Breast Augmentation

Breast augmentation makes the breast bigger by using a silicone implant. These implants come in round or tear drop shapes this is called anatomical shape and sizes.

The average size used would be somewhere around 325ml but this varies for each individual. The procedure gives no or very little lift
and if the breasts are made too large they are heavier and sag more. The size of the implant will be limited by the amount of loose skin available to cover it.

This procedure is most useful for regaining breast volume where the breasts have shrunk after breast feeding or where there has been too little breast formation at puberty. It is carried out as day surgery in hospital and usually takes one and a half hours.

A small incision is made under the breast and a pocket is created either on top of the muscle or underneath the muscle. If the pocket is underneath the muscle the implant will rest on the ribs and not move with the breast. After the pocket is formed it is irrigated with a Betadine solution and the implant placed and the incision line closed in layers. I usually use a suction drain overnight to remove even small amounts blood as I feel they may contribute to breast capsule contraction.

A light compression dressing is applied. Sutures are removed at one week. You should have at least 2 days off post operatively and preferably one week. You should perform only light duties in the first two weeks and no contact sports for one month.

The two main complications are bleeding and infection. The drains help prevent haematoma and an antibiotic helps to prevent infection. If a haematoma developed it would be necessary to go back to theatre to evacuate it, but this is uncommon. Rippling could occur in the overlying skin where there is not enough breast tissue to cover the implant.

The main problem is breast capsule contraction. In the past I have used textured implants and managed to get my rate down to a very small percentage but textured implants are not being used so much now due to the very small but definite risk of anaplastic large cell lymphoma or ALCL.

Capsule contraction can make the breasts feel firm and even distort the shape of the breast. Some years ago now we became aware that some people who had breast augmentation developed a form of lymphoma in the capsule around the breast implants. Provided it was removed early there
was no problem. However, if it was not removed it could progress and could be fatal. ALCL only occurs with textured implants and the deeper the texture the more the risk. However the overall risk remains very small.

ALCL can occur at any time but often around the seven year mark. The first symptom is usually a slight increase in the size of the breast due to seroma formation. Self-checking and regularly ultrasounds are advisable.