Breast Augmentation (Implants)

Breast enlargement / augmentation with hidden scars

'Breast enlargement has always been one of the most commonly performed cosmetic operations.'

Breast enlargement (Breast augmentation / breast enhancement / augmentation mammaplasty / "boob job') is one the most common cosmetic procedures of all time. It entails the placement of a "prosthesis' or soft implant behind the breasts which results in their projection in a forward and upwards direction. The aim is to enhance the beauty of the breasts which form some of  the most important and attractive aesthetic lines of a woman's body.  Those who seek enlargement do so for a variety of reasons. Amongst these are;

'To make my breasts more in balance with the rest of my body'

'To look more womanly'

'To fill out the bra I wear without the padding' 

'To look like I did before having children' 

To feel that I am more attractive''

'To wear a bikini without embarrassment'

Like any successful cosmetic procedure, it provides a boost to self-confidence and a consequent lift in social interaction. As with any procedure of consequence, it should be entered into only with full knowledge of how it is performed and of the potential risks. This means a period of quiet consideration of the risk/benefit ratio before making any decision to proceed.  

Silicone Gel implants are the most commonly used. Saline implants are another option that are far less favoured nowadays.

What are the different methods of augmentation?

Using 'implants' or 'prostheses'

This is the most common technique of projecting the breasts forwards, usually by the placement of a "prosthesis' behind the breast itself or behind the pectoralis muscle on which the breast rests. With careful matching of patient and the particular prosthesis, it can produce highly satisfying results.

Fat transfer from elsewhere in the body to the breasts

This is another technique that has not met with general favour. Dr. Fox was taught a safe and effective technique several years ago by Mel Bircholl, a Beverly Hills plastic surgeon. The fat was extracted from an area of excess fat accumulation and placed in multiple small increments behind the breast. It was a careful, precise and successful technique which never reached great popularity if for no other reason than for the very modest enlargement that could be achieved. Some careless practitioners, in trying to emulate this technique, inserted large amounts of fat into the breast itself, causing many problems and rightly drawing much criticism.

Fillers

In more recent times a technique that placed hyaluronic 'filler' behind the breast has been proposed. It has the potential to produce a very modest enlargement that might last around 2 years, and the needs repeating and at significant cost.

Where are the scars in breast augmentation using silicone or saline implants?

The most common approach incision is on the chest wall beneath the breast itself. There is another approach that produces a hidden scar: that is through one of the natural creases in the armpit (trans-axillary approach). It leaves a fine scar that is not only hidden but, when mature, is either difficult or impossible to distinguish from one of the natural creases. 

So why isn't every patient offered the option of this technique? The answer could reside in the words of a surgeon in an article in a recent article in the 'Aesthetic Plastic Surgery' journal published online on February 21, 2010. Quote ~ "Because the trans-axillary approach is technically demanding and is performed relatively rarely, many surgeons never master the technique.

A summary of the techniques follow;

Inframammary - In the crease beneath the breast. This was first one developed and continues to be the most commonly used, and for two reasons. Firstly, a significant number of breast surgeons consider it the easiest technique to both learn and perform. They often do not suggest an alternative. Secondly, most patients believe that, because of the prevalence of the inframammary approach, there must be no other reasonable alternative.

Transareola - Through a semicircular incision around the nipple area. This is not a favourite with either surgeons or patients. The placement of the implant requires dissecting through the breast itself in order to place the implant behind the breast. It leaves a scar around the nipple area which, although often fine, is usually obvious simply because of its prominent position.

Transumbilical - Through the 'belly button' or umbilicus. The scar is hidden in the umbilicus. This technique was thought to be a clever way of avoiding a scar on the chest wall or breast. The theory was good, but it only had a brief popularity before falling into disfavour. It was soon found that there was an unacceptable difficulty for the surgeon in controlling the formation of a pocket of suitable size and shape for the implant.

Transaxillary -  Through a natural crease in the armpit. The sole reason for the development of this technique (as for 3 above) was to avoid a scar on the chest wall or on the breast itself. It remains an excellent technique, although difficult for the surgeon to master and therefore often not offered as an option. It is an excellent way to avoid an obvious 'tell-tale' scar. Tom Stephenson MD of Los Angeles was one of its pioneers. At the time he instructed Dr Fox, he was President Elect of the American Society of Cosmetic Breast Surgeons.  

 

Are there different types of silicone implants?

Yes. The differences are in shape and the nature of the outside cover (shell).

The Content (fill) of all silicone implants has been a cohesive gel since 1994. Prior to that it was liquid silicone, which occasionally caused significant problems.

Shape

There are two basic shapes: round and 'tear-drop'(anatomical)

By far the most common is the round implant. It emulates the shape of a normal breast when the person is in the horizontal position, that is, it is round and dome-shaped. As with a normal breast, on assuming the upright position it forms a classic breast shape under the influence of gravity.

Tear-drop implants have a tendency to rotate, sometimes through 180 degrees. Also, the approach incision must be beneath the breast and  can be up to 6 cm. in length. Their popularity for augmentation declined, so that nowadays they are used principally for breast reconstruction after mastectomy and for those people with an abnormality of the anatomy of the chest wall.

Surface ('Shell')

The surface can be either smooth or slightly rough ('textured').

In the final stages of manufacture of a smooth implant, a 'textured surface' implant is formed by bombarding the surface with particles.
It was thought that there should be a reduction in the rate of 'Capsular Contracture' by texturing the surface. Whether this is achieved has been vigorously debated over the years. Recent research would appear to disprove its value.

Capsular contracture is the most common condition to spoil an otherwise successful result, and will be discussed separately.

How and where is the procedure performed and what is the post-operative course?

Breast augmentation or augmentation mammaplasty is most comfortably done under general anaesthesia in hospital and approved day surgery facilities usually as a day procedure. It is completed within 2 hours.
You are reviewed after surgery at one day, one week, one month and one year: then an annual check.

Return to work and physical activities - You may return to work one week after operation except if your or requires significant lifting or repetitive arm movements, in which case time off is extended.

What should be avoided after operation - Physical activity should not be excessive for at least one month. Any movement that causes the breasts to 'bounce' should be avoided for three months as should excessive handling of the breasts.  

What are some of the potential complications?

Short term

As with any surgical procedure bleeding or infection can occur.

Long term

Loss of integrity of the implant shell can occur, but since the content nowadays is a silicone gel (unlike the pre-1994 implants which contained liquid silicone), the silicone can not 'run' into the breast tissue as could occur with the liquid silicone implants. Loss of integrity of the shell is termed 'rupture' which gives the quite erroneous impression that the implant 'bursts'. It does not.

Capsular Contracture

In response to the presence of any foreign body, including all implants, the body coats it with a layer of collagen. This becomes a continuous 'bag' around the implant by about 4 weeks. This 'capsule' is normally both thin and strong and is closely applied to the surface of the implant. If this capsule becomes irritated or inflamed, it thickens and contracts (shrinks). In major degrees of contracture, the breast becomes round and firm. It is both unaesthetic and uncomfortable. Capsular contracture is the single most common 'event' to spoil an otherwise good result (see above). Adherence to post-operative instructions and the use of particular natural substances can help, although its occurrence can be quite unpredictable. Massage of the breasts which is still advocated by some should be strictly avoided.

How and where is the procedure performed and what is the post-operative course?

Breast Augmentation (Augmentation Mammaplasty) is most comfortably done under general anaesthesia in hospital and approved day surgery facilities usually as a day procedure. It is completed within 2 hours.
You are reviewed after surgery at one day, one week, one month and one year: then an annual check.

Return to work and physical activities

You may return to work one week after operation except if your or requires significant lifting or repetitive arm movements, in which case time off is extended.

What should be avoided after operation

Physical activity should not be excessive for at least one month. Any movement that causes the breasts to "bounce' should be avoided for three months as should excessive handling of the breasts.

Why choose The Victorian Cosmetic Institute for your breast augmentation?

Our surgeons specialise in breast augmentation, and in particular trans-axillary breast augmentation (through the underarm). We take the time to listen to your concerns, and to help determine the best options for you.

Our facility includes an accredited day surgery, where we can perform your treatment.

The first step is simply contacting us for your initial consultation, where we will discuss with you what is a realistic and achievable outcome, and what to expect from your treatment.

Making that first phone call about any cosmetic procedure can be a confronting task - many of our patients have preferred filling out our online enquiry form. We can then contact you and gain an understanding of the results you are hopeful of achieving and ensure the treatment is appropriate. 

It's as easy as clicking either of the buttons below and completing the provided form. Otherwise, you can phone us directly on 1300 863 824.

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