Breast Augmentation is a cosmetic procedure to enhance the size and shape of the breasts by introducing a synthetic implant behind the mammary gland or behind the pectoral muscle.
Anyone who is interested in having this procedure is strongly encouraged to discuss all technical aspects of the surgery (type of incision and the position, type and size of the implants) with their plastic surgeon prior to making a decision.
There are 2 main types of breast implants available today:
- Saline-filled – Saline-filled implants are filled with saline (salt water) during surgery
- Silicone Gel-filled – Silicone gel-filled implants are pre-filled with silicone gel.
All implants have an outer silicone shell (which can be either smooth or textured). The current generation of silicone gel implants are 6th generation implants and are made from a sturdier outer shell and contain a new “cohesive” inner gel which does not leak.
Breast augmentation is usually carried out under general anesthesia. The incision can be made under the breast, or along the edge of the areola (the pigmented part of the nipple), or in the armpit. The implant can be placed in a pocket made between the breast gland and the chest muscle, or between the chest muscle and the ribs. You can discuss with your surgeon the best method for you. The patient is given intravenous antibiotics during the procedure and both the implant and the implant pocket in the breast are washed with an antibiotic solution prior to insertion of the implant. The incision is then closed and the patient is placed in a support bra after the surgery. This helps hold the implants in the correct position until they heal. The patient will return home a few hours after the procedure and will need to be accompanied by a responsible person for a few days. A prescription will be given for pain medications to be used at home.
In the days following surgery you may gradually resume normal activities, but avoid overdoing anything. You will be given a post-operative instruction sheet before you go home. Ask your surgeon which activities are safe and which to avoid. Avoid any medications or health products that can increase the risk of bleeding after surgery.
Follow-up appointments will be arranged by the surgeon’s office to make sure everything is healing well.
POSSIBLE RISKS & COMPLICATIONS
Although great care is taken to minimize bleeding during surgery, blood may still accumulate around the implant. This occurs in about 1% of cases and usually develops in the first 24 hours after surgery. It is usually one-sided, but can rarely occur on both sides. The affected breast is swollen, painful and bruised. This usually necessitates surgical drainage of the blood and controlling the bleeding. The implant is then placed back in the breast.
To minimize the risk of infection, intravenous antibiotics are given to the patient during surgery and the both the breast pocket and implant are washed in an antibiotic solution. The risk of infection is about 1%. The affected breast will be hot, painful and red. You may also have fever. It can sometimes be treated with a course of antibiotics or the implant may need to be removed. Once the infection has resolved, the implant may be replaced in the breast.
The nipples may become more or less sensitive after surgery. This is usually temporary and will return to normal after a few months. It is rare to have permanent change in sensation.
Despite the advances made in implant technology, no implant can be guaranteed for life. The risk of this occurring with saline implants is about and 2-3% with each passing year and with silicone implants it is about 0.5%. With saline implants, a rupture or leak will cause the implant to deflate and your body will absorb the water and it will be eliminated by your kidneys. With the old generation of silicone gel implants, there was a significant risk with gel leakage. However, with the new generation of cohesive gel implants, even if there is a rupture in the outer shell, the gel is solid and does not leak into the breast. If
a rupture is suspected, an MRI is done to assess the implant and if it is confirmed, the implant will be replaced.
When an implant is placed in the breast, a layer of scar tissue called a ‘capsule’ forms around it. For most patients, this does not cause any symptoms or harm, but in a few patients, the capsule can harden and tighten over time. The risk of contracture increases by about 1% with each passing year. It can vary in severity. It may be hardly noticeable or it may make the breast feel very hard and uncomfortable. It may also change the shape of the breast. If it occurs, it can be treated either by a capsulotomy (making an incision in the capsule to release the tight area) or a capsulectomy (complete removal of the capsule).
Breasts implants and Cancer
Studies have shown that the risk of developing breast cancer is no higher in women with breast implants than without. One in nine women could develop breast cancer (with or without an implant) during their lifetime, so it is important to continue doing a monthly self-examination, as well as a yearly breast examination by your physician. Women over 40 years of age should have a yearly mammogram. The radiologist should be informed if you have an implant. If there is any difficulty in doing the mammogram, an MRI of the breasts can be done instead.
Breast implants and Breast-feeding
It is safe to breast feed after having implant surgery. It had been thought in the past that there was a risk of the silicone entering the breast milk. Studies have shown that this risk is almost zero. In fact, studies have shown the silicone content of infant formula to be much higher than in breast milk.