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It is a fact, unfortunately, that no amount of exercise,
hormonal treatment, or creams will have any noticeable
effect on the size of small breasts. There is no method,
other than surgical correction using implants, that
can increase the size and fullness of the breast, and
thus augmentation mammoplasty has become a very popular
method of enhancing the female form. I have been involved
with this popular operation for the last 25 years and
witnessed the evolution of this operation with all types
of implants used.
This operation has been successful in this country and
worldwide and has helped many women attain a better
figure, which in turn has made an important psychological
contribution to their feelings of femininity, confidence,
general sense of well-being and happiness. Physical
and psychological factors are closely linked in this
area.
Patients
are very carefully assessed by the surgeon in order
to assist patients in realising their expectations and
to achieve a mutual understanding.
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Augmentation mammoplasty
is suitable for women who perceive their breasts as
being too small, either because they have never had
full development of breast tissue, or as a result of
the loss of breast tissue that sometimes occurs after
pregnancy and breast-feeding. Small breasts may also
be due to massive weight loss. If breast sagging accompanies
small breast volume, a breast uplift operation, Mastopexy,
may be required. Augmentation and Mastopexy can be performed
together or separately. Post-mastectomy breast reconstruction
is also performed to correct the deformity resulting
from the removal of a breast, e.g. for cancer. Modern
surgical techniques allow the aesthetic plastic surgeon
to simulate a breast, and free the mastectomy patient
from the need to wear an external prosthesis within
the bra.
This
surgery does not usually alter breast function. Since
the operation does not interfere with breast tissue,
the possibility of breast-feeding after pregnancy remains
unaltered. It must be remembered that not all women
can breast-feed successfully anyway - the important
point here being that the breast will function the same
after treatment as before. There may be altered nipple
sensation.
Augmentation
Mammoplasty does not increase or decrease the chances
of later developing breast cancer. Hundreds of thousands
of augmentation mammoplasties have been performed worldwide
and there has never been any demonstrated relationship
between breast enlargement treatment using implants
and future breast cancer or other breast disease. Detection
of lumps can be easily diagnosed with modern methods.
Augmentation
mammoplasties involve the small breast being made larger
by the insertion of a pre-formed ‘gelatine-like’
material implant, into a pocket behind each breast,
through a small incision. (This is not to be confused
with silicone injections that are not used). The implant
is placed either above or below the pectoralis muscle
that covers the ribcage. The texture of the implant
is very similar to the natural feel of the breast. The
size of the implant can vary, according to the wishes
of the patient and the advice of the surgeon. However,
the size selected is based on the degree of stretch
within the breast and the amount of breast tissue available
to accommodate the implant. The patient’s general
physique and stature must also be taken into account.
There are now sizers available to assess the desired
size of implant. A natural looking result is the aim.
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Incisions
There are several variations to the above-described
technique. Different types of implant may be used.
The location of the incision can be varied. It may
be beneath the breast in the normal fold of skin,
or in the armpit, or it may be in the areola, the
pigmented area surrounding the nipple. These variations
can be discussed in greater detail with your consultant.
The main purpose of the procedure is to make the breasts
as attractive as possible. There will be scars but
these will be kept as small as possible and either
hidden, as stated above, beneath the nipple or under
the creases of the breast or in the armpit. In either
case they usually fade and become almost unnoticeable
after a period of time.
Some
factors to be considered when making your choice of
implants are the compatibility of implant materials
with your body over time, the need to have a well
read mammogram, and to be able to follow the implant
over a long time. Implants are man-made and can wear
out. Of course, the implants need to look and feel
right. All breast implants utilise a silicone shell
but the fillings differ. Silicone implants are gel-filled;
saline implants are filled with salt water.
The
operation is performed under general anesthesia or local
in certain cases. The procedure itself takes about one
to one and half-hours as a general guide. An overnight
stay in the clinic is required. After surgery a supportive
dressing is placed over the breast. One day later this
dressing is removed and the patient must then follow
the surgeon's instructions on the wearing of the correct
size bra. Arm movements must be restricted for a few
days. Stitches will dissolve and are not removed; the
patient can usually return to work within seven to ten
days. Heavy lifting and strenuous exercise must definitely
be avoided for three weeks, and patients should take
six weeks to gradually resume full activity. Any surgical
procedure of this extent will result in slight swelling.
At first a feeling of fullness, soreness and discomfort
is almost routine, but adequate pain relief medication
can be prescribed. Aspirin or any medication that may
contain aspirin should never be used. |
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1. Bleeding (not life
threatening)
- Any surgery carries the risk of bleeding or haematoma
(collection of blood under the skin). Bleeding can
occur although this has been minimised by using fibre
optic lights. If it occurs early, postoperative stage,
surgical drainage may be necessary. Any fluid collection
around implants may also require drainage.
2. A small
percentage can get infected which
will lead to break down of the incision necessitating
the temporary removal of the implant until the infection
clears. A new implant would be inserted about 3 months
later.
3. Capsular contracture/calcification
has been dramatically reduces due to new implants
- The most common problem with any type of breast
implant is a slowly developing firmness called “capsular
contracture”. The body’s natural response
creates a layer of scar tissue (“capsule”)
around the entire surface of any type of implant.
Ideally, the scar capsule will remain thin and pliable.
However, if the scar tissue shrinks and thickens (contracts),
it may compress the implant, making the breast round
and firm, sometimes tender and immobile. Capsular
contracture can start anytime after surgery, even
several years later, most commonly on one side only.
Often capsular contracture does not occur at all.
Because some form of scar capsule
always occurs with a breast implant, capsular contracture
is considered an inherent risk of a breast implant.
No one is sure of the cause, and some women have no
scar problems. However, it is believed that the surgical
method - whether placing the implant under the chest
muscle or above - as well as the composition and surface
treatment of the shell, can combine to modify the
body’s response.
Always discuss treatment of capsular contracture with
your surgeon.
4. Breast Symmetry
& Shape - Breast Augmentation does not
correct the asymmetry of the breasts and the implants
usually take the original shape of the breasts. Capsule
formation can change the shape of the breast, which
might need further surgery to correct it.
5. Pain & Discomfort
- Some occurs in the early post operative stage which
normally subsides as the healing takes place.
6. Rippling of implants
7. Leakage or Rupture
of the Implant - Modern implants are extremely
difficult to burst however this can happen as a result
of a severe blow to the chest or a road traffic accident.
Very occasionally the implant may rupture during manipulation.
Shells may simply wear out. Filler which has leaked
may require surgical removal. Rupture can be diagnosed
by ultrasound or breast x-ray.
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7. Breast Examination
& X-rays - There is no doubt that the
presence of a Breast Implant could interfere with
the ability of a radiologist to read a mammogram (breast
X-Rays). Not being able to make a good reading could
hinder the detection of early cancer but there are
now techniques, which overcome this problem. Statistics
have shown that mammograms are just as useful in detecting
early cancer in those with implants as in those without
when read properly. There are specific techniques
for viewing tissue around implants. You must inform
the physician ordering the X-ray and the one performing
the X-ray to take a “diagnostic X-ray”,
e.g., multiple views.
8. Any surgery
or injury to the breast may produce small spots of
calcium, which may be seen on mammography. These deposits
may not occur until years after the surgery and occasionally
a biopsy may be necessary to confirm that the spots
are harmless.
9. Sensory changes
- some impairment of sensation of the nipple may occur
following surgery. Usually all sensation returns to
normal in a few weeks; occasionally, changes in sensation
may be permanent. Sometimes the nipple area can become
extra sensitive. In addition, sensitivity in the lower
portion of the breast may be impaired until the sensory
nerves recover. Some patients even report an electric
shock type of sensation. These changes usually settle
given time.
10. Rejection
- True rejection is extremely rare.
11. Auto-immune Disease
- The main reason why silicone is so widely used for
medical purposes is that it is considered inert and
biocompatible, or neutral, in the body. Despite this
medical understanding, recent reports in the media
have suggested that silicone implants might cause
auto-immune disease, or specifically connected tissue
disorders. Connective tissue disorders occur independently
in the general population. Statistically, women to
begin with have a higher incidence of auto-immune
disease than men. Types of the disease, including
rheumatoid arthritis, systemic lupus erythematosus,
and systemic sclerosis (scleroderma), occur often
coincidentally along with implants. These patients
may also have silicone breast implants; this does
not mean the implants caused the disorders. The cause
and effect relationship between breast implants and
these diseases has never been proven.
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FREE
Breast Augmentation DVD is now available
The Cambridge Private Hospital is
producing a series of comprehensive informational
DVDs offering detailed information about procedures
performed at our hospital.
On Breast Augmentation DVD several subjects are discussed
including
Concepts of Beauty
The Procedure
Implant Placement
Choice of Implant
Safety Concerns
Possible Complication
Photo Gallery
Order
Breast Augmentation DVD
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