Breast Enlargement (Augmentation)
Breast augmentation is a cosmetic technique that aims to create full, soft and natural looking breasts. The ideal patient has small breasts or has lost breast tissue after pregnancy or breastfeeding.
There are many different anatomic features of small breasts that must be addressed prior to breast augmentation. These features include not only the size of the breast, but also the breasts’ asymmetry, the size and distribution of the breast tissue, the tightness of the skin, and the chest wall shape.
There are many techniques, types of implants, and positions of incisions to consider so that surgery does not only increase the size of your breasts, but also provides a very beautiful and natural shape. Your chosen specialist surgeon will give careful consideration all these anatomical considerations and together with you will create a plan.
Breast augmentation is not a one-size-fits-all operation. Most (but not all) patients requesting enlargement breast surgery wish to maintain a natural look. In order to achieve the best possible outcome, a number of factors have to be taken into account. These include patient height, width of chest and breast, amount of existing breast tissue and degree of droop of the breast.
In addition to these factors, there are many variations in the implants themselves and in potential positioning of the implants.
Implant Choice: High, Moderate or Low Profile, Round or Teardrop?
High profile implants can give a more frontal projection and, having a narrower base diameter, will tend to give a fuller figure. As such, they can be helpful in patients with a small amount of droop to the breast. For the wider chested patient, the moderate profile breast implant is still an excellent choice. Low profile implants work well in patients wanting a more minimal change.
The choice of round or tear drop implants is important. You may already have a personal preference but your surgeon will be able to advise in this area as well.
Scar Position and Placement Under or Over The Muscle?
There are several approaches through which breast implants can be placed, the most common are the peri-areolar (around the nipple) or the infra-mammary (under the breast) approach. The axillary (underarm) implant procedure is now less favoured as scars can be extremely visible. Your surgeon will have a preference which will be based upon a number of factors and these will be discussed in detail with you.
We know that your surgeon will employ a totally bespoke approach but for general guidance:
In patients with virtually no breast tissue, any size or type of breast implant can generally be used, but there are trade-offs. When there is little starting breast tissue, the larger the volume of implants used, the less natural the ultimate result. Breast tissue acts as camouflage on top of the implants to give a more natural result.
In patients with a relatively broad-based, moderate size breast to begin with, a small amount of droop allows the breast implants to fill out the skin envelope nicely. The existing breast tissue gives good camouflage and a very natural result. In these patients there is less need to impose shape and I will generally use round implants.
Patients with an intermediate amount of drooping of the breast require greatest consideration. In these cases particularly, the volume of the breast implants is important. If these patients go with larger breast implants, they will get more lift and probably not require a tightening procedure. However, this will should always be discussed.
Patients with a large amount of droop will generally require a tightening procedure. If the drooping is not addressed, the implant will make the breast look full but, eventually, the natural breast tissue will drape unaesthetically off the bottom of the breast implants. These patients require formal mastopexy at the time of their breast augmentation surgery.
Once you and your surgeon have agreed on the precise details of the surgical plan, they will outline a likely recovery, including time frame for return to normal activities including work, management of young children and exercise. As with all good medical practice, they will also discuss with you potential complications of breast augmentation.
Breast enlargement is performed under general anaesthesia and therefore you won’t be able to eat or drink for six hours before the operation.
You should expect detailed instructions to be provided by your hospital on exactly what you should and should not do before surgery. The procedure usually takes around 1-2 hours and an overnight stay is usual.
On the day of surgery you will be seen by your surgeon and your anaesthetist pre-operatively. They will discuss with you the procedure and reaffirm the surgical plan. Your anaesthetist will speak to you about previous anaesthetics and provide a plan for minimising the discomfort that you will feel after your operation.
After your breast augmentation surgery is complete you will awake gently in the recovery ward and you will be seen by your surgeon and anaesthetist to make sure that you are comfortable post operatively.
You will then return to your ward. Before discharge a plan will be made for you to be reviewed in the outpatient dept usually at a week.
The precise recovery plan as discussed with you pre-operatively and be confirmed by your surgical team and any modifications made. Most surgeons will allow you to return to work in one week and to begin some gentle physical exercise within the first week.
Of course, we don’t want you to put any strain on your new breasts and it is advised that you undertake a graduated return to normal activities, as guided by your surgeon.
As a general rule of thumb, however, following breast augmentation;
▪ You should be able to go home on the day or the day after your surgery
▪ You should be able to return to light work at one to two weeks
▪ You should be able to drive at one week
▪ You should be able to return to light exercise at two weeks but not building up to full exercise until 3 months
Frequently asked questions
You will be advised to bring with you a supportive bra. These should be non-underwired.
You should refrain from taking aspirin, non-steroidal painkillers (e.g. ibuprofen), or vitamin and herbal supplements, as these can increase the chance of bleeding.
Be sure to disclose everything you are currently taking, regardless of how menial.
Stop smoking and all other nicotine products several weeks prior to your procedure.
Choosing the correct implant size is important. Your surgeon will guide you but one of the best ways of choosing your implant size is to buy a sports bra of the size you want to be, preferably fitted professionally, and then perform the ‘rice test’.
The rice test involves measuring rice within a measuring jug. It is volume and not weight that is important. The rice is then placed within stocking feet and used to fill the bra.
Yes. Studies have shown no increased levels of silicone in breast milk in women who have had silicone implants.
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