Breast Surgery

BREAST AUGMENTATION MAMMAPLASTY (IMPLANTS)

Women consider having breast augmentation in order to improve their breast size or shape because they think their breasts are too small, uneven in size or unattractive.  Some women have breasts that do not fully develop or have significant change in size or shape after pregnancy, weight change or ageing.  The decision to have surgery should be an individual one to please you, not someone else.
There are three types of incisions used for inserting breast implants:

1. An inframammary incision is made under the breast at the fold or crease line. This is the most common incision.
2. A periareolar incision is made around the edge of the areolar (the darker skin around the nipple).
3. An axillary incision is made in one of the crease lines of the armpit.

There are two locations for implant placement:

1. The subglandular (or submammary) placement is between the breast tissue and the chest wall muscles.  This is the most common placement since it is easier to do and there is usually less pain after surgery. The disadvantage is that the implant may be more visible in slim women, and mammography examination may be more difficult and less effective.
2. The submuscular placement is between the muscles of the chest wall and the rib cage.  The advantage is that mammography may be more effective and the breast may be more attractive in slim women.  The disadvantages are that there may be more pain after surgery and the breast will move with certain muscle actions.

After the implants are in place, the incision is closed with stitches, a tape and dressing may be applied, and your surgeon will advise on the type of bra to be worn as well as other instructions.  You will be told to avoid lifting, bouncing etc. for a time period and when you will be able to return to normal activities. Some Doctors may advise massage exercises, but this may vary for the individual and the type of implant used. There are a variety of implants available to patients and this is generally decided after consultation with your Doctor. Silicone implants are predominantly the breast implant of choice due to their natural post-operative appearance and proven safety record.

BREAST REDUCTION (REDUCTION MAMMAPLASTY)

Very often women with unusually large sagging or uneven breasts are dissatisfied with their physical appearance.  Some experience pain or discomfort from the sheer weight of their breasts and the pressure of bra straps on their shoulders. Premenstrual congestion often adds to the discomfort. Large breasts can hamper a woman’s physical activities and make it difficult to find properly fitting clothes, particularly bras. Today, because of advances in surgical techniques thousands of women with these problems are being helped through a surgical procedure called reduction mammaplasty or breast reduction. This surgery is designed to improve the body contour, reduce pain, and make the individual more comfortable when engaging in physical activities. A breast reduction is usually performed in the hospital under general anaesthesia with the patient asleep. The physician may choose from a variety of surgical procedures depending upon what changes are desired. A comprehensive consultation is completed with the patient to ensure she is aware of the possible post-operative scarring. Prior to surgery the anaesthetist may prescribe premedication to the patient’s following a pre-operative visit from the surgeon to finalise the patients consultation. The breasts will then be carefully marked by the surgeon to indicate where incisions are to be made. Patients will be aware that a hospital stay of 2-4 days will be necessary depending on the extent of surgery or through patient choice. Pain connected with the procedure is minimal to moderate and is controlled with possible intravenous medication while in hospital for 24 hours and then oral when necessary. Antibiotics may be prescribed to prevent infection. The physician determines when normal activities can be resumed, however, strenuous exercise and overhead lifting must be avoided for several weeks. Sutures are removed in approximately seven to ten days.  Numbness around the treated area may occur and this condition is usually temporary. Swelling and discoloration disappear in a few days and scars from incisions, although permanent, fade significantly with time. There are number of preparations that can be applied to reduce the possibility of scarring post-operatively. Some insurance companies will pay a portion of the costs of this surgery if it is performed as a result of back or neurological problems related to large breasts.  Each insurance carrier is different and it is recommended that individuals check with their own agents to determine if there is coverage.

MASTOPEXY (BREAST RESHAPING OR LIFTING)

Some women find that their breasts sag with age, particularly after pregnancy and breast-feeding. This condition can be corrected either by breast reshaping and repositioning (called Mastopexy). Breast reshaping is designed to uplift and reshape sagging breasts. Sometimes this procedure is done in combination with augmentation mammaplasty. It is carried out in hospital under general anaesthetic. Sensation in the nipples is generally preserved but may be temporarily reduced for up to 3 months. Breast-feeding after a future pregnancy is possible, but may depend on the individual. Pain following the operation is usually minimal but analgesics will be prescribed if necessary. Recently developed techniques now produce a much more trouble-free post-operative recovery, with a high standard of cosmetic result. The scars run around the edge of the areola (nipple margin) and vertically down from the nipple to the infra-mammary crease (Lejour Mastopexy). This will also depend on the amount of skin to be removed.

REMOVAL & REPLACEMENT OF BREAST IMPLANTS

Women consider having removal and replacement of breast implants for many reasons including capsular contraction, reduction or increase in breast size, rupture of implant, weight gain or loss. The decision to have surgery should be an individual one to please you not someone else.

The operation will be done in a hospital or in operating rooms at the surgery. It is advisable to discuss with your Doctor and anaesthetist the type of anaesthesia, whether general (fully asleep), local (awake with numbing of the area) or a combination of local with mild sedation (partially awake). The risks of each type should be fully explained and understood.

There are 3 types of incisions used for inserting breast implants, usually using the previous scar but can also be made as follows:

• An inframammary incision is made under the breast at the fold or crease line. This is the most common incision.
• A periareolar incision is made around the edge of the areolar (the darker skin around the nipple).
• An axillary incision is made in one of the crease lines of the armpit.

The implants may be placed in the old pocket with or without pocket adjustment, or a new pocket is made. After the implants are in place, the incision is closed with stiches, a tape and dressing may be applied, and your surgeon will advise on the type of bra to be worn as well as other instructions. You will be told to avoid lifting, bouncing etc. for a time period and when you will be able to return to normal activities. Some doctors may advise massage exercises. You should follow your doctor’s instructions. You will be advised to watch for any signs of infection, bleeding or bruising. Any symptoms or concerns should be reported immediately to your doctor.

Before & After – 6 weeks post op