HMT Sancta Maria Hospital, Swansea

Breast Augmentation (Breast Enhancement)

Breast Size

Initially, breast size is determined genetically. However, size can fluctuate due to changes in weight, pregnancy and breast feeding. With advancing age the breasts change shape and gradually droop. Most women will notice a slight difference between the two breasts. Sometimes this is fairly noticeable.

Breasts can be enlarged by the insertion of implants under the breast tissue (or sometimes beneath the muscle behind the breast).

The Procedure

Breast Augmentation is usually carried out under general anaesthesia. An incision is made under the fold of the breast, allowing the implant to be inserted (Occasionally the incision is made around the areola or in the armpit).

Most commonly the implant is inserted beneath the breast tissue. In very slim women the surgeon may need to insert the implant beneath the muscle behind the breast to give a better looking result.

Implants

Implants are made from an outer layer of silicone.  Most are filled with a silicone gel but may occasionally be filled with saline. They come in various sizes. Your surgeon will discuss the potential size with you and find out your expectations and preferences.

Most implants are round. Occasionally ‘tear drop’ shaped implants are used. You will have the opportunity at your consultation to discuss this with your surgeon, and find the most  suitable implant for your requirements.

Limitations

The size of implant that can be used will be influenced by factors such as your weight, stature and looseness of skin around the breast.

It is not possible to predict accurately the size and shape of the breasts following augmentation. A predicted bra cup size is only a guideline. If there is a slight difference between the breasts before surgery, this is likely to remain after the operation.

Insertion of breast implants will not prevent eventual sagging of the breasts as a woman gets older.

Post Surgical Care

Wound drains are not always necessary, but may occasionally be used to drain away any excess bleeding from the breasts during the first 24 hours or so.

Nursing staff will ensure that you receive an adequate supply of pain killers, either as tablets or injections. If you experience any nausea you can be given medication to alleviate this. You will be encouraged to be up and about as soon as possible after surgery to minimize complications. The morning after surgery you will be able to walk to the bathroom and will be eating and drinking as normal.

Strapping will usually be applied after the operation to give additional support to the breasts. You will be asked to bring a sports bra with you to the hospital. This is often put on in theatre immediately after the operation.

Many surgeons will leave the strapping and dressings undisturbed untill your first outpatient appointment at around 10-14 days post operatively. Only a sports bra should be worn initially to avoid pressure on the healing scars.

Your surgeon will advise you to avoid strenuous activities such as lifting and sports for a few weeks.

Any specific instructions and details will be on the discharge sheet given to you before you leave hospital.

Risks

All surgical procedures entail an element of risk. These can include pain, bleeding, thrombosis and infection. Leakage of silicone does not occur with the newer ‘cohesive gel’ implants.   

Extensive research into silicone  implants has found no link to an increase in breast cancer or autoimmune diseases such as rheumatoid arthritis.

Occasionally the fibrous capsule which the body forms around the implant can become thick and contracted, leading to pain or hardening of the breast around the implant.  This can occur in around 10% of patients, occasionally requiring removal of the implant, or surgery to release the capsular contracture.

Breast augmentation does not interfere with breast feeding and no silicone is found in breast milk. There may be a noticeable difference in skin and nipple sensation following surgery. This often settles after a few months but can be permanent. There will be some scarring of the breast or armpit following surgery.  This fades during the first 12 months. The positioning of the scars means they are barely visible in underwear or swimwear.

Mammograms

Women with breast implants can still have mammograms.  You need to inform your breast screening unit in advance if you have had implants.  The mammogram technique used may need to be adapted to show as much breast tissue as possible on the X-Ray. The pressure applied to your breasts during the mammogram is unlikely to damage your implants.

The information contained in this website is not exhaustive.  A full consultation with a suitably qualified surgeon is essential to ensure that your individual risks are assessed and to ensure that this type of surgery is suitable for you.

Sources/Further Information:

· British Association of Aesthetic Plastic Surgeons (BAAPS)

· British Association of Plastic Reconstructive & Aesthetic Surgeons (BAPRAS)

· Breast Test Wales                            

· DOH Cosmetic Surgery:Information for Patients (Aug.2006)

· National Institute for Health & Clinical Excellence (NICE) Venous Thromboembolism (April 2007)

. NICE Surgical Site Infection Preventioin & Treatment of Surgical Site Infection (October 2008)