Breast Enlargement Surgery – What's REALLY involved? - By: Taimur Shoaib

Breast Enlargement Surgery – What's REALLY involved?
- The pros & cons of breast augmentation surgery.
By Taimur Shoaib, Consultant Plastic Surgeon, Glasgow, Scotland, UK.

One of the most common operations performed in the UK cosmetic surgery industry is breast enlargement surgery, or breast augmentation. This involves the insertion of an implant into the chest wall to enhance the size of the breasts. The implants are inserted into a pocket either below the breast tissue or below the pectoral muscle, or in some cases partially under each. Implants may be round or teardrop shaped; their surface may be smooth or textured; the contents may be silicone or saline, and there are advantages and disadvantages with each option. Some implants are more expensive than others (probably because they’re better!)

Different surgeons will use different implants for various situations, and most will be more than happy to justify what they're using and why. This can sometimes be an important part of the discussion during the consultation and at the end of the consultation both your surgeon and you should be happy with the choices made.

If you’re thinking of having this procedure done, then you might want to have: the best implants, the best surgeon and the best aftercare. I have my own views about the best implants, your surgeon should be highly experienced and should be able to perform all types of breast cosmetic surgery and should be doing this regularly, and your aftercare should be for at least a year because if you do need a minor tweak to get things right then it will happen within a year.

POCKET PLACEMENT

The implants need to be placed within a pocket. There are three types of pocket and the best place to put the implant depends on the characteristics of the breast being enhanced, the implant being used and the desired look.

Submuscular Pocket

The submuscular pocket is often referred to as "under the muscle", as the pocket is made under the pectoral muscle of the chest wall. This pocket is often used in women who have minimal breast tissue so that the top of the implant is hidden under as much of your own tissues as possible to prevent a sharp take off of the breast and to reduce the chances of the implant being felt or seen. However, it can lead to the muscle being pushed forward on top of breast tissue which slides down as time goes by. This can lead to a “double bubble” problem where there are two bulges on the chest wall which may need further surgery for correction.

Subglandular Pocket

This pocket is often referred to as one which is made "on top of the muscle". The "sub" part of subglandular means "under" and the "glandular" part refers to the breast itself. So, the subglandular pocket is made under the breast, on top of the muscle. This pocket is often used when there is already a reasonable amount of breast tissue in someone who has little projection but is generally flat. It can also work well in someone who already has a reasonable breast volume but simply wants to be larger and is also used when someone wants to have an enhanced look following their surgery.

Dual Plane Pocket

The dual plane pocket is one that is made partially on top of the muscle and partially under the muscle. It involves splitting and releasing the muscle at exactly the right point so that you can have the benefits of having some of the implant above the muscle and some of the implant below it. This is often used in women who have a low take off and little tissue in the upper pole of the breast. By using a dual plane approach, what we achieve is to get the upper part of the implant hidden by the muscle but we prevent the appearance of two bulges in the breast (the double bubble effect) because of the low take off of the breast tissue by placing the lower part of the implant above the muscle.

IMPLANT TYPES

Breast implants come in three different varieties: the shape, the surface material texture and the filler. All implants have a silicone outer coating and implants of each type come in various different sizes.

Implant Shapes

Implants may be round or teardrop (anatomical) shaped. Both types have their advantages and disadvantages and the shape of implant can be discussed at the time of the consultation.

Implant Textures

Implants can be smooth or textured. Textured implants have a rough surface and smooth implants have a smooth texture. Textured implants have a lower risk of developing capsular contracture, which is hardening of the breast as the years go by.

Implant Fillers

Implants are commonly called silicone implants or saline implants and this refers to the fluid used to fill the implant. All implants have a silicone outer coating, but the filler material can differ. The most common filler materials we use nowadays are silicone or saline. Saline implants are filled with salt water at the time of the operation and a valve within the implant reduces the risk of saline leaking out of the implant causing deflation. Silicone implants have been extensively tested for safety. Different types of silicone are also available - some implants have thicker silicone within them, and the silicone will not leak out of the implant even if the implant ruptures. Other implants use softer silicone gel. These implants are more affordable and feel softer but can potentially leak silicone into your breast.

SIZES

Choosing the right implant size is a matter of balancing what you already have with what you want and what we can use. You might be measured you during your consultation and these measurements will determine the size of the implant that should be used, the pocket placement (ie below the muscle or over the muscle) the shape of the implant and the incision placement. The amount of nipple droop (or breast ptosis) will also tell whether you need to think about any other procedures to reshape the breast at the time of implant placement or at some other time in the future.

Breast augmentation surgery is obviously designed to make your bra size bigger. One of the common questions at a consultation will be to find out what size you are just now and what size you would like to be. Although your surgeon will be able to give you a size which is roughly in keeping with what you want, there are usually never any guarantees of exact size. In fact, different bra manufacturers will have different sizes to fit the same person.

All this means that you will usually be able to have a breast size roughly within the region of what you are hoping to achieve.

Your surgeon may perform various measurements as part of the consultation. These may help you and your surgeon decide what implant sizes are best for you.

These measurements may include:
The distance between your nipple and the bone at the bottom of your neck
The width of the nipple-areolar-complex
The width of the breast itself
The distance between the two nipples
The distance between the nipple and the bottom of the breast
The amount of pull present within the skin of the breast
The thickness of the tissue at the top of the breast
The height of the inframammary fold
The point along the chest wall where the breast begins to take off
All these measurements will tell you and your surgeon what size of implant to use, what pocket to use, what incision to use, whether the same implants need to be used in each side and whether there is already some degree of asymmetry between the two sides.

Breast implants don't come in cup sizes, but they do come in volume or weight sizes. The bigger the implant, the greater the cup size increase you can expect to see after your operation. The bigger your bra band width that you currently use, the bigger the implant size you will need to increase your cup size by one letter.

Different surgeons will use different ways of deciding together with you what's best for your requirements. One way of deciding is to talk about implant dimensions. In other words, if we know how wide your breast already is, and if we know the measurements of the implants, then we can match this to how much of a size increase you want. If you do not have enough pull of skin within your own breast, you may not be able to have as large an implant inserted as you may want. In these cases, you might need two operations to go bigger in stages. The vast majority of women, though, will be able to have a single operation to help them achieve their aims.

WHAT YOU NEED TO KNOW ABOUT BREAST AUGMENTATION

The majority of people who have breast augmentation are very happy with the results. However, there are risks with any procedure and there are specific problems you should be aware of with breast augmentations and these include (but are not limited to): Infections, Blood clots, Scarring, Asymmetry, Wound healing delays, Nipple hypersensitivity, Nerve injury leading to sensory reductions at the nipple, Size issues - some women feel they should have been made bigger or smaller after their augmentation procedure, Implant palpability, Implant wrinkling, Implant deflation (in cases of saline implants), Implant migration and movement, Implant extrusion, Implant rotation (in cases of anatomic implants), Difficulty with mammogram interpretation, Changes in the way breast lumps are investigated and treated, Capsular contraction (the formation of a hard painful or distorting area of scar tissue around the breast implant), Silicone leakage (in cases of non cohesive silicone gel implants), Galactorrhoea (the inadvertent production of milk), Further surgery: all implants have a life-span that is limited and finite. In many cases, the patient lives longer than the implant. All women with breast implants should therefore prepare themselves for further surgery during the course of their life. All the natural effects of having larger breasts - bra strap marks, drooping of the breast tissue with time, development of prominent veins, etc.

However, the vast majority of women are absolutely delighted with their new breasts and it is a procedure associated with high levels of satisfaction. Breast enlargement or augmentation surgery is complex and every patient's needs and wants vary. Doing some serious research of the options available will allow women to decide on their own specific requirements.

About the author
Mr Taimur Shoaib is a consultant plastic surgeon in Glasgow. He specialises in reconstructive and cosmetic facial surgery and cosmetic breast surgery. He works at the Glasgow Nuffield Hospital and also at the Canniesburn Plastic Surgery Unit at the Glasgow Royal Infirmary. Website: www.shoaib.co.uk Phone: 0800-612-0886. Email: office@shoaib.co.uk

About the Author

Mr Taimur Shoaib is a consultant plastic surgeon in Glasgow. He specialises in reconstructive and cosmetic facial surgery and cosmetic breast surgery. He works at the Glasgow Nuffield Hospital and also at Canniesburn Plastic Surgery Unit

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