Breast Enlargement

Breast augmentation or augmentation mammaplasty is a surgical procedure performed to enhance the size and/or shape of a person’s breasts through the placement of breast implants. It is the most popular cosmetic surgical procedure in the United Kingdom.

Breast augmentation surgery is most commonly performed under a general anaesthetic and the procedure takes one to two hours in total to perform. An overnight stay is usually recommended.

Breast implants can be inserted in a number of ways and the approach used will depend upon the type and size of implant chosen, your body shape and your preference. A cut (incision) can be made in the crease underneath the breast (called an inframammary incision), or in the armpit (a transaxillary incision) or around the lower edge of the nipple (the periareolar incision), although this particular approach is not favoured by Mr Henley. A fourth technique involves using an endoscope (like a small telescope) to insert inflatable implants through a small incision in the tummy button (the umbilical incision). This method is highly controversial and is not a technique used by Mr Henley either.

Breast implants are pushed through the incisions and positioned either in front of (sublandular) or behind (submuscular) the chest muscles. Once the implant has been adjusted to the right position, the incisions are closed with stitches.

Myths about Silicone Implants

There is good evidence that silicone implants DO NOT cause breast cancer. Scientific studies have consistently shown that there is no increased risk of developing breast cancer for women who have breast implants. Similarly, there has been no independently reviewed research that demonstrates a clear link between silicone implants and autoimmune diseases such as rheumatoid arthritis. However, the presence of implants does make breast health screenings, such as mammography, a little more difficult. If you are having a mammogram or other diagnostic test to the breast, it is important to let X-ray staff know that you have implants in place. X-Ray staff can then make sure that the most appropriate method of screening is used.

The Medicines and Healthcare Products Regulatory Agency (MHRA), an agency of the Department of Health, provides detailed information about breast implants www.mhra.gov.uk. The MHRA have also produced a booklet “Breast Implants": Information for women considering breast implants which was revised and reissued in November 2006 (also available on their website).

Implant Choice

You may have already read that breast implants come in a variety of types and sizes. During consultation, Mr Henley will discuss in detail the look you wish to create; “Some people are looking for natural results - a subtle enhancement - whilst others are looking for “big” rather than “balance”. Finding the right size implant involves taking into consideration not only final size, but also your physical build, the width of the chest wall, skin texture, the amount of natural breast tissue you have already and your overall figure”.

All implants are made of an outer casing of silicone, but may be filled with either a silicone gel or salt solution called saline.

Some are round and some are more of a teardrop shape. The round ones are used when the breast already has shape, but you are looking for an increase in size or volume. The shaped implants are good for people who are flat chested, wanting to add both shape and volume to their breasts.

Implant sizes are measured in cubic centimetres or (cc) and most implant sizes range from 200 to 350 cc with a range of 150 to 750cc. A person with a large frame or build will need to have a larger size implant (in cubic centimetres) in order to achieve the same cup size as a person with a smaller frame. Implants need to be sized in proportion to your build. Different sized implants can be implanted if one breast is larger than the other.

After listening to your reasons for surgery and the look you want to create, Mr Henley will be able to advise you on what surgery may have to offer and then you can make an informed choice regarding the size, shape and type of implant to be used.

Choosing your Size

How big to go is not an easy decision and certainly one that should not be rushed. Mr Henley will provide you with inserts to use in order that you can identify the most appropriate size of augmentation. In Mr Henley’s practice, this sizing process has resulted in a 99% satisfaction rate with the increase in size of the breasts.

Risks and Side Effects of Surgery

In the hands of a skilled surgeon, complications are infrequent and usually minor. However, as with any operation, there are risks associated with surgery and specific complications associated with this procedure.

The greatest risk with this sort of operation is that the breast will feel harder than normal, a complication known as capsular contracture. This may develop in the first year or two after surgery. Regardless of the implant selected, the body will naturally form scar tissue around the implant. If this scar tissue shrinks or contracts, it can cause anything from a mild firmness to extreme hardening that can cause a visible deformity of the breast. This may develop in the first year or two after surgery and occurs in around one in 10 women. The risk is much less likely with the textured implants in current use rather than the smooth implants which used to be inserted. However, further surgery may be required to remove and replace the implant.

Many women complain about changes in nipple sensation. There can be a reduction or loss of sensation in the nipples. This may take up to six months to settle and very occasionally, can be permanent. An unpleasant oversensitivity can also occur, particularly when clothing rubs against them, and this takes a similar period of time to settle.

Scars result from any incision but breast augmentation incisions are usually well hidden in the breast crease or the armpit. However, there is a small risk that the scars may become red, raised and lumpy and this complication can take a long time to improve.

Implants can rotate or shift position after surgery and they can also weaken and rupture. Implant rippling or wrinkling can also occur.

Other risks include bleeding, delayed healing, wound infection, chest infection and blood clots in the leg known as a deep vein thrombosis, although all these risks are uncommon.

It is important to be aware that no implants should be viewed as life time devices and they may need to be replaced at some point, possibly in the next 15 – 20 years or sooner. The good news is that most surgeons would say that as long as there is no clinical concern or symptoms, there is no need for further surgery to replace implants. However, you will need to consider whether you are prepared to commit to the possibility of surgery in the future and its associated expense.

Recovery

You may feel that your breasts look really odd after surgery. Mr Henley advises

“It takes a good eight weeks for the implants to settle into their final position and up to six months for all the swelling to subside. For this reason, you should not rush to have surgery just before going on holiday or getting married.”

He continues

“Another strange thing you may experience is a gurgling sound coming from your breast and this is caused by fluid and air bubbles forming within the implant pocket whilst the implant settles down. These sounds will stop within the first few weeks as the air gets absorbed into the body. Don’t be alarmed if this happens; it does not mean that your implant is leaking.”

You will probably experience swelling and soreness for a few days after the operation, but you should not feel any severe pain. At the end of the operation, minimal dressings will be applied and your sports bra fitted. You will normally go home the day after surgery and should rest for one week. It is important that you undertake no strenuous activity at all, allowing the body the time it needs to heal. However, you still need to get up and move around every hour or so to avoid post-operative complications. Refrain from driving for the first week as well. Your dressing will be removed about a week after surgery. Mr Henley uses internal stitches and glue to close the wound so there are no stitches to take out. Apart form bathing, you should continue to wear a sports bra to give your breasts the necessary support for four to six weeks.

Depending on your occupation, you are likely to be back at work in about 10 to 14 days. After approximately four weeks you can start to increase your activities, so that by six weeks post-surgery, you have resumed your full normal physical activities. From this point onwards, you may use whatever bra you wish. Mr Henley will check that everything has settled at one year following the operation.

Over time, post-surgical swelling will decrease and incision lines will fade. The effects of your surgery should be long lasting, although future pregnancies, aging, gravity and weight gain or loss will alter breast shape.

You should be careful about having nipple piercing following this operation. There is a possible risk that bacteria can enter through the break in the skin at the nipple, causing an infection. This can spread backwards from the the piercing to the breast tissue and implants. Apart from any pain or discomfort caused by an infection, there is a possibility that your implants may need to be removed

Fat Transfer

This is a new technique which is in its infancy in the U.K. It has become very popular for filling in small dents and refining breast appearance. A further technique has recently been developed for its use in other breast surgeries, such as breast reconstruction and for small to moderate breast enlargement. It involves liposuction to harvest fat from an unwanted area and transferring it into the breasts. This can be combined with a suction enlargement device (Brava® Bra) or undertaken in isolation. The evidence to date suggests that the Brava Bra may enable a better take of the fat graft and that transfer on its own may require two or more procedures to achieve the desired increase in size. However there are no implants to worry about and any long term change in size is related to changes in weight of the person as a whole. At the present time it is probably best to think of the procedure as liposuction with the added benefit of some breast augmentation.

Breast augmentation before and after surgery

The following photographs illustrate four different types of a breast enlargement procedure.

Patient A - Small Subglandular Implants

This patient started with a minimal amount of natural breast tissue. However, it was really important to her that any enhancement looked completely natural. She said "I don’t want to look like I’ve had a boob job." The implants were inserted in front of the breast (pectoral) muscle - in the subglandular position.

Before surgery	Six weeks after surgery	10 months after surgery

Before surgery	Six weeks after surgery	10 months after surgery

At one week post op At one week, you can see that the implants are high up in the chest. It is not unusual for patients to become anxious at this point, believing that the implants inserted are oversized. However, it takes time for the implants to settle down into their final position.	Scars at six weeks The scars here show that the implant was inserted through the inframammary crease. This is the most widely used incision.	Scars at ten months At ten months, the scars have faded to an almost invisible line.

Patient B - Large Subglandular Implants

It is important to spend time at the pre-operative stage “test driving” the size you want to be. Choosing how big to go is not an easy decision. This patient wanted a much curvier look than the previous patient. This lady's implants were also inserted in front of (subglandular) the breast muscle.

Before surgery	Seven weeks after surgery	One year after surgery

Before surgery	Seven weeks after surgery	One year after surgery

Before surgery	Seven weeks after surgery	One year after surgery

Patient C - Submuscular Implants

This patient's implants were inserted behind the breast muscle - in the submuscular postion. She was very slim and wanted a larger augmentation which did not show the implants. She accepted the risk of movement with tightening of her chest muscles

Before surgery	Six weeks after surgery	Eleven months after surgery

Before surgery	Six weeks after surgery	Eleven months after surgery

 

These views show how the breasts become distorted when this lady tightens her chest muscles.

Muscles relaxed Six weeks after surgery	Muscles tightened

Muscles relaxed Eleven months after surgery	Muscles tightened

Patient D - Fat Transfer (No Implants)

This lady wanted a small to medium enlargement but did not want breast implants. The fat used to increase this lady's breast size was removed from her thigh area. The patient was delighted with her new shape - both top and bottom.

Before surgery Fat Transfer	11 months after surgery

Before surgery - Fat Transfer	11 months after surgery

Before surgery - Fat Transfer	11 months after surgery

Before surgery - Fat Transfer	11 months after surgery

Mr Henley would like to thank these patients for allowing their photographs to be displayed for the benefit of others who may be considering cosmetic surgery.

The information provided is intended to give a brief outline of the procedure. It is not a substitute for a personal consultation with a surgeon.