dr manafi / Procedures / Abdomen And Trunk / Breast Augmentation

Breast Augmentation

Breast augmentation depends on the patient’s body structure to the extent that the body fitness is maintained.

The operation is also called augmentation mammoplasty or breast reconstruction through increasing its volume. Breast implant is used in this method to create a larger and fuller breast or to replace the volume of the breast which was lost during pregnancy or weight loss. Implants are also used to reconstruct breast destroyed due to hit or cancer.

Breast augmentation is not appropriate for reconstruction of severely drooped breasts and if you want have large and lifted breasts, you should undergo a breast lift or breast enhancement surgery and simultaneous use of breast implant. Sometimes these two procedures cannot be performed at the same time and must perform with an interval.

The use of autologous fat injection to enlarge and shape the breasts has become common and had stunning outcomes which are comparable to implants and even more prominent in some cases. Implantation and fat injection can also be used in combination; a method which is called composite.

Frequently Asked Questions

  • Breast augmentation takes about 2 hours using implants and about 3 hours using fat injections.

  • Surgery is performed under general anesthesia and usually you need to stay in hospital overnight. The procedure takes about an hour or so.

  • Certain people may need mammography and ultrasound according to their age.

  •  This operation is more painful than other procedures and special care can reduce pain. Breastfeeding can continue in both methods (implants and fat injections).
  • Women need special bras after the surgery.

  • Breast augmentation depends on the body structure to the extent that the body fitness is maintained.

  • Surgeries requiring anesthesia are associated with some risks, but they can be minimized if the surgeon has more detailed information of the patient’s history, examinations and tests are carried out properly, and the surgery is performed in equipped clinics and hospitals which are approved by the Ministry of Health.

  • Hand movements will be limited for some time. Driving is forbidden for 1 month, because the implant may move

  • You can do light exercise after 2 to 3 weeks and contact sports after 2 months.

  • After surgery, patients underwent implant insertion will stay one night at the clinic and receive special care to prevent infection.

  • You can walk smoothly and do very light works the day after surgery, but avoid any heavy work including pulling or lifting heavy objects in the first 7 to 10 days. Depending on the job, many women can return to work after this time, but if your work involves stretching and lifting things, it is recommended to avoid working for 10 additional days. You can usually begin light hand and foot exercise after three weeks. Shoulder and arm exercises and swimming can be started after 6 weeks. Use a good sport bra when exercising. Driving is allowed after a week. Sexual activity can be started after about 4 weeks, although only slight touching of the breasts is recommended at this stage. Firmer touching of the breasts can be done after 2 months.

  • The dressing can be removed 4 to 5 days after surgery.

  • The main reason for production of the Trilucent implant, which is more radiolucent (invisible to X-rays), is to provide visibility of the breast tissue with mammography. The Trilucent implant is filled with (non-silicone) well refined soybean oil triglycerides allowing X-rays to penetrate better into the implant.
  • Although, this type of implant fade breast tissue to a lesser extent, the patient should inform the radiologist about the breast implant.
  • A critical problem regarding the Trilucent implants is the phenomenon of skin wrinkling. Since the filling material of Trilucent implants is liquid, some folds in skin covering of the breast should be expected.
  • In patients with soft and thin breast tissue, the wrinkles will be easily visible. Since the implants filled with salt water are almost 30 times less viscous than the Trilucent implants, the problem occurs more in these implants, while it occurs less in implants filled with silicone gel because they have thicker compound.
  • Clinical trials about this type of implants began since 1993 in UK. Totally about 5000 women have Trilucent breast implants. However, in March 1999, the Department of Health advised physicians not to insert the Trilucent implant until further notice. On June 6, 2000, the agency of medical procedures released a statement and advised women with Trilucent implants to remove them, because it was believed that the filling materials of the Trilucent implants produce harmful compounds. Therefore, further investigation is needed to determine its safety.

  • There are many forms of implants. Most of the currently used type of implants are still rounded. They look circular in front view and half month in profile view. Round implants are most commonly semi-fluid and are like a sticky and thick gel.
  • Recently an integrated silicone prosthesis is produced which is called anatomic or tear implant. Since this type is made of hard gel in comparison with the more fluid and smoother gel, it has a natural form of the breast in profile view. These implants are a little taller and fuller in the lower part. They tend to have a smoother transition from the upper chest wall to the breast top. Thus they have a little more natural shape, while round breast implants, give a rounder appearance to the breasts.
  • In addition, no break or rupture is created in the covering and no leakage of the gel is occurred due to thicker gel of these integrated (tear) implants. As a disadvantage, all breasts cannot enjoy from this particular type, just like standard silicone implants, and they are substantially more expensive than the standard silicone implants. Tear implants are slightly hard when touched, and the edges provide them more palpable and sensible. There are reports that they may lose their anatomic form over time.
  • However, an integrated silicone implant is recently produced and when its shell gets old or tear, no leakage of the materials occurs. Another advantage of tear implants already discussed is that the integrated implants do not lose their shape.

  • Breast implants have different types and sizes and each woman may easily select a variety of sizes. Most women select the breast implant based on their bra size. The purpose of examinations is to specify the size of the implant to provide the desired appearance. As you can imagine, different sizes of breast implants may have different outcomes at different times. To choose the best size of breast implant which can give you a more appropriate and harmonious appearance as your desire, the plastic surgeon measures your breast and chest size and specifies the most suitable size. In addition, through these measurements, he can imagine your appearance with the best breast size.
  • It is important to know that the available space under your breast is the limiting factor in selection of the implant size. Remember that as the volume of each type of breast implant increases, its width increases as well. Thus, if you choose a large breast implant, its edges may protrude from the main breast tissue and even reach to armpit. This is not ideal for most people and increases the possibility of wrinkles and other long-term adverse effects. Since most women have a realistic view about they want, almost all plastic surgeons can provide the expectations of their patient. 

  • There is no evidence that breast implants cause cancer in humans. On the contrary, recent studies have shown that women with breast implants are 30% less likely to develop breast cancer than the general population.

  • The most important thing about breast implants is the possibility of delayed diagnosis of breast cancer in silicone and salt water filled breast implants. Both of these types are contrast media and do not pass beams. This means that they prevent observation of breast original tissue during mammography.
  • Mammography techniques have been progressed over the recent years and radiologists can see the main parts of the breast tissue hidden under the breast implants as far as possible. However, it is important to understand that 10-20% of breast cancers cannot be detected by X-rays and most breast cancers are still discovered by physical self-examination. In this regard, most clinicians feel that breast implants can actually simplify the examination through touching. Women with breast implants should have regular mammography like other women and inform the radiologist about the implants allowing him to select special radiologic views. As a result, breast implants make harder the work of radiologists, although not preventing it.

  • Like all man-made products, breast implants do not last forever. Although they are very strong and resistant (even under pressure), they are also prone to aging and degradation over time. In simple terms, the outer shell of breast implants will get old and thin and eventually disappear. If this happens, its material leaks out and is usually called breast implant collapse, leakage, or rupture. Although it is clinically difficult to diagnose, someone may recognize that the breast is slightly flat or its shape has changed, but it is often barely noticeable. Sometimes the rupture is not recognized due to creation of a capsule around the implant.
  • As previously stated, the capsule is a biological bag encompassing any kind of breast implants. Therefore, after leakage from breast implant, its substances remain in the site by the body’s bag or capsule. However, despite clinically difficult diagnosis, we are often able to identify the exact conditions of any kind of breast implants necessary, thanks to the presence of ultrasound.
  • There are many diagrams and illustrations which specifies the life span of various types of breast implants before disruption. An average graph is about 20 years. However, getting old or torn varies among different people, for example, breast implants in women with regularly several hours a day physical exercises and breasts movement (such as aerobics instructors, marathon runners, riders, etc.) will naturally get old faster than those who have fewer exercises and movements. It is reasonable to assume and understand that breast implants can be destroyed earlier in these situations, therefore, in order to have a proper assessment of breast implants conditions, the patients are advised to be regularly examined by the specialist after 10 to 15 years and undergo ultrasound if necessary.

  • An important principle in breast augmentation is to create a pocket behind the main breast pocket where the breast implant will be inserted, although there are many details regarding the operation which should be known by patients.

  • In general, three main surgical incisions are used to insert a prosthetic breast. In under breast incision which is most commonly used, an incision is made under the breast line with a length of about 4 cm. This is the most common incision and the natural fold of the breast usually hides the scar completely. This type of incision is always covered by clothing. Since this incision provides a direct access to breast implant space that will be created, the exact size and shape of the pocket is important and the site of the implant in the breast pocket is precisely controlled.
  • Incision close to areola (dark skin around nipple) is another method which is made round its edge. The disadvantage of this method is that the skin fold cannot cover the scar and may disrupt breastfeeding.
  • The third method is incision made on one of the sub-axillary lines; this incision is less commonly used because finding a suitable location for breast implant is more difficult in some patients and may require an additional incision if a problem arises in the future. Although some people think that this incision is less visible than the others, in fact, this is not always the case, especially when wearing sleeveless dresses exposing the sub-axillary area. Remember that the scar will always remain and this is not related to the incision area. Naturally, the scars will completely improve and will be less visible over time, although no surgeon cannot predict the appearance of the wound. Some other incisions could be made such as at navel and so on which are less common.

  • Two sites or pockets exist for inserting the implant: sub-glandular in the front of chest muscle and sub-muscular behind the breast muscle. Pectoral muscles are chest muscles which usually grow in bodybuilders.
  • Sub-glandular pocket is the most commonly used site in UK. The striking and obvious appearance of the implant in lean women is the disadvantage of this method. The edges of the implant may be recognizable in the chest and it is recommended to use the sub-muscular method.
  • Although there are some types of breast implants which are more appropriate for the sub-glandular method, the original breasts were usually bigger than the present breasts in these women. When the original size is reduced, the skin shrinks and a form is created which is called “empty pocket.” In these circumstances, it is better sometimes to use the sub-glandular method in order to fill the skin that covers the original breast. In cases where the skin is very loose and sagging and nipples descend below the chest, the nipples should be lifted and the covering skin should be reduced with breast lift procedures or mastopexy. This will be determined at the time of consultation.
  • Sub-muscular pocket is the second site located between the chest wall muscle and the chest.
  • Sub-muscular pocket increases the covering of breast implant and the covering increases breast implant appearance. This site is particularly very useful in women who have very little breast tissue or not have it at all. More coverage in these conditions finally reduces some adverse effects on breast appearance explained above. As another advantage, it is reported that mammography is performed with a better quality in this method. But you may have much postoperative pain or discomfort and breast implant may move with certain movements of muscle and in case of partial dropping, breast shape will be different in lying and standing.
  • The decision about the site of breast implant will be made at the time of consultation and the experienced plastic surgeon will take the final decision with regard to all aspects.

  • Breast augmentation is partially associated with pain. Determining the amount of pain is difficult for each person. While some women know the procedure painful, others say they had very little post-operative pain. Inserting breast implants behind pectoral muscle is more painful, since some muscle should be cut to open the space for insertion of breast implants. Sincerely said, the majority of women have mild pain for the first five days which will need analgesics. However, signs and symptoms are significantly improved in most women after a week, and pain is relieved by conventional analgesics.

  • Your breasts will be somewhat swollen and bruised after surgery; this will disappear after two to three weeks. Sometimes swelling of the breasts may vary with each other; this is normal and will be resolved over time. If there is a big difference between the two breasts, please contact us for further advice.
  • After breast augmentation, the breasts may seem located above, which is normal. During the first two months after surgery, breast implants will gradually descend and will find their place regarding the effect of gravity and will return to normal. Do not worry if one side descends faster than the other side, because this may occur sometimes. An appropriate bandage should exist in the area after surgery and the site must keep dry for two weeks. The dressing will be removed and the wound will be examined and slightly cleaned after two weeks. There are no sutures, because they are internal and absorbable.
  • Carefully read the post-operative guidelines and observe them.

  • Change in nipple and breast sensation may occur. Some patients completely lose their breast sensation, others have reported only a slight decrease in their breasts sense, and some have even reported an increase in breast sensation. Change in breast sensation happens in most cases, is usually temporary, disappears soon, and improves gradually. The recovery period lasts sometimes up to eighteen months, although permanent loss of sensation may occur in a very small number of patients.
  • Breastfeeding can continue after operation and you’ll be able to produce enough milk. You should know that most women cannot naturally breastfeed satisfactorily, either with or without implant.
  • Pregnancy: if you become pregnant after the surgery, your breast tissue will grow and the skin will subsequently be stretched. Also during pregnancy and if you stop breastfeeding, breast tissue will shrink. Prediction of the time of the changes is impossible, but the volume of breast implant during the operation will remain constant.
  • Skin over the implant may fold or wrinkle in women with little or no breast tissue. Hydrogel breast implants with a slightly longer incision compared to silicone breast implants are more likely to develop this condition. Although the condition has no medical problem in itself, it is aesthetically undesirable. This can occur in any part of the breast. If you experience such a thing and if properly diagnosed, it will be recommended at the counseling time to insert the implant under the muscle in order to minimize this complication. It is pointed out that even when precautions are taken, wrinkles may still occur, which elimination is difficult and sometimes impossible.
  • In lean women after breast augmentation, the breast implants can be touched in the lower part of the breast close to breast fold.
  • The condition has no medical remedy, although women who do not remember it may suddenly become concerned regarding creation of a lump in their breast. In any case where there is uncertainty in this regard, it is always better to contact your surgeon to examine your breasts.
  • There is no risk of bursting or opening of breast implants when traveling by plane, swimming, diving, etc.

  • Scarring after surgery is not a complication, but it is a postoperative event. Fortunately, scars of breast augmentation are small (about 4 cm in length). You should always expect red, inflamed, snob scars which may even itch; but they disappear and flatten over time. This is a normal process in wound healing, however, remember that full restoration and healing may take about two years. To accelerate and facilitate this process, daily massage of the scars is recommended during this period. You should know that any responsible doctor can predict how the scars will look. As noted above, the scars will disappear and recover over time.

  • All operations may be associated with some risks and uncertainties. When breast augmentation is performed by a qualified plastic surgeon, problems and risks rarely occur. However, the body anatomy, the physical reactions, and the ability of wound healing vary considerably among patients and hence the final result is never completely predictable. These problems include skin infection, bruising, and darkening. Despite the daily and regular injection of preoperative and postoperative antibiotics, infection can occur with a probability of 1%. Symptoms such as pain, redness, and swelling with fever that may occur after breast augmentation should be immediately reported to the hospital. If not reported, infection can easily jeopardize the success of any surgery. If the infection was serious and did not respond to antibiotics, breast implant may have removed and not replaced until the infection is completely cleared.
  • Bleeding from a blood vessel leakage can cause swelling and bruising of the breast. If it is low, the body will be able to absorb it over time. Remarkable bleeding is called ecchymosis and may require evacuation in 1% of the cases.
  • Skin darkening or skin damage occurs when not enough blood is supplied to the skin. It occurs when the surgeon chooses the breast implant much larger than the pocket. It is a very rare condition and in fact, Doctor Manafi never experienced this problem and not expects it.

  • This is the most common problem which happens in implantation. Capsule is a layer of scar tissue that usually surrounds any artificial material placed in the body. This is a natural response of the body to a foreign substance. The capsule is often very soft and almost unrecognizable, thus it does not affect the breast implant. Capsule shrinks or tightens when the periprosthetic reactive tissue of breast shrinks and compresses it, so that the breast began to tighten or is completely stiffened in some cases. Most capsular contractions occur currently in silicone breast implants with smooth shell inserted many years before. Capsular contracture rate was 30% to 35% in the past.
  • With the advent of textured shell breast implants, the problem of capsular contracture is significantly reduced reaching to a rate of between 6% and 8% at present. The cause of capsular contracture is not clear, but it seems multifactorial. It is important to recognize that there are varying degrees of contraction and more often it occurs only in a low and gentle grade. However, in a very few cases, the contraction is so severe that disturbs the patient. It is even painful or distorts the breast. This may occur in one or both breasts and may be different in each side.
  • This may occur at any time, even years after surgery. Although it is most likely to occur in the first three years after surgery, unfortunately, there is currently no effective way to prevent capsular contracture. However, as previously stated, capsule per se is not harmful to patient’s health, except the fact that it may prevent mammography.
  • There is two ways to reduce or alleviate stiffness of capsular contracture, including open and closed capsulotomy. In closed capsulotomy, the tightened breast is manually squeezed and it is tried to tear or crack the capsule. If the work is done satisfactorily, the patient will feel the softness of the breast as the immediate result, although the wound covering resistance varies among people in terms of tear. In some cases, tearing occurs easily but the scar is so tough in others that it cannot be torn, resulting in a bad appearance. Closed capsulotomy may also result in bruising, bleeding, or even rupture of breast implant, the latter needs surgery in which the implanted breast is removed and replaced with another one. These unpredictable outcomes are a reason for limited performance of closed capsulotomy.
  • The other more controlled and hence preferred method is open capsulotomy which is done under general anesthesia. In this process, the old incision is re-opened and the thickened capsule is removed or loosed. Then the breast implant is replaced in its site or in another pocket, for example, under the muscle. Unfortunately, there is always the possibility of re-tightening, even after a satisfactory capsulotomy.

  • Girls who have gone through puberty, but still have small or not grown breasts. The operation is recommended for those over 18 years old whose physical growth has ended. 

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