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 Breast Augmentation

 Skin and Beauty


Best for Breasts
For breast augmentation, implants are still the safest and most reliable option. The new anatomical, cohesive gel implants give wonderful natural looking (and feeling) results. Medium-term fillers for the breasts are also available but are costly if using FDA-approved substances. Long-term fillers have uncertain safety track records thus far and are perhaps best avoided.


SURGERY
Breast enlargement is an operation commonly sought after by women in their 20s to 30s as well as those in their late 30s to 40s whose breasts may have drooped or shrunk after breast feeding.

how it’s done: The breast implant is placed in one of these two locations: deep to the natural breast tissue or even deeper, ie behind the pectoral chest wall muscle. The incision is made through the lower part of the areolar region (only possible in patients with large areolas); through an incision just above the spot where the breast and chest meet, also known as the lower inframammary fold (the most common); through the axilla or armpit (more suited for saline-filled implants).

Through the access incision, the surgeon creates the pocket for the implant. The implant is then placed into the cavity and the breast is shaped to the desired position. The incision is then closed carefully by suturing.

 The most popular and reliable method is silicone breast implants. All implants have silicone shells. The silicone "bag" can either be filled with saline water or silicone gel, while the shell can either be smooth or rough, the latter known as textured implants.

The textured implants are usually placed behind the breast tissue while the smooth implants are best suited behind the deeper pectoral chest wall muscle, as this is where the muscle acts as an additional layer to "protect" the implant.

best candidates: Patients should ideally be fit and healthy, with no major heart, lung or bleeding problems. As diabetics are prone to infection, they will need to be covered by antibiotics. Patients are usually required to tell the surgeon why they want the surgery and what their expectations are, to enable the surgeon to understand their requests and whether these can be achieved with the surgery.

possible complications: Hardening of breasts due to a layer of scar tissue (capsule). It is the response to implantation of the breast prosthesis, which the body recognises as foreign.

The capsule progress from grade 1- 4:
• Grade 1: breast feels soft and normal
• Grade 2: the breast feels firmer and
appears normal
• Grade 3: the breast feels hard and the
breast shape may be distorted
• Grade 4: the breast feels hard looks distorted and is painful.

Grade 3 and 4 usually means another operation is required to remove the capsule (capsulectomy) and replace the implant, or manipulate it (capsulotomy). This complication is liable to crop up again.

Asymmetry. Symmetry of the breast, as in all cosmetic surgery, cannot be guaranteed. Very few women have breasts that are totally symmetrical anyway, and unless the difference is greater than 25 cc, the discrepancy cannot be matched (gel implants come in increments of 25 cc). With saline implants, however, additional volumes of saline can be added into the implant.

Bleeding is generally rare. On average, about five per cent of patients may need to return to the operating theatre because bleeding is detected within four to six hours after surgery.

Infection is rare but possible. Antibiotics will be prescribed.

Scarring. There's always a risk of bad scarring especially in Asian skin.

High breast position. This tends to occur in A-cup patients. Flat-chestedness means the tight chestwall skin would need to stretch out to the new enlarged breast size in order to be pulled into the natural lower breast position, aided by gravity's pull. This usually takes up to one year to achieve the final natural breast position.

NON-SURGICAL ENLARGEMENT
The most natural is, of course, pregnancy. Frequently advertised breast enlargement techniques using pumps and natural plant extracts are certainly not as reliable and assured of success as surgery breast implants.

August 2009

Article Contributed by Dr Colin Song, Singapore General Hospital and Dr Colin Tham, KK Women's and Children's Hospital

This article first appeared on  All Women ! " Glowing with Health " Her World/ Singhealth 2008         
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