Breast Augmentation

The incisions are placed in a way to hide the subsequent scar into your skin crease.

There are 3 common incision sites although , the commonest one is inframammary.

1. Inframammary – under the breast crease
2. Transaxillary – in the arm pit
3. Periareolar – around the areola

Layers of the chest wall include –

The pockets used for implant placements are submuscular and subglandular

Submuscular pocket – this is the most favoured approach for impant placement . The implant sits in between the muscle and the rib cage ( layer 3 and 4 ).

The upper end of the implant being covered by mucles gives a nice take off from the chest wall and better contour especially in thin women with smaller breasts. Benefits include

• Less capsular contracture
• Less interference with mammography in later life
• More natural upper pole of breast

Subglandular pocket – The implant sits in between the breast tissue and the muscle ( layer 2 and 3 ).

If you have a good amount of breast tissue especially in the cleavage area this pocket suits better. Benefits include

• Quick recovery with very little pain
• Good cleavage
• Best suitable in tuberous breasts
• No animation problems of the muscle

DUAL PLANE TECHNIQUE

This is a new technique popularised in Texas and Sweden. It combines the advantaes of both the subglandular and submuscular pockets.

Dr. Mahadik dissects 50% above and 50% below the muscle to create a dual plane. The freed breast tissue flap then spreads better and sits well over the lower pole of the implant. This prevents the double bubble deformity ( a deformity which forms due to a tight band of skin over the breast ) . This technique is proving very successful in most type of implant procedures that are undertaken.

Modern day implants are ‘Cohesive’. That means they hold their original shape. They contain semiliquid cohesive gel inside a resilient silicone shell. The gel gives it a softer feel and the shell maintains the desired shape.

Advances in technology has made breast implants more safer with a more natural feel. They allow the surgeon to fold and insert the implants through a much narrow opening in the skin. Implants then unfurl into its natural shape once in their pocket on the chest.

Unfortunately, breast implants do not come in cup sizes. Cup sizes are confusing for implant manufacturers and for us as well.

1) C-cup from one bra manufacturer is not necessarily the same as a C-cup from another manufacturer and
2 ) Final cup size will be partially determined by the preoperative breast size, and every patient is different in this aspect.

However , it can be expected that a B-cup implant size is approximately 250g (cc) and a C-cup is 330cc in a woman of average height and average build

Measurements

The final size of an implanted breast is guided by these 3 factors + your desires to go ‘ how big ’

• Breast diameter ( width ) and height
• Projection of your natural breasts and
• Skin quality

Dr. Mahadik will do a careful physical examination and guide you to select an implant that suits you the best.

Your native Breast Diameter is the most important determinant of all in deciding what implant you can choose. This is often the starting point of your implant selection process.

As the implant size ( volume in cc ) goes up the implant diameter also goes wider. So larger implant than your chest size will look out of proportion and cause issues like migration of implant, symmastia and stretch marks. Smaller implant to your chest size does not give cleavage and upper pole fullness.

However, it can be expected that a B-cup implant size is approximately 250g (cc) and a C-cup is 330cc in a woman of average height and average build. That number will be higher if the woman is tall or has broad shoulders. Similarly, if the patient is shorter than average or has a narrower chest, that number can be expected to be slightly lower.

IMPLANT SHAPES

They come in 2 shapes , Round and Tear drop ( anatomical )

Each shape comes in 5 different Profiles or Projections or Heights to choose from. The choice depends on how much cleavage and side boobs you want. The more cleavage you want the higher profile you go. However, it is important to remember that putting an Extra or Ultra high profile does give people that ‘fake boob’ look which could be someone’s choice.

• Low Profile
• Medium or Moderate Profile
• High Profile
• Extra High Profile
• Ultra High Profile

Round Implants

They are round from all over and provide same girth all over. They are ideal for those patients with well-shaped natural breasts who desire a straightforward enlargement in all dimensions but specially in the upper pole.

Tear drop ( anatomical )

They are fuller in bottom half and sloping in the upper half , like natural breasts. Use of the teardrop (anatomical) shape depends on the patient’s desire, as well as her breast shape. Two groups of women who benefit from teardrop-shaped breast implants ;

• Women who want a more natural look with a gentle slope in the upper half of the breasts
• women who have mild droopy and/or tuberous breasts. Mild elevation of the nipple in relation to the breast mound can be achieved without the need for extra scars on the actual breast

No matter what the coating or the shell is, the inside is silicone gel for all types of silicone implants.

The choice and advances in coating surfaces (smooth, textured and polyurethane ) are to reduce capsular contractures and reduce implant migration. Technology is fast evolving and we hope that one day we have a ‘ prefect implant ‘

Smooth Implants

They give a relatively softer feel especially important under thin breasts. Although they come with a higer rate for capsular contracture, they pose less of a risk for ALCL ( a very rare cancer associated with breast implants )

Textured Implants

Textured or rough surface implants claim to reduce capsular contracture and pocket migration. Highly active and athletic women should go for textured implants for a better tissue hold and less displacement.

Polyurethane Coated

Theses newer implants claim to have 1-2% capsular contracture rates than 5-7% for others. They are more firm and give a somewhat unnatural feel to the breast. Biggest advantage is that they firmly hold the breast tissue with the least migration.

WHAT IS CAPSULAR CONTRACTURE

RECOVERY

RISKS

General risks

• infection and bleeding
• loss of sensation to nipple
• poor scars

Specific risks

• Capsular Contraction• Breast implant malposition
• Breast implant rotation
• Rippling within cleavage
• Breast implant palpability
• Animation deformities
• Breast implant rupture
• Breast asymmetry
• Anaplastic Large Cell Lymphoma (ALCL)

# How does an implant fit through a small insicion (skin cut ) ?

Modern implants are made out of cohesive gel. This allows them to be folded and squeezed into the pocket through a small skin cut. They regain their original shape once inside. the pocket.

# What are implants made of and are they safe

Breast implants that Esmee Clinic uses are made of silicone. There is no evidence that silicone implants causes any disease in the body.

# What is silicone

Silicone is derived from the naturally occurring substance, silicon. Silicon is a metal-like element that reacts with oxygen to become the most common substance on earth, silica. From beach sand to crystals, silica exists on the earth naturally. With intense heat and carbon, silica becomes silicon, which then can be further processed to become silicone. It is commonly used in lubricants and oils, such as polishes, body lotions, soaps, processed foods, chewing gum, and waterproof coating

# Do implants interfere in diagnosis of breast cancer in later life

Breast implants do not interfere in breast self /clinical examination in any way.

You should inform the doctor before doing mammograms about your implants so he can take additional views to see as much of the breast tissue as possible. You may need a radiologist experienced with this.

# Can there be no scars

Any skin cut heals with a scar. We hide the scars in skin folds and by meticulous suturing techniques. In most women scars are inconspicuous. You should speak to your surgeon if you have a tendency for hypertrophic scars or keloids.

# How long do the results last.

They last for a good many years which depends on what age you have them put in. This is because even if the implant stays the same, your breast tissue keeps on changing as you age. So an implant done at 20 yrs of age looks very different when you are post pregnancy 40 yrs.

Majority will likely need to be replaced eventually and about 1% to 2% of breast implants break or deflate each year

# My Breasts are loose from breast feeding . Implants or breast Lift…how do I choose my implant ?

Many women in their mid thirties, walking in the consult room have this question. “Can my drooping be corrected with just implants or do I need a lift”.

Breast implants provide volume and Breast Lifts provide just support and not volume. Sometimes the answer could be “both”

Implants alone will correct drooping, but only in early stage. drooping when . Implants alone help,

1. Breast drooping is mild
2. The nipple is still near the centre of the breast and does not point downward
3. The patient is happy to go at least one cup larger Breast lift (with or without an implant) is better when:

• Breast drooping is moderate or severe
• The nipple is at the bottom of the breast or points downward
• The patient is already a C or D cup breast size and doesn’t want to be larger

4. The areola is too large and the patient wants it reduced

# Can they cause trouble if I am pregnant again.

Breast Implants do not interfere with pregnancy. Your breasts will enlarge at pregnancy like other bodily changes.

Is there an increased chance of cancer after breast Implant surgery
No, there isn’t.

# Confused between 350 and 375 cc ?

The difference between 375 cc and 400 cc is so small as to be hardly noticable after surgery.
Remeber as well that when you try on the implants inside a bra they appear slightly larger than the same size implant after surgery. So always err on the larger size.

# How do I bring my breasts close together to get a better cleavage.

Natural breasts do fall out to the side, and to some extent, implants will do the same. A bra will give you the appearance you are creating with your hands. However, the only other way to gain more cleavage in that area is to add volume with a round implant

I have one breast larger than the other . Can implants fix this

Yes. Its very rare to have perfectly symmetrical breasts. The asymmetry can be minimised with choosing appropriate sized implants. You should not expect perfect symmetry.

# When can I resume sex after breast augmentation ?

Absolute no for the first 10 days as rise in blood pressure can risk a bleed. Avoid straining the arms and upper body and manual handling for 4 weeks. We advocate breast massage from 3 weeks post surgery. Unrestricted activities at 6 wks.

# Compression Garments vs Bra after surgery

There is no evidence that compression garments help in anyway. Dr Mahadik likes to support the lower pole with a support snug fit bra for 4 weeks. This is applied before the patient is shifted off the operation table

# My breasts and nipple are stinging, even 3 weeks post surgery ?

The nerves of the breast skin and the muscle are stretched quite a lot. This causes hyperaesthesia and typical ‘ zingers’ which is sharp stabbing nerve pain. Sometimes it is a deep seated burning pain.

• Nipple sensation can remain unchanged to that of the pre-operative state, OR
• Or, the nipple sensation can increase to the point of being too sensitive and sometimes painful, OR
• The nipple sensation can decrease to the point of being numb.

Breast massage with a moisturiser commencing 3 weeks post surgery desensitises the nerve pain and comforts the patient.

Most of this will get better in 3 months time. However, up to 10% remain with permanently altered nipple sensation – either too much or not enough.

# How does breast massaging after implant surgery help

Firstly, all patients are advised to “massage/moisturise” the breast skin commencing prior to surgery and continuing for 3 months after surgery.

At 1 week post-op we advise all our patients to commence massaging down the cleavage line to help reduce the swelling and start to define the new cleavage.
– At the three week post-op stage you are then instructed on how to commence massaging, designed to help soften and settle your breasts.
– Also at the 3 week stage we advise all our patients to commence massaging the scar/incision which helps soften it

# Does long-term ongoing massaging reduce the future risk of capsular contracture?

The answer is “probably not”. However it does play a vital role in the initial softening of the breasts and reminds patients that their new breasts are not “fragile” and that they can be handled normally.

# What is implant fluff or Drop ?

Most of the swelling settles in 6 weeks after surgery and you can really start to appreciate how things are going to look. With time the superior fullness of breast tissue corrects itself. The breast softens and settles called as a fluff or a drop. This takes anywhere between 3 – 6 months

# What are unrealistic expectations in a Breast implant surgery

Research says most women have realistic expectations that if this is done, they will look more satisfying to their own eye and to others.

Unrealistic expectations are common when sense of self and self esteem are fragile . Those patients who are going through major life changes like divorce, death in the family, a new partner or a job should wait before any mental heath issues like depression and anxiety are addressed.

# What is my Final cup size

Unfortunately, breast implants do not come in cup sizes. They come in volumes of the gel inside. Out of the several reasons the important ones are 1) C-cup from one bra manufacturer is not necessarily the same as a C-cup from another manufacturer. And 2 ) Final cup size will be partially determined by the preoperative breast size, and every patient is different in this aspect.

However, it can be expected that a B-cup implant size is approximately 250g (cc) and a C-cup is 330cc in a woman of average height and average build. That number will be higher if the woman is tall or has broad shoulders. Similarly, if the patient is shorter than average or has a narrower chest, that number can be expected to be slightly lower.