The size of breasts is genetically determined. Once developed, the breasts may change in size as a result of 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 in those with big breasts, 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.
Breasts can be made larger by placing an implant either under the breast tissue or behind the muscle on which the breast lies. The choice of position is determined by many factors such as the available breast tissue and the presence of drooping. Implants are usually inserted through incisions in the inframammary fold. Alternatively, the incisions may be made around the areola or in the armpit. In general these alternative incisons are not recommended as they have an increased risk of infection and are often more noticeable.
Different scar positioning
Subglandular | Submuscular
A breast implant is made of an outer layer of silicone, and modern implants have cohesive silicone gel fillers. Some implants are round and others are shaped more like a natural breast (anatomical or tear-drop shaped). Either can give excellent results, and the decision to use one or the other will be made at the clinic visit. The manufacturers life expectancy of breast implants is 10 or more years, and they generally do not need removal unless the breast shape changes. The risk of rupture is proportional to how long you have had them in for, as well as lifestyle and possible injury eg trauma to the chest area. The most recent figures suggest a very low rate of 0.5% at 2 years after surgery, incrreasing to around 10% at 10 years.
Expectations and complications
Leakage of silicone is rare nowadays with the latest generation cohesive gel which is semi-solid, but may follow rupture of the implant following significant trauma eg a traffic accident. This silicone is almost always contained within the fibrous capsule which the body forms around the implant (intracapsular rupture) . Medical grade silicone leakage has never conclusively been linked to serious health problems.
The scar tissue which the body normally forms around the implant can become thickened and contracted – this is called capsular contracture. The newer designs of implants have features to reduce the likelihood of this happening, such as texturing around the implant. This condition occurs to some extent in around 5% of patients and usually starts six or more months after surgery. It can lead to pain, and/or an abnormally hard feel of the implant in the breast. Treatment may be needed and occasionally requires 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 to some degree with mammography, which is an X-ray screening method for breast cancer. Special X-ray views can be taken to minimize this interference. Most women have some degree of asymmetry between breasts and breast and 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 much more likely in the saline (salt water) filled implants, and less likely in the semi-solid silicone implants, which also have a more natural feel.
Breast augmentation will usually 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.
No-scar breast augmentation is possible, with the implants being introduced through the tummy as part of an additional abdominoplasty procedure. There are absolutely no scars as a result anywhere on the chest wall. Patients who have had weight loss or following pregnancy particularly benefit from this intriguing technique.
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.