Breast Enlargement (Augmentation)

Breast Augmentation

Breast Enlargement (Augmentation)

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This fact sheet is for women who are considering having breast augmentation (enlargement). This type of surgery can also be used after mastectomy to reproduce the look of an original breast when a woman is dressed in normal clothes.

A breast enlargement operation usually involves placing an artificial implant either under your breast tissue, or under your chest muscle behind your breast.

Why have breast augmentation?

The reasons women may choose to enlarge their breasts include:

• feeling that your breasts are too small
• loss of breast volume after pregnancy (although enlargement will not lift them)
• a difference in size between your two breasts
• reduced breast size after losing weight

Age limit for surgery varies. Normally, it is done after the development of the mammary glands is completed, e.g. not before the age of eighteen. It is recommended that breast augmentation should only be performed if the woman does not plan to conceive; pregnancy and breast-feeding result in changes of volume of this body part, therefore producing a negative effect on the results of the surgery.

Implants

The breast implant is made of an outer layer of firm, elastic silicone, but may be filled with silicone gel or salt water (saline). Your surgeon will discuss the various options with you. Enlarging the breasts requires the insertion of implants. An incision (cut) is made around the nipple, or under the breast or armpit. The implant is pushed through and positioned either behind or in front of the chest muscles (pectorals). There will be bruising and swelling for a few weeks. Approved silicone implants are considered safe.

There have been various concerns raised about the use of silicone breast implants in recent years. For some time their use in Australia was restricted. Some of the health concerns regarding breast implants included the suspicions that silicone may cause, or contribute to, certain diseases.

                     
        Anatomically shaped breast implant                    Rounded breast implant

Diagrams showing placement of an implant in front of the pectoral muscle (A) and behind the muscle (B).

Can the implant leak?

Statistics show that Breast implants can leak in around 10 percent of women, this usually begins six or more months following surgery. Quite often the implant has to be removed.

The implant can either leak slowly through the coating, or suddenly if the implant breaks open. This can lead to pain and an abnormally hard feel to the implant in the breast.
The body naturally forms a fibrous capsule around the implant, which helps to contain the contents of the implant. The newer designs of breast implants have features to reduce the likelihood of the implant leaking or breaking.

There have been concerns that leaking breast implants may be linked to serious health problems such as cancer but there is no conclusive evidence to support this.

Can I breastfeed with implants?

For the vast majority of women who have breast augmentation, breastfeeding is no more difficult with implants than without.  In fact, some women who have breastfed before and after they had implants put in say that breastfeeding with implants is easier!   

However, it is a good idea to think ahead to the possibility of breastfeeding if you are a woman who has not started a family or may have another child. In previous years, women who received implants were usually older, married, and had already finished having children. Now, younger women, single women, and women who have not finished or even begun childbearing are having breast augmentation surgery.

Will the implant affect mammography?

There is no evidence that women with breast implants are at increased risk of breast cancer. It is important that all women including those with breast implants participate in a routine programme of breast cancer detection, including both breast self examination and (for women over 50) mammography.

Mammography is a special X-ray examination of breast tissue used in the early detection of breast cancer. The NHS Breast Screening Programme provides free screening every three years for women, in the UK, aged 50 and above.

The presence of silicone gel filled breast implants may interfere with standard mammography as silicone is radiopaque, and the physical presence of the implant may obscure part of the breast tissue and distort breast structure. The amount of interference varies depending on a variety of factors including the position of the implant. However studies indicate that breast cancer in women with breast implants is not diagnosed at a later stage compared with women without implants. If undergoing a mammogram it is important that you inform the hospital you have implants, you will then undergo a specific x-ray designed for implants.

How long will the implant last?

The average life of a breast implant is for at least 10 years. Eventually some of the advantages of the enlargement surgery will be lost and you may need further surgery.

What happens before a breast enlargement operation?

It is important to discuss with your surgeon what you are hoping to achieve from the surgery and the result you want is realistic.

You will see your surgeon for a consultation to decide the exact nature of your breast augmentation procedure, and to educate yourself on exactly what will happen.

The surgeon will tell you when your surgery will take place and how long it is likely to take. A couple of hours are normally about right for the length of the operation, which may be done either under local anaesthetic while you are awake, or under a general anaesthetic.
Your surgeon should also tell you what to expect afterwards, and how long healing will take to be completed.

Pre-operative Instructions

 After a consultation with your plastic surgeon and arranging for the operation date, you shall undergo al pre-operation examination. If, after the first consultation, there are any concerns about the surgery, another consultation can be arranged.

One month before the operation, do not use any medications containing acetylsalicylic acid (Aspirin etc.). It can increase bleeding during and after the surgery.

It is assumed that no acute illnesses occurred in the period of at least three weeks before the planned operation (viral illness, cold, etc.). Report any and all illnesses to the hospital/clinic.

Drink two to three liters of mineral water daily three days before the operation, however, 6 hours before the operation do not drink, eat, or smoke.

Have a good night’s sleep the night before the operation; you should be well rested before the operation. No alcohol may be consumed the night before the operation.

Wash your hair the day before the operation and do not put any facial cream, milk or make-up on the day of the operation. Any jewelry, including earrings, should not be worn.

We recommend for you to be accompanied by a close person in the time of your stay in Prague, at the clinic and in your hotel/suite. Immediately after the operation, you must not drive any vehicle by yourself.

What should I expect in hospital/The operation?

There are different ways of carrying out a breast implant operation. The incision may be made in the armpit, around the aureole (nipple), or beneath the breast.

The disadvantage of cutting through the armpit is that it can be difficult to stop any internal bleeding if the implant has to be removed later. The lymph glands are also in this area and can cause complications.

The advantage of cutting beneath the breast is that it gives good access. Some surgeons cut a little higher than the crease beneath the breast so that the scar line does not show when you are lying on your back. The implant is placed either in front of the chest muscle or behind it. Some surgeons prefer to place the implant in front of the muscle especially when working with breasts that have become empty bags of skin as this method fills them up nicely. Placing the implant against the ribs and behind the muscle works well with larger implants. They are less likely to be seen or felt and there is more padding in front of them. The muscle forms a sleeve over the implant and lessens the risk of encapsulation.

Breast augmentation is performed under general anaesthetic and usually takes about two hours to perform, during which the patient is of course completely unaware of the procedure taking place. Your surgeon will measure your breasts and assess their shape, your skin and the position of your nipples. Before the operation, drawings are made on the breast with the patient standing.

Your surgeon may want you to have a mammogram taken. He or she may also suggest that you have a photograph taken of your breasts before the operation so that the results of surgery can be compared with your original appearance.

If you are having a general anaesthetic, you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

 
Illustration showing the position of breast implants

What to expect after the operation

You will be given painkillers to help relieve any discomfort as the anaesthetic wears off. Patients stay overnight at the clinic and are usually released from the clinic the following morning. Before the patient leaves, the bandages are changed and the drains are removed. Rest is recommended for several days and the patient should avoid any physical strain. The suture is of self-absorbent material.

In three to four weeks, supposed the wound has healed as expected, the patient may begin applying the scar pressure massage. The patient will be instructed on how to massage the breasts to prevent the formation of a fibrous capsule around the implants and to assist in the formation of the natural shape of the breast.

Before you go home your nurse will give you advice about caring for your breasts, hygiene and bathing. He or she will also give you advice about wearing a special supportive bra in the days after the operation.

                                 
Before                                                                   After

Recovering from a breast enlargement

Once home, you can take more painkillers if you need to, as advised by your nurse or surgeon.

There are some important things to remember while recovering from a breast enlargement:

• don't shower for four to seven days after the operation
• don't lift heavy objects
• don't do any strenuous activity for the first two to three weeks after the operation as advised by your surgeon - if the implant is placed under the muscle, activity may be restricted for longer
• The patient may resume routine activities after 7 to 10 days.
• One to two months after surgery, the breasts are considered to be stable. 

Deciding on treatment

It's important not to rush into the decision to have any cosmetic operation. And it's sensible to discuss the options with your GP, who may be able to recommend reputable surgeons or give advice about how to choose which hospitals to be treated in

Breast enlargement is a commonly performed and generally safe operation. For most women who want the operation, the benefits in terms of improved appearance outweigh the risks. However, if you are deciding whether or not to have this procedure you need to be aware of the possible side-effects and the risk of complications.

Side-effects are the unwanted but usually temporary effects of a successful procedure. An example is feeling sick after the general anaesthetic.

Anyone having a breast enlargement can also expect:

• pain, swelling, tenderness and bruising for at least a few days
• a burning sensation in the nipples for a few weeks, but this should go away as you heal
• Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. The main complications of any operation are bleeding during or soon after the procedure, infection and an abnormal reaction to the anaesthetic.

Specific complications of breast enlargement include those listed below.

• There may be a difference in size between the two breasts, possibly caused by natural differences that are highlighted by the surgery.
• You may get an infection in the breast. If this happens, the implant may need to be temporarily removed to allow the infection to be completely treated.
• Abnormal scar tissue can form around the pocket in which the implant sits. This may squeeze the implant and cause firm, painful breasts. This is known as capsular contracture. If the breast goes hard, further surgery may be required.
• There is usually a temporary difference in skin and nipple sensation following breast enlargement but this can be permanent.
• Fluid can build up around the implant. This is called a seroma and may require further surgery to remove.