Women seek breast enlargement (known as breast augmentation in medical terms) for a number of reasons. Some women have always had small breasts and wish to look more feminine. With some women the breast tissue shrinks after they have children and they want the breasts to look like they did before.
Others may seek to be bigger because of their careers (models, film stars, dancers). In each group, the choice is between surgical and non-surgical procedures. Non-surgical procedures include the Brava bra , Macrolane injections and Lipofilling (fat transfer) amongst others. The surest way of enlarging the breasts is by the use of implants which may be made of silicone or saline.
Silicon implants are the commonest type of implants used in the UK. Saline implants were commonly used in the US after the scare with silicone implants in the last decade. The investigations and review of evidence have failed to find any health problems caused by silicon.
Silicon implants are either round or shaped (anatomical). The choice of implant shape depends on the woman’s expectations and the shape of the breast. Generally round implants will give a rounder fuller breast shape and shaped implants a more sloping natural look although this is a generalisation.
The implants may contain various amounts of silicon which may be somewhat liquid (like hair gel) or solid (high cohesive gel-like the inside of Turkish Delight). The advantage of high cohesive gel is that in the rare case of implant rupture the silicone does not leak out of the implant. These implants can also be form stable or memory gel implants or shape retaining implants with a negligible risk of causing rippling.
Implants may be placed behind the breast or behind the muscle (partly or wholly). The decision depends on the amount of existing breast tissue and the size of the skin envelope covering the breast and the shape of the breast. There needs to be approximately 2cm of breast thickness in the upper part to ensure that the margins of the implant are not visible. Hence if you can ‘pinch more than an inch’ in the upper part of the breast, the implant can be placed behind the breast tissue. The incisions for breast enlargement may be in the fold underneath the breast, around the nipple, in the armpit or around the belly button. There are pros and cons with each but the easiest and safest is the one in the fold on the underside of the breast.
The surgery takes between 1-2 hours. It is usually done under general anaesthetic but can be done under total intravenous anaesthesia where it is not necessary to put a tube into the mouth.
The stitches are dissolvable and do not need to be removed. The surgery will require an overnight stay if done in the afternoon. Drains are placed to avoid any collection of blood or fluid around the implant and can usually be removed the following day.
The aftercare advice
- Normal activity can be resumed in 2 weeks
- Avoid exercising for 6 weeks
- Avoid lifting heavy weights for 6 weeks
- Do not go on long haul flights for 6 weeks to avoid the risk of deep vein thrombosis
- Wear a sports bra day and night for 6 weeks
- Shower normally for the first two weeks
- Avoid baths for two to three weeks
Clinic appointments (all covered within the fee)
- 1 week
- 4 weeks
- 4 months
- Infection- less than 1%, may require antibiotics and if this does not work , the implant will need to be removed to allow the infection to subside
- Bleeding-significant bleeding requiring a return to the operating room is very rare (1%)
- Bruising- uncommon but more likely with implants placed under the muscle
- Swelling- some degree of swelling is common after any operation. Sometimes fluid may collect around the implant and cause one breast to look larger than the other. This fluid tends to disperse but may need draining.
- Implant rupture- is very rare. The manufacturers guarantee lifetime free replacement of implants if this occurs.
- Implant displacement or rotation- occurs rarely if aftercare advice is followed. Would require surgery to reposition the implant. The one year guarantee covers all costs if this is required.
- Capsule contracture- hardening of the capsule around the implant may tighten around the implant and cause pain. High incidence in smokers, following infection or bleeding and in women who have radiotherapy. Would require a revision procedure with removal of the implant and the capsule and replacement with a new implant.
- Altered sensation of the nipple- nipple may be less or more sensitive and this resolves in a few weeks. Rarely sensation is permanently lost.
- Scars- the scar tends to heal to leave a faint thin line. Protecting the scar with total sun block cream for 6 months is strongly advised.
- BIA-ALCL (Breast Implant Associated- Anaplastic Large Cell Lymphoma) – The reported incidence in the UK is 1 case for every 24,000 implants. It is associated with textured implants used in breast augmentation and breast reconstruction. The incidence varies with the manufacturer and seems to be higher in those implants that have aggressive texturing
- Breast Animation deformity – happens occasionally but exclusively when implants are placed under the muscle. Correction would require further surgery.
- Implants cause breast cancer – no evidence. Recently there have been reports about a rare form of lymphoma being found in women with breast implants but this is very rare (BIA-ALCL see above)
- Implants prevent lumps being found- the implants being behind the breast would make lumps more easily felt rather than difficult to feel
- Women with implants cannot have mammograms- mammograms are possible, special views may be required.
- Mammograms damage implants- untrue
- Implants may interfere with breast feeding-untrue