BREAST AUGMENTATION

What is Augmentation Mammaplasty?
Augmentation mammaplasty is an aesthetic (cosmetic) surgical procedure to increase the size of breasts. Augmentation mammaplasty will also correct slight sagging of the breast and can increase breast firmness. A similar procedure can be used to recreate a breast after mastectomy.

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When is Augmentation Mammaplasty Desirable?
You may wish to have an augmentation mammaplasty if you feel your breasts are smaller than normal or out of proportion to your body size. Augmentation mammaplasty is also useful if your breasts are unequal in size or if they have decreased in size following pregnancy.

Two different circumstances most frequently create an interest in surgical breast enlargement. The first involves congenital under development or an imbalance in the amount of naturally existing breast tissue relative to the other body measurements such as hip circumference and height. In this instance, there may be problems with breast asymmetry or shape deformities. The second situation is caused by a natural loss of breast volume which follows a large weight loss or the child-bearing years. The breast often takes on a collapsed or deflated appearance and clothing no longer fits as nicely through the chest.

A consultation with your plastic surgeon is the first step when you are considering an augmentation mammaplasty. You should frankly discuss your goals and expectations about looking and feeling better after surgery. You should always keep in mind that the desired result is improvement, not perfection.

Choice of Implant
Surgical augmentation of the breast is accomplished by using an artificial implant that is placed beneath the breast tissues. The implant varies in size according to the wishes of the patient. The implant itself contains a jacket or bag and a "filler" that is contained within the jacket.

The Jacket: Silicone in its more solid "rubberlike" form is still used to create the implant's jacket, which maintains the volume of the saline filler. In recent years, some patients have raised concerns about the potential for implanted silicone to cause diseases. To date, however, these claims have not been substantiated by carefully performed scientific studies that have examined the health of thousands of previously augmented patients.

The Filler: The once popular silicone gel is no longer available for use as a filler. The readily available saline filled implant is most commonly used at present. Recently a new, safe form of silicone gel has been developed and is now available for use as a filler in the new generation gel filled implants.

Saline Filled implants: These are most readily available and most commonly used in Australia at the present time. They are known to be safe. In the event of prosthetic rupture, saline is released from the implant and is absorbed by the body harmlessly. Saline implants are less expensive than new generation gel filled implants. They are available in either "round" or "anatomical" (tear drop) shape.

Gel filled Implants: At the present time the new coherent gel implants are not readily available in Australia but can be used following individual patient notification with the Therapeutic Drug Administration. Because the gel is coherent, meaning it sticks together in a predetermined shape, it does not carry the risk of dispersal should implant rupture occur. It also can maintain a breast shape more effectively especially in the upper pole of the implant. Gel filled implants come as "Anatomical" having a tear drop shape. They are considerably more expensive than saline filled implants.

Choice of Implant Placement
Breast Implants can be placed either under the breast tissue or partially under the muscle of the chest wall (pectoral muscle). The suitability for implant placement depends on your preexisting breast shape and size. Excellent results can be achieved with the use of both placements. This will be discussed with you and determined at the time of consultation.

Choice of Incision
Three approaches to the operation using a different incision for each can be used: a) Sub mammary - incision the inframammary fold b) Peri-areolar - incision made around the nipple c) Axilliary - incision in the armpit

All three approaches can achieve excellent results. In general, the sub mammary incision is most commonly used as it is quicker and more straight forward with a lower chance of complications and quicker recovery time. Discussion at the time of consultation will determine the most appropriate approach for you. Incision placement is influenced by such factors as apparel preferences and implant placement.

Scars are an unavoidable result of the incisions required to place breast implants, but they generally are small and can be placed inconspicuously. In some cases, the implants can be placed with the aid of a lighted rod called an endoscope, which permits even smaller incisions and scars. During the consultation for breast augmentation, discussion will lead to a decision regarding the amount of breast augmentation that best meets your needs.

Do I need to stay in hospital?
The surgery is generally performed on an outpatient basis. The procedure can be done with local anaesthetic and sedation or under general anaesthesia. The operation usually takes about 90 minutes. There is no need for taping after the procedure and dissolving sutures are used so none need to be removed afterwards. Generally you will be able to go home 2 hours after surgery.

Some discomfort arises from the stretching of the breast tissues, but it largely resolves within two to three days and is well-controlled with simple oral medication such as Panadeine. Showering is allowable 48 hours postoperatively.

Patients generally return to work within one week, but should avoid exertional activities over the three to four weeks required for bruising and swelling to resolve.

What about Complications?
Breast augmentation is an open surgical procedure that is associated with a low incidence of complications. At your consultation these will be discussed with you and you will be able to ask any questions you have about them.

Post-operative complications include blood accumulation or infection adjacent to the implant. Both problems occur infrequently, but can necessitate a second operation or temporary removal of the implant. Because implants are a medical device, they can fail at any point after implantation. This is uncommon, but it would require implant replacement surgery because leaking would cause the involved breast to shrink to the preoperative size in the case of saline filled implants and implant distortion in the case of gel filled devices.

Some patients develop a firm layer of scar tissue around their implants which can make the breast hard to the touch or painful. Called "capsular contracture," this can cause the breast contour to be asymmetrical and may require secondary procedures for improvement. Nipple sensation can be increased or decreased by the procedure. Although this is almost always temporary, it can be permanent. Most patients are able to breast-feed following augmentation.

Scarring can be unpredictable and some patients can develop hypertrophic or keloid scars. This is very unusual but can be improved with steroid injections and silicone sheeting

Breast Screening
Breast implants do cause some interference with the ability of mammography to detect early breast cancers. This is an important consideration that patients should discuss with a physician, particularly patients with a first-degree relative who has had breast cancer. All augmented patients need to inform their radiologists of their implants so the screening technique can be favourably modified.

Despite these limitations, approximately two million women are estimated to have undergone breast enlargement surgery. The overwhelming majority are satisfied with the results.

How important are psychological factors in relation to this procedure?
Emotional stability is the primary factor to be considered before any aesthetic surgery is performed. A "new body" does not guarantee a new life or an end to all personal problems. It is mostly the mental attitude of the individual that determines a successful outcome. Breast augmentation can improve your appearance and renew your self-confidence; the rest is entirely up to you.

General Information
Should there be any questions regarding breast augmentation, be sure to get them answered in advance by Dr Drielsma. Well meaning friends are not a good source of information. Find out everything before proceeding with the operation - a well informed patient is a happy one.

Finally, there can be no absolute guarantee with any surgery. Remember the realistic aim of this operation is improvement, not perfection.

Please note: The above information mentions only some of the benefits and complications of a breast augmentation. This information should not be regarded as a substitute for information and advice provided by Dr Drielsma during consultation.