The breasts are the most attractive and feminine trait of a women’s personality besides being an important functional organ. Full looking breasts seem to make a woman feel more complete. The shape and size of the breast can be changed by augmentation mammoplasty. Women desirous of larger breasts can fulfill their wishes by this procedure. Cosmetic breast enlargement is done by placement of a breast implant behind the breast and chest wall muscles.
The breast implants are available in many sizes and shapes. All breast implants are made with silicone envelope (bag). Many of them contain only silicone gel. The inflatable implants come empty and after placing in the body, it is filled with saline. There are other double lumen implants that have silicone gel in their inner compartment and saline in the outer. The US FDA has approved cohesive gel silicone implants for breast augmentation.
If there is excessive sagging of the breasts, breast tightening with reshaping (mastopexy) can be done at the same time. Because the implants are placed behind the breasts tissue and the muscles, there are usually no problems in breast examination after the enlargement. Also, there is no problem in breast-feeding after this surgery. Till date, there is no recorded evidence of increased risk of breast cancer after silicone implant surgery. The scars of surgery are well hidden and the breasts look and feel natural.
Pre Surgical Evaluation for Breast Implants
After the initial consultation, a clinical examination is performed to assess the breast architecture including size, symmetry, proportion to rest of the body and any other anomalies. The surgical plan will depend on the findings of the clinical evaluation. The presence of any breast diseases also needs to be ruled out.
The size or volume of the implant to be used will depend on 5 key factors – your expectation/desire, chest size, amount of existing breast tissue, skin envelope of the breast and any drooping of the breast.
Blood tests, a baseline mammogram or Ultrasonography of the breasts and other tests for anesthesia also form part of the pre surgical evaluation.
Operative and post operative:
The augmentation surgery is carried out under general anesthesia and is painless. About 2 inches cut is made under the breast where it joins the chest wall. After making adequate space under the breast tissue or the underlying muscle the breast implant is placed and cut is closed. Most of the cases go back home same evening and can resume light routine activities in about 2 to 3 days time. Stitches are removed after 7 to 10 days.
Results and complications:
Increase in the size of breasts and breast lift gives a great feeling of satisfaction to most of the cases. It enhances one’s appearance and self esteem. Depending upon the size of the implant there is one or more increase in the cup size of the bra. The post operative period following breast implant surgery is generally pleasant and well tolerated. Minor discomfort, feeling of stretch, swelling and bruising can be expected. Most patients are able to start normal daily activities starting the next day and return to office work in 2-3 days time. Decreased sensation over the breast can occur and usually recovers in a couple of weeks. Formation of tight capsule around the implant causing it to feel hard or deformed is sometimes seen. Capsular contracture can occur as a late complication. Our body forms a capsule around the implant. This capsule can thicken and distort the implant in some cases. The exact reasons and causative factors for capsular contracture are not known. Breast exercises instituted 2 weeks after the surgery and continued for a year afterwards go a long way in preventing capsular contracture. Rarely infection can occur around the implant in which case it may require long-term antibiotics, replacement or even removal. Occasionally, complications such as bleeding, infections, changes in sensation, asymmetry, rupture, leakage or deflation of implants, psychological problems, healing problems, unsatisfactory scars etc. can occur. Firmness or hardness of the breasts in varying degrees can also occur in a few patients. On extremely rare occasions, it may be necessary to remove an implant due to rejection by the body.
Pre Op. Instructions:
1. Wash whole body with liquid Betadine surgical scrub soap 24 hours prior to surgery.
2. Wash only the chest with Betadine surgical scrub on the night before and morning of surgery.
3. Nothing by mouth (not even water) for 6 hours prior to surgery.
4. Take medicines according to the instructions given.
5. Shave the underarms 6 days prior to surgery. After this, don’t shave them until 3 weeks after the surgery.
6. Never shave the breast or the nipple area.
7. No Aspirin or Vitamin E or Birth control pills for 2 weeks before the surgery.
8. Stop smoking or drinking alcohol at least 2 weeks before the surgery.
9. Please do not wear any jewellery (nose rings, ear rings, toe rings, bangle).
Post Op. Instructions:
1. Diet as directed. Liquids on the day of surgery. Normal diet can be resumed the next day.
2. See the doctor as advised in 3-5 days after the surgery.
3. Take medicines according to the instructions given in the prescription.
4. Do not take Aspirin or Birth control pills for 2 weeks after the surgery.
5. Do not get the areas of surgery wet until further instruction.
6. Keep the head elevated at all times and do not turn on sides for three to four weeks from the day of surgery.
7. Arm movements: Limit the use of your arms almost entirely for the first 3 weeks following the surgery. You may raise your arms to the level of the shoulders during the next three weeks. Raising the arms above the level of the shoulders should not be done until 6 weeks after the surgery.
8. Do not undertake any strenuous activities or exercises or lift heavy objects for 8 weeks.
9. The areas of surgeries will have to be massaged as advised starting from 3 weeks.
10. Wear loose fitting clothes, which opens in the front or back (to avoid arm movements). Wear the brassiere prescribed after the surgery as advised.
11. Long distance travel can be undertaken 14 days after the surgery.