Can I undergo breast augmentation?

Breast augmentation is a surgical procedure to enhance the size of breasts. This can be carried out for following reasons:
1. Personal reason
2. Loss of breast volume following pregnancy or weight loss
3. To correct the difference in breast size. Or
4. To reconstruct breast following breast surgery.

What are the methods by which breast size can be increased?

Currently the oldest and most popular procedure for enhancing the breast size is breast implants. Recently introduced procedure for breast enhancement is Fat transfer. Fat is harvested from different areas (for instance thigh or stomach) of the body, is filtered and processed and then injected into the breast. Generally fat transfer increase the breast size by ½ or 1 cup size only. Additional sessions of fat transfer can be done to further increase the size of breast.
Currently there are no bust creams or medicine to enhance breast size.

What is a breast implant made of?

Breast implant is a synthetic device the shell (outer covering) of which is made of silicone. The filling inside this shell can either be saline (salt water) or silicone gel and they are called saline or silicone implant. It is important to note that the shell of both saline and silicone implant is made of silicone.

Which implant to choose - saline or silicone?

There are no studies which show that the saline implant is better or safer than silicone implant or vice versa. Both types of implant are US FDA approved or CE (europe ) certified. Silicone implants look and feel more natural. Also there is issue of rippling and palpability with saline implant. Majority of patients undergo silicone breast implant.

Which are the companies manufacturing breast implants?

Currently in India following brand implants are available. They are 1. Eurosilicone 2. Nagore 3. Motiva. All these implants are CE (european) certified. Please click on the link for more details. However availability of the above implants may vary. Some of these brands offer warranty for certain duration. The warranty covers the cost of implant only.

What are the different shapes of implant available?

Two main types of implant shapes are available: round and teardrop (anatomical) implants. In addition recently Motiva has come out with Ergonomix implants which assume round shape when patient is lying down and tear drop shape when patient is standing up. In majority of patients the shape of breast is not influenced by the shape of implant. So in these patients whether one uses round or teardrop implants there will be no difference in the final outcome. Tear drop implants suffer from some disadvantages like rotation and unnatural appearance when lying down. Having said that there are specific set of indications where teardrop implants will be useful. The final decision of the shape of implant is taken after detailed consultation with the doctor.

What size of the implant will be used?

The size of the implant will depend on your desire, your doctor’s judgement, and the breast tissue characteristics. Commonly the implants vary in size between 200 to 350 cc.

What sort of anesthesia will be given?

For breast augmentation you will be required to be put to sleep (general anaesthesia).

What incision will be used?

Incision under the breast in the fold is the most commonly used. For saline implant incision around the nipple or in the arm is sometime used.

Where is the implant placed- behind or in front of the muscle?

Commonly the implant is placed in front of the muscle. However in very thin individuals the implant will be placed behind the muscle. In very thin individuals the muscle provides extra layer of padding which helps to hide the edge of implant.

What to expect after surgery?

1. There will be padded dressing under the breast in the fold where the incision was taken.
2. Stretching sensation and heaviness will be felt as the breast size has suddenly increased. This will get better with each passing day
3. Pain: the soreness is similar to something you feel after heavy exercise. Pain control gets better with each passing day
Turning in bed may be sore for the first few days. Any pressure on the treated area may also be sore for sometime.
4. Medication: Antibiotics and painkillers are given for a week following the surgery.
5. Sensation: The nipple may feel numb or sometimes hypersensitive. This happens because tiny nerves going to the nipple are stretched during the surgery and they take time to regenerate. This regeneration of the nerves may give tingling sensation for few weeks. Complete recovery of sensation can take from 3 to 6 months.
6. Swelling: Swelling is a normal consequence of any surgical procedure. Swelling of breast (which won’t be noticeable in normal clothing) can take approximately 4 weeks to go away.
7. Bruising: may be seen around the incision site. It can take 2 to 4 weeks to go away.
8. Clothing: its best not to wear bra for the first month or so. This encourages the implant to settle down into normal shape. However for social engagement you can wear sports bra or any loose fitting bra without wires.
9. Hospital Stay: Mostly you will be discharged the same evening. Rarely you need to stay overnight.
10. Stitches: Melting (self dissolving) stitches are used so there is no need to remove them.
12. Dressing: Dressing will be removed within a week.
13. Result: Generally there is increase in 2 cup sizes after breast augmentation with breast implant. Initially for the first month or so the size may appear bigger because of swelling. Implant may appear higher initially. In approximately 3 months as the implant settle down the breast appears more natural.

Dos and Donts:

1. Activity: One can increase the level of activity with each passing day and as per your comfort level. It is normal to feel tired after any long surgery under general anaesthesia and this can take few weeks to go away. heavy exercise, gym, swimming can be started 4 to 6 weeks with gradual stepping up.
2. Diet: As it takes a month to get back to your normal exercise routine one should reduce calorie intake by about 10 to 15% till then. This is to balance the intake and output. For one month salt intake should be less as salt increases swelling.
3. Shower: One can wet the area of incision after 4 to 5 days.
4. Steam and sauna: Should be avoided for 6 months. This is because the sensation in treated areas can take upto 6 months to recover .
5. Smoking: Smoking 4 weeks before and after surgery can increase the risk of complications.
6. Long haul flight: Following precautions need to be taken when travelling in long haul flight: Drink plenty of water. Every 2 hours or so walk in the aisle for 5 minutes. Even while sitting keep your heel on the floor and point your toes as high up as possible. Then keep the toes on the floor and raise your heel as high as possible. Repeat 10 times every ½ hour. If possible wear the stockings which were given to you during your hospital stay. All this is done to prevent clot formation in the leg veins.

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Dr. Sandip Jain