Forehead lift

 

Breast enlargement

 

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For whom is this treatment intended?

The first group that is eligible for breast enlargement is the young women with insufficient breast growth. Around the age of 16 this becomes apparent and the breasts will have ceased to grow. The second group that visits my practice is the women in the age group 30 - 40, whose breasts have lost volume after pregnancy and are therefore more sagging and smaller. A third, smaller group is the women between the ages 50 - 60.

Photo album breast enlargement

1. Minimum age

The common rule is a minimum age of 18 years old, however, an exception can be made. This is also applicable in case of congenital deformities. When the patient is very young, we will make an extra careful consideration prior to the breast enlargement, involving the parents and in some cases a psychologist. It is conditional that parents are present at the first consult when the patient is of very young age.

2. A natural result

Whether the outcome of the procedure will be natural is not only determined by the shape of the breast implant (round or anatomic), but is a combination of 1) the shape and volume of the own breast, 2) the volume en the diameter of the breast implant and 3) placement of the implant over or under the breast muscle.

With young women with little breast growth the implant will be usually placed under the muscle, but in case of a small compact natural breast sometimes over the muscle. Where breasts have decreased in volume after pregnancy and they start to sag, than a larger volume is required. I prefer to place a larger volume under the muscle (larger breast implants I place preferably under the muscle due to the weight and the risk of sagging breasts long term) but if that fills up the breast insufficiently then I will place the implant over the muscle. Summarized, the volume, diameter of the implant and the position versus the muscle will be set individually for the best result.

Since 1995 I use Eurosilicone round breast implants for all esthetic breast enlargements (there is no financial interest).

Side note: The natural result will be visible after the first weeks/months after surgery. At first the breasts will be slightly swollen and the scars still have to fade. People close to you will not always recognise that, so occasionally you might get well-meant, but premature, critical remarks. Read more about this in the article comments from family and friends.

3. Period prior to surgery

It is preferable to stop smoking in the period around the operation, because it can cause coughing when waking up from general anesthetic , whereby the chance of bruising increases. However, to stop smoking with a breast enlargement is not an absolute condition. Best not to use anticoagulants like Ascal and aspirin.

4. The surgery and the Dual-plane technique

The silicon breast implant will be placed over or under the muscle through a 4 cm wide incision in the fold under the breast. In case the own breast is larger and possibly drooping (see also under breast lift), than it is preferable to place the implant over the muscle to also make a firmer breast. When the implant is placed under the muscle than I will use the Dual-plane technique. In this case the breast muscle is partially detached so that the upper half of the implant lies over the muscle and the bottom half directly behind the chest. Both techniques can give a good and natural result. In both cases the operating time is about two hours and the skin will be closed using dissolvable stiches.

5. After the surgery

After the operation you will stay in the clinic or hospital for a few hours. Prior to going home the drains, that discharge the little remaining fluid and blood, will be removed. The breasts feel firm and will be dressed with foam tape or a compression vest will be used. Implants under the muscle will cause pain the first day after the surgery, in spite of the fact that pain medication is used. I have heard the pain being described as if someone has been jumping up and down on your chest. Breast implants’ over the muscle are usually painless. The dressings or the vest can be removed the next day. After that you take daily showers. After 1 or 2 weeks the stiches will be removed. For a period of 2 weeks you wear a bra and you should retain from any breast muscle exercises for 4 weeks. After 4 weeks the implants will be settled well enough to pick up almost any activity.
Prior to going home you will receive clear instructions.

6. Lifespan of implant and capsular contracture

Breast implants are modernized. The density of the fluid used has increased so that the gel does not drain, not even in the hypothetical case of a rupture of the implant. The shell of the implant is so solid that rupturing is virtually impossible.

The lifespan of implants is some decades, but there is no set time to replace the implant. That will vary from patient to patient. If there are no complaints, firmer. The latter is probably caused by ‘the transpiration’ of the implants, which slightly increases capsular contracture because silicones are encapsulated by the body. In severe cases this causes pain and the breasts can be deformed.

Capsular contracture can be a reason to replace the implants, but is in itself no medical ground. In rare cases of external trauma, like a car accident, the implant van rupture en silicone gel can leak to the chest area. Obviously this will be medical ground to remove the damaged implant en to replace it.

Most manufacturers will give some form of guarantee on the implants. As is the case with all medical implants a hundred percent guarantee cannot be given. See my article about guarantee.

7. Breast implants in the media

The breast implants used by me for breast enlargement and breast reconstruction are manufactured by two international companies Allergan and Eurosilicone. These implants meet all international quality criteria and have been found safe.

Worldwide millions of women have silicone breast implants. In case there are new developments around safety than we will be updated about those by our national and international associations Nederlandse Vereniging Plastische Chirurgie and International Society for Aesthetic Plastic Surgery (ISAPS).

Some media publish research findings that are premature and possibly unreliable. It is regrettable that this regularly causes unease under women with breast implants whilst it is based on unfinished and unverified research.

 

8. Injection of fat or lipofilling not yet a reliable technique

For the time being it does not seem feasible that with one or more fat injections breasts can be enlarged same as with breast implants. Injected fat will only last in small amounts and in highly vascularized tissue. With breast enlargement a large volume (240 to 500 cc) is needed and breast tissue is only mildly vascularized. There will be substantial fat necrosis causing an allergy and inflammation. Antibiotics cannot cure this. However, it is a technique in development and there are indications that with the injection of small amounts during multiple surgeries the volume of the breast can be increased. 

9. Silicone implants and breast cancer

One of every nine women will be faced with breast cancer. Silicone implants do no cause cancer. From major epidemiology studies in the United States we know that the risk of breast cancer is not increased by breast implants. Self-examination of the breast is made easier: all breast tissue lies over the implant and there is no breast tissue under the implant. Check-ups by means of a mammogram are harder to do with a silicone breast implant. Making a mammogram can be a painful procedure. Although there is no risk of rupturing the implant, it does potentially require multiple attempts to get a good x-ray. That is why I recommend patients with breast implants to go to a hospital facility to have the mammogram made. Also in case of breast implants Mammography is the best method for tracing breast cancer.
Finally there is no delay in tracing cancer when a woman has breast implants and there is no difference in prognosis.

However, if you had lumps in the breasts (benign) on multiple occasions for which further check-up by a surgeon was required, or more than one family member has been diagnosed with breast cancer, than I will advise against a breast enlargement.

Dr. Erik J.F. Timmenga