What is it?

Breast Augmentation is an operation to increase the size of the breasts using implants. The implants have a
silicone shell that can contain either sterile saline/water or silicone liquid/gel.

The Operation

Depending on the size of the breast, a pocket is surgically created either underneath the breast tissue or
underneath the muscle underneath the breast. The surgery is performed under general anaesthesia.
Depending on the type of implant used, it can be performed either through a scar around the nipple, a scar
underneath the breast, a scar in the armpit or very occasionally, through a scar around the belly button.

Any Alternatives

In the past, silicone itself was directly injected into the breast tissue but this is not something that is
recommended at present. There are some external suction devices, which can be applied to the breast, and
this has been reported to increase breast size following sustained use. It is not as yet absolutely clear if this
is a permanent increase in size. Sterile derivatives of Soya Oil have also been used as ‘fillers’ for implants
but these should no longer be used.

Before the Operation

It is important for your surgeon to assess the type of breast augmentation that is requested. It is also
important to understand why it is requested, as to whether it is brought about by a change in life
circumstances or a problem that has been ongoing for some time. It is also important to try and understand
the patient’s expectations as to the outcome and size of breast implants. There are a large number of
breast implants available and the exact type of implant, whether round, shaped, containing saline sterile
solution or silicone jelly, would all need to be discussed in detail with your surgeon prior to the operation.
Pre-operative review would also assess how fit you were for surgery. The type of scar and the exact site
and placement of the implant would be discussed in combination with a physical examination of your
breasts. This will indicate the extent of breast tissue that is available and where the implants should be
placed. The size of implants should also be discussed taking into consideration the amount of skin laxity
and breast tissue that is present. If the breasts are very droopy, breast augmentation alone may not be
sufficient and corrective surgery may be required in order to place the nipples in a different position. The
site of the scarring would also be agreed. It is likely that the surgeon may also want to take some
photographs prior to surgery. These are kept in your patient records. Your surgeon is likely to have the
type of implant available for you to feel and understand how it works. It may also be helpful to get an idea of
the type of volume that you require by filling bags of water with various volumes of fluid to gauge the breast
size that you might wish for.

After in Hospital

The operation is likely to take around one hour. On return to the ward you will have dressings around your
new breasts and these may be in the form of a comfortably fitting bra, or some wrap-around padded
dressings. It is also likely that there will be drains in each breast. You may be nursed in a semi-upright
position, as this can tend to minimise swelling and hence make you feel more comfortable. Your chest may
feel quite sore following your return to the ward. The nurses will be able to give you painkillers for this, either
by injection or tablet form. You may also feel your breathing somewhat restricted as the surgery to create
the pockets to place the implants can often make the chest feel slightly tight. The nurse will make regular
checks and monitor blood pressure, pulse and temperature. The drains are usually taken out on the day
following surgery. Should there be more fluid in the drains than expected, you may well be able to be
discharged from hospital and then return to have the drains removed a few days later.

After at Home

It is important that you rest on your return home. Excess use of the arms and upper chest area by regular
activities which one would normally undertake can cause further irritation and bleeding. It is best to continue
to wear a firm tight fitting bra both night and day for a further two weeks. The bra may be removed for
washing but one should avoid getting the wounds wet for probably one week following surgery. You should
also avoid sleeping face downwards for one month. It is probably best to avoid doing any heavy activities,
particularly lifting the elbows above the shoulder level, or any heavy lifting for a further three to four weeks.
You may also find that your nipples have altered sensation following the surgery but this is likely to improve
as time passes. The scars themselves may be massaged from two weeks following surgery. However, it is
not often necessary to massage the breasts themselves. It is probably best for you not to drive for at least a
week following surgery. You should then be quite sure that you are able to perform an emergency stop.

Complications

As with any surgical procedure, bleeding can occur but the drains that are left after the operation are usually
sufficient to control this. Very occasionally if bleeding continues to be a problem, it may be necessary to
return to theatre to stop the bleeding. In making a pocket into which is placed the implant, one of the
structures that can occasionally be damaged is the nerve supply to the nipple. This can result in complete
loss of sensation to the nipple but more often results in either decreased or very occasionally increased
sensitivity. This increased sensitivity can be uncomfortable. Any time an object is placed within the body,
the body forms a film around it. This film can occasionally instead of staying nice and loose, increase in
thickness, become scarred and occasionally become uncomfortable. This is known as ‘capsule formation’.
This tends to occur in about 10% of patients who have breast augmentation. It occasionally will only affect
one side as opposed to both sides where bilateral breast augmentation has been performed. The type of
capsule can vary from a firm feeling to one where the breast becomes very firm and hard, like a tennis ball.
In these situations the treatment depends on the ongoing problem. Occasionally it may be necessary to
remove the implant entirely and to replace it. Infection can also occur. If the implant becomes infected then
it is likely that the best option is to remove it.

There has been some controversy as to the use of silicone implants. Many surgeons continue to use
silicone implants both for reconstruction and for aesthetic augmentation. There have been a number of
studies which indicate that there is no definite evidence that silicone causes any problems within the body.
However, there are undoubtedly some people who have had breast implants that do have some
unexplained symptoms. Most people benefit from having breast augmentation performed.

General advice

Having a bilateral breast augmentation performed can be somewhat uncomfortable. It is important to avoid
driving for about a week following surgery and to be sure that one is able to perform an emergency stop. If
the sensitivity of the nipple has been altered by the surgery, this may take some months to recover and
indeed may never fully return to normal. It is important that placement of the implants is discussed with the
surgeon prior to surgery. The implants will tend to stay where they are placed and will not move around the
chest wall, as a normal jelly-like breast would do. The patient would need to have an understanding about
this prior to surgery.