Reasons for Wanting Bigger Breasts
The first breast enlargement in medical history took place over 100 years ago. The reasons for wanting bigger breasts vary but the main reasons a woman wants breast enlargement are that
- She feels her breasts are too small
- She has unequal breasts
- She wants to regain the size and shape of her breasts after pregnancy/breastfeeding or experiencing significant weight loss.
Improvement in body image usually leads to enhanced self esteem and personal confidence.
Breast Implants (Prostheses)
Many types of breast implants are commercially available. There is no scientific evidence so far to suggest that silicone causes breast cancer or joint disorders. However there is a small risk of developing a rare form of cancer in the scarring tissue around the implants called atypical large cell lymphoma (ALCL). The risk of this is approximately 1 in 30,000 and is highly curable. The shape of the implant can be spherical or anatomical (natural shape or tear-drop shape). This is an example of an anatomically profiled silicone implant:
Furthermore, silicone implants can be smooth or roughened (textured). Smooth implants are less likely to cause rippling (wavy feeling of breast) than textured implants but are more likely to cause scarring and hardening around the implant (this is called capsule formation).
Women considering breast augmentation should be made aware of the fact that the quality (and therefore the cost ) of silicone implants varies according to the manufacturer. The author prefers the use of silicone implants approved by the FDA. FDA approval means that implants have been extensively tested for safety. Choosing the right implant is a key to successful breast augmentation or breast enhancement surgery and this decision should be made jointly by the woman and her doctor.
How is it performed?
There are 4 ways of making the surgical incision (cut):
- Inframammary incision: the cut is made at the lower border (fold) of the breast. This short scar heals well and fades away over time.
- Periareolar incision: the cut is made at the border of the darker skin surrounding the nipple.
- Axillary incision: the cut is made in the armpit.
- Umbilical incision: the cut is made around the belly-button and the implant is inserted with the aid of a long tube (endoscope)
The implant can be placed under the muscle on the chest wall (subpectoral) or directly under the breast itself (submammary). The author prefers the former method in very slim women in order to reduce the incidence of the implant palpability (the ability to feel the implant) . The submammary (behind the breast) approach causes less pain and leads to faster recovery after surgery. Furthermore it is associated with a more natural and superior cosmetic outcome than the submuscular approach. Therefore this represents the preferred method in most cases.
Problems with Augmentation
Wound infection develops around the implant in 2% of cases causing pain, discharge, redness and/or fever. Antibiotics are initially used to deal with this complication. If this fails, the implant will require removal and replacement. The surgeon may decide to allow the infection to resolve before inserting a new implant.
This refers to a blood collection (haematoma) around the implant. The risk of this complication can be minimised by a careful control of bleeding points during surgery and the use of drains (thin tubes) to drain the blood immediately after the operation. Women are also advised to avoid using Aspirin-like drugs the week before the operation. Haematoma may require surgical evacuation.
In the long-term, most breast implants are associated with the formation of a tough layer of tissue around them, called a capsule. In severe cases the capsule becomes very hard, causing discomfort and distortion of the breast. It can be dealt with surgically. Smooth-surfaced implants are more likely to develop this complication than textured (rough-surfaced) implants. The chance of this complication occurring with modern implants is only approximately 5%, which is a very small risk.
Reduced breast sensations
Silicone leak may cause a breast lump or a lump in the armpit (swollen lymph gland). The diagnosis can be made by an ultrasound scan, however MRI scanning is the most accurate test. When leak occurs, it is advisable to replace the implant. However this is not a medical emergency!
The procedure itself takes between 1 to 2 hours. The stitches are dissolvable, and the wound is covered with a water-proof dressing. The patient feels tired and sore for a few days after surgery but should be up and around in 24 hours. The discomfort can be controlled by simple oral pain killers. Patients are usually given a surgical bra which should be worn for approximately one week after surgery. Then they are advised to use a sport bra for further 3 weeks. The swelling in the breasts may take two to three months to go completely.
Women who have breast augmentation can breastfeed and can have mammograms after surgery. The procedure costs £ 4000-6000.
Potential complications and risks of Breast Augmentation / Implants surgery:
- Bleeding haematoma (1-2%)
- Infection leading to removal of the implants (1-2%)
- Capsular contracture (15%)
- Interference with nipple sensation and contractility
- Loss of sensation in the breast skin
- Breast asymmetry
- Migration of the implants
- Movement of the implants
- Movement of the implant if placed un sub-muscular pockets
- Rotation of shaped implants
- Palpability of the implant
- Seroma; including delayed seroma
- Unfavourable scarring including keloid scars
- Chronic pain
- Reduction in sensitivity of mammography in breast cancer detection
- Implant rupture
- Gel leakage
- Anaplastic large cell lymphoma (very small risk; approximate risk 1/30000)
- General anaesthetic risks: DVT (Vein clot), PE (Lung clot) and MI (Heart attack).
The aesthetic outcome of replacement of implants:
For information on ALCL click here
For information on Auto augmentation from articles written by professor K. Mokbel