Breast Augmentation

Overview

Breast augmentation has become the most frequently performed cosmetic surgery procedure in Ireland.
Before you consider breast augmentation we strongly advise you discuss this with your GP to get the best possible outcome and who can refer to a consultant plastic surgeon of your choice.

Breast augmentation can give you;

  • A more flattering look
  • A better proportioned figure
  • Enhanced confidence and improved self esteem

PIP Implants

Recent media reports about the potentially faulty breast implants may, understandably, cause concern among women who have these implants.  Aesthetic Surgery Ireland would like to take this opportunity to confirm we have never used this type of implant.  If you have any queries relating to this please feel free to contact us on 01-2314040 to schedule an appointment with one of our surgeons.

Quicklinks to PIP Information

 

What are the primary reasons for undergoing breast augmentation?

  1. To increase the size or improve the shape of the breasts,
  2. Reconstruction of the breast following mastectomy,
  3. Replacement of existing implants
  4. Correction of a congenital deformity.

What is the Anatomy and Physiology of Breasts?

The breast contains fatty tissue which gives the breast its shape and feel: the elasticity of the skin also plays a role in determining the shape of the breast. Milk ducts, glandular tissue, blood vessels, nerves and lymph ducts are also present in the breast.

There are a variety of breast implant options available if you are considering breast augmentation. You and your consultant plastic surgeon should discuss your expectations in detail and choose the most suitable implant for your needs.

What are the design features of Breast Implants?

The success of breast implant surgery is a function of the surgeon’s skill, patient characteristics and implant design.The design of breast implants has evolved greatly over the past 40 years and the current designs are now considered to be significantly safer than the original versions.

The Shell
Breast implants comprise an outer layer, or ‘shell’, filled with silicone gel or with saline (a salt and water) solution. The majority of breast implants (90%) used in Europe are made of a silicone shell and filled with silicone gel. In addition to its proven safety silicone provides a natural feel to the breast.

The Surface
The surface of a breast implant can be either smooth or textured. Textured implants provide a surface that encourages the breast tissue to integrate to the surface of the implant instead of growing in a linear pattern around the implant. This helps to prevent slipping and keep the implant in place.

How safe is silicone in breast implants?

Silicone is a compound made from silicon, a natural chemical element. Silicones have been used in moisturising creams, suntan lotions, lipsticks, medicines, food preparation and many other everyday products for more than 50 years.

You should discuss your personal preferences and expectations with your consultant plastic surgeon and determine what you see as the ideal shape and size for your new breasts.

What size options do I have with breast implants?

The size and shape of breast implantsBreast enhancement offers you a unique opportunity to alter the shape of your breasts rather than just change your bra size. Generally, the larger you want your cup size, the larger the breast implant the surgeon will consider. For the most natural look you will probably want your new breasts to be in proportion, or balance, with your body as a whole. The width of your breast will determine the space between the breasts (cleavage). It also determines the outer curve of your breasts, a contour that is essential to the balance between your breasts and hips.

What shape options do I have with breast implants?

Today women in Ireland have a choice of implant shapes:

Round Shaped Breast Implants

Round and Teardrop Shaped Breast Implants Round is the traditional shape for breast implants. If there is enough breast tissue for adequate coverage, flattering, natural-looking results are achievable. Generally, round breast implants provide a full, rounded appearance to the upper portion of the breast and a flattering increase in cleavage. It is important to note that, in the course of time, as a result of gravity and the ageing of the skin and breast, the upper part of round breast implants may become emptier, which means they may droop more than anatomical breast implants.

‘Teardrop’ or anatomical shaped breast Implants

‘Teardrop’ or anatomical implants are a more recent development, are growing in popularity and are designed to produce a more natural-looking effect that follows the body’s natural lines. If you look at an anatomical implant from the front, it appears oval in shape. It is highly recommended that that you choose a consultant plastic surgeon familiar with the surgical techniques necessary for anatomical implants.

What happens before the Operation?

Anatomical breast implants: from the front When preparing for a breast augmentation the patient should be well informed and have realistic expectations. Your surgeon will want to evaluate your current physical health and history and explain the procedure. Before you proceed, you and your surgeon will carefully discuss the benefits and risks. If you decide to proceed with the operation you will be required to confirm your understanding of all aspects of the surgery and agreement to proceed with the operation by signing a consent form. Photographs are usually taken pre-operatively as a record and to help plan your surgery.

What happens during the Operation?

Anatomical breast implants: from the frontOn the day of your surgery the consultant plastic surgeon will draw marks on your breast and chest skin to show where the particular incisions will be made which will be used as the entry point for insertion of the implant. The surgery is usually performed under general anaesthesia. All anaesthetics carry a risk and you should discuss these risks with the anaesthetist.

The surgery usually lasts between one and two hours and in Ireland the majority of breast implant surgeries involves an overnight hospital stay. Depending on the surgeon’s technique you may have a drainage tube in place for a day to allow any blood or fluid that may collect in the wound and around the implant to escape. This also allows the surgeon to monitor that the procedure is progressing as planned.

Incision Options

Breast Positioning

What happens after the Operation?

Typically after your operation you will need someone to take you home when you are discharged by the consultant plastic surgeon. You may have some dressings around your breasts as well as a surgical bra or elasticised bandage. Initially your breasts will feel firm and may be swollen and will be sitting high on your chest. As the swelling goes down, they will drop into a more natural position and shape.

For several days after the operation, you may feel a little tired and sore. Your breasts may remain swollen and sensitive to physical contact for as long as a month. It’s also normal to experience a feeling of tightness in the breast area as your skin adjusts to your new breast size. Some women who have had children note that this tightness feels similar to the changes in their breasts following childbirth. The full results of your enhancement may not be visible until your breast tissue and muscles adjust.

Post-operative care

Post operative care is very important. That is why at Aesthetic Surgery Ireland we place such an emphasis on your surgeon being based in Ireland. He or she will always be available for follow-up consultations or to discuss any concerns you may have. Your surgeon has conducted the operation and is therefore best suited and qualified to provide post-operative care for you.

Generally for most patients post-operative care involves the use of a post-operative bra or sports bra for extra support and positioning while you heal. However, if any unusual symptoms occur after surgery such as fever, or noticeable swelling or redness in one breast, you should contact Aesthetic Surgery Ireland immediately. Outside working hours you should contact the ward of the hospital in which you underwent your surgery.

You can resume gentle exercise within a couple of weeks and increase your exercise at a comfortable pace with your surgeon’s approval. However, you should avoid intense physical activity for the first 6 weeks after your surgery.
Ideally, you should have a check-up every six months to a year.

How long do breast implants last?

Breast implants are generally expected to last 10 years or more and, in some cases, they may last as long as 20 years. Breast implants can be removed at any time and, after 10 or more years, some women opt to replace older implants with newer models

What are some of the potential complications of breast augmentation?

The vast majority of breast augmentation procedures proceed without complications. However, there are risks associated with any type of operation and breast surgery is no exception. Side effects and complications specific to breast enhancement surgery are rare, but may include the following:

RISKS

(i) Infection

Infections associated with breast augmentation surgery tend to be very low. You will be given an antibiotic at the time of your surgery to prevent infection. If, despite this, you develop an infection as a result of the surgery, you will need to see your surgeon as soon as possible. In most cases you will be given an antibiotic for treatment. If antibiotic treatment is not successful you may need to have another operation to remove the implant until the infection has cleared. Later, the implant may be replaced.

(ii) Allergic reaction to anaesthetic

At the moment, the best estimate is that a life-threatening allergic reaction (anaphylaxis) happens during one in 10,000 to one in 20,000 of all anaesthetics. Most people make a full recovery from anaphylaxis. The statistical chance of dying as a result of an anaphylactic reaction during anaesthesia during any operation is between one in 200,000 and one in 400,000 anaesthetics.

(iii) Nerve damage

It is possible, but highly unlikely, that you suffer nerve damage after a general anaesthetic. The risk of a significant peripheral nerve injury lasting more than three months is estimated to be less than one in 2,000 patients having a general anaesthetic. Permanent damage, lasting more than a year, is estimated to occur in less than one case in 5,000.

(iv) Poor wound healing

Wound healing may take longer in cases of:

  • Infection
  • Bleeding
  • Fluid accumulation
  • Overly tight stitches
  • Over-large implants
  • Improper support during healing
  • Pressure against the scar tissue.

To avoid poor wound healing, your surgeon may recommend that you wear a sports bra for approximately five months after surgery. Wound healing may also take longer in patients who have diabetes, who have other medical conditions, or who smoke.

(v) Pain

Following any surgical procedure pain of varying intensity may occur, Should this happen following breast implant surgery you will be prescribed appropriate pain medicine to take in hospital and at home after your discharge, if necessary. Improper implant size, placement, or surgical technique may result in additional pain. Very occasionally, severe pain associated with arm movement has been reported. Pain may also occur later if capsular contracture occurs. Unexplained pain rarely occurs.

(vi) Changes in nipple and breast sensation

The breast and nipple may become painfully sensitive or may lose all pleasurable sensation. In most cases, these changes are temporary but, in rare cases, nipple sensory changes are permanent.

(vii) Rotation

Rotation of the implant may rarely occur. Proper placement and pocket dissection reduces the risk of this occurrence. Also, textured implants encourage adherence to the breast fibres, reducing the incidence of rotation. If an implant does rotate further surgery is usually required to reposition it.

(viii) Haematomas

Haematomas (a solid swelling of clotted blood within the tissue) may form where the implants have been placed. The risk of infection is higher if a large haematoma or seroma (a collection of watery fluid within the tissue) is present immediately after surgery. The surgeon may place a surgical drain at the time of the surgery to help prevent small haematomas. But, in some cases, the surgeon may need to re-operate to remove a large haematoma. Reported chances of haematoma after breast enhancement are slight at 1.6%.

Medium-term side effects & complications

(i) Scarring

There will be a scar where the surgeon has made the incision into your skin. The position, the length and the type of scar may vary according to a number of factors. Some patients may develop a thick red scar known as a hypertrophic scar. Occasionally, scar tissue can extend beyond the original incision; in these cases, it is called a keloid scar: it isn’t always possible to predict which patients will develop this type of scar.

(ii) A breakdown of skin (known as necrosis)

This may occur due to thinness of the skin flap over the implant or trauma to the skin during surgery. Sometimes, it may require removal of the implant.

Long-term side effects & complications

(i) Capsular contraction

The body’s normal response to a foreign body, such as a breast implant, is to form a shell, or a capsule, of tissue around it. This tissue may tighten or contract and may cause the following:

  • Extreme hardening of the breast
  • Pain ranging from mildly uncomfortable to severe
  • Extreme sensitivity to touch
  • Wrinkling or distortion of the breast
  • Movement or displacement of the implant

Depending on the severity of the contracture you may need to have a further operation to have the capsule and/or implant removed. Capsular contracture depends on many factors, including:

  • The surface of the implant: capsular contractures are much less likely to form around textured implants
  • How the implant was placed
  • The technique used by the surgeon
  • How/if the surgical site was protected after surgery

Reported rates of capsular contraction are lower in patients with submuscular placement of the implant and in those with textured implants.

(ii) Rupture or gel leakage

Most modern breast implants have a thicker shell which incorporates a barrier layer to reduce the risk of gel diffusion. The use of high-viscosity silicone gel will also reduce the possible effects of rupture. Improvements in device manufacture and design and surgical techniques have contributed to the lower rates of rupture and/or deflation reported in recent studies. If a silicone gel implant ruptures, given its cohesiveness, the gel is usually contained within the capsule around the implant and very rarely does it migrate within the body: sometimes the gel may be found in nearby breast and other body tissues. However, with improved modern implants this migration of silicone is diminished. In some cases implant rupture can occur in the absence of any symptoms. However, when symptoms occur they may include the following:

  • Lumps in the breast
  • Decreased breast size
  • Distorted shape
  • Asymmetry
  • Pain

You should see you surgeon immediately if you notice any of these symptoms, or if you think your implant may have ruptured. In some cases, removal, and/or replacement, of the implant may be necessary.

(iii) Gel diffusion (gel bleed through the shell envelope)

Rupture of the implant isn’t the only means by which silicone may escape into the surrounding tissues. Silicone fluid may escape through the implant shell even without a tear. The term ‘gel diffusion’ has been used to describe this occurrence. Nowadays this is very rare due to improvements in implant and gel design. Although most of this gel diffusion will be absorbed by the capsule surrounding your implant, your body’s ‘scavenger’ cells, or macrophages, may try to destroy this silicone. If the silicone cannot be destroyed, it is carried by the scavenger cells to the lymph glands for disposal. Fortunately, advancements in implant technology and design have improved shell features, reducing gel diffusion.

(iv) Calcification

Calcium deposits can form in the scar tissue surrounding the breast implants and may cause pain, firmness and be visible during mammography. These deposits must be identified as different from the calcium deposits that are a sign of breast cancer. Should this occur, additional surgery might be necessary to remove and examine calcifications.

(v) Granulomas

Where silicone gel leaks into the breast and other nearby body tissues including the lymph nodes, small reactive lumps may sometimes form. If there’s a large amount of leaked silicone, larger lumps may form. These lumps are described as granulomas. They are not cancerous, but it may be difficult to distinguish them from cancer. Therefore, your surgeon should examine these breast lumps and ultrasound or mammogram investigations may be required.

What are some of the other potential issues of breast augmentation surgery?

Dissatisfaction with cosmetic results can related to asymmetry, implant displacement, or incorrect size or shape of the implant. Patients may also be dissatisfied with the way the implant feels or the appearance of surgical scars. In the case of saline (water)-filled breast implants, the saline solution may lead to more pronounced ‘sloshing’ and movement, compared to silicone implants. You should discuss these issues with surgeon during your scheduled follow-up examinations in the first year after the operation.

Frequently Asked Questions

What is a breast implant?

Typically a breast implant consists of a silicone shell that’s filled with silicone gel or cohesive silicone gel with shape-retaining memory. Not only are there choices in fillers but the design of the shell that contains the silicone gel can also vary. The surface may be textured or smooth. Your surgeon will discuss the benefits of the various breast implant options available and help you choose the best breast implants for you.

How are breast implants placed?

A breast implant is usually inserted either under the breast tissue or under the pectoral muscle. The incision for insertion is most often made in the fold of skin under the breast. Although it’s less common, the incision may be made around the areola (the area around the nipple), or in the armpit.

Are breast implants available in different shapes?

Breast implants are available in two basic shapes. Some implants are round while others are shaped more like a ‘teardrop’, closely resembling the natural shape of a breast; these are called anatomical implants. Traditional round breast implants increase breast size and give a full, round look to the upper part of your breasts. However, they don’t offer the more subtle, natural look of anatomical implants. Anatomical breast implants follow the natural shape of your breasts to give you the increased size and enhanced shape you want.

What are some possible complications?

Undergoing any surgical procedure can involve the risk of complications such as reaction to the anaesthesia, infection, swelling, redness, bleeding, and pain. Possible complications specific to breast implants include the following:

  • Deflation or rupture
  • Capsular contracture (a hardening of the breast tissue in contact with the implant)
  • Formation of calcium deposits
  • Haematoma (a solid swelling of clotted blood within the tissues)
  • Seroma (a collection of fluid within the tissues)
  • Changes in breast and nipple sensation

Please note that with all procedures there is a possibility of patient dissatisfaction with the outcome.

Some other possible complications related to dissatisfaction with cosmetic results include the following:

  • Wrinkling
  • Asymmetry
  • Implant displacement
  • Incorrect size or shape

Patients may also be dissatisfied with the way the implant feels or the appearance of surgical scars. The full extent of any potential complications should be clearly explained to you by your consultant plastic surgeon during your consultations prior to the operation.

When may a second operation be necessary?

If a patient is dissatisfied with the aesthetic result or if she experienced a complication, a second operation or revision procedure, may be necessary. This procedure usually involves replacement of the implants.Depending on your age and the type of implant you may need to replace the implant at some time in your life.

Is it safe for me to breast-feed if I have breast implants?

During a breast enhancement procedure, the glandular tissue where milk is produced is not disturbed. Current studies show that women with breast implants are able to breast-feed; however, there isn’t a lot of research available on the effects of silicone on breast-fed babies. There’s no evidence that silicone from breast implants is present in breast milk, or whether silicone, if swallowed, is absorbed by babies or passes through them. It must be remembered that bottle-fed babies are exposed to silicone through the bottle and teat and silicone is also present in many processed foods.

Should I have regular mammograms?

It is recommended that all healthy women over 50 years of age have a mammogram every two years for the early detection of breast cancer. Women with breast implants should adhere to the same screening schedule. The radiographer performing the mammogram should be informed that implants are present as the technique used for the investigation may need to be modified.

What size implant should I choose?

Breast enhancement gives you the chance to change more than just your bra size. It allows you change the size, shape, and fullness of your breasts. For the most natural-looking results, your surgeon will advise you in choosing breast implants that bring the size and shape of your breasts into balance with your body as a whole. It’s important to remember, though, that size isn’t the only consideration; shape is also important. For example, choosing breast implants that increase the width of each breast will give you more cleavage and enhance the outer curve of your breasts—creating a flattering balance between your breasts and hips.

How long does the surgery take?

Breast enhancement surgery usually lasts approximately one hour: the actual time depends on your surgeon’s technique. The location of the incision and the placement of the breast implant will help determine the length of the procedure. The procedure usually involves an overnight stay at the hospital before being discharged.

Are silicone breast implants safe?

Silicone is widely used in pharmaceutical and food products and also in many medical devices such as pacemakers, heart valves, etc. Silicone has long been regarded as one of the most compatible materials available for implants in the body. Silicone has been extensively tested in laboratory and clinical studies with the results widely published in respected medical journals. The general conclusions of these studies prove the safety of silicone in medical devices, including breast implants. There has been no epidemiological evidence found associating silicone breast implants with permanent connective tissue disease or cancer.

Are silicone breast implants banned in the United States?

No. Silicone gel breast implants were previously banned in the U.S. except for use in clinical studies and reconstructive surgery. In November of 2006, silicone-filled breast implants were approved by the US Food and Drug Administration (FDA) for breast enhancement, reconstruction, and revision. These silicone implants are the first to earn such approval since 1992, when the FDA decided that silicone breast implants shouldn’t be used for cosmetic breast enhancement.

Your consultant plastic surgeon can provide you with further details if you wish to read further about this topic.