If you’re considering breast augmentation surgery, selecting the right surgeon is one of the most important decisions you’ll make.
Beyond achieving your desired aesthetic outcome, a skilled surgeon must carefully evaluate your unique anatomy—your breast shape, chest wall structure, and tissue characteristics—to determine the optimal surgical approach.
Breast size and shape is genetically determined, but can
change throughout life in response to weight changes,
pregnancy/breast feeding and ageing.
As part of the natural ageing process, the elastic tissues of the breast and skin tend to droop/sag (ptosis). This can also be seen after pregnancy, breast feeding and weight loss. It is normal for most women to have two breasts which are slightly different in size and shape.
If this difference is significant, then surgical correction may be
sought.
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Breasts may be made larger by placing an implant (or fat grafts)
in a pocket created under the breast tissue or behind the
pectoral muscle of the chest (especially in very slim women with
little breast tissue). Implants are usually inserted through
incisions in the fold under the breast (inframammary fold).
Your surgeon will meet with you to assess your suitability for the
procedure and help you to decide on the type, shape and size
of implant that will be best for you. The surgeon will also spend
time discussing the surgery, scars, expectations and potential
complications of this procedure.
A breast implant consist of an outer silicone shell and silicone
gel filling. While saline (salt water filled) implants are available,
these are not often used in the UK, and are considered to have
a less natural feel than the silicone filled implants.
Some implants are round, while others are anatomically (tear drop)
shaped. Both have pros and cons and can give excellent results.
The average life expectancy of a breast implant is 10 –
14 years. This is an average, so while implants can stay in,
without problems, for much longer, occasionally problems can
arise in a much shorter timeframe.
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While no surgery, however big or small is not without risk, breast augmentation remains the most common cosmetic procedure in the UK and the USA, which is is a reasonable indication of its safety and satisfactory outcome in most patients.
Complications specific to implants include:
One of the most common complications with breast implants is capsular contracture (10% at 10 years). When a breast implant is inserted in to the body, the natural response of the body is to create a wall of protective scar tissue, called a capsule, around the implant.
In most women, this scar tissue is soft and thin, however in a some women (up to 10% of women at 10 years after augmentation surgery), this scar tissue can become thicker and distort the shape and position of the implant. This is called a capsular contracture. This problem may be detected at about a year after surgery to a greater or lesser extent, but usually takes several years to become noticeable when looking at the breasts.
In some cases the capsular contracture can lead to pain, hardening of the implant and loss of the normal shape of the breast. While the recommendation for minor degrees of capsular contracture is to avoid surgery, in more severe cases treatment may be needed to remove the scar tissue and replace the implant. This corrective surgery would not be covered by any guarantee and would incur a cost to the patient.
There may also be a risk of numbness, shooting pains, indentations, dog ears, hard red lumpy scarring, asymmetrical or adverse scar position, asymmetry, dissatisfaction with the aesthetic outcome and breast droop.
(BIA-ALCL) is a rare complication estimated each year to affect about 1 in 30,000 patients who have silicone implants.
Breast Implant Illness (Bii),
Refers to a wide range of symptoms, including joint and muscle pain, chronic fatigue, and memory
and concentration problems, breathing problems, sleep disturbance, rashes and other skin problems, dry mouth and dry eyes, anxiety, depression, headaches, hair loss and gastrointestinal problems, in people who have any type of cosmetic breast implants (including silicone, saline, smooth surface, textured surface, round, or teardrop-shaped). It can develop whether implants have ruptured or stayed intact and can appear any time after implant surgery.
In many, but not all cases, surgery to remove the breast implants may resolve the symptoms. It’s unclear how many people with breast implants develop Bii. There are currently no medical tests that can identify if someone has Bii and tests may need to be carried out to exclude other diseases such as autoimmune or connective tissue disorders, chronic fatigue syndrome, thyroid disease, Lyme disease and menopause that might be causing the symptoms. There are also side effects of some breast cancer treatments, such as hormone and chemotherapy that may produce similar symptoms to Bii.
Some patients report that their symptoms improve if their implants are removed (with or without some, or all of the surrounding capsule), but this is not true for all.
More guidance on Bii can be found at these websites:
Uk Government Breast Implants Illness
FDA Gov Complications Breast Implants
Other complications that may occur with breast augmentation are those those associated with any type of surgery. These include such things as bleeding (haematoma), bruising, swelling, infection, seroma, skin breakdown or loss (necrosis), delayed healing, asymmetric healing, and pain. There is also a risk of complications affecting general health such as anaemia, deep venous thrombosis and pulmonary embolism.
Many studies have been carried out into silicone breast implants and these have shown that, at present, there is no evidence that these implants are associated with an increased incidence of breast cancer, nor do they cause autoimmune diseases such as rheumatoid arthritis.
Breast augmentation does not interfere with breast feeding, nor does any silicone enter the breast milk. Breast implants may make mammography x-rays difficult when screening for breast cancer, however other methods, such as ultrasound or MRI scans, are as effective in the detection of breast cancers in women with implants. Rates of detection of cancerous lumps in the breasts of women with implants has been shown to be no different than women without implants.
While most women have a variable amount of asymmetry between their breasts that does not require correction, this difference in size or shape may occasionally appear exaggerated after augmentation.
A breast with an underlying implant will not necessarily feel or behave like a breast without an implant. Implant augmented breasts will usually feel a little more firm than a breast without an implant, and will tend to maintain their shape in most positions (such as when lying flat). Some women (especially if very slim), may need some time to allow the body to adjust to having an implant inside.
It may also take some time for the true size and shape of the breast to settle after augmentation surgery, making final cup size unpredictable. Creation of a full cleavage, where the breasts are close together in the midline, may not always be possible, particularly in slim women where the implants may have to be placed behind the pectoral muscles. Larger implants will also be heavier and may speed up the drooping of the breasts during the ageing process.
A breast augmentation operation will leave a permanent scar in the inframammary fold of the breast, which is usually well hidden by a bra or bathing costume. These scars will usually soften and fade over a period of about 2 years, however, the appearance and behaviour of scars can vary greatly between different individuals.
It is also worth mentioning that there is little evidence to show that a breast augmentation procedures has any beneficial impact on long term happiness or satisfaction, and it is therefore not advisable to undergo this procedure while experiencing adverse/significant life events, such as after separation or divorce.
Following a bilateral breast augmentation procedure, there will be swelling and bruising, most of which should settle in the first few weeks. The scars may take about 2 weeks to heal, although may take several months to fully mature.
While 2 weeks of sick leave may be sufficient for employment such as a desk-based job, it may be advisable to take a little longer for more physical work and refrain from heavy, upper body exercise for about 6 – 8 weeks. It is usually advisable to wear a sports type bra night and day for the first 2 – 3 months after surgery in order to support the breast.
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