Breast augmentation

What is breast augmentation?

Breast augmentation is a surgical procedure that increases the size and changes the shape of a woman's breast. The procedure is commonly known as a 'boob job'.

There are a number of ways of performing this procedure. The main types are the insertion of silicone or saline implants (implant breast augmentation), or fat transferred from elsewhere in the body (non-implant breast augmentation) to enhance breast size or shape.

Reasons for breast augmentation

Breast augmentation can be performed for a number of reasons, which are often extremely personal. Breast augmentation might help to:

• Perform a reconstruction of your breast after surgery. For example, a mastectomy after breast cancer or other medical conditions;
• Improve your breast appearance, if you feel that your breasts are not the same size and shape (asymmetric), and;
• Enhance your self-confidence or self-image.

Implant breast augmentation

Breast augmentation is commonly performed using implants. There are numerous surgical techniques for the insertion of breast implants, which differ in the location of the incision (the surgical wound or scar), the type of implant and the location of the implant. The incision for a breast implant can be located in the crease beneath your breast (inframammary), in your armpit (transaxillary), around the nipple (periareolar) and occasionally, around your bellybutton (transumbilical). The type of breast implants commonly used are:

• Saline implants - these are filled with sterile salt water (saline). These implants are typically inserted as empty shells, which can then be filled to various levels with saline once they are in the correct position, and;
• Silicone implants - these are pre-filled with silicone gel. They are inserted into the breast in its pre-filled size, which may be technically more difficult.

The breast implant is inserted behind the breast tissue; however, it can be located either in front of (sub-glandular) or behind (sub-pectoral) the chest wall muscle (known as the pectoral muscle).

The surgical technique used by surgeon for the insertion of breast implants depends on numerous factors, including your breast anatomy, skin thickness, body size and the size or shape you want your breasts to be.

Non-implant breast augmentation

Fat harvested from elsewhere in the body can be used to increase and/or change the shape of the breast. The fat is harvested using liposuction techniques where a thin tube is inserted through tiny incisions, attached to a surgical vacuum pump, to suck out fatty deposits from stubborn fatty areas like the hips and abdominal wall. The fatty deposits are then injected into the breasts.

It is a minimally-invasive alternative to implants and has the added benefits of reducing unwanted body fat while also avoiding foreign bodies like implants. However, there is a limit to how much it can increase breast size and the results can be variable.

What happens during the procedure?

Breast augmentation surgery is typically performed in hospitals under general anesthesia. Before your procedure, your surgeon may make markings on your breast and chest area to help guide them during the procedure.

For the insertion of your breast implant, your surgeon will need to make an incision. The desired implant is then inserted under the breast tissue to either the sub-glandular or sub-pectoral position. If it is a saline implant, it may be filled after being inserted. The incision is closed with stitches and the wound is dressed. In some cases, a temporary drain tube may be placed at the site of your procedure to remove any excess fluid or blood. This is often easily removed on the wards or in the clinic, in the days that follow your procedure.

For non-implant breast augmentation, liposuction is used to harvest fat, commonly from the abdominal wall, thighs and buttocks. This fat is then selectively reinjected into the breast. There are often no incisions made in the breast.

Often a tight undergarment is placed over the breasts and advised to be worn for a few weeks following the procedure. This helps to reduce swelling and bruising from the surgery.

What happens after the procedure?

After your surgery, there may be some pain, swelling and sometimes bruising, which usually subsides after a few weeks. To help with the pain, you may be prescribed pain medications and advised to wear a supportive bra/undergarment for additional breast support. While healing, it is important to avoid any strenuous activities, physical contact or jarring movements. It is essential to keep the wound area clean to avoid infection. If you experience an increase in pain, redness or discharge from your wounds, it is advised you seek medical attention.

Longer-term care can involve visiting your surgeon to check that you have adequately recovered without any complications. The incision scars generally fade over time to become thin white lines.

Potential complications

Breast augmentation is a surgical procedure that carries potential risks. These can include:

• An allergic reaction to the anesthetic during the operation, which can in rare cases be fatal;
• Infection of the wound site;
• Deep vein thrombosis;
• Alterations to breast and nipple sensation including temporary or permanent numbness;
• Implant rupture or deflation - if saline implants leak, saline can be reabsorbed by the body and is non-toxic. However, if silicone implants leak, the silicone cannot be absorbed by the body and can cause pain. It can also cause granulomas, which are lumps caused by inflammation around leaking silicone. Sometimes the silicone can travel to the armpits and cause granulomas in the lymph nodes of this area;
• Formation of breast implant-associated anaplastic large-cell lymphoma - this is a rare cancer of lymphatic tissues related to breast implants;
• Difficulty breastfeeding;
• Alterations to the shape of breasts due to scar tissue, caused by a process called capsular contracture, and;
• Lowered effectiveness of breast cancer screening due to concealment of breast tissue during a mammogram.

Even with augmentation, over time as you age, your breasts may change shape. Other factors that can affect the outcome of your procedure include weight changes, pregnancy and gravity. If you become dissatisfied with the appearance of your breasts, it is possible to have further breast augmentation operations; however, this can be more technically challenging.

Alternatives to breast augmentation

Breast augmentation is an elective surgery that can be expensive and has associated risks. The surgical outcomes are not guaranteed to last forever; your breasts may continue to change shape as you age. It can help to talk to your doctor or a counsellor about your appearance concerns, as you may decide you do not require breast augmentation. Other alternatives are to wear padded or push-up bras, or undergo a breast-lift surgery known as mastopexy, which does not involve breast implants.

References

1. Breast Implants (augmentation). Better Health Channel. Accessed September 8 2014. link here
2. Breast Augmentation Results - Tests and Procedures - Mayo Clinic. Accessed September 9 2014. link here
3. Miranda Roberto N. Tariq N. Aladily H. Miles Prince Rashmi Kanagal-Shamanna Daphne de Jong Luis E. Fayad Mitual B. Amin et al. Breast Implant-Associated Anaplastic Large-Cell Lymphoma: Long-Term Follow-Up of 60 Patients. Journal of Clinical Oncology December 9 2013 JCO.2013.52.7911. doi:10.1200/JCO.2013.52.7911.
4. ONeill J. K. and G. I. Taylor. A Novel Method to Remove Silicone Gel after Breast Implant Rupture. Journal of Plastic Reconstructive & Aesthetic Surgery 59 no. 8 (August 1 2006): 88991. doi:10.1016/j.bjps.2005.11.019.
5. Shaaban H. and R. Alvi. Locoregional Silicone Spread after High Cohesive Gel Silicone Implant Rupture. Journal of Plastic Reconstructive & Aesthetic Surgery 60 no. 10 (October 1 2007): 116667. doi:10.1016/j.bjps.2007.01.081.

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