Measuring Up

Created on 25th September 2008

Top surgeon Andrew Skanderowicz of the London Cosmetic Surgery Centre examines breast augmentations

Breast augmentation is still the top surgical procedure for women in the UK. Despite the silicone breast-implant controversy that blighted this operation in the late 1980s and early 1990s, silicone breast implants are now very firmly back on the agenda, according to medical director of the London Cosmetic Surgery Centre and co-author of Every Woman's Guide to Cosmetic Surgery, Andrew Skanderowicz FRCS.

There are no exercises or medications currently available that can safely, effectively and permanently increase breast size. The current recognised, accepted and regularly performed method for increasing breast size involves the insertion of a silicone breast implant behind the natural breast tissue.

Various methods have been tried intermittently over the years with limited success, most notably fat injections, which never seemed to gain popularity in the UK because of the high incidence of failure and complications. However, it seems that this method is currently experiencing a resurgence in popularity as some surgeons, especially from the USA, claim consistently good, but rather limited results.

From time to time adverts appear in the Press claiming a revolutionary technique to enhance breast size. Usually such claims employ the use of tablets, creams or local stimulation such as vacuum pumps. I would urge extreme caution when considering these options, as invariably these claims are a short-term scam to make huge amounts of money for the perpetrator.

No one should ever purchase any breast-enhancing oral preparations that are advertised in the Press unless they have previously discussed it with a qualified medical practitioner. Any medical preparation that has received proper approval for the treatment of any condition will have previously been extensively researched. Results will have been published in the medical press and, if it is a non-prescription drug, it will be readily available in chemists.

Why seek breast enlargement?
In general, three types of women seek breast enlargement. The first consists of those who have never had a full development of breast tissue and simply wish to become larger.

The second group consists of those who may have had normal breast development but who wish to become larger because their breasts have decreased in size or changed shape following pregnancy, weight loss or ageing.

The third group consists of those who have suffered previous breast disease, particularly cancer, where breast tissue has been surgically removed. These patients seek breast reconstruction, which usually involves the insertion of a breast implant. 

The types of implants available
All breast implants currently available have an outer silicone plastic shell called silastic, which has either a smooth or textured surface. It is the nature of the filling substance that differentiates the types of implant. Implants are manufactured in various shapes and sizes to suit different requirements.

Other filling agents besides those described below have been used in the past but have been withdrawn because of safety issues, for example, Trilucent implants (vegetable oil) and Hydrogel implants (salt and sugar solutions).

• Standard silicone gel - This filling has a long history of reliable use with a natural feel. The main disadvantage is the possibility of leakage and rupture.
  

• Firm cohesive silicone gel - This filling is made to a solid consistency that maintains its shape. The gel does not ooze if the implant ruptures. The main disadvantages are its high cost, an unnatural feel and asymmetry with rotation of the implant.
  

• Saline - This is a biocompatible filler with a long history of use. The main disadvantages are that they are unsuitable for women with little breast tissue as well as being more prone to wrinkling and rupture. Saline implants come with smooth and textured surfaces and once inserted into the breast pocket can be inflated with saline to the required size. Unfortunately these implants are not very popular with UK surgeons as they have an increased tendency to rupture as a result of the friction forces between the saline filler and the silicone shell. Or deflate due to failure of the filling valve.
  

Over the last 25 years implant manufacturers have developed a wider range of sizes, shapes and types of implant. The ‘round' implant is the most popular shape used by surgeons in the UK. Every woman is unique and the size and shape of the implant is usually determined at the time of consultation although the final decision will be made at the time of the operation.

Pre-operative consultation
At the pre-operative consultation you should have a list of questions for your surgeon in the unlikely event that he will not have covered any of the important points pertinent to this operation. You should ask the following:

How big will I be after the operation? It is not possible to pick a breast off the shelf because surgeons can only work with the materials at their disposal, i.e. the patient's tissues, which influence the size and shape of the implant that it is possible to insert. Surgeons, at best, can only give a patient an approximate idea of the size; making promises can lead to disappointment. Showing preand post-operative photographs is useful, as a patient's reactions will nearly always indicate their likely reaction to the result of the operation.

What are the likely complications?

How long do the implants last and when should I change them?

How long do I need to stay off work?

How safe are silicone implants?

Any other questions you can think of that may be pertinent to your situation.

The operation
A general anaesthetic is used in most cases, although this procedure is increasingly performed under intravenous sedation and local anaesthesia on a day-care basis. The incision - 3 to 4 cms in length - is most commonly made in the crease underneath the breast or around the areola. A pocket for the implant is created in the breast which is then inserted and the skin is closed with stitches that do not come through to the skin surface so there are no stitch marks. A bandage or supporting bra is usually applied. This is removed the following day when the patient is fitted with a bra. The sutures are removed after seven to ten days. CSMUK