Breast Advice

Created on 25th February 2009

Consultant cosmetic surgeon, Rajiv Grover, examines breast implant options

Breast augmentation (enlargement) is the commonest cosmetic procedure in the UK. There is, however, a growing trend for women who have completed their family to have the procedure, but rather than looking for an enlargement, they are seeking a more natural look and are trying to get back what they had before childbirth rather than changing the way they look. This is known as ‘breast rejuvenation'.

Breast augmentation is suitable for women who have naturally small breasts or where there has been shrinkage in size following a pregnancy or weight loss. All breast implants rely on a shell (the outer part of the implant) and a filling which is usually silicone gel. Recent advances in implant technology have included the following:

1. Tear drop shape: a more natural shape to prevent the stuck-on look
2. Cohesive gel: a consistency of semi-solid jelly to reduce leaking
3. Texturing of the surface of the implant (rough rather than smooth)
4. Better information on the true lifespan of implants
5. Achieving a natural look after having children

Tear drop shape

The most important goal of breast enlargement must surely be to achieve a natural look. If there is a reasonable amount of breast tissue to start (usually a B cup or larger) then inserting a breast implant means it will be covered by a reasonable thickness of your body's own tissue giving a smooth natural outline. If the chest is very thin and you have a small amount of breast tissue the implant will only have a thin covering of your body's tissue and may look ‘stuck on' with a visible outline to the upper half of the breast implant. To reduce this appearance the newer implants are tear drop shaped to give a gentler slope to the upper part of the breast. Other techniques such as placing the implant under the muscle also help to reduce this problem. Perhaps where tear drop implants are particularly helpful is following breast feeding when there has been significant loss of volume from the lower half of the breast. Particularly if such a person is thin, tear drop implants here have revolutionised the results of breast augmentation.

Cohesive gel

Advances in the technology of silicone have lead to cohesive silicone gel which has the consistency of jelly and does not leak even if there is a break in the implant. The safety of silicone implants has been extensively investigated over the past decade and much of the controversy has now been cleared. Silicone breast implants have not been found to cause harmful effects in an independent review into all published research by the UK Government (Independent Review Group 1998) and this has since been confirmed in the European Union and the United States Government by the Food and Drug Administration (FDA 2007) where silicone breast implants are now widely used again for cosmetic enhancement.

Texturing of breast implants

One of the most important long-term problems with breast implants was hardening; the body produced a capsule around the implant rather than the usual thin film of membranous tissue seen when any foreign material is inserted in the body. This used to affect 15 to 20 per cent of women with implants (1 in 5) over the first ten years and was found to be due to implants having a smooth surface. The advent of a textured surface to the implant reduces the body's reaction to implants and so the rate of hardening over the first ten years has dramatically reduced to 4 to 5 per cent (1 in 20).

How long do breats implants last?

Despite being resistant to extreme pressures breast implants are still susceptible to daily wear and tear. This means that the outer shell or coating of the implant may develop tiny cracks after twelve to fifteen years. Until recently advice regarding changing implants assumed that they may need to be automatically removed at ten years. A large study was published in the American Journal of Plastic and Reconstructive Surgery in 2006 investigating women who had breast implants for longer than ten years with MRI scans. Only 8 per cent of women had any problems with the implants after an average of twelve years. The current advice is therefore to have a check once a year after twelve years but there is no need for automatically replacing implants unless they are symptomatic which may not be the case for many more years.

Achieving a natural look after children (‘breast rejuvenation')

Most women are looking for a natural look after breast enhancement and one of the latest trends is for women who have completed their family and are looking to get back what they had rather than looking to be very large. The goals of women in this growth area are to look natural, enhance the breast by one or one and a half cup sizes and to have a gentle slope to the upper pole so no one would know they have had surgery. These goals are met by the use of the ‘tear drop' implant, combining its use with possibly a lift of the breast if there has been significant drooping of the breast tissue. Statistics from the implant manufacturers suggest a rise of 38 per cent in the use of tear drop implants particularly in the small sizes (175 - 225 cc) which would increase breast size by one to one and a half cup sizes. This subtle change to the breast is termed ‘breast rejuvenation'.
CSMUK