|The Essential Facts*|
|Length of Procedure|
|General or light sedation (twilight anaesthesia) and local anaesthesia|
|Day case or 1 night stay|
|Time off work|
|Getting back to normal/sport|
Breast enlargement is the second most common cosmetic surgery in the USA after liposuction. It is the third most common after liposuction and tummy tucks at our CosmeSurge® Centers in Dubai, Abu Dhabi, Sharjah, Fujairah, Al Ain, Ras Al Khaimah & Oman. For the women concerned, small breasts take a severe emotional, social, and sexual toll. Their most important attribute of femininity is missing.
Breast augmentation is designed to increase the size and or alter the shape of a woman’s breasts through the use of the latest and safe artificial breast implants or fat transfer using the patients own fat. Women may choose to have this operation either as a reconstructive technique following breast cancer surgery, to balance asymmetrical breasts, or to improve their body figure.
Breast augmentation can be performed at any age after the breasts are fully developed. The ideal patient for breast enlargement is emotionally stable, understands her personal motivations and has realistic expectations.
If your breasts are sagging, a breast lift may be recommended in conjunction with augmentation.
There is no scientific evidence that breast augmentation increases the risk of breast cancer. The presence of breast implants, however, makes it more technically difficult to take and read mammograms.
Over last ten years plenty of evidence has been collected about the safety of silicon implants. Silicon is the second most common substance on earth after oxygen. The implants were first developed 40 years ago and underwent constant improvements. We are now at CosmeSurge using exclusively the FDA approved fifth generation of implants filled with cohesive gel with no risk of the silicon migrating anywhere in the body.
The implant is placed in a pocket either directly behind the breast tissue or underneath the pectoral muscle which is located between the breast tissue and chest wall.
One of the advantages of a saline-filled implant is that, because it is filled with saltwater after being inserted; only a small incision is needed. Often, an incision of less than one inch is made underneath the breast, just above the crease, where it is usually quite inconspicuous. Another possible location for the incision is around the lower edge of the areola.
A third alternative is to make a small incision within the armpit and place the implant. We have a Brazilian surgeon (Dr Claudia) who is comfortable with this approach.
However water filled implants leak out and frequently feel un-natural due to the rippling effects of the water inside a plastic bag. Most surgeons prefer a silicone implant as they feel very natural.
Before the operation, the size of the implant should be agreed upon with the patient by simulating the results and taking her ideals into consideration. The sizes most in demand are between 250 to 375 ml in volume. Individual factors and personal preferences will help you and your plastic surgeon to determine your appropriate breast size, the location of incisions, and whether the implants will be placed on top of or underneath the chest muscle.
Neither the surgeon nor the patient should choose the size of the implant. The patient’s height, shape, shoulder width and rib cavity dictate to a large extent the correct size. Patients who have suffered from undersized breast for a long-time generally demand larger implants than would otherwise be suitable for their figure. The surgeon who bends the rules too much in order to accommodate patients’ unreasonable wishes does a disservice to them as their breasts sag later on if they are too big for them.
The operation can be done with local anesthesia and deep sedation or general anesthesia. Once the incision is made, the surgeon creates a pocket into which the implant will be inserted. This pocket is made either directly behind the breast tissue or underneath the pectoral muscle which is located between the breast tissue and chest wall.
An incision is made either underneath the breast just above the crease, around the lower edge of the areola (the pigmented skin surrounding the nipple) or within the armpit.
The patient usually goes home next day. The pain can be severe at times in the following two days and requires strong pain killers and muscle relaxants. Keeping the patient overnight allows for better pain control, intra-venous antibiotics and the placement of a small drain if necessary to evaluate and prevent any blood from collecting around the prosthesis which may increase the risk of breast hardening in the future (capsular contraction)
Changes in nipple or breast sensation may result from breast augmentation surgery, although they usually are temporary.
When a breast implant is inserted, a scar capsule forms around it as part of the natural healing process. In two out of every one hundred patients the capsule may tighten and compress the implant, causing the breast to feel firmer than normal. Capsular contracture can occur to varying degrees. If it is severe, it can cause discomfort or changes in the breast’s appearance. In such cases, more surgery may be needed to modify or remove the scar tissue, or perhaps remove or replace the implant with the patients own fat, something our surgeons in Germany pioneered. Capsular contraction is less likely to occur if the patient massages her breast for ten minutes twice a day for two month after removing the stitches.
An infection should it occur usually manifest itself within the next three weeks after implantation. This complication occurs in one out of one hundred patients. Should it happen, it would necessitate the removal of the implant and the use of antibiotics. Re-implantation can be done three months later once we are sure that the infection has cleared. The end result is usually as good as there was never an infection. However the interim period is hard on the disappointed patient. Choosing a surgical hospital such as our Emirates Hospitals – a hospital that admits no patients except for clean elective surgery – goes a long way towards minimizing the occurrence of infections.
A small asymmetry in breast shape is not uncommon. Patients should realize that 90% of women have nonsymmetrical breasts. Breast implants are not lifetime devices and cannot be expected to last forever. If a saline filled implant breaks, its contents are harmlessly absorbed by the body within hours. On the other hand, silicone implants are guaranteed to stay intact for ten years. My advice, if you do not want to take any chances, is to go for a silicone implant which gives the most natural feeling but to replace the implants every ten to fifteen years as the capsule gets weaker after that period and could possibly allow silicone to leak into the surrounding areas creating hard to remove internal scar tissue.
The patient need to wear a special braw for one month after surgery and should avoid heavy lifting or strenuous exercise for at least one month. A patient should listen to her body as she gradually increases her activities. Pain indicated that the patient is doing something that she is not ready for.
The breasts are swollen for several weeks so they seem too large and asymmetrical. The implants settle down to their final shape in three months at which time most patients are delighted with their new breasts.
A recent study conducted at the University of Minnesota in consultation with the Food and Drug Administration (FDA) did a 10 year follow-up with 450 women who had undergone breast augmentation. Almost 96% of women with saline filled implants stated they would make the same choice again. 93% were satisfied or very satisfied with their breast implants and 71% rated their breast implants as soft and natural. I expect that satisfaction rates with the new generation of FDA approved silicone implants are even higher due to their softer and more natural look and less problems with leakage.
Breast enhancement pills, breast enhancement cream and breast enhancement exercise programs are the three advertised ways of increasing breast size naturally. However, the U.S. Food and Drug Administration (FDA) state that no breast enhancement product has never been proven to actually work.