Breast enlargement booklet

A breast enlargement is a plastic procedure which can enhance your breast shape and size. The breast enlargement is mostly performed when breasts are too small, and have lost volume and have changed in shape due to pregnancy or weight loss. A soft and natural implant enlarges the volume and makes your breasts look naturally beautiful and firmer.

Breasts consist of fat tissue, gland tissue, blood vessels, nerves, lactiferous ducts and lymph glands, all covered by skin. The shape of the breast is especially determined by the elasticity of the skin and the proportion of fat tissue to gland tissue. Young breasts especially consist of gland tissue which makes them firmer. As years go by, the gland tissue changes to fat tissue, which is soft. Through gravity and decreasing skin elasticity, breasts start to sag as you get older. Pregnancy and weight loss can also change the shape of your breasts.

Breasts do not contain muscle tissue, so exercises to enlarge them do not have any effect.

Currently, high quality implants are used for breast enlargements, they are 100 % reliable. Scientific research has proven that they won’t harm the health. All modern implants are made of medically approved silicones, filled with a cohesive silicone gel or with a physiological saline, and they are available in different shapes and materials.

Sometimes it happens that the body forms a solid capsule around the implant: the breasts become hard and painful. But this can usually be corrected with a small operation. There is also a small risk that the body rejects the implant. Luckily, capsule forming and rejections are uncommon complications (capsular contracture).

The shape of the implants is round or anatomical. A round implant gives also the upper part of the breast a round and spherical look. In case of an upright position, there occurs some teardrop form of the implant.

Through gravity and a decreased skin elasticity, it might be possible that the breast starts to sag. This might occur in case of every implant and strongly depends on the weight of it. An anatomical implant has a teardrop form by which the upper part of the breast is filled in a more natural way, even on the long term.

Current implants contain a cohesive gel and can not leak like the older generation of implants. They last longer too.

Together with your plastic surgeon, you will have to chose the kind of implant as well as the size of the implant. The most natural look is created by making your new breasts form a natural entity with your body.

Not only the cup size, but also the proportions of your own figure are important factors.

The implants can be placed right under the breast gland (sub mammal) or behind the breast muscle (sub muscular). When placed on the muscle, implants will keep their original shape. Although this occurs less often in case of currently developed implants, the disadvantage is that there is a bigger chance of capsule contracture. It might also be that you will feel the edges of the implant in case you have a thinner breast skin.

When placed right under the breast muscle, there is only a slight possibility of capsular contracture. The disadvantage is that, when the implant is inserted there, the remedial period after the operation will be longer and the pressure of the breast muscle can deform or displace the implant. The exact place of the implant will be broadly discussed with your plastic surgeon during a prior consultation.

The breast implants can be inserted in three different ways. Through a small incision in the armpit, in the lower part of the nipple or in the fold under the breast. All these methods guarantee you that scars will be almost imperceptible after the operation.

A breast enlargement takes approximately 1 hour. You can go home the same day.

After a breast augmentation, you will be required to wear a special, well-fitting bra, which supports the new shape of your breasts and which counters swelling. The first days, arm movements might be uncomfortable. Of course your breasts might feel a little tight because of the bruises and wound fluid. This will automatically disappear. We advise you to take some rest during the first days after the operation.

Afterwards you can restart your daily activities. But be careful when lifting things, sporting and reaching high, during the first weeks.

A breast enlargement is a surgical operation. The definitive result is not immediately seen after the breast augmentation. The swelling must disappear and breast tissue and breast muscles must adjust to the new shape. After approximately three months you will see the definitive result. The feeling in your nipples will be different during the first weeks. This varies from person to person, from over-sensitive to non-sensitive.

You will gradually get back the normal feeling in your nipples. Scars might be a little red during the first months. But they will gradually get the colour of your skin and almost disappear.

Types of implants

Currently, different types of implants are available. They all have a covering of silicones with a rough texture. This functions to counter capsule-fibrosis as much as possible. The content of the implant consists out of liquefied or fixed silicones, salt water or soy-oil.

In the nineties silicones have been broadly discussed. Since then, there has been a great evolution of the quality of silicone-filled implants. The liquefied silicone-filling is more often replaced by fixed types, which do not leak. Possible alternatives, next to physiological serum, are a monobloc gel or a well-balanced hydro gel.

All possibilities will be of course broadly discussed during the consultation, and according to your wishes the implant which gives the most satisfying result will be chosen.

First appointment

Choosing to have your breasts enlarged is a highly personal decision. As choices will have to be made about size as well as shape it is extremely important that you are well advised.

During a first appointment one of our experienced surgeons will explain in detail what the various options are. Advantages as well as disadvantages, risks and expectations will be outlined and explained to you.

The plastic surgeon will ask you questions about your medical history, your general physical condition, your needs and expectations.

Our plastic surgeon will see to it that you are extremely well informed. This will allow you to make a well founded decision. He will help you in choosing the treatment that is best to obtain the desired result.

The implant

For breast enlargement we use medical silicone implants. These are of a superior quality and are 100% reliable. Scientific research has shown the material to be safe. The implants we use are made of medically approved silicone. Yet there are differences. Below you will find a more detailed explanation.

1. Filling

Physiologic Salt Solution

This type of filling remains very stable for many years. Should a leak occur in the implant’s silicone wall the solution is set free, but is absorbed through the body without any problem or risk. Another advantage is that these implants are filled when they are in place, which requires a smaller incision for the surgery.

A disadvantage is that these fillings feel unnatural because they contain a liquid, which is unstable (splashing). Also this type of implant has a smooth contour, accounting for a higher risk of capsular contracture.

Liquid Silicone Gel

This type of filling gives the supplest and most natural feel. It is round in shape, but becomes more drop shaped when standing, as the silicone gel then flows to the bottom of the implant.

Should a tear occur in the implant wall the gel will be released into the body and removal is very difficult.

This is not dangerous as the substance is well supported and not carcinogenic.

Solid or Cohesive Silicone Gel

More and more liquid fillings are being replaced by this more solid form as there is no risk of leakage. It hardly feels more firm compared to the liquid filling and even if there is a tear in the implant’s wall, it will not leak.

As this type of filling is qualitatively the best, this is highly recommended by our plastic surgeons.

Other

There are also implants filled with sugar solutions or other organic material. Some of these have already been taken off the market as the content’s chemical composition had changed after some time, making it harmful for the bearer of the implant.

2. Shape

Round breast implants

This shape fills the breast in the upper part. In an upright position it becomes somewhat more drop shaped, which is enhanced by a sub muscular positioning of the implant.

Anatomic or teardrop shaped breast implants

This shape fills the upper part of the breast in a natural way. The filling is less outspoken in the upper pole which can produce a more natural result especially when the enlargement is more substantial. A disadvantage of this implant shape is that a slightly larger incision is needed for putting the implant in place.

3. Size

Next to the type of filling and the shape you will also need to decide on the size of the implant together with the plastic surgeon. The most natural result is to have your new breasts blend naturally with your body.

It is not only the size of the cup itself that matters, it is important to let yourself be guided by the right proportions , harmonious with the rest of your body.

The Treatment / Surgery

Here too there are various options the plastic surgeon will discuss with you during a first appointment.

What follows is a short survey.

1. Positioning

As you can see a breast enlargement involves making some important choices. That is why our plastic surgeons will assist you by giving you the best professional advice and help you to look for the most suitable solution for you to obtain the best result.

The place of the breast implant is of major importance. It can either be inserted under the breast gland (sub glandular) or behind the breast muscle (sub muscular).

Under the Breast Gland (sub glandular)

This is an option with which a good result is obtained when there is sufficient breast gland tissue. For patients with little breast gland tissue it is possible that the top edge of the implant is felt. With a liquid filling also wrinkles can become visible. The risk of capsular contracture is slightly higher.

Behind the Breast Muscle (sub muscular)

By placing the implant beneath the breast muscle, it is covered with an extra layer of muscle. This seriously lowers the risk of being able to feel the edge of the implant.

As the layer of muscle exercises pressure on the upper pole of the implant, the round implant takes on the shape of a drop.

The risk of capsular contracture is lower in this case.

2. Incision

There are three possible procedures: a small incision will be made in the lower edge of the areola, in the crease of the underside of the breast or in the armpit. Each of these methods have their own advantages and disadvantages.

Via the areola

This type of incision is made through the areola making the scar hardly visible. The size of the scar is determined by the size of the areola.

This technique obviously limits the size of the breast implant. Larger enlargements with cohesive silicone gel implants are not always possible with this technique. Also the risk of infection is slightly larger than with the other methods which will be described below.

Via the natural crease beneath the breast

This is the most common procedure which allows for larger breast implants. Also here the scar is hardly visible because it occurs in the natural crease beneath the breast. For re-surgery in case of e.g. capsular contracture this method will always be preferred.

Via a small incision in the armpit

This is another possibility to perform breast enlargements, but breast implants tend to shift and move upwards. The scar is not in the breast area and unobtrusive.

After Treatment

Plastic surgery lasts about an hour. A water resistant bandage is put in place and you will be wearing a special support bra. When the breast implant was put in place via the armpit a Redon-drain will need to stay in place for 24 hours.

You can go home the same day. For a month you will need to wear the special well fitting support bra day and night.

It will support your breasts’ new shape and limit any swelling. It is made to measure and fitted on immediately after surgery.

Sutures should be removed after 14 days. Two weeks later the scars may be massaged.

In case of sub muscular positioning the first four days are expected to be quite painful. Adequate pain relief medication will therefore be prescribed.

We advise you to take a few days rest after surgery. You will be able to resume your normal daily activities except for lifting heavy objects, practising sports or reaching high. You must wait at least a month before doing any of these.

Result

A breast enlargement involves medical surgery. The final result is not visible immediately after the operation. Swelling needs to disappear and the breast tissue and in some cases the breast gland will need time to adapt to the new shape. It will take about a month to get an idea of the final result.

The sensitivity in your nipples can be different for a few weeks. This differs from person to person and goes from highly sensitive to completely insensitive. The sensitivity in your nipples will gradually return to normal.

Scars can be quite red the first few months. Gradually the redness will diminish until they have the colour of the skin and practically become invisible.

This overview aims at giving you a general first idea on what a breast enlargement means. We hope to welcome you in person soon in order to give you the best individual and personal advice.

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