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Breast Enlargement -
About the Operation
Indications for surgery
This procedure is obviously for patients wishing to increase the size/fullness of the breast and/or remove some minor droop. Patients tend to be those that either always had small breasts or those that have lost breast volume following children. For a small group of patients with very different sized breasts then it can be done on one side only.
Procedure in brief
The procedure involves the placement of an implant under the breast tissue. This can be placed directly below the breast (sub glandular placement) or under the chest wall muscle (sub-muscular placement). Access to place the implant can be through the arm pit (trans-axillary approach), nipple (trans-aereolar approach) or under the breast at the crease (infra-mammary approach). The advantages of these different options are discussed below.
Under the muscle or breast?
Placing the implant under the muscle gives more ‘padding’ over the implant and therefore can reduce the chances of feeling or seeing the implant edge. This is often preferable in very thin patients where the ribs are easily noticeable. Under the muscle also has a slightly lower capsule formation. It does require the partial division of the muscle, which is uncomfortable, and increases the risks of bleeding slightly. This division reduces the chance of muscle twitching over the implant but this can still be seen some times.
Implants placed directly under the breast fills any laxity slightly better. It can therefore give a slightly better ‘lift’. It is less painful to have done and frequently removes the need for a drain.
I will usually place an implant under the breast and reserve under the muscle if you are thin or express a specific wish.
Which approach?
The armpit incision avoids a scar on the breast. However, it does leave a scar in the armpit, which can be visible in some patients, and it is only good for sub-muscular placement. Under the breast crease (infra-mammary approach) is most frequently performed and can be used for all operations. The scar heals well and can be hidden in the crease. The nipple approach is useful if the nipple is larger and the breast small. Some concerns remain regarding higher infection risks.
Fat Injection techniques
This is a method of increasing fullness or volume by injecting the patients own fat. It is usually used in the breast or face for both cosmetic and reconstructive problems. The fat is removed by liposuction from the thigh or abdomen, specially prepared and re-injected into the area using small needles.
In the breast it has started to be used for breast augmentation and breast asymmetry (differing breast sizes). It is well established in treating defects or depressions following breast cancer removal.
The great advantage of the technique is the ability to permanently enhance these areas with the patients own fat. The disadvantage is the unpredictable survival of the fat. Usually about 50% of the injected fat survives and the treatment may need repeating. There are virtually no scars and depending upon the area to be treated it is performed as a day-case under local or general anaesthetic.
Scars
The scars will depend on the technique used (as above). They tend to be quite pink in the first 6 weeks moving to purple over next 3 months and then fade to white. Most patients will form very good quality scars over time. Some reach this quickly, others take longer or may form raised or stretched scars. How other wounds have healed may be an indication.
Medicines and smoking
All medical history will be sought before any surgery. Do not take herbal medicines prior to surgery or for 3 days following (arnica etc). Also avoid aspirin, ibuprofen, and voltarol-based tablets. It is always better if you do not smoke. If you are a smoker try and stop for 6 weeks before and five days after surgery as it can reduce the chances of complications
