Cosmetic Surgery
Breast Enlargement
There are two common reasons for surgical breast enlargement. The first is that the breasts are too small by comparison other body measurements such as hip circumference and height. This may be because the breast tissue did not develop adequately in the first place, or because they reduced in size as part of the aging process or following breast feeding or weight loss. The second is breast asymmetry (inequality in size or shape). This may be developmental or because of previous surgery for breast cancer or benign disease.
Surgical augmentation of the breast is achieved using an artificial implant that is placed deep to the breast tissues. The implant size is varied according to the wishes of the patient. The implant itself contains a jacket (capsule) and a "filler" of saline with or without silicone gel.
In recent years, some patients have raised concerns about the potential for implanted silicone to cause disease. To date, however, these claims have not been substantiated by carefully performed scientific studies examining the health of thousands of patients who have previously undergone silicone implant augmentation.
THE OPERATION
During the surgery, an implant is placed under the existing breast tissue or under the chest muscle, depending on the patient's breast shape and size. The procedure is done under general anaesthesia and takes about 20 minutes each side. It requires one nights stay in hospital afterwards.
Scars are an unavoidable result of the incisions required to place breast implants, but they are small and can be placed inconspicuously in the fold underneath the breast or through any previous scars.
Some discomfort arises from the stretching of the breast tissues, but it largely resolves within two to three days and can be minimised by using simple pain killers such as ibuprofen (Neurofen). Patients generally return to work within one week, but should avoid excessive exertion for the three to four weeks it takes for bruising and swelling to resolve.
POSSIBLE PROBLEMS
Following any surgery, howerver meticulously performed, there can be complications. Augmentation is no exception.
Postoperative complications can include excessive bruising around the implant or infection. This is in spite of the use of antibiotics during the procedure. Both problems occur infrequently, but can necessitate a second operation or temporary removal of the prosthesis. Although the implants are designed to withstand even the possible impact involved in a car accident they may occasionally leak. This is uncommon, but if it occurs, the implant would need to be replaced. Some patients develop a firm layer of scar tissue around their implants which can make the breast hard to the touch or painful. This is called capsular contracture. this can cause the breast contour to be asymmetrical and may require secondary procedures for improvement. Nipple sensation can be changed by the procedure. Most patients are able to breast-feed following augmentation.
Breast implants do interference with mammography making the detection of early breast cancers more difficult. This is an important consideration particularly if you have a family history of breast cancer. All augmented patients need to inform their radiologists of their implants so any screening technique can be modified.
Despite these limitations, approximately two million women are estimated to have undergone breast enlargement surgery. The overwhelming majority are very satisfied with the results.
Information kindly Provided by Prince Phillip Hospital, Llanelli
BREAST REDUCTION
Surgical reduction of breast size is a common plastic surgical procedure. Reduction mammaplasty is rarely done only for purely cosmetic reasons. This operation aims to reduce the weight of the breast. Patients who choose this surgical procedure are almost always very happy with the results.
The patient with very large breasts can suffer from a variety of symptoms. The weight of the breast tissue can cause back strain and discomfort. The bra straps often cut into the shoulders causing permanent grooves in the shoulders. Especially in summer sweating beneath the breasts can cause a chronic skin rash. Self consciousness about breast size and teasing, particularly at school, is common. Large breasts often interferes with a woman's ability to exercise and move her arms.
Breast hypertrophy(enlargement) may occur at any time in life from puberty to old age. The operation of reduction mammaplasty is carried out to relieve these symptoms and should not be confused with the "breast lift" or mastopexy procedure which is done for cosmetic purposes only. (The majority of insurance policies will cover medically indicated breast reduction but not mastopexy).
Diagnosis and Planning
At the patients first visit the surgeon will take a medical history and perform an examination. He will determine what benefit might be obtained from the procedure. All operations carry some risk and reduction mammaplasty procedure is no exception.
There are risks associated with the anaesthetic. These risks are usually quite small but they will be discussed with you.
There will be some bleeding during the operation but it is seldom necessary to transfuse patients undergoing this procedure. There is a possibility of infection in any surgical procedure and this is in spite of routine treatment with antibiotics. Any incision through all the layers of skin will leave some scaring. Usually the scars fade with time but there is a small risk of developing thickened (hypertrophy or keloid) scars. Particularly the vertical scar will tend to widen with time. All these possible side effects will be discussed with you.
Some loss of sensation of the nipple can be expected after surgery, although it is rarely completely numb. It may be possible to breast feed after such surgery.
During the examination the surgeon will assess your general health and will examine and often take some measurements of the breasts. He will ask about family history of breast disease and may recommend a mammogram prior to operation. The surgeon will ensure that there are no other breast diseases present and no general health problems that would prevent safe surgery. Discussion about the amount of tissue which will be removed and the possible complications of breast reduction surgery will help you understand the process. The surgeon will show you pictures of the likely result and the surgical procedure.
OPERATION
Prior to operation the surgeon will use a special felt pen to mark the breasts both with you standing and lying. There are several acceptable surgical techniques depending on patient anatomy and the surgeon's preference but mostly it will involve marking out and area for the new nipple in a position higher than the old, and reducing the size of the nipple as well as marking the area of skin and breast tissue to be removed.
The precedure usually takes about 2 hours. The stiches used are soluble and hidden beneath the skin. They do not need to be removed afterwards.
AFTER THE OPERATION
The usual stay following breast reduction surgeryis 3 days. The operation does not usually cause much pain afterwards, although some tightness and bruised discomfort is common. You may need to take some simple painkilllers such as paracetamol for a few days afterwards. A wound drain is placed at the time of surgery and will be removed before you go home. A small amount of loss from the wound is common and can be absorbed by a light dressing.
You will need to wear a good supporting bra day and night for 3 months after the surgery to reduce the tendency for the wounds to stretch. You will be seen in the clinic after 6 weeks and then only as needed after that.
