Breast Augmentation: Your Choices

Created on 28th November 2011

Patrick Mallucci, one of the founding members of Mybreast, an organisation dedicated to bringing the highest standards to breast surgery, reviews the augmentation procedure

Breast augmentation (enlargement) has come a long way since the inception of the first implants in the early 1960s and is now the most popular operation in the UK with over 30,000 procedures being carried out last year. Implants today are highly sophisticated products of advanced research and technology.

The first implants were known as the first generation implants and today we are in the fifth generation of implant production. The advances in implant design have led to the production of devices which are safer, more predictable and much longer lasting than their earlier counterparts.

The main differences being in shell technology, which has drastically reduced silicone leakage, shell breakage and capsular contracture (hardening of the implant). The silicone gel itself is also very different, being much firmer than it used to be - now known as cohesive gel - allowing for more predictable shaping of the implant, less leakage, reduced hardening and greater longevity. However, not all implants are the same in terms of quality and manufacture and it is important that you do your homework here too.

Implants come in two basic shapes - round or anatomical (tear drop) - this gives the patient and surgeon the ability to chose the most appropriate implant for each individual. It is not to say that one type or shape is better than another; it is important to find the best match for each case. Silicone remains the material of choice for breast implants and all doubts about its safety have now been laid to rest. Even in the US silicone implants were reintroduced into the mainstream last year as the preferred choice of implant.

Many women benefit from breast augmentation for all sorts of reasons and in the right person it can be a life enhancing procedure. Commonly, women fall into three main categories: those who have never had any significant breast development; those who have lost breast volume following pregnancy and breast feeding; and those who simply want to  be bigger than they are. In each case the key to a successful outcome is good communication between surgeon and patient.

For the surgeon it is vital to be able to understand the desired outcome and expectation of the patient and to assess whether this expectation is realistic or not. One thing I tell all my patients is that the outcome of surgery depends very much on the starting point - and every woman's breasts are different sizes, shapes and dimensions each requiring individual planning. Some women will require more than just an implant and occasionally will also need a lift at the same time in order to obtain the best result.

The procedure is carried out under general anaesthetic and requires either an overnight stay in hospital or can be done as a day case procedure. Different incisions can be used to approach the breast in order to place the implant into the breast pocket - there are normally three options: a small incision underneath the breast (in the fold), around the lower half of the areola, or via the arm pit. It is important to discuss with your surgeon the advantages and disadvantages of each and to select the most appropriate one for you.

The implant can also be placed in different positions within the breast - it is positioned either on top of the pectoral muscle or underneath it. Broadly speaking, those who are very slim and have small breasts will have the breast implants placed behind the muscle in order to provide as much ‘cover' over the implant as possible. Those who already have a reasonably sized breast often have enough cover already for it not to be necessary to place the implant underneath the muscle.

The ‘dos and don'ts' after the procedure depend partly on the patient and on the surgeon's advice. In general, women are advised to avoid strenuous upper body activity (swimming, moving weights) for 4-6 weeks with other activities gently being encouraged as pain and discomfort wears off. Good aftercare is essential in terms of bra selection for support, and monitoring of the healing process - advice will be given to promote the best scar healing.

Breast augmentation today is a safe procedure, and while complications do arise in unusual circumstances it is important to discuss these with your surgeon. In the long term the main problems that are encountered are of hardening of the implant or breakage/ rupture. Neither are a health risk but simply mean that it is time to replace the implant. Implants are much more durable than they once were and to reflect this the best implant manufacturers now have a lifetime warranty on their implants. It is no longer necessary to change them every ten or so years; if all is well they can be left in place indefinitely. CSMUK