Augmentation of the smaller breast is one of the most commonly performed plastic surgery operations, and one which can generate benefit and concern in equal measure. Augmentation must not be undertaken lightly, but for well selected patients can be of great personal and emotional benefit.
Augmentation has a role for those who have failure or maldevelopment of breast tissue, developmental breast asymmetry, or who have lost breast volume after pregnancy and breast feeding (postpuerperal atrophy).
Preoperative assessment and planning are essential elements of breast augmentation. Preliminary discussions explore medical history and aims of surgery, and are followed by examination and measurement to analyse current condition and potential treatments. It is the aim of surgery to produce a harmonious result of natural and long-lasting benefit. One is reminded that for some patients the complete avoidance of surgery might be an obvious choice. Risks and benefits must be compared, family history of breast cancer must be recorded and relevance of current plans for breast follow up and screening explained.
All patients attend a minimum of two preoperative consultations giving time for plans to be confirmed and questions answered. Measurements, patient goals and expectations, combine with tissue characteristics in the process of implant selection.
Implants are usually filled with a silicone gel, contained within a silicone elastomer shell. Devices vary in shape, size, surface, gel characteristics and dimensions. Usually a number of options consistent with patient goals are selected for theatres, the final selection taking place peroperatively after pocket preparation.
The insertion of an implant brings with it a commitment to long term follow up, care with breast screening, and an acceptance of replacement or maintenance surgery in the years ahead. Implants can be palpable or visible postoperatively. Distortion of implant shape can relate to capsule and scar formation.
Breast augmentation surgery can be a day case procedure or more often part of an overnight hospital stay. Surgery requires a general anaesthetic, takes between one and two hours to perform and is a generally a well tolerated process. The area is protected with a light dressing for one week after surgery, and pain killers are prescribed for regular use over first days.
Recovery from any procedure requires common sense regarding a return to normal activities, increasing mobilization with each passing day. Support at home is advised if family life is frantic!
We endeavour to avoid complications associated with the general process of surgery or specific to the procedure itself. Anaesthetic support is delivered by very experienced anaesthetists, and ward care provided by nursing staff familiarwith the surgery. Complications are infrequent but can be early (bleeding, infection, delayed healing or implant loss) or late (poor scar, bad shape, or silicone related problems). There is a risk of sensory changes affecting the skin or nipple, and which can be slow or rarely incomplete in recovery.