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Breast Augmentation

Causes of small breasts

The size of breasts is genetically determined. Once developed, the breasts may fluctuate in size in response to changes in weight, pregnancy and breast feeding.

The ageing process causes the shape of the breast to change so that they gradually droop (called ptosis). This effect is greater following pregnancy, breast feeding and in particular after a large weight loss. Most women have breasts of slightly different sizes, but occasionally a very marked difference may develop.

The operation

Breasts can be made larger by placing an implant either under the breast tissue or behind the muscle on which the breast lies. Implants are usually inserted through incisions in the inframammary fold. Alternatively, the incisions may be made around the areola or in the armpit.

Breast implants

A breast implant is made of an outer layer of silicone, but may be filled with silicone gel, salt water or soya bean oil. Some implants are round and others are shaped more like a natural breast. Either can give excellent results. The manufacturers' life expectancy of breast implants is 10 or more years, although implants can stay in without problems for a much longer time.

Expectations and complications

Leakage of silicone can occur either as a slow seepage, or following rupture of the implant. This silicone is almost always contained within the fibrous capsule which the body forms around the implant. Silicone leakage has never conclusively been linked to serious health problems. The capsule which the body normally forms around the implant can become thickened and contracted. The newer designs of implants have features to reduce the likelihood of this happening. This occurs to some extent in around 10% of patients and usually starts six or more months after surgery. This can lead to pain, and/or an abnormally hard feel of the implant in the breast. Treatment may be needed and occasionally removal of the implant. Breast augmentation does not usually interfere in breast feeding, and there is no evidence that any silicone is found in breast milk. The presence of breast implants does interfere in mammography, which is an X-ray screening method for breast cancer. Special X-ray views can be taken to minimize this interference. Soya filled implants do not interfere to such an extent, but this type of implant is not suitable in all patients. Most women have some degree of asymmetry between breasts and breast augmentation may occasionally exaggerate this difference. A breast that has an underlying implant will not necessarily feel like a normal breast, and some women may be acutely aware of the implant as a foreign body within the breast. There is usually a difference in skin and nipple sensation following breast augmentation. The size and shape of the breast following breast augmentation surgery will adjust with time and is to some extent unpredictable. It is also not always possible to create a cleavage with breast augmentation. The weight of the implant may influence the age-related changes that normally take place in breasts. Movement of the fluid which fills the implant may occasionally be seen through the skin, this being more likely in the saline (salt water) filled implants, and less likely in the more viscous silicone implants, which also have a more natural feel. Breast augmentation will always leave scars on the breast or in the armpit, and although the scars will settle over 12 or more months, the appearance of the scars does vary between different individuals. This scarring is placed in such a position as to minimize visibility even when wearing a swimming costume. Complications that occur with breast augmentation include those associated with all forms of surgery, as well as the specific problems of bleeding and infection. Any infection that may occur in the tissue around the implant can usually be treated with antibiotics, but may require surgical removal of the implant.

Safety of silicone

Whatever the filling of the implant, the outer layer is made of silicone. Silicon is a naturally occurring element which becomes silicone when it is combined with carbon hydrogen and oxygen. Silicone is manufactured into many items including cosmetics, foods and medical implants. Many studies have been conducted to establish whether silicone breast implants cause certain diseases. As a result of these studies we can say that at present there is no evidence to suggest that silicone breast implants are associated with an increased incidence of breast cancer. There is also no evidence to suggest that these implants cause autoimmune diseases such as rheumatoid arthritis.

© British Association of Aesthetic Plastic Surgeons

Reproduced with the kind permission of the British Association of Aesthetic Plastic Surgeons (BAAPS).

For more information, visit www.baaps.org.uk

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