Plastic Surgery - Breast enlargement



Dentists	Plastic Surgery	Private Hospitals

Plastic Surgery

Breast Enlargement (Breast Augmentation)

There are no gymnastics, ointments or commercially available hormones or even massage that can enlarge breasts.

About implants: Silicone- or salinefilled implants and semiliquid (cohesive) anatomic shaped silicone implants are available on the market. Polyvinylpyrrolidinefilled (PVP) implants of earlier generations did resorb water and grew in the body so this type will not further be discussed. A couple of years ago a new implant emerged on the market filled with methylcellulose, a biologic filler that degrades to sugar by the enzymes of the body. The filler is also partly radiographically translucent and the implants do not totally obscure the gland at mammography. Scientifically there are no scientific evident correlation between silicone implants and cancer disease, rheumatic or other systemic diseases. Some women with silicone implants do have an activation of the immune system, which in some individuals might cause diseases. The explanation for this is scientifically not known.

Saline and methylcellulose are totally harmless substances and in case of leakage they are totally absorbed. All implants have a limited lifetime due to chemical and physical degradation of the silicone shell. In some scientific articles the rupture rate of implants at 8 years is about 50%. Therefore, it is commonly recommended to evaluate silicone implants for breakdown after 10 years. Leaking silicone will first stay within the capsular formation around the implant before it gradually and slowly penetrates into the body. As saline and methylecellulose are totally and immediately absorbed a puncture will be noticed at once as a deflation of the implant. How long the longevity of an implant is in individual cases can never be estimated. All implants are leaking except for the cohesive teardrop shaped silicone implants that does not leak or rupture. However, they will degrade from the surface.

The choice of prostheses and their placement will be discussed at consultation. Cohesive silicon implants (Mentor®)) are the preferred implants at the clinic but as patient You can have a choice regarding implants and the placement of the incision.

Every foreign body causes an encapsulation by fibrous tissue when placed in the human body. This fibrous tissue can shrink, making the implant feel hard. We are talking about capsular contracture of different degrees.

Aesthetically there are no differences between implants with fluid fillers. The teardrop shaped cohesive silicone implants can be placed above or below the muscle. With smooth implant shells the capsular contracture rate is high, even with submuscular placement of the implant. A textured shell however, disorients the formation of fibrous tissues and makes it less prone to shrink. This reduces the risk for capsular formation and the implants need not to be massaged or placed below the muscle. The submuscular placement was chosen for implants with smooth shells to prevent for contracture but it has the disadvantage of displacing or flattens the implant when moving the arms, which can be very embarrassing. The muscle also tends to lift the implant into a higher position than wanted.

There is one major disadvantage with textured implants though and that is the palpability of edges and folds at light fingerpalpation on the skin. In approximately 10% these folds are visible and can only be prevented by submuscular placement. Saline filled implants have more of these drawbacks than siliconeimplants have. This problem is not seen with semiliquid siliconeimplants.

The placement of implants under the muscle is more painful than the placement above the muscle and subglandular placement gives a more natural look.

Contents	Placement	General anaesthesia ( extra charge)	Softness (no capsular contracture)	Placement of incision	Comments
Silikone: Liquid	Subglandular		Soft	Axilla Border of areola Submammary fold	Palpable folds possible. Natural haning shape.
Silikone: Liquid	Submuscular	x	Soft	Axilla Border of areola Submammary fold	Palpable folds to the side. Derformation on armmovements. Rides high. More painfull.
Semiliquid Silicone: Anatomic tear drop shape	Subglandular		Semisoft Semisolid	Submammary fold 6 cm long	Long incision. Implants can rotate. Acceptable firmness. More painful.
Semiliquid Silicone: Anatomic tear drop shape	Submuscular	x	Semisoft	Submammary fold 6 cm long
Hydrogel: Liquid Carboxymethylcellu lose = "sugar" (PVP=polyvinylpyrrolidi ne)	Subglandular		Soft as silicone	Axilla Border of areola Submammary fold	Palpable filds possible. Natural hanging shape.
	Submuscular	x	Soft as silicone	Axilla Border of areola Submammary fold	Palpable folds to the side. Deformation on armmovements. Rides high. More painful.
Saline Liquid	Submuscular	x	Semisoft Unelastic	Axilla Border of areola Submammary fold
All implants: Textured silikonesheeting = unregular = palpable folds and edges, sometimes visible. All implants with liquid content do fold!

Anaesthetic: The combination of conscious sedation and local tumescent anaesthetic works like a general anaesthesia. General anaesthesia can of course be provided.

Technique: The incisions are placed either at the lower boarder of the nipple, in the axilla or in the breast fold according to patient selection. For semiliquid siliconeimplants the incisions have to be a little longer and they must be placed in the breastfold.
A pocket is made between the gland and the breast-muscle or between the breast-muscle and the ribs.
The gland itself is totally undisturbed and breast-feeding is fully normal. A rigid bandage is applied when implants lie in the subglandular pocket and is kept for 1 week.

Operating time: 1-2 hours.

What happens afterwards?

	During the first 24 hours there will be quite heavy tensile pain, which will gradually disappear during the first week.
	Augmentation through the axilla will be more painful and every movement of the arm will cause pain.
	The breasts will swell up heavily and the swelling will dissolve during the first month.
	The stitches will be removed at about the 10th day.
	You should sleep on the back for 3 weeks.
	Driving the car is forbidden during the first week.
	Physical activities should be abandoned for one month.
	Transient hypersensitivity of the nipples for 12 months is common.
	Sun exposure directly to the scars should be avoided for 6 months as to prevent for permanent hyperpigmentation and redness of the scars.

COMPLICATIONS

Referred unwanted biologic events can occur with a certain low frequency and must be regarded as calculated risks. Other risks not mentioned can also occur. For patients this must be considered before a decision for plastic surgery is made.

Bleeding: All operations can cause postoperative bleeding. These risks increase by the intake of analgesics and Vitamin E. These should be avoided 2 weeks prior to the planned operation.

Infection: All operations can cause infections. An implant has to be removed temporarily and can be reinserted after a few months in case of infection.

Capsular Contracture: Implants can get severely hard in approximately 5% and more seldom can pain and deformation of the breast occur. In case of severe contracture, the capsule has to be removed operatively (the implant is kept).

Dislocation: In some cases the implant can slide down to a too low position due to gravitation. A too high positioned implant is rarely seen when placed above the muscle. If correction is indicated the pocket will be closed or opened surgically.

Scarring: All scars are red for a couple of months and they fade away during the fist year. Direct sun or solarium against the scars should be avoided to prevent them for permanently become red or pigmented. The scars are normally very discreet.

Impaired sensibility: Independent of the placement of the incisions, the sensibility of the nipple can be impaired or get totally lost. A transient numbness or hypersensibility is however normal.

Smoking: Smoking does compromise bloodcirculation and healing. Smoking should be abandoned prior to a planned operation.

This text is edited and controlled by Dr. Per Gunnar Opitz, Opitz plastikkirurgiska klinik i Malmö Sweden