Advantages

• Hidden in the fold
• No scarring of the breast mound
• Same scar may be used later for breast lifting surgery
• Specific congenital breast abnormalities may be corrected via this incision
• Evidence of a breast augmentation may not be obvious in time

Disadvantages

• May move superiorly over time as the implant drops
• Peri –Areolar Incision
• Scar may be visible
• Interference with sensation
• Increase risk of capsular contractures

Although it is good to know the various options available, often the decision is made for us by the shape of the breast or the desired result.

An implant can be placed under the muscle, under the breast tissue or partly behind the muscle and partly behind the breast tissue. Once again mostly luckily, the decision is made for us based on your breast features.

If your skin pinch thickness is more than 2 cm we may place the implant below breast tissue alone. In thin ladies the implant is placed in a duel plane position behind breast tissue and muscle at the top and behind breast tissue at the bottom.

I will discuss the placement of the prosthesis with you so as to ensure the most appropriate placement in order to correct any deformities and give you the best possible shape.

I only use silicone implants. South African plastic surgeons have the most experience with silicone prosthesis in the world today. Studies have shown that silicone does not cause or predispose to cancer or any other chronic disease. I use smooth round silicone implants and not the textured type. New evidence suggest that there may be an association without evidence of causation between textured implants and anaplastic large cell lymphoma. In short it’s safer to use the smooth implants.

• You will always feel the implant. If you do not want to feel the implant you should not have a breast augmentation.
• The two breasts will never look and behave exactly the same. I am not sure why that is but the one breast will always be a bit more sensitive, higher, larger or number than the other.
• You may feel that your breasts have not been lifted sufficiently following the procedure. It is important to understand that breast augmentation is not a lifting procedure although the implant does give the impression of a small lift. It is perfectly acceptable and often preferred to do the lifting and the enlarging in two separate procedures. Two separate procedures ensures the safety of your breast skin and nipples and often results in a better cosmetic result.
• There is a very good if not absolute chance that you may need another operation once you have had a breast augmentation. The second operation may be to replace the implant for various reasons or to lift sagging breast. The reality is that most women will require more than one cosmetic procedure on her breast during her lifetime.
• The full cosmetic appearance can only be fully appreciated a year after the procedure

The procedure is done under a general anaesthesia in theatre. I would suggest that you remain in hospital for one night however the procedure may be done as a day case. The procedure takes anything from 60 to 120 minutes depending on addional procedure e.g. a mastopexy or lift. You will have 2 drains which remains for a few days. I will see you once a week until all the wounds are healed, that may take anywhere from 3 to 8 weeks.

A breast augmentation is a painful procedure especially if the muscle is raised in anyway. I would recommend that you take it easy for 2 weeks. You will have to visit a hairdresser to help with styling your hair. No physical exercise is allowed until all the wounds are healed. Sweating is not permitted on the surgical scars. You may drive after 2 weeks and return to full physical activity after 3 months. Your body will guide you as to when the best time is to resume full exercise. Do not do anything that is painful or uncomfortable. The massaging and moving of the implants are no longer necessary.

Should you develop a complication you would have to return to theatre which will require additional theatre and hospital costs.

In my opinion, the two biggest complications associated with a breast augmentation is infection and capsular contracture. Both of these are late complications.

Should you develop an infection you would have to remove the infected prosthesis and replace the prosthesis after one year.

An easy way to understand a capsular contracture is as follows: Your body forms a capsule around a foreign body in order to protect your immune system from the object. With time or in some people due to inherent immune stimulation this capsule may become hard. There are different grades of capsular contractures. Grade one and two are not problematic. Grade three is liked by some patients as it lends firmness to the breasts. Grade four is associated with pain, discomfort, coldness and anatomical distortion. Once you have formed one capsular contracture the risk of a subsequent capsular contracture is about 80%, mostly due to immune system stimulation.

Some other possible complications:

Local Complications

• Haematoma formation (Bleeding)
• Seroma formation
• Delayed wound healing
• Infections
• Sensory changes in the nipples and breasts
• Systemic Complications
• Fluid and electrolyte abnormalities
• Deep vein thrombosis
• Pulmonary Embolism
• Cosmetic Complications
• Malposition and displacement of the implant
• Implant rupture and leakage of the implant
• Asymmetries of the breasts (pre-existing asymmetries may be aggravated)
• Capsular Contracture (hardening of the tissues around the implant)
• Visibility of the implant around the edge

It is important to consider the complications. Although I have been lucky with a low complication rate I cannot predict which patient will develop a complication. I think that it is important that if you open yourself to an operation you also open yourself to the possibility of compilations. It is important to evaluate the complications and consider your course of action should you develop a complication.