Breast augmentation surgery is one of the most popular cosmetic surgeries in America with more than three hundred thousand procedures performed in 2011. It is a major surgery requiring a qualified and experienced surgical team backed by good infrastructural facilities.

Breast augmentation may be done using implants or injecting one’s own harvested fat from other body areas using liposuction procedure. In majority cases, however, implants are used to augment breasts.

There are several aspects of breast augmentation that may be of interest to the potential candidates for the procedure and some of them are given below:

Implants – There are three types of breast implants which are used in breast augmentation –

  • Saline implants with elastomer silicone shell filled with sterile saline solution were the most widely used implant in the 1990s and early 2000s before silicone implants were approved for use by FDA and were freely available in the market. The saline implants may be pre-filled or post filled with saline solutions. In the post filled option, the incision to put in the empty shell is much smaller compared to the pre filled option. Present day shells are made of stronger materials preventing shell failures which were common during earlier days.
  • Silicone implants with elastomer silicone shell filled with silicone gel are the most used implant at present. Over the years the silicone implants went through many stages of improvement and the latest generation products have stronger shells and denser filler gels thereby minimising the likelihood of shell rupture, filler leakage and filler migration after an unlikely event of shell rupture.
  • Alternative composition implants with fillers such as soy oil and others are not very common for use in America.

Surgical techniques

1)    Anaesthesia is administered to keep the patient painless and in comfort. There are options of intravenous sedation with local anaesthesia and general anaesthesia. A special procedure called Awake Breast Aug belongs to the former option.

2)     Incisions to put in the implants are made in locations where the resultant scars, if any, will be least visible.

i)      Inframammary incision – This is made in the natural infra-mammary fold, at the lower junction of the breast and the chest wall. This incision being close to the merging line of breast tissue and chest muscle allows better placement of the implant even though it may leave a slightly more visible scar.

ii)    Transaxillary incision – This is made in the armpit and from there a dissection tunnel to the mid-section allows the implant to be in place. This may be done with endoscope or bluntly i.e without endoscope’s visual facility. Though it does not produce any visible scar in the breast, it could lead to slight asymmetry of the implant positions.

iii)   Periareolar incision- This is made along the bottom half of the circular periphery of the areola. This incision may not be sufficient enough for placing silicone gel implants, though the scar may be less visible than Inframammary incision due to the light pigment of the areola.

iv)   Transumbilical incision – This is made at the navel and from there a dissection tunnel upward to the breast allows the implant to be in place. It is performed bluntly i.e without endoscope’s visual facility but is not a common technique. This technique is not used for silicone gel implants which are not compressible enough for insertion through small incisions.

3)     Placing the implant  in any of the two ways

i)     Sub-muscular placement that is under the pectoral muscle.

ii)    Sub-mammary or sub-glandular placement that is behind the breast tissue but over the pectoral muscle.

4)      Closing the incision with sutures in the breast tissues and sutures or surgical tapes in the skin.

Recovery

The incision scars develop in about 6 weeks after surgery and start fading away after a few months. There could be some pain and discomfort after surgery for a few days particularly in case of sub-muscular implant placement. The patient is advised against strenuous physical activities for about six weeks, though she is encouraged to do regular gentle exercise of her arms by flexing and moving during this period. This reduces pain and helps healing process. The improved implantation techniques in recent times have led to faster recovery time and in most cases, allow the patients to resume their normal lives after 24 hours of the procedure, without bandages, fluid drains, medical bra.

Risks

There are risks in breast augmentation surgeries similar to any other surgery such as adverse reaction to anaesthesia, post surgery bleeding, fluid accumulation and wound infection. Specifically it may cause some breast pain, new sensation in the breasts, swelling in the surgery locations, but these go away within a short time.

One of the outcomes of breast augmentation could be capsular contracture which occurs when the normal scar tissue turns into hard fibrous capsule around the implant. This may induce contraction in the implant leading to hardening and deformation of breasts. The incidence of capsular contracture has come down sharply with the improved implant technologies and may further be avoided with gentle massaging of breast under medical advice. In some cases the capsular contracture may have to be treated with further surgery.

Post surgery monitoring

According to statistics, 20% of the patients receiving cosmetic implants required explantation (removal) at ten year mark. After the breast augmentation surgeries, the patients need to go for follow up visits as advised by the surgeons to check on the implants and the breast health.