| Breasts are made up of a combination of glandular tissue, connective tissue and fat, and the ratio of these varies between women. The size and shape of the breasts often changes over time due to pregnancy, breastfeeding and menopause. Many women view their breasts as a vital component of their gender identity, motherhood and sensuality, and often feel insecure if their breasts have changed over time.
Breast augmentation is a surgical procedure that increases the volume of the breasts through the insertion of prosthetic implants. Implants range in volume from 90 to 900 millilitres and also come in different shapes. They have either saline or silicone filling, smooth or textured silicone or textured polyurethane envelopes.
Procedure
The breast augmentation procedure involves the surgical placement of a saline or silicone gel-filled implant in each breast to push the breast tissue forward. The patient is anesthetised, either with general anaesthetic or twilight sedation, and the chest area is cleaned and marked up with guidelines by the surgeon. Then the surgeon makes an incision that enables them to lift the breast tissue to create a pocket above or below the pectoral muscle for the implant. Depending on a patient's anatomy, breast condition and other factors, the implant can be inserted through four different incision sites according to the patient and doctor's choice of which will work best and takes into account where the residual scarring will be located.
After making an incision, the surgeon cuts a channel through the tissue to the final location of the implant. Having created the path, the surgeon then separates tissue and/or muscle to make the implant pocket. Surgeons create the pocket to receive the breast implant using one of two methods: blunt or electrocautery dissection. With blunt dissection, a curved, blunt steel instrument or the doctor's index finger is used to separate tissue to create the pocket. While blunt dissection can cause bleeding and trauma, it is fast and effective. Electrocautery dissection employs electrical current to cut tissue and coagulate bleeding vessels at the same time, resulting in greater visibility and consequently greater accuracy for surgeons. Because using electrocautery dissection causes less bleeding and tissue trauma, it can shorten recovery time. The implant is inserted through the incision and strategically positioned by the surgeon.
The incision is closed with sutures or surgical glue and covered with tape, which helps the tissues adhere. In some cases additional dressings may be applied or a surgical bra may need to be worn
Incision Types
When planning a breast augmentation, the choice of incision site is an important consideration. The goal is to minimise scarring as much as possible. Incision placement is generally a matter of personal preference, however it is important to consider the type of implant and your anatomy. There are four options of incision types to choose from when considering undergoing a breast augmentation.
Inframammary
The inframammary incision is the most common breast augmentation incision used today, made in the crease under the breast close to the inframammary fold. The surgeon creates a pocket for the breast implant, which is slid up through the incision, then positioned behind the nipple.
This incision offers the best exposure for visualisation and allows the implant to be placed over, partially under or completely under the chest wall muscle. The surgeon is able to work within close proximity of the breast so placement and bleeding can be controlled. The scar is hidden in the crease under the breast and is not normally visible when wearing a bikini top.
Periareolar
The periareolar incision is currently one of the most widely used methods for placing breast implants. An incision is made just beyond the areola, which is the darker area of skin surrounding the nipple. The incision should be made at the very edge of the areola where the dark tissue meets the lighter breast tissue, which makes the scar least visible.
Similar to the inframammary incision, the periareolar incision allows the surgeon to work close to the breast. It is possible for the surgeon to easily and precisely place the breast implants in various positions in relation to the chest muscle.
However, this is the only incision that involves cutting through breast tissue and ducts. Sensitivity in the nipple may be reduced. Any complication in scar healing may be highly noticeable as they are situated right in the centre of the breasts.
Transaxillary
The transaxillary incision is made in the natural crease of the armpit and a channel is created down to the breast. This may be performed with an endoscope (a small tube with a surgical light and camera in the end) to provide visibility. The implant is inserted and moved through the channel into a prepared pocket.
The greatest advantage of an underarm breast augmentation incision is that no scar is left on the breasts. The scar is virtually invisible in the armpit fold and lack of tension makes for straightforward healing.
The greatest risk with the incision is complications with asymmetry, a higher incidence of the implant being positioned too high.
Transumbilical or navel (TUBA)
The TUBA incision is made on the rim of the navel. An endoscope can be used to create a tunnel and to provide visibility to the surgeon. After a pocket is created in the breast, the implant is inserted through the incision and moved up into the breast area and positioned in the pocket.
The resulting scar from the TUBA incision is virtually undetectable and does not appear on the breasts. Inserting breast implants through the navel requires only one incision (and scar) for both breasts, while other incision sites require separate incisions.
However, this incision can only be used for saline implants as the filling is added after the implants are placed. Also, the distance of the incision from the breast can reduce the surgeon's ability to control bleeding and to position the implant correctly.
Types of Implants
Filling
Saline and silicone breast implants both have an outer silicone shell however they differ in material, consistency and techniques used for placement. Both types of implants have their own advantages and risks.
Saline-filled implants use a medical grade saltwater solution, which makes the implant feel like a water-bed. This can be controlled to an extent by the volume of fill in the implant. If implant rupture occurs, the saline is absorbed by the body. However, saline implants feel firmer than silicone implants and have a higher risk of visible folds and ripples.
Silicone gel-filled implants contain a cohesive gel, designed to mimic real breast tissue. It has a slightly firm, non-runny consistency, which can give a more natural feel. As the gel is not liquid, the risk of dispersal if the implant ruptures is minimised. It also maintains shape better than a saline implant, especially in the upper part of the implant.
Texture
Implants can come in textured or smooth. Textured implants have a thicker shell. Textured implants often carry the risk of causing an unwanted rippling effect in the skin. Smooth implants have a thinner shell and are said to last longer and are less likely to cause rippling.
Shape
The two basic forms of breast implants are round or teardrop (anatomical) shaped. Round implants, depending on their fill can give a defined round shape or assume more of a teardrop form when the patient is upright. They tend to provide more upper pole fullness than anatomical implants, which are fuller in the lower pole.
Anatomical implants more closely resemble the natural shape of a breast. However, they demand a greater degree of accuracy in positioning and if they shift after surgery, the shape of the breast may be distorted.
Anatomical implants can also provide greater projection in proportion to the size of the base, making them particularly suitable for women with little natural breast tissue.
Recovery
After the procedure, you will be taken to a recovery area where you can relax before going home with your driver. You will be given the prescription for the medication you are to take for the first couple of days. Typical instructions for breast augmentation recovery include limiting movement and getting plenty of rest. Any activity that involves lifting or bending should be avoided as it can increase pain and soreness and can delay healing.
The first 48 hours are generally the most difficult, you may experience discomfort and fatigue during this time, and some patients may feel nauseated from the anaesthesia. Your chest may feel tight and uncomfortable, and your breasts will be very firm, high and swollen.
After a few days the dressings are removed. Depending on the type of technique used, you may have drains and compression bandaging. Some surgeons recommend wearing a surgical bra during healing. Bruising fades in the first week or two and any stitches are removed after about one week. Many women are able to return to office work after three to five days. For more physical work, wait one or two weeks. Recovering from breast augmentation surgery can take several months in its entirety, depending on what kind of procedure you have undergone.
Risks/Complications
As with any surgery there are risks involved, patients should be fully aware of any potential risks and complications.
They may include:
• Capsular contracture (hardening of the breast)
• Rippling
• Infection
• Haematoma (bruising)
• Sensation loss or change
• Implant displacement
• Rupture
• Breastfeeding difficulties
• Asymmetry
• Further surgery required |
