Patients are taking a more active role in the decision making processes regarding breast augmentation mammoplasty (BAM) surgery, however, pre-operative discussions regarding implant types and other choices, can be a source of confusion. In an attempt to clarify these issues, Waverley Plastic Surgery has developed a standardised form that addresses “The Seven S’s” topics of discussion, that are most frequently raised by patients prior to their breast enhancement surgery.
The “Seven S’s” of breast augmentation.
1. Size – how big should the implant that I choose be?
Choosing the appropriate implant is a key factor in the whole process of successful breast augmentation surgery, but cup size is only part of the equation. A good result will be that which achieves a fuller bust in proportion with the rest of the woman’s body. This requires specific consideration of the individual dimensions that determine breast aesthetics; cleavage, fullness at the sides and top of the breast, and how far the breast projects out from the chest wall. The patient and surgeon need to spend time discussing the existing breast form (size and shape) and determining what feature(s) the patient specifically wants to enhance. A 250cc implant beneath a “B” cup sized bosom may produce the desired “C” cup augmentation but fail to achieve that which she was seeking to improve, for example a deeper cleavage or greater lateral fullness to balance broader hips. (Note: most women do not want an unnaturally large bust, but often choose a bigger implant than they thought they would.)
2. Silicone vs Saline – what is the implant made of?
All commercially available breast implants are made of an outer silicone-rubber shell, which then contains either a cohesive silicone gel (silicone implants) or salt water (saline implants). Whatever filler is chosen, there are advantages and disadvantages. Patients with “silicone vs saline” issues are generally concerned about what happens if the prosthesis were to rupture and silicone escape into the surrounding tissues. The choice of implant should be based on what provides the best result, not what is the least problematic if something goes wrong, as it is very unusual for any breast prosthesis to leak or rupture.
Silicones are man-made substances containing silicon, oxygen and other chemicals. Silicone products are biocompatible (i.e. accepted by the human body without adverse reaction), reliable, flexible and easy to sterilise, making them an ideal choice for implantable medical devices. Silicone gel implants are pre-filled. This imposes certain limits on how and where they can be inserted into the breast. Silicone implants are considered to provide a more natural feel to the augmented breast and the consistency of the silicone provides an excellent medium, complementing the breast’s natural shape. With recent advances in silicone technology, it is extremely unlikely for these implants to leak and the highly viscous cohesive gel (similar to the consistency of turkish delight) limits the spread of the silicone beyond the immediate vicinity of the implant.
Due to the face that these types of implants are inflated with saline after insertion into the breast envelope, saline implants can be delivered via a much smaller hole, for example, within the areolar or the armpit. This smaller scar may or may not be a determining feature for an individual patient in the choice of implant. Additionally, because they are filled after insertion, this allows for minor filling adjustments during surgery.
Saline implants are however, more likely than the silicone filled implants to cause visible “rippling” around the edges. They can also feel firmer to the touch. If a saline filled implant were to leak, harmless salt water escapes into the surrounding tissues and the empty silicone shell is simply removed.
Placing the implant above the muscle involves less dissection and so less likelihood of bleeding. The disadvantage is that in the absence of significant breast tissue to cover it, small implant irregularities may be more prominent. For patients wanting to enhance their cleavage, for example, a round implant placed above the muscle would be the preferred combination.
Placing the implant behind the muscle is thought to reduce the incidence of capsular contracture (see “shrinkage”) and provide a smoother graduation and a more natural appearance overall.
4. Shape – will the implant be round or teardrop shaped?
Round implants are less expensive and due to their symmetry, aren’t disfiguring if they rotate inside the breast pocket. Round implants are useful for enhancing cleavage and fullness at the top of the breast. Teardrop shaped implants provide a superior result in certain patients, putting the bulk of the augmentation behind the nipple. In the very small breasted patients, these anatomically shaped implants provide a significantly more natural result. Silicone implants are now available in a variety of styles, with dual gel prostheses, asymmetrical shapes and others.
5. Scar placement – where will the scar be?
There are three options; armpit, around the nipple or under the breast (infra-mammary fold).
6. Surface – is the coating of the breast implant smooth or textured?
Textured implants are thought to be associated with less capsular contracture (i.e. hardening of the scar tissue around the breast) but this is unproven. In the long term, there has been anecdotal evidence that textured implants can be associated with wrinkling in the lower part of the breast in thin women. Smooth implants are marginally less expensive, and may provide a more natural feel.
7. Shrinkage – what is capsular contracture?
All patients develop scar tissue around implants. It is the body’s natural response to foreign devices and occurs with heart valves, joint prostheses and pacemakers, and breast implants. Capsular contracture is the shrinkage and subsequent hardening of this scar tissue. With regard to BAM surgery, scar contracture can be mild, moderate or severe; in the worst case scenario the scar contracture can distort the implant. The correction of this distortion may require further surgery, including removal of the implant.
Breast augmentation is performed under a general anaesthetic and takes around an hour. You will usually stay overnight in Hospital, however some patients opt to be discharged on the same day. You do not usually require any drains or special dressings following the operation.
Your breasts are usually a bit swollen and tender after the surgery and may feel a bit tight for a few days. There is often some numbness of the breasts which resolves in the following weeks. It is usually best to avoid any strenuous activity for a month or two, but gentle exercise can be resumed after a couple of weeks. Keeping surgical tape on the scars for 3 months can help to minimise the scarring for the best possible aesthetic result. It is important to continue regular breast self-examination after the surgery.
Please contact us today if you would like further information or want to make an appointment with Mr David Ying to discuss breast augmentation surgery or any of the breast surgery procedures we offer.