 What is entailed?
This is a surgical procedure augmenting the existing size of the breasts by inserting implants (breast prostheses) into a surgically prepared fold behind the breast mass. The implants are made of a permanent outer shell of silicone, filled with either a very pure semi-fluent (or gel-like silicone solution) or with a physiological saltwater solution. Why choose enlargement?
The desire for a more attractive breast, inevitably within our society means a desire for what is perceived as the perfect shape. With a larger waist and hip size in particular, the breast needs to be in proportion. This in turn allows one to buy clothes "off-the-peg" more easily. The woman seeking help is either young, and feels she is suffering from breast development that was somewhat stinted, or older, and wanting to correct the inevitable effects of child-birth and lactation, such as sagging and loss of volume. This is quite normal for a mother following one or two births. Apart from massive weight-gain, augmentation with implants is the only way to permanently enlarge the breasts. With pronounced sagging, the implantation is combined with a breast-lift to deal with the excess of skin. (See Breast Lifting) Young women with hereditary small breasts rarely have a sagging problem, so would probably not need a īliftī The Operation
There are various surgical alternatives allowing the implant preparation and installation to be made. The incision can be made either 1. Within the fold beneath the breast, 2. Around the areola (the pigmented area surrounding the nipple) or 3. High in the armpit (where the hair grows). The positioning of the implants can be behind the breastīs glandular (milk-producing) tissue, or deeper, behind the great breast muscle. The surgeon takes various factors into consideration such as the volume and shape of the breasts, any sagging (ptosis), before selecting the most suitable method to follow. The patient too, may well have preferences to convey concerning all facets of the procedure including the type of implant (silicone or saltwater), the size of the implant, and the scar location. In this clinic, surgery is carried out under local anaesthetic combined with tranquillisers. It takes around one hour for saltwater implants via the armpit, and 45 minutes up to one and a half hour for silicone implanted via a breast incision. A few hours after the surgery has been completed the patient is ready to return home with her new bust. The Healing
The breasts will be tender, or even very tender, for the first 24 or 48 hours following surgery. The discomfort is more severe if the implantation is deeply behind the breast muscle. Because one can usually find a suitable resting position without pain, very often no ache is felt. Pain of course will be felt whenever the patient moves her arms, or even considers it. This is because the surgery has "damaged" the great breast muscle (pectoralis major) and such movements are always initiated by its contraction. Patients will benefit greatly, and assist the healing process, by keeping to a total relaxation regime. One gram of paracetamol, with or without codeine, taken four times a day (maximum dose) eases the discomfort. As acetylsalicylic acid enhances the risk of haemorrhage, it is forbidden two weeks before, and one week after surgery. During the first few days following surgery, a gurgling sound may be heard from the breasts when changing position. This is quite usual and is caused by body fluid which inevitably collects around the new implants. Within five days the fluid will have been absorbed. Sometimes, a little air can be trapped in the pocket immediately after surgery. This too is nothing to be worried about. There is no hazard in flying with breast implants. The convalescence
Stitches in the armpit can be removed after 10-12 days. If under the breast, the intracuticular stitches will remain for 3 weeks. During the first 4-5 days it is advisable to relax and be at peace with your body. After less than one week, the patient can move much more easily although for the first 14 days the breasts will feel swollen and uncomfortable. Exercise should be kept to a minimum - just gentle walking for the first 10 days. No jumping or riding for the first 3 weeks. After 4 weeks some gentle swimming can be sensible exercise and after 6 weeks patients may chose their own activities. The final bust shape will not be apparent until after 3 to 6 months. Complications
The most serious complication is bacterial infection. Thankfully extremely rare, it can occur within hours of surgery, or with a progressive fever over some days up to one week. This bacterial growth adjoining the implant can be dangerous, and in the very unlikely event of it occurring, the implant must be taken out. A new implant could then be put in after 4-6 months. It must again be stressed that these infections are extremely rare. (A small irritation of the scar is not an indication of a bad infection) Diminished sensation of the nipple or other part of the breast can occur in some cases. Because superficial nerves enter the breast skin via the space between two ribs, minor damage, particularly in the case of a larger implant, can result in some loss of feeling for weeks, months or even permanently. Following surgery a capsule always forms around the implant. In a few cases, after some six months the scar formation becomes rigid, and if this condition does not diminish within a year, the surgeon will rupture the formation by gently squeezing to break up the hardness of the capsule. This is done while the patient is fully awake, and without anaesthetic to lessen the risk of damage to the implant. Alternatively further surgery may be required to divide the capsule. Twenty years ago the problem was much more common, but now the augmented breasts should feel soft and natural. Of course, it is impossible to carry out the breast enlargement procedure without some risk of the implant becoming hard. Implants can rupture. The outer silicone shell can break, and the valve of a saltwater prosthesis can leak. Overnight the breast can lose volume. A leak from a silicon-filled implant may go unnoticed for months or even years, because only a small amount has discharged onto the scar capsule. This may then thicken to stop the silicon penetrating its protective shell and escaping. If the implanted breast eventually hardens this can be a tell-tale sign of leakage. There is no solid proof that silicone-filled breasts pose any danger to a woman. On the contrary, after decades of use our experience is that our bodies accept silicone very well. Providing the implanted breast undergoes no change in the way it feels when handled, there is absolutely no need to replace the prosthesis after a set number of years. The final result
Following surgery, almost every woman - whether she has had regular or even oversized implants is a happier person than prior to the operation! This holds true even when the result - technically speaking - may not have been a 100% success. |
