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Breast Augmentation (implants) Breast Surgery: Dr. Peers has the experience of several thousand breast operations and is familiar with all of the commonly used techniques and implant types. As every individual is different the choice of procedure depends on body type, patient goals and which operation is most likely to give the desired result. Breast Augmentation: Breast augmentation includes a variety of techniques to increase the size and fill in the shape of the breast. All of the commonly used techniques rely on a synthetic implant to give fullness and volume to the breast. All currently used implants have a silicone shell. This shell can be filled with saline (the salt and water solution used in intravenous solutions at the hospital) or with silicone gel (newer silicone gel implants have a "cohesive" gel which retains its shape and is not liquid. Since it is not liquid it is less likely to flow out if an implant shell breaks). Implants can be placed behind the pectoral muscle which is best for thin patients with very little breast tissue and skin which has not been over stretched by pregnancy. If the breast has some skin looseness and a reasonable layer of breast tissue then the implant can be placed in front of the muscle but behind the actual breast tissue. This way the implant can better follow the patients normal breast contour. There are three incisions approved by the implant manufacturers. The axillary incision is hidden in the armpit and is done using an endoscope and a saline inflated implant placed under the muscle. The periareolar incision is placed along the lower edge of the areola and in 90% of patients produces a scar that is difficult to see. Any implant can be used and implants are easily placed in front of or behind the pectoral muscle. The sub mammary incision is in the fold under the breast and can be used with any implant or implant position, but it does leave an exposed scar under the breast which can be noticeable.
How is it done? The operation is usually done under a general anaesthetic (implants placed in front of the muscle can also be done under local anaesthetic) in the private operating suite. This is a daycare procedure that takes 1 to 1-1/2 hours ( you are at the facility for 3 to 4 hours total). There may be drains for the first 1 to 2 days to prevent fluid collection around the implant. Patient discomfort varies, but is usually quite noticeable for 48 hours and then subsides. Some tenderness may persist for up to a month. Subpectoral muscle placement is more uncomfortable than sub mammary. Regular day to day activities can be resumed within a few days. Vigorous exercise or heavy lifting are to be avoided for one month. What are the potential risks? The most common problems with breast implants relate to the fact that they are not a natural body tissue. The body's natural response to any prosthesis is to surround it with a layer of scar tissue. This also happens with breast implants and is called a capsule. This is usually a good thing as it helps to hold the implant in place. If, however, it thickens and tightens it forms a capsular contracture which makes the breast feel firmer than normal, gives the implant a round or folded shape, and may cause discomfort. If this is severe enough it may require a re-operation. Over time implants can leak. This is more likely with saline implants and can happen slowly or very quickly. The saline used is regular intravenous solution which is absorbed by the body without any side effects. A leaking implant cannot be repaired and must be replaced - which requires a re-operation. Implants cause shadows on mammograms which can make breast tumours harder to see. The technologist doing the mammogram can partially compensate for this. Calcium deposits can form around any implant. These are not harmful, but can contribute to hardness and can show up on mammograms. Infections can happen as with any surgery. They are not common and can usually be treated with common antibiotics. If the infection does not respond to antibiotics it may be necessary to remove the implant (which can usually be replaced later). Blood collections may develop early post operatively. If they are large enough they may require removal. Delayed wound healing may happen in small breasts with larger augmentations. This is best prevented by not attempting to make the breasts too large. If it does happen touch up surgery is necessary. Some changes in nipple sensation are noted by about 10% of patients. In some this can be permanent. Implants can shift out of position. This is more likely with the sub pectoral operation. If this happens it can give an unnatural shape to the breast and may require a re-operation.  Before  After  Before  After  Before (left), After (right) |
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