Breast Enlargement Surgery (Breast Augmentation)

What are the benefits of breast augmentation surgery?

Breast augmentation is one of the safest and most rewarding cosmetic procedures performed today. But a women's desire for larger breasts is a complex one, involving personal, cultural, sociological and other issues. Many medical studies show that the media's view about the body image significantly influences the public. Patients should be sure of their decision and should have realistic expectations.

The surgery is addressed to certain categories of patients among which we mention:

• patients with small breasts, disproportionate comparing to the body shape
• patients who desire a pronounced enlargement of the breast volume
• Women who experience unilateral or bilateral breast hypoplasia (an incomplete development of the breasts that remain small)
• women who experience unilateral or bilateral breast agenesis (the involution of the breast)

Related to the above mentioned patients types, the benefits of the breast augmentation surgery are the following:

• increasing the breast size, because breasts are too small
• enhancing the overall body shape, balance and proportions
• achieving an enhanced appearance and size, following pregnancy and/or weight loss
• restoring appearance through reconstruction following mastectomy (breast amputation)

In conclusion, one may notice that the benefits are both physical and psychological. However, deciding whether to have or not breast augmentation surgery fully depends on the patient's will. It is not a treatment recommended by the surgeon.

How is breast augmentation surgery performed?

Individual patients and personal preferences may determine the specific technique selected to increase the breasts size. It is advisable to discuss the methods with your surgeon before the operation.

The methods refer mainly to the implant positioning. There are two types: submuscular and subglandular.

In the case of submuscular positioning the implant is inserted beneath the chests major muscle. The advantages of this procedure are:

• deeper placement and more padding over the implant
• mammograms readily performed
• supposed lower rate of capsular contracture

The disadvantages may be:

• breasts may feel firmer

In the second type of positioning, the implant is placed above chests major muscle. The advantages are:

• this is a more anatomical position for augmentation of the breast.
• Less post-operative pain
• Faster healing

This procedure also has its disadvantages, among which:

• increased visibility and palpation
• supposed higher rate of capsular contracture
• more difficult with mammography performance

The incision placement is also a matter of choice that needs to be discussed with the cosmetic surgeon. It depends on both patient and surgeon's preference and the size and type of implant to be placed. There are 4 types of incisions:

• periareolar – at the margin between the areolas and the breast skin, hardly visible scars
• inframammary – the most common one, the incision being placed under the breast, just in the inframammary crease
• transaxillary- at the armpits level; this incision is indicated for the patients who prefer not to have any scars

The breast augmentation is mainly performed with silicon gel.

Following the insertion and placement of the breast implants, the incisions are closed with sutures. The chest area is wrapped with a supportive bandage in order to support the breasts and aid the recovery.

The procedure is commonly performed under general anesthesia and may require one or two hours to complete.

Risks

As with any surgery, there are possible risks and complications to consider. Surgical complications occur infrequently. Although they are more likely in patients with compromised immune system, bleeding disorders or conditions that interfere with wound healing, the patient should be aware of them. The risks that are common to all type of surgeries are listed below: 

Infection

If this occurs, the implant might need to be removed temporarily (for about six weeks). In case the patient can experience pain or redness following the surgery, and if this is the case the surgeon should be notified immediately. However, sometimes prior to and after the operation, the patient is given antibiotics in order to prevent this complication.

Bleeding and Haematoma Formation

Some patients can lose blood after a breast augmentation and the drains may not drain all of the blood. The blood can accumulate in the pocket created for the implant. As a consequence, the breast may swell and become increasingly painful.

If this occurs the patient has to undergo another operation in order to have the haematoma removed and the bleeding stopped.

Capsular Contracture

It is a result of tightening of the scar tissue surrounding the breast implant. Even if its occurrence is not predictable, incidents of symptomatic capsular contracture can increase over time. If this becomes painful or causes a mis-shape in appearance of the breast, additional surgery to release the scar may be needed. The surgeon may suggest taking certain anti-inflammatory medicines that can soften the tightness. Massage and movement of the implants along with the use of compression straps may also help in these cases.

Altered Nipple Sensation

Some patients may experience loss of nipple sensitivity. On the other hand, a small minority of patients may develop nipple hypersensitivity.

Firmness and Discomfort

These problems usually result from asymmetrical or excessive contracture of the scar or capsule which forms around the implant itself. The scar capsule forms as a normal response to the implantation of foreign material. The shape of the breast can be distorted by excessive contracture.

The breast firmness can also be caused by Calcium deposits that may form in the scar tissue. They are usually detected by mammography and may need to be evacuated surgically.

Asymmetry

Since all paired organs are generally uneven, it is likely to stay that way after the surgery as well. If the unevenness is noticeable enough and may be annoying for the patient, a new operation is possible.

Questions

Before the operation, the patient would like to talk with the surgeon concerning the technique, risks, preparation, qualification, even insurance coverage and other issues.

We have summarized below some of the more specific questions related to breast augmentation surgery:

• Who qualifies for this kind of surgery?
• What are the risks of surgery?
• What should I expect after surgery?
• Will I be able to breast feed my baby?
• How much sensation will be left in my nipples after surgery?
• How long will it take for the swelling to go down after surgery?
• How long do I have to wear a special bra after breast augmentation?
• How is the size of the implant determined?
• How long will the implants last?
• Will I experience any pain?
• How long will it be before I can start normal activities?
• How much will the entire procedure cost?
• What is the implant made of?
• What holds the implants in place?
• What kind of incisions will be used and how will the scars look?