"Doctor, I don't want huge breasts like a stripper. I just want them to look a little fuller, a little perkier, just like they were before I had my children".
Despite the common perception of cosmetic surgery as being only for models, celebrities and the super-rich, the vast majority of my clients are in fact ordinary people who simply want to look their best. Breast augmentation (or "boob job" as it's often humorously termed) is sometimes portrayed as being a particularly frivolous form of cosmetic enhancement, and yet a large proportion of women seeking this operation are doing so for very understandable reasons, and have well-grounded and realistic views about what they wish to achieve.
Large breasts have gone in and out of fashion over the centuries, but the works of great artists across all epochs and cultures demonstrate that the "ideal" breast shape has remained essentially unchanged. It is, naturally enough, the shape of youth and fertility. The youthful female breast sits proudly forward from the chest wall, exhibiting a smooth and gentle convexity as it falls from the collarbone to the nipple, and a tighter curvature underneath the nipple before meeting the chest wall at the "inframammary fold". The nipple itself, sitting slightly above the level of this fold, points directly forward when viewed from the side, and slightly outward from the midline when viewed from above. The nipples are centred on the breast mounds, which ideally are symmetrical, almost meeting in the midline, and protruding just slightly further than the lateral chest wall at each side.
In the young female breast prior to pregnancy, most of the breast tissue is fat, with some glandular and fibrous elements. Pregnancy and breastfeeding cause massive growth of the glandular component, which stretches the overlying skin, often resulting in stretch-marks. It is rare for breasts to return to their original shape after pregnancy - usually there is some residual skin redundancy, and the breasts may in fact become smaller than they were. These factors result in a loss of apparent fullness in the upper pole of the breast ( the part above the nipple), some sagging of the nipple itself, and a general appearance of deflation.
Some post-lactational breasts are so stretched out of shape that they need lifting (which involves removing some of the "spare" skin, inevitably resulting in scars); but many can respond very satisfactorily to simple augmentation with prosthetic breast implants. The past fifteen years has seen a dramatic improvement in the technology of breast implant manufacture. "Silicone" (a complex polymer of silicon, oxygen, and organic side chains) got a bad name in the early 90s with a widely-publicised worldwide class action against the then-largest manufacturer of silicone breast implants, Dow Corning. It's worth pointing out that this legal case was settled "out of court" and the medical claims against silicone were never legally tested. Exhaustive analysis of statistical data since then has determined that most of the claimed side-effects of silicone do not in fact occur. Most pertinently, there appears to be no link whatsoever between silicone implants and cancer, auto-immune disease or chronic fatigue syndrome.
For a few years in the late 90s, silicone breast implants fell completely out of favour, with saline (salt-water) implants taking their place. Since the turn of the century however, newer and better silicone implants have been introduced and gradually approved by the regulatory authorities of various countries (with the American FDA - suprisingly - lagging behind Europe and Australia in this regard). These new implants feature a number of key improvements. Firstly, they now contain "cohesive" gel - which feels soft and pliable, but retains its shape if cut, rather like Turkish Delight. This lessens the chance of silicone oozing into surrounding tissues if the implant ruptures. Secondly, implant shells are now usually constructed in three layers of hard silicone-polyurethane-hard silicone, which greatly increases their toughness and resistance to rupture, as well as preventing "seepage" of silicone gel contents to the outside. Finally, the outer surfaces can be "textured" to reduce tissue reactions which can lead to scarring and contractures - a significant problem in the past.
Another major improvement in breast augmentation is the introduction of less-invasive surgical technique, which allows the operation to be done as a "day" case under twilight anaesthesia. Patients are often very surprised to find how little pain and disruption they experience with this procedure (although of course, your mileage may vary). At Bioscor, breast augmentation is done exclusively in this way. We use USA-made Inamed implants - I generally recommend silicone gel implants as they look and feel more "natural" than saline. From the surgeon's point of view, it is very gratifying to be able to restore a more youthful and aesthetically pleasing shape to post-childbirth breasts. It is undoubtedly one of the best applications for this much-maligned procedure.
Note: Breast augmentation surgery may not be suitable for all patients. Suitability can only be determined by consultation and examination, and in some instances, further tests.
©2007 Dr Tony Prochazka
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