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Breast augmentation: This is one of the most popular cosmetic operations and involves placing a breast prosthesis behind the breast or pectoral muscle in order to enlarge the breast which was either too small to begin with or which decreased in volume following child bearing.

Who should have this operation?

Breast augmentation is the only option available to the woman who feels that her breasts are too small.

How is it done?

The operation involves placing a breast prosthesis in a surgically created pocket either behind the breast tissue or even deeper behind the pectoral muscle on which the breast lies. The decision as to where to make this pocket should be will depend on a number of factors including the patient's age, the degree of droopiness of the breasts (if present), the type of prosthesis being used and the extent of the patient's physical and sporting activities. The most common site is sub -(under) -pectoral, as this tends to result in a lower incidence of firming or hardening of the breasts after the operation.

Regarding the incisions for this operation, there are three alternatives available.
  1. Inframammary - The incision is made just above the fold under the breast. This is the most common site and is widely used by plastic surgeons around the world as it gives the surgeon the best view of the operative field and allows for the most effective means of dealing with any problems such as bleeding which may arise during the operation.

  2. Periareolar - The incision is made around the lower half of the circumference of the areola. While this incision usually gives a very good scar, unless the patient has a very large areola, which is unusual in women with small breasts, it provides a very small aperture through which to perform the surgery and makes visualizing the inside of the breast very difficult.

  3. Axillary - This is where the incision is made in the armpit. The purpose of this approach is to leave no scar on the breast. While that objective is achieved, there are down sides to using this site.
    The scar is always visible when wearing a sleeveless garment.
    The access to the breast during the operation is extremely limited and the surgery must be performed blind, as there is no direct visualization of the interior of the breast possible.
    The prostheses may have a tendency to ride up and out after this operation creating a bulge in the armpit.

What sort of anaesthesia is required?

This operation is performed under general anaesthesia.

How long does it take?

The operation takes sixty - seventy five minutes.

Is it very painful?
You will need to have one injection for pain on waking from the anaesthetic but with the use of anti-inflammatories and oral analgesics, the post -operative pain is well controlled.

How long will I need to remain in hospital?
You will go home on the day of surgery.

How long will I be off work?
Most patients take two to three days off work, depending on the type of work. As you shouldn't drive for three to five days if possible, this might dictate how long you take off work.

What about exercise?
You will need to avoid any forms of exercise, which involve the arms for at least three weeks. Ten days after the operation you will be able to return to walking, cycling etc.

Are there any complications associated with this operation?
Apart from possible but very rare complications from the anaesthetic, the most likely potential problems associated with this operation are:
  1. Loss of nipple sensation. If this does happen it is most likely to be very short lived and to recover within a matter of weeks. Permanent loss of sensation is entirely unpredictable and occurs in less than 5% of patients.

  2. Firmness or hardness of one or both breasts. The likelihood of this happening is 10% or less. If it occurs, it is due to the naturally developing scar tissue
    around the prostheses contracting and compressing the prostheses in the process. This complication is avoided by creating a large cavity at the time of operation and initiating suitable manipulation of the prostheses within days after the operation.

How long will the operation last?

This is difficult to say but I have patients who are still happy with the result of their operation more than twenty years later.

In the event that a prosthesis ruptures after some years or possibly some direct trauma as may be experienced in a motor vehicle accident, it would be necessary to insert a new one.

Will having this operation make it more difficult to assess a mammogram?
Radiologists are able to compensate for the presence of the prostheses and are able to assess the status of the breast tissue despite their presence.

Is there any link between having this operation and breast cancer?
Absolutely not.

Are there any dangers associated with the prostheses that might cause illness in the patient?
There is no evidence available to date to support these contentions.