Breast Augmentation

“Make Life More Beautiful” is a trademarked slogan of Mentor, an American manufacturer of breast implants. Indeed, a vast number of women choose to make their life more beautiful with breast augmentation using implants. According to FDA currently there are between 5 and 10 million women with breast implants worldwide.

Breast augmentation consistently ranks as the most commonly performed cosmetic procedure for the last decade – both worldwide and in South Africa. Statistics from ISAPS (International Society of Aesthetic Plastic Surgery) show that in 2016 alone 1,449,337 breast enlargements using silicone implants and further 61,780 using saline implants were performed worldwide.

Furthermore, ISAPS statistics demonstrate a steady increase in the number of breast augmentations performed per year, with the number in 2016 having grown by 11% compared to 2015.

The reason for such popularity is a very high level of satisfaction with the results of breast augmentation. A study published in the journal of Plastic and Reconstructive Surgery in May 2013 reported that a staggering 98% of women who underwent breast augmentation felt that the results met or exceeded their expectations. Women in this study reported both improved self-esteem and improved quality of life. Other studies have demonstrated improved body image and sexual satisfaction. “I feel more like a woman” is a common statement amongst women with breast implants. While some women get breast implants as part of a primary breast augmentation, for others it is part of the “mommy make-over” to “get their body back” after having children.

What is a Breast Augmentation?
Breast augmentation, or enlargement, is a surgical procedure during which a pocket is created either behind the breast tissue or behind the pectoral muscles and breast implants are placed. The goal of this procedure is to add volume and enhance the shape of the breasts.

What are breast implants?
Breast implants are medical devices used to enlarge the breast size, correct the breast shape or reconstruct the breasts after mastectomy or in cases of congenital abnormality.

What is in a breast implant?
Breast implants consist of a shell and a fill. The shell is made of silicone and may be smooth or textured. The fill may be silicone or saline.

What are the shapes of implants and which one is better?
Implants come in two shapes – “round” and “anatomical”. Round implants are shaped as a half sphere so they offer more projection in the upper pole of the breasts (cleavage). Anatomical implants are shaped as a teardrop offering less projection in the upper pole and more in the lower pole of the breasts, which is the natural shape of the breasts (hence the name anatomical).

The choice of implant shape largely depends on the preferences of the patient. This will be discussed in the pre-operative consultation.

Where are implants placed?
Implants may be placed under the breast or under the muscle. The advantages and disadvantages of either placement will be discussed in the pre-operative consultation. As a rule, in ladies who do not have sufficient soft tissue cover in the upper pole of the breasts (less than 2 cm on a pinch test), the implants should be placed under the muscle to avoid visibility.

Where will the scars be?
Scars are placed in the inframammary crease or around the areola. In the majority of cases, scars hidden in the crease under the breast off the best aesthetic result. The advantages and disadvantages of each scar position will be discussed in the pre-operative consultation.

How long is the procedure and what is the expected recovery time?
Breast Augmentation surgery normally takes one hour and is performed as a day case, so there is no need to stay in hospital overnight. Recovery time is generally one week, during which it is recommended not to drive or return to work. You will be asked to wear a special post-surgical supportive bra and avoid doing sports for six weeks.

Will I be able to breast feed?
Pregnancy and breast feeding are not affected by breast augmentation so most patients with breast implants can successfully breast feed. Studies showed no increase of silicon content in breast milk of women with breast implants.

Will I have changes in nipple sensation?
There may be an increase or decrease in the feeling in the nipple and/or breast. In most cases this is temporary and will fully recover, however is a small percentage of cases the changes may be permanent.

What can go wrong with my implants?
Both silicone and saline implants may rupture and/or leak. Saline implants may deflate. The tissue capsule around the implants may tighten (capsular contracture) causing the breasts to become hard, distorted and in advanced cases painful. Implants may get displaced due to gravity, trauma or capsular contracture. Wrinkling of the implant (rippling) may be seen or felt through the skin.

Will my implants ever sag? Can I avoid wearing a bra if I get breast implants?
Although breasts with implants tend to hold their shape longer and better than natural breasts, no one can withstand the effects of aging and gravity. However, we can counteract gravity by wearing a good bra, which is important for maintaining your breast shape whether you have breast implants or not. Changes in size of the breasts with pregnancy or weight fluctuations can also predispose to breast sagging.

Do implants last for a lifetime?
In the majority of cases implants need to be replaced. The longer you’ve had implants the higher the likelihood of developing problems (capsular contracture, rupture, leak, etc). It is not true that breast implants have to be changed every five or ten years, but they certainly need to be monitored and replaced should a problem develop.

Can old implants be reused?
No, it is not safe to reuse old implants. It places the patient at higher risk of infection and other implant related complications.

What follow up screening is necessary after placement of breast implants?
The investigation of choice in women with breast implants is an MRI. FDA recommends performing an MRI 3 years after placement of implants and 2 yearly thereafter to monitor for “silent rupture” – rupture of implants which is asymptomatic as the silicone is contained within the tissue capsule. Over the age of 40 years routine mammogram and ultrasound should be performed yearly for breast cancer screening.

Do implants cause breast cancer?
No, breasts implants are not associated with increased incidence of breast cancer. In fact, studies have shown that patients with implants get diagnosed with breast cancer at an earlier stage and therefore have a better prognosis.
It has recently been established that breast implants are associated with a rare treatable type of T-cell lymphoma – Breast Implant Associated Anaplastic Large Cell Lymphoma (BIA-ALCL). This disease is extremely rare – as of February 1, 2017, 359 were reported to FDA. For more information refer to FDA website.

Is it more difficult to detect breast cancer in a woman with breast implants?
Special views displacing the breast tissue off the implants (Eklund views) will be required to adequately visualize the breast tissue following breast augmentation. It is very important to go to a radiology center that specializes in breast imaging and inform the radiologist that you have implants.

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