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Breast augmentation

What is the Breast augmentation?

Breast augmentation denotes the breast implant and fat-graft mammoplasty procedures for correcting the defects, and for enhancing the size, form, and feel of a woman’s breasts. The surgical implantation approach effects global breast augmentation using either a saline-filled or a silicone-filled prosthetic breast; fat-transfer approach effects the augmentation, and corrects the contour defects of the breast hemisphere with grafts of fat tissue.

Women may choose to under go breast enlargement surgery for various reasons. These personal reasons may center around breasts that are perceived to be under developed or because of differences in the sizes of the breasts or from changes after pregnancy or breast feeding. Some women may be happy with their breasts but just want them made fuller. Often after weight loss, aging or childbirth a woman's breast volume and shape may change. Women may also consider breast implants if they‘re having surgery as treatment for breast cancer or other conditions that may have affected the size and shape of their breasts.

For the augmentation and aesthetic enhancement of the size, form, and feel of a woman’s breasts there are two types of breast implant devices: saline implants filled with sterile saline solution and silicone implants filled with viscous silicone gel.

Silicone gel implants are the most commonly used type of breast implants. The silicone filler can either be a fluid-like gel or a firmer jelly-like gel. Both of these are surrounded by a firm elastic shell (made of silicone elastomer) that may be smooth or textured. The more solid gel has the advantage of keeping its shape if the implant shell ruptures. However, the softer silicone gel has a more natural feel than other implants but can show wrinkling on the skin in very slim people. Choosing the more solid gel implants may mean you're left with a slightly larger scar. Your surgeon will advise you on the best type for you.

Saline implants have the advantage of being filled with a substance that is found naturally in your body. However, saline implants may be more likely to rupture and cause wrinkling of your skin, and they may also feel and look less natural. Saline implants may be inserted empty and filled by your surgeon once they are in place.

Both silicone and saline breast implants come in a variety of shapes and sizes. Implants can either be round or teardrop-shaped. Your surgeon will talk through the options with you.

Another breast augmentation method is fat transfer. Fat transfer is a medical procedure that uses the patient`s own fat tissue to increase the volume of fat in the subcutaneous area of the body. Fat grafting to female breasts can be performed for cosmetic reasons, breast augmentation, to correct breast asymmetry, tuberous breast, a condition in which the adult breasts fail to develop in puberty and result in extremely small, narrow and sagging breasts, or to correct Polands Syndrome, a rare birth defect characterized by underdevelopment or absence of the chest muscle (pectoralis) on one side of the body. The procedure can also be used to soften the overall look of existing breast implants by “blurring” the line between implant and breast tissue.

Fat may be removed from most places on the body, however, the most common places to remove fat for fat transfer include the abdomen, love handles and other areas where fatty cells typically store themselves.

What is the procedure?

Augmentation with implants

There are three alternatives where the incisions are made for the placement of breast implants:

- underneath the breast, just above the crease, where the incision is usually quite inconspicuous;

- another possible location for the incision is around the lower edge of the areola;

- a third alternative is to make a small incision within the armpit.

Once the incision is made, the surgeon creates a pocket into which the implant will be inserted. This pocket is made either directly behind the breast tissue or underneath the pectoral muscle which is located between the breast tissue and chest wall.

Breast enlargement usually takes between one and two hours.

Your surgeon will now make the breast implant incisions you discussed during your consultation. He or she will create a pocket behind the breast tissue or under the pectoral muscle tissue based on the implant placement position the two of you chose during your consultation. Once the pocket is created, the breast implant will be inserted. If you opted for silicone-filled implants, the already-filled implants will be put in place; saline breast implants are usually filled after the shell is put in the pocket.

If you have very small breasts, or if you are having implants inserted after a mastectomy (surgical removal of one or both breasts), you may need a tissue expander inserted for a period of time before receiving your permanent breast implant(s). A tissue expander looks like a regular saline implant, but it has a port through which additional saline can be added. This allows the surgeon to stretch the breast and make room for the implant.

Expandable saline breast implants work in a similar manner to tissue expanders, but are permanent. A filler port is left near the incision, and more saline is added every week until you are satisfied with the size of your new breasts. At that time, the filler port is removed and the saline implant seals itself shut. More saline can be added for up to six months after surgery.

After the breast implants are in place, your surgeon will check for symmetry. He or she will place you in an upright position to see how the implants look when you are seated. If everything looks good, your surgeon will close the incisions. Usually, a dressing will be applied to protect the wounds, keep the tissue and implant securely in place, and to reduce swelling.

Augmentation using fat transfer

Fat transfer to the breast involves two distinct procedures: harvesting and injecting. The fat cells are acquired through one of several types of liposuction: laser liposuction, ultrasound-assisted liposuction or water-assisted liposuction.

Once harvested through a syringe, the cells are processed for transplantation. This involves removing anesthetics, lipids and medical fluids from the fat. The goal is to obtain healthy fat cells devoid of other tissue, which increases the likelihood of successful cell transfer and reduces the chances of injecting unwanted substances with the fat. The healthier and purer the injected material, the greater the yield of viable fat cells.

After processing, the fat cells are carefully injected, drop by drop in dozens of small injections, into the space between the skin and the breast capsule surrounding the breast and/or behind the breast between the breast and chest wall. This meticulous technique enables the plastic surgeon to sculpt the breasts as desired. The medical consensus is that if the fat is injected into these areas, it will be easier to monitor long term, and to avoid many of the problems that may arise from significant fat being injected into the breast tissue itself. However, because these injection sites are limited in size, fat grafting to the breast can produce only modest augmentation.

Some surgeons help the process along by instructing their patients to wear tissue expanders prior to surgery.

What kind of result can you expect?

Breast augmentation will make your breasts fuller and enhance their shape. You will find it easier to wear certain styles of clothing. Like many women who have had breast augmentation, you may have a boost in self-confidence.

Except in the event of implant deflation requiring surgical replacement with a new implant, the results of your breast augmentation surgery will be long-lasting. However, gravity and the effects of aging will eventually alter the size and shape of virtually every woman's breasts. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast "lifting" to restore their more youthful contour.

It's important to know that after receiving breast implants, results are not permanent and they may require replacement during your lifetime. You should expect to have future visits with your plastic surgeon to discuss changes in your breasts.

Over time, your breasts can change due to aging, weight fluctuations, hormonal factors and gravity. If, after a period of years, you become dissatisfied with the appearance of your breasts, you may choose to undergo a breast lift or implant exchange to restore a more youthful contour.

If patients choose breast augmentation by transferring fat, there is no risk of rejection or allergic reaction, since the fat cells come from your own body. The procedure also allows the surgeon more latitude when it comes to shaping the breasts than saline or silicone implants do. There are no incisions; however, there are multiple small openings from the liposuction and injection procedures.

The downside of fat transfer to the breast is that the transplanted fat cells often do not survive long term. They may be absorbed by the body, liquefy, form a cyst, calcify or produce scarring within the breast tissues. If this happens, you likely will lose some volume and may develop some lumps.

Fat grafting also provides limited volume (less than a cup size) as compared to traditional implants.

Recovery period and recommendations

You should be walking under your own strength immediately after your breast augmentation surgery. It is very important that you walk a few minutes every few hours to reduce the risk of blood clot formation in your legs.

The first 2-5 days following your breast augmentation surgery you may feel stiff and sore in the chest region. Any dressings will be removed within several days, and you may be instructed to wear a support bra. Your breasts may feel tight and sensitive to the touch, and your skin may feel warm or itchy. You may experience difficulty raising your arms. You should not lift, push or pull anything, or engage in any strenuous activity or twisting of the upper body. Some discoloration and swelling will occur initially, but this will disappear quickly. Most residual swelling will resolve within a month.

Stitches will be removed in about a week. If you have dissolvable stitches, the amount of time they will take to disappear depends on the type of stitches. However, for this procedure, they should usually disappear in about six weeks.

After breast augmentation by transferring fat, mild pain, swelling, bruising and discomfort are normal after a fat transfer breast correction surgery and you will be most likely back to normal in 1 to 2 weeks. Depending on the area having received the fat transfer, recovery from swelling and bruising may take about 1-7 days.

You may experience some soreness and discomfort after your procedure. Do not attempt to perform any activities that make you feel uncomfortable. Although recovery from a fat transfer breast correction should be quick, don't push yourself if you are uncomfortable. If you experience any abnormal side effects or severe pain, contact your doctor for recommendations.

Possible side effects and complications

Some of the potential complications that may be discussed with you include reactions to anesthesia, blood accumulation that may need to be drained surgically and infection. Although rare, an infection that does not subside with appropriate treatment may require temporary removal of the implant.

Specific complications of breast enlargement include those listed below:

- It's common to have a slight difference in size and shape between your breasts, and this can be highlighted by implants.

- You may get an infection in your breast. If this happens, your surgeon may need to remove the implant to allow the infection to be properly treated.

- Abnormal scar tissue can form around the implant. This can squeeze the implant to make it round and firm. This is called capsular contracture and can be painful. You might need another operation to treat this.

- Your breast skin and nipple may feel more or less sensitive after breast enlargement. This usually improves over a few months. If you lose sensation after breast enlargement, it may be permanent.

- Sometimes scars can become red, thick and painful and may need more surgery.

- Implants can sometimes affect the skin on your breast and you may find your skin has ripples and creases. This most commonly happens in very thin people or after sudden weight loss.

- Implants can leak. This may be a slow seeping or a sudden split. If this happens, your implant may need to be taken out.

After breast augmentation by transferring fat, some potential risks are those similar to any fat transfer and may include firmness and lumpiness, bleeding or hematoma (a pool of blood forming under the skin), nerve damage or wound dehiscence, when a surgical wound opens. Sometimes, fluid collection, or seroma, around a surgical wound happens. Cysts may also form in the area where fat is transferred.

Infection and fat migration are possible, as are a reaction to the anesthesia and possible burns from laser- or ultrasound-assisted liposuction. Liposuction also adds the potential for creating deformities at the donor sites if too much fat is removed. There’s no guarantee of breast symmetry, and you may be generally dissatisfied with some aspect of the final results (size, shape, appearance, etc.).

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