BREAST AUGMENTATION
Breast Augmentation or enhancement is a procedure to increase or restore breast volume. It can help boost self-esteem, confidence and improve the quality of life in women who feel their breasts are inadequate or unfeminine.
Women who seek augmentation
· Unhappy with the size and shape of their breasts
· Loss of volume following childbirth or weight loss
· Asymmetry or unequal sized breasts
· Congenital [from birth] absence or deformity of breasts
Options
Synthetic implants or fat transfer are the options available, suitability of which need to be discussed with your surgeon.
Saline or Silicone implants are medical prosthetic devices and have a silicone shell [outer covering] that may be smooth or textured.
Saline implants are filled with a sterile saline solution of similar concentration to that found in the body. If the implant leaks, the implant will deflate and the saline is absorbed by the body.
Silicone implants are filled with a cohesive gel, which provides a more natural appearance to the augmented breast. 5th generation silicone implants have been available since the mid 1990s and the firmer cohesive gel almost eliminates the occurrence of a filler leak or migration of the silicone filler from the capsule to elsewhere in the woman’s body.
Saline or silicone implants come in round or anatomical shapes. Various factors are taken into account such as skin quality and elasticity, existing breast tissue, position of nipple, body type to determine which would be the most suitable implant for you.
Fat transfer may be suitable for some patients. In this procedure fat is harvested from the patients body [abdomen, thighs] and used to augment the breasts. Only a limited amount of fat can be transferred in one sitting and further stages may be needed to achieve a fuller volume.
Procedure
The operation is performed under a general anaesthetic and the duration of the procedure is 1-2 hours. The implant is placed via a sub-mammary incision [placed under the breast in the crease line]. Other incisions are the periareolar and axillary.
The implant is placed either in the sub-glandular plane [behind the breast gland], sub-muscular [behind the muscle] or in a dual plane [partly behind muscle and partly behind gland]. This is decided on an individual basis. After placing the implant, the wound is closed in layers and a light dressing applied.
A. Axillary
B. Periareolar
C. Inframammary
Subglandular [Behind the breast gland]
Submuscular [Behind the muscle and breast gland]
Aftercare
Patients go home later the same day or the next morning.The dressing is changed in 4-5 days and following that a soft supportive non-underwire bra should be worn for 6 weeks. Patients can return to work in 7-10 days and full activity in 6 weeks.
Potential Risks
As with any operation there is a risk of bleeding or infection but this is rare. After the operation there may be some swelling and discomfort which is easily managed by oral medication and settles within a few days.
There may be some altered sensation in the nipple and breast but this is temporary and more likely with the periareolar incision. The scars tend to settle with time however if you do have a tendency towards keloid or hypertrophic scarring, discuss this with your surgeon as early scar management will help.
The body tends to form a capsule around the implant, this is a natural process and the capsule is usually soft and supple. However, in some women this capsule can get tight or harden requiring intervention. With the newer generation textured implants the incidence of capsular contracture is much lower.
Breast Augmentation is a commonly performed procedure and can have a gratifying and positive psychological impact on a woman’s life. It is however important to realise that breast implants do not come with a lifetime warranty and it is possible that they may need replacing in the future. Therefore have an honest and open discussion with your surgeon and have realistic expectations of what can be achieved.
General Issues
Breast Feeding - Implants do not interfere with the ability of a woman to breast feed, however some studies have shown there may be a reduction in milk production.
Breast Cancer - Extensive studies have shown good evidence that there is no increased risk of breast cancer in women with silicone implants. If a woman with silicone implants does develop breast cancer, evidence shows no difference in detection or survival rates from women without implants. FDA approved use of silicone implants in 2006.
Other sites for information :
BREAST REDUCTION
Breast Reduction or Reduction mammaplasty is a procedure to reduce the volume of the breast tissue and reshape the breast to an aesthetically pleasing shape.
Women with large heavy breasts may suffer from one or more symptoms and therefore seek treatment
• Neck, shoulder or backache
• Shoulder grooving
• Eczema under the breast fold
• Social embarrassment
Options
The options for breast reduction include Liposuction or Surgical excision of excess skin and tissue and reshaping of the breast.
Liposuction is suitable for younger patients who do not have drooping of the gland or nipple. In patients where there is excess tissue and skin along with drooping of the breast surgical reduction is needed.
Procedure
The procedure is performed under a General Anaesthetic and takes 3-4 hours. 2 basic skin incisions are used - the inverted T or the vertical scar incision. The decision as to which procedure is suitable for you will depend on breast size, volume and droopiness of the breast tissue [position of the nipple].
The nipple areola complex is shifted to the new position, excess tissue removed and skin re-wrapped to achieve better shape.
A.
A.
A.
A.
A.
A. Inverted T Scar
B. Vertical Scar
B.
A.
B.
Aftercare
A light dressing and strapping of the breasts is done. In some cases it may be necessary to use a drain which is removed after 1-2 days. Patients usually go home the next day. A change of dressing is done after 4-5 days and you will need to wear a soft supportive [non underwire bra] for 6-8 weeks. Return to work after 2 weeks and full activity in 6-8 weeks.
Potential Risks
As in with any operation there is a small risk of bleeding and infection. If a hematoma [collection of blood] does occur-exploration and removal of the collection may become necessary. Alteration of nipple sensation can occur post operative but does recover in most patients. Very rarely, nipple necrosis can occur in patients having massive reductions and those who continue to smoke.
Scars can be lumpy [hypertrophic] and early scar management is done to try and reduce this and achieve minimal scarring.
Breast reduction is a procedure with very high patient satisfaction, scars fade well with time and the relief from symptoms of having heavy breasts has a huge impact on lifestyle and psychology of the individual.
General Issues
Breast Feeding- Various studies have shown that breast feeding may be possible in a small proportion of women but it is safest to assume this ability may be lost.
Breast Cancer - all patients undergoing a reduction mammaplasty have a preoperative mammogram or ultrasound, and tissue is sent for histology.
MASTOPEXY [Breast Lift]
Breast lift or mastopexy is a procedure to reshape the breast to a younger aesthetically pleasing breast. Over time a woman’s breasts often change, losing their firmness and youthful shape. This presents as droopy or saggy breasts and in addition there may be loss of breast volume.
These changes occur following
· Breastfeeding
· Pregnancy
· Weight loss
· Ageing and effect of gravity
Options
The techniques for mastopexy include the periareolar, vertical scar or inverted T scar technique. The procedure appropriate for you will be decided on consultation and takes into account various factors such as breast size and shape, nipple areola size and position, droopiness of the breast, skin quality and excess. When there is loss of volume an Augmentation mastopexy can be performed where an implant is used to provide volume.
Procedure
The procedure is performed under a General Anaesthetic and takes 2-3 hours. A vertical scar or periareolar incision is usually used depending on the individual. If there is a lot of skin excess then an inverted T scar incision may be indicated. The nipple areola complex is shifted to a higher position and the skin re-draped to give an aesthetically pleasing result. In some cases patients may have reduced volume in addition to ptosis [droopy breast] in which case an Augmentation mastopexy may be more suitable [Breast lift and implant insertion]. Here the implant is inserted under the breast tissue to increase the volume and if needed the excess skin is removed and nipple shifted to a higher position to give a more aesthetic shape.
Periareolar Scar
Inverted T Scar
Vertical Scar
Aftercare
Patients usually go home later the same day or the next morning. A light dressing and strapping of the breast is done, which is removed after 4-5 days and then a supportive bra [non underwire bra] is advised for 4-6 weeks. Return to work in 10 days and full activity in 6-8 weeks.
Potential Risks
As with any operation there is a risk of bleeding or infection but this is rare. After the operation there may be some swelling and discomfort which is easily managed by oral medication and settles within a few days.
There may be some altered sensation in the nipple and breast but this is temporary and more likely with the periareolar incision. The scars tend to settle with time however if you do have a tendency towards keloid or hypertrophic scarring, discuss this with your surgeon as early scar management will help.
If an implant is used the body forms a capsule around the implant, this is a natural process and the capsule is usually soft and supple. However, in some women this capsule can get tight or harden requiring intervention. With the newer generation textured implants the incidence of capsular contracture is much lower.
Mastopexy is a procedure which reshapes and restores a more youthful appearance to the breast.
GYNAECOMASTIA CORRECTION
Gynaecomastia is enlargement of the male breast and may cause low self esteem, psychological upset or social embarrassment. This can be due to physiological change or pathological [due to another underlying cause].If it is pathological then investigation and treatment for the primary cause must be done. Physiological gynaecomastia commonly occurs at puberty and regresses in 1-2 years but if it persists surgical treatment can be sought for it. The breast enlargement may be due to excess fatty tissue, glandular tissue or a combination with or without skin excess.
Options
The treatment options depend on whether the breast enlargement is more of fatty tissue or of the glandular element and also if there is excess skin. Liposuction or power assisted liposuction [PAL] is done to remove the excess fatty element but if there is excess glandular tissue or skin this may need to be excised.
Procedure
The procedure is performed under a General Anaesthetic and takes 1-2 hours. Liposuction is done to remove the excess fatty tissue via tiny incisions placed in the skin crease. A periareolar incision is used if excess gland needs to be removed. The scar is limited to just around the areola region which is well concealed. When there is extra skin it is removed in a donut pattern and the scar limited to the areolar margin.
Aftercare
Patients go home later the same day or next morning. A compression dressing is applied over the chest area which is changed to a pressure garment. This will need to be worn for 4-6 weeks. Patients return to work in 7-10 days and full activity in 6-8 weeks.
Potential Risks
As in with any operation there is a small risk of bleeding or infection. A hematoma or collection of blood can occur [which is more likely if there is a lot of extra glandular tissue which needs removing]. Scars tend to settle well and skin shrinkage is good with regular wear of compression garments.
Liposuction Alone
Liposuction + Skin + Glandular Excision
Liposuction + Skin + Glandular Excision
Before
Liposuction + Skin + Glandular Excision
Liposuction + Skin + Glandular Excision
Liposuction + Skin + Glandular Excision
Before
After
After
NIPPLE RECONSTRUCTION
Nipple reconstruction is done following Breast Reconstruction to recreate the nipple areolar complex. It can be done under a local or general anaesthetic depending on patient preference. The procedure takes 30-45 minutes and involves raising local flaps to recreate the nipple. A skin graft can be used for the areolar region or after 8-12 weeks the areolar area can be tattooed to give a natural appearance.
Dr Vimla Rajan, Dr Ruchika Rajan
L-21 Green Park [Main] ,New Delhi 110016, INDIA.
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