Bazaar's Cosmetic Procedures Guide: Breast augmentation explained

From Harper's BAZAAR

According to BAAPS, there were 26,043 cosmetic surgery procedures in 2018 with more than 12,000 UK women having some form of cosmetic breast surgery.

Breast procedures are typically split into three categories; augmentations, reductions or mastopexies (more commonly known as a breast uplift), with each tailored to address personal concerns and to suit your body and lifestyle.

Here, Professor Marcos Sforza, expert aesthetic surgeon and scientific director, MyBreast Cosmetic Surgery, tells Bazaar everything you need to know about breast augmentation; from whether you are an ideal candidate, what recovery entails and the potential risks and complications associated with surgery.

How can you tell if you are a suitable candidate?

Breast augmentation is a surgical procedure which aims to increase the size, shape or fullness of the breast.

You are considered a suitable candidate if you want to achieve the following:

· Enlarge naturally small breasts

· Restore breast size and shape after pregnancy, weight loss and breastfeeding

· Restore breast symmetry

· For fat transfer augmentation procedures, patients who are a dress size 10 or above and desire a modest increase in size. (Those smaller than a dress size 10 probably won’t have enough fat to harvest to make a considerable difference)

Breast augmentation techniques

Techniques for breast augmentation vary, depending on the type of result you want.

1. Implants

The most well-known method to enlarge breasts is through a breast implant, which is a medical prosthesis placed inside the breast to augment, reconstruct or create the physical form of the breast.

Breast augmentation with implants takes around half a day and is done under general anaesthesia. You should only require the maximum of an overnight stay in hospital after your procedure.

The standard implants most commonly used are saline or silicone gel implants.

Saline implants are filled with a sterile saline solution, like saltwater. The solution is held within an elastomer silicone shell. These implants can be filled with different amounts of saline solution, which affects the feel, firmness, and shape of the breast.

Silicone gel-filled implants consist of a silicone outer shell filled with a silicone gel. Round, silicone implants come in various gel configurations.

How to choose your implants

The base width of your chest is going to define the parameter of implants you can safely choose from. Your skin may impose a size limit too, particularly if there’s a tight envelope to your breast tissue.

For women lacking projection due to weight loss or deflation since breastfeeding, a higher profile may be required to fill out the missing space.

Implants can be round, or teardrop shaped. Shaped implants have a tapered upper edge and give more projection behind the nipple.

At MyBreast Cosmetic Surgery we use the latest 4K technology to enhance the decision-making process when choosing implants for candidates. It projects a full body scan of a patient’s body onto a mirror screen, showing their reflection post-procedure (for example, with adjusted breast sizes and shapes) in a full live body proportion scale.

It is a big step forward for surgeries like breast augmentation because it enables patients to select implants to fit their anatomy, as well as helping them see how their breasts would appear when lifted, reduced or reconstructed.

2. Fat transfer

Fat transfer is the surgical process by which fat is transferred from one area of the body to another area. The surgical goal is to augment the breasts by injecting fat into the chest area. Excess fat is usually taken from the hips, thighs or abdomen.

The procedure usually takes up to three hours and is best for those wanting a subtle change in breast size.

3. The ‘hybrid’ boob job

Hybrid breast surgery combines implants with the reshaping possibilities offered by fat transfer. It creates more natural-looking breasts without having to position the implant under the muscle.

By incorporating fat transfer, hybrid breast augmentation also allows the use of smaller implants, so the risks of issues like capsular contracture or potential sagging over time, are greatly reduced.

The procedure usually takes around half a day and may require an overnight stay in hospital.

In the pipeline...

We are being introduced to the Ergonomix implants, which will eventually replace the teardrop-shaped kind filled with silicone.

Ergonomix implants have a cohesive but soft gel that adapts to a patient’s movements. You are a strong candidate for this type of surgery if you want more natural volume in your breasts without the extreme shape sometimes created by other implants.

Bioengineered smooth surface implants are also now available through minimally invasive techniques, which are particularly suited to women whose natural breasts may no longer be as robust as they once were.

What happens during a breast augmentation procedure with implants?

If you are choosing implants you will discuss the incision options for your procedure with your surgeon before surgery.

The following options are possible:

· Inframammary incision (done in the crease beneath the breast)

· Periareolar incision (around the nipple)

· Transaxillary incision (in the armpit)

The choice of incision depends on several factors, including how much enlargement is involved and the type of implant being used.

You will need to decide on the placement of your implant too.

A submuscular placement goes under the pectoral muscle. Submuscular positioning is recommended if you are very lean because the muscle better conceals implant characteristics, edges and rippling may be less visible.

Sub glandular placement goes behind the breast tissue, over the pectoral muscle. Advantages include no interference with pectoralis muscle function and no requirement for stretching of muscle for the implant to settle into its final position.

The surgeon will then close the incisions with layered sutures, or stitches, in the breast tissue. Skin adhesives, surgical tape and stitches will seal and keep the skin closed.

What happens during a breast augmentation procedure done by fat transfer?

You and your surgeon will select where you want the fat to be removed from before a local anaesthetic is injected into the area. Your surgeon will create a small incision and, using a sterile technique, carefully insert a cannula connected to a syringe to extract the fat by liposuction.

After removing the fat, the surgeon purifies it by removing debris, red blood cells, stem cells and oil. Only mature fat cells are injected back into the body. Fat is injected in a thin line of droplets so the new fat cells can feed off neighbouring cells until the blood supply develops to support them.

What happens during a hybrid breast augmentation procedure?

During the surgery, the implants are first placed in the breasts. This is usually done above the chest muscle depending on the individual’s anatomy and desired final cup size. The fat is removed from your chosen area via liposuction.

The fat is filtered and washed in a closed system, so there is no risk of infection and injected around the implant with special cannulas.

What are the benefits of a hybrid breast augmentation procedure over implants or fat transfer?

One of the reasons women choose a hybrid breast augmentation is because there are the added benefits of liposuction included, which include a more streamlined figure post-surgery.

It is also better for those requiring at least a two-cup size increase in breast size, as this is not always achievable through fat transfer alone.

How long results will last?

Although breast implants don’t 'expire', they aren’t guaranteed to last a lifetime. The average saline or silicone implants may last anywhere from 10-to-20 years, so those considering a standard augmentation or hybrid augmentation will need to get their implants replaced.

Up to 20 per cent of people have their implants removed or replaced within eight-to-10 years, due to complications or cosmetic concerns.

A fat transfer procedure is permanent, but breast size can be impacted by weight gain or loss and pregnancy post-surgery, so you will need to be prepared to maintain a healthy, stable weight.

Potential risks and complications

Implants

· Responsible surgeons urge patients to consider how their implants of choice will age with them. Remember, the bigger the implants, the more the skin may stretch over time

· Breast implants can also occasionally be susceptible to leaks and ruptures. The signs to look out for vary, depending on your implant type

· Saline-filled implants contain sterile saltwater. If they rupture, the fluid leaks out of the shell and is absorbed into the body

· You will not experience symptoms from the leakage, but the implant will deflate, and your breast will lose volume

· Silicone implant leakage or ruptures come with more side effects. Along with the loss of volume, you may notice a deformity in the size or shape of the breast due to scar tissue forming around the implant

· Silicone leaks can also cause your skin to look red and sore. Your breasts may look swollen, feel numb or develop tingling, burning or pain in the affected area

· If concerned about a breast implant leak or rupture, it’s imperative to speak to your surgeon straight away. They will likely recommend immediate surgical removal, but a new implant can usually be inserted at the same time if wanted

Fat transfer

· During a fat transfer procedure, roughly 70 per cent of the cells successfully become part of the new area. Due to this, surgeons must be careful not to 'over-correct', and insert more fat cells than needed, as this may cause residual lumps

All breast procedures

· The most common side-effects to any breast procedures will be some swelling and bruising of the breasts after the operation

· All breast procedures are performed under anaesthetic and it is possible to have an allergic reaction to it (anaphylaxis). Symptoms include breathing difficulties, increased heart rate, hives and swelling. However, serious reactions to anaesthesia are very rare

· A poor physical response to anaesthesia can sometimes develop into a chest infection. There is a small risk of this happening, but this greatly increases if you smoke

· There will be scars from the surgery. These will fade to become paler over about a year, but it’s unlikely they will ever completely disappear. Occasionally, scars may become wider, thicker, red or painful, and you may need to have surgery to correct them

· Before the surgery, your surgeon should discuss any medicines you’re taking, as some increase your risk of bleeding. It’s important to control high blood pressure too

· A seroma could occur, which is when fluid collects in the breast. This may need to be drained by having a needle through the skin, or by having another operation

· Blood clots can form in the leg, which causes pain and swelling and will need to be treated with blood-thinning medication

Recovery from breast procedures

The recovery for all breast procedures is similar. When you awake from surgery, your incisions will be covered, and your chest may be wrapped. You will need to book at least two-to-three weeks off work, as you can expect one to two weeks of bruising, swelling and discomfort.

Any non-dissolvable stitches are removed after one to two weeks; drains come out within a week. You should ensure you can see your surgical team regularly for the first few weeks after a procedure, as it is likely to need some regular dressings on wounds during this time.

Once all the wounds are healed, it’s likely the surgeon will want to see you at about three-to-six months after your surgery.

For at least three weeks, you cannot lift anything over 10 pounds, and that includes children! You will need a primary caregiver during this time and gym enthusiasts should refrain from push-ups, pull-ups or intense yoga for around two months. You will not be able to drive for at least the first week, and possibly into the second, and then only for short journeys.

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