BREAST AUGMENTATION

Author: Dr Chia Hui Ling

Breast augmentation uses implants, and sometimes a combination of implants and fat grafting, to increase breast size, improve symmetry, or restore volume lost after pregnancy, weight change, or ageing.

It is a well-established operation, but the decision to go ahead is a personal one, and it helps to have a clear, honest picture of what surgery can and cannot do for you.

•      Increases breast volume and projection to a size that feels proportionate to your frame
•      Improves symmetry between breasts that differ noticeably in size or shape
•      Restores fullness lost after pregnancy, breastfeeding, or significant weight loss
•      Can improve how clothing and swimwear fit, and how you feel in them
•      You are in good general health and, ideally, a non-smoker
•      Your breast development is complete and you are not planning pregnancy in the near term
•      You have realistic expectations about size, feel, and the visibility of scars
•      You understand that implants are not lifetime devices and may eventually need revision

The final result is best judged over months rather than days, as swelling settles and the tissues soften.

TREATMENT

Breast augmentation is usually performed under general anaesthesia or sedation, as a day surgery procedure. These are some points about the surgery which you can discuss more on with your surgeon:

•      Implants can be inserted through an incision under the breast fold, around the areola, or in the armpit
•      Placement may be above or below the chest muscle, or a dual-plane combination, chosen based on your tissue thickness and goals
•      Saline or silicone gel implants come in a range of sizes, profiles, and surface textures
•      Surgery itself typically takes one to two hours
•      Most people take about a week off work, longer for physically demanding jobs
•      Swelling and firmness settle gradually over six to twelve weeks
•      Strenuous exercise and heavy lifting are usually restricted for four to six weeks
•      A supportive bra is worn for several weeks to help the tissues settle


1. Types of Implants

- Implant shape:  Round  v  Anatomical (Tear Drop)
- Implant surface:  Smooth  v  Textured
- Implant content:  Silicone  v  Saline

2.  Location of the Scars

-  Inframammary (crease below the breast)
 -  Axillary (armpit)
 -  Periareolar (around the areola) 

3.  The Placement of Implants

-  Subglandular (Above the pectoralis and under the breast)
-  Subpectoral (Under the pectoralis muscle)

4.  Additional procedures 

(This may be required depending on your condition)
 -  Nipple Reduction

The details of the procedure, expected outcomes, risks and other treatment options (eg, fat transfer or hybrid breast augmentation) should also be explained to you. 

Your surgeon may use a 3D-imaging simulation system to help you visualise the possible result after breast augmentation. Or you may be asked to wear a tight T-shirt, and implants of different sizes are inserted under the T-shirt to simulate the augmentation.
  • Preparing for Surgery

    Do inform your plastic surgeon of previous breast conditions and breast surgeries, any medical conditions and medications. Your surgeon may send you for breast screening if you are approaching or more than 40 years old. Avoid blood-thinning medications, anti-inflammatory drugs or herbal supplementations as they can increase the risk of excessive bleeding during surgery, unless indicated by your doctor.



  • Surgery

    The procedure is often carried out under general anaesthesia or intravenous sedation. The planned incision, as discussed with your plastic surgeon, will be made and a pocket for the implant will be created.  The implants are then inserted using stringent aseptic (sterile) technique, followed by closure of the wounds.



  • Post-Surgery Care

    Early after the operation, you will experience tightness and/or discomfort over the chest. Depending on the technique and type of implants used, your surgeon should provide important instructions regarding your level of activity, the type of post-surgical garments and whether to massage or not. Swelling is expected after the surgery and will largely subside in 1 to 2 weeks. It will take a few months to see the final and more natural results.

FAQs


How long do breast implants last?

Implants are not designed to last a lifetime. Many last well over a decade, but they should be thought of as devices that may eventually need replacement or removal, whether due to a complication or simply personal choice.

Will I still be able to breastfeed?

Most people are able to breastfeed after augmentation, especially with incisions placed away from the areola, but there is no absolute guarantee, and individual milk supply varies for reasons unrelated to surgery.

Will the implants feel natural?

They will feel close to natural for most people, more so with newer gel implants and correct sizing for your tissue, but there is usually some difference in feel compared with natural breast tissue, especially on firm compression.

How do I choose the right size?

Sizing is a conversation, not a single number. It depends on your chest width, existing tissue, skin elasticity, and lifestyle, and your surgeon will help you translate a look you like into a suitable implant volume.

When can I return to exercise?

Light walking is fine within days, but most people wait four to six weeks before resuming upper body exercise or high-impact activity, guided by comfort and their surgeon's advice.

Will I also need a breast lift?

If there is noticeable sagging alongside volume loss, an implant alone may not fully address the drooping, and a combined lift may give a more balanced result.


COMPLICATIONS AND MANAGEMENT


As with any operation involving an implanted device, there are risks beyond those of surgery in general, and it is worth understanding them before committing.

  • Bruising, swelling, and temporary changes in nipple sensation are common in the first weeks
  • Capsular contracture, where scar tissue around the implant tightens, can cause firmness or discomfort. This risk is very low with latest 6th generation smooth implants (Motiva - less than 1%).
  • Implant rupture or leakage, which will require a surgery to change the implant - this is uncommon in latest generation of implants
  • Visible rippling or palpable implant edges, mainly in people with thinner tissue coverage
  • Infection or bleeding requiring further treatment, though this is uncommon
  • A rare lymphoma (*BIA-ALCL) has been linked to certain rough textured implants; your surgeon can discuss current risk data if these implants are offered



*BIA-ALCL  

An uncommon complication with the use of textured implant is Breast Implant Associated Anaplastic Large Cell Lymphoma, or BIA-ALCL. The risk ranges from 1 in 30,000 cases to 1 in 4000 cases. There are currently no known reported cases occurring in Oriental patients in the medical literature. Do contact your plastic surgeon if you experience breast enlargement at 1 year or more after your surgery (most common sign), or if you develop a mass in your breast or axilla.