Augmentation

I have included here an article I have written on Breast Augmentation, which should provide good background information.

Referring to the aforementioned article, Breast Augmentations are usually performed under local anaesthetic with conscious sedation and are normally day case procedures, whether the implant is placed above or below the pectoral muscle.

I usually do not use drains and waterproof dressings are applied in order that the patient can shower from day one.

No bandaging is required and the patient usually is usually fitted with a surgical bra.

“STORM IN AN A-CUP”

Breast Augmentation has become fashionable again. It seems that the furore over implants has waned and more and more women are, once again, seeking an increase in the size of their breasts.

So, who typically, has breast augmentation and what does a breast augmentation involve ?   What are the options available ?

Breast augmentation is an operation to increase the size of the breasts. It involves the insertion of an implant below the breast tissue to increase breast volume. Patients who typically seek breast augmentation are usually in two age categories. There’s the nineteen to twenty-nine year age group – who generally have not had children and who have always had small, A-cup sized, breasts. They seek an increase in the size of their breasts, and this can most certainly be performed, without interfering with their ability to breastfeed. The second group of patients are those in their mid to late thirties, who also seek an increase in the size of their breasts but this is usually after they have completed their families and breastfeeding. These patients often state that their breast volume was adequate prior to having children and breastfeeding, but now feel that their breasts have “shrunken” and require augmentation to return to their previous size and form.

The concern often expressed by patients is “can cancer still be detected?” – “can I have a mammogram?”… It is important to remember that implants are placed behind the breast tissue and this means that one can still palpate the breasts for lumps etc. Mammograms are, also, still possible. If necessary, an ultrasound may also be performed.

Breast augmentation involves placing an implant below the breast tissue or the pectoral muscles. The optimal position is usually determined by your plastic surgeon in consultation with you. The amount of breast tissue, your body fat, the amount of breast ptotis (droop) will determine the optimal position for inserting your implant. Patients who are very thin and have little soft tissue cover, and minimal breast tissue, might best be served by having the implant placed below the muscle. Those with more breast tissue, and sufficient soft tissue cover, can have the implant inserted below the breast tissue. If the breasts are excessively ptotic (droopy), they might require not only the placement of an implant but also a mastopexy (lifting of the breast). The surgeon will usually be able to discuss the above with you on examination.

There are also various options available as to how best to ‘insert’ the implant i.e. what is the best ‘access incision’… The incision for placement of the implant may be made in the inframammary crease i.e. the breast fold underneath breast; via the areola (incision in the lower half of the aerola usually provides access);   or via the axilla under the arm. The incision used for placing of implants usually heals with a very fine line scar that is barely visible.   The incision is usually about 4.5 – 5.0 cms in length. Implants are also now being placed via the umbilicus. This technique is not commonly performed. The site of the incision will obviously be decided in consultation with the plastic surgeon.

But, what about the implant – and what should one choose ? Silicone or saline breast implants ? Breast implants consist of an outer shell containing a filling. This shell is, most commonly, silicone and the filling can be either silicone gel or saline. Silicone appears to be the most popular filling in South Africa. Silicone implants have been the subject of much controversy since the F.D.A. stopped their use in breast augmentation patients in the United States.   However, all scientific research and data, to date, has shown that there is no link whatsoever between silicone and any form of cancer nor any auto-immune connective tissue disease i.e. arthritis or likewise. The FDA has approved the use of FDA approved silicon implants. Your surgeon will generally have implants available in his consulting rooms and you would be able to choose, in consultation with him, which you would prefer.

As for size – how does one choose ? There are no “B-cup” or “C-cup” implants the implants are usually in millilitres of fluid i.e. 200 mls; 220 mls;  250 mls etc. Should you desire a C-cup, the implant required would obviously depend on the amount of breast tissue you have at present and then adding to that the volume of the implant. This size choice can also be made at the time of your consultation with the surgeon.   He can show you the various sizes.     These can then be tested in a bra, wearing the type of T-shirt you prefer, and this will then give you an idea of the final result. It is important to remember that the implant size should be in keeping with your physique and the amount of tissue you have present to accommodate this size. You cannot insert an extremely large implant if there is insufficient tissue to cover same !

Are there any risks associated with breast augmentation? Of course, there are risks associated with all surgery and the same applies to breast augmentation. Common surgical complications such as bleeding and infection, can occur. These usually occur in the immediate post-operative period and will need to be dealt with by your surgeon. Bleeding will merely require evacuation of a clot and there is usually no further problem. Infection, however, is a slightly more dreaded complication and can result in removal of the implant. Treatment with antibiotics will be required before replacement of the implant, and only once all the infection has cleared. A complication peculiar to breast implant surgery, is the formation of a capsular contracture. All implants result in capsule formation. This capsule is usually soft and very pliable and the body’s normal response to the insertion of any foreign body. (This same capsule forms around a “pacemaker” inserted to control the speed of your heart.) However, in some patients, this capsule can harden, causing a condition known as “capsular contracture”.   Should this occur the breast will have an unnatural and slightly hard and distorted appearance.   Breast implants have improved in their structure and the incidence of capsular contracture appears to have decreased. Should this, however, occur there are methods to treat it and this can obviously be discussed with your surgeon. It is important to remember that the implant is not going to ‘explode’ on the aeroplane ! – and is extremely unlikely to rupture, except in extreme trauma, such as in a motor vehicle accident etc.

What about the surgery? The operative procedure is usually fairly quick, being performed as “day case” surgery, having the surgery in the morning and being home the same day.   Returning to strenuous exercise, such as gym etc., is usually delayed for up to three weeks.   Performing normal daily activities can usually be done within 48 – 72 hours. The procedure can be performed under general anaesthetic or local anaesthetic with sedation. The procedure performed under local anaesthetic with sedation, usually involves an anaesthesiologist keeping you in a ‘twilight zone’, whilst the surgeon infiltrates the local anaesthetic and performs the procedure.

Breast augmentation is a fairly safe and straightforward procedure. There are various options as to implant placement; access incision; and size. The options that are best suited to you are decided in consultation with your surgeon. All patients are individuals and their treatment is, therefore, individualised according to their physique and requirements. There is not one method that suits all patients – the method your friend had will not necessarily suit you !   Remember, all surgery carries some risk. It is important that you are fully informed and discuss all with your surgeon prior to the operation.

NEW DISEASE ENTITY

Breast Implant Associated Anaplastic Large Cell Lymphoma (BI-ALCL)

BI-ALCL is an extremely rare and highly treatable type of lymphoma that can develop around breast implants.

BI-ALCL is not a cancer of breast tissue.

BI-ALCL is very rare and there is therefore limited data.   More information is needed to fully understand the possible association between breast implants and BI-ALCL.

The exact origin of the disease is unknown and researchers are exploring immunological, genetic and bacterial causes.

Based on the latest scientific information, the FDA and MHRA (UK) are not recommending any change in current best practice to post-implant care and check-up.   Women with breast implants should be advised to perform regular breast self examination and consult their healthcare practitioner if they notice any changes.

Changes such as pain, lumps, swelling, fluid collection or unexpected changes in breast shape, including asymmetry should be brought to your healthcare practitioner’s attention.

Changes were most often noted after the initial surgical sites were completely healed (mostly 6 to 8 years post surgery).

Please contact me should you have any queries or concerns.