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Breast Augmentation
Breast augmentation and augmentation mammoplasty are plastic surgery terms for the breast-implant and the fat-graft mammoplasty approaches used to increase the size, change the shape, and alter the texture of the breasts of a woman. As a primary reconstruction, augmentation mammoplasty is applied to effect a post–mastectomy breast reconstruction, the repair of the chest wound consequent to the removal of a cancerous breast; to correct congenital defects of the breast(s); and to correct congenital defects of the chest wall. As an elective, cosmetic surgery, primary augmentation changes the aesthetics — of size, shape, and texture — of healthy breasts.
Advantages:
- Enhances figure
- Improves breast fullness and body curves/li>
- Helps in breast reconstruction after breast cancer, congenital chest defects or injury
- Improves self-confidence and self-image
Indications:
- Aesthetic improvement in women who have small breast or have lost weight after pregnancy or sudden weight reduction
- To correct a prior breast reconstructive surgery/li>
- To reconstruct a lost breast as in mastectomy (breast removal after cancer), or severe chest injury or chest congenital defects
Breast Augmentation is not helpful in severe drooping breasts. For drooping breasts, breast lifting surgery is advised, which can be performed with breast augmentation surgery.
Implants were first made in 1961 and have since then undergone many changes and modification to suit the current needs.
Types of implants:
Implants filled with saline solution
Breast augmentation: saline-solution filled breast implant devices, a spherical model (left) and a hemispheric model (right).
Implants filled with silicone gel
Silicone-gel breast implant devices, a spherical model (left), a shaped model (center), and a hemispheric model (right).
Alternative composition implants filled with soy oil or polypropylene string
Saline solution implants can be first inserted and then filled. This helps in making a small incision during insertion. It gives a good feel, texture, shape and a better realistic look as compared to silicone gel implants. If these implants leak the fluid is absorbed by the body and excreted normally causing no damage to the body
Silicone gel implants are technically superior as there is no wrinkling of the overlying skin envelope. Also there is no rippling or fluid movement visible. They are immediately noticeable. These are generally advised after mastectomy or for women who have very less breast tissue.
Placement of Implants:
Implants can be placed in 4 different ways:
Subglandular: the implant is placed just underneath the mammary gland. This results in higher chances of capsular contracture and is not suitable for thin women.
Subfascial: The implant is placed between the fascia covering the muscle and the pectoris muscle (chest muscle). This position gives better fixation of the implant and less movement.
Subpectoral: The implant is placed between the layers of the pectoralis muscle. Since the incision requires the muscles to be cut and mobilised, the healing time is more.
Submuscular: the implant is placed under the muscle layer and is generally preferred in breast reconstruction. Recovery time is more.
Subglandular and Submuscular placements
Types of Incisions:
Inframammillary Incision: this is the most common incision and is made under the breast. The scar is not visible as it comes in the natural crease. It allows maximum room to insert the silicone gel implant.
Periareolar: The incision is made around the areola (dark area surrounding the nipple) on the inner side. It is a small incision and used only to adjust the implant position. It is done when breast lift is also required. The incision is not very popular as there may be damage to nerves and breast feeding is affected. Also the chances of capsular contracture are more.
Transaxillary: The incision is made vertically in the armpit crease and the implant is tunnelled through horizontally
Transumbilical: The incision is made around the navel and the implant is pushed through vertically upwards. Not very popular as the implants may break while pushing.
Transabdominal: the incision is made in the abdominal wall and the implant is pushed through upwards. Again not a very popular surgery.
The surgery is carried out under general anaesthesia. The choice of implants and the type of incision and placement depends on the requirement, patient’s anatomy, medical condition, surgeon’s expertise and surgeon- patient relations. The surgery takes around 2-4 hours.
Types of Incisions:
- The scar requires around 6 weeks to heal.
- The patient is advised against any strenuous exercise.
- Complete range of movement at the shoulder and breathing exercises are a must.
- Sub-muscular implants require more healing time as the incision is long and the muscles are cut.
- Pain killers as advised can be taken in cases of severe pain.
- Normal routine activities can be resumed after 10 days of surgery.
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