An open letter to patients
The following is an open letter to prospective patients regarding breast enlargement or breast augmentation.
If you are contemplating breast enlargement, you have probably been self-conscious about your appearance for a number of years. Sometimes, the breast never develops fully and you may recall being teased about your small breasts when you were at school. Or, your breasts may have been normal but then lost their shape following pregnancy or after breast-feeding. In either case, you may feel anxious because of your lack of breast fullness and feel compelled to modify your life in many ways. For example, you may wear padded bras or push-up bras and feel unable to wear certain types of clothes, such as low-cut tops or dresses with a low neck-line. You may feel too embarrassed to wear bathers during summer. You may even have feelings of envy towards other women with larger breasts. These are all reasons why women consider breast augmentation.
With a breast augmentation procedure, we are aiming to produce a breast which is not only larger but also looks and feels natural. We also aim to do this in the safest possible manner.
If you are contemplating breast enlargement, you probably already have quite a bit of knowledge about the subject. There have been numerous articles in magazines and programmes on television, not to mention the large amount of information that is available on the Internet. You know that there are many options available and you may feel confused and unable to make a proper choice.
Over the last 25 years, I have inserted more than 4000 breast implants, both silicone and saline, and in this letter I would like to share some of my thoughts with you, so that you can feel confident about the choices that you make.
The first choice is where to make the small incision through which the implant will be inserted. The most popular site is just above the skin fold on the underside of the breast. This site is the most practical because the surgeon can go straight down onto the chest wall and then make the pocket behind the breast without cutting through or damaging the breast in any way. The resulting scar is only about 3 cm long and, with time, becomes almost invisible.
Other possibilities for the incision are around the nipple and in the armpit.
A scar around the nipple is used if a lot of loose skin is present and it has been decided to remove some skin together with a breast enlargement operation. It is not the site of first choice because in order to make a pocket behind the breast from this position, the surgeon has actually to cut through the breast tissue and, in the process, inevitably damages some of the breast ducts and nerves to the nipple. Also, the scar is situated on the front of the breast and may therefore be more visible.
The incision in the armpit is not our first choice because women worry about the scar being visible in bathers and sleeveless dresses whenever they raise their arms. Also, in some women, the armpit can be a long way from the breast and it can be difficult to insert the implant low enough on the chest wall so that it looks natural. A third reason not to use this approach is that there is a higher risk of infection when the implant is placed through the armpit. So, given the 3 choices, a small incision under the breast is favoured by most women.
The next choice is whether the implant should be placed in front of or behind the pectoral muscle. This decision is made easy if you know that when implants are inserted in front of the pectoral muscle, 60% will develop a condition known as spherical capsular contracture. This means that the breasts will feel hard due to scar tissue forming around the implant. On the other hand, when the implant is placed behind the pectoral muscle, less than 1% develop capsular contracture. This is the reason why most surgeons who do a lot of breast implant work, prefer to place the implants under the muscle. This simply gives you the best chance of having a breast which looks and feels soft and natural. Some people are concerned about alteration in function of the muscle but this very rarely happens even in athletic women who do a lot of sport. Also in thin women, placing the implant under the muscle makes it much more difficult to detect. This means that it is difficult to tell the difference between the various types of implant (such as round vs anatomical, silicone vs saline), so you are free to choose whichever is safest. Another reason to place the implant behind the muscle is that it does not interfere with mammography or breast screening.
The next decision, and one that I know causes a lot of anxiety, is what type of implant to use – silicone or saline, textured or smooth.
The first thing you need to understand is that any medical device, when implanted in the human body, is going to have a certain lifespan. Whether that device is a heart pacemaker, an artificial hip or a breast implant, its lifespan can be expected to be limited. With breast implants, the risk is that they will leak. With a silicone implant, if the implant leaks, then the silicone can spread into other tissues such as the lymph glands in your armpits. Often, the first sign of a leaking silicone gel implant is a firm lump under the arm. An MRI can detect, but cannot predict, implant leakage.
Some MRI studies have shown that 40% of silicone gel implants are leaking after 8 years! I have personally seen silicone implants leak after only 3 years, with the silicone causing lumps under the arm. These were modern high cohesive gel implants. The gel had liquefied after only three years at body temperature! This is the reason many women prefer saline implants. Saline implants have one remarkable safety feature. As they are filled with salt water (intravenous saline solution), if they leak, for whatever reason, then the salt water is simply and harmlessly absorbed by the body. The shell of the implant can easily be removed and another implant inserted in its place.
With such an overwhelming safety advantage, the only other consideration is whether saline implants are as soft as silicone implants. This depends on the design of the saline implant and on where it is placed. If the implant has a smooth wall and is placed under the muscle, then it is very difficult to feel the actual implant and it is difficult to tell the difference between a silicone and a saline implant. If, on the other hand, the implant has a thicker, textured surface and especially if it is placed in front of the muscle in a thin person, then not only will the implant be palpable but rippling may also be visible and the result may not be satisfactory.
For these reasons, most women, when presented with this information, have a clear preference for saline implants with a thin smooth wall, placed behind the pectoral muscle.
What about the so called “textured implant”, where the surface is covered with a fine texture? Not only is it unnecessary, it is dangerous! Textured implants have been associated with a rare but serious condition known as Anaplastic Large Cell Lymphoma (ALCL). This is a cancer of the capsule around the implant and is believed to be caused by bacteria that colonize the textured surface. We see about six cases a year in Australia and these women require radical surgery and chemotherapy. The risk increases with time and it presents with swelling of the breast, often years after the implant has been inserted. Many women have not been warned of this risk but fortunately fewer surgeons are using textured breast implants.
As “Anatomical” or “Tear Drop” implants must be textured to stay in position, these are not recommended. A round implant adopts a tear-drop shape when you stand and becomes flatter when you lie down – just as the normal breast does. Thus a smooth round implant actually looks and moves more naturally.
The next choice is one that women worry about a lot – “What size implant should I choose”? Some women want only a slight increase but most women feel that if they are going to have the procedure, then it should be worthwhile! Most women though are concerned that the result should look natural. Of course, when choosing the size of implant, a lot will depend on your height, your build and how much breast tissue you already have. At your consultation, I will take a number of measurements but, as a guide, a simple method to try at home, is to fill an old stocking with a measured amount of rice (say 250 or 300 ml) and to place this inside a sports bra. Add or subtract 25ml at a time until you feel comfortable with the result.
So far I have discussed the many choices available to women contemplating breast enlargement surgery. If you do decide to undergo breast enlargement surgery, I would like to explain a little about what you should expect on the day of surgery and afterwards.
For the last 25 years, we have been performing breast enlargement surgery as a Day Case, which means that you can have your operation in the morning and are able to go home in the afternoon. Your hospital stay may be even shorter! As you will have had an anaesthetic, it is necessary that someone pick you up and look after you on your first night. The operation takes about one hour and a number of steps are taken during the surgery to prevent post-operative complications. Specifically, a drain tube is always placed into the breast so that any blood or fluid that might form post-operatively, is drained away from the breast. In this way, bruising is minimised and recovery is enhanced. In addition, you will be given antibiotics during and after the operation in order to prevent post-operative infection. ( This is extremely rare).
To prevent pain, you will be given a powerful anti-inflammatory and pain-relieving tablet just before the procedure and afterwards, as required In addition, at the conclusion of the operation, a long-acting local anaesthetic called Marcain is instilled around the implants. This means that although there may be a feeling of tightness or a slight ache as if you have had a work-out at the gym, pain should be well controlled. Once you get home, we suggest that you go to bed and get a good night’s rest.
When you leave our hospital, you will be given an appointment to return the following morning and, at that time, the drain tubes will be removed and your breasts will be checked for bruising, swelling and tenderness. Further pain-relieving medication will be required over the next few days.
You can expect to return to gentle normal activity after 3 days and, after 1 week, you will be shown how to massage your breasts in order to achieve the best possible softness and naturalness in the final result. Massaging the implants around inside the surgically-created pockets, helps to maintain the pockets at a larger size than the implants. In this way, the implants are able to move freely inside the pockets and simulate normal breast movement. You should be able to return to work after 1-2 weeks (depending on what you do) and do more strenuous activity after 3-4 weeks.
We will provide you with some skin-coloured Micropore tape and we suggest that you keep your small surgical scars covered with tape for 6 months in order to obtain the finest, most inconspicuous scar. This tape should be changed once a week, and Rosehip Oil should be applied to the healing scar. A course of LED light therapy is offered and your post operative check is about 6 weeks after surgery.
I hope that, having read this letter, you will feel more informed and better able to make your decision regarding breast enlargement. If you have any other questions, my staff and I would be delighted to answer them for you. We realise that breast enlargement surgery is not just about enlarging the breasts but about improving your self-confidence and happiness. Our aim is to do so safely, effectively and with minimal discomfort and disruption to your lifestyle.
- If you only desire a small volume increase (eg 1 cup size) then you may be able to avoid implants altogether by having an Autologous Fat Transfer. Fat can be transferred from your abdomen, hips or thighs to provide the most natural breast augmentation of all! And you also get a liposuction! To find out more Click here.