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Other names for breast enlargement
are breast implants, breast implantation or breast
augmentation.
Dr. Chartchai's patients in Bangkok
ask for breast augmentation when they want to increase
their breasts by one or more cup sizes. Some may
also wish to restore the loss of fullness after
pregnancy, to balance a difference in breast sizes
or shapes, or as a reconstructive technique after
breast cancer surgery.
Breasts are made of glandular
tissue (which produces milk after pregnancy), ducts
that connect the glandular tissue to the nipple,
fat, and connective tissue. Breasts sit above the
pectoralis muscles and the muscular fascia
(the strong thin covering of the pectoralis
muscles). Aging makes the connective tissue looser
and stretched. Over time, gravity takes its toll,
pulling the tissue down and making breasts sag.
What do you want to change?
If you are very sensitive about your breast size,
breast shape, or the difference in size between
your breasts, surgery may be the option for you.
Most women who want breast augmentation
just want to be larger and look better in and out
of clothing. For some, increasing breast size may
mean that clothes are easier to buy because their
upper body size and lower body size match standard
clothing sizes.
Some women face other issues,
including anatomical issues that can be only partially
corrected or modified by augmentation surgery. Examples
include breasts that are different in size, breasts
that are tubular shaped (not conical), and breasts
with unusual placement of nipples.
For patients with asymmetrical
breasts where the difference between breasts is
not great placing a larger implant on the smaller
side may completely eliminate the difference. If
the asymmetry is significant, the smaller breast
may not have enough skin, so augmentation alone
is not the appropriate procedure.
If the patient has tubular breasts
(breasts that are narrower and perhaps somewhat
longer or more pointed than normal), breast augmentation
surgery may help to a limited degree. Tubular breasts
are difficult to make identical but a skilled, experienced
surgeon can come very close.
Saggy breasts can occur because
of congenital reasons, childbirth, breast feeding,
or aging. Breast augmentation can fill the extra
skin, increase fullness in the upper part of the
breast and generally make breasts larger. However,
augmentation will not lift the nipple height or
fill the extra skin above drooping breasts. If the
amount of sagginess is too great, a breast lift
may also be needed.
Procedure
Breast augmentation surgery provides for the insertion
of saline or silicone implants into the breast.
Most implants are positioned behind the pectoral
muscles. This results in more accurate mammograms
and may reduce infection and capsular contracture
(hardening of the tissue around the implants), so
the implants will stay softer. Other choices are
available for positioning, and will be discussed
at the consultation.
Silicone implants are usually
inserted through an incision made in the crease
of the lower part of the breast, in the axilla (the
armpit), or in the lower edge of the areola (the
pigmented skin around the nipple).
Cohesive silicone gel or saline
Concerns about the safety of silicone gel implants
became a major issue in the early 1990s in the United
States. Since then, the medical community has new
information and cohesive silicone gel implants are
the most popular choice among women.
Today's cohesive silicone gel
implants have stronger and less permeable shells.
They feel very natural when inserted in the chest.
Instances of capsule formation and breast deformity
have decreased significantly.
Saline implants are somewhat less
soft and feel less natural than silicone gel implants.
They feel like a plastic sandwich bag filled with
water. After insertion, a saline implant can usually
be felt at the bottom or along the lower sides of
a woman's breast as an edge or as slight wrinkles.
Recovery time
For the first 48 hours the patient will be given
pain medication and wrapped in a light dressing.
For 2 weeks the breasts will be sore and bruised,
and swollen for several months. Compression bandages
may be worn for several days. Immediately after
surgery, the implants sometimes sit too high on
the chest wall, but they usually drop into a normal
position over the next day or weeks.
The patient can return to work
in 2 weeks. The patient should wait 2-3 months before
resuming strenuous exercise.
Possible complications
Dr. Chartchai's surgical techniques are intended
to minimize the likelihood of any complication.
These complications or side effects include but
are not limited to asymmetry (uneven breasts or
nipples), hematomas (a collection of blood around
the implant), poor scarring, changes in nipple sensation
(it may decrease, disappear altogether, or even
intensify), capsular contracture (a tightening of
the scar tissue that naturally forms around the
implant), and deflation of saline implants. If the
milk ducts are cut, breast feeding may not be possible.
Please discuss these complications
and your other concerns with Dr. Chartchai at the
time of your in-person
consultation.
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