Augmentation mammoplasty (also known as breast augmentation) is a procedure aiming to augment the size, enhance the shape or change the texture of the breasts. It involves the insertion of an implant beneath the breast and it is one of the most commonly performed cosmetic surgeries.
In addition to increasing the size of naturally small breasts, it can also improve the volume of such that have changed shape and size following a specific condition, e.g. pregnancy or weight loss. It is also a corrective procedure for unevenly sized breasts.
It is important to know that mammoplasty is a procedure, which may require subsequent commitment as there might be the need for a revision later on. Routine implant replacement is not recommended unless the patient is dissatisfied with the shape or size, or there is a specific problem, which has developed. A breast implant also interfere to a certain extent with mammography scanning, therefore, the medical specialists must be notified of implants before undergoing such a diagnostic procedure.
During their first consultation, the patients will be asked about the problems related to their breasts that are bothering them as well as their expectations about the outcome of the surgery. The surgeon will then examine the person, evaluate her health and discuss possible results and suitable types of implants if the patients are considered fit for this type of surgery. Alternatives and possible risks and complications will be mentioned as well. The surgeon must be notified of smoking habits and medicaments taken if there are such. Then, a certain “cooling off” period will be provided, so that the patient can think on the additional details about the procedure she was provided with and then make a final decision whether to go through with it or not. A second consultation after this period of time is possible. Some of the candidates not suitable for this procedure are such having had previous radiation therapy, girls under 18 years of age, patients suffering from an infection, and pregnant or currently breastfeeding women.
Breast augmentation surgery is usually done under a general anaesthetic. It involves creating a pocket for the placement of an implant. The method of insertion depends on the individual anatomy and the recommendations of the surgeon. There are several options for the location of the incision: the crease where the breast meets the chest (inframammary); around the areola (peri-areolar); in the armpit (trans-axillary). For each procedure, maximum effort will be put to reduce scarring to as little as possible.
The inframammary approach consists of a short incision underneath the breast and leaves a thin scar which is well hidden within the crease of the breast. This method provides a larger access point and is suitable for the insertion of larger breast implants.
The peri-areolar approach requires an incision around the outer edge of the areola and the scar is hidden in the pigment transition zone. The method is convenient when there a slight to moderate breast lift is involved as well.
The trans-axillary approach involves a small incision in the area of the armpit. Special equipment and instruments are used to ensure optimal placement of the implant. A small scar remains within the armpit but there is no scarring on the breast whatsoever.
The nature of the scars depends on the technique used. All scars tend to be red for around six weeks and then might turn purplish in colour over the next three months but will eventually fade to white. In most cases, the scarring is quite satisfactory with abnormal scarring being very uncommon for this procedure.
There are different types of breast implants and the most suitable will be chosen after a consultation with a plastic surgeon who will offer a recommendation after assessing the chest wall, the current breast volume and the availability of skin, which can accommodate the implant. The patient’s view of the preferred size range is important and based on it and the individual characteristics, the surgeon can offer the most suitable implant size. In general, the slimmer the patient is, the less natural very large implants will look. A balance must be achieved between the patient’s wishes and the realistically possible outcomes.
There is also a difference in shape among the different implants. They can be round or teardrop (anatomical). With the round ones more volume can be achieved at the upper part of the breast without any control over the height and width, whereas with the teardrop ones, the surgeon can choose height and width separately, thus have better control over the final contour of the breast.
The implants are made from medical-degree silicone and are absolutely safe. There is no link between breast augmentation and breast cancer or any other malignant diseases. There might be cases of silicone gel leak but the only consequence, apart from a certain amount of discomfort, will be the need for re-operation.
Before the insertion of the implant itself, the surgeon will use a trial implant to make sure the right type was chosen. It is then removed and the definitive one is placed, after which the incision is closed. The patient might be able to go home within the same day but many remain overnight. The patient might feel tired and sore for a few days but a certain amount of activity is regained within 24 to 48 hours post-surgery. The breasts will be sensitive to touch for about three to four weeks. It is very easy to control the postoperative pain with medicaments prescribed by the doctor. It is recommended for the patients to take one to two weeks off from work and full exercise is achieved within six weeks. The breasts might be too high or feel too tight initially but after about six weeks a more natural shape will be achieved.
In some cases bleeding around the implant might occur. The risk of this happening is less than 1%. It usually occurs right after the surgery or within two weeks. The symptoms are a very swollen and tight breast. The patient must return to the operating room to have the blood removed and the bleeding stopped. This requires also an overnight hospitalization. The implant will not be removed. Fortunately, even though it might prolong the recovery period, this is not likely to affect negatively the overall result of the surgery.
The most serious complication after breast augmentation is the development of an infection but it is very rare (less than 1% of the cases). It appears within the first two to three weeks after the surgery with the breast being swollen, tender and reddish in colour. There might be wound discharge and fever. Some cases are contained with a course of antibiotics but most patients with an established infection must have the implant removed. Three to six months are needed for the infection to resolve after which a new implant might be inserted.
Adverse Capsular Contracture
In every patient, a scar or a capsule is formed around the implant. Most of the time it is not considerable and the breast still feels soft and natural but in certain cases (for unknown yet reasons) there is scar contracture and the breast feels rather firm, more so than a normal breast. The majority of the patients are not bothered by it, however, in a small number of cases the breast becomes unnaturally firm and may change shape (usually a more spherical one). It might also become more sensitive to touch. It is safe to leave it as it is but some patients decide to have another surgery to remove the implant and the capsule. After that, a new implant can be inserted. This is the most common reason for re-operation. Unfortunately, even after removal, there is still a chance for another capsular contracture to occur.
Altered Feeling of the Breasts
There is almost always a certain extent of a change in the sensation in the breasts after a breast augmentation surgery. The changes usually consist of numbness in the area of the scar and oversensitivity of the nipples, which usually passes with time. In certain cases, there might be numbness of the nipples. If it remains for more than six weeks after the surgery, it is likely that it is permanent.
Feeling or seeing the implants under the skin
This usually happens in thin patients and it will not improve with time. The results are much better if the patient has a sufficient amount of her skin to cover the implants. It must be accepted as a downside of the surgery and it cannot be fixed with a re-operation. A slight improvement can be made with injecting small amounts of the patient’s fat under the skin.
As tough as implants are, sometimes the outer shell may fail and a leak may occur. It poses no danger as in most of the cases the contents will be contained within the capsule and the patient will not experience any adverse symptoms. Occasionally a change in shape or a lump might be noticed. This requires a scan to confirm that an implant has indeed ruptured after which it is removed and replaced.
Very rarely teardrop implants may rotate behind the breast. The implant will usually return to its normal position on its own or helped by a gentle push. There is no problem if it happens once but if it keeps happening numerous times a re-operation must be performed. Implant rotation is more common in patients with large implants used to correct markedly sagging breasts.