Breast Augmentations - 3 Typical Reasons for Going Under the Knife - By: Felicity Lightbody

Breast enlargement remains the most popular cosmetic surgical procedure and patients love the results. The majority of women requesting breast enlargement fall into one of three typical groups:

1. The first group are young women with relatively small breasts, who would like to go larger to enable them to wear their choice of clothes, and feel more confident with their bodies.

2. The second group are young women with normal breasts who simply wish to have larger breasts.

3. The third group are those ladies whose bodies have suffered the ravages of childbirth, resulting in smaller emptier breasts –especially in the upper part of the breast which becomes relatively empty. This third group tend to be more conservative and do not want their breasts to made much bigger but are looking more for a restoration of breast shape.

Ladies do occasionally request this procedure for other reasons; for example one breast may be larger than the other; or the breast shape may not be quite normal and a simple implant procedure can help reshape the breast.

There are a number of important considerations that should be taken into account by patients considering a boob-job:

Site of incision

Breast implants can be inserted through incisions in different sites. Often this choice is determined by the surgeon according to which he/she feels most comfortable with. Most well trained surgeons are able to use any approach, but each approach has advantages and disadvantages:

1. Armpit scar: Using a scar in the armpit means there is no scar on the breast at all, which is of course great. Unfortunately though, using this approach makes it very difficult to create the pocket low and centrally enough and the final result often disappoints because the implants sit too high and too lateral on the chest wall. Furthermore, it is more difficult to accurately control bleeding which may in turn increase the chance of developing a capsule.

2. Areolar scar: this approach is good because the resultant scar is well hidden at the junction of the dark areola and the paler breast skin. The drawback with this approach is that the nipple ducts often contain a normally harmless bacteria called Staphylococcus Epidermidis. This bacteria has been implicated in up to 80% of capsular contractures. Most surgeons now seal off the nipples during surgery with a plastic adhesive dressing, but this cannot be done with the areolar scar approach. Therefore there is a higher risk of capsular contractures with the areolar scar technique. Furthermore, cutting around the lower half of the areola is more likely to damage the nerves to the nipple and result in numb nipples.

3. Crease scar: This approach does leave a scar on the breast, but if done accurately, leaves the scar exactly in the crease underneath the breast, where it is well hidden and settles nicely. It allows great access to create the pocket exactly where required and to control any bleeding. The nipple can be sealed off during surgery which minimises the chance of contaminating the implant with Staphylococcus Epidermidis.
Belly button scar: (also known as the TUBA, or Trans Umbilical Breast Augmentation) Some surgeons have used a small cut placed in the belly button to insert the implants. This means no scarring on the breast. This approach is only possible if saline implants are used (see 'Saline vs silicone implants' below). The empty implant is rolled up like a cigar, inserted through the scar and pushed up into place on the chest. Once in place the empty implant is then inflated with saline. However, using this method, it is very difficult to control the position and shape of the pockets, and to control any bleeding. Thus patients having a TUBA often end up with asymmetric breasts or a very wide cleavage.

Saline vs silicone implants
All breast implants consist of an outer envelope made from silicone rubber, and an inner filler material. There are now only 2 filler materials available:

Saline: Saline (salt water) is a poor quality filler, it feels too soft and liquid, like a bag of fluid, and implants filled with saline generally tend to slowly deflate. As they deflate they develop ripples or folds which may be felt and often seen through the breast skin. They have never been popular in the UK, and only gained popularity in the USA after the temporary withdrawal of silicone implants.

Silicone: Silicone gel most closely resembles the consistency of natural breast tissue and is the implant filler of choice of the vast majority of breast surgeons in the world.

Are silicone gel breast implants safe?
There is a long answer and a short answer to this question. The short answer is 'yes' implants are safe – there are no long term general health consequences to having silicone implants inserted.

The long answer deals with the issues which arose in the late 1980's and which resulted in a legal case in the USA. The first generation of silicone gel implants were developed in the 1960's. These had a very thick outer shell, but felt hard. In the 1980's a Second generation of silicone gel implants was developed – these had a much thinner outer shell. They felt more natural, but unfortunately they were more prone to leaking and caused many problems. The third generation of silicone gel implants, with thick, laminated, textured outer shells was introduced in 1990. In the mid 1990s a fourth generation of implants, with thicker cohesive gel (often called 'jelly babies') was developed. With these newer implants if the implant shell ruptures, the silicone does not run everywhere but remains intact as a gel.

Due to the problems experienced with the second generation of implants, by the end of the 1980's it was alleged that up to 154 symptoms, including connective tissue diseases, were associated with silicone gel breast implants. At the time of the legal challenge, there was a lack of data to demonstrate the safety of silicone gel and this resulted in a global settlement by the silicone implant manufacturer Dow Corning in 1992. In the same year, the American FDA recommended a voluntary moratorium on the use of silicone gel breast implants in America. In the UK the same issue was investigated and in 1992 the Independent Expert Advisory Group found no evidence for an association with connective tissue disease and recommended that silicone gel implants continued to be available. The French Ministry for Health reached the same conclusion in 1996. In 1998 a further review by the Independent Review Group in the UK confirmed that there was no evidence for any long term health consequences with silicone gel implants.

Size of implant
This is probably the most difficult part of the decision making process; there is very often a dilemma between going too big and not going big enough. Unfortunately, due to the vagaries of the human body, it is not possible for surgeons to predict accurately what sized implant will create a particular cup-sized breast. For this reason, no surgeon will ever guarantee what the final cup size will be. Therefore, it is well worth taking time to decide upon implant size.

Selecting the implant size starts with establishing what cup size a woman currently is and roughly what cup-size a woman would like to become. As a crude rule-of-thumb, each 100-150g of implant will increase the bust by one cup-size.

Breast enlargement surgery is generally a simple, safe surgical procedure, which produces predictable results. As with any surgical procedure it is wise to choose your surgeon carefully and to spend time thoroughly discussing the above issues so that you end up with the result you hoped for.

About the Author

Felicity is a committed correspondent writing for VIP Cosmetic Surgery about women, beauty and style. The company offers a range of cosmetic and plastic surgery procedures such as breast enlargement birmingham, tummy tuck, liposuction through to Botox injection treatments. VIP are the UK's only cosmetic surgery provider whose cosmetic surgeons are all members of the prestigious BAAPS and BAPRAS organisations. For a free consultation visit VIP Cosmetic Surgery UK and for more cosmetic articles please visit our site.

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