Breast enlargement

Breast enlargement - characteristics

Woman’s breasts, as an attribute of female attractiveness, have attracted broad interest from both sexes for centuries. No other surgical procedure has caused so much controversy and brought out so many emotions over the years. The earliest reported attempts of breast enlargement date back to the beginning of the twentieth century. They involved injections of liquid paraffin and then silicone and were accompanied by a large number of serious complications often leading to the disfigurement of women subjected to this treatment.
The procedure was revolutionised in the early sixties when the first silicone implants were introduced; however, they were far from perfect. To achieve better results it was necessary to keep modifying them gradually for almost 50 years and perform many clinical tests to assess the safety of their use. Much later, at the beginning of the nineties, implants filled with physiological saline were authorised for use.

The dynamic development of minimally-invasive procedures has entered the world of plastic surgery. Now one method of boob job is the endoscopic method, with access through the belly button or armpit with the use of saline implants. However, the current most popular implants are those filled with silicone gel with a cohesive substance and differing levels of liquidity. They may be in an anatomic or round shape and their silicone capsule may have a smooth or textured surface. Their profile also differs, as they may be either low or high.

What are round implants?
The base of round implants is wheel-shaped. This is the flat side of an implant, which will be directed towards the chest. The other side of the implant is equally convex. A round model better fills the upper part of the breast, therefore the final shape is similar to the shape of a ball or a sphere. They make breasts look perfect, which is far from natural; however, it is preferred by a lot of men.

These implants are often chosen by patients willing to display their breasts and willing to boast about them. Patients opting for this model are often pleased that the interference of a plastic surgeon is apparent. These type of implants have been made fashionable by celebrities. They are much cheaper than anatomic models. The implant consists of a durable silicone capsule filled with silicone gel. Its level of liquidity may vary; however, due to its cohesive consistency, in the case of the capsule bursting, its contents will not leak outside.

The surface of the silicone capsule of the implant may be totally smooth or textured – gently rough, velvety to the touch. The use of textured breast implants lowers the risk of the most common complication, that is, capsular contraction on the surface of the implant. The volume of an implant is given in cubic millimetres. However, it is not the most important parameter in choosing an implant as this is the sum of three factors: height, width and projection. In round implants the width is the same as the height due to the basis of the implant being wheel-shaped. Projection means anteroposterior diameter, which is the most important factor contributing to the final size of breasts after an operation. Implants used currently do not need to be changed with time as they last the patient’s lifetime. However, a change in body weight or the natural aging processes may create the need to exchange an implant for a different-sized one to improve the appearance of the breasts.

What are anatomical breast implants?
Implants with this shape look similar to a tear or a drop of water. A convex surface is characterized by a full bottom part with the layer of the gel thinning towards the top. The flat side of the implant is called the basis and is directed towards the chest. The implant consists of a durable silicone capsule filled with silicone gel. There may be more or less liquid; however, due to its cohesive substance, if the capsule bursts, its contents will not leak outside.

In comparison to round implants, anatomical implants give a more natural look to augmented breasts. They are usually chosen by those patients who want to conceal the interference of a plastic surgeon. The price of these implants is higher than that of round implants. The surface of the silicone capsule of an implant may be entirely smooth or textured – gently rough, velvety to the touch. The use of textured implants reduces the risk of the most common complication, that is, capsular contraction on the surface of the implant.

The volume of these implants is given in cubic millimetres. However, it is not the most important parameter in choosing an implant as this is the sum of the three factors: height, width and projection. The height of an implant is the internal length of the basis of the implant vertically, that is, towards the collarbone. The width is the length of the basis horizontally. Projection means anteroposterior diameter, which is the most important factor contributing to the final size of the breasts after an operation.

Implants used currently do not need to be changed with time as they last the patient’s lifetime. However, a change in body weight or the natural aging processes may create the need to exchange the implants for different-sized ones to improve the appearance of the breasts.

Breast enlargement - benefits

The main benefits of boob job procedures are of a psychological nature. Patients undergoing this treatment have a chance to become more confident, which may translate into success in their professional or private life. They also become pleased with the look of their own body and get rid of complexes, which is important in increasing one’s satisfaction with life. Their partner’s approval brings about feelings of attractiveness and enhances their relationship. Patients who have lost their breasts due to disease obtain a symmetrical weight load, which is important for preventing degenerative spinal conditions. Breast reconstruction allows one to forget, at least to some extent, about a disease and the unpleasant process of its treatment.

Indications for surgery

Indications for breast enlargement include:

• innate breast asymmetry and deformation of mammary glands, which occur in Polland’s syndrome or so-called tubular breasts,
• acquired breast asymmetries caused by mastectomy or injuries,
• changes to the size and shape of breasts due to pregnancy or breast feeding,
• changes to the size and shape of breasts caused by weight loss,
• a desire to change the appearance of their breasts in patients who are not happy with the current size and shape of their breasts.

Contraindications for the treatment

Contraindications for breast enlargement procedures include, among others: unrealistic and impossible to realize expectations of the patient; haemorrhagic diathesis and vascular haemorrhagic diathesis; serious systemic diseases, such as advanced heart, renal, hepatic failures; diabetes; active inflammations; systemic infections; immunodeficiency; widespread fibrosis or ischemia of chest tissue, which may be, among others, a consequence of former radiotherapy and prevents the performance of the procedure; unfinished diagnostic or oncological treatment due to cancer.

Before the procedure

During a pre-surgery appointment before breast enlargement, a thorough examination will be performed to establish the anatomic conditions of a given patient with respect to the potential asymmetry of their mammary glands, grade of ptosis and also potential deformation of the chest and spine, and an appraisal of the sensitivity of the nipple and areola. Moreover, pictures of the area subject to the procedure will be taken. Implants are chosen individually depending on the effects expected, anatomic conditions and the skills and preferences of the surgeon. For the purpose of the best choice of implant, the use of specially-developed computer software is increasingly common. Preoperative procedures should include a thorough analysis of the health condition of the patient, taking into account her expectations with regard to the effects of the procedure as well as her motivations for subjecting to the procedure and postoperative co-operation.
A doctor decides what tests will be necessary before the breast enlargement surgery. Their purpose is to establish the condition of the patient before the procedure of breast enlargement, to improve the safety of the procedure itself, as well as the aesthetic which accompanies it.
Usual tests include:

• biochemical tests (level of glucose, creatinine, sodium, potassium)
• blood cell count,
• C-reactive protein level ( CRP),
• blood group,
• haemostatic parameters (APTT, INR) ,
• urine analysis,
• test for hepatitis B and C antibodies and antigens,
• breast scan or mammogram,
• chest X-ray,
• ECG test.

Recommendations may also involve an MRSA nasal swab from the nares or sanitation of the mouth to lower the risk of infection.
It is important to refrain from smoking before the breast enlargement procedure for about 4 weeks and at least 2 weeks after it, and if this is not possible, at least to limit smoking significantly. Substances contained in tobacco smoke impede to a large extent microcirculation causing impairment in postoperative wound healing, which translates into an increase in the number of complications.

The doctor should be informed about all medication used by the patient. All medication, including OTC, dietary supplements and contraceptive pills should be mentioned. Before an appointment a list of medicines with the specific name of a given substance, its strength and doses should be made. They may be also taken to the appointment.

For 2 weeks before the procedure, medicines containing acetylsalicylic acid (ASA) such as Acard or Aspirin may not be taken. A doctor should be informed about all chronic illnesses, serious illnesses and history of serious illness and all surgical procedures undergone. Preparation of comprehensive medical records such as hospital discharge cards or information on the treatment of chronic diseases in out-patient clinics is very important.

Type of anaesthetic

The procedure of breast enlargement is performed under general anaesthetic. This requires the presence of an anaesthetist, who also admits a patient for this type of anaesthetic based on laboratory test results, coexistent diseases and a physical examination. The aim of the medication given during this kind of anaesthetic is the complete elimination of pain and consciousness, muscle relaxation and the elimination of spinal reflexes. This means that a patient under general anaesthetic is asleep and is unaware of the procedure. Mechanical ventilation through the use of a respirator is necessary. Six hours before the breast enlargement procedure a patient should refrain from eating and drinking. These restrictions aim to minimize the risk of complications connected with the techniques of anesthetising and mechanical ventilation. Failure to adhere to this recommendation may have serious consequences, such as aspiration pneumonia or respiratory failure, which endanger the patient’s life.

How is the procedure performed?

The procedure of breast enlargement takes about 60-120 minutes. A skin incision is made in such a way so as to make the scars as barely visible as possible. They may be placed in the subpectoral fold, where the skin joins the areola, or also in the armpit, which is the least frequently used position of surgical incision. Following that, the space where the implant will be placed is prepared. Depending on the technique of the procedure, it may be placed under the pectoralis major muscle or mammary gland.
In a Dual-Plane technique, which combines the two abovementioned methods, an implant is covered partially by the pectoralis major muscle and partly by the mammary gland. The wound is stitched in layers. The skin is usually stitched with an intradermal stitch, which gives a good cosmetic effect. Drainage is not usually used, however it may be necessary in some cases.

Course and duration of recovery

Right after breast enlargement procedures, the patient stays in a recovery room where their main vital signs are monitored. Pain is usually treated with the use of orally-administered medication, typically non-steroidal, anti-inflammatory drugs. The length of hospitalization depends on the course of the procedure and the patient’s condition. It does not usually exceed 3 days. Drains, if used, are removed before leaving the clinic. Non-dissolvable skin stitches are removed during a first check-up appointment on the 7th or 10th day after surgery. Dissolvable stitches are not removed as they dissolve after 3-4 weeks.

Check-up appointments are scheduled individually depending on the need, however, the first visit usually takes place after one week from the breast enlargement surgery, the next may be scheduled, for example, in one, three and twelve months. After that, check-ups are performed once a year. They are particularly important due to the possibility of diagnosing potential complications and applying treatment early. The early post-surgery period takes about 14 days and should be used for resting. After this time, it is possible to get back to work. After about 3 months, the result of the surgery may be considered permanent.

Breast enlargement – results

As a result of the procedure of breast enlargement with round implants, the upper part of the breast is filled better; therefore the final shape is similar to the shape of a ball or a sphere. They make the breasts look perfect, which is far from natural; however, it is preferred by a lot of men. These implants are often chosen by patients willing to display their breasts and willing to boast about them. Patients opting for this model are often pleased that the interference of a plastic surgeon is apparent. One should also not forget about the psychological effects of a better body look, such as feelings of attractiveness and increased self-esteem.

The result of the procedure of breast enlargement with anatomical shaped implants is the natural look of the augmented breasts. These implants are usually chosen by those patients who want to conceal the interference of a plastic surgeon. One should also not forget about the psychological effects of a better body look, such as feelings of attractiveness and increased self-esteem.

Recommendations after the surgery

In the early post-surgery period, physical activity should be limited and driving is also not allowed. Breast enlargement procedure is a serious surgical procedure; therefore the body needs time to recover fully. The early post-surgical period takes about 14 days and it should be devoted to resting. After that, a patient may return to work.

It is necessary to wear a special, elastic, modelling bra with no wires for about 2 months following the procedure. This aims to prevent the implant from moving. Such a risk is higher in the first 2 -3 months after the procedure, which is a consequence of the natural wound healing process. For the same reason, a patient should refrain from undertaking intensive physical activity.

Sunbathing or using sun beds should be avoided for 6 months. Due to the risk of discoloration of the scar and, therefore, a negative cosmetic effect, it is recommended to avoid exposure to UV light. Check–up appointments are scheduled individually depending on the patient’s needs. The first appointment is usually scheduled one week after the treatment. Following that, the appointments are scheduled after, for example, one month, three months and twelve months. After that, check-ups are performed once a year. These are particularly important due to the possibility of discovering early potential complications and to take up early effective therapeutic measures sufficiently in advance.

How long do the results last?

A change in body weight or the natural body ageing processes may result in the need to exchange the implant for a different size to improve the appearance of the breasts. These features and factors are individual to each patient. The implant itself does not require changing as modern implants are supposed to last a lifetime.

How to avoid complications?

Total avoidance of complications after breast enlargement procedures is not possible as there are factors which are beyond the control of the patient and the surgeon. These can not be predicted and therefore can not be prevented. Close co-operation of the patient with the doctor, following pre and post-surgery recommendations, and the provision of full medical records before the procedure allows, to a great extent, the minimisation of the risk of complications. Sticking to check-up appointments and contacting the doctor if there are worrying symptoms are important for detecting complications in their early phase and to allow for quick and effective intervention.

Breast enlargement – possible complications

The most common complications after breast enlargement are:

• Capsular contracture – hardening of the breast area around the implant- whose frequency is even 20% and which leads to deformation and hardening of the breasts. Correcting this problem may require further surgery.
• displacement of an implant, for example the implant moving upwards causing deformation of the upper part of breast, as well as sagging of the implant, which causes protrusion in the lower part of the breast. An implant may also be displaced towards the centre or the side of the chest.
• Rupture of the implant, which may cause pain and malformation.
• Scarring – this is connected with individual genetic predisposition and might not be predicted. It leads to the occurrence of wide, thick, intensive in colour, purple-red scars which may be accompanied by pain, burning or itching).
• Infection which may lead even to the necessity of removing the breast implant.
• Hematoma or seroma, which may require draining.
• Impaired or increased sensitivity of the nipple and areola or skin of the breast,
• Mondor’s disease: a condition which involves thrombophlebitis of the superficial veins of the breast and anterior chest wall
• Cases of Galactorrhoea have also been reported.

Additional post breast enlargement complications, which may happen after every operation, include: haemorrhage; stroke; heart attack; adverse reactions to medication given, which may lead to anaphylactic shock; pulmonary embolism or deep vein thrombosis. These are serious, life threatening complications which require hospitalization.

Do breast implants increase the risk of autoimmune diseases?
A connection between breast implants and autoimmune diseases has not been proven.

Do breast implants increase the risk of breast cancer?
They do not increase the risk of breast cancer. It should be noted that patients who have undergone breast enlargement with the use of implants should be subject to screening for the early stage of breast cancer. It is possible to perform mammography; however, it is more difficult. For better visualization of breast tissue, a breast scan or MRI may be recommended. The doctor performing the scan should be informed about the breast enlargement procedure.

Is it possible to breastfeed after a breast enlargement procedure with breast implants?
Breast feeding after breast enlargement procedures with use of breast implants is absolutely possible. It has been proven that the silicone contained in the implants is not excreted into human milk and is therefore not dangerous to infants. Additionally, breast milk is recommended by paediatricians as the most appropriate type of food for a baby and it should be used for a period of six months at least. Breastfeeding is also an important preventative measure against breast cancer.

Recommended additional treatment

The surgery itself does not always guarantee the achievement of the desired effect. In such a case it may be necessary to use additional surgical techniques. One of them is mastopexy, also known as a breast lift; that is, lifting the breasts to correct their sagging. In some cases it may be advisable to dissect part of the gland or to move the nipple and the areola.

Author: Barbara Bełda MD

Literature::
Aesthetic and reconstructive surgery of the breast; 2010; Editors: Elizabeth J. Hall-Findlay, Gregory R. D. Evans, Plastic and Reconstructive Surgery; 2010; Editors: Maria Z.Siemionow, Marita Eisenmann-Klein, Oncoplastic Breast Surgery a Guide to Clinical Practice;2010; Editors: F.Fitzal, P.Schrenk, Grabb and Smith’s Plastic Surgery 6th Edition;2007; Editors: Robert W. Beasley, Sherrell J.Aston, Scot P.Bartlett, Geoffrey C.Gurtner, Scott L.Spear