Breast Surgery

Breast Augmentation (Mammaplasty)

What is Breast Augmentation ?

Perky and full looking breasts seem to make a woman feel more complete. Thanks to advances in science, this can be a reality for any woman. More importantly, breast implants have been proven to be safe and does not affect functions of the breast. Nor do they cause or increase the chance of tumors or breast cancer. Even breast feeding can be done normally later.

The US FDA has approved cohesive gel silicon implants for breast augmentation. Implants are available in various sizes and the right choice of implant depends on the amount of existing breast tissue, the chest size and personal choice.

before breast augmentation
after breast augmentation

The scars of surgery are well hidden and the breasts look and feel natural.

A state of the art operation theatre using sterile techniques, complete range of sophisticated instruments and above all meticulous care during surgery are key to avoiding complications.

The surgery is done as a day care procedure. Upper body exercises and fondling of breasts are to be avoided for a month. Desk jobs and light physical activity can be resumed in a few days. The operation is carried out in our cosmetic surgical center in Mumbai, India under general anesthesia on an outpatient basis. An implant (prosthesis) is placed through an incision, under the breast tissue or under the muscle. The incision can be made under the breast, around the nipple or in the armpit. It generally takes two to three hours to complete the entire procedure. An implant surgery is composed of an outer shell filled with saline (salt water). The outer surface may be smooth or textured, and implants come in various shapes to meet the individual woman’s needs.

Types of Breast Implants

Implants can be broadly classified as SALINE and SILICON breast implants depending on its contents.

Saline implants have saline solution (salt water) inside the pliable silicon shell. Saline implants were extensively used prior to USFDA approval for cohesive gel implants. Saline breast implants are very safe, but have shown long term problems of rippling, sloshing and deflation

Silicone breast implants are available in the round or circular (most commonly used) as well as the anatomic or ‘teardrop’ shape. These are also available as low, moderate and high profile. We use only MENTOR or MCGHAN brand of implants (both are US FDA approved).

Pre Surgical Evaluation for Breast Augmentation

The size or volume of the implant to be used will depend on 5 key factors-
      - Your expectation/desire
      - Chest size
      - Amount of existing breast tissue
      - Skin envelope of the breast
      - Any drooping of the breast

Blood tests, a baseline mammogram or ultrasonography of the breasts and other tests for anesthesia also form part of the pre surgical evaluation.

Access / Incision for Breast Augmentation

Two most commonly used approaches to breast augmentation are the infra mammary crease approach and the circum areaolar approach.

In the infra mammary approach, a fine 5 cm incision is made beneath the breast in such a way that the final scar falls in the crease below the breast. As the final scar falls in a natural crease, it fades well over a period of time. The infra mammary crease is the most hidden portion of the breast and most women prefer to have the access from this area.

In the circum areaolar approach, the incision is made in the lower half circle of the areola. The advantage in this approach is that the final scar blends in well in the natural color interface of the areola and breast skin.

Trans axillary approach employs an incision in the crease in the under arm area. TUBA or Trans umbilical breast augmentation uses access from the navel using endoscopy instrumentation. Both these approaches are possible with saline implants, the use of which is decreasing since USFDA approval for cohesive gel implants.

Possible complications

Common surgical risks as with any other surgery are bleeding and infection which can delay healing of the incision and may cause wide scars. Healing is a concern with people who smoke (cessation for a few weeks prior to surgery is a must) and in diabetics. Because the breast tissue is braced and lifted there is bound to be scars which might feel lumpy but will soften with time. The scar will be visible for a few months and will either be pink or dark. This will fade with time but will not be totally invisible. Rarely people may have an increase or decrease in sensation of the nipple for a few months. This improves with time as swelling of the breast reduces

Breast Augmentation Procedure

The surgery is performed under general anesthesia. The breast implant surgery takes about 2 hours to complete. The space / pocket for the implant is made in any of the following locations
      - Below the gland (sub glandular)
      - Below the muscle (sub muscular), or
      - Dual plane (where the upper half of the implant is below the muscle and lower half below the gland).

The decision to create a particular pocket in each case is made considering the type of implant and tissue characteristics of the breast..

The pocket is created with meticulous technique using fibreoptic special illuminating devices and magnification. The adequacy of the pocket is checked during the surgery using disposable sizers.

Small tubes to drain off the collecting fluid may be placed, which are removed in 24-48 hours.

Post Breast Implants Surgery

The post operative period following breast implant surgery is generally pleasant and well tolerated. Minor discomfort, feeling of stretch, swelling and bruising can be expected. Most patients are able to start normal daily activities starting the next day and return to office work in 2-3 days time. Decreased sensation over the breast can occur and usually recovers in a couple of weeks.

24 Hour Service

For most of our patients, getting back to work early is a priority. Thanks to an innovative post operative regimen designed by Dr. Thomas, return to work the very next day is possible now. A special set of exercises instituted on the first post operative day helps to reduce the discomfort and tight feeling after surgery. Fifth generation silicon gel implants are preferred for augmentation as their feel is closest to being natural.

Complications are rare following breast augmentation. Early complications include collection of serous fluid or blood, sensory changes, infection, implants mal position.

Infection can occur in the early post operative period. The infection rate in breast implant surgery is less than 1%. Antibiotic treatment results in resolution of the infection in most cases. In cases where the infection has not resolved, the implant will have to be removed and inserted few weeks after complete resolution of the infection.

Capsular contracture can occur as a late complication. Our body forms a capsule around the implant. This capsule can thicken and distort the implant in some cases. The exact reasons and causative factors for capsular contracture are not known. Capsular contracture rates at our centre have been much lower than international standards, thanks to our protocol of preventive measures. Breast exercises instituted 2 weeks after the surgery and continued for a year afterwards go a long way in preventing capsular contracture.

So if you are looking for Breast Surgery like Augmentation or Enhancement in India then your best option is CSI. You may visit our clinics in Mumbai and Goa for consultation of breast augmentation surgery by our expert cosmetic surgeons.

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