BREAST ENLARGEMENT

Other names for breast augmentation are breast implants, breast implantation or breast enlargement.

 

Dr. Chartchai's patients in Bangkok ask for breast augmentation when they want to increase their breasts by one or more cup sizes. Some may also wish to restore the loss of fullness after pregnancy, to balance a difference in breast sizes or shapes, or as a reconstructive technique after breast cancer surgery.

Breasts are made of glandular tissue (which produces milk after pregnancy), ducts that connect the glandular tissue to the nipple, fat, and connective tissue. Breasts sit above the pectoralis muscles and the muscular fascia (the strong thin covering of the pectoralis muscles). Aging makes the connective tissue looser and stretched. Over time, gravity takes its toll, pulling the tissue down and making breasts sag.

 

What do you want to change?
If you are very sensitive about your breast size, breast shape, or the difference in size between your breasts, surgery may be the option for you.

Most women who want breast augmentation just want to be larger and look better in and out of clothing. For some, increasing breast size may mean that clothes are easier to buy because their upper body size and lower body size will be standardized.

Some women face other issues, including anatomical issues that can be only partially corrected or modified by augmentation surgery. Examples include breasts that are different in size, breasts that are tubular shaped (not conical), and breasts with unusual placement of nipples.

For patients with asymmetrical breasts where the difference between breasts is not great placing a larger implant on the smaller side may completely eliminate the difference. If the asymmetry is significant, the smaller breast may not have enough skin, so augmentation alone is not the appropriate procedure.

If the patient has tubular breasts (breasts that are narrower and perhaps somewhat longer or more pointed than normal), breast augmentation surgery may help to a limited degree. Tubular breasts are difficult to make identical but a skilled, experienced surgeon can come very close.

Saggy breasts can occur because of congenital reasons, childbirth, breast feeding, or aging. Breast augmentation can fill the extra skin, increase fullness in the upper part of the breast and generally make breasts larger. However, augmentation will not lift the nipple height or fill the extra skin above drooping breasts. If the amount of sagginess is too great, a breast lift may also be needed.

 

About breast implants

Speaking of breast implants or prostheses, let’s visualize a synthetic bag made of silicone as its envelope or shell, which contains a type of fluid material inside. When appropriately implemented, these bags enhance visual appeal of ladies’ breasts and thus boost their self-confidence.
There are two core subjects to understand about these synthetic bags:

1. Content inside the bags. At present, the element is either silicone gel or saline water.

2. Type of surface of the silicone envelope or shell. It can be either smooth or textured, with varying degrees of roughness.

For decades, the science of breast implant has been continually researched on and modernized since its first introduction for human breast enlargement in 1962. That very pair of implants contained silicone fluid, which was ideal thanks to its pleasantly soft feel and more natural-to-touch character. 

Ever since the implants were first introduced, there have been a variety of liquid materials used for filling inside. These different components yield mixed outcomes. However, for the current global medical practice, the professionally accepted substances used in manufactured implants are either silicone gel or saline water. Each has its own pros and cons.
As a result of medical literature reports regarding adverse events, the USFDA amended the ranking of breast implant to class III in the Medical Device Amendment ratification. According to the 1982 USFDA statement, breast implants were deemed to present “…a potential unreasonable risk of illness or injury…”

Between 1992-2009, the USFDA called for a voluntary withdrawal of silicone gel-filled implants from the US market. Germany, France, Spain, Austria and Italy followed suit. Nevertheless, the use of silicone gel-filled implants was still eligible in other parts of the world.
However, in 2010, the USFDA lifted the ban on silicone gel-filled implants after over a decade-long studies failed to provide dependable evidence that the gel-filled implants cause any connective tissue disease, reproductive problems, or breast cancer as previously disputed.

The type of surface of the implants does matter, both in the case of silicone gel-filled and saline water-filled variety. We will now look more into this.

Among possible undesirable complications after breast augmentation with implants, capsular contracture is the most common type. But what is it exactly? Our bodies will naturally build up fibrous capsules to surround the implants. Overly contracted fibrous capsule can result in untoward firmness of the implanted breasts.
In 1968, coating the silicone shell with polyurethane was the attempt to counteract capsular contracture. Despite the comparatively significant effectiveness of reducing rate of capsular contracture during its early years of usage, polyurethane-coated implants were removed from the US market in 1991. This was due to the possibility of coating degradation in the long run, which is a safety concern.
In an effort to emulate the polyurethane implants’ success in reducing chance of capsular contracture, different surface coating or texturing techniques were developed by leading implants manufacturers.
In 1997, the first case of BIA ALCL was published in the medical literature. BIA ALCL (Breast Implant Associated Anaplastic Large Cell Lymphoma) is a rare type of cancer of the immune system. But it was in 2011 that the USFDA first report a possible link between breast implants and ALCL. And it was not until 2016 that an association between textured implants and ALCL was recognized (even the first textured implants was introduced in the 1980s).

In 2019, the Allergan produced BIOCELL textured breast implants (with the model name of Natrelle®) were recalled after strong specific relationship of these particular implants to BIA ALCL cases and the followed death cases.
Textured implants which reduce the chance of capsular contracture are still available from other manufacturers with different technology of production.

Conclusion:  Based on the currently available evidence, the USFDA accepts that silicone gel filled breast implants contain a reasonable assurance of safety and effectiveness when applied as labeled and strictly by professionally trained plastic surgeons.
Despite possible local complications and adverse outcomes, professionals agree that it is generally safe for patients to receive a breast augmentation operation. It is highly recommended that patients should always be fully informed about the accompanying benefits and/ or risks. Implant manufacturers and physicians should continue to provide accurate and up-to-date information for patients to help inform their decisions.

 

 

 

Procedure
Breast augmentation surgery provides for the insertion of saline or silicone implants into the breast. Most implants are positioned behind the pectoral muscles. This results in more accurate mammograms and may reduce infection and capsular contracture (hardening of the tissue around the implants), so the implants will stay softer. Other choices are available for positioning, and will be discussed at the consultation.

Silicone implants are usually inserted through an incision made in the crease of the lower part of the breast, in the axilla (the armpit), or in the lower edge of the areola (the pigmented skin around the nipple).

 

Recovery time
For the first 48 hours the patient will be given pain medication and wrapped in a light dressing. For 2 weeks the breasts will be sore and bruised, and swollen for several months. Compression bandages may be worn for several days. Immediately after surgery, the implants sometimes sit too high on the chest wall, but they usually drop into a normal position over the next day or weeks.

The patient can return to work in 2 weeks. The patient should wait 2-3 months before resuming strenuous exercise.

 

Possible complications
Dr. Chartchai's surgical techniques are intended to minimize the likelihood of any complication. These complications or side effects include but are not limited to asymmetry (uneven breasts or nipples), hematomas (a collection of blood around the implant), poor scarring, changes in nipple sensation (it may decrease, disappear altogether, or even intensify), capsular contracture (a tightening of the scar tissue that naturally forms around the implant), and deflation of saline implants. If the milk ducts are cut, breast feeding may not be possible.

Please discuss these complications and your other concerns with Dr. Chartchai at the time of your in-person consultation.