Breast augmentation (implantation)

Till today only plastic surgery is capable of the breast enlargement for aesthetical reason. The essence of the operation is: the plastic surgeon places implants under the breast tissues, hence we receive larger breasts than the original, however natural touchy, shaped and behaving breasts. This kind of operation has already been done for over 40 years and the number of the women having prostheses is over several millions.

Can the implants cause any illness or later health deterioration?
In 1992, a silicon scandal broke out in the United States, and the FDA (the American Food and Drug Association Authority) ordered a silicon moratorium and came into force. In the past years the American plastic surgeons could only use salt solvent filled implants. However, most European countries’ Plastic Surgeon Associations did not accept this American opinion, since they have not kept it medically substantiated, hence the operations continued without any limitation (in Hungary too). In recent years, many hundred of thousand patients had post examinations. Based on these it became clear that in connection with the operation there were no illness or health deteriorations. It can not be proven that the implants are causing breast cancer or increasing its risk factor or that the material is weakening the immune system; perhaps silicon compounds can get into the mother’s milk or cause embryonic damages.

The breast implants produced nowadays have got no expiration date, so after the implantation, as far as there are no problems, they can remain on their place during the whole life. If the change becomes still necessary later on, this can be solved with a simple operation. Later pregnancies are of no problem, breast feeding is also possible with some exceptions. It is imaginable, that after many pregnancies, the breasts will slacken, that would occur without implants anyway, but this situation can be resolved with a new operation. Several months after the operation, all physical activities, even sport race can be practiced including air flights, therefore there is no limitation in the later lifestyle.

Does the implants disturb any illness or disclose breast cancer?
The implants don’t burden the touching examination, which plays an important role in the early diagnosis of the breast cancer, because the implants situated behind the breast gland in all cases. The mammography (the special X-ray examination of the breast) is difficult to value after certain implants cases, but the gland is also transparent by modern picture producing processes like CT, MRI or Ultrasound.

What is the reason of the operation and at what age can it be done?
The operation is not reasonable to carry out sooner than the age of 18.

There are three groups of women going for the operation:
1. Women between the age of 18 - 25 years: the breast gland is less than average and more underdeveloped, or the two breasts are dissimilar shaped and sized.
2. Women between the age of 25 - 40 years: following one or two pregnancies the gland state is regressed, the breast slackening causing psychological problems.
3. Women over 40 years of age: less in numbers, but in this age group operations are accomplished also, and there is no upper age limit.

How does the operation happen?

The majority of the operations is accomplished in general anaesthesia, since it is more convenient and secure for the patient. Before the intervention general laboratory tests are necessary (blood, urine, ECG) which can be completed in our clinic. Patients at the age of 35 - 40 years have to do a mammography examination as well.
The implants can be placed behind the tissues through a short 3,5 - 4,5 incision. This can happen at the areola or under the breast, so called submammarial fold. The implant can be placed under the breast gland or even deeper under the breast muscle. Both cases have advantages and disadvantages, in a lot of cases the constitutional factors determine the chosen method. In average, the operation takes about 1 - 1,5 hours long. At the end a thin tube is lead out from the operated area to drain the leaking wound tissue fluid into a sucking flacon. This is usually removed at the next day of the operation. At the end of the operation the patient receives a bandage and a special tight bra on the operated area.

What type of implants are used in our clinic?

In our clinic the American (Mentor) and the French (Eurosilicon) implants are used. These naturally have the European Union compulsory CE certification (among guarantee of health care products quality control and assurance). The outer wall is silicon elastomer of the implants used by us, its surfaces smooth or rough, inside cohesive gel filled. (This is a jelly type gel, not fluid silicon, hence it cannot leak out to the breast tissue.) Our implants by form could be lentil shaped low or high profiled or drop form, the so called anatomical.

How do the first two days pass and the following 2 - 3 months after the operation?

Resting: Generally the patient is required to spend a night in our clinic, on the next morning it is allowed to go home. It is advisable to travel by car but the patient isn’t yet allowed to drive by herself. Driving a car is allowed earliest 3 - 4 days following the operation. After the operation about 7 - 10 days it is necessary to relax at home, that means laying in bed. All physical activities should be reduced to the minimum. After 7 - 10 days lighter physical, or intellectual, office and sitting work can already be done. In the first two weeks the patient has to come about twice for a check-up and changing the bandage. The stitches are removed on the 12th - 14th day.

Pain: Blunt, expansive type of pain (not unbearable and gradually decreasing in strength) in the first 3 - 4 days. Simple painkillers like Algopyrin, Demalgon might be of help. In the first two days little fever occurs often. The sign of the wound mending is a slight itching feeling on the intervention area after the 4th - 5th day.
It can cause unpleasantness that you should not sleep on the stomach in the first week.

Cleaning: Water mustn’t reach the wound for four days. From the fifth day on, the patient can take a shower (not bathing). This time the over flowing clear water, even shampoo, can not cause inflammation on the operated area. After the short shower the wound can be dried carefully with a hand towel, the patient has to put a sterile band on the wound and get the special bra on.
Two weeks after the operation normal lifestyle can return: work can begin and foreigners can return home. However, for several months intensive sports like, tennis, swimming, gymnastic, dancing, aerobic are not suggested. Sunbathing, solarium is not suggested for a further two weeks, and for half a year the use of a sun protective cream is necessary. It is important to wear a bra for further 2 - 3 months, but only within daytime.

Possible complications:

• Capsule shrinking: the organism separates the implants as a foreign material and forms a thin capsule around it. Following the operation, this shell already develops after two-three weeks after the implantation, but in majority of the cases causes no complaints and is not sensible. Occasionally, the capsule becomes thick, shrinks and may deforms the implant or can shift from its place. The breast can become hard and deformed, and finally a tense unpleasant feeling might appear. This complication could cause complaints after 1 - 2 years after the operation. To resolve it, there can be another operation done, where the preceding capsizing status can be restored. In such cases the implants don’t have to be replaced at all costs. Nowadays, the occurrence of capsule operations is only of a few percentages high. Most probably the reason for that is the general use of rough surface implants in the last years.
• Implant shift off and slipping away: can occur in the first days, the chances are 1 - 2 %, rarely occurs that a new operation is necessary.
• The cracking of the outer silicon wall: a rare complication, its reason could be a serious chest injury, e.g. car accident. The filling material arrives between the tissues. If it is a salt solvent, than it will be absorbed without trace. If this is a silicone gel, it can be removed with another operation.
• Secondary bleeding: The chance is 2 - 3 %. There is rarely a need to empty the developed haematoma by an operation.
• Inflammation: the chance is 2 - 3% for it and sometimes can be cured without an operation by antibiotics or draining. However, if an operation is required, the material has to be removed and can be replaced in minimum 2 - 3 month time.
• Chronic scar development (keloid): occurs in the intervention wound in a few percent. In such cases often only the wound healing is longer, the area of the wound is red and the cicatrice is brighter. This time a spontaneous healing can be expected and the healing can be quickened with different cremes. It is very rare necessary that an injection has to be given in the cicatrice and a correction operation is even more scarce.
• Sensation disturbances: turning out in 4 - 5% on the nipple area or on the adjacent the skin. The regeneration mainly happens by itself, but can easily take a year.

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