Breast augmentation, whilst increasing the size of breasts, can also be used to give a fuller cleavage. People who have different sized breasts can also benefit from augmentation, which can be used to produce more equal breast sizes. Whilst implants can help improve slightly droopy breasts, very droopy ones may also need a breast lift (mastopexy) or a mastopexy on its own.
How is breast augmentation surgery performed?
Implants are placed either under the breast tissue (sub-glandular technique) or under the muscle of the chest wall (sub-pectoral technique). The implants are silicone shells, which are either pre-filled with silicone gel (silicone implants) or made ready for the surgeon to fill with salt water during surgery (saline implants).
Should implants be put under the muscle or not?
There is an argument that putting implants under the muscle can help reduce risks of complications such as infection and capsule contracture (see below). Sub-muscular placement is also used in very slim or small-breasted women as this helps to hide the edge of implants, which could otherwise be visible. Also, saline implants have a tendency to form folds and ripples which can be easily felt; putting implants under muscle helps to hide these ripples.
The sub-muscular technique, though, requires cutting of the muscle which can be quite sore after surgery. It may also result in less noticeable cleavage being produced by the implants. Many surgeons also believe that, as the implant is only partially covered by the muscle, the benefits are only minimal.
Ultimately, the decision of where to place the implant is down to a number of factors and your surgeon will be able to discuss with you which method may give you the best augmentation result.
Are saline or silicone implants best for breast augmentation?
There is no clear answer to this, and surgeons will argue their case for either, based on their own experiences. Saline implants have the advantage that they can be put in through cuts at the breast crease, the armpit, around the areola (darker part around the nipple), or even around the belly-button. Silicone implants are generally put in through a cut in the crease under the breast, which may be more easily visible.
Many people have the opinion that saline implants do not feel as natural as silicone implants. Saline implants are also more prone to forming ripples and folds which may be easily felt.
Very rarely, implants can rupture. Saline implant rupture will lead to deflation of the breast. Silicone implant rupture can often go unnoticed with no consequence, especially with the newer implants. Silicone rupture can, however, occasionally cause painful tightening of the breast or gland swelling in the armpits.
There had been fears in the past that silicone implants could possibly give an increased risk of autoimmune diseases, and even cancer. These fears led to silicone implant use being banned in the USA, in place for saline implants. Since then, large studies have shown no increased risks of cancer, autoimmune disease or breast feeding risks from silicone implants, and they are now again being used in the USA. For this reason, most surgeons in the UK have become more used to using silicone implants, whilst surgeons in the USA may still be happier to use saline implants, based on their experience and opinions.
Are implants otherwise the same?
No, there are still more choices! They may have a smooth or rough (textured) surface; some people believe textured implants help to reduce capsule formation (see below).
They may also be round or shaped implants - round implants tend to give a slightly more obvious enlargement with a fuller cleavage. Shaped implants give a more natural looking enlargement, but usually not as full a cleavage. Shaped implants can also occasionally turn around, needing re-operation to reposition them.
And, of course, they come in different sizes.
Your surgeon should discuss with you what sort of size and shape you want to be. Be aware, though, that the surgeon can only be guided by size requests - they cannot guarantee a specific cup size, as your cup size can vary according to which bra specialist measures you!
What risks are involved with breast augmentation surgery?
Infection - if the skin only is infected then this usually settles with antibiotics, although it can lead to worse scarring. If the area around the implant gets infected, then this can result in the implant needing removal, possibly to be left for a few weeks before replacement.
Capsule formation - implants are seen by your body as foreign material, and will naturally form a tough 'scar' shell (capsule) around the implant. This capsule is usually of no significance and cannot be felt, but can occasionally become thickened, tight and painful. This can happen over months or years, and it is still unclear as to why people form these 'capsule contractures'. If they cause problems, the capsules may require surgery to release them, and rarely the implants may even need to be removed.
Implant rupture - modern implants are designed to be ever-resilient, and rupture is quite rare. Saline implant rupture will lead to deflation, silicone implant rupture may even go unnoticed with no consequences.
Rippling - more commonly occurring in saline implants, rippling can sometimes be felt at the edge of the implant, and can occasionally even be seen.
Sensory changes - due to the cuts needed to access the breast and the tissue being stretched, the breast skin or nipples can either have reduced sensation or even heightened sensation to the point of being uncomfortable.
Asymmetry - whilst the surgeon will try to make both breasts look the same size and shape, no-one starts off with identical breasts. Augmentation can sometimes make such differences more obvious, and nipple positions may also be slightly different.
Other SurgeryWise articles
You may also be interested to read our article on Breast lift (mastopexy) or other Cosmetic surgery articles
Any procedure involving skin incision can also result in unfavourable scarring, wound infection, or bleeding. This list of risks is not exhaustive, and you should discuss possible complications with your specialist. Whilst these risks will seem very worrysome, and indeed can be serious, it should also be borne in mind that many people have no postoperative problems whatsoever.
The information provided is as a guide only and you should discuss matters fully with your specialist before deciding if this is the right procedure for you. Please also read our disclaimer