Techniques

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Minimally Invasive Breast Augmentation

Early attempts at minimally invasive breast augmentation in the late 19th century and early 20th century have usually ended up in horror stories, due to the complications associated with injecting primitive “fillers” to increase the breast size. With recent technological advancements in filler technology, these complications are now mostly a thing of the past. Newer breast fillers now make use of the same materials which have been used for dermal fillers. The common ones are Macrolane, which is a hyaluronic acid based filler, initially used for the face. These fillers are non-permanent, meaning that they are gradually absorbed by the body and thus do not have the side effects of forming granulomas, a problem with earlier, non-absorbable fillers. However, the price to pay for this safety feature, is that regular top-ups are needed every 1-2 years as the injected filler will gradually be metabolised by the body and decrease in size. Many people still find this regular topping up a good trade off compared to taking the plunge and undergoing invasive surgery.



Who is it for?

Minimally invasive breast augmentation or breast fillers are good for:
- ladies who want to increase approximately 1 – 2 cup sizes (about 200 ml per breast)
- ladies with laxity after pregnancy and breastfeeding
- ladies with droopy nipples
- ladies with lack of projection of nipples

These procedures are especially attractive to busy or working class ladies who can’t take much time off work to go for conventional surgery. In this situation, most ladies can return to their normal daily lives within the same day or the day after. The exception is that strenuous exercise, bouncing and running should be avoided for a week or two after the procedure. There is mininal scarring involved, local anesthesia is extremely safe, and the feel and look is natural and the shape and location of fillers can be controlled by the doctor.

The procedure

Breast fillers are typically done under local anaesthesia, using small injection sites below the breast. Using a large bore needle, fillers are injected into the desired areas to increase the bulk and to correct misshapen areas. During the procedure and immediately after, some swelling, tenderness and redness may occur. There is a very small risk of infection, and usually a course of antibiotics may be prescribed. After the procedure, the patient can return to society almost immediately, with the exception that she should avoid strenuous exercise for at least a week.

Implants

For women desiring a more permanent breast enlargement, or who desire more than 2 cup sizes larger, then implant based techniques are the preferred route. Silicone breast implants have been FDA approved and are generally safe for use. However the recommendation is that MRI be done every 2-3 years to check to make sure the implants have not burst through their silicone shells, although this is optional.

Who is a candidate?

Women desiring to change the size or proportion of their breasts through surgery. You must be at least 18 years old to get a breast implant in the USA.

Who isn’t a candidate?

If you are currently pregnant or breast-feeding or have an active infection anywhere in your body. If you have an existing malignant or pre-malignant breast cancer for which you have not yet received adequate treatment.


The procedure

There are many different shapes of implants, and just as many ways to insert them using surgery. Generally, manufacturers make implants in many shapes and sizes to address different needs, be it volume enhancement, correcting sagginess, or correcting asymmetry. There are different surgical “approaches”, including the following:

- inframammary : inserted from the lower portion of the breast
- axillary : inserted from an incision in the armpit
- periareolar : inserted via small incisions around the nipple areola
- trans-umbilical : inserted through a small incision near the belly button. (this works only for saline implants)

During the procedure, a small incision is made via one of the “approaches”. The implant is then carefully inserted either below the breast tissue, or below the chest muscle. After the procedure, the patient may experience some pain, bruising and some change in sensation may be experienced. There will be small scars in the site of insertion, and depending on the size and type of implant used, can vary from just a few centimetres to several inches. Other concerns could include rupture, contraction of the tissue surrounding the implant, and also shifting of the implant from its original desired site with time. If these happen, corrective surgery may be required. Should the implant no longer be desired, it is readily and usually completely removable by surgery.

The procedure can be done under local or general anaesthesia. General anaesthesia procedures carry more risk of anaesthesia and higher cost, but total surgery time is shorter, hence the doctor can do more procedures in a day.

Inserting breast implants under local anaesthesia is more widely preferred nowadays, as the procedure is much safer, it does not carry the risk of general anaesthesia, and no hospitalization is needed after the surgery. However, the surgeon needs to spend more time and effort to complete the procedure, hence it may be less preferred by busy surgeons.

Breast Lift/Mastopexy

As a woman ages, and especially after pregnancy or breastfeeding, the breast and the surrounding skin tends to sag, and the breast volume shrinks. For these women, an operation called mastopexy may be the solution. There are many surgical methods to lift the sagging breast. These usually include cutting off the excess skin, and anchoring the breast to a higher point, with re-positioning of the nipple to a more youthful position. Some surgeons may also insert an internal mesh support to prolong the results of the mastopexy procedure. Some side effects of breast lifts include scarring, loss of sensation, and frequently recurrence with further aging.

After a breast lift, women are advised to wear supportive brassiere and reduce vigorous exercise to reduce further sagging.

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