BREAST AUGMENTATION
What is Breast Augmentation?
This is a procedure whereby both (sometimes one) breasts are made larger in size. This is achieved by placing a permanent synthetic implant into the breast. This procedure is usually done for cosmetic purposes where self-confidence, self-esteem or self-image is suffering as a result of what is perceived to be inadequate breast size. In certain birth deformities (congenital deformities) one breast may not develop as large as the opposite one. In these cases, breast augmentation is a reconstructive procedure.
There are also conditions were the shape of the breast is abnormal (tubular). In cases like this a combination procedure involving augmentation and nipple/areola reduction is usually performed. This would be explained in detail to any patient.
General Questions
We usually perform this procedure under local anaesthetic with intravenous sedation. It is remarkably well tolerated although one can of course use a general anaesthetic if the patient so prefers. Via 4 – 5cm incision on the under surface of the breast, a pocket is made between the breast tissue and the chest wall muscle. The implant is placed in this pocket and the incision closed.
At the time, a plastic drainage pipe is placed through the skin under the arm on both sides to allow drainage of any bleeding that occurs post operatively. These drains are usually removed 24 – 48 hours later. In specific cases it may be necessary for reasons which will be explained to the patient, to place the implant not under the breast tissue but under the chest wall muscle.
This procedure usually takes 1-2 hours in theatre and patients are usually discharged +24 hours later. Full healing of wounds takes up to 10 days and most patients are able to return to work 2 – 3 weeks post operatively. It is important to note that it takes 8 – 10 months for the final shape of the breast to develop and scars may take up to 18 – 24 months settle completely
Post operative bleeding and infection are the most feared complications. Fortunately this is very uncommon as alll precautions are taken to prevent this. In the event that post operative bleeding should become apparent, immediate removal/drainage of this blood collection is mandatory. This is usually done in theatre.
With the presence of a synthetic foreign body under the breast tissue, infection always remains a theoretical risk. It is extremely rare but needs to be treated aggressively should if happen. lf one or both breasts become increasingly painful at any stage post operatively, infection should be suspected.
In rare cases, it may be necessary to remove the implants
temporarily if the infection does not respond quickly to intravenous
antibiotics. | must stress that this is a very rare occurrence.
The most
important complication of breast augmentation is that of capsular contracture.
This occurs when the body produces an excessively active scar tissue capsule
around the implant. As the scar tissue matures it pulls tightly around the
implant causing the breast to become very hard to palpation. This is offen
associated with cramp-like pain. It is said that 10 – 15% of patients will
develop this complication and that it is unpredictable who will. It is possible
to relieve this contracture surgically but there always remains a small risk of
recurrence. The other major issue in breast augmentation surgery involves the
question of use of silicone implants in the body. The following information is
presented to reassure any patient who is considering such a procedure..
In 1998, an independent review group (IRG) was established at the request of the U.K. Department of Health in response to concerns expressed by women in relation to silicone gel breast implants. The IRG looked at the existing and emerging scientific evidence for a link between silicone gel breast implants and effects on health:
Tumouregenicity
– investigators examining recent rates of growths or tumors of the breasts
provided by the U.S. National Cancer Institute have seen no increased risk
among women with breast implants even after a 10 year period.
Risk of
cancer – there is no scientific evidence that women with breast implants are
more susceptible to cancer than other women. Epidemiological studies have shown
no increase in the incidence of breast carcinomas in women with breast implants
compared with women without breast implants. Further research is ongoing.
Risk to
pregnancy – a review of the published literature indicates that studies in
animals to date that have evaluated silicone materials for birth defects or
other reproductive effect have shown a lack of activity.
Auto-immune disease – case reports have documented that the following symptoms and conditions have occurred co-incidentally with the presence of silicone breast implants.
Chronic fatigue, muscle pain, joint pain and swelling, enlarged lymph glands, scleroderma, systemic lupus erythematosus, Raynaud’s phenomenon, rheumatoid arthritis and other non-specific physiologic complaints. None of these studies represent conclusive evidence that silicone breast implants can cause auto- immune diseases or connective tissue disorders. Removal of the breast implant and the surrounding capsule is a recognised precaution if a persistent immune response is suspected although among the cases reported, removal of implants did not consistently result in an improvement or remission of the disorders manifested. Epidemiological studies on selected groups have provided preliminary results that demonstrate no connection between silicone implants and certain connective tissue disorders such a rheumatoid arthritis etc.
A report published in 1998 by a U.S. National Science panel evaluated the scientific data on implants in relation to immune dysfunction. No association was found between silicone gel filled implants and any of the connective tissue or immune disorders.
In 1999 and independent review from a committee at the Institute of Medicine in the U.S. concluded that a review of the toxicology studies of silicone and other substances known to be in breast implants does not provide a basis for health concerns.
Lastly, ongoing evaluation of a breast
containing a breast implant with mammography or physical examination or
ultrasound is not hindered in any way. As long as the person checking the breast
for any possibility of lumps is aware of the implant this should not prevent
detection of any breast lump or tumor (growth).
Before
surgery please do not take any products that contain aspirin of high doses of
Vitamin E for 3 weeks prior fo surgery.
Smokers
should discontinue smoking. If this is not possible they should cut down to 3 –
4 cigarettes a day before surgery and avoid all smoking for 24 hours before
surgery. Smoking causes coughing especially after an anaesthetic which causes
discomfort and might even cause bleeding after your operation.
Please
report any signs of a cold, infection, boils or pustules appearing within 3
weeks of Surgery.
The night
before and the morning of surgery please shower or bath with Betadine (or alternative
in case of allergy). Please wash your hair with antiseptic shampoo the day
before surgery. Arm pits should be shaved closely on the day before surgery.
Post
operative advice – it is extremely important that you limit the use of your
arms for at least 3 weeks. Do not lift your arms above shoulder level. Keep
your elbows to your sides. Do not lift anything heavy or drive a car until 3
weeks after surgery.
It is
advisable to stay in bed for the first 24 hours although the patient may go to
the bathroom with assistance.
If you are
comfortable on your side, this is permissible, however do not attempt to sleep
on your stomach for 4 weeks after surgery.
You must
expect some moderate pain and discomfort for the first few post operative days.
This will be similar to muscle pain after strenuous physical activity.
The breasts
will be bandaged for +4 – 5 days and are usually waterproof. Please do not
brassiere until you have been given permission to wear one. The breasts will be
bruised and swollen moderately for up to 10 days post operatively. Any signs of
bleeding or rash should be reported. If, one breast becomes considerably larger
than the other, please notify your doctor.
Patients
must not expect the breast to look normal a week or so after operation. The
final shape will only be reached 6 – 8 months later and the final appearance of
the scars will be apparent at 18 – 24 months. The scars may have to be treated
with special tapes, creams or injections if they become problematic.
Please
avoid getting overheated and do not sit in the sun for 2 weeks after surgery.
We advise wearing loose fitting clothes that are easy to slip on or off with
minimal use of the arms. Please do not wear tight sweaters.
Please avoid large crowds and any persons who have colds or flu for at least 6 weeks after surgery.
Lastly, we strongly recommend wearing adhesive paper tape over
the scars for 3 months post – operatively. A close fitting supportive bra
should be worn for 2 weeks post – operatively. We do not suggest post-operative
massage of breasts as we use textured implants.
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