BREAST AUGMENTATION, also known as an augmentation mammaplasty or breast enlargement, is a surgical procedure to enhance the size and shape of the breasts. This is one of the most commonly requested procedures with an extremely high overall satisfaction rate.
Refinements in surgical and anaesthetic techniques along with major advances in breast implant technology have and will continue to impact favorably on the safety and reliability of the procedure.
Reasons why patients request breast augmentations:
Enlarging the breasts to make the body more proportional
- You consider your breasts too small or under-developed
- You believe your figure would be better proportioned, particularly with respect to your hip size.
- You are limited with clothing choices and / or find it difficult to buy underwear or swimwear
Reshaping and enlarging breasts that have lost their shape
- After pregnancy or breast-feeding
- Associated with ageing or weight loss
- Balancing breasts that differ in size or shape
- Failure of development / tuberous breasts
Besides the positive aesthetic outcome following a breast augmentation I find that my patients enjoy substantial psychological benefits, including enhanced self-esteem.
The ultimate goal of the consultation is to evaluate and convey what is surgically feasible and to reach common ground as to the final aesthetic outcome.
It is important to understand that everybody starts with differing anatomical breasts and some degree of asymmetry – this may influence the final outcome. If you are older than 40 or if you have a family history of breast cancer a pre- operative mammogram is essential. Pre-operative photographs are taken routinely.
DURATION OF SURGERY
Between 1 and 2 hours
The procedure is usually performed under deep intravenous sedation with local anaesthesia. This ensures complete comfort without awareness during the procedure, rapid recovery and good post-operative analgesia. Alternatively general anaesthesia may be employed.
I generally use textured silicone gel implants. Please read the FAQ’s regarding ‘silicone’ below.
From the late 80’s, 3rd generation implants became available characterized by significant technological advances greatly improving in their safety profile.
Breast implants come in a variety of sizes, shapes and forms.
Common to all implants is an outer shell made of silicone and a filling, usually saline (salt water) or silicone gel (‘gummy bears’). In South Africa most augmentations are performed using gel implants for their superior, natural feel.
Implant shapes are either round or anatomical (teardrop). Round implants are used almost exclusively in South Africa. It is interesting to note that in Western Europe the majority of breast augmentations are now performed using anatomic shaped implants. Anatomic shaped implants were created in an attempt to achieve a more natural appearance, particularly the avoidance of the unnatural, rounded upper pole to the breast (i.e. fuller in the lower half and flatter in the upper half.) To date there is controversy amongst plastic surgeons as to the potential benefits and indications for the use of anatomic shaped implants.
In this respect, patients requesting a ‘natural look’, will benefit using these implants – albeit at a slightly higher price!
Breast implants also come in a variety of sizes. The width of the base of the implant, its projection and volume can be selected to create the optimal implant to suit your individual proportions and requirements.
During a breast augmentation, implants are inserted through an incision - usually made in or just above the breast crease, around the areola (pigmented skin surrounding the nipple) or in the armpit and placed into a ‘pocket’ created either below the breast tissue or below the chest muscle (pectoralis major) to add volume and enhance shape. In general I would consider the inframammary incision suitable for most breast augmentations.
Where the areola diameter is sufficiently large or where an areolar reduction may enhance the breast proportions this may be a suitable alternative. The ‘pocket’ position is largely determined by the adequacy of skin cover (thickness/laxity) in the region of the anticipated margins of the new breast implant. In thin patients I would generally use the sub-muscle plane. For all other cases a subglandular or subfascial plane is used.
To reduce the likelihood of infection, antibiotics are given intravenously during the operation, shields are applied over the nipples to prevent bacteria in the nipple ducts contaminating the wound and the implants and cavity soaked in antibiotics prior to placement.
Every woman’s recovery is different.
For the first 24 to 72 hours after your procedure you will experience the most discomfort. Your breasts will be swollen and very tender. The swelling takes 3-4 weeks to settle. It is crucial that you do not over exert yourself within this early recovery period as this may encourage bleeding or exacerbate swelling.
A sports bra is worn immediately post operatively as this improves comfort and is designedto provide you with extra support while you heal.
No under wire bras are to be worn for the 1st 6 weeks.
You will be required to sleep on your back for up to 1 week after surgery. As this is often very uncomfortable, sleeping tablets are prescribed for the first few nights along with regular pain medication.
A detailed scar management protocol is provided to optimize healing and promote inconspicuous scars. Remember however that the process of scar maturation may take upto 2 years.
Patients can usually return to work within a week to 10 days. Strenuous activities may be recommenced between a month and 6 weeks.
CONSEQUENCES AND COMPLICATIONS
Every surgical procedure carries risks. Potential complications to any operation includereaction to anesthesia, bleeding, infection and poor healing. Breasts may not be perfectly symmetrical or nipple height may vary slightly. This will often mirror the pre-operative, un-operated dissimilarities – the natural breasts usually show some variation.
Rarely, permanent loss of sensation in the nipples or areas of breast skin may occur. Incision lines, which will heal and fade over time, will be permanently visible, although located in easily concealed areas by clothing. Occasional poor healing of incisions maylead to necessary scar revision surgery.
Gravity and the effects of aging will eventually alter the size and shape of every woman's breast, in which case the patient may choose to undergo a second breast lift procedure.