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 There have been significant advances in breast augmentation surgery (breast enlargement) since the “bad old days” of runny, liquid silicone prototypes that were implanted in the early 1960’s.
Not only have there been enormous improvements in silicone gel implant technology involving both the “filling” and the shell, but also a better understanding and refinement of the surgical techniques used. I think (and hope) that we have moved away from being “breast stuffers,” to using a more biodimensional model to aid us in providing each patient with the best possible implant to suite their specific needs, based on their particular anatomy.
Major strides include, but are not limited to, the following:
Cohesive gel technology: Current breast implants contain a semi-solid silicone gel (sometimes referred to in the lay press as “gummy bears” The advantages are numerous, and include better preservation of implant form (so-called “form stable implants”), minimal risk of a gel bleed, or seepage of the content through the implant wall, and no risk of the gel leaking out everywhere, which was a major problem with early prototypes.
Improved implant shell technology: The current implants shells are very much thicker than their predecessors, and have a sophisticated texturing process on their surface to lessen the risk of the potential long term complication of capsular contracture.
Biodimensional approach: The modern approach to breast enlargement, using specific measurements on each patient’s chest to help select the most appropriate implant. In essence, it involves taking a few simple chest measurements, the most important of which is the pre-existing breast width, and using this data to establish the base print of the implant. Once this is established, one can look at the various degrees of projection, which may vary from low to extra-high. The system is not “absolute”, but is a useful guide for implant selection.
Breast augmentation is one of the most commonly performed surgeries both in my practice, and internationally.
There are many ways to perform a breast enlargement operation, with variables including the type or make of implant used, incision placement, and implant position with respect to the pectoralis major muscle..
Each has advantages and disadvantages, and all things considered, I have opted for the techniques listed below:
Preferred Breast Augmentation Techniques
I most often use round, low or medium profile, cohesive, textured silicone gel prostheses (Eurosilicone - France). Depending on each patient’s chest measurements, which would include soft tissue pinch thickness / cover, the implants may be placed either in front of (pre-pectoral), or partially beneath, the chest wall muscle (“dual plane”). In general, the thicker the existing breast tissue, the more likely I am to suggest placement in front of the chest muscle, and vice versa for very thin patients with little soft tissue cover. Should we decide upon placing the implant in front of the muscle, I always use the “subfascial” approach, which was first described by Dr Ruth Graf of Brasil. The pectoral fascia is a thin but fairly tough covering over the pectoral muscle, and may give the implants placed in front of the muscle, better support. Either way, I do the augmentation surgery via a small (5cm) incision in the breast crease, which leaves a very acceptable scar that fades over a few months to become barely visible in most cases.
The Consultation:
At the consultation, you will be fully informed of the normal process of the surgery, as well as any complications that may arise (fortunately very rare!). After an examination to assess that you are a good candidate for the surgery, certain measurements of your chest and breasts will be made, and routine pre-op pictures are then taken. You then have an opportunity to "try on" the full range of sizers in the office - I keep a full range of low and medium profile implant testers in the office, and encourage you to chose the look the you think will suite you best - a bra is provided for this purpose, so that by placing the different testers in the bra, you can see how you would like to look post op. This is noted, and is used as a guideline for the size of breast implant that is used during the surgery. If you wish, numerous before and after pictures will be shown to you, to give you some idea of the effect of the breast augmentation, but it is important to realise that the biggest determinant of your result is what you start off with!!! What the operation achieves is an enhancement of your existing shape; the better the pre-op shape - the better the post op result!
Patients of 40 years or above requesting any aesthetic breast surgery are encouraged to have a mammogram before the surgery, if one has not been done in the preceding year.
The Surgery:
The operation is done under deep IV sedation, by a certified anaesthetist, and long acting local anaesthetic is infiltrated into the breast. This ensures a safe and comfortable procedure, of which you will have no conscious recollection.
The operation itself takes between 1 and 1.5 hours, and generally you are discharged the same day; i.e. there is no need for overnight stay in the hospital.
To limit the chance of infection, antibiotics are given IV during the operation, and the implants are soaked in a special "cocktail" of antibiotics prior to placement. To date, I have had no infections after this operation that required implant removal, although this is an inherent risk when using prostheses of any sort. Most people are very happy with the results of this quick procedure.
Post Op:
For subfascial implants, recovery from the breast enlargement procedure is very fast, and discomfort only slight to moderate for a few days. If the implant is placed partially beneath the chest muscle, the recovery is somewhat slower, and the early post op course, more painful, although we would obviously give you stronger pain tablets in this case. A post operative stay (in Cape Town) of about a week to 10 days is optimal.
FAQ’s about BREAST AUGMENTATION / ENLARGEMENT
Q1. Do I need to wait until after I have had children, to have the surgery?
A1. No – you can have the surgery at any time. Most patients who have this operation have not had any children yet.
Q2. Will I be able to breast feed if I have implants?
A2. Yes – the implants are placed behind the breast, and do not interfere with the ability to fall pregnant, carry a pregnancy, or breastfeed. Obviously, your breasts will get larger in pregnancy and with breastfeeding, but no more or less than without implants.
Q3. What about the possibility of breast cancer?
A3. Large studies have shown that having breast implants neither increases your risk of developing breast cancer, nor delays the diagnosis of cancer, nor negatively affects the outcome should you develop cancer in the future. We routinely use breast implants to reconstruct breasts after patients have had a mastectomy for cancer.
Q4. What about mammograms – can I still have them if I have implants?
A4. Yes, although you would need to tell the radiographer that you have breast implants. Often, in addition to a mammogram, the radiologist will perform and ultrasound / sonar examination of the breasts.
Q5. What about anatomic or teardrop shaped implants - don’t they give a more natural result?
A5. In short…. No! Whilst conceptually a good idea, anatomic implants have not lived up to initial expectations. No cosmetic benefit over standard, round implants have been noted in the vast majority of patients presenting for cosmetic breast augmentation, and some very definite potential disadvantages have emerged, including rotation of the implants, a larger access incision needed to place them, and they are generally firmer than round implants. They may have a place in breast reconstruction after mastectomy, but a very limited role in cosmetic breast enlargement, in my opinion.
Q6. Do you use cohesive implants?
A6. Yes – all Eurosilicone implants are filled with cohesive silicone gel (gummy bears). I only use textured surface implants. Website www.eurosilicone.com
Q7. Is it necessary to have the implants replaced routinely after a certain period of time?
A7. No. I usually recommend that a routine “check-up” be performed 10 years after the surgery, but if at that time, you are happy with the size, shape and feel of your breasts, there is no need for a routine “trade-in” of the implants for a new pair.
Q8. What about the armpit incision for breast enlargement – do you use it?
A8. No – I prefer the incision to be placed in the breast crease (under the breast). The reason is that this incision is the most versatile for implant placement; the implant can be placed either in front of, or partially behind the chest muscle, and I have the most control over the exact seating of the implant, allowing me to place it accurately. The armpit incision may leave you with a conspicuous scar (albeit not on the breast) that may be visible in strappy tops, and may result in implants that are “high riding” (i.e. the implants do not rest on the breast crease, but somewhat higher, which looks very unnatural)
Q9. Could I have saline implants? – I have heard they are better than gel implants.
A9. I do not like saline implants, but will place them if you wish. In the early 1990’s there was a silicone scare in the USA, and so, although the saline implants do not feel nearly as natural as the silicone ones, they came into common usage because of this scare, not because they were better in any way. They slosh, may leak, and do not feel natural at all. Since the early 1990’s numerous scientific studies have validated the safety of modern cohesive gel implants.
Q10. Which is better: Under the muscle or on top of the muscle?
A10. Both are very acceptable methods of placing the implants – neither is more correct than the other, and each has distinct advantages and disadvantages. I use a biodimensional approach to best ascertain the implant size, and placement there-of with respect to the chest muscle. Each patient is therefore assessed on their own merits.
Final thought: This operation is extremely popular the world over, but is in fact, a series of compromises that each patient must be willing to make in order to be happy with the outcome. To have larger breasts one must accept a scar (where-ever it is placed) a silicone (or saline) implant in the breast, and the risk of being able to feel (or even see) the implant through the breast. As a very prominent breast enlargement surgeon in the USA has written: “If you (the patient) want perfectly soft breasts with absolutely NO chance of being able to see or feel the implant, don’t have the surgery!!”
All that said, this is one of the commonest operations that I perform, and the vast majority of patients are thrilled with the results!
Feel free to email me about any of the above, or any aspects that may be worrying you.
For more information as detailed on the American Society of Plastic Surgeons website, click here.
For information on other procedures, click here
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