Breast Augmentation Surgery in 2011

More than a 100 years ago,surgeons first used surgical procedures in order to increase the size and reshape the female breast. The earliest known breast augmentation was attempted as early back as 1895, when surgeons obtained a benign fat tumour from the woman’s own back. Since then, all sorts of synthetic and non-synthetic materials have been used. In the early to mid-1900s these materials included glass balls, paraffin, ivory, foam sponges, rubber, wool and even ox cartilage! Most of these materials met with disastrous results of course and it wasn’t until the early 1960s that Cronin & Gerow, two Texan plastic surgeons, developed the first generation of silicone breast prostheses that a new era in breast augmentation was born.

In the present day, breast augmentation is the most commonly performed cosmetic plastic surgery in the Western world. The reason for this is the new improvements in both implant material and surgical techniques used. Modern plastic surgeons have the ability to choose from well over 1000 different sized, shaped and filled implants, pairing them with a custom procedure matched to the patient’s ideals. The operation has evolved into one that is scientifically a lot more precise and well-planned, so that the results are longer lasting and much more predictable. The recovery period has also decreased – minimum drains and dressings are required and woman are able to return back to work within a week of the breast augmentation being performed. Modern synthetic breast implants differ in their shell, shape, size and filling material. Here follows a short summary of each of these:

Breast Implants – The outer shell

The outer shell of an implant is generally made of silicone and can be smooth or textured. Smooth implants may achieve a smoother look and feel in very thin patients but have traditionally been associated with a higher incidence of capsular contracture and therefore require massaging for a year or so after surgery to prevent this. Capsular contracture, or capsule hardening, can occur years after surgery and can make the implant feel extra firm as well as distort its shape. Surgery is usually needed to correct this and therefore,a lot of research has gone into ways of reducing its incidence. Modern silicone implants have capsular contracture rates of less than 10 per cent. Textured implants have a rough surface and therefore promote tissue growth, generally reducing the rate of capsular contracture and promoting good maintenance of implant positioning. They do not require massaging postoperatively but sometimes subtle visible wrinkling can occur in very thin patients. A new implant shell, made form polyurethane has recently been reintroduced into the market. Polyurethane shelled implants are not a new thing and have actually been around since the 1970s. Made in Brazil, these implants feel somewhat velvety to the touch and are sometimes referred to as ‘Brazilian Furry Implants’. There is growing evidence that these implants have the lowest rate of capsular contracture of any implant i.e. less than one per cent; however they can prove the most difficult to remove should a problem arise.

Breast Implants-The Shape:

Implants can generally be either round or anatomical (teardrop) shaped. When round implants are very large they may produce quite an unnatural look. However, patients with pre-existing well-shaped breasts who desire a relatively simple and modest increase in breast volume achieve excellent results with round implants. Teardrop implants are designed to look as natural as possible and are becoming increasingly popular in breast implant surgery. Their downside is that they are more expensive than round implants and that, over time, they could rotate in their positioning. They are only available with a textured surface and evidence has shown that these implants are more likely to keep their shape better over time and therefore produce longer-lasting results.

Breast Implant Size:

Implants come in various base widths, heights, projections and volumes. Determining the size of the implant is a very personal thing and a surgeon would spend a good deal of time both assessing the patient’s desires and measuring them for the right fit based on their goals and desires.

Breast Implant Fill:

The two most common filling materials are saline and new generation silicone. Silicone has come a long way since the silicone elastomer used in the early 60s that was notorious with high capsular contracture rates and leakage. Modern silicone fill is extremely safe, highly cohesive and is now the preferred choice of the majority of surgeons and patients alike. Saline implants can deflate, generally feel less natural and are more likely to show rippling.

These days, more techniques are available than ever before when it comes to the operation itself. The three main technical variables to consider are incision site, implant placement plane and accessory procedures.

Breast Augmentation Incision site:

Incision sites are normally: underneath the breast, around the
nipple and via the armpit or belly button (if saline implants are used).
The underneath breast (infra mammary) incision however, is the most often used incision
for this type of surgery.

Breast Implant Placement Plane:

The implants can be placed entirely under the breast tissue itself (sub glandular), under the fascia over the pectoralis muscle (subfascial), under the whole pectoralis muscle (sub muscular) or combination of both sub muscular and sub glandular (dual-plane).

Accessory Procedures:

For women who have other issues that cannot be corrected with surgery alone, accessory procedures need to be looked at. Such procedures include a concomitant breast lift, nipple reshaping and breast tissue reshaping techniques. These procedures can be done at the same time as the breast augmentation itself.