Women may seek breast enlargement due to lack of normal development of breast tissue or to recapture the loss of volume and shape after child birth and / or breast feeding. For some women, their breasts may develop in a 'conical' shape (TUBULAR BREASTS) which may be corrected with the addition of breast implants.
Occasionally, women who have lost some weight may end up with a very droopy breast requiring a breast uplift (Mastopexy). To re-create a ‘youthful’ shape and volume this may be combined with a breast implant (MASTOPEXY WITH AUGMENTATION). This is a demanding procedure and often done in 2 stages. J S has developed a technique to do this procedure reliably in a 'single' stage - thereby saving time and effort for such patients. This technique, A.S.A.M Technique (Adjustable Single stage Augmentation and Mastopexy), has been presented in various professional meetings
Breast implants come in different shapes and sizes. Broadly they can be either a ‘tear drop’ / anatomical shape or a ‘round’ shape implants. Almost all the implants have a silicone shell. The content of the implant is either silicone gel or salt water (normal saline). The saline based implants are mainly used in Reconstructive areas while silicone gel-filled implants are used in the Aesthetic / cosmetic sector.
The detailed initial consultation and the appropriate measurements of the patient’s breast helps JS to choose the right size and shape of implants to fit their individual needs.
If the patient has some breast tissue to ‘hide’ the edges of the implant, it is best to place the implant beneath the breast tissue itself. When the women presents with little or no breast tissue, it is best to place the implant below the chest muscle (pectoralis major).
Implants are inserted through a short scar placed at the curve of the breast (infra mammary). Although the incisions can technically be hidden in the armpit (axillary) or around the edge of the nipple/areola (peri areolar), this may not be possible for all women. From his experience, J S feels that the small advantage offered to keep the scar 'hidden' are outweighed by the disadvantages. Therefore, J S uses the 'infra mammary' scar (kept at the under surface of the breast) as his preferred option.
The operation may take around 90 minutes. By taking meticulous care during the procedure, J S avoids the need for any drain. Rarely, in complicated Secondary procedures, a drain may be required - but only for 24 to 48 hours. Antibiotics are used during and after the operation in order to reduce the chance of infection. The dressings are supported by a sports bra and the patient is advised to keep this bra for at least 4 weeks. Around 2 months after the operation, when the scar is maturing, a proper fitted or an under wired bra can be worn.
During the first dew days after the procedure, it is best to reduce any strenuous excercises or work commitments. Driving is not advised – both for patient comfort and for the insurance purposes.
All the women who have a breast implant would form a ‘shell’ like scar tissue around the implant. Professionally, this is called a ‘Capsule’. In the majority of the women this capsule may remain soft. In a small percentage of women (less than 10%) this capsule may become harder (Capsular contracture) during the months and years after the operation. This hardening may be uncomfortable/ painful for the patient or it may even distort the shape of the breast. In such extreme cases, it is advisable to remove the implant and the capsule. Further augmentation may have to be delayed for a few months.
If there are any signs of infection (like redness / pain / tenderness in the breasts) it is advised to start some antibiotics immediately. In most cases, this may be enough to control the infection. If the infection continues and the patient is becoming unwell, she may need to be admitted and the implant may need to be removed to maintain the health of the patient.
Women who have had breast implants may have the mammogram and would be able to carry out normal self examination for breast cancer. Some patients may experience disturbance to the nipple sensation (numbness or hyper sensitivity).
Rotation of the implant may happen when 'tear drop' / 'anatomical' shaped implants are used. By careful implant selection and appropriate pocket development during operation, this risk is minimised.
Although the current breast implants are much safer and sturdier, most manufacturers recommend the implants to be changed around 10-12 years. If there are no problems of capsule contracture or major change in the shape, the implants may be retained for longer periods.