Breast Augmentation (Implant)

Breast Augmentation (Implant)

Breast augmentation is surgery to increase breast size. Breast augmentation can also reshape the breasts and correct breast sagging (breast ptosis) to a certain extent. Breast augmentation is done by using either breast implants or autologous fat graft.

Breast augmentation is most commonly done using breast implants. A breast implant has an outer silicone shell filled with either silicone gel (silicone implant) or saline water (saline implant). The gel inside a silicone implant is cohesive silicone gel (for example MENTOR^® MemoryGel^®) which holds together uniformly while resembling the natural give of breast tissue. Compared to saline implants, silicone implants have a more natural feel and much lower rippling and leakage incidence.

The outer surface of an implant can either be smooth or textured. Generally, smooth breast implants feel softer than textured implant. Smooth implants can also move more easily with the implant pocket, giving them a more natural movement. Textured breast implants stimulate scar tissue to stick to the implant, making them more stable and less likely to move around inside of the breast. Textured implants are reported to have lower incidence of tight scar capsule (capsular contracture).

Breast implants are available in two shapes: round or teardrop shape. Round implants are the classic design and remain very popular even until today. Round implants tend to create fuller and curvier breasts compared to teardrop implants. Teardrop implants, also known as anatomical implants, slope gently from the top to the bottom, resembling the natural shape of a breast. Teardrop implants tend to give the breasts a more natural shape and are suitable for patients who prefer more natural and subtle results.

Breast implants are either put under the breast (subglandular placement) or under the chest muscle (submuscular placement). Subglandular placement is easier and faster to perform, and  subglandular implants offer more pronounced roundness to the breasts and better cleavage line. However, subglandular implants may be more visible and palpable especially in skinny patients. Subglandular implants also are associated with higher incidence of capsular contracture. Submuscular placement offers extra tissue coverage for the implant and is suitable for thin patients, patients with very small breasts, or patients who had undergone mastectomy. Extra tissue cover also means less chance for the implants to be visible or palpable. Submuscular implants have lower incidence of capsular contracture and are less likely to interfere with mammography. On the other hand, submuscular placement takes longer operation time and recovery is usually longer. Compared to subglandular placement, the results of submuscular placement may be more subtle and less pronounced, and the breasts may not move or feel as natural as in subglandular implant placement. Submuscular implants may interfere with chest muscle movements in athletic patients and cause distortion that may be visible during exercises involving chest muscles. Dual plane placement is a variant of submuscular placement, in which the upper portion of the implant is placed underneath the muscle, while the lower portion remains in a subglandular position. Dual plane placement offers good tissue coverage for the implant while provides excellent support to the lower breast, enable the breasts to look full and yet natural.

Our clinic uses Mentor™breast implants and Motiva™ breast implants.

Preparation

1. 1. Inform the doctor of any pre-existing medical conditions and drug allergy. All medical conditions must be treated and stabilized before surgery.

   2. Stop smoking at least one week before surgery. Smoking is harmful to wound healing and increases the risks of other post-operation complications.

   3. Stop the following medications and supplements from one week before surgery until one week after surgery.

      1. All supplements containing vitamin E, ginseng, ginkgo, garlic, fish oil, and other ingredients that increase bleeding during the procedure. Other supplements, traditional medicine, and herbs, in which ingredients are unknown, have to stop as well.

      2. Medicine that increases bleeding during the procedure such as aspirin, NSAIDs, and warfarin. However, you may need to consult your physician who prescribed the medication before you stop them.

   4. On the day of surgery, wear simple and comfortable clothing. Do not wear any makeup. Do not wear any jewelry and metal objects on the face and body.

Surgery

Duration: 1-2 hours

Anaesthesia: General Anaesthesia

Hospitalization: Half a day (daycare)

Recovery*: Back to work in 3-7 days, light exercise after 1 week, heavy exercise after 4 weeks. * The actual speed of recovery may vary from person to person.

Surgery Technique: There are 3 approaches to insert breast implants:

Breast implant – incision placements

1. 1. Inframammary approach: The incision is placed in the breast fold (inframammary fold) where the breast and the chest meet. This is the most popular approach used for breast augmentation. The technique offers excellent control and safety during pocket dissection and implant placement. The scar is hidden by the breast in standing and sitting positions but may be visible on lying down. Inframammary approach does not affect nipple sensation and future breastfeeding.

   2. Periareolar approach: The incision is placed in a semi-circle around the lower half of the areolar margin. The scar is usually well concealed by the bumpy texture and darker skin of the areola. The disadvantages of this approach are a higher risk of breastfeeding difficulty, changes in nipple sensation and infection. This approach is also not suitable for patients with small areola because the incision may be too small for the implant to pass through.

   3. Transaxillary approach: The incision is placed in the armpit. A tunnel to the breast is formed so that a pocket can be created to insert the implant. The use of an endoscope is often required in transaxillary approach. The main advantage of transaxillary approach is there are no scars on the breast, scar only in the armpit. However, visualisation and control can be less than ideal compared to other approaches. Implant placement also can be more difficult because it is done through the armpit, which is far from the actual breast itself. The armpit scar is visible when wearing sleeveless shirts and the scar can make shaving of axillary hair more difficult.

Post-operative Care**

1. 1. What to expect:

      1. Swelling usually peaks on the second to third day after surgery and will gradually subside after that.

      2. There may be tight sensation in the chest for one to 2 weeks, especially if large implants are used in patients with small breasts and tight chest skin.

      3. A supportive bra to support the breasts is used during the first month.

   2. General care:

      1. Gently massage the breasts for the first 1-2 months.

      2. Avoid smoking for at least one month. Smoking increases the risk of wound complications.

      3. Sleep on the back. Avoid sleeping on one side to prevent pressure on the breasts.

      4. Adequate rest and sleep are helpful for a speedy recovery.

      5. Be relaxed and calm. Contact the clinic if there are any queries.

   3. Medicine:Finish the oral antibiotics as prescribed. Take the painkiller as prescribed when necessary.

   4. Wound care:After the removal of wound dressing, clean the wound with a clean cotton tip soaked with sterile water/saline. Apply antibiotic ointment.

   5. Physical activity:Avoid heavy physical activity and exercise for at least one month.

   6. Follow-up: Come back one week after surgery for review.

   7. Emergency: If there is heavy bleeding, a rapid increase in swelling or severe pain, immediately contact the clinic/doctor for advice.

** The instructions in this list are only for general guidance. If you have any specific queries or concerns during the post-operative recovery, please contact the clinic for further advice.