Who is breast augmentation suitable for?
Even though it is now a very advanced operation, modifying the size and volume of your breasts is a serious procedure. For this reason, women considering this surgery should carefully consider all the risks accompanied with it. The decision to undergo the procedure should be unequivocal, based on the woman’s own desired appearance for her breasts. A patient should come to her decision free of external influences.
Good physical health is also required since this is a relatively extensive surgery. In addition, preoperative consultation and examinations are essential for success of the procedure. The optimum age limit for plastic surgery of the breasts cannot be accurately stated and depends on when the development of mammary glands ends, which is usually not earlier than 16 years of age.
At the same time, it is certainly better to insert implants into the breasts where it is assumed that they will no longer change as a result breastfeeding. However, surgery before pregnancy is not necessarily ruled out, though it is necessary to anticipate that the size and condition of the breasts will change because of lactation and pregnancy. Moreover, re-operation is likely to be necessary. A woman should not undergo breast enlargement at least one year after giving birth.
Breast implants themselves have no effect on the foetus and pose no risk to the development of the baby. The presence of implants does not prevent a woman’s ability to breastfeed, and worldwide medical studies have not shown elevated silicone content in breast milk. Almost every physically mature and healthy woman considering breast augmentation is a theoretically suitable candidate for the procedure, providing she has realistic expectations.
Problems that breast augmentation can solve:
- Dissatisfaction with breast size
- Dissatisfaction with breast shape and volume
- Changes in shape and firmness of breasts as a consequence of breastfeeding
- Reduction in the shape and firmness of breast as a result of weight reduction
- Significantly different sizes (breast asymmetry)
How to choose an implant?
Several types of implants are currently available. They differ in shape, type of filler material and finish, each of which has an impact on the appearance of cleavage after surgery. A doctor should always assist you with the correct implant selection during preoperative consultation.
What types of breast implants exist?
The implants are grouped by filler material, namely implants filled with soft gel or with saline solution. (The latter are most commonly used in the USA.) In our experience, the most commonly requested implants are the ones filled with silicone gel solution. The silicone gel is very close in consistency to the tissue found inside breasts, so it closely simulates the movement, palpation and behaviour of the breast. So-called cohesive silicone, a silicone gel, is used. The main advantage is this silicone’s cohesion in the implant, for example, during ruptures, or dual cohesive silicone gel, where the use of two gels of different densities ensures constant height of the areola projection and precise imitation of the breast structure. Liquid silicone is currently not used for breast implants any more.
In addition, the implants’ shapes differ in terms of anatomical form, roundness and asymmetry when the choice of shape is mainly dependent on the desired result of the operation. The advantage of using anatomically shaped implants is that they very closely copy the shape and slope of the breast, resulting in a very natural looking cleavage. Sometimes, however, a circular implant is more suitable for the required outcome of the patient. Thanks to its form, it supports the full and firm shape of the lifted breasts. However, it is not recommended for a significant size increase or where there is a deficiency in the breast’s fatty tissue because the border between the implant and the natural breast tissue can be considerably more visible. Finally, asymmetric implants can help with differences in breast size and are always placed under the mammary glands.
The surface of the implants may also be different. For practical purposes, we categorise the types of implants into smooth, textured and micro-textured. Currently, however, the exclusive use of textured implants is recommended, and smooth implants are not currently used any more. Due to the roughened surface, the textured implants fit better into the breast tissue and show a lower risk of post-operative complications. The surface only has a minimal effect on the visual result of the operation.
Placement of implants and incisions
The subsequent placement of implants and performance of incisions deserve their own section. Implants are placed under the mammary gland, under the breast muscle or partially under the muscle. Both methods of breast augmentation (under the muscle or under the mammary gland) bring advantages and disadvantages. The choice depends on the condition and size of the gland, the condition and elasticity of the skin, and the muscle strength. The implant must be sufficiently covered. If it is not, the implant is visible and is not aesthetically appealing.
The incision through which the implant is inserted by the surgeon may be performed in several ways. Mostly, it is made below the breast line, areola or underarm or in the region of the navel. (However, the umbilical approach is not used in our part of the world.)
The choice of which implant is best depends on both the patient's ideas of the outcome of surgery as well as the agreement with the plastic surgeon and the real possibilities and the patient’s build. That is why preoperative consultations and examinations are extremely important. The surgeon uses these opportunities to explain not only the course of the surgery but also post-operative care and answers questions about your individual case.
Breast augmentation procedure
Breast augmentation is usually performed under general anaesthesia. The breast surgery itself takes about 2 hours. After surgery, the suitable length of hospitalisation is 1 day. (The length is determined by physician.) Before and after surgery, most patients are prescribed antibiotics as a precautionary measure because the surgery involves the placement of foreign bodies into the patient. Therefore, any possible infection must be prevented. The length, time and route of administration of antibiotics depend on the surgeon.
The method of insertion and placement of the implant depends on the patient's anatomical disposition and the surgeon's recommendations. The insertion is performed through a 3-4cm long incision, either along the line where the breast meets the chest, or through the nipple areola or in the armpit. Each cut is done with care so that the resulting scar is as inconspicuous as possible. Preparation of the tissue involves the creation of a pocket, into which the implant is inserted.
The implant is inserted directly into the breast pocket under the breast tissue or under the muscles of the chest wall. It is important that the correct implant size is carefully selected. Implants must be fully covered with breast tissue. Otherwise, the edges of the implant might be easily visible, and the result may look unnatural.
For a few days after surgery, drains may be used, though mostly during hospital care only. Various sutures, mostly intra-dermal or single-suture, are used to close the wound, which are removed 7 to 10 days after surgery.
After surgery, the breasts are fixed in place with a special elastic bra, which the patient is recommended to use for 4 to 8 weeks. For the month after cosmetic breast surgery, the patient is recommended to sleep on her back and limit strenuous and sporting activities.
After surgery, patients experience pain and pressure in the chest, which is even more considerable when the implant is placed under the muscle. Approximately five days after surgery, the patient usually takes painkillers (analgesics), until the pain gradually stops. After insertion of the implants, the breasts are tightly bound in a bandage. After surgery, the patient wears an elastic bra, usually for 4 to 8 weeks. The specific period is to be determined by the surgeon.
In addition to a short period of hospitalisation, it is recommended during the first week after breast surgery to follow a rest regimen, predominantly in the lying position. For the first few days, it is therefore beneficial to make provisions for household assistance and also, if required, help with any children. It is possible to continue in daily activities and do light household chores within 10-14 days after surgery.
Demanding work, lifting loads, exercise, fitness training and other sports activities are allowed gradually after about two months following breast surgery. But an elastic bra must be worn for support. Intimate contact should be made very carefully during the first month after surgery. Return to physically undemanding work is thus possible in about 14 days. After 3 months, the augmentation result is considered to be permanent. Check-ups by the plastic surgeon should be done after 4 and 12 weeks and then one year after surgery.
During each surgical procedure, post-operative complications may emerge, although they occur only in a small percentage of cases. The most common are the complications related to healing and infection of the surgical wound and the area of the implant. Another surgical complication may be bleeding. For this reason, it is important to conduct a laboratory blood clotting test prior to surgery and to strictly abide by the rest regimen after surgery. Patients may also experience pain in the forearm and hand after surgery. It is a consequence of elongation of the nerves passing from the underarm to the upper limbs. However, these difficulties are temporary and disappear within a few days or weeks.
Medical studies from leading world-class clinics have confirmed that breast implants and augmentation have no demonstrable effect on the incidence of breast cancer in women. On the contrary, it has happened several times that, thanks to the check-ups to which the women regularly undergo after surgery it was possible to detect this disease at its early stage.
Every quality implant used in our clinic has passed a stress test conducted by its manufacturer. In the first phase of the stress tests, the implant is stretched to 700% of the original size. To pass this test every implant must withstand this tension without any damage. As a quality test, a car accident simulation is used when a weight of 4.5kg is released in free fall against the implant. For further safety checks, the implant is exposed to a static pressure of 600 kilograms. Only an implant which resists such checks is suitable for insertion into a human body.