Breast Implants – Breast Enlargement – Breast Augment

Breast 'enlargement' or breast 'augmentation' is the most popular plastic surgical operation because it offers an immediately visible result and because it improves self-confidence in women who want to have larger breasts. The treatment is relatively straightforward and safe for patients in terms of the surgery and aftercare. There is minimal down-time after the operation. Modern types of breast implants maintain good breast shape for longer and many manufacturers now offer a lifetime product guarantee against implant rupture or capsule contracture.

Overview

You may feel that your body image and self-confidence would be better if you had fuller breasts. In some cases it may be a desire to achieve a 'balanced figure' where your natural breast size does not match a fuller body shape. Medical research demonstrates that quality of life is improved for women who choose to have breast enlargement. Breast implant surgery has been available for more than 50 years and remains the world's most popular plastic surgery operation. It is a procedure which has stood the test of time. Implant technology has improved considerably and continues to do so. The implants come in a wide range of sizes. It is therefore possible to choose between quite a subtle enlargement or a more generous one.

What are Breast Implants made of?

Breast implants have an outer layer made of silicone rubber or polyurethane which is textured to help it bond to the tissues in the breast. Earlier types of breast implant had a smooth outer layer. These earlier implants tended to develop a thick membrane ('capsule') which would tighten with time and cause the breast to evolve an unnatural shape. The texturing reduces and slows capsule development but cannot completely prevent it. The implant is filled with a thick silicone gel which is designed to mimic the texture of normal breast tissue. Again, there has been considerable progress in the physical properties of silicone gel: it is thicker ('cohesive') which allows implants to come in a greater choice of shapes and makes it less likely to leak out of the breast implant. Saline water filled implants are also available.

How long do implants last?

Breast implants do not last for ever but typically for 10 - 20 years. It is important to understand that further surgery to remove or exchange the implants is likely in the long term and a small proportion of patients will require further surgery at an earlier stage.

How is the surgery done?

Enlargement is achieved by positioning an implant between the breast tissue and the rib cage. This fills the breast, pushing it forwards and upwards. Breast size and cleavage are enhanced as a result. The implants are introduced through a small surgical wound in the breast crease and the procedure takes approximately an hour. It is a general anaesthetic operation usually performed as a day case or overnight stay. A soft supportive bra should be worn for 6 weeks after surgery. You can return to most daily tasks, work and activities within a few days of surgery but strenuous or repetitive activity must be avoided for 6 weeks. Some pain can be expected in the days after surgery. This is usually minimal and many patients describe it as 'uncomfortable' rather than 'painful'. There is always some swelling in the tissues and it takes approximately 3 months for breasts to soften and feel normal after surgery.

What is the difference between water and silicone-gel filled implants?

Silicone-gel is a more natural texture than water and better allows the implant to retain its shape. Breast implants leak and occasionally split over time. Whilst silicone gel is harmless to humans, it remains in the breast or sometimes migrates towards the arm-pit. Modern silicone gels are designed to minimise leaking and migration. Water is absorbed if it leaks from the implant.

Should my implants be over-the-muscle or under-the-muscle?

It is a contentious issue amongst the surgical community.  The principle benefit of placing the breast under the muscle is to minimise the chance of feeling or seeing the upper margin of the implant - the muscle adds an extra thickness of tissue covering the implant.  The muscle also flattens the upper part of the implant which may make for a more natural ‘down-slope’ to the breast.  There is also some evidence to suggest that capsule contracture rates are lower although there is contrary and inconclusive evidence with this regard as well.

Under-muscle Breast Augmentation also comes with some disadvantages.  It is more disruptive of natural anatomy and therefore patients may experience more pain in the short- and possibly long- term.  Movements of the arm cause the pec muscle to tighten and this will make the breasts move (known as ‘breast animation’).  Some patients find this movement very noticeable and unfavourable.  In the longer term, the muscle tends to widen the cleavage by pushing the implants apart.  The muscle only covers the upper part of the implant so it may still be possible to feel the implant in the lower margins of the breast.  Patients with larger and more droopy breasts may find that the implants don’t drop into the breast so well - the implant is held slightly high by the muscle and the breast seems to slide off the implant (‘waterfall’ effect).

In summary, the advantages of going under-muscle are strong for patients whose breasts and trunk are slender, especially if they choose a large implant relative to their natural size.  These advantages become less clear for patients who already have more developed breasts; the availability of teardrop implants may further reduce the under-muscle benefits.

Patients who are very physically active should be cautious about under muscle implants.

Are there any risks from breast implant surgery?

It is impossible to eradicate all the risks associated with surgery. However, breast implant surgery is a very safe procedure if performed by a fully qualified and trained plastic surgeon using good implants in hospitals with a high standard of care. Risks are bleeding inside the breast (less than 1%), infection (less than 1%) and capsular contraction (1-2% per year). Each of these risks may require revision surgery. Other potential problems are: implant displacement or rotation, loss of nipple sensation, poor scars, asymmetry of the breasts, and implant rupture. Very occasionally, patients will ask for implants to be removed voluntarily because they find them uncomfortable or become unhappy with the enlarged appearance.

What happens if I have children?

Breast implants do not pose any problems or risks for pregnancy or breastfeeding in the long term. It should be remembered that some women with unoperated breasts are unable to breast feed.

You must not be pregnant or breastfeeding at the time of surgery. It is advisable not to become pregnant for 12 months after breast implant surgery in order to allow the breast to fully settle.

The breast will change in shape and fullness throughout your life. This is especially true during and after you have completed your family and it is impossible to predict whether you might require further surgery as a result of this.

Should I be concerned about breast cancer and breast implant surgery?

This depends on your age and any family links with breast cancer. Breast implants themselves do not have any causal link with breast cancer which is unfortunately very common disease affecting approximately 1 out of 8 women.

The accuracy of routine breast screening is slightly affected by implants and you must tell your breast service that you have implants when you go for screening tests in the future.

Your breasts will be examined for lumps when you attend for your consultation. If you are over 40 or have other risk factors (family history of breast cancer) you will be advised to have a mammogram before breast enlargement and it is helpful to have this done prior to your consultation.

In recent years there are a couple of rare types of cancer - BIA-ALCL and BIA-SCC - which may be caused by textured surface implants.  These are thought to be rare, maybe affecting 1 in every 30,000 breast implant cases. Because these are newly discovered diseases and because it is rare, data is still emerging.  The principle warning sign of these is rapid and unexpected swelling of one breast some years following breast implant surgery.  If this occurs you should seek specialist investigation urgently.

What can make breast implants look unnatural?

Once the implant is inserted, your body grows a membrane ('capsule') around the implant. Depending upon the individual way your body responds to the implant, and also to the type of implant used, the capsule can become tough and tight with time. This changes the shape of the implant and the breast. Approximately 10-20% of implants will develop a significant capsule within 10 years of surgery although the latest types of implant may have lower rates of capsule contracture. If this happens the implants can be exchanged and the capsule is disrupted or removed.

If very large implants are chosen for an otherwise small breast this may give a rather rounded and over-augmented look. Patients who start with very small breasts and / or very thin skin in the upper part of the breast may also find that the upper edge of the implant is more apparent. This effect can be offset by placing the implant more deeply under the chest wall muscles ('sub pectoral' or 'sub-muscular' or 'dual plane' technique). Breasts which have become droopy may require an uplift as well as an implant ('augmentation-mastopexy') in order to achieve a desirable look; using an implant only for this type of breast creates a 'double-bubble' appearance.

Will I be able to feel the implants?

This depends upon the amount of breast tissue already present before your surgery. It is quite common for slim patients to be able to feel the contour of a breast implant on the lower, outer portion of the breast. This is also true for the upper portion of the breast if a large implant has been used to augment a small breast. Furthermore, significant capsule thickening will be possible to feel.

Are breast implants right for me?

Only you can truly decide whether this is the right operation for you. This depends upon the way you perceive your own body and the impact that it has on your interaction with other people in your professional and personal life. It is vital that you make a choice which is right for you and that you have space and time to make this choice. Through a careful and supportive consultation Mr Harley will help you to determine what is achievable in the context of size, shape and your general medical health. You will also have a full explanation of the advantages and the potential problems that can be associated with breast enlargement. If you are a healthy adult, the surgery is a low risk procedure.

Can implant surgery be combined with other procedures?

Yes, breast implant surgery is commonly combined with other cosmetic procedures for example tummy-tuck, labiaplasty or liposuction.

Why have my surgery with Mr Harley?

Oliver Harley has had extensive experience and training in plastic surgery of the breast in the UK both within the cosmetic sector and the NHS. Communication and empathy is vital for providing good, safe care; a personal service is offered which includes opportunity for additional pre-operative consultations, follow up for a year after surgery as necessary. You will meet Mr Harley at all consultations and this will enable him to understand your cosmetic objectives, to reassure and support you throughout the process and to ensure the best possible outcome from your surgery.