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Breast Augmentation or Augmentation Mammaplasty

Breast Augmentation | Breast Enlargement | Boob Job | Mammaplasty

There are no exercises, hormones, or other medications which can have any real effect upon the size of a small breast. Surgical correction has become possible with the use of the latest highly cohesive silicone gel or saline filled breast implant. This breast enlargement surgery consists of the insertion of a preformed implant partially behind the pectoralis major muscle (in most instances), known as the Dual Plane technique via a small surgical incision. Using various breast implant sizes and shapes (anatomical or round), the breast can be increased as may be desired. The texture of the material is practically indistinguishable from normal breast tissue.

Size is limited by the degree of stretch that can be comfortably achieved in the existing breast. When the small breast has previously been larger (as in an earlier pregnancy), elasticity will permit easier adjustment. When significant amounts of breast tissue have never developed, size can also be greatly increased, but not to as great an extent.

Many patients for this operation are women who have experienced gradual breast shrinkage following one or more pregnancies – not an uncommon occurrence. The breast enlargement surgery has been used to restore fullness where the post-pregnancy change has resulted primarily in sagging with lesser degrees of shrinkage. It has also quite often been employed for those young women naturally endowed with small breasts. One of the more recent developments is the use of breast implants to compensate for breast deformities incidental to other types of breast surgery. In selected cases, where removal of the breast is necessary because of malignant disease, restoration can be considered with the use of a silicone breast implant. Modification of the primary surgical procedure must be consistent with the extent of the disease and must not compromise ultimate recovery.

In the performance of a breast augmentation procedure, there are several different surgical approaches (locations of incisions), each with its own proponents. There are also different kinds of implants (silicone cohesive gel implant in a silicone shell, saline filled, etc.). Each of these has some special advantage in selected situations and some undesirable aspects accompany each. The differences are too numerous to be discussed here and should be reviewed carefully with Dr Braun, who will have his own preferences based upon his experience.

All sutures are absorbable and hence do not require removal. You will stay in hospital for one day and your recovery will take approximately seven days.

Eyelid Surgery

The following statements will answer some of the more frequent questions.

  • There has never been any demonstrated relationship between the silicone prosthesis and the future development of breast cancer.
  • The implant will not interfere with future breast-feeding if the patient becomes pregnant.
  • The surgical incision will leave one small scar around the lower areola or under the breast of approximately 2.5cm in length. This will gradually fade and become relatively unnoticeable. Alternative incisions are located under the breast or through a small incision under the arm. The final choice of incision and type of prosthesis to be used is left to the patient.
  • Most patients are completely comfortable with the change and cease to be aware of the breast implants after the first two to three months.

What are the risks?

  • Every surgical procedure involves some risk. When performed under proper operating room conditions, this operation is not dangerous. It does not involve any internal organs.
  • Unfavourable scar formation (particularly when sited under the breast) that remains uncomfortable for an extended time (six months to a year) may occur, but this is unusual and virtually never occurs with the areolar incision.
  • Occasionally, the breast may become somewhat firmer because of tightening of the fibrous capsule which forms around the breast implant. The incidence seems to be considerably less if the implant is moved carefully shortly after the surgical procedure. Manipulating the implant in all directions maintains a larger pocket and consequently there appears to be less chance for contracture. If undue firmness does develop, some improvement may be obtained by secondary surgical release which involves partial reopening of the old incision and sectioning of the scar tissue at the margins of the implant. Usually, this is a limited procedure. The incidence of capsular contracture appears to have been reduced even further by placing the implant under the pectoralis major muscle (sub-pectoral placement). There is some evidence to show that the drug, Accolate, taken for a period of time after breast augmentation surgery may reduce the rate of capsular contracture even further.
  • Infection at the site of implant is unusual but can be treated quite satisfactorily, often without removal of the implant.
  • Displacement or asymmetry to a significant degree is not at all common. Minor displacements may be present but are generally not different from variations considered to be within normal limits
  • It should be noted that occasionally there may be a collection of blood around the implant within the first twenty-four to forty-eight hours after the surgical procedure. If the amount is significant, it may be necessary to remove this by reopening the incision to control bleeding and then replace the implant in its original position.
  • There may be some loss of sensation to the nipple area. This is more often a temporary condition and will return within 3-6 months. Incisions around the nipple do not increase this risk.

The size of the implant is carefully estimated beforehand by the patient trying on preformed sizers at the initial consultation. Selection is based upon the patient’s general stature and chest size, and the amount of breast tissue already present. Although some women prefer to have the largest implant, there may not be sufficient room to accommodate it without undue tension and some discomfort. Oversized implants may result in poor contour and the presence of irregular firmness just under the surface. The implant is not really “in” the breast – it is “under” the muscle which is behind the breast. After the procedure the patient may return to her normal activities within three days, avoiding strenuous exercises for three weeks. Additional instructions will be provided which should be followed closely. The primary aim is to obtain a soft natural looking breast.

Plastic Surgeon Dr. Saul Braun operates from the Netcare Rosebank Hospital, situated in the up-market Northern Suburbs of Johannesburg.

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