Augmentation Mammoplasty (AM)- Cosmetic Breast Surgery
The size of your breasts is determined by the genes you inherited from your
No exercises, creams, or machines can change the size of your
Breast surgery can enlarge small breasts using implants, reduce the
size of large breasts, or lift sagging breasts.
Keep in mind
Any surgical procedure done on your breasts will leave scars. Surgeons can hide
many scars by making the incisions under the fold of the nipple. Before you make
a decision about having breast surgery, ask your doctor to show you some
photographs so you can see what the scars will look like.
Some forms of breast surgery, especially breast reduction, can make it
impossible to breast-feed. If you are concerned about not being able to
breast-feed, talk to your surgeon before you have any type of breast surgery.
Many women have one breast that is slightly larger than the other.
breasts differ so much in size that their bras and other clothing do not fit
properly and they feel self-conscious. A surgeon can perform surgery on one or
both breasts to make them look more alike. Your surgeon will help you decide
whether you would feel more comfortable making the smaller breast larger (using
a breast implant) or making the larger breast smaller.
Breast enlargement technically called Augmentation Mammoplasty (AM) is a
surgical procedure to enlarge small breast or breast that has lost their
fullness by inserting a synthetic implant under the skin or muscle of the
For patients with mild to moderate breast sagging, it will also improve
the shape of breast and the positioning of the nipple. The breast enlargement
surgery is one of the most popular cosmetic procedures.
Breast implants usually feel like a natural breast.
The major disadvantage of
implants is that they sometimes become surrounded by scar tissue that makes the
breast feel hard, or areas around the nipples or the incisions feel numb.
Reasons for Augmentation Mammoplasty
Aesthetic or cosmetic reasons for breast enlargement include:
Feeling that the breasts are simply too small or out of proportion
Loss of breast volume after pregnancy
Difference in size between the two breasts
Breast size that has reduced after losing weight
Breast surgery may also be offered to women having surgery for
breast cancer or
other rare conditions affecting the size and shape of the breasts.
Types of implants
All breast implants utilize a silicone shell but the fillings differ, either
gel-filled or saline-filled. The gel filled implants contain high cohesive gel,
which is more cross linked than a standard silicone gel and provides a higher
resistance to flow. If the implant shell is ruptured, the inside gel will rarely
escape (not leak).
The outer silicone shell, which give the prosthesis its elasticity and
integrity, may be smooth (shiny polished) or textured (finely rough) surface.
The breasts, augmented with textured implant, providing a disruptive surface for
collagen interface, have a lower tendency to develop contracting capsules than
the breasts augmented with the smooth implants.
Breast implants may not last a lifetime and the rates of rupture in saline
filled implant is higher than the gel filled one.
The preferable shape of the implants should be, low to moderate profile
(projection), providing natural upper fullness as well as nice cleavages of your
Brands available are - PIP and Sebbin (from France).
Deciding on the Size of breast implants
The implant should not be too small or too large in comparison to the patient's
chest wall dimensions. The goal is to augment the breasts to a size that is in
better proportion to the physique and to maintain a very natural look. There are
many factors effect the such as your original cup, your expected cup and your
physique including the chest muscle.
If you have board chest, especially the position of your nipple is far apart,
the selected size of implants should be rather big with low to moderate profile
(wide base dimension) to get a closer nice cleavage.
If you have some degree of breast sagging, the selected size should be quite big
with moderate to high profile, providing upper breast fullness and also
improving the nipple position.
If you have little breast tissue and/or very thin skin, the proper size should
be chosen carefully (for example: not more than 280cc.). Too big implant may
cause abnormal thinness of skin (translucency) or visible and/or palpable
wrinkling (rippling) in an implant.
Talk with your surgeon about the results that you desire-.
Inquire what types of implants are available and discuss the advantages of each.
Ask your doctor where he or she will make the incisions to best hide the scars.
The most common incision site is in the fold under the breast. Another possible
location is around the
outer edge of the
areola. When the procedure is performed
properly, it should not affect the sensation in your nipples or any other part
of your breasts. Although loss of nipple sensation is rare, it is possible,
especially when a very large implant is used. No breast implants or breast
enlargement procedures have been linked to breastfeeding problems. Breast
enlargement is sometimes done through an incision in the armpit, which reduces
the risk of loss of sensation in the nipples and does not leave a scar on or
under the breast. However, this procedure is more difficult because the implant
must be inserted over a longer distance to its final position in the breast. In
rare cases, the implant may done up slightly too high.
Endoscopy has made it
easier for doctors to perform this type of breast-enlargement procedure.
The common incision sites are:
1) Under the arm (auxillary):
2) Around the nipple (periareolar):
3) Within the fold under the breast (inframammary):
4) Umbilical or navel (transumbilical): This incision results in a single hidden
scar (no breast scars) and no chance of causing difficulty with breastfeeding.
Only inflatable implants are used in this procedure. Implants must be inserted
entirely deflated and inflated only after they are in place.
The location of the implant-under the chest muscle or over it - is a personal
choice. Placing the implants submuscularly can help reduce the chance to get
capsular contracture and also visible/palpable wrinkles in an implant, which are
related to the thinness of the overlying tissue cover (skin and breast tissue).
Besides, implants placed under the chest muscle interfere less with detection of
tumors on a mammogram. In some cases, a surgeon may feel that a more natural
shape is possible when the implant is placed over the muscle. You and your
doctor together can determine the best option for you.
The Surgical procedure
Breast enlargement surgery is performed in an outpatient surgery facility or in
a hospital operating room and usually does not require an overnight stay in the
You are likely to be given
local anesthesia to numb your chest and a sedative to
relax you during the procedure. General anesthesia to put you asleep during the
surgery is an option. The procedure takes about 11/2 to 2 hours.
For breast enlargement, the surgeon makes an incision at the predetermined site
(in your breast or armpit) and separates the tissues to create a pocket for the
The newly formed pocket may be rinsed with an antibiotic solution to reduce the
risk of infection.
During the procedure, your surgeon may tilt the position of the
to observe the effect of gravity on the position of the breast when your body is
upright. The surgery takes 1 to 1.5 hour.
The surgeon then inserts the implant and closes the incision with stitches. Tape
and a gauze bandage may be applied after the incision is closed and you may be
dressed in a special bra that provides good support and light pressure to reduce
Recovery & After care
After breast enlargement surgery, you may feel substantial discomfort or pain,
especially if the implant is placed under your chest muscle. If your pain is
severe, your doctor can prescribe pain-relieving medication. You can bathe
normally soon after the surgery. The stitches will be removed after about a
week, but the area will still be swollen and bruised. Each breast may heal at a
different rate. Most of the swelling is likely to subside within 6 weeks. The
scars will be pink for about 6 weeks and will begin to fade in about 6 months.
Avoid sexual arousal for a week after the procedure because it can increase
blood circulation to the breasts and cause swelling. After that, sexual activity
without breast contact is fine until your breasts no longer feel sore - about
another 2 to 4 weeks.
The patient is requested to have early breast exercise to prevent the breast
firmness (capsular contracture). There are two main technique for
which are pressing and squeezing technique. The aim is to maintain the space
around the implant as well as prevent the thickness of surrounding capsule
(capsular contracture). Only gentle manipulation of the implants is recommended,
the proper time should be between 15-20 minutes 2 or 3 times a day. You may
adjust your own schedule later if your breast contour improves satisfactorily
and there is no resistance while exercising.
Although breast enlargement is a simpler form of surgery than other cosmetic
breast procedures, complications can occur. Many women who have breast implants
have them replaced in another procedure at some time in their life, usually
because of capsular contraction.
Capsular contraction occurs when the tissue
surrounding a breast implant becomes tight, forming a capsule around the implant
and causing the breast to feel unusually hard. Some women are not bothered by
this hardness; others find it extremely uncomfortable and unattractive. You may
feel a firmness in your chest when you hug someone or when you lie on your
To correct this problem, the surgeon may need to perform a procedure called an
open capsulotomy in which he or she reopens the incision and makes a cut in the
tissue capsule to relieve the pressure. If this procedure does not provide
sufficient relief, the implant and the surrounding scar tissue will be removed.
The scar tissue may adhere to the breast tissue, making removal
Implants that contain saline (salt) solution have a lower rate of
capsular contraction than silicone implants.
Various other problems can occur with breast implants. Your nipples may feel
overly sensitive or less sensitive than before; both conditions are likely to
improve over time. Implants can sometimes leak. Saline that leaks from an
implant is safely absorbed by your body. Although research has not found a link
between silicone from breast implants and illness, in most cases in which a
silicone implant ruptures or leaks, a surgeon will recommend replacing it with
saline-filled implant. If you have silicone implants that are not painful, hard,
leaking, or causing you any other problems, you do not need to have them
Infection, as manifested by swelling, tenderness, redness and fever, is an
extremely rare complication of breast-enlargement surgery.
If an infection
develops, the implant must be removed and the surgically created pocket must be
cleansed thoroughly. A new implant can be inserted after about 3 to 6 months.
Hematoma formation, which is manifested by enlargement and discoloration of
tissue, may, if happened, need to be removed. Meticulously stop bleeding,
surgical tube drainage and postoperative pressure bandage are important to
prevent this sort of complication.
Rupture of the implant
For saline filled implant, if the implant shell is ruptured, there is a rapid
change in shape of the implant and you absolutely need to change the new one.
For standard silicone gel, if the implant shell is ruptured, the escaping gel is
usually contained by the scar envelope in the surgical pocket and may be
undetectable except by Magnetic Resonance Imaging (MRI). In case of the high
cohesive gel, if the implant shell is ruptured, the gel will normally not escape
or migrate from its shell due to a higher resistance to flow.
Implants may interference with Mammography in detection of Cancer-As silicone is
opaque to x-ray, an implant may theoretically interfere with the early detection
of cancer by mammography as it may obscure part of the breast. Newer techniques
of breast compression improve the amount of breast that can be visualized.
Alternatively, most surgeons feel that the implant may improve the detection of
tumors by palpation.
To obtain a comprehensive packet of information on breast implant issues,
request FDA's publication, "Breast Implants, An Information Update," by calling
the agency's breast implant information line at 1-800-532-4440. For on-line
information, see the Breast Implant Information on this Website.
Dated 20 October 2012