RE Plastic Surgery

Breast augmentation is suitable for patients who seek increased volume and projection of their breasts. This is usually carried out using implants which are formed with a silicone envelope, but can be filled with either saline (salt-water solution) or silicone gel.

At present, silicone gel implants are approved for use in the UK and Europe. They are generally accepted as giving the best results for a natural reconstruction. Saline implants have a less natural feel and consistency, and are prone to show ripples as well as having a higher leak rate.

There have been repeated debates about the safety of silicone implants, with emotional reports of severe symptoms in individual patients. An Independent Review Group report commissioned by the Department of Health (published in 1998) confirmed no health risk to women based on current data and on published reviews of several hundred thousand patients. There is no increased risk of immune-based disease, nor is there an increased cancer risk. This echoes the experience of other patients having silicone-coated devices e.g. cardiac pacemakers and joint replacements.

The implants can be positioned either under the breast tissue, or under the chest muscle. The choice of position is influenced by the amount of breast tissue that you have, the thickness of the muscle and your level of physical activity. The implant does not reside within the breast tissue itself and therefore has no direct influence on breast feeding. The presence of an implant can make mammography slightly more complex with special positioning required, however it does not reduce the efficiency of mammography.

The operation is usually carried out under general anaesthesia with an overnight stay. The incisions can be placed around the nipple but are most often placed underneath the breast. Drainage tubes are not placed for those implants positioned underneath the breast but may be inserted in those patients with submuscular placement due to an increased risk of bleeding.

You may have a transient loss of sensation in the nipple, and the scar may take some time to settle down. Most patients return to work within a week, and the use of a sports-type support bra is encouraged. There will be some minor swelling within the breast tissue for several weeks after the procedure.

Over-large implants can cause the breast skin envelope to stretch over time with dropping of the breast and therefore a carefully tailored approach to size and shape is necessary. The main long-term side-effect is that of excessive scarring around the implant, called a capsular contracture. In most women this is asymptomatic, but a small number of patients may require surgical division of the capsular scarring.

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