiotics are given during the operation to best reduce your risk of infection.
Due to the injections and the surgery itself, your breasts will be quite swollen at first. If you have never had children the breasts will be quite tight, improving over the first 4-6 weeks. If you have however had children in the past, you may find the sensation somewhat like when your “milk comes in”.
You are also more likely to settle in faster and become less swollen. It is not essential to wear a bra after the surgery. An elasticated lycra-aerobic top may feel quite comfortable but no support is essential. It is not recommended that you be fitted for a bra for six weeks after surgery, as it takes approximately this long for your final size to be settled upon. Getting back to normal Unless your job entails heavy lifting, you should be able to return to work within a week of surgery.
No vigorous exercise is advised for two weeks. Exercises such as bench-press which specifically stress the pectoralis muscle should be avoided for six weeks. Expect some soreness when using your pectoralis muscles for approximately a month after surgery. At first when you are instructed on massaging the prostheses you will note some discomfort. In general, the more you massage the prostheses the more relaxed the pectoralis muscle becomes and the less it hurts.
Massage must be done at least three times a day and should be continued indefinitely to maintain a large pocket and therefore a soft result. If your implants are smooth-walled you will be instructed on how to massage and move the prosthesis to maintain the large space (pocket) that was made. Textured, shaped implants are generally not to be massaged for fear of mal-rotation which may require reoperation. In general, scars take about a year to get to their best but the peri-areola scar may be unremarkable within a week or two of surgery. Expect some sensory changes to the breast.
Some numbness is normal after surgery and may last for a couple of months. Whilst long-term loss of sensation is possible, this is very rare. Some women describe improved sensation after surgery and this may reflect a more positive attitude towards their breasts. Once fully recovered from surgery there is no activity that you are restricted from. This includes diving and flying.
Women with prostheses should have mammography performed only if a women of similar age and history without prostheses would also be recommended for mammography. Be sure to warn the mammography technician that you have prostheses. If you are from Gold Coast, Sunshine Coast or anywhere else near Brisbane, write down any questions that you have and bring them with you at the time of your consultation, or telephone and ask our friendly staff.
FOR INFORMATION ON BREAST IMPLANTS PLEASE SEE THE THERAPEUTIC GOODS ADMINISTRATION WEBSITE
or call the Publications Officer on 1800 020 653