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BREAST AUGMENTATION

1HOW CAN WE DESCRIBE A ‘PERFECT’ BREAST?
The are broad variety of breast sizes and shapes along with diversity in aesthetic preferences make it not an easy task to define the ‘perfect’ breast. Nonetheless, some of the typical features most frequently used to describe ‘ideal’ breasts include: full, balanced, symmetrical and firm. Whereas, the ideal nipple is generally described as symmetrical, circular, same color, pointing up a little and proportionate with the breast size in overall. Latest survey conducted in Britain involving different ethnic groups from both women and men revealed that surprisingly 87% of the respondents voted for the ideal and most attractive breast proportions are to be 45% breast above the nipples and 55% below with the nipple at an upward 20-degree angle.
2WHAT IS BREAST AUGMENTATION?
Breast augmentation is also known as ‘augmentation mammoplasty’ which is a form of plastic surgery designed to enhance a woman’s breast size and shape.
3WHAT ARE THE REASONS TO UNDERGO A BREAST AUGMENTATION PROCEDURE?
Following are some of the most common reasons to undergo a breast augmentation procedure. The women who:

⦁look for larger, rounder and fuller breasts

⦁are embarrassed because their breasts are too small

⦁believe that their breast are disproportionate with the rest of the body

⦁have asymmetrical breasts

⦁have lost breast volume after pregnancy or an excessive weight loss

⦁have an injury in the breasts after mastectomy

4WHO IS A GOOD CANDIADATE FOR BREAST AUGMENTATION?
You are a good breast augmentation candidate if you have one or more of the following conditions:

⦁have naturally small breasts

⦁one breast is smaller than the other

⦁look of your breasts bothering you

⦁shape and size of the breast has changed due to weight loss

⦁breast volume lost after pregnancy and breastfeeding

⦁seek for an improvement in the look of the breasts

⦁firmness of the breasts lost after having children

⦁have complications from a previous breast surgery

5WHAT ARE THE FACTORS TO CONSIDER BEFORE UNDERGOING A BREAST AUGMENTATION PROCEDURE?
Breast augmentation is probably the most customizable cosmetic surgery which presents individuals vast number of options in terms of how they prefer their implants to look and feel. There are six main factors to consider prior to undergo a breast augmentation surgery.

⦁Implant Size

Breast implant size will determine the overall volume of the breasts which has a major impact on the final result of a breast augmentation procedure. Breast implants are measured in ccs and range between 120cc up to 960cc. Implant size preference is generally made based on the patient’s autonomy as well as the desired degree of naturalness of the final outcome. The most effective way to determine the implant size is to try different implant sizes and see how each size looks.

⦁Implant Type

Another important decision regarding the implants is to choose between silicone or saline. Silicone implants are pre-filled with a silicone gel that designed closely mimic the feel of a human breast tissue. Although there is no sufficient supporting scientific evidence, it is considered to have a more natural appearance and feel.On the other hand, saline implants are initially placed into the body in its empty form, and then filled with sterile salt water solution. Therefore, small incision is required compared to a silicone implant. Moreover, it is more convenient for the surgeon to set the implants to meet specific aesthetic outcome of the patient.

⦁Incision Pattern

There are a total of four different types of incisions:

⦁Around the lower half of the areola (periareolar)

⦁Underarm area (transaxillary)

⦁Below the curve of the breast (inframammary)

⦁Navel area (transumbilical or TUBA)

Periareolar and inframammary are the most common types of incisions used. In the periareolar type, incision is made around the lower half of the areola which allows for the scar to be hidden in turn. This type of incision is often combined with mastopexy and breast lift. In the inframammary type, incision is made in the crease below the curve of the breast. It is ideal for silicone implants as it reveals the breast tissue-pectoralis muscle interface better. On the other hand, both transaxillary and transumbilical incisions are performed mostly on using saline implants. In the transaxillary type, small incision is made in the armpit creating a tunnel to insert the implant in. There is no scar created in this kind of technique on the breast. Whereas in the transumbilical type, incision is made in the naval area, creating a tunnel up to the breast area. Both type of incisions involve an empty saline implant that rolled up like a tobacco and get through the created tunnel to be inserted in the breast. After that, the implant is then filled to the required amount.

⦁Implant surface texture

There are two different types of surface for breast implants which are smooth and textured. Some of the features of both options are outlined below

⦁Smooth breast implants

⦁outer silicone shell is shiny

⦁outer silicone shell is slippery in texture

⦁provide a more natural shape

⦁more chances of displacement compared to textured implants

⦁tend to last longer

⦁Textured breast implants

⦁outer silicone shell is thicker and firmer

⦁outer silicone shell is less slippery in texture

⦁designed to reduce capsular contracture, however it is not yet

evident that it does prevent more than smooth breast implants

⦁tend to create more friction in the implant

⦁fit more to meet shape breast implant needs

⦁Implant shape

There are two different types of shape for breast implants which are teardrop and round. Some of the features of both options are as follows:

⦁Teardrop breast implants (Shaped / Anatomical / Contoured)

⦁designed to mimic the appearance of a natural breast.

⦁asymmetric shape

⦁Upper area is thinner and slopes into a fuller and rounder base.

⦁More volume in the bottom part when viewed from side

⦁Oval shape when viewed from front

⦁Suit better with textured surface implant

⦁Softer for the touch

⦁Round implants

⦁Completely symmetrical round shape

⦁Most common used shape for breast augmentation

⦁No deformity in the breast shape

⦁Both textured and smooth surface can be used

⦁tend to be less costly than tear drop implants

⦁More volume in the bottom part when viewed from side

⦁Implant profile

When it comes to breast augmentation surgery, it is not only the size and placement of the implants that matter, the degree how they should be projected form the body is equally important to achieve the best results. Implant profile measures the forward projection which the types ranging from low to high. Implants of exactly the same size can have different widths that will eventually produce various levels of projection. There are several options varying on the implant manufacturers. Let’s have a look at some of the popular types briefly.

⦁Low profile implants

⦁flat in appearance

⦁widest out of all implants types

⦁chest is minimally projected

⦁usually more cleavage than higher profile implants. 

⦁ideal for women with wider chests.

⦁Moderate profile implants

⦁tend to have the most natural results

⦁narrower and thicker than low profile, wider and thinner than high profile implants

⦁well balance of volume and cleavage

⦁ideal for women with narrower chests and medium size frame.

⦁High profile implants

⦁implant is very narrow at the base providing maximum projection

⦁fullest and most rounder outcome

⦁produce the most impressive curves out of all types

⦁ideal for women with narrower rib cage and smaller body frames

In terms of determining the most appropriate type of profile implant, there are two main interconnected considerations need to be made. These are natural body characteristics and the desired outcome targeted to be achieved. Thus, same implant will look completely different on two different individuals depending on the chest types. Furthermore, particular preferences whether more natural or subtle or requiring more rounder or fuller look will indeed determine the most ideal type of profile implant accordingly.

WHICH IMPLANT TYPE IS THE RIGHT ONE FOR ME?

At the end of the day, the golden question is which implant type do suit me the most? Unfortunately, no straight answer can be given to this question as there is no implant style, shape, construction or size that can be considered as the best one. Each women has an exclusive aesthetic goals and the right implant will vary significantly from woman to woman. As a matter of fact, right implant is need to be carefully selected for the right patient and MediExpert has a highly customized approach in terms of meeting the specific aesthetic goals of each particular patient.
6WHAT DO I NEED TO DO BEFORE THE SURGERY?
Following needs to made prior to the surgery in order to ensure that the patient is healthy enough for the procedure:

⦁Stay away from smoking and drugs

⦁Undertake blood tests

⦁Ensure that the patient is psychologically healthy

⦁Avoid all sorts of blood thinners and certain anti-inflammatory drugs

⦁Any other medications will also be checked thoroughly as they might lead to complications

7WHAT ARE THE STEPS IN A BREAST AUGMENTATION PROCEDURE?
The following steps are taken in a common breast augmentation procedure.

⦁ADMINISTRATION OF ANESTHESIA

A typical breast augmentation procedure is performed under a general anesthesia. However, in some cases intravenous sedation is also applied. MediExpert’s surgeon’s will provide you the best solution consulting the patient.

⦁OPENNING INCISIONS

Since breast augmentation is s highly customizable procedure, incision alternatives will be discussed thoroughly to determine the most appropriate option in order to meet the specific aesthetic goals of each patient. After the consultation, MediExpert surgeon will make an incision and create a pocket for the implant to be inserted into by using a special tool in one out of the four following primary areas:

⦁Around the lower half of the areola (periareolar)

⦁Underarm area (transaxillary)

⦁Below the curve of the breast (inframammary)

⦁Navel area (transumbilical)

Incisions are made in discreet locations as much as possible to minimize visible scarring. Incisions differ based on the type of breast implant used, degree of desired enlargement, patient’s anatomy and surgeon-patient preference accordingly.

⦁INSERTING AND PLACING THE BREAST IMPLANT

After the implant pocket is created, the implants then will be inserted into position. Once the placement is made, surgeon will check and ensure the proper placement and symmetry. The method for placement and positioning breast implants vary based on the type of implant used, degree of desired enlargement, type of body and recommendations of the surgeon.

⦁CLOSING THE INCISIONS

After the surgeon is fully satisfied with the proper insertion and symmetry of the breasts, incisions are then closed with multiple layered sutures starting with closing the deeper tissue and followed by the surface incision itself.
8WHAT ARE THE BENEFITS OF BREAST AUGMENTATION?
Some of the benefits of undergoing a breast augmentation surgery are as follows:

⦁Desired volume and curve will be added enhancing more firmer, fuller and more shapely breasts.

⦁Asymmetrical breasts will be balanced

⦁Restoring the lost volume of sagging breasts due to aging, pregnancy and breastfeeding

⦁Clothing will fit more nicely

⦁More balanced physique that is proportionate with the body is enhanced providing with an improved overall figure

⦁Love life is improved

⦁Self-confidence is boosted as women feel more comfortable and confident for their body

9WHAT IS EXPECTED IMMEDIATELY AFTER THE SURGERY?
Post operative period is extremely important for a quicker healing and recovery period. Following are most likely to be expected within the first few days after the surgery:

⦁you will be kept under observation for few hours to make sure that there is not any clotting or excessive bleeding

⦁you are most likely to feel exhausted

⦁incisions may remain covered with gauzed dressings up to a week

⦁you may experience less feelings in the breasts and nipples for few days

⦁you may be asked to wear a supportive surgical bra or an elastic bandage

⦁swelling is considered normal which will gradually diminish over the next weeks

10HOW LONG IS THE BREAST AUGMENTATION PROCEDURE?
It takes typically between 1-3 hours depending on the factors such where the incision is made, form of anesthesia is used and the type of placement for the implant.
11IS THERE ANY AGE LIMIT?
Patients must be over 18 to undergo the procedure.
12WHAT KIND OF PAIN SHALL I EXPECT AFTER BREAST AUGMENTATION?
There is some degree of pain after the breast augmentation procedure which can be considered as mild to moderate pain. Pain is manageable and subsides within only a few days time which is easily controlled by prescribed pain relievers in order to reduce any possible discomfort.
13WILL I LOSE SENSIVITY IN MY BREAST?
Although most of the patients do not complain about the changes of sensation in the nipples, there is a possibility that sensation may be a little different than of prior to the surgery. Most of the loss of feeling typically resolve within 2-3 months, however in some cases it may take up to 2 years for the nipples and the area around the scar to resolve completely. In rare cases, sensation might never return to 100%.compared to how it felt previously. This rare case usually occurs when breast augmentation is combined with a breast lift. The appropriate size of the implant meeting the size of chest diameter is the driving factor that impacts sensory changes. Therefore, once again we need to underline the importance of selecting the right implant for the right body to achieve the best results.
14WILL THERE BE ANY SCARS LEFT?
Some degree of scarring is inevitable after breast augmentation procedure, however these scars are often minor, flat and gradually fade over time. Immediately after the surgery, the scar will typically appear as red and visible. Then the scar will be converted in the form of a thin white incision line. There are several factors affecting the appearance of scars. Some of them include:

⦁age

⦁skin elasticity

⦁skin tone

⦁genetics

⦁past sun exposure

⦁technique performed

⦁ability of the surgeon

⦁body’ reaction to heal

⦁smoking

⦁alcohol consumption

⦁following surgeon’s instructions both in pre and post operatively

It is difficult to provide a specific timetable for the healing of the scars as there are several stages of healing in the months after the surgery and it may take up to a year for the scars to fully mature and in some cases might be much less than that depending on the variable factors given above. One thing for sure is that MediExpert’s priority is to leave the scar in a well hidden spot where it is less visible as possible and the complete guidelines will be given both pre and post operatively in order to minimize the scarring.
15HOW LONG IS THE RECOVERY TIME?
Breast augmentation is a cosmetic procedure that has one of the most quickest recovery period. After the surgery, some fullness and tenderness around the chest is normal as the tissues getting adapted to the presence of the breast implants. Swelling and temporary soreness are typical side effects after breast augmentation, however discomfort after the procedure is usually mild to moderate which can be easily managed by prescribed pain relievers for a few days. Most of the patients stop taking pain medication after three days. You will be recommended to sleep back elevated in order to reduce swelling at the chest area. Although healing period may vary from patient to patient, initial recovery period after breast augmentation procedure is usually 1-2 weeks. Most of the swelling will diminish after the first few weeks, whereas it is normal for the some of the swelling to remain into a certain extent for about 6 months.
16SHOULD I NEED TO STAY IN THE HOSPITAL AFTER BREAST AUGMENTATION?
It is typically an outpatient procedure, however in the case of secondary or revision procedures; it may be necessary to stay overnight at the hospital whether there is not an adult who can accompany the patient after the surgery.
17WHEN WILL THE STITCHES REMOVED?
Stitches are generally dissolvable type. If not, the stitches will be removed within 7-10 days after the surgery.
18WHEN CAN I GO BACK TO WORK?
Most of the patients can return for a desk job within 3-7 days. It may take between 2-3 weeks to return work for a physically demanding job.
19CAN I DRIVE AFTER THE SURGERY?
It is typically 1 week is required to start driving after the surgery.
20WHEN CAN I START EXERCISING?
Arm movements will be restricted within the first couple of days after the surgery. Starting with two days following the surgery, you will be instructed to start massage techniques at home to soften and relax the breast implant pocket to achieve natural looking results. Most patients are able to resume light exercises within 1-2 weeks after the surgery, whereas upper body exercises, heavy lifting and yoga can be resumed after 4-6weeks.
21WHAT HAPPENS TO MY BREASTS AND BREAST IMPLANTS IF I BECOME PREGNANT?
First of all, breast implants do not pose any risk to get pregnant and there is not any unusual complications during pregnancy associated with breast implants. The breasts naturally increase during pregnancy which is called ‘engorgement’, this does not involve any negative affect on the implants.However, breast tissue expands with pregnancy as for the women having little breast tissue will have a minor expansion, whereas for the women having more breast tissue may lead to a sagging after pregnancy. In this case, a breast lift procedure can assist on correcting the appearance. As a matter of fact; augmented breasts with implants are less likely to lose their volume and shape, thus not experience such drastic changes.
22IS IT SAFE TO BREASTFEED AFTER BREAST AUGMENTATION?
It is perfectly safe to breast feed the baby after breast augmentation as the implants do not affect baby and the mother.
23WILL I BE ABLE TO BREAST FEED WITH BREAST AUGMENTATION?
Some women are unable to breastfeed whether they have underwent a breast augmentation surgery or not, whereas some women have not breastfed before the surgery so they do not really know whether they can. For those women who had practiced breastfeeding prior the surgery, there may be a minor risk of not being able to breastfeed after the procedure. The rare inability to breastfeed after the procedure is considered to be from a damage to milk ducts during the surgery, or the cause might be the milk ducts and surrounding breast tissue pressurized by the implant placement. This additional pressure from the implants might not let the milk go through having combined with the pressure from the milk engorgement. Studies indicate that a rare risk of difficulty of breastfeeding tend to increase for the very large size of implants.
24CAN BREAST AUGMENTATION COMBINED WITH OTHER SURGERIES?
Breast augmentation can be performed with different kinds of surgeries. The most common multiple surgery combined with breast augmentation is a breast lift (mastopexy). There is not any hard scientific data supporting that the risks and complications are higher than those of the two surgeries performed separately. On the contrary, there are benefits of having these surgeries at once as initially it avoids the risks of two surgeries, anesthesia applied one at a time and advantageous in terms of saving time and money accordingly.
25 HOW LONG WILL THE BREAST IMPLANTS LAST?
Unfortunately, there is not a cosmetic surgery that can be guaranteed to last forever. The most possible complication from breast augmentation for both silicone and saline implants is a ‘rupture’ which means basically for the implant to develop a leak or a hole. Although majority of the implants last between 10-20 years without any complications on average, there are no guarantees as some may last for a lifetime, some may have complications earlier on. According to recent FDA reports, 20% of women have their breast implants repaired or replaced within the first ten year followed by the surgery.
26ARE RUPTURES DANGEROUS?
There is nothing to worry about with saline implant ruptures as saline is only a sterile salt water and it is absorbed naturally within the body in the case of escaping from the implant. Whereas, ruptured silicone implants do not pose any health risks either, however it is highly advisable for the ruptured implants to be removed as soon as they are detected. It is recommended that women with silicone implants should have an MRI initially 3 years after the procedure and again followed by every couple of years after that.
27WHAT ARE THE POTENTIAL COMPLICATIONS AND RISKS OF BREAST AUGMENTATION?
Although modern techniques for breast augmentation are very safe, as with any other surgery there are some risks involved. Some of the rare complications from a breast augmentation surgery are as follows:

⦁Bleeding

⦁Infection

⦁Altered nipple sensation

⦁Capsular contracture

⦁Breast asymmetry

⦁Implant shifting

⦁Implant leakage

⦁Implant breakage

⦁Mammography interference

⦁Deflation

⦁Unexpected size outcome

28WHEN CAN I SEE THE RESULTS?
Changes to your breasts will be visible immediately after the surgery, however these changes will not be the final results. It may take a few months for swelling to subside, skin to stretch, scar to heal and the breast implants to settle depending on the type of implant used, size of the implant, technique performed and patient’s body to heal accordingly. Therefore, it is generally six months required to see the final shape and appearance of your breasts when the swelling is completely gone and implants are settled in its position.
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