An interesting case history that shows the application of modern breast augmentation surgery is that of Pam (not her real name) a 34 year old woman who had three children. She had been through all the normal weight fluctuations associated with her pregnancies and was currently wearing a size 12B bra. Pam felt that her appearance was “not feminine”. She felt that her breasts represented “empty sacks”. Pam had become very self-conscious about her appearance, found herself worrying about her breasts every day and even found herself admiring the breasts of other women. Despite being happily married and a busy mum Pam had a very strong desire for breast augmentation. She just wanted to feel normal again.
During her examination I measured the volume of her breasts at 225 ml on each side. As she was used to wearing bras in the 12 range I explained to her that each 150 ml represented 1 cup size. Therefore 150 ml of breast volume would be full A cup, 300 ml a full B cup, 450 ml a full C cup, 600 ml a full D cup and so on. At 225 ml she would not quite fill a B cup. I fitted Pam with a 12C sports bra and inserted sizers of various volumes in order to compare different sizes and see what looked best. I started off quite small, adding just 175 ml. We progressed upwards through 250 ml, 300 ml, 350 ml and even 400 ml! Pam finally settled on 350 ml as this added volume provided her with a natural look while at the same time providing a very significant breast augmentation. It was useful for Pam to try the larger 400 ml implant and she saw that this size made her look overweight and a little “frumpy”.
Selection of size for breast augmentation is a very important matter and I believe that it should be a process rather than decided at the time of consultation. I therefore suggested to Pam a way that she could trial her desired size at home. My suggestion was that Pam purchase a size 12C sports bra (with no underwire). She was then to measure 350 ml of rice in a measuring jug and empty the rice into a stocking. She then had a precise volume of 350 ml which she could place into her bra and wear continuously for a week. Pam was free to try larger sizes (such as 375 ml) or smaller sizes (such as 325 ml) and Pam had the task of deciding her ultimate preferred volume.
Pam called me 2 weeks prior to her surgery just to discuss the size further and she settled on 350 ml.
On the day of operation Pam was a little nervous as is expected. She was very reassured by the professional attention provided by the nursing staff. Prior to the surgery I made some marks on Pam’s chest representing the site of the incision (below the breast just above the inframammary fold) and the limits of my dissection. Pam then walked into the operating theatre and was given a light general anaesthetic. I injected long-acting local anaesthetic all around her breasts so that she would be as pain free as possible when she awoke. A small incision was made beneath each breast and a pocket made for the implants under the pectoral muscles. The pockets were irrigated with an antiseptic solution prior to the insertion of the saline implants. As Pam had chosen saline rather than silicone implants only a very small incision was required (3 cm) and the implant was inflated insitu when it was behind the muscle. It has been found that when implants are placed behind the pectoral muscles it is usually not possible to tell the difference in feel between silicone and saline implants. The use of the subpectoral pocket for implants results in breasts which are soft and natural and of course the use of saline implants provides great peace of mind. With all the problems associated with silicone implants it was reassuring for Pam to know that we have inserted over 4000 saline implants over the last 20 years and have had only 4 leakages.
Following closure of the incision Pam was taken back to her bed and watched over by a recovery nurse until she was fully awake. Pam was soon sitting up in the chair beside her bed and was able to go home by mid afternoon.
Pam was seen in our post-operative clinic the following morning when her small drain tubes were removed and she was placed in a bra. As Pam had breasts with a volume of 225 ml and we added 350 ml in the form of implants, her total breast volume now measured 575 ml (almost a full D cup!).
Pam was able to drive and do light housework after 2-3 days and after a week we instructed her how to massage her implants to make sure that they moved within their pockets to produce the most natural result.
Pam was next seen 6 weeks after her operation at which stage the post-operative photograph was taken. She is naturally delighted with the size of her new bust and feels a much more confident person.
It is clear that breast augmentation is not just about making the breasts larger but, more importantly, about helping a women become a more confident person. The challenge is to do the procedure in a way that is safest and most comfortable for our patients. The combination of Saline Implants and Day Surgery allows us to achieve this goal.