Good candidates for breast augmentation include those who are bothered by the feeling that their breasts are too small. Breast augmentation should only be considered when breast development is complete. The patient must be emotionally mature and understand her own motivations for wanting this procedure. It is thus worth indicating that the basic sine qua non of the operation, which is as well justifiable for all types of the plastic surgery operations, resides in the fact that the best candidates are those who are mature enough to fully understand the procedure and have realistic expectations about the results.
Breast augmentation is one of the most frequently requested cosmetic operations. It is a simple procedure used to enhance breast size or to correct symmetry. Modern and improved prostheses ensure that associated health risks are minimal.
Breast implants are made from medical grade silicone. This is a polymer that has been tried and tested and is used in a number of other medical devices. Silicone is also used in frequently occurring household items such as shoe polish, hair conditioner, and kitchen implements. As far as we can tell this material is safe. All of us already will have small quantities in our bodies, apparently without affecting us. If you have breast implants, small quantities of silicone come off the surface of your implants and will be taken up in the lymph glands in your armpit and will end up in your liver. Silicone is inert in the body, you cannot react to it or reject it. There is no association between breast augmentation and breast cancer or cancer of any other part of the body. Neither is there any proven association with any other illness. There have been recent reports of an illness called anaplastic large cell lymphoma (ALCL) in association with breast implants, but it is sporadic and extremely rare, it does not seem to be as serious as ALCL occurring elsewhere. Over time the implant shell may fail and the silicone gel may leak out. Whilst this may cause symptoms and will result in re-operation to remove and replace the implants there is no evidence that a ruptured breast implant causes ill health.
In every patient the body forms a scar or capsule around the implant that fixes it in place. In most people this is not obvious and the breast feels soft and looks natural. In a proportion of patients (for reasons that are not fully understood) this scar contracts around the implant and makes it feel firmer than a normal breast. In most patients they are not too troubled by this as the breast still looks satisfactory. However, in some patients the breast becomes unacceptably firm and may take on a spherical shape. It may also become tender. If this happens you should see the surgeon again to discuss the situation. Sometimes if the contracture is not too bad then you may decide to stay as you are. It is certainly safe to do this. Some patients will elect to have the implant removed and the capsule released/removed. This is called a capsulotomy or a capsulectomy. A new implant can then be inserted. Hopefully this will improve matters. The risk of noticeable firmness is up to 10% of all breast augmentations, but most of these patients will not need revision surgery. The chance of having a re-operation for any reason is about 1% a year. So, after 10 years about 10% of women will have had a re-operation. Adverse capsular contracture is the most common reason for re-operation. In addition, once capsular contracture has happened once it is more likely to happen after the revision operation.
Most patients will get some alteration in the sensation in their breasts after breast augmentation surgery, the most usual symptoms being some numbness near the scar, and oversensitivity of the nipples. This oversensitivity gradually settles down, but usually takes several months to do so. A few patients will get numbness of the nipples. If numbness persists for more than six weeks after the surgery it is likely to be permanent.
In particularly slim patients it is to be expected that you will be able to feel the edges of the implants. This is an inevitable consequence of the operation and will not improve with time. It is much less likely in patients who start off with a reasonable amount of their own tissue covering the implant. As time goes by some people will be able to see or feel ripples or folds in their implants perhaps when leaning forwards. For most patients it is best to simply accept that this has occurred and is a limitation of the surgery. It can be difficult to correct with another operation. In some patients the situation can be improved by injecting small amounts of your own fat under the skin. This is called lipomodelling or lipofilling. Occasionally a more marked crease can be felt. This can be a sign of adverse capsular contracture.
Implants are made to be very tough, but the shell can eventually fail and a leak can occur. This is not usually a serious event, in many cases the leak is contained within the capsule and the patient does not notice a problem. Patients may, therefore, have an implant that has failed and be unaware of it. This does not appear to be harmful. Some patients will notice a change in the size, shape or consistency of the implant. A lump might appear and the breast look swollen. If these things happen you should seek advice. A scan will usually be carried out and if this suggests the implant has ruptured, removal and exchange of the implant will be advised.
The only alternative surgical technique to enlarge the breast is lipofilling. This is a relatively new technique where fat is removed by liposuction from another area of the body such as the hips or thighs and injected into the breast area. Only a relatively small amount of fat can be injected so patients will require multiple episodes to bring about a worthwhile effect. Some of the fat is absorbed in the initial weeks after the operation, but fat that lasts beyond this time will bring about a permanent enlargement. This is a much more gradual approach compared with implant based breast augmentation, but does avoid a breast implant. Since it is a relatively new technique we cannot be entirely sure how effective it will be in any given patient.