Breast Augmentation

My Dearest Patient,

A breast augmentation is a procedure by which your breast size and shape is enhanced. Media exposure has lead us to desire breasts just a little bit …and sometimes a lot more, perfect than what we have. In today’s time you may have almost whatever your heart desire. It is possible to have those drop-dead gorgeous breasts in time for that special event!

There are many ways to increase the size of your breasts. A small increase may be achieved via fat fills obtained from liposuction. Fat fills allow for a small increase of about a cup size. Should you want a bigger augmentation with fat fills you would need multiple procedures. Fat fills are very unpredictable. Roughly about forty present of the transplanted fat will be reabsorbed, the same volume may not be reabsorbed in each breast leading to an unequal size. The transplanted fat may also form hard lumps called fat necrosis which improves over time but may never completely disappear. Transplanted fat and the survival there of, is a dynamic process therefore the breast size will change dramatically with a gain or loss of overall body fat.

The most reliable and predictable way of increasing the breast size is by means of silicone breast implants (please read the section on silicone implants). A silicone implant will increase the size and improve the shape. An implant will allow for a dramatic change in your breast size and appearance.

There are many indications for having a breast augmentation and varies from patient to patient. Patients may be flat chested having a masculine appearance and desire a more feminine appearance which may be achieved by implants. After pregnancy and breastfeeding you often see the hollowed out appearance of the upper pole of the breast called parenchymal maldistribution which is easily corrected via breast implants. Unequal breast, small breasts and sagging or drooping breasts are other findings easily corrected via silicone implants.

You may ask why I use silicone implants. South African plastic surgeons are fortunate enough to have one of the longest experiences and exposure to silicone implants. In 1992 the American FDA banned the use of silicone prosthesis but not so in South Africa. After many years of testing the ban was lifted to the rest of the world and silicone implants were proven to be safe. I do not use saline implants as saline implants have a chance of spontaneous deflations as we have heard in the media.

It is important to be realistic about your expectations as well procedure. The aim is not to have an operation in your twenties, thirties, forties and fifties. Every time you have a procedure on your breasts the tissues becomes thinner and thinner and you may have more and more complications. A realistic aim would be to have one procedure below the age of 35 and one procedure after the age of 35. You may need a few touch ups as needed but still these need to be realistic. It is important not to place too large a set of implants. Large implants in association with gravity will stretch the skin a breast tissue leading to premature sagging of your breasts.

Once you have had one set of implants you will certainly need another. Sooner or later they will need replacement and then best to replace them all at once, or both front ones as least. The truth of the matter is that it is impossible to predicts when the replacement will be needed. In some people it may be within two years, in some people between two and fifteen years and some people never ever. The US FDA, United States Food and Drug Administration currently recommends every 10 years.  I would recommend once yearly clinical and ultrasound examinations to assess the integrity of the implants and replace if needed.

It is also important to note that the medical insurance will not pay for the primary or secondary procedures. Thus financial planning for subsequent procedures are very important.

You will always feel the implant. If you do not want to feel the implant do not have the operation. You do however become use to the implant over time as it becomes integrated in your body.

You will be able to breastfeed.

You will lose some sensation in your breast and nipples depending on your incision choice, implant position and implant size.

You will lose some power in your pectoralis muscle if the muscle is elevated and divided in any way. This does however return to normal but can take up to two years. If the implant is placed partially under the muscle your breast will always move with you contract your pec muscles. In order to avoid this you will have to place the implant sub-glandular or below the breast tissue.

Implants placed directly under the breast tissue are more obvious, have a more rounded appearance, do not move but have a higher incidence of capsular contracture i.e. becoming hard over time. It is important to carefully weigh the advantages and disadvantages.

Those are the bad thigs. The good news is that almost all patients are happy even if it just due to the increase in size. In fact the most common complaint I hear is” I should have gone bigger”

Let’s look at the most important decisions regarding your implant:


During your consultation we shall evaluate your preferred size by fitting different types of prosthesis. It may also be of value to perform the “rice test”. Fill a small plastic bag with rice, measured using a measuring jug. I would recommend starting with 300 ml. From here you will be able to determine the size increase you and your partner are most comfortable with. Put these zip lock bags in your sports bra, also ideal to camouflage your eventual operation. The value will guide me in selecting an implant. Please remember that the bigger the implant the worst the implant would look over time due to the stretching and thinning of the skin. Also the bigger the implants the bigger the chance of complications and bigger the scars need to be to allow access to the breast. In my experience there is a size that will fit your breast base and envelope perfectly. In my theatre I have all different sizes and shapes of implants. I will select the size that suits your breast the best but I do need an indication of what exactly it is that you are looking for.

Incisions / Cuts,

Your breasts largely determine which incisions would be most appropriate for you. That would be either a skin fold incision or a cut around your nipple areolar complex.

We will determine which of these incisions are most appropriate for your breasts. Both of these incisions have advantages and disadvantages and there is in fact no right or wrong incision.

Infra-mammary fold incisions


  • 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


  • 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.

In Conclusion 

Thank you for reading this pamphlet. I am sure you will be happy with your breast augmentation as most ladies are. The vast majority of patients are happy with their augmentation and wishes they had gone.



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